An Examination of Factors Contributing to the Acceptance of Online Health Misinformation

The "multiple exposure effect" (MEE): How multiple exposures to similarly biased online content can cause increasingly larger shifts in opinions and voting preferences

In three randomized, controlled experiments performed on simulations of three popular online platforms - Google search, X/Twitter, and Alexa - with a total of 1,488 undecided, eligible US voters, we asked whether multiple exposures to similarly biased content on those platforms could shift opinions and voting preferences more than a single exposure could. All participants were first shown brief biographies of two political candidates, then asked about their voting preferences, then exposed to biased content on one of our three simulated platforms, and then asked again about their voting preferences. In all experiments, participants in different groups saw biased content favoring one candidate, his or her opponent, or neither. In all the experiments, our primary dependent variable was Vote Manipulation Power (VMP), the percentage increase in the number of participants inclined to vote for one candidate after having viewed content favoring that candidate. In Experiment 1 (on our Google simulator), the VMP increased with successive searches from 14.3% to 20.2% to 22.6%. In Experiment 2 (on our X/Twitter simulator), the VMP increased with successive exposures to biased tweets from 49.7% to 61.8% to 69.1%. In Experiment 3 (on our Alexa simulator), the VMP increased with successive exposures to biased replies from 72.1% to 91.2% to 98.6%. Corresponding shifts were also generally found for how much participants reported liking and trusting the candidates and for participants' overall impression of the candidates. Because multiple exposures to similarly biased content might be common on the internet, we conclude that our previous reports about the possible impact of biased content - always based on single exposures - might have underestimated its possible impact. Findings in our new experiments exemplify what we call the "multiple exposure effect" (MEE).

Beliefs in Misinformation About COVID-19 and the Russian Invasion of Ukraine Are Linked: Evidence From a Nationally Representative Survey Study

BACKGROUND

Detrimental effects of misinformation were observed during the COVID-19 pandemic. Presently, amid Russia's military aggression in Ukraine, another wave of misinformation is spreading on the web and impacting our daily lives, with many citizens and politicians embracing Russian propaganda narratives. Despite the lack of an objective connection between these 2 societal issues, anecdotal observations suggest that supporters of misinformation regarding COVID-19 (BM-C) have also adopted misinformation about the war in Ukraine (BM-U) while sharing similar media use patterns and political attitudes.

OBJECTIVE

The aim of this study was to determine whether there is a link between respondents' endorsement of the 2 sets of misinformation narratives, and whether some of the selected factors (media use, political trust, vaccine hesitancy, and belief rigidity) are associated with both BM-C and BM-U.

METHODS

We conducted a survey on a nationally representative sample of 1623 individuals in the Czech Republic. Spearman correlation analysis was performed to identify the relationship between BM-C and BM-U. In addition, multiple linear regression was used to determine associations between the examined factors and both sets of misinformation.

RESULTS

We discovered that BM-C and BM-U were moderately correlated (Spearman ρ=0.57; P<.001). Furthermore, increased trust in Russia and decreased trust in the local government, public media, and Western allies of the Czech Republic predicted both BM-C and BM-U. Media use indicating frustration with and avoidance of public or mainstream media, consumption of alternative information sources, and participation in web-based discussions indicative of epistemic bubbles predicted beliefs in misinformation narratives. COVID-19 vaccine refusal predicted only BM-C but not BM-U. However, vaccine refusers were overrepresented in the BM-U supporters (64/161, 39.8%) and undecided (128/505, 25.3%) individuals. Both beliefs were associated with belief rigidity.

CONCLUSIONS

Our study provides empirical evidence that supporters of COVID-19 misinformation were susceptible to ideological misinformation aligning with Russian propaganda. Supporters of both sets of misinformation narratives were primarily linked by their shared trust or distrust in the same geopolitical actors and their distrust in the local government.

Does exposure necessarily lead to misbelief? A meta-analysis of susceptibility to health misinformation

A meta-analysis was conducted to quantify the overall effect of health misinformation exposure on shaping misbelief. Aggregation of results from 28 individual randomized controlled trial studies (n = 8752) reveals a positive but small average effect, d = 0.28. Moderation analyses suggest that adults who are younger and female tend to develop higher misbelief if exposed to health misinformation. Furthermore, media platform, message falsity, and misbelief measurements also contribute to the exposure effect. These findings offer nuanced but crucial insights into existing misinformation literature, and development of more effective strategies to mitigate the adverse impacts of health misinformation.

Predicting User Engagement in Health Misinformation Correction on Social Media Platforms in Taiwan: Content Analysis and Text Mining Study

BACKGROUND

Health misinformation undermines responses to health crises, with social media amplifying the issue. Although organizations work to correct misinformation, challenges persist due to reasons such as the difficulty of effectively sharing corrections and information being overwhelming. At the same time, social media offers valuable interactive data, enabling researchers to analyze user engagement with health misinformation corrections and refine content design strategies.

OBJECTIVE

This study aimed to identify the attributes of correction posts and user engagement and investigate (1) the trend of user engagement with health misinformation correction during 3 years of the COVID-19 pandemic; (2) the relationship between post attributes and user engagement in sharing and reactions; and (3) the content generated by user comments serving as additional information attached to the post, affecting user engagement in sharing and reactions.

