The evolution of NCI’s Health Information National Trends Survey: methods, data, and future directions

Abstract

The National Cancer Institute’s (NCI’s) Health Information National Trends Survey^® (HINTS^®) was conceived in 1997 during a multidisciplinary conference focused on risk communication that included attendees representing the fields of psychology, health behavior, health education, public health, clinical medicine, and health journalism. The key recommendation from the conference was for NCI to develop a premiere communication-specific population survey to track health and cancer communication-related phenomena. This led to NCI developing and launching HINTS in 2003. HINTS is a cross-sectional, nationally representative survey of the US noninstitutionalized adult population (18 years and older) that collects data on the public’s need for, access to, and use of health- and cancer-related information and health- and cancer-related knowledge, attitudes, and behaviors. As of 2024, HINTS had been administered 17 times over a 21-year period. The resulting datasets can be used for secondary analysis to examine a range of social and behavioral research questions in cancer control and population sciences. The datasets can be examined individually or merged to test for trends over time or to create larger samples for analysis. The evolution of the program has included testing and changing instrument administration modes, oversampling specific populations, and assessing priority constructs, as well as conducting methodological experiments to keep pace with emerging trends in survey research. HINTS has also expanded beyond its cross-sectional format to include data linkages and a longitudinal panel, enabling researchers to address a wider range of research questions. HINTS methods, data products, and impact are discussed.

Background

A JNCI Monographs issue published in 1999 titled Cancer Risk Communication: What We Know and What We Need To Learn summarized the proceedings of a 1997 risk communication conference where experts issued a recommendation to establish a national surveillance program that would: monitor changes in the health information environment over time; explore uses of different health communication channels and health information sources; assess the association between channel usage and health- and cancer-related knowledge, attitudes, and behaviors; and build an evidence base for planners, administrators, communicators, practitioners, and policymakers.¹ In response, the National Cancer Institute’s (NCI’s) Division of Cancer Control and Population Sciences (DCCPS) launched the Health Information National Trends Survey^® (HINTS^®) in 2003, with the goal of detecting changes and trends in health communication and health information technology, documenting disparities and communication inequalities, and identifying opportunities for applied communication interventions. HINTS was a central component of NCI’s “Extraordinary Opportunity in Cancer Communication,” outlined in the NCI fiscal year 2001 budget proposal.²

Throughout its history, the primary aims of the HINTS program have been to identify and track information support needs in the population and provide scientifically rigorous, transparent, and useful data products and resources for extramural researchers, federal partners, and public health and communication practitioners and to make these resources easily accessible using an open science framework. For the last 2 decades, HINTS has collected nationally representative data about the American public’s knowledge of, attitudes toward, and use of cancer- and health-related information. Although other national health data collection programs exist (see here for a comparison of the US Department of Health and Human Services– (HHS-) sponsored surveys: https://aspe.hhs.gov/reports/guide-hhs-surveys-data-resources), HINTS is the only nationally representative, probability-based, federally funded, public-use survey that includes items related to health and cancer communication, information technology, and the evolving cancer information environment.

Details about HINTS methodology have been published elsewhere^3-11 and are available on the HINTS website at https://hints.cancer.gov/data/methodology-reports.aspx. This commentary draws from many of those publications, and specifically from a Data Resource Profile published in the International Journal of Epidemiology,⁷ in order to reflect on how HINTS has evolved since its inception.

