mation on the Web said it helped them improve the way they take care of themselves (Pew Internet & American Life Project, 2000b). Forty-five percent of African-American users said the Internet helps them find health care information, compared with 35 percent of whites (Pew Internet & American Life Project, 2000a).

On one hand, these numbers are remarkable; all of them would have been near zero only a few years ago. On the other hand, they provide only the beginnings of evidence that the Internet, as it is now used, has a substantial role in health. We do not know whether those reporting Internet influence on decisions are making many new decisions about major aspects of their health or are only reporting on quite rare and/or trivial decisions, such as which brand of daily vitamins costs the least. Moreover, we do not know the extent to which self-reporting about these activities is accurate and reliable.

Networking for Health (Institute of Medicine, 1999b) identified four classes of Internet health applications: (1) real-time video transmission, (2) static file transfer, (3) remote control information search and retrieval, and (4) real-time collaboration. Each of these applications has potential uses for diverse populations that should be more fully developed.

One of the characteristics of the Internet that consumers and patients value most is access to vast amounts of information coupled with the opportunity to customize information to individual needs and characteristics. Furthermore, consumers are making use of information that until recently was available only to health professionals. For example, National Library of Medicine searches increased from 7 million in 1996 to 120 million in 1997, when free public access was inaugurated (Eysenbach and Jadad, 2001). The Internet has many other important attributes as well. Users can access information at their own pace, when and how they want, theoretically at least, 24 hours a day, 7 days a week. Communication can be real time or asynchronous, one-to-one or in a group. Multiple presentation modes can be used, such as video, audio, text, and/or animation. Moreover, interactive health communication systems can be entertaining (Lieberman, 2000).



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