Internet filters can also block health sites

Devices intended to protect young people from pornography may screen out useful medical information.

By Susan J. Landers, AMNews staff. Jan. 20, 2003. Additional information

Washington -- Teens are more likely to seek health information online than from physicians, but they could well be stymied by Internet filters.

A study funded by the Henry J. Kaiser Family Foundation found that the filters required in schools and libraries can block access to health information. If set on their most restrictive levels, Internet filters can block access to a wide array of sexual health issues such as safe sex and condom use, said the study, published in the Dec. 11, 2002, JAMA.

However, filters can be adjusted to allow access to health information while still blocking pornography, noted the researchers.

"Filters can strike a good balance between protecting kids from pornography while still giving them access to online health information, but only if they're configured carefully," said Kaiser Family Foundation Vice President Vicky Rideout. "Otherwise they can be a serious obstacle, especially on issues such as pregnancy, sexually transmitted diseases, and birth control."

Ann Arbor, Mich., family physician Caroline Richardson, MD, an author of the study, is also concerned about the impact of the restrictive filters on teens who don't show up for care in physicians' offices. "There tends to be a gap in care, especially for those teens who are uninsured," she said. "They may need access to health information, but not have access to health care."

Dr. Richardson, who is also a lecturer in the University of Michigan's Dept. of Family Medicine and a research scientist at the Dept. of Veterans Affairs, points to the Internet's increasingly important role in the nation's health care delivery system as a driving force behind the study.

"One of my main areas of research is health services delivery and access," she said. "The thought that we might gradually be eroding the power of the Internet to provide these kinds of interventions because of blocking software in schools and libraries was very concerning to me."

That teens spend a great deal of time online is no surprise, but they apparently spend a significant proportion of that time researching health issues, according to a Kaiser study conducted in 2001. That study indicated that 70% of 15- to 17-year-olds have used the Internet to look up health information; 40% have researched sexual health issues such as birth control or sexually transmitted diseases.

The study also found that 73% of schools and 43% of libraries use filters of some kind. The Children's Internet Protection Act of 2000 requires filters on all computers in schools that receive federal funds. The law's requirement that libraries also use filters was overturned by a federal court and is awaiting review by the U.S. Supreme Court.

Screening levels

The JAMA study, "See No Evil: How Internet Filters Affect the Search for Online Health Information," tested the six most commonly used filters at their "least," "intermediate," and "most" restrictive settings.

At their least restrictive level, the filters block an average of 1.4% of health sites, according to the study. When set at their most restrictive level, the filters block 24% of health sites.

However, the amount of pornographic content blocked was found to increase only marginally, from 87% at the least restrictive configuration, to 91% at the most restrictive.

The researchers conducted online searches of 24 health topics such as breast cancer, diabetes and birth control and six pornographic terms, such as free sex, hardcore porn and teen porn across six different search engines popular with teens. The 3,000 health and 500 pornographic sites that came up during the searches were then tested against the six filters most widely used by schools and libraries.

In addition to level of restriction, each filtering product can be configured to block many different categories of content. Some can be adjusted to specify exceptions for medical or sex education information.

"Whoever is making the decisions needs to think really hard about the settings they are picking because when they make decisions about the settings, they are also making decisions about access to health information," said Dr. Richardson.

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