Misleading Health Research Articles

Helpful or harmful? Navigating the impact of social media influencers’ health advice: insights from health expert content creators

BackgroundWith the growing role of social media influencers (SMIs) in providing health advice, concerns arise regarding the usefulness and reliability of online health information. This exploratory research focuses on health expert content creators (HECCs), who offer a unique perspective due to their combined medical knowledge and social media expertise.MethodsWe conducted semi-structured in-depth qualitative interviews with HECCs to explore their views on SMI-driven health communication, their motivations for participating on social media, and the strategies they employ to counteract misleading health messages on the platforms. The study employed thematic qualitative text analysis to identify key themes and patterns.ResultsHECCs highlighted the complex role of SMIs in public health, acknowledging their potential to promote positive health behaviors while also noting the risks associated with the spread of inaccurate or oversimplified health messages. The findings emphasize the urgent need to broaden health communication research to address not only misinformation but also overgeneralized health messaging, which can be equally detrimental.ConclusionsThe findings underscore the importance of expanding health communication research to address both misinformation and overgeneralized health messaging. Practical recommendations are provided to mitigate the spread of misleading health information by SMIs, informed by the experiences and strategies of HECCs.

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

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. 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. 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. 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. 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.

Using artificial intelligence (AI) to assess the prevalence of false or misleading health-related claims.

Complementary healthcare in the United Kingdom is subject to voluntary, publicly funded regulation. Many such practices include pseudoscience. There are concerns that regulated practitioners make misleading health claims. This study used an artificial intelligence (AI) tool to measure the prevalence of such claims. Websites operated by practitioners of pseudoscientific complementary and alternative medicine, registered with the Complementary and Natural Healthcare Council, were downloaded and assessed by the AI, which determined whether a website was relevant to the investigation and, if so, identified health-related claims that it judged as false or misleading, supplying a rationale. Of 6096 registrants, 1326 met the selection criteria, of which 872 clinics had 725 relevant and operational websites. The AI assessed text from 11 771 web pages, identifying false or misleading claims in 704 (97%) of the websites. The AI's performance was quality-assured by four human assessors, who manually reviewed 23 relevant web pages. Humans identified on average 39.5 claims likely to be judged false or misleading by advertising regulators, the AI identified 36. Humans misidentified an average of 4.8 claims, AI misidentified two. Most practitioners of pseudoscientific therapies registered with the Complementary and Natural Healthcare Council make misleading health claims online. AI could support regulator efficiency.

Cannabinoid Content and Label Accuracy of Various Hemp-Derived Haircare, Cosmetic, and Edible Products Available at Retail Stores and Online in the United States.

Aim: To evaluate the label accuracy and content of various hemp-derived cannabidiol (CBD) products (cannabinoid products with ≤0.3% Δ9-tetrahydrocannabinol [THC]), as well as evaluate advertised claims on product labels. Methods: Hemp haircare, cosmetics, and food/drink products that were advertised to contain CBD were purchased from retail stores in the Baltimore, Maryland area (purchased in July 2020) and online (purchased in August 2020). Cannabinoid concentrations were measured using gas chromatography-mass spectrometry. Percent deviations between labeled and actual CBD concentrations were determined. Label information such as references to the Food and Drug Administration (FDA), external testing claims, and other claims (i.e., cosmetic or beauty, therapeutic, health halo effect, or "other") were quantified. Results: Ninety-seven products were purchased (35 in-store, 62 online). Of the 71 products with a specific total CBD amount on the label, 35 (49%) were underlabeled (>10% more CBD than advertised), 27 (38%) were overlabeled (>10% less CBD than advertised), and 9 (12.7%) were accurately labeled (within ±10% of labeled CBD). The median (range) percentage deviations were -53% (-100%-76%) for haircare products, +18% (-100%-1076%) for cosmetics, and -1% (-100%-4468%) for food/drinks. CBD label accuracy did not differ significantly between products with external testing claims versus those without (t40 = 0.23, p = 0.82). Overall, 24% of the 97 (total) products made a cosmetic or beauty claim (e.g., "skin looks more youthful"), 40% made a therapeutic claim (e.g., "pain relief"), and 86% made a health halo effect claim (e.g., "paraben-free," "dye-free," etc.). Most products (63%) did not include a disclaimer that claims had not been evaluated by the FDA. Conclusions: Most of the products included in this sample were inaccurately labeled for CBD content, including those claiming to have been tested by third party laboratories. A notable finding was that 10 products did not contain any CBD. Many products made therapeutic claims or used marketing tactics to seemingly convey they were safe/healthy, but only about one-third included disclaimers that these statements had not been evaluated by the FDA. These findings highlight the need for proper regulatory oversight of cannabinoid-containing products to ensure quality assurance and deter misleading or unfounded health claims in product marketing.