METHODS

Data were collected from the Facebook pages of a fact-checking organization and a health agency from January 2020 to December 2022. A total of 1424 posts and 67,378 corresponding comments were analyzed. The posts were manually annotated by developing a research framework based on the fuzzy-trace theory, categorizing information into "gist" and "verbatim" representations. Three types of gist representations were examined: risk (risks associated with misinformation), awareness (awareness of misinformation), and value (value in health promotion). Furthermore, 3 types of verbatim representations were identified: numeric (numeric and statistical bases for correction), authority (authority from experts, scholars, or institutions), and facts (facts with varying levels of detail). The basic metrics of user engagement included shares, reactions, and comments as the primary dependent variables. Moreover, this study examined user comments and classified engagement as cognitive (knowledge-based, critical, and bias-based) or emotional (positive, negative, and neutral). Statistical analyses were performed to explore the impact of post attributes on user engagement.

RESULTS

On the basis of the results of the regression analysis, risk (β=.07; P=.001), awareness (β=.09; P<.001), and facts (β=.14; P<.001) predicted higher shares; awareness (β=.07; P=.001) and facts (β=.24; P<.001) increased reactions; and awareness (β=.06; P=.005), numeric representations (β=.06; P=.02), and facts (β=.19; P<.001) increased comments. All 3 gist representations significantly predicted shares (risk: β=.08; P<.001, awareness: β=.08; P<.001, and value: β=.06; P<.001) and reactions (risk: β=.04; P=.007, awareness: β=.06; P<.001, and value: β=.05; P<.001) when considering comment content. In addition, comments with bias-based engagement (β=-.11; P=.001) negatively predicted shares. Generally, posts providing gist attributes, especially awareness of misinformation, were beneficial for user engagement in misinformation correction.

CONCLUSIONS

This study enriches the theoretical understanding of the relationship between post attributes and user engagement within web-based communication efforts to correct health misinformation. These findings provide a foundation for designing more effective content approaches to combat misinformation and strengthen public health communication.

Misinformation and COVID-19 vaccine uptake hesitancy among frontline workers in Tanzania: Do demographic variables matter?

Although COVID-19 vaccination has been widely considered as an important remedy to confront COVID-19, people remain hesitant to take it. The objective of this study was to assess the moderation effects of demographic characteristics on the relationship between forms of misinformation and COVID-19 vaccine uptake hesitancy among frontline workers in Dar es Salaam and Dodoma, Tanzania. Using a sample of 200 respondents, it assessed the differences in ratings on misinformation regarding COVID-19 vaccine based on respondents' demographics. The study used a Five-point Likert scale questionnaire distributed through snowball sampling to frontline workers from Dar es Salaam and Dodoma regions. Data was analyzed using binary logistic regression. It was found that the forms of misinformation revealed were manipulated imposters, satire, fabricated contents and false contents with their connection, which they influenced COVID-19 hesitancy significantly. With exception of age, that significantly moderated hesitancy, this study uncovers that, sex and education level moderated insignificantly in predicting those who are misinformed; misinformed individuals are not any less educated or not based on one's sex, different than individuals who are informed. The study informs policy makers on devising appropriate strategies to promote COVID-19 vaccination uptake among the different contextual demographic variables. Promotion of information, media and health literacy to the general public should be considered to deter spreading of vaccine-related misinformation.

Clinician-patient communication about cancer treatment misinformation: The Misinformation Response Model

Objective

Cancer treatment misinformation (CTM) is pervasive and impacts patient health outcomes. Cancer clinicians play an essential role in addressing CTM. We previously identified four self-reported responses that characterize the communication process clinicians engage in to address CTM. Clinicians 1) work to understand the misinformation; 2) correct the misinformation through education; 3) advise about future online searches; and 4) preserve the clinician-patient relationship. We sought to confirm and expand on the model we developed by observing cancer clinicians' communication while addressing CTM with a standardized patient (SP).

Methods

17 cancer clinicians were audio recorded in a SP encounter, in which a breast cancer SP asked three questions based on CTM. We thematically analyzed transcriptions of the recordings.

Results

Clinicians used four responses with associated strategies and skills to address CTM in a standardized clinical encounter, confirming the previously developed model. The four responses were: (1) work to understand the misinformation; (2) correct the misinformation through education; (3) advise about future online searches; and (4) preserve the clinician-patient relationship. This observational approach allowed us to refine strategies within each response and identify communication skills clinicians enact to address CTM.

Conclusion

These findings provide a strong foundation for the Misinformation Response Model for cancer clinicians. Future research should examine which components of the model are most effective in improving patient outcomes.

Innovation

This is the first study observing clinicians' communication through simulated practice with SPs about CTM.

Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis

BACKGROUND

Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread.

OBJECTIVE

This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation.

METHODS

Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information.

RESULTS

Over 35.61% (1740/4959) of respondents reported encountering "a lot" of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing "some" amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access.

CONCLUSIONS

This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions.