Unique constructs and measures

Each HINTS administration includes a core set of measures that comprise approximately half of the instrument to assess the following among survey respondents: sociodemographic characteristics, communication technology access and utilization, cancer history, health and cancer information-seeking, cancer prevention and screening knowledge and behavior, cancer-related risk behaviors, cancer risk perceptions, patient-provider communication, and healthcare access and use. Additional constructs and items have been included in HINTS administrations to capture timely or emerging phenomena (eg, electronic medical records and patient portals, clinical trial knowledge, social media use, health misinformation perceptions, genetic testing, caregiving, palliative care, climate change, telehealth use) or to glean greater detail on core constructs. Most questions on the survey are asked of all respondents, with the exception of questions that follow skip patterns (eg, cancer type and cancer treatment questions are asked only of those reporting a history of cancer; internet satisfaction questions are asked only of those who report going online). HINTS is the only federally funded survey that includes items related to health and cancer communication, information technology use, and the information environment in addition to items related to health-related knowledge, attitudes, and behaviors. Its communication and technology focus allows researchers to monitor changes in the health communication environment and study the impact of communication on key processes affecting the health of American adults.

Methodology

HINTS collects data from a nationally representative sample of the US adult, civilian, noninstitutionalized population using a probability-based survey. To date, the HINTS survey has been conducted by Westat on behalf of NCI. The sample is drawn in 2 stages: the first stage randomly selects addresses from the US Postal Service file of stratified residential addresses, and the second stage selects an adult within the selected household using the next birthday method¹³ (prior to transitioning to postal administrations in 2008 due to declining landline coverage, landline telephone numbers were selected using random digit dial [RDD]). HINTS routinely oversamples high-minority census tracts and since 2022 has oversampled rural/nonmetropolitan counties. Special iterations of HINTS have oversampled other subpopulations such as cancer survivors (HINTS-Surveillance, Epidemiology, and End Results [SEER] 2021), residents of Puerto Rico (HINTS Puerto Rico 2009), Central Appalachian counties (HINTS 4 2011-2014), and current smokers (HINTS-Food and Drug Administration [FDA] 2015 and 2017).

Every sampled adult who completes a HINTS questionnaire receives a full-sample weight and a set of 50 replicate weights. The full-sample weight is used to calculate population and subpopulation point estimates. Replicate weights are used to compute accurate standard errors for those estimates, given the complex sampling procedure used for data collection. The use of sampling weights is done to ensure valid inferences from the responding sample to the population, correcting for nonresponse and noncoverage biases to the extent possible. Replicate weights are calculated using the “delete one” jackknife replication method.

Institutional review board approval

Each HINTS administration has been approved through expedited review by Westat’s Institutional Review Board and subsequently deemed exempt by the US National Institutes of Health Office of Human Subjects Research Protections. Institutional Review Board approval information for each iteration of HINTS can be found at https://hints.cancer.gov/about-hints/institutional-review-board.aspx.

Response rates

See Table 1 for the mode, sample size, and response rate for each HINTS iteration from 2003 to 2024. Response rates to federal surveys have been declining for many years, and the declines have been attributed to several social and environmental factors (eg, 2-worker households, a cluttered information environment) that have made it difficult to contact prospective respondents and have increased the likelihood that, if contacted, they will refuse to participate.¹⁴ HINTS prioritizes examining and implementing effective strategies to increase response rates, reduce bias, and improve data quality. One such strategy included transitioning mode from RDD to postal (first as dual mode in 2008 and as postal thereafter) in order to reduce the impact of declining response to RDD surveys with the proliferation of cellular telephones. Similarly, HINTS piloted a push-to-web option in 2019 and implemented push-to-web as a standard mode in 2022 in order to provide postal households with a mode option and to appeal to younger respondents. The HINTS program has also experimented with different incentive amounts, cover art, and survey materials; conducted mode experiments to examine concurrent and sequential designs for postal and push-to-web options; and tested for and implemented interventions to reduce straight lining and speeding in web mode. Other efforts to increase response and improve data quality have included adding follow-up mailings to random subsamples of nonrespondents; adding a commitment statement to ask respondents to commit to providing accurate and thoughtful responses; implementing weighting based on the US Census American Community Survey and Centers for Disease Control and Prevention’s (CDC’s) National Health Interview Survey to examine potential bias; and conducting nonresponse bias analyses, which have demonstrated relatively low bias in the HINTS samples.⁹ Although methodological research suggests that the negative impact of declining survey response rates on data quality may not be as dramatic as previously assumed,¹⁵ the HINTS program aims to assess and reduce potential bias in each iteration through methodological experiments and sampling and weighting procedures. Results of these embedded experiments and their impact on response rates and key survey estimates are described in each HINTS methodology report and are available at https://hints.cancer.gov/data/methodology-reports.aspx.

