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Many public health organisations are making use of online social networking sites, such as Facebook, to disseminate information. The University of Kentucky’s Kentucky Center for Smoke-free Policy (KCSP) has a Facebook page to disseminate evidenced-based information about secondhand smoke and smoke-free policy. Facebook can foster dialogue,1 but users can also post irrelevant or inappropriate information.2 In 2011, electronic cigarette (e-cigarette) advocates placed multiple postings to the KCSP Facebook page (kysmokefree) in what appeared to be an attempt to redirect the discussion on KCSP’s Facebook page from advancing a smoke-free policy to harm reduction.
In 2011, the Madison County (Kentucky) Board of Health amended its smoke-free regulation to prohibit use of e-cigarettes in the same places as cigarettes.3 E-cigarette advocates strongly opposed the change via public testimony, communication with tobacco control advocates in the community and members of the Board of Health, Internet forums, and open records requests to the Health Department. The open records request came from an advocate affiliated with the Consumer Advocates for Smoke-free Alternatives Association (CASAA), a harm reduction advocacy group.
One month before Madison County’s amended regulation was adopted, Facebook postings by advocates of the e-cigarette began appearing. Soon after the regulation was amended, postings intensified over a 4-day period. A major theme of the postings was to promote e-cigarettes as a smoking cessation aid with statements including: ‘Technically there is no evidence to say e-cigarettes are “not a safe alternative to smoking”. My doctor disagrees! Says it is MUCH safer than smoking and approves of my use of electronic cigarettes. If you say it can’t be proven they are safe then it also can’t be proven that they are unsafe…’
Using information from the open records request to the Madison County Health Department, advocates of e-cigarettes posted an email from the Director of KCSP to the Health Department on the kysmokefree Facebook page in which the Director repeated information she had heard about a harm-reduction researcher and his possible relationship with the tobacco industry. Advocates of the e-cigarette made repeated postings requesting supporting evidence for the content of the email. There also was an erroneous claim on another posting: ‘kysmokefree [Facebook page] has clear connections to the DRUG INDUSTRY as evidenced by significant funding from the Robert Wood Johnson Foundation that currently holds nearly $1 Billion of equity in Johnson & Johnson.’ Over a period of 4 months, KCSP’s Facebook page moderators responded with scientific information to some of the postings and removed 27 inappropriate postings.
As more advocacy groups join Facebook, they should anticipate that interested parties may post information that could confuse the public, such as information that is not based on evidence. Prior to starting a Facebook page, health advocates need to develop guidelines to handle inflammatory, disruptive or inaccurate postings (box 1). It is important to thoughtfully consider when to engage in discussion about what is and is not true, and when to remove postings. The benefit of an interactive site like Facebook as compared with a traditional, information-only format website is the facility of dialogue. Scientists must balance the responsibility to disseminate evidenced-based information with open discussion, and health advocacy organisations on Facebook need to have a plan to moderate inaccurate postings.
Funding This research was funded in part by NCI Grant CA-113710. The funding agency played no role in the selection of topic, conduct of the research or preparation of the manuscript.
Contributors All authors conceived this paper and contributed to the draft. AF took the lead on the first draft.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.