The Digital Health Revolution: Exploring the Impact of Online Cancer Information on Self-Reported Preventive Behaviors

Cancer, one of the leading causes of death worldwide, is a disease characterized by uncontrolled cell growth within the body. While there have been many improvements in the treatment of cancer clinically, there is now an urgent need to improve cancer-related communication. This study explores the impact of online health information, specifically cancer-related information and prevention, among members of the general public. Through a randomized survey, we examined what information leads people to take action to minimize their cancer risk and communicate with their providers. Through evaluation of the various modes of communication, we were able to provide insight into which are more effective and better received by members of the general public. Through this, ways of bettering these avenues of communication and strengthening the bond between them will be highlighted and more easily elaborated on by future studies. The results of our study indicated that 60% of participants asserted that they are motivated by online preventive information to take steps to limit their cancer risk, while only roughly 44% of participants overall agreed that their doctor has communicated with them about when proper cancer screenings should be scheduled for the future. Although patients may be turning to the Internet now more than ever due to various reasons, when comparing self-reported rates of comprehension among the study participants, 35% agreed that the cancer-related information they can access online is confusing, while fewer than 22% of participants agreed that the cancer-related information they receive directly from their doctor is confusing. This is indicative of the limitations the Internet may have when undertaking the role of being a medical resource, especially when acting as a replacement for in-person medical appointments where patients can communicate directly with their physicians. Ultimately, these results provide a unique perspective into how people receive, evaluate, and implement cancer-preventive steps and general health-related information in a post-COVID-19 world, where the Internet is now strongly embedded in healthcare.

Utility and Comparative Performance of Current Artificial Intelligence Large Language Models as Postoperative Medical Support Chatbots in Aesthetic Surgery

BACKGROUND

Large language models (LLMs) have revolutionized the way plastic surgeons and their patients can access and leverage artificial intelligence (AI).

OBJECTIVES

The present study aims to compare the performance of 2 current publicly available and patient-accessible LLMs in the potential application of AI as postoperative medical support chatbots in an aesthetic surgeon's practice.

METHODS

Twenty-two simulated postoperative patient presentations following aesthetic breast plastic surgery were devised and expert-validated. Complications varied in their latency within the postoperative period, as well as urgency of required medical attention. In response to each patient-reported presentation, Open AI's ChatGPT and Google's Bard, in their unmodified and freely available versions, were objectively assessed for their comparative accuracy in generating an appropriate differential diagnosis, most-likely diagnosis, suggested medical disposition, treatments or interventions to begin from home, and/or red flag signs/symptoms indicating deterioration.

RESULTS

ChatGPT cumulatively and significantly outperformed Bard across all objective assessment metrics examined (66% vs 55%, respectively; P < .05). Accuracy in generating an appropriate differential diagnosis was 61% for ChatGPT vs 57% for Bard (P = .45). ChatGPT asked an average of 9.2 questions on history vs Bard's 6.8 questions (P < .001), with accuracies of 91% vs 68% reporting the most-likely diagnosis, respectively (P < .01). Appropriate medical dispositions were suggested with accuracies of 50% by ChatGPT vs 41% by Bard (P = .40); appropriate home interventions/treatments with accuracies of 59% vs 55% (P = .94), and red flag signs/symptoms with accuracies of 79% vs 54% (P < .01), respectively. Detailed and comparative performance breakdowns according to complication latency and urgency are presented.

CONCLUSIONS

ChatGPT represents the superior LLM for the potential application of AI technology in postoperative medical support chatbots. Imperfect performance and limitations discussed may guide the necessary refinement to facilitate adoption.

Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand

BACKGROUND

Pregnancy is a unique period of women's lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand.

METHODS

A descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis.

RESULTS

Five categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy.

CONCLUSION

The findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Artificial Intelligence in Postoperative Care: Assessing Large Language Models for Patient Recommendations in Plastic Surgery

Since their release, the medical community has been actively exploring large language models' (LLMs) capabilities, which show promise in providing accurate medical knowledge. One potential application is as a patient resource. This study analyzes and compares the ability of the currently available LLMs, ChatGPT-3.5, GPT-4, and Gemini, to provide postoperative care recommendations to plastic surgery patients. We presented each model with 32 questions addressing common patient concerns after surgical cosmetic procedures and evaluated the medical accuracy, readability, understandability, and actionability of the models' responses. The three LLMs provided equally accurate information, with GPT-3.5 averaging the highest on the Likert scale (LS) (4.18 ± 0.93) (p = 0.849), while Gemini provided significantly more readable (p = 0.001) and understandable responses (p = 0.014; p = 0.001). There was no difference in the actionability of the models' responses (p = 0.830). Although LLMs have shown their potential as adjunctive tools in postoperative patient care, further refinement and research are imperative to enable their evolution into comprehensive standalone resources.

Evaluation of Oropharyngeal Cancer Information from Revolutionary Artificial Intelligence Chatbot

OBJECTIVE

With burgeoning popularity of artificial intelligence-based chatbots, oropharyngeal cancer patients now have access to a novel source of medical information. Because chatbot information is not reviewed by experts, we sought to evaluate an artificial intelligence-based chatbot's oropharyngeal cancer-related information for accuracy.

METHODS

Fifteen oropharyngeal cancer-related questions were developed and input into ChatGPT version 3.5. Four physician-graders independently assessed accuracy, comprehensiveness, and similarity to a physician response using 5-point Likert scales. Responses graded lower than three were then critiqued by physician-graders. Critiques were analyzed using inductive thematic analysis. Readability of responses was assessed using Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL) scales.

RESULTS

Average accuracy, comprehensiveness, and similarity to a physician response scores were 3.88 (SD = 0.99), 3.80 (SD = 1.14), and 3.67 (SD = 1.08), respectively. Posttreatment-related questions were most accurate, comprehensive, and similar to a physician response, followed by treatment-related, then diagnosis-related questions. Posttreatment-related questions scored significantly higher than diagnosis-related questions in all three domains (p < 0.01). Two themes of the physician critiques were identified: suboptimal education value and potential to misinform patients. The mean FRE and FKRGL scores both indicated greater than an 11th grade readability level-higher than the 6th grade level recommended for patients.

