Children, Adolescents, and Young Adults

While children do not have legal authority to make crucial healthcare decisions, childhood is the time when many health and well-being practices are formed, particularly those related to nutrition and exercise. Childhood is also the time when individuals develop the foundation of health and science literacy essential for health functioning throughout the life span. A number of information tools can support such learning, from educational games to tools allowing children to create content that can be shared with others (e.g., health information outreach and classroom presentations). Children and adolescents living with chronic illnesses may need support in understanding their condition and handling their self-care. Young adulthood presents novel and unique health information challenges because it is the time of transition from pediatric to adult care. It is also the time of switching to health insurance policies that are not connected to the parents’. In addition, young adulthood is the time when sexual health and mental health constitute important health concerns. While young adults do have these prominent health information needs, they typically live busy lifestyles that make them underutilize information outreach programs, unless they are delivered in ways that are easy to integrate into the rest of their lives.

Living with chronic illness has been associated with an increase in PHR and portal adoption in the general population, and the same appears to be true of children and adolescents. People who grow up with a life experience of illness are not only the portal users of tomorrow, but the portal users of today. Yet less is known about the adolescent population and their portal usage than about other populations. A review of medical literature in PubMed published between 1991 and March 2019 done by the first author of this book yielded 26 studies of personal health records or patient portals in which children and young adults were involved. Since 2009, only five studies involved the young adult demographic. A large study of PHR adoption (75,056 patients) revealed, in the age group 18-35 specifically, that nonadopters (17%) were slightly more common than adopters (14%). (The highest proportion of adopters was in the age group 36-50) (Yamin et al., 2011). Yen et al. (2018) and Ali et al. (2018) included the same age bracket in usability studies. Only two studies focused on college students specifically (Walker et al., 2009; Whetstone & Goldsmith, 2009).

The health status of college students investigated thus far has been mixed. Walker et al. (2009) recruited healthy students. Whetstone and Goldsmith (2009) recruited from the general population, and not from hospitals or clinics; checking for health status, they found 15% were living with chronic illnesses. The American College Health Association conducts an annual survey of undergraduate students. Data from the Fall 2018 survey revealed that 8.5% of undergraduate respondents (N = 27,864) reported living with a chronic health problem or serious illness (e.g., diabetes, asthma, and cancer). Mental health diagnoses reported included anxiety (21.4%) and depression (16%) (American College Health Association, 2018). This is a demographic composed of people likely to be early and avid adopters of CHI technologies. For more on college students and chronic health issues, see below in the section on Intermediaries.

Exemplar Technology: College Students

An example of an app for college students is MyFitnessPal, an Under Armour product. This app is one of many self-monitoring technologies that give users feedback and track their food intake and weight. In May 2018, it was ranked the second most popular “health and fitness” app by 20,000 US respondents aged 18 and up, with over 19 million active users (Clement, 2019). MyFitnessPal’s website includes such health-supporting features as a food diary, a searchable food database providing caloric estimates, and a personalized diet profile (MyFitnessPal, n.d.). Use of trackers to count calories is highest among members of the Millennial generation, according to a 2018 survey (Mintel, 2019). One recent study (Patel et al., 2020) defined Consistent Trackers as users who fulfilled all the self-monitoring tasks established by the researchers (weight and diet tracking) at least 6 days a week for at least 75% of the weeks of the trial. MyFitnessPal was the app used in this study. The researchers’ conclusion: Consistent Trackers lost twice as much weight as the Inconsistent Trackers, and even more so at the 6-month point.

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