“How can we use TikTok in a way that supports public health work but make it safe for its users and make sure we are not unintentionally profiting from it? We need to make sure to hold TikTok accountable.”

Marco Antonio Zenone
Public Health Researcher 

Introduction

TikTok, a highly engaging social media platform, has exploded in popularity over the last few years. With a short-form video design and an algorithm that recommends videos according to the user’s preferences, it is no surprise that this platform has garnered over one billion monthly users. However, among the endless amount of entertaining videos, ranging from lip-syncing to dancing trends, some videos can raise public health concerns. Videos of people giving incorrect medical advice, promoting health-harming products, misinformation, conspiracy theories and hateful content are also found in the midst of fun, trendy challenges by the platform’s young user base. 

Even though the platform has incredible reach, public health researchers know very little about the adverse effects of TikTok. In episode 95 of the Public Health Insight podcast, Leshawn Benedict speaks with Marco Antonio Zenone, a Ph.D. student at the London School of Hygiene and Tropical Medicine who co-authored a commentary piece called: ‘TikTok and public health: a proposed research agenda.’ Together, they discuss the six public health-related concerns explored in the paper, the impacts of these concerns on the younger demographic of Tiktok and the urgency of further research on these concerns. 

In this blog post, we’ll outline these six public health-related concerns and explore the next steps Marco recommends to combat the adverse health-related implications of TikTok. 

What are the six public health-related concerns with TikTok?

Health Harming Product Promotion

Accompanied by the rise of social media platforms, there has been a rise in influencers. An influencer is someone on the platform that has access to a vast audience and can persuade others to act based on their recommendations (Kim & Kim, 2022). We often hear ‘influencer’ associated with platforms such as Facebook, Instagram or Twitter. Research often focuses on the effects of these social media influencers on their users. However, TikTok is often neglected in this research despite its massive user base. 

Marco talks about JUUL, an E-cigarette company, during the podcast and how the company utilized Instagram to promote their vaping product. Although this product is not supposed to be sold to minors, it became wildly popular among teenagers in part due to going viral on social media. Marco stresses the dangers of promoting similar products to a young audience by influencers on TikTok. Alcohol, for example, was portrayed positively 98% of the time in TikTok videos with the hashtag ‘#alcohol’ according to one study (Davis, 2021). When products which can be potentially harmful to health are portrayed in a ‘cool’ way on social media platforms such as TikTok, the young user base can be negatively  influenced. Marco emphasizes that public health professionals and researchers need to be proactive and look into the adverse impacts of promoting products that can harm health.

Misinformation/Disinformation Spread 

During this podcast section, Marco and Leshawn talk about conspiracy theories. As a user of TikTok, I have often encountered conspiracy theories on this platform. Conspiracy theories such as fake moon landings or the earth being flat are just one aspect of the misinformation that is prevalent on social media. They point toward a bigger problem on platforms like TikTok, and that is the amplification effect of information that can occur through user-to-user video sharing. Similarly to conspiracy theories, this amplification effect can occur in information regarding health on TikTok. Marco points the listener toward COVID-19 and the 2020 U.S. Election and discusses how these topics were affected by misinformation spread online. Similarly to these topics, health information sharing through TikTok is vulnerable to inaccuracy, relying on anecdotal evidence rather than scientific evidence. What is the impact of this utter capacity to share misinformation on TikTok? Marco says, “Simply, we don’t know”.

Medical Advice and Health Illness Portrayal

There is evidence that suggests that TikTok users that offer medical advice, usually using hashtags like #mental health or #acne, get engagement from users (Zenone et al., 2021). The quality of this information isn’t known, and the credentials of the users are also largely unknown. Marco emphasizes that it is important to ask how we can make this information, which reaches billions of users daily, reliable and accurate.

Corporate Interest 

An interesting point that Marco brought up concerning misinformation on these social media platforms was that of corporate interest. Why doesn’t TikTok remove all the misinformation on its platform? Marco says, “Social media is so regular in our lives that often we forget that these are for-profit businesses. We might intuitively think that they will remove the false information online, but that isn’t true”. The more videos there are, the more profit TikTok makes. This introduces a conflict of interest between what is best for business and what is best for the users of TikTok. 

Sensitive and Hateful Content

Over 1 billion videos get viewed on TikTok each day, and sometimes people share sensitive or hateful content. Marco gives credit to TikTok for banning hate speech and removing over 2 million transphobic videos. But, with so much content, it is incredibly hard to moderate everything. Some users may encounter inappropriate or triggering content – for example, people sharing traumatic stories of sexual and physical violence might reach users that are not mentally or emotionally prepared to view them (Zenone et al., 2021). Further research is urgently required on this topic, especially on the moderation policies of TikTok.

Problematic Usage and Addiction 

During the discussion of this last public health concern, Marco mentions that there is speculation that TikTok causes addictive behaviour among its user base, which consists largely of young individuals. Anecdotal evidence suggests some users feel depressed or anxious after using TikTok, but there is a dire need for further research. It is important to investigate how users interact with the platform, policies and interventions that prevent misuse and overuse. 

Earlier on in this blog, I mentioned that TikTok has a special algorithm that curates the user’s feed to their liking. This has the potential to make users addicted. In a Forbes article, “Digital Crack Cocaine: The Science behind TikTok’s success”, Dr. Julie Albright, a USC professor and author, says, “You’ll be in this pleasurable dopamine state, carried away. It’s almost hypnotic, you’ll keep watching and watching” when discussing TikTok (Koetsier, 2022). 

To learn more about social media and its addictive tendencies, check out this video in which Dr. Andrew Huberman, a neuroscientist and professor from Stanford University, explains the relationship between social media and dopamine.

Conclusion/Key Takeaways

Throughout the podcast, Marco highlights the urgent need for research concerning public health and TikTok. In each of the six public health concerns mentioned in the commentary, ‘TikTok and public health: a proposed research agenda’, the lack of research is glaringly evident. TikTok is downloaded all over the world. However, Marco points out that social media has prioritized specific markets when employing solutions to its adverse effects. He says, “84% of the budget for hate speech for Facebook was reserved for the United States”. So, solutions and research need to have a global scope. “We need to ensure this research is happening, and it’s happening everywhere”.

Auditing from independent perspectives about product promotion, funding attention for TikTok, and urgent research on accuracy in health information coming from TikTok are all solutions that Marco suggests to address the six public health concerns discussed throughout the podcast. These steps need to be taken on a global scale so that a balance can be achieved by utilizing TikTok for its benefits and making sure that while doing so, the young user base of TikTok is not adversely affected. Keeping in mind the health-harming product promotion, misinformation spread, corporate interest, health illness portrayal, sensitive content and problematic usage, how urgent do you think it is for public health professionals to hold TikTok accountable? Can TikTok, with its massive reach, become a valuable tool for public health if these concerns are addressed?

Written by: Areej Amer