CONCLUSION

ChatGPT responses may not educate patients to an appropriate degree, could outright misinform them, and read at a more difficult grade level than is recommended for patient material. As oropharyngeal cancer patients represent a vulnerable population facing complex, life-altering diagnoses, and treatments, they should be cautious when consuming chatbot-generated medical information.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2252-2257, 2024.

Mental health misinformation on social media: Review and future directions

Social media use for health information is extremely common in the United States. Unfortunately, this use may expose users to misinformation. The prevalence and harms of misinformation are well documented in many health domains (e.g., infectious diseases). However, research on mental health misinformation is limited. Our review suggests that mental health misinformation is common, although its prevalence varies across disorders and treatment types. Individual differences in susceptibility to misinformation have been documented for health misinformation generally but less so for mental health specifically. We discuss conceptual issues in defining mental health misinformation versus other classifications such as overgeneralizations from personal experience. Although there is clear evidence for false and actively misleading content, future research should also explore the role of negative healthcare experiences and health disparities on mental health misinformation on social media.

You must be myths-taken: Examining belief in falsehoods during the COVID-19 health crisis

The prevalence of health myths is increasing with the rise of Internet use. Left unaddressed, online falsehoods can lead to harmful behaviours. In times of crisis, such as the recent COVID-19 pandemic, the circulation of many myths is exacerbated, often to varying degrees among different cultures. Singapore is a multicultural hub in Asia with Western and Asian influences. Although several studies have examined health myths from a Western or Eastern perspective, little research has investigated online health falsehoods in a population that is culturally exposed to both. Furthermore, most studies examined myths cross-sectionally instead of capturing trends in myth prevalence over time, particularly during crisis situations. Given these literature gaps, we investigated popular myths surrounding the recent COVID-19 pandemic within the multicultural setting of Singapore, by examining its general population. We further examined changes in myth beliefs over the two-year period during the pandemic, and population demographic differences in myth beliefs. Using randomised sampling, two online surveys of nationally representative samples of adults (aged 21-70 years) residing in Singapore were conducted, the first between October 2020 and February 2021 (N = 949), and the second between March and April 2022 (N = 1084). Results showed that 12.7% to 57.5% of the population were unable to identify various myths, such as COVID-19 was manmade, and that three of these myths persisted significantly over time (increases ranging from 3.9% to 9.8%). However, belief in myths varied across population demographics, with ethnic minorities (Indians and Malays), females, young adults and those with lower education levels being more susceptible to myths than their counterparts (p < 0.05). Our findings suggest that current debunking efforts are insufficient to effectively counter misinformation beliefs during health crises. Instead, a post-COVID-19 landscape will require targeted approaches aimed at vulnerable population sub-groups, that also focus on the erroneous beliefs with long staying power.

Counteracting sexual and reproductive health misperceptions: Investigating the roles of stigma, misinformation exposure, and information overload

OBJECTIVE

Sexual and reproductive health (SRH) misperceptions constitute a critical precursor to undesired health outcomes for women. Drawing on the model of stigma management communication and exposure effects, we aimed to investigate the underlying processes of SRH misperceptions.

METHODS

A nationwide survey was conducted via quota sampling with Chinese women (N = 1000). Structural equation modeling with maximum likelihood estimation and 5000 bootstrapping resamples were used to test the hypotheses.

RESULTS

Stigma perceptions positively predicted information avoidance (β = 0.207, p < 0.001), which, in turn, was positively associated with misperceptions (β = 0.195, p < 0.001). Misinformation exposure significantly predicted misperceptions (β = 0.607, p < 0.001), and this relationship was mediated by information avoidance (β = 0.020, 95% CI [0.007, 0.040]). Moreover, information overload strengthened the relationship between misinformation exposure and information avoidance (β = 0.153, p < 0.001) as well as the relationship between misinformation exposure and misperceptions (β = 0.077, p = 0.006).

CONCLUSION

Stigma and misinformation exposure play prominent roles in the formation of SRH misperceptions. Information overload facilitates the misinformation-misperception transformation.

PRACTICE IMPLICATIONS

To counteract SRH misperceptions, health education should alleviate SRH stigma perceptions and strategically design messages to avoid information avoidance and overload.

Canadians' knowledge of cancer risk factors and belief in cancer myths

BACKGROUND

Many untrue statements about cancer prevention and risks are circulating. The objective of this study was to assess Canadians' awareness of known cancer risk factors and cancer myths (untruths or statements that are not completely true), and to explore how awareness may vary by sociodemographic and cognitive factors.

METHODS

Cancer myths were identified by conducting scans of published, grey literature, and social media. Intuitive-analytic thinking disposition scores included were actively open- and close-minded thinking, as well as preference for intuitive and effortful thinking. A survey was administered online to participants aged 18 years and older through Prolific. Results were summarized descriptively and analyzed using chi-square tests, as well as Spearman rank and Pearson correlations.