Table 1.

Health Information National Trends Survey (HINTS) design and response rates (2003-2024).

Administration (year)	Data collection period	Mode	N and response rate (RR)
HINTS 1 (2003)	Oct 2002-Apr 2003	Random digit dial	N = 6369, RR = 33%
HINTS 2 (2005)	Feb 2005-Aug 2005	Random digit dial (+web pilot)	N = 5586, RR = 21%
HINTS 3 (2008)	Jan 2008-Apr 2008	Postal and Random digit dial	N = 3582 (mail), RR = 30.9% N = 4092 (RDD), RR = 24.2%
HINTS Puerto Rico (2009)	Apr 2009-June 2009	Random digit dial	N = 639, RR = 76%
HINTS 4 cycle 1 (2011-2012)	Oct 2011-Feb 2012	Postal	N = 3565, RR = 37.91%
HINTS 4 cycle 2 (2012-2013)	Oct 2012-Jan 2013	Postal	N = 3630, RR = 39.97%
HINTS 4 cycle 3 (2013)	Sept 2013-Nov 2013	Postal	N = 3185, RR = 35.19%
HINTS 4 cycle 4 (2014)	Aug 2014-Nov 2014	Postal	N = 3677, RR = 34.44%
HINTS-FDA (2015)	May 2015-Sept 2015	Postal	N = 3738, RR = 33.04%
HINTS-FDA cycle 2 (2017)	Jan 2017-May 2017	Postal	N = 1736, RR = 34.05%
HINTS 5 cycle 1 (2017)	Jan 2017-May 2017	Postal	N = 3285, RR = 32.4%
HINTS 5 cycle 2 (2018)	Jan 2018-May 2018	Postal	N = 3527, RR = 32.85%
HINTS 5 cycle 3 (2019)	Jan 2019-Apr 2019 Jan 2019-May 2019	Postal (+web pilot)	N = 4573 (mail), RR = 30.2% N = 865 (web), RR = 30.6% N = 5438 (total), RR = 30.3% (overall)
HINTS 5 cycle 4 (2020)	Feb 2020-June 2020	Postal	N = 3865, RR = 37%
HINTS-SEER (2021)a	Jan 2021-Aug 2021	Postal	N = 1234, RR 12.6% (overall)
HINTS 6 (2022)	Mar 2022-Nov 2022	Postal and push to web	N = 6252, RR = 28.07% (overall)
HINTS 7 (2024)	Mar 2024-Sept 2024	Postal and push to web	N = 7278, RR =  27.31% (overall)

^aThe sample for HINTS-SEER (2021) was drawn from 3 SEER registries.

Data quality

To ensure data quality prior to data collection, each administration has included cognitive testing of the survey instrument. The goal of cognitive testing is to provide valid measures of the constructs of interest with a minimum of response error.¹⁶ An explanation of cognitive testing procedures for each HINTS administration can be found here: https://hints.cancer.gov/about-hints/instrument-development.aspx. Post data collection, data quality efforts for the RDD surveys included direct data entry, wherein the computer-assisted telephone interview (CATI) program ensured proper skip patterns were followed and constrained data entry to valid values for each survey item. The CATI program also allowed for range and edit checks on the entry of numeric responses to questions such as age, length of time since last search for health information, servings of fruits or vegetables consumed daily, height and weight, and other numeric response questions. For mailed surveys, post data collection quality control checks are conducted on the scanned data and electronic images of the survey. Quality assurance staff compare the hard copy questionnaire with the data captured in the database item-for-item. Scanned data are validated according to HINTS specifications, which include rules about how items are treated when the scanner flags a response that does not fit the parameters of a programmed variable (eg, when more than 1 answer is checked on a question that asks for a single response, when numbered response fields are answered with decimals). Violations of validation rules are flagged and reviewed by verifiers who examine the images and the corresponding extracted data and resolve discrepancies.

