Risky Business on TikTok: Qualitative Analysis of Hazardous Substance and Alcohol Challenges Among Youth

TikTok’s rapid growth has been accompanied by an increase in viral “challenges,” some of which encourage young adults to engage in hazardous behaviors, such as ingesting toxic substances, misusing over-the-counter medications, and consuming alcohol/drugs. This study systematically characterizes such TikTok challenges, evaluates their medical risks, and explores how this content may inform clinical education and public health prevention efforts.

This qualitative content analysis examined TikTok videos depicting harmful challenges, identified through platform hashtags. Eligible videos (with audio, non-duplicate, and visually or verbally representing a challenge) were coded by two independent researchers using standardized abstraction forms capturing challenge characteristics, routes of harm, substances involved, documented complications, demographic targeting, and associated warnings. Safety suggestions or health information were classified as misinformation or disinformation based on consensus ratings from four board-certified emergency physicians; discrepancies were resolved through third-party adjudication. Descriptive statistics and Cohen’s kappa coefficients summarized findings.

Forty-five TikTok videos met inclusion criteria; 38 (84%) represented highly prevalent youth challenges (>30,000 views). Most participants were adolescents or young adults; 34% were teens or preteens, and 53% male. Challenges were disseminated primarily via the For You Page algorithm, shared audio/visual templates, and hashtag-based “copy-and-remix” practices, with reach driven by high completion rates and watch time, followed by rapid shares, comments, and saves. All challenges were judged medically dangerous and associated with potential burns, poisoning, seizures, arrhythmias, coma, or death. Nineteen (42%) challenges (e.g., Tide Pod, Dusting/Chroming, Benadryl, Nutmeg) were later banned yet continued to circulate through re-uploads. Misinformation or disinformation was identified with every challenge. Interrater reliability was substantial (Kappa = 0.83).

Hazardous TikTok challenges are widely disseminated, highly engaging, and disproportionately involve youth, exposing participants to substantial risk of severe toxicity and injury while revealing critical gaps in platform moderation and health communication.