Introduction.

Demand for consumer health information is not a recent trend. It has an extensive and proud history. The movement of medical consumerism can be traced to 1945 when Baby and Child Care was published by pediatrician Dr. Benjamin Spock. His book introduced innovative child-rearing techniques that changed the way parents raised their children. Fifteen years later, consumer-based medicine made its debut with the contraceptive pill. The Pill empowered women to take control of their bodies by preventing pregnancy. Ralph Nader's book, Unsafe at Any Speed: The Designed-in Dangers of the American Automobile, published in 1965, instantly became a reference for consumer safety and advocates. In 1969, during the women's civil rights movement, a comprehensive book, Our Bodies, Ourselves, was published (Boston Women's Health Book Collective, 1969). Written by women for women, Our Bodies, Ourselves invited women to get acquainted with their bodies and pay attention to inner cues for healthy living.

The women's movement ushered in a new era of consumer health information, when patients and physicians formally initiated open relationships that led to the partnerships we see today in health care. In 1972, the American Hospital Association published the Patient's Bill of Rights, which stated, "the patient has the right to receive from his physician complete current information concerning his diagnosis, treatment and prognosis in language the patient can reasonably be expected to understand" (American Hospital Association, 1975). The early consumer health information programs in the 1970s and 1980s bore witness to a radical change toward empowered consumers who began asserting their new role and questioning the state of health care practice.

Today, the Internet has transformed the way consumer health information is distributed and who has access to it. In the past, consumers who requested current, detailed, and in-depth information had to be diligent and willing to visit libraries, get help from librarians using unfriendly databases, and read very technical medical literature. Now consumers and librarians have options for accessing materials through friendlier databases and search engines, for formatting the materials--now in several digital formats as well as in print--and in the variety of materials available to suit all levels of understanding due to an explosion in consumer-specific medical writing. Librarians are expert searchers. They no longer are required to wade through stacks of reference textbooks and miles of print journals in seeking answers to patron's requests. Across the nation, libraries are utilizing human, print, and electronic resources as well as developing their own approaches to the ever-changing expectations and consumer health issues. With the advent of the Internet, information that would have normally taken days to obtain at financial expense can now be downloaded and distributed in seconds.

The Internet has propelled the consumer health movement to the forefront of libraries. Academic health sciences, clinical, hospital, consumer health, and public librarians across the country are seeing a continuous growth in the number of requests for health information from their patrons. "Typically, from 5 to 10 percent of all questions at a public library reference desk involve consumer-health" (Dewdney, Marshall, & Tiamiyu, 1991, p. 189). Internet savvy consumers are completing their own online health information searches. Patrons are seeking free, quality, electronic health information written in lay terminology, though both Internet and non-Internet users are seeking librarians for what they can not find.

The National Library of Medicine (NLM), the world's largest medical library, is one of the many government agencies providing high-quality, user-friendly health information on the Web for the public. In 1999 NLM officially changed its mission statement to include health information for the public and quickly developed a conscientious response to the consumer health revolution triggered by the explosion of the Internet.

NLM, health-related organizations, and many information/database vendors are providing gateways to resources for the public as well as separate paths/screens for information professionals who are often better equipped to navigate using the language of medical professionals. These professionals are also skilled in determining the appropriateness and authenticity of the medical information they find and review for consumers. The consumer health revolution is giving librarians, particularly public librarians, a challenge in many communities. Serving diverse populations and managing multiple health literacy levels are just a few of the challenges libraries face. Patrons who are seeking health information often find medical terminology difficult to interpret and understand.

An exploration of consumer health issues, trends, and research is covered in this and the next issue of Library Trends. In this issue, part 1--Strategic Strides toward a Better Future--contributors examine the many facets that comprise consumer health information services. Kristine Alpi and Barbara Bibel address the challenges of meeting the health needs of diverse populations and how libraries play a significant role. Ellen Gay Detlefsen presents a literature review on the information behaviors of seniors and African Americans and gives tips on how to evaluate Web-based consumer health information for these two targeted populations. Margaret Allen, Suzanne Matthew, and Mary Jo Boland discuss the challenges related to providing health information for immigrants and refugees in the development of health education and health literacy programs. Heidi Thiessen Sandstrom describes the planning, implementation, and evaluation of the educational health literacy symposium. Lynda Baker and Claudia Gollup's research assesses the readability of information in ten standard medical textbooks. Diana Kovacs discusses her challenges in developing Web-based health information workshops. Javier Crespo covers quality issues in health information Web sites. Lastly, Naomi Miller, Rebecca Tyler, and Joyce Backus describe the development of MedlinePlus, which includes quality control processes, the integration of information from the National Library of Medicine and the National Institutes of Health, technical and staffing infrastructures, the use of feedback for quality improvement, and future plans.

The authors--representing medical, academic, government, and public libraries as well as library school faculty--have been selected because of their reputation, expertise, and successes in the consumer health arena. I hope that the contributions to this focused issue will provide a valuable resource for librarians with an interest in providing consumer health information services at their institutions.

ACKNOWLEDGEMENTS

The author wishes to express her sincere appreciation to Jenifer Grady, Director, ALA-Allied Professional Association, American Library Association, and Elaina Norlin, Program Officer, Institute of Museum and Library Services, for their positive energy, encouraging words, and editorial assistance.

REFERENCES

American Hospital Association. (1975). A patient's bill of rights. Chicago: American Hospital Association.

Boston Women's Health Book Collective (1969). Our bodies, ourselves: A book by and for women. New York: Simon & Schuster.

Dewdney, P., Marshall, J. G., & Tiamiyu, M. (1991). A comparison of legal and health information services in public libraries. RQ 31(2), 185-196.

Nader, Ralph. 1965. Unsafe at any speed: The designed-in dangers of the American automobile. New York: Grossman.

Spock, Benjamin. 1945. Baby and child care: Common sense book of baby and child care. New York: Meredith Press.

Tammy L. Mays, Consumer Health Coordinator, NN/LM, Greater Midwest Region, Library of the Health Sciences, University of Illinois at Chicago, 1750 West Polk Street, Chicago, IL 60612

LIBRARY TRENDS, Vol. 53, No. 2, Fall 2004 ("Consumer Health Issues, Trends, and Research: Part 1. Strategic Strides toward a Better Future," edited by Tammy L. Mays), pp. 265-267