The use of e-cigarette devices (i.e., vaping) has been linked to short- and long-term health complications for adolescents and young adults (AYA), including respiratory harm (Gotts, Jordt, McConnell, & Tarran, 2019; Lee, Lee, & Lee, 2019), impaired brain development (Wawryk-Gawda, Lis-Sochocka, Chylińska-Wrzos, Budzyńska, & Jodłowska-Ję-drych, 2019), poor mental health (King, Reboussin, Spangler, CornacchioneRoss, & Sutfin, 2018), and amplified risk of cigarette smoking and other substance use (Soneji et al., 2017; Veliz et al., 2020; Watkins, Glantz, & Chaffee, 2018). Still, vaping among AYA persists; 10% of U.S. middle and high school students (Birdsey et al., 2023) and 17% of U.S. young adults aged 19–30 reported past-month nicotine vaping in 2022–2023 (Patrick, Miech, Johnston, & O’Malley, 2023).

Vaping prevalence is disproportionately high among sexual and gender minority (SGM) AYA compared to heterosexual and cisgender AYA, consistent with longstanding disparities in tobacco use and tobacco-related disease (Lee, Griffin, & Melvin, 2009; Li et al., 2021; Quinn et al., 2015). Currently, 13% of lesbian, gay, bisexual, and transgender adults report vaping—a rate twice that of heterosexual adults (Al Rifai et al., 2020). Similarly, vaping prevalence is twice as high among sexual minority girls than heterosexual girls and three times as high among transgender youth than cisgender peers (Johnson et al., 2019). Identity-based harassment and the subsequent disparate burden of mental illness (Meyer, 2003) might precipitate tobacco use among SGM AYA (Evans-Polce, Schuler, Kcomt, McCabe, & McCabe, 2023). Moreover, given evidence that vaping negatively impacts AYA mental health (King et al., 2018), SGM AYA vaping may exacerbate poor mental health from minority stress rather than relieve it. More prevalent vaping might also stem from aggressive targeted marketing of tobacco and nicotine products to SGM communities (Smith, Thomson, Offen, & Malone, 2008). Tobacco advertising in magazines and bars and sponsoring pride events has likely contributed to tobacco normalization in SGM culture (Coulter, Bersamin, Russell, & Mair, 2018; Truth Initiative, 2022).

Social media use is a determinant of vaping-related norms, attitudes, and intentions (Kava et al., 2020; Vogel et al., 2020), all of which predict behavior (Ajzen, 1991; Yang, 2023). Frequent exposure to tobacco- and nicotine-related content on social media has been associated with subsequent use (Clendennen, Loukas, Vandewater, Perry, & Wilkinson, 2020; Pokhrel et al., 2021), more positive tobacco attitudes and norm perceptions (Pokhrel et al., 2018), and lower support for tobacco control policy (Tan, Lee, & Bigman, 2015). SGM individuals report higher engagement with tobacco content online than do heterosexual individuals (Soneji et al., 2019) and therefore might also be disproportionately impacted by online content. While the tobacco industry continues to promote products through direct advertisement (Huang, Kornfield, Szczypka, & Emery, 2014; Kreitzberg, Murthy, Loukas, & Pasch, 2019; Liang et al., 2015) and influencer endorsement (Vassey et al., 2022), a substantial amount of positive product content is organic and peer-generated (Morales, Fahrion, & Watkins, 2022). As a result, new social media content often references current trends, relatable commentaries, and other culturally relevant details (Morales et al., 2022) that may particularly resonate with AYA, perhaps contributing to the message’s perceived authenticity and influence as AYA seek to align themselves with the idealized versions of their peers that they view on social media (Vogel et al., 2014, 2015).

Social identity theory (Tajfel & Turner, 1979) suggests that vaping content from SGM peers—who may be viewed as members of SGM AYAs’ own community—might be particularly influential for SGM AYA. Social media, however, also exists as a critical space for SGM individuals to seek SGM-specific information, learn from SGM role models, share SGM-centric experiences, and experiment with identity (Fox & Ralston, 2016). For this reason, vaping content from SGM social media content creators might contain unique messages and delivery features not reported in previous research on TikTok’s overall vaping content (Allem, Majmundar, Dharmapuri, Unger, & Cruz, 2019; Basch, Fera, Pellicane, & Basch, 2021; Marynak, Robichaud, Puryear, Kennedy, & Moran, 2022; Morales et al., 2022; Purushothaman et al., 2022; Rutherford, Sun, et al., 2022). There is a lack of research regarding vaping content created by or for SGM individuals on social media. Focusing on the vaping content that is shared by SGM creators can delineate unique messages SGM AYA might see on social media. Moreover, first-hand observation of how SGM AYA are already communicating about vaping on social media offers a novel complement to research soliciting responses to intervention materials (Hinds, Chow, Loukas, & Perry, 2021; Lee et al., 2022; Patterson et al., 2024b; Tan, 2024) by identifying culturally relevant content and delivery ideas for SGM AYA-tailored social media messaging.