RESULTS

Responses from 734 Canadians were received. Participants were better at identifying known cancer risk factors (70% of known risks) compared to cancer myths (49%). Bivariate analyses showed differential awareness of known cancer risk factors (p < 0.05) by population density and income, cancer myths by province, and for both by ethnicity, age, and all thinking disposition scores. Active open-minded thinking and preference for effortful thinking were associated with greater discernment. Tobacco-related risk factors were well-identified (> 90% correctly identified), but recognition of other known risk factors was poor (as low as 23% for low vegetable and fruit intake). Mythical cancer risk factors with high support were consuming additives (61%), feeling stressed (52%), and consuming artificial sweeteners (49%). High uncertainty of causation was observed for glyphosate (66% neither agreed or disagreed). For factors that reduce cancer risk, reasonable awareness was observed for HPV vaccination (60%), but there was a high prevalence in cancer myths, particularly that consuming antioxidants (65%) and organic foods (45%) are protective, and some uncertainty whether drinking red wine (41%), consuming vitamins (32%), and smoking cannabis (30%) reduces cancer risk.

CONCLUSIONS

While Canadians were able to identify tobacco-related cancer risk factors, many myths were believed and numerous risk factors were not recognized. Cancer myths can be harmful in themselves and can detract the public's attention from and action on established risk factors.

Ivermectin prescription fill rates among U.S. Military members during the coronavirus disease 2019 (COVID-19) pandemic

This report describes ivermectin prescription fill rates among U.S. active component service members (ACSM) over time during the early phases of the COVID-19 pandemic. Information about the unsubstantiated benefits of ivermectin for coronavirus 2019 (COVID-19) prevention and treatment was widely available online early in the COVID-19 pandemic. Ivermectin prescription fill rates increased among ACSM during periods of Alpha and Delta coronavirus variant predominance, but not during the predominance of the Omicron variant. At the peak of the fill rate curve, in August 2021, rates were higher among men compared to women, older compared to younger age groups, senior officers compared to junior officers, senior enlisted compared to junior enlisted service members, and those with a bachelor's or advanced degree compared to those without a bachelor's degree. Ivermectin prescriptions were more likely to have been filled at a retail pharmacy than at a military hospital or clinic. During the COVID-19 pandemic fill rates for ivermectin prescriptions among ACSM increased, including those without a qualifying diagnosis. Rates peaked in August 2021 but subsequently declined. The decrease in ivermectin fill rates was coincident with vigorous efforts to correct previous misinformation and implement pre-authorization requirements for prescriptions. Research on the impact of unproven online claims about clinical and public health interventions has potential to curtail future unnecessary and potentially harmful treatments.

Trust in information sources as a moderator of the impact of COVID-19 anxiety and exposure to information on conspiracy thinking and misinformation beliefs: a multilevel study

This study investigates the intricate relationship between exposure to information sources, trust in these sources, conspiracy and misinformation beliefs, and COVID-19 anxiety among 509 Omani citizens aged 11 to 50, representing 11 governorates. Employing structural equation modeling, we not only examine these associations but also explore how trust and COVID-19 anxiety act as moderating variables in this context. Additionally, we delve into demographic factors such as age group, educational level, gender, and place of residence (governorate) to discern potential variations.Our findings reveal that trust in health experts is inversely related to belief in conspiracy theories, while trust in health experts negatively correlates with exposure to conspiracy and misinformation. Intriguingly, trust in health experts exhibits divergent effects across governorates: it diminishes conspiracy and misinformation beliefs in some regions but not in others. Exposure to personal contacts and digital media, on the other hand, is associated with heightened beliefs in misinformation and conspiracy theories, respectively, in select governorates. These distinctions may be attributed to proximity to Muscat, the capital city of Oman, where various media outlets and policy-making institutions are situated. Furthermore, lower educational attainment is linked to greater belief in conspiracy and misinformation. Females reported higher levels of conspiracy theory beliefs and COVID-19 anxiety while no significant differences were detected in misinformation beliefs.This study sheds light on the intricate dynamics of misinformation and conspiracy theories in the context of COVID-19 in Oman, highlighting the pivotal roles of trust and COVID-19 anxiety as moderating factors. These findings offer valuable insights into understanding and addressing the spread of misinformation and conspiracy theories during a public health crisis.

Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review

BACKGROUND

Oral conditions such as gingivitis and periodontitis are correlated with adverse pregnancy outcomes such as preeclampsia, preterm birth and low birth weight. Oral health-related unfavourable beliefs can have negative influences on oral health behaviours including hesitation in accessing preventative dental treatments and dental service utilization. The objective of this systematic review was to examine unfavourable beliefs that expectant or new mothers frequently hold about oral health and the safety of dental care during pregnancy.

METHODS

An electronic database search on PubMed, Scopus, CINAHL, and MEDLINE (Ovid) followed by forward and backward citation tracing of the included studies was conducted. All English primary studies regardless of the year of publication were independently screened by two reviewers to identify studies addressing unfavourable beliefs about oral health and dental care during pregnancy. The CLARITY tool was applied to assess the risk of bias in the included studies.

RESULTS

Out of a total of 5766 records, 39 quantitative and six qualitative studies met the inclusion criteria. The commonly held unfavourable beliefs were regarding the safety of dental services utilization and dental treatment procedures, the adverse impacts of pregnancy on oral health, and oral hygiene necessity during pregnancy. The most discussed unfavourable beliefs included "pregnant women lose their teeth because of pregnancy" (n = 18), "dental treatments are not safe and harm the fetus" (n = 17), and "the developing baby absorbs calcium from the mother's teeth" (n = 14).