Why Do Only Some Cohort Studies Find Health Benefits From Low-Volume Alcohol Use? A Systematic Review and Meta-Analysis of Study Characteristics That May Bias Mortality Risk Estimates.

Assumptions about alcohol's health benefits profoundly influence global disease burden estimates and drinking guidelines. Using theory and evidence, we identify and test study characteristics that may bias estimates of all-cause mortality risk associated with low-volume drinking. We identified 107 longitudinal studies by systematic review with 724 estimates of the association between alcohol consumption and all-cause mortality for 4,838,825 participants with 425,564 recorded deaths. "Higher-quality" studies had a mean cohort age of 55 years or younger, followed up beyond 55 years, and excluded former and occasional drinkers from abstainer reference groups. "Low-volume" alcohol use was defined as between one drink per week (>1.30 g ethanol/day) and two drinks per day (<25 g ethanol/ day). Mixed linear regression was used to model relative risks (RRs) of mortality for subgroups of higher- versus lower-quality studies. As predicted, studies with younger cohorts and separating former and occasional drinkers from abstainers estimated similar mortality risk for low-volume drinkers (RR = 0.98, 95% CI [0.87, 1.11]) as abstainers. Studies not meeting these quality criteria estimated significantly lower risk for low-volume drinkers (RR = 0.84, [0.79, 0.89]). In exploratory analyses, studies controlling for smoking and/or socioeconomic status had significantly reduced mortality risks for low-volume drinkers. However, mean RR estimates for low-volume drinkers in nonsmoking cohorts were above 1.0 (RR = 1.16, [0.91, 1.41]). Studies with lifetime selection biases may create misleading positive health associations. These biases pervade the field of alcohol epidemiology and can confuse communications about health risks. Future research should investigate whether smoking status mediates, moderates, or confounds alcohol-mortality risk relationships.

Quitting Smoking With … Smoke? Unauthorized Claims Used by Herbal Cigarette Manufacturers.

Herbal cigarettes are made with non-tobacco plant materials (eg, tea leaves, hemp), are typically sold pre-rolled in packs and with filters, and are combusted and smoked like tobacco cigarettes. Herbal cigarette manufacturers have a history of making misleading health claims and at least one company has previously settled with the U.S. Federal Trade Commission over deceptive advertising. This study examined current claims and product characteristics of herbal cigarettes sold by a popular online retailer. We searched Amazon.com for "herbal cigarettes" and "hemp cigarettes" and identified all herbal cigarette products sold on the first page of search results (n = 51). Two coders independently content analyzed each product's Amazon page for claims (eg, smoking cessation, health), product characteristics (eg, flavors), and presence of disclaimers and warnings. Overall, 78.4% of product pages made smoking cessation claims (eg, "A more scientific way to quit smoking," "…decreases nicotine craving symptom and helps to quit tobacco smoking"). Further, 45.1% of product pages included claims describing lower risk/exposure compared to tobacco products (eg, "…without the addictive nicotine and toxic chemicals found in tobacco cigarettes"). Some herbal products were available in multiple flavors, including menthol (21.6%) and fruit (17.7%). Only 35.3% of products included visible health warnings on product packaging. Many herbal cigarette products sold on Amazon.com make unauthorized cessation and health claims. Regulatory agencies must act decisively to stop the misleading advertising of these products and develop appropriate warnings to educate the public about the potential harms. This content analysis documents the use of unauthorized and misleading claims made in the marketing of herbal cigarettes. These findings highlight the need for enforcement of existing federal regulations, which prohibit deceptive advertising. Research is needed to inform the development of appropriate warning labels that can be used to inform consumers of the potential harms of smoking herbal cigarettes.