Accessible data resources

HINTS adheres to the F.A.I.R. (Findable, Accessible, Interoperable, and Reusable) principles set forth in the National Institutes of Health’s Strategic Plan for Data Science.¹⁷ Each public-use dataset available for download on the HINTS website contains the dataset (available as SAS, STATA, and SPSS data files); format and format assignment files and guidance for formatting (for SAS); a comprehensive codebook; a history document; a survey overview and data analysis recommendations document, which includes SAS, Stata, SPSS, and R code for data management and analysis; English and Spanish annotated versions of the survey instrument; and a methodology report. In addition, NCI invests significant time and effort into the public-facing online codebook that is updated on the HINTS website (https://hints.cancer.gov/) with each data release. Topline prevalence estimates are provided, both for weighted and unweighted data, for every item that has been asked on HINTS since 2003, by survey year and across years, when applicable. A variety of HINTS reports are available (https://hints.cancer.gov/publications-reports/nci-reports.aspx), including documents providing analytic assistance for testing for trends over time, and journal issues and government reports featuring compilations of HINTS studies.

Data users who plan to publish using HINTS are provided with a checklist (https://hints.cancer.gov/data/pricssa.aspx) in order to facilitate compliance with Preferred Reporting Items for Complex Sample Survey Analysis guidelines. These guidelines were developed to increase consistency in reporting and aid in reducing analytic and reporting errors, thereby increasing transparency and reproducibility of secondary analyses of complex sample survey data.¹⁸

All HINTS data collection efforts have corresponding public-use datasets that are available for download, for free, from the HINTS website (https://hints.cancer.gov/data/download-data.aspx) upon agreeing to standard Terms of Use. Restricted-use datasets that contain geocodes and other data that have been suppressed due to disclosure risk are available by request upon satisfactory completion, submission, and review of a data request form and stringent data use agreement (https://hints.cancer.gov/data/restricted-data.aspx). No HINTS data are kept internally at NCI for intramural use.

Scientific contributions

Social, behavioral, and communication science and cancer prevention and control

A complete bibliography of HINTS publications, which number nearly 1000, is maintained on the HINTS website: https://hints.cancer.gov/publications-reports/hints-publications.aspx. The most frequently cited HINTS study to date provided some of the first nationally representative estimates of health-related uses of the internet, levels of trust in different health information sources, and preferences for cancer information sources among US adults, shedding light on the public’s consumption of health information in the internet age.¹⁹ Other highly cited HINTS papers examined predictors of eHealth²⁰ and social media use²¹ to provide insights on the digital divide. The field’s reliance on these papers demonstrates the unique and foundational role of HINTS as a surveillance tool and how the survey generates data on emerging trends in health communication and health information technology.²²

A series of HINTS Briefs have been developed to provide a snapshot of noteworthy, data-driven research findings for public health and health communication practitioners. HINTS Briefs, which provide population-level estimates for specific survey questions and summarize significant research findings from recent peer-reviewed journal articles using HINTS data, are available for download at https://hints.cancer.gov/publications-reports/hints-briefs.aspx.