CONCLUSIONS

Unfavourable beliefs about oral health and dental care utilization are common among pregnant women and new mothers. The literature suggests that a low level of oral health knowledge and seeking information from social networks can contribute to such beliefs. This has implications for health promotion.

Examining the Persuasive Effects of Health Communication in Short Videos: Systematic Review

BACKGROUND

The ubiquity of short videos has demonstrated vast potential for health communication. An expansion of research has examined the persuasive effect of health communication in short videos, yet a synthesis of the research is lacking.

OBJECTIVE

This paper aims to provide an overview of the literature by examining the persuasive effect of health communication in short videos, offering guidance for researchers and practitioners. In particular, it seeks to address 4 key research questions: What are the characteristics of short videos, samples, and research designs in short video-based health communication literature? What theories underpin the short video-based health communication literature? What are the persuasive effects of health communication in short videos? and What directions should future research in this area take?

METHODS

Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 10 databases up to March 10, 2023, generated 4118 results. After the full-text screening, 18 articles met the eligibility criteria.

RESULTS

The current research lacks a uniform definition of short videos, demonstrates sample biases in location and education, and adopts limited methodologies. Most studies in this synthesis are theoretically grounded or use theoretical concepts, which are predominantly well examined in persuasion research. Moreover, relevant topics and suitable themes are effective in persuasive health communication outcomes, whereas the impact of diverse narrative techniques remains ambiguous.

CONCLUSIONS

We recommend that future research extends the definition of short videos beyond time constraints and explores non-Western and less-educated populations. In addition, researchers should consider diverse methods to provide a more comprehensive examination and investigate the impact of audience targeting and narrative techniques in short video health communication. Finally, investigating how the unique aspects of short videos interact with or challenge traditional persuasion theories is essential.

Deepfakes and scientific knowledge dissemination

Science misinformation on topics ranging from climate change to vaccines have significant public policy repercussions. Artificial intelligence-based methods of altering videos and photos (deepfakes) lower the barriers to the mass creation and dissemination of realistic, manipulated digital content. The risk of exposure to deepfakes among education stakeholders has increased as learners and educators rely on videos to obtain and share information. We field the first study to understand the vulnerabilities of education stakeholders to science deepfakes and the characteristics that moderate vulnerability. We ground our study in climate change and survey individuals from five populations spanning students, educators, and the adult public. Our sample is nationally representative of three populations. We found that 27-50% of individuals cannot distinguish authentic videos from deepfakes. All populations exhibit vulnerability to deepfakes which increases with age and trust in information sources but has a mixed relationship with political orientation. Adults and educators exhibit greater vulnerability compared to students, indicating that those providing education are especially susceptible. Vulnerability increases with exposure to potential deepfakes, suggesting that deepfakes become more pernicious without interventions. Our results suggest that focusing on the social context in which deepfakes reside is one promising strategy for combatting deepfakes.

Web-Based Health Information–Seeking Methods and Time Since Provider Engagement: Cross-sectional Study

Background

The use of web-based methods to seek health information is increasing in popularity. As web-based health information (WHI)–seeking affects health-related decision support and chronic symptom self-management, WHI-seeking from online sources may impact health care decisions and outcomes, including care-seeking decisions. Patients who are routinely connected to physicians are more likely to receive better and more consistent care. Little is known about whether WHI-seeking impacts the frequency at which patients engage with health care providers.

Objective

Our primary objective was to describe the associations between the use of web-based methods to seek information about one’s own health and the time since last engaging with a health care provider about one’s own health. Additionally, we aimed to assess participants’ trust in health care organizations to contextualize our findings.

Methods

We analyzed data from US adults participating in the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Survey (N=1034). Bivariate associations between demographic characteristics and health information–seeking methods were assessed with Pearson chi-squared tests. Bivariate associations of Medical Mistrust Index (MMI) scores with each health information–seeking method and time since provider engagement were assessed with F tests and adjusted Wald tests. We fit a multivariable logistic regression model to assess the association between WHI-seeking within the 12 months prior to survey (alone or in combination with provider-based methods versus provider only) and engagement with a provider more than 1 year prior to the time of survey, adjusting for age, race and ethnicity, sex, education, insurance coverage, and MMI.

Results

Age, race and ethnicity, educational attainment, health insurance source, MMI, and time since provider engagement were each significantly associated with the health information–seeking method in bivariate analyses. Compared to using only provider-based health information seeking methods, WHI-based methods alone or in combination with provider-based methods were associated with a 51% lower likelihood (odds ratio 0.49, 95% CI 0.27-0.87) of engaging with a provider within the previous year. Participants who used WHI-seeking methods alone and those who had not engaged with a health care provider within the previous year demonstrated a higher mean MMI score; however, MMI was not a significant predictor of time since engagement with a provider in the multivariable analysis.

Conclusions

Our findings from a nationally representative survey suggest that for those who use WHI-seeking methods (alone or in combination with provider-based information-seeking methods), there is a statistically significant lower likelihood of engaging with a provider in a year compared to those who only use provider-based methods. Future research should consider the intent of a person’s visit with a provider, trust in health care systems, methods of provider engagement, and specific web-based platforms for health information.