Perceptions of Health Misinformation on Social Media: Cross-Sectional Survey Study.

Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public's experience with health misinformation on social media. The goal of this analysis was to examine perceptions of the social media information environment and identify associations between health misinformation perceptions and health communication behaviors among US adults. Analyses used data from the 2022 Health Information National Trends Survey (N=6252). Weighted unadjusted proportions described respondents' perceptions of the amount of false or misleading health information on social media ("perceived misinformation amount") and how difficult it is to discern true from false information on social media ("perceived discernment difficulty"). Weighted multivariable logistic regressions examined (1) associations of sociodemographic characteristics and subjective literacy measures with misinformation perceptions and (2) relationships between misinformation perceptions and health communication behaviors (ie, sharing personal or general health information on social media and using social media information in health decisions or in discussions with health care providers). Over one-third of social media users (35.61%) perceived high levels of health misinformation, and approximately two-thirds (66.56%) reported high perceived discernment difficulty. Odds of perceiving high amounts of misinformation were lower among non-Hispanic Black/African American (adjusted odds ratio [aOR] 0.407, 95% CI 0.282-0.587) and Hispanic (aOR 0.610, 95% CI 0.449-0.831) individuals compared to White individuals. Those with lower subjective health literacy were less likely to report high perceived misinformation amount (aOR 0.602, 95% CI 0.374-0.970), whereas those with lower subjective digital literacy were more likely to report high perceived misinformation amount (aOR 1.775, 95% CI 1.400-2.251). Compared to White individuals, Hispanic individuals had lower odds of reporting high discernment difficulty (aOR 0.620, 95% CI 0.462-0.831). Those with lower subjective digital literacy (aOR 1.873, 95% CI 1.478-2.374) or numeracy (aOR 1.465, 95% CI 1.047-2.049) were more likely to report high discernment difficulty. High perceived misinformation amount was associated with lower odds of sharing general health information on social media (aOR 0.742, 95% CI 0.568-0.968), using social media information to make health decisions (aOR 0.273, 95% CI 0.156-0.479), and using social media information in discussions with health care providers (aOR 0.460, 95% CI 0.323-0.655). High perceived discernment difficulty was associated with higher odds of using social media information in health decisions (aOR 1.724, 95% CI 1.208-2.460) and health care provider discussions (aOR 1.389, 95% CI 1.035-1.864). Perceptions of high health misinformation prevalence and discernment difficulty are widespread among social media users, and each has unique associations with sociodemographic characteristics, literacy, and health communication behaviors. These insights can help inform future health communication interventions.

Road To Deceased Donor Transplantation in Egypt.

In Egypt, there is presently a growing need to have a deceased donor transplant program. Egypt conducted its first kidney transplant from a living donor in 1976 and a first partial liver transplant in 2001. Since 2009, the Egyptian Health Authorities Combat Transplant Tourism in concordance with ethics codes and the Declaration of Istanbul Custodian Group has been in place. The Egyptian Transplantation Law of 2011 mentions that organs could be procured from deceased donors based on a will and on family consent. This law has had many critics, including religious authorities who have stressed that organs cannot be taken from a person with brain death because, in their view, life ends with death of all organs. Many intensivists disagree over the definition of death. In addition, the media has communicated contradicting and sometimes misleading health care information. Mummification is rooted in pharos practice and linked to religious beliefs. The ancient Egyptians believed that, by burying the deceased with their organs, they may rejoin with them in the afterlife. Since 2019, the transplant community in Egypt has started collaborations with international transplant organizations and campaigns with doctors and celebrities to donate their organs after death, which have stressed that a deceased donor program could help against end-stage organ mortality. In November 2022, after communications with politicians, President Abdelfattah El Sisi directed the government to establish a regional center for organ transplantation, which aimed to be the biggest in the Middle East and North Africa region. The new center will be part of a new medical city that would replace Nasser Medical Institution in Cairo, Egypt. The Ministry of Health issued an official form to be signed by a person before his death, accepting use of organs, to give hope and support to other patients in need.