Public health and surveillance

The HINTS program has engaged with and informed the work of several federal agencies and offices in various capacities (eg, as co-funders, item development leads, and data users). Partners have included the HHS Office of the National Coordinator for Health Information Technology (now called the Office of the Assistant Secretary for Technology Policy), which uses HINTS to measure trends in the adoption of several aspects of the 2010 Patient Protection and Affordable Care Act (PL 111-148) and its Meaningful Use mandate such as implementation of and access to electronic medical records; the FDA, to inform regulatory activities and tobacco-related communication efforts; the Federal Communications Commission; the CDCs; and the HHS Office of Disease Prevention and Health Promotion, which uses HINTS to track national progress toward 6 Healthy People targets related to health communication and health information technology objectives.¹²

Additional projects: evolving beyond cross-sectional data collection efforts

The HINTS program has conducted several additional data collection efforts, beyond the routine, cross-sectional data collection efforts, to provide users with enhanced resources and data.

HINTS-SEER

In the standard iterations of HINTS, 12%-17% of respondents have reported a cancer history. To increase representation from adult cancer survivors, in 2021, NCI sampled survivors from 3 SEER program cancer registries: Iowa, New Mexico, and Greater Bay Area. Sampling frames were stratified by time since diagnosis and race/ethnicity, with nonmalignant tumors and nonmelanoma skin cancers excluded. Participants completed a self-administered postal questionnaire, and responses were linked with anonymized SEER registry data for each participant. The overall response rate for HINTS-SEER (N = 1234) was 12.6%; a nonresponse bias analysis indicated few demographic differences between respondents and the pool of sampled patients in each registry. Weighting was conducted using demographic control totals reflecting the eligible population within each of the 3 SEER registries. Although not nationally representative, the HINTS-SEER samples are probability-based samples of the frames from which they were drawn, and weights for each registry scale up to the registry population, thereby making the samples representative of the respective registries, which are comprehensive for the respective areas they cover. Most of the sample was 10+ years since diagnosis (n = 722; 60.2%), 392 respondents were 5 to less than 10 years since diagnosis (29.6%), and 120 were less than 5 years since diagnosis (10.2%). Common cancers included male reproductive (n = 304; 24.6%), female breast (n = 284; 23.0%), melanoma (n = 119; 9.6%), and gastrointestinal (n = 106; 8.6%). Tumors were mostly localized (67.8%; n = 833), with 22.4% (n = 282) regional, 6.2% (n = 72) distant, and 3.7% (n = 47) unknown. HINTS-SEER data are available to researchers who submit a restricted data request and may be used for secondary analyses to examine a range of social, behavioral, and healthcare outcomes among cancer survivors. Additional procedural details about HINTS-SEER have been published elsewhere.¹¹ To date, researchers have used HINTS-SEER to explore topics such as genetic testing among cancer survivors²³ and the association of comorbidities on patient experiences with clinical trial discussions and participation.²⁴

HINTS Data Linkage Project

There is an increasing interest in using contextual data, beyond self-reported information, to help understand and explain cancer-related outcomes. To support this effort and provide novel and useful data resources, the HINTS program developed the HINTS Data Linkage Project (HDLP). This entailed linking restricted-use, geocoded HINTS data at the individual respondent level, with contextual variables at different geographic units. All restricted HINTS datasets include respondent ZIP Code, county, and state for users to link their own geographic data. However, HDLP 2020 pre-links HINTS 5 cycle 4 data (2020; n = 3865), with more than 70 external variables at the county-level chosen from trusted and reliable sources including the US Census, the Agency for Healthcare Research and Quality, and the US Department of Agriculture. HDLP 2022 expands on this and provides restricted HINTS 6 data (2022; n = 6252) linked at both county and census tract levels with 102 external variables. The external variables fall into 5 categories: (1) social and economic factors (eg, income inequality, social vulnerability index, segregation index, percentage of households receiving public assistance); (2) demographics (eg, percentage of population 65 years or older, percentage of population by race/ethnicity, and English language ability); (3) information technology (eg, percentage of households with broadband internet, households with no computer or computing devices); (4) built environment (eg, fitness centers and recreational sports per 100 000 people, fast-food restaurants, community health centers, provider shortages); and (5) physical environment (eg, percentage of days with good air quality, air particulate matter). Data users can leverage HDLP for multilevel analyses to explore contextual factors that contribute to health and cancer communication-related phenomena. For example, data users can examine associations between county-level broadband access and individual-level online health information-seeking behaviors, or census tract-level socioeconomic status with individual healthcare access. HINTS intends to continue to provide linked datasets with each biennial administration.