TikTok connects people globally through short-form video sharing, a departure from traditional social media that typically facilitate photo and text sharing among friends. The app hosts 100 million users in the United States, 47.4% of whom are aged 10–29 (Dean, 2022). The most prominent feature on TikTok is its “For You Page” (FYP), a continuous feed of videos tailored for each user. Videos suggested on the FYP can be created by any TikTok user and are influenced by the person’s previous video engagement, following, friends, geolocation, and most conspicuously, an algorithm’s often precise perceptions of that user’s interests, hobbies, and identities (Ohlheiser, 2021; TikTok, 2022b). Accordingly, informal TikTok communities connect individuals across the world who share similar interests and identities (e.g., BookTok, GymTok), including SGM young people (Hiebert & Kortes-Miller, 2023), who engage in an informal subculture called “QueerTok.” TikTok also serves as a digital platform for sharing health information. Some videos promote healthy behaviors like COVID-19 vaccination; others feature (and glamorize) harmful habits like nicotine use (Morales et al., 2022), which is reflected on “NicTok.”

Videos promoting vaping receive thousands of views, likes, comments, and shares (Marynak et al., 2022; Morales et al., 2022; Sun et al., 2021). Popular e-cigarette content that normalizes vaping may undermine public health prevention and cessation interventions. TikTok claims to monitor and remove harmful content, and according to TikTok’s Community Guidelines (TikTok, 2022a), depictions of tobacco and nicotine are not eligible for FYP recommendation (i.e., content will not be pushed to TikTok users’ tailored feeds). However, content moderation may be unsuccessful in removing noncompliant videos (Rutherford, Sun, et al., 2022) and this claim has not been validated. If the algorithm associates an identity with a behavior, such as SGM identity with vaping, it may push positive tobacco/nicotine messages to SGM AYA regardless of whether they vape. Alternatively, if a TikToker who uses tobacco/nicotine engages with vaping content, their FYP feed may become inundated with positive nicotine messaging. In both cases, the app would reinforce favorable normative beliefs toward vaping among peers, in both descriptive and injunctive norms, and likely increase the audience’s vaping behavior (Yang, 2023).

In this study, We aimed to identify and describe vaping experiences and perceptions of SGM AYA as depicted in TikTok content to inform culturally tailored social media messaging for SGM AYA. Our team used four study accounts to collect videos containing vaping content for qualitative content analysis. Drawing from the principles of Youth Participatory Action Research (Kornbluh, Ozer, Allen, & Kirshner, 2015), SGM and allied young adult researchers were involved at every step of the research process. By centering SGM perspectives, we developed a nuanced understanding of how the messages shown to SGM TikTok users differ from mainstream vaping narratives on social media that have been previously documented. Additionally, using TikTok as a study setting permits dynamic monitoring of emerging habits, brands, and attitudes that inform health communication efforts and tobacco control policy.

In March and April 2022, we captured data from four study TikTok accounts; three focused on SGM vaping posts and a fourth did not specify sexual or gender identity for comparison. Four young adult researchers controlled one account each. We collected 440 videos; after removing duplicates (n = 137), we conducted qualitative thematic analysis with 303 unique TikTok videos.

Our team consisted of four young adult researchers (undergraduate and graduate students: CB, AF, MM, AM), a faculty mentor/project lead (SLW), and two faculty co-investigators (EAV, MK) who collaborated during all stages of the research process. Throughout data collection and analysis, the young adult researchers met independently of the project lead to discuss protocols and emergent findings. During full-team meetings, all researchers discussed updates and exchanged feedback. In qualitative research, researchers bring value by leveraging “their theoretical perspective, bank of knowledge, personal experience, methodological repertoire, creativity and imagination” (Eakin & Glad-stone, 2020). Through our co-learning approach, the young adult researchers brought their insider perspective (Tracy, 2010) as TikTok users to design an innovative study protocol and interpret the videos. SGM team members brought important perspectives to data collection and interpretation. A deeply collaborative relationship between faculty and mentees subverted academic power imbalances while simultaneously inspiring a passion for research among the young adults, which elevated our analysis.

This study was determined not to be human subjects research by the University of Iowa Institutional Review Board.

The 198 SGM videos in our dataset received a combined 1,485,499 likes and 23,549 comments. Videos ranged in popularity (min likes: 3; median: 1300; max: 2,000,000). Of the 198 SGM videos, 46% discussed addiction and 16.7% (n = 33) made explicit or implicit reference to ambivalence (co-occurrent viewpoints that were mixed, and sometimes, contradictory) toward vaping or its negative consequences (Table 1). One third of videos referenced a relatable experience, habit, or phrase that would be familiar to viewers who vaped. Videos also depicted sensory effects (14.1%), discussed vaping in the context of romantic or sexual partnership (14.1%), showed off vape collections or vape tricks (13.6%), and described experiences of initiation (7.1%) and cessation (9.1%).

