Abstract
BACKGROUND: Despite consistent evidence of the relationship between alcohol use and cancer risk, awareness of the alcohol-cancer link remains low among American adults. Given the increasing prominence of social media as a health information source, this study systematically examined samples of alcohol-related Instagram and TikTok posts to identify mentions of the alcohol-cancer link and characterize post content. METHODS: We collected public Instagram and TikTok posts made on or before May 12, 2024, via a hashtag-based search for posts tagged with #alcohol, #beer, #wine, #liquor, and #cocktail. Following an iterative codebook development process, two independent coders qualitatively reviewed random 2% (n = 1666) samples of Instagram posts and 20% (n = 725) samples of TikTok posts. Cohen's κ for each coding category ranged from 0.65 to 1.00 for Instagram posts and 0.61 to 1.00 for TikTok posts, while percent agreement for codes with low training sample prevalence ranged from 96.0% to 100% for both platforms. We examined posts identified as featuring intoxication or binge or high-intensity drinking, having been made by an influencer, featuring alcohol products, and targeting specific groups using inductive thematic content analysis. RESULTS: Across both platforms, only one post, a TikTok video, mentioned the relationship between alcohol use and increased cancer risk. Posts often positively depicted alcohol and commonly considered beverages containing large amounts of alcohol as single drinks. 48.6% of Instagram posts were made by commercial entities and 69.7% showed an alcohol product. 68.1% of TikTok posts were posted by influencers, 52.7% were comedic, and 24.7% referenced intoxication, binge, or high-intensity drinking. CONCLUSIONS: Cancer risk communication is largely absent among Instagram and TikTok posts, which often portray alcohol use in a positive light. Social media represents a critical, yet underutilized, channel for disseminating public health information about the alcohol-cancer link. Content analyses can inform strategic, audience-tailored messaging for improving public awareness.