HINTS panel

In 2022, the HINTS program undertook an effort to recruit a longitudinal panel from its probability-based mixed-mode survey. As an alternative to traditional cross-sectional survey modes, probability-based online panels present an opportunity to build a cohort of respondents to complete future surveys, which has the administrative benefit of time and cost savings and the scientific benefit of person-to-person data linkages and longitudinal analyses that can examine changes over time. The goal of the HINTS Panel is to recruit and maintain a panel of HINTS respondents to be surveyed in the future and whose data can be used for longitudinal analyses.

Research on probability-based online panels suggest that there are fewer differences among point estimates from online panels of probability samples when compared with point estimates obtained from nonprobability samples.²⁵ In addition, there may be fewer instances of straight-lining in probability-based online panels.²⁶

The first cohort of respondents for the HINTS Panel, referred to as the P6 cohort, were recruited from HINTS 6 (2022). The final question on the survey, which was a self-administered paper questionnaire with a push-to-web option, invited respondents to participate in future surveys for NCI and used an open field to ask respondents to provide their email address if they were interested in participating. Respondents who provided an email address were later invited and consented to join the HINTS Panel via email. Although both paper and web respondents were able to join the panel, panel members were required to complete all panel activities on the web via a HINTS Panel website. A similar recruitment procedure was followed with HINTS 7 (2024). This procedure differed slightly because first and last names were asked, in addition to email addresses, to better track and ensure that the same person is responding to all subsequent surveys.

At the time of submission, NCI had enrolled 1379 people into the HINTS Panel. Panel enrollment survey data with linkages to panelists’ cross-sectional HINTS survey responses will be available for secondary data analysis in 2025. The HINTS Panel is poised to rapidly monitor emerging issues in public health and cancer prevention and control.

Strengths and limitations

HINTS enables monitoring of national trends in health- and cancer-related knowledge, attitudes, and behaviors. It is unique among national data resources in its focus on health communication and health information technology. The HINTS program offers data for investigators from diverse disciplines to examine population use of health- and cancer-related information and examine associations with related outcomes, during a time of unprecedented change in the media and communication landscape. Since its inception, the HINTS program has invested heavily in efforts to ensure that the data are readily and easily accessible and usable.

HINTS data are cross-sectional; as such, inferences about temporality and causality cannot be made. Similar to other national health surveys, response rates for HINTS are generally lower than in-person (ie, face-to-face) probability surveys and have declined over time. Although lower response rates may introduce bias in the data, significant efforts are made in each HINTS administration to reduce potential for bias.

Population-level surveys are usually constrained to measuring constructs of interest with only 1 or 2 survey items in order to reduce respondent burden and allow for a range of topics to be studied. Therefore, the number of items available for measuring complex attitudinal and behavioral constructs is often limited. Although use of single items for measurement of social and behavioral constructs is not ideal, this approach is common in large-scale and national survey research. When compared with validated multi-item scales, single-item measures can have similar test-retest reliability and construct validity²⁷; however, single items are less reliable than scales and may attenuate observed associations.²⁸ Constraints on survey length have also led to changes in content across survey administrations, thereby limiting the temporal trends and comparisons that may be tracked over time.

Although the sampling strategy for HINTS includes oversampling high-minority census tracts and rural areas, the probability-based sampling method of postal addresses inevitably excludes the unhoused. Moreover, the use of English and Spanish instruments likely limits the ability of non-English and non-Spanish speakers from participating in the survey.

Despite these limitations, HINTS offers scientifically rigorous and useable data with unique content and adheres to principles of open science to make the data easily available and accessible.