How Health-Related Misinformation Spreads Across the Internet: Evidence for the "Typhoon Eye" Effect

Online health-related misinformation has become a major problem in society and in-depth research is needed to understand its propagation patterns and underlying mechanisms. This study proposes a psychological typhoon eye effect to understand how health-related misinformation spreads during the pandemic using two national studies. In Study 1, we collected online search data from the United States and China to explore the relationship between the physical distance from the epicenter and the spread of health-related misinformation. Two common pieces of health-related misinformation were examined: "Microwaves kill coronavirus" in the United States and "Taking a hot bath can prevent against COVID-19" in China. Our results indicated a "typhoon eye effect" in the spread of two actual pieces of health-related misinformation using online data from the United States and China. In Study 2, we fabricated a piece of health-related misinformation, "Wash Clothes with Salt Water to Block Infection," and measured the spread behavior and perceived credibility of the misinformation. Again, we observed a typhoon eye effect on the spread behavior as well as the perceived credibility of health-related misinformation among people with limited education. In addition, based on the stimulus-organism-response theory, perceived credibility could serve as a mediator in the relationship between physical distance from the epicenter and the spread of health-related misinformation. Our results highlight the importance of psychological approaches to understanding the propagation patterns of health-related misinformation. The present findings provide a new perspective for development of prevention and control strategies to reduce the spread of health-related misinformation during pandemics.

Motivational Influences Affecting Middle-Aged and Elderly Users' Participation Intention in Health-Related Social Media

Social media provide users with multi-directional dialogue for creating and sharing health information that can effectively promote the self-management of health. In regard to the 'greying' trend in social media, most researchers have studied the health-related social media (HRSM) acceptance status and use behavior of middle-aged and elderly people, and have explored the role of HRSM in this group. However, the continuous participation of users is the key to the successful operation of HRSM, and is an essential prerequisite for the subsequent HRSM behavior habits of middle-aged and elderly people. Therefore, we aimed to explore what motivations drive the first use of HRSM among middle-aged and older adults, and the impact of their perception of HRSM, after personal use, on their intention to use it continually. In the study, we used the partial least squares structural equation model (PLS-SEM) to analyze data collected from online questionnaires. The results showed that a self-protection motivation and a social motivation promoted the initial participation of middle-aged and elderly individuals. In addition, these people experienced deeper levels of perceived usefulness and perceived entertainment after their initial participation. The results also revealed that these two perceptions could positively influence middle-aged and elderly individuals' intention to continue with their participation. Our findings should help service platforms to better understand the needs of middle-aged and elderly users. This would help researchers and practitioners to gain a more complete understanding of the motivation of middle-aged and elderly people for participating in HRSM, and the related impacts this may have.

Public Engagement with Biotechnology Inside and Outside the Classroom: Community-Focused Approaches

Biotechnology offers vast benefits to the environment, animals, and human health, and contributes to improving socioeconomic conditions for the public. However, biotechnology innovations continue to trigger public concern and opposition over their potential social, health, and ecological risks. There is an opportunity to increase knowledge and acceptance of biotechnology through engagement, education, and community participation. In this perspective, we highlight crucial factors that shape the public perception of biotechnology and present opportunities for scientists to effectively communicate their ideas while engaging with local and global communities. Initiatives that seek to involve communities in design, development, and adoption processes are crucial for the successful implementation of biotechnology-based solutions.

Narrative elaboration makes misinformation and corrective information regarding COVID-19 more believable

OBJECTIVE

People gather information about health topics from online channels oftentimes awash with misinformation. Investigating this problem during the COVID-19 pandemic is important, as the misinformation effect occurs when misleading details are embedded in narratives and questions. This pilot study investigated whether narrative elaboration increases believability in misinformation statements about COVID-19, and willingness to share these statements online.

RESULTS

Results from our online survey (n = 80) demonstrated that narrative elaboration increased believability in both misinformation and accurate statements, with a more pronounced effect on younger adults. Future research may investigate cognitive vulnerabilities imposed by elaborate narratives embedded in online health misinformation with increased attention on developing misinformation resilience among younger adults.

Consumer Attitudes towards Food Preservation Methods

The development and scope of using various food preservation methods depends on the level of consumers’ acceptance. Despite their advantages, in the case of negative attitudes, producers may limit their use if it determines the level of sales. The aim of this study was to evaluate the perception of seven different food processing methods and to identify influencing factors, such as education as well as living area and, at the same time, to consider whether consumers verify this type of information on the labels. Additionally, the study included the possibility of influencing consumer attitudes by using alternative names for preservation methods, on the example of microwave treatment. The results showed that conventional heat treatments were the most preferred preservation methods, whereas preservatives, irradiation, radio waves and microwaves were the least favored, suggesting that consumers dislike methods connected with “waves” to a similar extent as their dislike for preservatives. The control factors proved to significantly modify the evaluation of the methods. The analysis of alternative names for microwave treatment showed that “dielectric heating” was significantly better perceived. These research findings are important as the basis for understanding consumer attitudes. Implications for business and directions of future research are also indicated.

Dynamics of social corrections to peers sharing COVID-19 misinformation on WhatsApp in Brazil

OBJECTIVE

Online COVID-19 misinformation is a serious concern in Brazil, home to the second-largest WhatsApp user base and the second-highest number of COVID-19 deaths. We examined the extent to which WhatsApp users might be willing to correct their peers who might share COVID-19 misinformation.

