Emergency Medicine and Health Care ISSN 2052-6229 Original Open Access A pilot study assessing whether African American women visiting the emergency department give different answers than an anonymous, internet-based population Mandy J. Hill * and Richard M. Grimes Abstract Background: Preventive vaccine uptake by adults in the United States is poor. For all reported preventive vaccines, the national rate of immunizations is lower for African Americans than for Whites, Hispanics or Asians. here is also a racial disparity in uptake of the vaccine for pathogenic human papillomavirus (HPV) with African American women being less likely to complete the three shot series. his study sought to determine if diferent information would be obtained from a group of young African American women responding to an internet based survey versus when that instrument was completed in-person at a medical venue. he subject matter of the survey was the willingness to participate in a study using a smartphone application aimed at improving HPV vaccine uptake. Methods: A survey was administered to 40 young African American women aged 18-26 years, 19 seeking non-emergent care in an emergency department (ED) and 21 recruited online via a social networking site and email. Results: Analyses utilizing an independent t-test and chi-square test (respectively) conirmed diferences in the ED versus the internet population with regard to education (P=0.000 P=0.001), age at sexual debut (P=0.03; P=0.03), and payment source for health care (P=0.03; 0.09). he entire internet group had some college education, but 42.1% of the ED respondents had less than a college education. he ED group was less likely (31.6%) to rely on private insurance to pay for their care than the internet group (57.1%). Marginally signiicant indings between the two groups were noted with consistent sexual partner (P=0.08; P=0.11). Most study participants were comfortable with an HPV application on their smartphone and used them frequently in both populations. Conclusion: Study indings suggest there is signiicant variance in the education level, age at sexual debut, and payment source for healthcare among study subjects recruited in diferent populations based on settings and survey medium. However, superiority of the data collected from these two mediums cannot be conirmed. Further research is needed comparing delivery approaches of self- reported survey methods based on setting and medium. Keywords: Emergency department, survey methodology, internet based surveys, face-to-face surveys, human papillomavirus, smartphone © 2014 Hill et al; licensee Herbert Publications Ltd. his is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). his permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction African Americans visit the emergency department (ED) at twice the rate of Whites [1,2]. EDs also provide care to populations that are vulnerable to HIV and sexually transmitted infections (STI), including the human papillomavirus (HPV) [3]. Existing literature reveals extremely high STI rates in EDs [3-8]. The Center for Disease Control & Prevention and the United States Preventive Services Task Force (USPSTF) recognize the ED as an important clinical setting for STI prevention [3,9]. CDC reports that African American women are far more likely to contract STIs [10]. Therefore, it is important to conduct surveys to assess readiness for STI prevention efforts in an ED setting among high risk persons, such as African American women. Such surveys will provide data confirming or negating the acceptability of STI prevention messages. In addition, survey tools and data obtained from an ED population can be compared to women recruited from different environments and who may demographically differ. The internet has been frequently used to survey individuals with regard to health related matters [11,12]. These surveys have been particularly useful in obtaining responses from surveys on sensitive topics such as sexual behaviors and drug abuse [13-15]. The internet provides a way of accessing large numbers of individuals at a very low cost. Respondents can choose to: participate or not, remain anonymous, and give responses without fear of repercussions. However, it should be recognized that internet based surveys yield biased results which cannot be generalized. Aside from the fact that not everyone has a computer, tablet, or smartphone, there is clear evidence that these biases may be quite significant when the surveys deal with stigmatized behaviors. For example, men who have sex with men (MSM) who respond to internet surveys present a different risk profile than those who are recruited from Gay bars or other venues [16-18]. This may be the result of MSMs altering their risks depending on the venue that they use to meet sex partners [19]. There is also evidence that the design *Correspondence: Mandy.J.Roberts@uth.tmc.edu University of Texas Health Science Center at Houston, Medical School, 6431 Fannin, JJL 420, Houston Texas 77030, USA. CrossMark ← Click for updates