Future directions

With the ever-evolving communication and technology landscape, HINTS will be positioned to capture population trends related to emerging areas of communication science, such as health misinformation, telehealth, and artificial intelligence. Broad areas of focus in future HINTS administrations will align with priority areas outlined by DCCPS, including digital health, climate change, modifiable risk factors, health equity, health policy, and data strategies. By aligning with these priority areas, outlined at https://cancercontrol.cancer.gov/research-emphasis/future-directions, HINTS will continue to produce national estimates of public perceptions and awareness about cancer risk factors such as alcohol,²⁹ the harms of climate change on health,³⁰ and health policies or regulatory actions, such as menu calorie information requirements.³¹ In addition, HINTS is well positioned to continue monitoring communication inequalities among at-risk health disparity populations in order to identify opportunities for intervention. For example, pinpointing age- and geography-related disparities in the likelihood of being offered telehealth by a health-care provider can inform practice-level changes aimed at facilitating telehealth access among older and/or rural patients.³²

Continuing to develop and nurture a robust data user community focused on answering important health and cancer communication research questions that can inform applied public health and health communication practice remains a priority for NCI. This has been and will continue to be facilitated through regular data users conferences and data user satisfaction surveys. In addition, NCI will continue to respond to the needs of HINTS data users by collecting longitudinal data through the HINTS Panel, expanding the HDLP to include additional HINTS datasets and additional multilevel linkage variables, continuing to prioritize the needs of cancer survivors and caregivers in item development, and keeping pace with important developments in the communication and health information technology landscapes (eg, emerging social media platforms, responses to online misinformation, changes in telehealth policy, artificial intelligence) as well as changes in the cancer context (eg, multicancer early detection tests, evolving screening guidelines, behavioral risk factors linked to early onset cancer diagnoses). HINTS will continue to test cutting-edge methods to reduce bias and increase data quality. HINTS will also continue collaborating with federal partners to enhance data collection and track policy implementation and guideline adherence related to cancer screening and diet, weight, and physical activity.

Impact and conclusion

Since its inception in 2003, HINTS has surveyed more than 70 000 US adults and has been the government’s premiere surveillance mechanism for health and cancer communication-related outcomes. Evidence generated from HINTS data have had impact in several domains. First, by tracking the use of digital health technologies such as online health information and mobile health apps, HINTS data have helped document and describe the integration of technology into health care. Second, data from HINTS have been critical to advancing the understanding of health literacy and its impact on health outcomes. Third, the identification of disparities in health information access has contributed to efforts to address gaps resultant of the digital divide. In addition, HINTS data have been used to enhance patient-provider communication by informing initiatives aimed at enhancing patient engagement and satisfaction.

The evolution of the HINTS program has included testing and changing instrument administration modes, oversampling specific populations, and assessing priority constructs as well as conducting methodological experiments to keep pace with emerging survey research. The HINTS program has expanded beyond cross-sectional data collection to include geospatial data linkages and a longitudinal panel. Public-use and restricted-use data files are available to the research community for secondary analyses examining a range of social and behavioral research questions to advance cancer control and population sciences.

Author contributions

Kelly D. Blake, ScD (Conceptualization, Methodology, Project administration, Supervision, Writing—original draft), Richard P. Moser, PhD (Data curation, Methodology, Writing—review & editing), Heather D’Angelo, PhD, MHS (Writing—review & editing), Anna Gaysynsky, MPH (Writing—review & editing), and Robin C. Vanderpool, DrPH (Writing—review & editing)

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health. HINTS is conducted by Westat via contract number HHSN261201800002B.

Conflicts of interest

The authors have no conflicts to disclose.

Data availability

HINTS data are publicly available at https://hints.cancer.gov/data/download-data.aspx. Restricted-use data files are available upon request with the execution of a data use agreement at https://hints.cancer.gov/data/restricted-data.aspx.