NOTE: In this story, all names of fogeys and kids have been modified to guard their privacy.
August 7, 2023 – America's teens love TikTok, the video-sharing social media app. Nearly 60% of teens between the ages of 13 and 17 use it every day, in accordance with the Pew Research Center. And by some estimates, the biggest share of TikTok users are between the ages of 10 and 19. That might be an issue, given the outcomes of a latest study that examined how TikTok users interact with the app's health content.
The study, during which Journal of Health Communicationanalyzed 400 videos tagged with the hashtags #EduTok and #health. The researchers found that the preferred health-focused videos on the platform tended to give attention to three topics: nutrition, exercise, and sexual health. That's hardly surprising, given TikTok's relatively young audience. But amongst those health-focused videos, those with the best response featured people offering inspirational appeals and steps to emulate the creator's own behavior.
In other words: not health workers. Influencers.
Risky role model
The study found that videos using this way of motivational behavior, called role modeling, often contained either misleading information or medical advice from a physician for the influencer's specific situation that was not intended for most people. Much of it also appeared to be things that the majority people couldn't do.
“Role models on TikTok are rich, beautiful, thin white women. They have the means to buy expensive vegetables. They can wake up every day and walk on the beach,” said Dr. Nicole O'Donnell, the study's lead creator. “It doesn't promote the image of health, it promotes the image of being thin and rich.”
Many of the videos used the word “research” to suggest credibility without providing specifics. For example, they promised “daily, evidence-based health tips” but omitted the sources so viewers couldn't confirm their validity. And many included some kind of sales pitch or suggestion that certain products could help the viewer be just like the influencer.
“The problem is that these people speak with such authority,” said Dr. Katrine Wallace, an epidemiologist on the University of Illinois. TikTok videos to counter the health misinformation she encounters on a every day basis. “There are no standards of proof for making videos on TikTok. You can say anything you want without training, and if you sound like you know what you're talking about, people will assume you know.”
Terry T., a mother from New Jersey, said her 16-year-old son fell victim to those pseudo-authoritarian videos.
“We had a tense moment recently about how much protein teenagers need,” she explained. “I forced him to look it up at Harvard and the Mayo Clinic, where it comes from people who have studied medicine, not people trying to sell you a protein supplement.”
The researchers also found an inclination to select a single point from legitimate scientific research after which exaggerate it.
“There's a lot of shocking content, like saying you shouldn't eat at restaurants because they're so scratchy that you'll get heavy metal poisoning,” O'Donnell said. “The whole point of these platforms is to keep people there and get them to watch content. And if you're outraged, you'll keep watching.”
A dangerous trend: self-diagnosis
The study found that videos with a message encouraging self-diagnosis also tended to have higher reach and engagement. Ellen R., a mother from San Jose, California, believes her daughter Bea's experience is resulting from this.
By the time Bea deleted TikTok from her phone, she had already diagnosed herself with social anxiety disorder, ADHD, anxiety, major depression, borderline personality disorder, and bipolar disorder—and convinced medical professionals that she had several of those conditions. She was 13 years old on the time.
Ellen blamed TikTok, particularly the mental health videos that Bea consumed like candy.
“She watched videos of people describing their mental health symptoms and self-harm, and the content really grabbed her,” Ellen said.
The more videos Bea watched, the more she attributed her normal adolescent moodiness to mental crises. And since the videos showed her exactly which symptoms could lead on to which diagnosis, she could argue that she had these illnesses.
“She had access to all these symptoms and descriptions, so she started to identify with this community of people struggling with mental illness,” her mother said. “She kind of built that up within herself.”
The role of the algorithm
One possible reason Bea was so drawn to those videos: TikTok's algorithm. One of the app's primary features is the FYP, or For You Page. When users open the app, they discover a feed of videos not from people they follow, but from people who find themselves creating similar content to what they've already seen.
“If you like cats, you'll see a lot of cat videos,” Wallace said. “If you like anti-science misinformation, you'll see even more of that.”
The problem with the FYP is that the algorithm cannot detect Why You're watching a specific video or why you didn't just scroll past something that didn't interest you.
“Let's say what you're watching is exciting, but it's not about a topic you're particularly interested in, but you sit there and watch it anyway. The algorithm shows you more of it,” says Dr. Allison K. Rodgers, a Chicago-based fertility doctor and gynecologist who makes TikTok videos, often along with her 16-year-old daughter. Your account has 1.2 million followers. “It just wants to keep you on the app as long as possible.”
For young people, who spend a median of 92 minutes a day on TikTok, this algorithm can make them very serious errors.
The latest peer pressure
As a youngster within the twentieth century, you bought your information the old-fashioned way: from newspapers, magazines, books and, most significantly, friends. Today, nonetheless, teenagers are only as more likely to get advice on dropping pounds, exercising or stopping pregnancy from social media. This wider net can have dangerous consequences.
“When people see other people doing something and think it's cool, they want to do it too,” Rodgers said. She recalled videos encouraging young women to drink pineapple juice to enhance their vaginal aroma and a TikTok challenge during which girls inserted ice cubes into their vaginas.
Ellen blames this latest peer pressure for a few of her daughter's self-diagnoses.
“Because of the way the algorithm works, you just keep getting more and more of this content,” she said. “When all the TikTok videos you see are about depression, cutting and anxiety, you start to think, 'That's the way the world is. That's how I am, too.'”
Viral filters may also affect teenagers' self-image. When Katie F's daughter tried a filter that was speculated to show her what she would seem like as an old woman, she didn't like the outcomes.
“She found a few videos from dermatologists who pointed out that these apps are really accurate in their predictions. She also saw some videos from individuals who were motivated by them to improve their skincare routine,” Katie said. “Eventually she came to me because she was confused about it. She was afraid that if she didn't do something she would age prematurely.”
Katie's daughter was 14 on the time.
How to navigate TikTok's health content
As any parent knows, you'll be able to't just ban your teens from TikTok—they'll discover a solution to start using it again. Instead, there are things you'll be able to do to assist the young people in your life use TikTok safely. Encourage them to:
- View the login information. “There are people who are anti-medicine and anti-doctors and who spread misinformation that has the potential to cause harm,” Rodgers said. Before following any advice, check the creator's background after which Google them. “A practicing doctor should be easy to find.”
- Think in regards to the message. “What health messages are they communicating?” O'Donnell asked. “Are they sharing actionable steps or resources? Are they sharing links to WebMD? Or was there outrage involved? Did they just highlight the severity of the health concerns?” Dramatic stories about one person's experience don't really let you know anything.
- Understand the importance of information. “An anecdote is not the same as a study, and not all studies are the same,” Wallace said. “If something says an ingredient is dangerous, it may be based on an animal study where it was given 30,000 times the human dose.”
- Watch for subtle promoting. “People sharing medical information probably shouldn't have a link to purchase their supplements or diet program,” Rodgers said. If the creator is promoting specific products, that's a red flag.
- Watch out for followers. “I saw a video where the creator said he went to the doctor because he thought he had ADHD, but the doctor said that wasn't the case, despite his own experience,” Wallace said. The creator trusted what he saw on TikTok greater than a licensed doctor. “Why go to the doctor if you don't believe that person is an expert?”
- Check before you reinforce. “If you see a headline that sounds sensational, make sure it's current and published in a reputable place before sharing,” Wallace said. By taking this step, your teen might help stop the spread of misinformation.