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

Background: TikTok is a microvideo social media platform currently experiencing rapid growth and with 60% of its monthly users between the ages of 16 and 24 years. Increased exposure to e-cigarette content on social media may influence patterns of use, including the risk of overconsumption and possible nicotine poisoning, when users engage in trending challenges online. However, there is limited research assessing the characteristics of nicotine poisoning-related content posted on social media.

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

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

Results: A total of 132 TikTok videos associated with the hashtag #nicsick were manually coded, with 52.3% (69/132) identified as discussing firsthand and secondhand reports of suspected nicotine poisoning symptoms and experiences. More than one-third of nicotine poisoning-related content (26/69, 37.68%) portrayed active vaping by users, which included content with vaping behavior such as vaping tricks and overconsumption, and 43% (30/69) of recorded users self-reported experiencing nicotine sickness, poisoning, or adverse events such as vomiting following nicotine consumption. The average follower count of users posting content related to nicotine sickness was significantly higher than that for users posting content unrelated to nicotine sickness (W=2350.5, P=.03).

Conclusions: TikTok users openly discuss experiences, both firsthand and secondhand, with nicotine adverse events via the #nicsick hashtag including reports of overconsumption resulting in sickness. These study results suggest that there is a need to assess the utility of digital surveillance on emerging social media platforms for vaping adverse events, particularly on sites popular among youth and young adults. As vaping product use-patterns continue to evolve, digital adverse event detection likely represents an important tool to supplement traditional methods of public health surveillance (such as poison control center prevalence numbers).