Pedagogy and Propaganda in the Post-Truth Era: Examining Effective Approaches to Teaching About Mis/DisInformation

The rapid dissemination of information through various media platforms has significantly transformed the landscape of health communication and public health. The COVID-19 pandemic underscored how health faculty and practitioners face an increasing challenge in navigating the complex terrain of mis/disinformation that permeates the online world. The proliferation of false or misleading health information poses a significant threat to public health, eroding trust in evidence-based practices and potentially leading to adverse health outcomes. In this post-truth era, it is crucial to equip students and those working in health occupations with the knowledge and skills that enhance their media literacy and ability to discern credible from suspect information. However, we must go further to help students critically examine mis/disinformation from an ecological perspective to understand the historical and socio-political factors that lead to its spread and their vulnerability to it. In this paper, we offer a rationale for focusing on pedagogy to prevent and to mitigate the spread of mis/disinformation in health promotion, and we provide examples of evidence-based approaches for doing so. Additionally, we offer resources to support teaching and learning in this area and identify opportunities for future research.

Analysis of social media compliance with cannabis advertising regulations: evidence from recreational dispensaries in Illinois 1-year post-legalization

BackgroundIn the USA, an increasing number of states have legalized commercial recreational cannabis markets, allowing a private industry to sell cannabis to those 21 and older at retail locations known as dispensaries. Research on tobacco and alcohol suggests this new industry will use aggressive marketing tactics to attract new users and promote greater intensity of use. Of concern is that cannabis company advertising campaigns may be appealing to youth, promote false or misleading health claims, and disproportionately target low-income and minority communities. In this study, we evaluated recreational cannabis dispensary compliance with advertising regulations on social media in the state of Illinois.MethodsPrimary data were collected from a census of recreational dispensary Facebook and Twitter business pages during the first year of recreational sales in 2020. A quantitative content analysis was conducted to systematically analyze the data; a codebook that detailed a protocol for classifying posts was developed prior to the analysis using advertising regulations outlined in the Illinois Cannabis Regulation and Tax Act. Violations of advertising regulations were organized into three categories: advertisements that may be appealing to youth (< 21 years old), advertisements that make health claims, and other advertising violations. The data were analyzed cross-sectionally and longitudinally. Additionally, differences in compliance were assessed by dispensary and neighborhood characteristics.ResultsThe results of the analysis revealed substantial and persistent non-compliance throughout the entire study period. Overall, nearly one third of posts had at least one violation and approximately one in ten posts met the criteria for appealing to youth or contained health claims. The majority of posts with health claims included health claims that were not qualifying conditions for medical cannabis access in the state of Illinois. No differences in compliance by neighborhood and dispensary characteristics were found.ConclusionsThe findings from this study suggest that systematic monitoring and enforcement is needed to ensure compliance with advertising regulations.

An Elicitation Study to Understand Young Adults' Beliefs About Seeking Health Information From Social Media Influencers.

Social media influencers increasingly make health recommendations on social media. Research on influencer health messaging is mixed in that some studies show it can result in misleading or harmful health information, and others demonstrate it can lead to beneficial behavioral outcomes. However, there is little research on young adults' beliefs about following health guidance from influencers. Guided by the reasoned action approach, this study examined young adults' attitudes, normative beliefs, and control in seeking health information from social media influencers using focus groups (n = 31). Results suggest that young adults obtain health information from influencers and perceive them as a source of health education. Several barriers to getting health information from influencers were mentioned, including sponsorship, lack of credibility, and perceived normative pressure to critically analyze influencer content from peers and family. Practical and theoretical implications for future research are discussed.

