Anxiety, Knowledge and Help: A Model for How Black and White College Students Search for HIV/ AIDS Information on the Internet

The spread of HIV/AIDS is likely to occur on college campuses where drugs and alcohol abuse can lead to unsafe sex, which can lead to HIV/AIDS infection and transmission (American College Health Association, 2007; CDC, 2003; CDC, 2006). Nearly half of all new HIV/AIDS cases occur in people younger than 25 (CDC, 2002). Eleven Historically Black Colleges and Universities (HBCUs) in a southern state in the United States have struggled to deal with an increase in HIV/AIDS infections among students (Keels, 2005). A joint study by that state's public health department and the United States Centers for Disease Control and Prevention (CDC) prompted increased HIV/AIDS education efforts among the 11 HBCUs after the study revealed a spike in HIV cases among college male students statewide, from two in 2000 to 56 in 2003 (CDC, 2003). Forty-nine out of the 56 HIV cases were black male college students. Health care researchers fear the problem has or will extend to other campuses. Nationally, African-Americans, who make up 12% of the United States' population (30 million), account for 45%, or 25,000 of the new cases yearly in the United States, and are seven times more likely to contract HIV than whites (Falco, 2008). Nearly 56,300 people in the United States became infected with HIV in 2006, "which translates to about 40% more cases than officials had estimated" (Falco, p. 1). More than half of new HIV infections occurred in homosexual or bisexual men. College students, many of whom grew up with the Internet, have a high degree of what Bandura (1977) would describe as self efficacy: confidence at using computers and accessing the Internet from years of practice. While college students are more likely than any other segment of society (Escoffery, Miner, Adame, Butler, McCormick, & Mendell, 2005; McKillen, 2002) to seek out health information on the Internet, most of them lack the online health information literacy skills to choose HIV/AIDS Web sites wisely among the millions of Web sites on the Internet (Ivanitskaya, O'Boyle, & Casey, 2006; Nsuangani, 2003; Peterson, Aslani, & Williams, 2003; Smith, 2008). Online health information literacy is defined as an effort to "provide citizens with the skills so they can improve search capabilities and evaluate the quality of health Web sites" (Institute of Medicine of the National Academics, 2004, p. 1). It was within the context of HIV/AIDS, its potential impact on college students, and their growing use of the Internet as a health information resource that this study was launched. Thirteen white students from a predominately white university in the Southeastern United States, and fifteen black students from a predominately black university in the same region, were given this hypothetical: "Pretend that a best friend or loved one had acquired HIV/AIDS. Where would you go on the Internet to get information?" A grounded theory analysis (Glaser & Strauss, 1967) of the recorded and transcribed "think alouds" (Shapiro, 1994) revealed a three-stage model that explained how these black and white students searched for online health information, using HIV/AIDS as a case study (Smith, 2008). These findings are presented and discussed below. Literature Review Concern over people's inability to discern good online health information from bad prompted the National Network of Libraries of Medicine, and the Medical Library Association to focus on online health-information literacy (National Cancer Institute, 2005; National Network of Libraries of Medicine, n.d.; The Medical Library Association, n.d.). Improving online health information literacy became part of the Healthy People 2010 campaign, which the U.S. Department of Health and Human Services launched in 2000. The campaign consisted of a set of disease prevention and health promotion objectives for America to reach by 2010 (United States Department of Health and Human Services, 2000). One of those objectives included improving online health information literacy, as more people seem to be turning to the Internet as a source of health information Use of the Internet as a Health Resource Grows As a resource for health information, 85% of American adults (113 million people) have searched the Internet for at least one of 17 health topics. …