ner-city African-American women. They used CHESS as much as affluent white women with breast cancer (Gustafson et al., 2000). However, they used it very differently. In particular, low-income women (older and younger) used the computer-mediated communication services (e.g., electronic discussion groups) less frequently and information services (e.g., frequently asked questions and library) and analysis services (e.g., decision analysis and health tracking) more often. A growing body of research suggests that using IHC for information and analysis is more important to improving quality of life than using them for emotional support (Bass et al., 1998; Shaw et al., 2000; Boberg et al., 1997; Smaglik et al., 1998). This suggestion may be especially relevant for diverse populations. CHESS also has resulted in quality-of-life improvements, shorter ambulatory care visits, and fewer and shorter hospitalizations (Gustafson et al., 1999). These are particularly noteworthy health services outcomes.

Computer games are another important IHC. Packy and Marlon is a Super Nintendo video game designed to teach children with diabetes self-management skills to address specific challenges facing diabetes patients. The characters are two adolescent elephant friends with diabetes who are going to a diabetes summer camp. The players (one or two) play the role of the elephant friends who must save their camp from rodents who have scattered the camp’s food and diabetes supplies. Players must help their elephant character monitor blood glucose, take appropriate amounts of insulin, review a diabetes logbook, and find foods that contain the right amount of food exchanges. Through entertaining experiences, players learn about self-care and typical social situations related to diabetes. To win, players must learn how to engage in behaviors that help their character stay healthy. Packy and Marlon improved diabetes-related communication between parents and children with diabetes, increased parents’ ratings of self-care and self-efficacy, and reduced clinic visits (Brown et al., 1997).

Psychosocial programs for health promotion will be implemented increasingly via interactive Internet-based systems in a variety of formats. For example, young women at risk for eating



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