Cautionary Considerations for The Role of Artificial Intelligence in Healthcare

Dear Editor Artificial Intelligence (AI) has the potential to revolutionize healthcare by making it more accessible and adaptive. The use of AI technologies, including large language model tools (LLMs), offers exciting possibilities for improving health outcomes and supporting healthcare professionals, patients, researchers, and scientists. However, it is crucial to approach the integration of AI in healthcare with caution, taking into consideration the lessons learned and potential risks highlighted by experts. One of the key considerations raised in the field of AI in healthcare is the potential for biased data used to train AI systems. Biased data can lead to the generation of misleading or inaccurate health information, exacerbating existing disparities and hindering equitable access to care. To mitigate this, it is important to ensure that AI systems are trained on diverse and representative datasets, reducing biases and promoting inclusiveness and equity (1). Ensuring the reliability and accuracy of AI-generated responses, particularly in LLMs, is another critical aspect that requires attention. Although LLMs can produce responses that appear authoritative and plausible, there is a risk of these responses being completely incorrect or containing serious errors, especially in the context of health-related information. Rigorous evaluation, expert supervision, and transparent quality assurance mechanisms are necessary to ensure the reliability of AI-generated insights and prevent potential harm to patients (2,3) The protection of sensitive health data and the preservation of patient privacy are paramount in the development and deployment of AI technologies. It is crucial to establish robust consent procedures, implement secure data storage practices, and prioritize data protection measures. Striking the right balance between data accessibility and privacy protection is essential to maintain public trust and ensure the responsible use of AI in healthcare (4,5). Furthermore, the potential misuse of AI technologies, including LLMs, for the dissemination of health-related disinformation poses a significant concern. Highly convincing false health information generated by AI systems can be difficult for the public to differentiate from reliable sources. Proactive measures, such as regulation and monitoring, are necessary to prevent the spread of health-related disinformation, preserve public trust, and uphold the integrity of healthcare systems (6,7). In harnessing the potential of AI to improve human health, it is imperative for policy-makers, healthcare professionals, and technology firms to prioritize patient safety, protection, and well-being. Ethical principles, transparency, accountability, inclusiveness, and responsible governance should underpin the design, development, and deployment of AI technologies in healthcare. While AI holds immense promise in transforming healthcare, it is essential to approach its implementation with caution. By learning from the challenges and risks highlighted by experts, and by adhering to ethical principles and responsible practices, we can maximize the benefits of AI while minimizing potential adversities. This will not only ensure the well-being of individuals but also contribute to the advancement of healthcare for all. Keywords: artificial intelligence, technology, healthcare

Social media users' perceptions about health mis- and disinformation on social media.

This study used recently released nationally representative data with new measures on health information seeking to estimate the prevalence and predictors of adult social media users' perceptions of health mis- and disinformation on social media. Most adults who use social media perceive some (46%) or a lot (36%) of false or misleading health information on social media, but nearly one-fifth reported either none or a little (18%). More than two-thirds of participants reported that they were unable to assess social media information as true or false (67%). Our study identified certain population groups that might be a focus of future intervention work, such as participants who use social media to make decisions. The perception by social media users that false and misleading health information on social media is highly prevalent may lend greater urgency to mitigate the spread of false or misleading health information that harms public health.

Navigating the EU Health Claim Regulation

Abstract The Health Claim Regulation (HCR) is the legal framework used by food businesses to highlight the benefits of their food products on labels or in promotional communications in the European Union (EU). The rules aim to ensure consumer protection from misleading health claims and to promote fair competition, the free circulation of foods bearing health claims and innovation. There are different authorisation procedures managed by the European Commission (EC) for distinct types of claims and considerable guidance is available both on the presentation of the dossier and the scientific aspects of substantiation of the health claim. While thousands of health claims have been submitted by applicants, only a small percentage have been authorised and the rate of submission has slowed dramatically from the early years of the HCR’s introduction. Nevertheless, applicants have been successful and health claims have been authorised in each health claim type. More recently, the introduction of the Transparency Regulation has impacted the submission process in significant ways, and it remains to be seen if this change will encourage or deter applicants from submitting. While the HCR has been in place for 16 years, there are still many outstanding items, such as nutrition profiling and “on hold” claims that affect businesses. In addition, authorities often take different views on the flexibility that can be applied to authorised health claim wording. This makes implementation of authorised health claims across the EU often complex for businesses to manage. However, despite these issues, the HCR has made strides to protect consumers from misleading claims and provided a robust framework for the scientific evaluation of health claims which is highly regarded worldwide. Information © The Author 2023

How Physicians Tackle Internet-Misinformed Patients: Going Beyond Traditional Patient-Centered Communication - A Study Protocol.

