摘要：Objectives. In an antifluoridation case study, we explored digital pandemics and the social spread of scientifically inaccurate health information across the Web, and we considered the potential health effects. Methods. Using the social networking site Facebook and the open source applications Netvizz and Gephi, we analyzed the connectedness of antifluoride networks as a measure of social influence, the social diffusion of information based on conversations about a sample scientific publication as a measure of spread, and the engagement and sentiment about the publication as a measure of attitudes and behaviors. Results. Our study sample was significantly more connected than was the social networking site overall ( P < .001). Social diffusion was evident; users were forced to navigate multiple pages or never reached the sample publication being discussed 60% and 12% of the time, respectively. Users had a 1 in 2 chance of encountering negative and nonempirical content about fluoride unrelated to the sample publication. Conclusions. Network sociology may be as influential as the information content and scientific validity of a particular health topic discussed using social media. Public health must employ social strategies for improved communication management. Approximately 74% of Internet users in the United States use social networking sites 1 such as Facebook, which has 1 billion users worldwide, and YouTube, which is the second most used search engine globally. 2 Much of the content shared peer-to-peer across these and other social sites is copied from, derivative of, or in response to traditional media content. 3 News sites, Facebook, YouTube, and blogs are among the “most trustworthy” sources for retail information, and all have a strong influence on purchasing decisions, 4 demonstrating the power of both expert and professional and amateur- and peer-created content. Additionally, 8 of 10 Internet users seek health information online. 5 This collective evidence suggests that these Internet users are likely using social media sites to obtain health information. 6 Although social networks play a vital role in health behaviors, 7–9 searching for health information online can be problematic, specifically information on childhood vaccinations and community water fluoridation (CWF, or fluoridation). Decreasing childhood vaccination rates and preventable disease outbreaks in the United States have resulted in widespread discussion across mainstream and social media sites in recent years. 8–17 Yet, according to 1 study, because of deficient reporting by popular media, less than 25% of survey respondents were aware that the majority of scientific evidence supports the safety and effectiveness of vaccines. 18 Additionally, antifluoride activists are organizing on social media sites 19 with the intention of lobbying the Environmental Protection Agency’s Office of Water, despite having proposed arguments that do not align with current scientific consensus about CWF in the United States. 20–22 The Departments of Labor, Health and Human Services, and Education Appropriations Bill 2015 subcommittee draft report states, “The Committee is concerned about conflicting information in the media regarding the benefits of community fluoridation.” 23 Seemingly, communication challenges contributing to suboptimal beliefs and behaviors about these leading 24 public health interventions do not exist in isolation. Public health is encountering an emerging threat of “digital pandemics,” the rapid far-reaching spread of unrestricted and scientifically inaccurate health information across the Web through social networks. 25 Improved communication between researchers and media reporters is indeed recommended but is only part of the solution. Public health challenges stemming from online misinformation are at the complex intersection of scientific research, mass media, and the emergence of social network activism through user-created content and consumer reception of information. We performed, to our knowledge, a first of its kind observational study designed to explore this challenge and the epidemiology of digital pandemics.