In our qualitative analysis, we identified sentiments and themes concerning the intersection of SGM AYA vaping perceptions and TikTok practices. Important themes included: nicotine addiction, side effect ambivalence, vaping as identity, vaping in relationships, and vaping for social media trends. In our dataset, TikTok videos typically featured one individual. To act out a conversation, individual creators posed questions in video text that they answered in the video or they edited together several clips of themselves playing multiple characters. This delivery format was used by multiple creators and appeared across themes.

In this qualitative, young-adult engaged study, we leveraged both scientific and cultural knowledge to identify important narratives in SGM vaping content on TikTok, including commentary on one’s addiction, ambivalence towards health consequences, and use of vaping to participate in cultural trends. With a non-SGM comparison dataset, we were able to discern themes and sentiments unique to SGM creators, including partner influence on initiation and vaping as a component of identity, as well as identify higher prevalence of ambivalence narratives and lower prevalence of cessation narratives in SGM content. Using TikTok as a public health surveillance tool can enhance understanding of current vaping beliefs and help anticipate culture shifts, particularly among more dynamic populations, like AYA. Our findings suggest that SGM vaping subculture on TikTok reflects positive vaping messages and an intersection of vaping and SGM identity in a way that might perpetuate positive vaping norms.

Our findings are consistent with the current body of work that suggests vaping content on TikTok is prevalent and shares positive messages about vaping (Basch et al., 2021; Morales et al., 2022; Rutherford, Lim, et al., 2022; Sun et al., 2021). Videos that featured a creator’s nicotine addiction appear consistently in vaping TikTok studies (Morales et al., 2022; Sun et al., 2021; Tan & Weinreich, 2020). Here, we further establish that creators mention their unintentional (or “accidental”) addiction, sometimes starting to vape because of partners or friends, which is consistent with reports that young adults who experiment with tobacco and nicotine perceive low susceptibility to nicotine dependence (Mantler, 2012; Moffat & Johnson, 2016). Given that exposure to social media portrayals of risky behaviors with high “like” counts activates brain regions associated with reward processing and attention (Sherman, Payton, Hernandez, Greenfield, & Dapretto, 2016), vaping videos with high engagement may encourage viewers to try vaping.

Our focus on SGM AYA adds important nuance to our understanding of TikTok’s vaping content. Our findings suggest SGM videos more often describe ambivalence to negative health effects of nicotine use and the importance of nicotine use in romantic/sexual partnership, and they less frequently depict cessation, than non-SGM videos. Recent work has reported adolescents generally associate vaping with negative traits, including vaping being “unattractive” (McKelvey, Popova, Pepper, Brewer, & Halpern-Felsher, 2018); our work complicates this previous finding. We found there was no consensus on the perceived effect of vaping on someone’s attractiveness. Moreover, SGM videos uniquely portrayed vaping as an identity, which is consistent with previous work that reported SGM adolescents who vape are more likely than their non-SGM vaping peers to identify as a “vaper” (Donaldson et al., 2021).

In the context of TikTok, the content we observed that downplays addiction and health consequences and integrates vaping into partnerships and SGM identity presentation may further normalize vaping in SGM AYA culture. Viewing more tobacco content is associated with higher likelihood of vaping (Emory, Buchting, Trinidad, Vera, & Emery, 2018) and having more positive expectancies of nicotine vaping (Pokhrel et al., 2018). A recent study suggested even passive media exposure leads to vaping among AYA (Liu, Lochbuehler, Yang, Gibson, & Hornik, 2020). We find vaping videos included sentiments of indifference that are accompanied with the glamorization of physiological side effects or dismissal of health consequences. Our analysis adds that this ambivalence is more prevalent in SGM content. When these themes are pervasive, they may reinforce pro-tobacco norms, perceptions, and attitudes. Moreover, vaping messages from SGM creators, especially videos that reference SGM identity, might be particularly persuasive for SGM AYA.

Nicotine vaping content on TikTok may disproportionally influence SGM AYA. SGM AYA already experience disparate peer victimization (Gill & McQuillan, 2022) and therefore might be compelled to participate in TikTok’s vaping culture as a coping mechanism for minority stress (Evans-Polce et al., 2023). As such, SGM AYA might find both a sense of community and, as (Ma et al., 2022) described, its associated “social incentives.” SGM social spaces, such as bars, have traditionally been utilized by the tobacco and alcohol industries as venues for targeted marketing, which has contributed to substance use disparities (Belt et al., 2014; Stevens, Carlson, & Hinman, 2004). Vaping content in online SGM social spaces may similarly normalize and encourage vaping. Further, a recent study suggested adolescent SGM males vape to fit in with their peer groups (Ma et al., 2022); TikTok might present another opportunity for this process to occur.