The proliferation of misleading and irrelevant health information on the Internet has become a significant public concern. Inappropriate use of online materials can cause harm to patients' health and quality of life. While close attention has been paid to health campaigns and education programs that aim to disseminate accurate health knowledge, the role of physicians, who directly communicate with patients in medical encounters and provide personalized information, has been overlooked. Therefore, this study focuses on physicians and their communication strategies with internet-misinformed patients (IMPs). This study aims to understand the communicative strategies physicians use to tackle IMPs and explore connections between physicians' communicative strategies and patient-centered communication. Approximately 10 to 15 physicians from diverse cultural backgrounds, including Ticino (an Italian-speaking region in Switzerland), Milan and China will be interviewed. Interviews will be conducted in-person or online through video conferencing software programs. Physicians will be asked about their experiences with IMPs, communicative strategies for addressing patients' misconceptions, balancing patient preferences, decision-making obstacles, and envisioning an ideal relationship with them. A thematic analysis will be utilized to analyze data, employing a general inductive approach. The results will provide valuable insights into effective clinical communication strategies that address patients' misuse of internet materials and inform policymakers and healthcare providers about the limitations and applicability of patient-centered communication in the current digital era.

Fighting the infodemic: the 4 i Framework for Advancing Communication and Trust

BackgroundThe proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.MethodsA multi-pronged search strategy was used to identify tools and approaches for combatting health-related misinformation and disinformation. The search strategy included a scoping review of academic literature; a review of gray literature from organizations involved in public health communications and misinformation/disinformation management; and a review of policies and infodemic management approaches from all U.S. state health departments and select local health departments. A team of annotators labelled the main feature(s) of each tool or approach using an iteratively developed list of tags.ResultsWe identified over 350 infodemic management tools and approaches. We introduce the 4 i Framework for Advancing Communication and Trust (4 i FACT), a modified social-ecological model, to characterize different levels of infodemic intervention: informational, individual, interpersonal, and institutional. Information-level strategies included those designed to amplify factual information, fill information voids, debunk false information, track circulating information, and verify, detect, or rate the credibility of information. Individual-level strategies included those designed to enhance information literacy and prebunking/inoculation tools. Strategies at the interpersonal/community level included resources for public health communicators and community engagement approaches. Institutional and structural approaches included resources for journalists and fact checkers, tools for managing academic/scientific literature, resources for infodemic researchers/research, resources for infodemic managers, social media regulation, and policy/legislation.ConclusionsThe 4 i FACT provides a useful way to characterize the current ecosystem of infodemic management strategies. Recognizing the complex and multifaceted nature of the ongoing infodemic, efforts should be taken to utilize and integrate strategies across all four levels of the modified social-ecological model.

Development and Evaluation of a Serious Game Application to Engage University Students in Critical Thinking About Health Claims: Mixed Methods Study.

