Marketing or health promotion? A citizen science study of social media influencers’ health content

Abstract Background Social media influencers (SMI) became the dominant source of health information among adolescents, exerting influence through appealing content and para-social relationships. Personalized social media feeds of adolescents paired with latent platform algorithms result in myriads of individual information environments, which remain closed to researchers. Citizen science offers a solution to peek inside this black box and identify: What health content is disseminated by social media influencers and consumed by adolescents? Methods The citizen science study adopted a contributive approach, where adolescents collected and categorized SMI profiles and posts from their own feeds with a pre-tested survey tool which was available on Google Tabs. Data collection was conducted on Instagram, TikTok, and YouTube between April and May 2023 and subsequently analyzed by the research team. Results The study involved 19 school classes, containing 326 students, aged 12 to 19 years. They documented 255 SMI profiles and 2147 posts, primarily on Instagram and TikTok. Key topics included fitness, beauty ideals, and nutrition, while mental and sexual health received less attention. Although 41.5% of the posts contained advertising, the citizen scientists classified 63.5% as health-promoting. Topics relating to dietary supplements (84.1%), addictive substances (55.6%), nutrition (53.8%) and sport (47.2%) were particularly ad-heavy. Despite mental and sexual health having the lowest advertising rates at 35.4% and 37.7% respectively, this still accounts for over one third of the documented posts. Conclusions SMI present a distorted image of health that emphasizes nutrition, fitness and beauty ideals, while topics such as mental and sexual health are neglected. The positive reception of posts containing ads indicates a lack of critical reflection. Policies for advertising practices and balanced health education, including media literacy, are necessary to address these trends. Key messages • Social media influencers propagate a distorted health image, defined by nutrition, fitness, and beauty ideals. • Adolescents lack the necessary skills to critically reflect on ad littered social media influencer health content.