Health information is commonly accessed online. The majority of adults now use the internet — and increasingly, social media such as Twitter, Facebook and YouTube — as their first source of health-related information when they are looking for health and medical advice. This freely available information on social media, however, comes at a cost because of the ubiquity of inaccurate, misleading and outright false information that can have negative consequences on people’s health choices and behaviors.
For years, e-cigarette manufacturers falsely advertised through television ads and social media influencers that e-cigarettes contain only water vapor and are harmless. This is untrue and it plays down the risks and addictiveness of e-cigarette use — and it may be partly responsible for the youth vaping epidemic.
As public health and tobacco control researchers, we are also concerned about the adverse impacts of inaccurate information that e-cigarettes are just as, or more harmful than, smoking on cigarette smokers. This misinformation can deter cigarette smokers from lowering their health risks by switching to e-cigarettes completely and thus, lowering the harms of exposing their loved ones to secondhand smoke exposure.
There is general agreement among medical experts that the short-term health risks from e-cigarettes are considerably lower than smoking regular cigarettes, although the longer-term risks and benefits are not known. The Centers for Disease Control and Prevention (CDC) advises that e-cigarettes have the potential to benefit adult smokers if used as a complete substitute for regular cigarettes and other smoked tobacco products.
Until recently, we knew little about how misinformation affects smokers’ perceptions about trying e-cigarettes. We conducted the first randomized controlled trial of its kind and found that cigarette smokers were less likely to purchase e-cigarettes after being exposed briefly to tweets falsely stating that e-cigarettes are as or more harmful than regular cigarettes, compared to a control condition. They were also more likely to wrongly believe that using e-cigarettes is more harmful than smoking. The study involved 2,400 U.S. and U.K. adult cigarette smokers (who were not using e-cigarettes at the time of the study) to assess the effect of viewing misinformation about e-cigarette harms on Twitter on their intention to purchase e-cigarettes, and their perceived relative harm of e-cigarettes compared to regular cigarettes.
While we do not yet know whether the impact of misinformation exposure on smokers’ reduced intentions to consider using e-cigarettes ultimately translates into worse health outcomes for smokers and their families, we do know that misinformation online is not going away anytime soon. As officials continue to debate how to combat fake news and information on social media, there are a few important steps they can take to promote the public’s health and well-being and minimize the adverse effects of misinformation.
Public health agencies should advise smokers that although e-cigarettes are not completely harmless, the current evidence shows the short-term health risks from using e-cigarettes are considerably lower than smoking regular cigarettes. Quit lines (over-the-phone coaching by a counselor to help quit smoking), mobile apps and web-based tools for cessation, and smoking-cessation campaigns should consistently share accurate information about the relative harms of smoking versus switching completely to e-cigarettes, if a smoker is unable or unwilling to quit.
Smokers should be encouraged to seek out health information from reliable, up-to-date sources such as the CDC and the U.K.’s National Health Service websites for accurate information on the harms of smoking compared to switching completely to e-cigarettes.
Physicians and health care professionals should be aware that some of their patients who smoke may have seen misinformation on social media, and therefore may have misperceptions about e-cigarettes. They should seek to correct any misperceptions and consider the ways to support their patients to obtain accurate health information.
Finally, policymakers and social media platform companies should ensure that all social media content associated with e-cigarettes is consistent with official health guidance and should work to ensure that accurate information is being promoted on their platforms.
Cigarette smoking is the leading cause of preventable death, causing 7 million deaths per year worldwide, and social media’s influence on smokers’ misperceptions about e-cigarettes could mean they will continue to be harmed — or killed — by cigarette smoking.
Caroline Wright, PhD, is a senior research associate and Cancer Research U.K. Population Research Postdoctoral Fellow at Bristol Medical School at the University of Bristol, England. Follow her on Twitter @DrCLWright.
Andy Tan, PhD, MBBS, MPH, MBA, a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania and an associate professor at the Annenberg School for Communication. Follow him on Twitter @Andy_SL_Tan.