Public Health Implications of Image-Based Social Media: A Systematic Review of Instagram, Pinterest, Tumblr, and Flickr

Introduction: Image-based social media Instagram, Pinterest, Tumblr, and Flickr have become sources of health-related information and tools for health communication. No known systematic review exists that summarizes the existing research and its health implications. Methods: We searched EBSCOhost Academic Search Complete, PubMed, and Web of Science in January 2016, April 2017, and November 2017, with the following : Pinterest, Instagram, Tumblr, or Flickr. Only public health-related, peer-reviewed research articles were included (excluding surveys of self-reported social media use). Results: Sixty-six research articles were included. All 12 experimental studies used Instagram. Of the 54 observational studies, 38 studied Instagram; 12, Pinterest; 7, Tumblr; and 6, Flickr; some studies investigated more than 1 platform. More than half of the included articles were related to mental health and substance abuse (n = 39, 59%). Other topics included chronic diseases, infectious diseases, surgery, injury prevention, pharmacovigilance, sexual and reproductive health, and adolescent psychology with functional magnetic resonance imaging. Discussion: Public health-oriented research on Instagram, Pinterest, Tumblr, and Flickr is increasing. Most observational studies investigated questions ranging from public perception of diseases or interventions (vaccination) and undesirable media exposure (“echo chamber,” distorted body image, underage substance use, and pro-suicide messages) to information dissemination and online engagement (likes and comments). A few studies attempted to use image-based social media as intervention tools, but the results were mainly exploratory. Conclusion: More research is needed to study how social media users discuss health through sharing images online, and how public health professionals can communicate effectively using image-sharing social media.