Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: A Retrospective Observational Infodemiology Study

Background: TikTok is a rapidly growing microvideo social media platform with 60% of monthly users between the ages of 16 and 24. Increased exposure to e-cigarette content on social media may influence usage patterns, including the risk of overuse and possible nicotine poisoning, when users engage in trending challenges online. However, there is little research evaluating the characteristics of nicotine poisoning-related content posted on social media.

Goal: We sought to assess the characteristics of content on TikTok that is associated with a popular hashtag related to nicotine poisoning.

Methods : We collected TikTok posts associated with the #nicsick hashtag, using a Python programming package (Selenium) and used an inductive coding approach to analyze video content and features of interest. The videos were manually annotated to generate a codebook of nicotine disease themes. Statistical analysis was used to compare user engagement characteristics and video duration in content with and without active nicotine disease TikTok topics.

Results: A total of 132 TikTok videos associated with the hashtag #nicsick were hand-coded, with 52.3% (69/132) identified as discussing first-hand and second-hand reports of poisoning symptoms and experiences at suspected nicotine. More than a third of content related to nicotine poisoning (26/69, 37.68%) described active vaping by users, which included content with vaping behavior such as vaping tips and overconsumption, and 43% (30/69) of registered users themselves – reported having suffered from nicotine illness, poisoning or adverse effects such as vomiting following nicotine consumption. The average number of followers posting content related to the harm of nicotine was significantly higher than that of users posting content unrelated to the harm of nicotine (O=2350.5, P=.03).

Conclusion : TikTok users are openly discussing first-hand and second-hand experiences with nicotine-related adverse events via the hashtag #nicsick, including reports of overuse resulting in illnesses. The results of this study suggest a need to assess the usefulness of digital monitoring on emerging social media platforms for adverse vaping events, especially on sites popular among youth and young adults. As patterns of vaping product use continue to evolve, digital adverse event detection likely represents an important tool to complement traditional methods of public health surveillance (such as poison control center prevalence figures).