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Correspondence to Tianze Sun, The University of Queensland, Saint Lucia, QLD 4072, Australia; [email protected]
Introduction
Use of electronic cigarettes (also known as e-cigarettes or personal vaporisers) has increased among adolescents.1 For example, the prevalence of past 30-day e-cigarette use among USA high school students increased threefold from 9.3% in 2014 to 27.5% in 2019.2 Emerging evidence suggests that vaping has detrimental effects on the developing brain, lungs and heart.3
Adolescents (aged 13 to 18 years) are particularly susceptible to peer influence4 that is increasingly exerted via social media, use of which is ubiquitous among adolescents in high income countries.5 Adolescents are routinely exposed to e-cigarette endorsements from peers and influencers on Twitter, Instagram and Facebook.6–8 Studies indicate that exposure to e-cigarette marketing and user-generated e-cigarette-related content on social media is associated with a greater likelihood of future e-cigarette use among adolescents.9 10
TikTok is the fastest growing platform worldwide, attracting 800 million monthly users, and a third of users in the USA are aged 14 or younger.11 TikTok is a publicly available video-sharing platform that allows users to create short video clips related to dancing, lip-synching, talent and other trends. Due to its unique appeal,12 users on average spend 52 min and watch more than 200 videos per day.13 TikTok’s community guidelines restrict uploading videos featuring ‘the depiction, promotion, or trade of drugs or other controlled substances’. Advertising of tobacco and alcohol products is also prohibited on the platform.14 15 This study systematically assessed the content of popular e-cigarette/vaping-related videos on TikTok.
Methods
Sampling strategy
In September 2020, a snowball sampling procedure16 produced 157 vaping-related hashtags that TikTok creators used to promote videos by directing users to a page of uploaded videos, each of which showed the number of views received. All videos could be streamed by the general public. We identified the top viewed hashtags based on the number of views on 17 November 2020 (online supplemental table 1). This procedure is based on a previous TikTok content analysis.17 The top nine vaping-related hashtags identified were ‘#vape’, ‘#vapetricks’, ‘#juulgang’, ‘#puffbar’, ‘#nicotine’, ‘#vapenation’, ‘#vaping’, ‘#vapeshop’, and ‘#vapelife’. Another potentially highly viewed hashtag, ‘#immuneupvapedown’, was excluded because the tagged videos were played...