Characterization of False or Misleading Fluoride Content on Instagram: Infodemiology Study

Abstract

Background Online false or misleading oral health–related content has been propagated on social media to deceive people against fluoride’s economic and health benefits to prevent dental caries. Objective The aim of this study was to characterize the false or misleading fluoride-related content on Instagram. Methods A total of 3863 posts ranked by users’ total interaction and published between August 2016 and August 2021 were retrieved by CrowdTangle, of which 641 were screened to obtain 500 final posts. Subsequently, two independent investigators analyzed posts qualitatively to define their authors’ interests, profile characteristics, content type, and sentiment. Latent Dirichlet allocation analysis topic modeling was then applied to find salient terms and topics related to false or misleading content, and their similarity was calculated through an intertopic distance map. Data were evaluated by descriptive analysis, the Mann-Whitney U test, the Cramer V test, and multiple logistic regression models. Results Most of the posts were categorized as misinformation and political misinformation. The overperforming score was positively associated with older messages (odds ratio [OR]=3.293, P<.001) and professional/political misinformation (OR=1.944, P=.05). In this context, time from publication, negative/neutral sentiment, author’s profile linked to business/dental office/news agency, and social and political interests were related to the increment of performance of messages. Although political misinformation with negative/neutral sentiments was typically published by regular users, misinformation was linked to positive commercial posts. Overall messages focused on improving oral health habits, side effects, dentifrice containing natural ingredients, and fluoride-free products propaganda. Conclusions False or misleading fluoride-related content found on Instagram was predominantly produced by regular users motivated by social, psychological, and/or financial interests. However, higher engagement and spreading metrics were associated with political misinformation. Most of the posts were related to the toxicity of fluoridated water and products frequently motivated by financial interests.

Toothpaste-related interests of Google users from different countries

“…In spite of these facts, a recent study identi ed 36 charcoal-based products, 72% of which had Instagram pro les with numerous followers and high engagement rates. These products are advertised as natural or organic, free of metals and with bleaching properties [41,42]. Moreover, celebrities' commercial appeal in promoting these products associates them with an image of high quality [43].…”

“…The aim is to persuade their followers to purchase the so-called natural products, even if they lack scienti c evidence of safety and e cacy [44]. The misleading uoride information on Instagram is primarily commercial and is consumed motivated by social, psychological, and/or nancial interests [42].…”

Ethical principles for infodemiology and infoveillance studies concerning infodemic management on social media

“…The literature also shows that many people use these platforms to connect with their peers and exchange their experiences about health conditions (7). Indeed, the big data originating from these types of user interactions play an essential role in developing infodemiology and infoveillance studies (8,9). According to Eysenbach (10), "infodemiology is the science of distribution and determinants of information in an electronic medium, specifically the Internet, with the ultimate aim of informing public health and public policy, " while "infoveillance refers to using infodemiology data for digital surveillance purposes. "…”

“…Indeed, the big data originating from these types of user interactions play an essential role in developing infodemiology and infoveillance studies ( 8 , 9 ). According to Eysenbach ( 10 ), “infodemiology is the science of distribution and determinants of information in an electronic medium, specifically the Internet, with the ultimate aim of informing public health and public policy,” while “infoveillance refers to using infodemiology data for digital surveillance purposes.” Although both sciences are essential to support the planning and implementation of public health actions, researchers must make ethical considerations when collecting, analyzing, and presenting digital data derived from people’s activity on social media.…”

Online health search via multi-dimensional information quality assessment based on deep language models

“…Health misinformation has become increasingly prevalent online due to the lack of health literacy [10] of nonprofessionals and due to the infodemic phenomenon [11], that is, the rapid and wide spread of both accurate and inaccurate information about a medical topic in modern internet [12]. Recently, health misinformation-related topics, like "vaccine" or "the relationship between coronavirus and 5G", on social media platforms, such as Twitter and Instagram [13][14][15], and across countries [16] have gained scientific interest. Thus, new credibility-centred search methods and assessment measures are crucial for tackling open issues in health-related information retrieval [17].…”