Our findings suggested vaping is an important facet of SGM identity on TikTok. Beyond the scope of this study, future work may validate this finding outside the context of TikTok in SGM AYAs’ offline realities. By stratifying our results by identity in an exploratory analysis, we offered a glimpse into which themes may be more prominent in different subgroups, which is especially important because tobacco use prevalence varies across SGM identities (Romm et al., 2022). In SGM-focused research on tobacco, effort should be made to separate identity groups to highlight specific perceptions, mechanisms, and strengths that can be leveraged in focused interventions.

Social media observation is a powerful tool for research on an array of populations and health topics (Kanchan & Gaidhane, 2023). To prepare for emergent threats in a quickly changing tobacco and nicotine landscape and maintain effective tobacco control policies (Ling et al., 2022), social media research offers a venue for rapid, fluid methods for data collection, analysis, and response. For AYA specifically, future work should continue to use widely used social media platforms to discern attitudes and behaviors in an unobtrusive manner. Studies that leverage machine learning techniques might draw from the qualitative findings here to categorize large samples. Social media research about AYA content, including machine learning studies, should use robust collaboration with young researchers to inform its design, interpretation, and implications. Longitudinal studies can document how social media content changes over time as social norms, product markets, and social media policy change. When conducted thoughtfully, especially as ethical and methodological guidance standardizes (Al-Zaman, Khemka, Zhang, & Rockwell, 2024; Bour et al., 2021), social media research in collaboration with young people advances the field substantially.

Public health practitioners may address vaping perceptions through clear messaging (Escoto, Watkins, Welter, & Beecher, 2021) and tailored SGM campaigns like FDA’s “This Free Life Campaign” (Guillory et al., 2021) using short-form videos. Our finding that videos downplay addiction are consistent with other observational TikTok studies about vaping (Allem et al., 2019; Basch et al., 2021; Marynak et al., 2022; Morales et al., 2022; Purushothaman et al., 2022; Rutherford, Sun, et al., 2022) and reports from intervention development studies that addiction messaging is not as impactful as other messaging topics (Escoto et al., 2021; Stalgaitis, Jordan, & Isaac, 2023). We found SGM videos about addiction more often conveyed personal addiction than non-SGM videos about addiction, which might reflect more dependence among SGM AYA who vape, reflect more self-awareness among SGM AYA, and/or reflect differences in how creators use social media. Additional investigation into identity-specific addiction and vaping norms and perceptions may assist in making interventions to change norms and perceptions more targeted, and consequently, more effective. Moreover, since partnerships also served as an influential mechanism of initiation for SGM people, vaping interventions focused on interpersonal relationships may be particularly effective. We hope these observational findings from short-form videos generate hypotheses to test in the growing body of theoretically-informed (McQuoid et al., 2023), community-engaged work (Tan, 2024) to reach SGM AYA with vaping prevention and cessation content through social media (Hinds et al., 2021; Lee et al., 2022; Patterson, 2024a; Patterson et al., 2024b).

Regulating nicotine vaping-related content on social media platforms is an important yet complicated goal for public health. The unique design of TikTok and its algorithm complicates the mechanisms through which vaping content influences AYA with no vaping, light vaping, and heavy vaping. TikTok claims to monitor and remove harmful vaping content; however, a recent article found removal “does not specifically target content with high engagement” (Rutherford, Sun, et al., 2022), suggesting current regulation efforts must be significantly refined. To promote AYA health and prioritize disparately targeted groups like SGM AYA, we must continue to scrutinize current practices and recommend new routes for action. Tactics like limiting AYA exposure to pro-tobacco content through age-gating (restricting access to content based on age) or efforts to remove content that circumvents moderation (e.g., using #v@pe instead of #vape) may be promising initial steps.

Our qualitative study, led by young adult researchers, identified common sentiments in vaping content generated by SGM creators. We reported several key emergent themes, such as vaping addiction and an associated ambivalence, vaping as a salient part of their lives, and the roles of vaping in partnerships. Parallel to offline realities, vaping culture appeared integrated in SGM culture on TikTok.

This study reinforces the need for vaping content regulation on social media, as well as the continued development of vaping prevention interventions, not only to support SGM AYA, but also other groups that have been disproportionally targeted by the tobacco and vaping industries. Future research should continue to engage with social media platforms like TikTok to both monitor elements of vaping practices and gain authentic information regarding priority populations. Building research teams that include both scientific expertise and lived experience and that are grounded in co-learning enriches and accelerates social media-based health investigation.