Misleading portrayals of the safety of tobacco use are widespread on YouTube, where the viewership of popular pro-tobacco videos has soared over the past half-dozen years, according to research by the Annenberg Public Policy Center (APPC) of the University of Pennsylvania.
In an article published today in the Harvard Kennedy School Misinformation Review, APPC researchers found that from 2013 to 2019, different kinds of popular tobacco-themed YouTube videos saw "dramatic increases in views per day, especially for tutorials about vaping products."
The research follows up on a 2013 content analysis done by APPC which identified five major categories of pro-tobacco videos on YouTube. For example, among instructional or "how-to" videos, the highest-performing video in 2013 was on how to use a pipe, with just over 62,000 total views or 47 views per day. But in 2019, the most-viewed instructional video was on "the art of vape," which had logged over 40 million total views or over 68,000 per day.
Another category is managing risk, in which videos claim that the risks of tobacco use can be managed by various fixes, without offering scientific evidence. In this category, the top-performing 2013 video concerned cigarette smoking, with 85,000 total views or 63 views per day. In 2019, the top-viewed video in this category was on vaping, which had over 3.5 million views or over 1,600 per day.
"The easy access of such [video] material suggests that YouTube is a fertile environment for the promotion of tobacco products despite its banning of tobacco advertising," the researchers said.
YouTube, tobacco videos, and adolescents
YouTube is the second most popular website for U.S internet traffic, after Google, and reaches 85% of adolescents. That sweeping reach gives it the potential to influence the information that young people receive on many topics -- including products that are hazardous to their health, like tobacco. Although the use of cigarettes by young people has declined in recent years, vaping has sharply increased and emerged as the main alternative to cigarettes among adolescents.
"Although we have no direct evidence of the effect of pro-vaping videos, the rise of vaping among adolescents in the last few years has been accompanied by dramatic increases in viewership of vaping videos," said lead author Dan Romer, APPC's research director. Past APPC research has found that misleading YouTube videos promoting e-cigarettes and hookahs made young adults feel more positively about those products.
In 2013, APPC researchers used a set of keywords to locate pro-tobacco videos on YouTube, from which they used a pool of 200 randomly selected videos to create a taxonomy with five categories of pro-tobacco videos: demonstrations of "fun ways to use tobacco"; instructional or tutorial videos; managing risk; assertions that tobacco use is actually healthy; and assertions that the risks of tobacco use are no greater or are less than other life risks, without describing the risks of tobacco products.
Using keyword searches and YouTube's recommendation algorithm, the researchers found the most viewed video in each of the five categories in the taxonomy. In those categories, they used keyword searches and YouTube's recommendation algorithm again in 2019 to find the top-ranked videos at that time. In four of the five categories, the best-performing videos had more than a million views.
"This suggested to us that the misleading tobacco videos we identified on YouTube are part of the information environment that eludes the restrictions that apply to regular tobacco advertising and product promotion," said co-author Patrick E. Jamieson, director of APPC's Annenberg Health and Risk Communication Institute.
Eluding YouTube's tobacco ad ban -- and making a profit
Although YouTube has banned ads for tobacco products, both YouTube and the users who create tobacco videos are legally permitted to profit from them, Romer said. "One of the perverse consequences of this business model is that a video with misleading information about a harmful product such as tobacco can be a source of profit for both YouTube and the creator," he said. "But the information in the video will go unchallenged."
Currently, there is little incentive for YouTube to remove the videos. Under Section 230 of the Communications Decency Act (CDA) of 1996, YouTube and other social media platforms are not regarded as publishers of the content they host. Under Section 230, "it is not clear who is responsible for protecting the public from misleading health content on the internet," the Annenberg researchers said:
"As our study of YouTube illustrates, producers of misleading tobacco content can primarily represent private individuals rather than tobacco manufacturers. Indeed, the producers of the tobacco videos we identified... do not appear to be employees of the tobacco industry. Although we did not see evidence of any connection to the industry, it is nevertheless possible that a content creator could receive endorsement payments from a tobacco company."
Romer added, "Clearly this consequence was not anticipated when the CDA was passed. Perhaps it is time to revisit this measure to more appropriately recognize the business model that has emerged in social media. All content is potentially monetized and the platforms should have to recognize their role in hosting it."
How to counter misleading information
One way to counteract misleading tobacco videos, the APPC team said, is to place corrective ads that counter the misinformation on the same page as the pro-tobacco videos. In an earlier study, APPC researchers found it was possible to counteract pro-tobacco videos on YouTube by showing a corrective message on the severity and scope of health risks associated with smoking.
In the current study, they also noted that other researchers have proposed that the government give incentives to social media platforms to modify their terms of service to allow them to remove misleading health information.
In addition to Romer and Jamieson, the research was conducted by APPC senior designer Zachary Reese.
"Misleading Tobacco Content is on the Rise on YouTube" is published in the Harvard Kennedy School Misinformation Review.
The research was supported by the National Cancer Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.
The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication's role in advancing public understanding of political, health, and science issues at the local, state and federal levels.