MATERIALS AND METHODS

We conducted a cross-sectional online survey using Qualtrics among 726 Brazilian adults to identify the types of social correction behaviors (SCBs) and health and technological factors that shape the performance of these behaviors.

RESULTS

Brazil's WhatsApp users expressed medium to high levels of willingness to engage in SCBs. We discovered 3 modes of SCBs: correction to the group, correction to the sender only, and passive or no correction. WhatsApp users with lower levels of educational attainment and from younger age groups were less inclined to provide corrections. Lastly, the perceived severity of COVID-19 and the ability to critically evaluate a message were positively associated with providing corrections to either the group or the sender.

DISCUSSION

The demographic analyses point to the need to strengthen information literacy among population groups that are younger with lower levels of educational attainment. These efforts could facilitate individual-level contributions to the global fight against misinformation by the World Health Organization in collaboration with member states, social media companies, and civil society.

CONCLUSION

Our study suggests that Brazil's WhatsApp users might be willing to actively respond with feedback when exposed to COVID-19 misinformation by their peers on small-world networks like WhatsApp groups.

Predictors of COVID-19 Vaccine Acceptance and Hesitancy among Healthcare Workers in Southern California: Not Just "Anti" vs. "Pro" Vaccine

In this study, we evaluated the status of and attitudes toward COVID-19 vaccination of healthcare workers in two major hospital systems (academic and private) in Southern California. Responses were collected via an anonymous and voluntary survey from a total of 2491 participants, including nurses, physicians, other allied health professionals, and administrators. Among the 2491 participants that had been offered the vaccine at the time of the study, 2103 (84%) were vaccinated. The bulk of the participants were middle-aged college-educated White (73%), non-Hispanic women (77%), and nursing was the most represented medical occupation (35%). Political affiliation, education level, and income were shown to be significant factors associated with vaccination status. Our data suggest that the current allocation of healthcare workers into dichotomous groups such as "anti-vaccine vs. pro-vaccine" may be inadequate in accurately tailoring vaccine uptake interventions. We found that healthcare workers that have yet to receive the COVID-19 vaccine likely belong to one of four categories: the misinformed, the undecided, the uninformed, or the unconcerned. This diversity in vaccine hesitancy among healthcare workers highlights the importance of targeted intervention to increase vaccine confidence. Regardless of governmental vaccine mandates, addressing the root causes contributing to vaccine hesitancy continues to be of utmost importance.

Text Analysis Methods for Misinformation–Related Research on Finnish Language Twitter

The dissemination of disinformation and fabricated content on social media is growing. Yet little is known of what the functional Twitter data analysis methods are for languages (such as Finnish) that include word formation with endings and word stems together with derivation and compounding. Furthermore, there is a need to understand which themes linked with misinformation—and the concepts related to it—manifest in different countries and language areas in Twitter discourse. To address this issue, this study explores misinformation and its related concepts: disinformation, fake news, and propaganda in Finnish language tweets. We utilized (1) word cloud clustering, (2) topic modeling, and (3) word count analysis and clustering to detect and analyze misinformation-related concepts and themes connected to those concepts in Finnish language Twitter discussions. Our results are two-fold: (1) those concerning the functional data analysis methods and (2) those about the themes connected in discourse to the misinformation-related concepts. We noticed that each utilized method individually has critical limitations, especially all the automated analysis methods processing for the Finnish language, yet when combined they bring value to the analysis. Moreover, we discovered that politics, both internal and external, are prominent in the Twitter discussions in connection with misinformation and its related concepts of disinformation, fake news, and propaganda.

The Impact of COVID-19 Pandemic on Searching for Health-Related Information and Cyberchondria on the General Population in Italy

Objectives: The Internet has become one of the most common sources people use to search for health-related information, a behavior rapidly increased during the novel Coronavirus disease 2019 (COVID-19). The present study aimed to investigate behavioral patterns in the online health-related searches and Cyberchondria (CYB) during the COVID-19 pandemic time, in order to explore socio-demographic and psychopathological factors related to CYB. Methods: During the third wave of the COVID-19 pandemic in Italy, a cross-sectional online survey collected the main socio-demographic variables and habits related to Internet use of 572 participants. CYB was measured by the Cyberchondria Severity Scale-Short Version and different psychopathological factors were measured by specific questionnaires: the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale, the Short Health Anxiety Inventory, the Meta-Cognitions about Health Questionnaire, the Internet Addiction Test, the Maudsley Obsessional-Compulsive Questionnaire-Short Version, the Rosenberg's Self-Esteem Scale, and the WHO Quality of Life-BREF. Descriptives, non-parametric ANOVAs, and Spearman correlations were performed. Results: In the present sample, the Internet was the main source participants used to search for health-related information and nearly one-third increased this habit during the pandemic. Higher expression of CYB emerged in females, in younger participants, in students, and in those suffering from a physical/psychiatric illness. CYB showed a positive correlation with different phenomenology of anxiety (i.e., anxiety about COVID-19, health anxiety, general anxiety, metacognitive believes about anxiety) and with depression, obsessive-compulsive symptoms, and problematic usage of the Internet. Conversely, quality of life and self-esteem showed a negative correlation with CYB. Conclusion: During the COVID-19 pandemic, the use of the Internet for health-related information and CYB contribute to the psychological stress affecting individuals and society. Delineating subjects more vulnerable to CYB and associated psychopathological factors will help to elaborate operational indications for prevention and psychological support.