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Videos posted on TikTok depicting e-cigarettes mostly make vaping look cool and fun, researchers found.

An analysis of 808 videos, selected using hashtags on vaping, indicated that 63% portrayed e-cigarettes in a positive light, whereas only 13% were judged negative; the remaining 24% were considered neutral, according to doctoral student Tianze Sun, of the University of Queensland in Saint Lucia, Australia, and colleagues.

And if you questioned how influential 808 videos could be, consider that the 512 classified as positive had amassed nearly 1.1 billion views and 141 million "likes," Sun's group . In contrast, the 105 negative videos attracted 193 million views and 33 million "likes."

"While moderating content on social media can be challenging, given the high rates of youth participation on TikTok, there is a case for strengthening the platform's moderation and age access policies," the group wrote. found that, as of March 2021, 25% of U.S. users were younger than age 20.

Sun and colleagues were particularly concerned that the prevalence of videos about vaping -- perhaps including those that are merely neutral, or even the negative ones -- "may create social norms around vaping and increase its social acceptance." Moreover, they worried that the TikTok site design that offers related content when a user views a particular video "means that the reach of videos on TikTok may be more substantial" than may be the case with other video-sharing platforms.

To identify vaping-related videos out of the billions posted on TikTok, Sun's group searched for hashtags such as #vaping and #vapetricks, as well as one associated with the popular Juul brand of e-cigarette. They then selected 1,000 with the most page views, eventually discarding 192 that proved to be duplicates or were discovered not to involve vaping despite the hashtags.

Five reviewers scored the videos for their general portrayal of vaping, the perceived age of the video presenter, and the themes used, such as comedy/joking, warning of dangers, or overt marketing (these could overlap).

Just over half the videos were humorous in some way, the researchers determined. About 35% were related to the social acceptability of vaping, such as by hashtagging user groups (e.g., #juulgang) or by portraying the practice as a cultural or social identifier. Nearly 30% came across as product advertisements.

Perhaps most disturbingly, 20% showed users performing tricks with vaping devices (such as vapor rings) -- these were also the most viewed by far, at 460 million -- and 16% were "how-to" instructionals on making, using, or modifying liquids and devices. Just 11% were classed as warnings about negative health effects or other problems stemming from e-cigarette use.

The content analysis also found that references to nicotine addiction -- seen in 20% of videos -- weren't necessarily negative about vaping. Many were meant as jokes, which may "trivialize" nicotine's well-documented addictive quality, the researchers wrote.

Limitations to the study included the reviewers' fallibility and the deliberate exclusion of anti-vaping videos posted as part of a tobacco control campaign (these are shown without the user specifically selecting them, and are looped continuously, thus exaggerating the page-view count). The hashtag-based selection process also meant that videos lacking hashtags could not be included. Additionally, Sun and colleagues were unable to assess how much influence the videos actually had on viewers' subsequent attitudes and behavior.

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