YouTube recommendations expose viewers to pro-tobacco content

YouTube is a popular social media platform that many people turn to for health information, including on tobacco products. Research from Truth Initiative published in Nicotine and Tobacco Research finds some viewers seeking tobacco-related information on YouTube were recommended pro-tobacco videos, even though they started with anti-tobacco content. Many of these videos come from self-described medical experts rather than public health organizations and could spread misinformation about tobacco and nicotine addiction. 

Nearly 90% of YouTube users in a study said they use the platform to look for health information. YouTube’s “recommended video” algorithm drives over 70% of views, making it a powerful influencer of reach and exposure.

The study authors call for strong regulations to ensure that social media platforms are transparent about their algorithms and have safeguards in place to protect young people from potentially harmful content.

Key takeaways from this study

• 13% of video recommendations on anti-tobacco videos led to pro-tobacco videos. While more than half (56.1%) of videos led to recommended videos aligning with the original stance on tobacco, only 10.4% of pro-tobacco videos led to anti-tobacco videos compared to 13.3% of anti-tobacco videos that led to pro-tobacco videos.
• More users go from anti-tobacco to pro-tobacco videos rather than vice-versa. Researchers estimated that between 1.9 million to 3.2 million viewers would click to watch a pro-tobacco video from an anti-tobacco video, compared to 1.5 million to 2.4 million viewers who would watch an anti-tobacco video suggested from a pro-tobacco video.
• For pro- to anti-tobacco journeys, YouTube rarely recommended videos from credible public health sources (6.3%). Instead of pointing to videos from the Surgeon General or organizations like the Centers for Disease Control, recommendations from pro-tobacco videos mostly led to videos by organic users (35.9%), news/media (29.7%), and self-described medical experts (28.1%).
• Self-described medical experts expose viewers to pro-tobacco content. When anti-tobacco videos suggested pro-tobacco content, most of these suggested videos (81.6%) were created by people describing themselves as medical or public health experts, dramatically higher than just 28.1% for pro-to anti-tobacco videos.
• Single content creators can have outsized effects on content recommendations. Four YouTube channels accounted for all recommended anti-to pro-tobacco videos from a self-described subject matter expert. One podcaster with two channels accounted for 95.2% of these recommendations. 

Understanding social media algorithms is key to promoting public health information

Strong regulations and enforcement regarding social media content, and the algorithms that dictate viewership, should be put in place. 

Transparency about how social media algorithms work could also help researchers and regulators understand how to create and share public health messaging content.