Misleading health claims are widespread in the media, and making choices based on such claims can negatively affect health. Thus, developing effective learning resources to enable people to think critically about health claims is of great value. Serious games can become an effective learning resource in this respect, as they can affect motivation and learning. This study aims to document how user insights and input can inform the concept and development of a serious game application in critical thinking about health claims in addition to gathering user experiences with the game application. This was a mixed methods study in 4 successive phases with both qualitative and quantitative data collected in the period from 2020-2022. Qualitative data on design and development were obtained from 4 unrecorded discussions, and qualitative evaluation data were obtained from 1 recorded focus group interview and 3 open-ended questions in the game application. The quantitative data originate from user statistics. The qualitative data were analyzed thematically, and user data were analyzed using nonparametric tests. The first unrecorded discussion revealed that the students' (3 participants') assessment of whether a claim was reliable or not was limited to performing Google searches when faced with an ad for a health intervention. On the basis of the acquired knowledge of the target group, the game's prerequisites, and the technical possibilities, a pilot of the game was created and reviewed question by question in 3 unrecorded discussions (6 participants). After adjustments, the game was advertised at the Oslo Metropolitan University, and 193 students tested the game. A correlation (r=0.77; P<.001) was found between the number of replays and total points achieved in the game. There was no demonstrable difference (P=.07) between the total scores of students from different faculties. Overall, 36.3% (70/193) of the students answered the evaluation questions in the game. They used words such as "fun" and "educational" about the experiences with the game, and words such as "motivating" and "engaging" related to the learning experience. The design was described as "varied" and "user-friendly." Suggested improvements include adding references, more games and modules, more difficult questions, and an introductory text explaining the game. The results from the focus group interview (4 participants) corresponded to a large extent with the results of the open-ended questions in the game. We found that user insights and inputs can be successfully used in the concept and development of a serious game that aims to engage students to think critically about health claims. The mixed methods evaluation revealed that the users experienced the game as educational and fun. Future research may focus on assessing the effect of the serious game on learning outcomes and health choices in randomized trials.

How Should State Licensing and Credentialing Boards Respond When Government Clinicians Spread False or Misleading Health Information?

The spread of health misinformation by health care professionals who also hold government positions represents a long-standing problem that intensified during the COVID-19 pandemic. This article describes this problem and considers legal and other response strategies. State licensing and credentialing boards must use their authorities to discipline clinicians who spread misinformation and to reinforce the nature and scope of professional and ethical obligations of government and nongovernment clinicians. Individual clinicians must also play an important role by actively and vigorously correcting misinformation disseminated by other clinicians.

Consumer Protection Against Processed Food Advertisements with Misleading Health Claims

This research will answer the role of the Food and Drug Supervisory Agency (BPOM) towards Indonesian citizens as consumers in supervising processed food advertisements with misleading health claims, as well as the responsibility of business actors to consumers in Indonesia as the party that is harmed by business actors' promotional activities in the form of advertisements. which is misleading. This research was conducted using normative methods. The results of the study show that business actors must be responsible for misleading advertisements produced by business actors, as well as for processed food advertisements with health claims, a regulation is required that requires advertising materials to be registered through the Ad Registration System (SIREKA) page which is managed and approved by BPOM as product category of drugs and health supplements. Processed food advertising rules for carrying out the registration can provide certainty to consumers to find out the truth of claims about food product advertisements in circulation.&#x0D; &#x0D;

Cross-sectional multimedia audit reveals a multinational commercial milk formula industry circumventing the Philippine Milk Code with misinformation, manipulation, and cross-promotion campaigns.

The Philippine Milk Code was enacted in 1986 to protect breastfeeding and reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is categorized as "substantially aligned" with the International Code of Marketing of Breast-milk Substitutes ("the Code"), but its provisions are assessed as relatively weak in prohibiting promotion to the general public. The extent to which violations of the Philippine Milk Code persist in traditional media platforms and in the digital space has not been systematically explored. This study employed a cross-sectional multimedia audit to examine the marketing and promotion of products under the scope of the Code, as well as those regulated by the Philippine Milk Code. Through a media monitoring conducted from March to September 2018, a total of 430 unique television (n = 32), printed (n = 87) and online (n = 311) promotional materials were identified. A coding tool was used to analyze the content, including the marketing elements used in the materials. Our findings show that commercial milk formula (CMF) for children ≥36 months old was the most promoted type of product (n = 251); and staging of events (n = 211), provision of special discounts or financial inducements (n = 115) and the use of taglines (n = 112) were the most used marketing elements. Promotion of CMF for children <36 months old was uncommon, which supports the conclusion that there is broad compliance with the Philippine Milk Code in terms of the types of products promoted. However, analysis of marketing elements reveals that the CMF industry circumvents the Philippine Milk Code through the use of false and misleading health and nutrition claims, emotionally manipulative language in promotional materials, and cross-promotion. The findings indicate gaps in enforcement and regulatory measures that require urgent attention.