Abstract
BACKGROUND: YouTube has become a prominent source of health information, particularly during the COVID-19 pandemic. However, the quality and reliability of its content remain variable. This study aims to evaluate the impact of the pandemic on the quality, reliability, and informational structure of smoking cessation videos published on YouTube. METHODS: This comparative descriptive content analysis included 600 YouTube videos collected across three periods: pre-COVID (November 2018-October 2019), mid-COVID (June 2020-May 2021), and post-COVID (June 2023-May 2024). For each period, the top 50 most-viewed and 50 randomly selected videos for the keywords "quit smoking" and "smoking cessation" were analyzed. After applying exclusion criteria, 271 videos were included. Video quality was assessed using the Journal of the American Medical Association (JAMA) Benchmark Criteria and Global Quality Score (GQS), while engagement metrics (view count, like ratio, watch time) were recorded. RESULTS: Of the 271 videos, 66.8% were classified as useful, while 33.2% were misleading. A significant difference in content quality was observed across the three COVID-19 periods (p = 0.017). Videos from the mid-COVID period were significantly more likely to be rated as useful and high-quality compared to the pre-COVID period (p = 0.030), reflecting a temporary increase in content reliability during the pandemic peak. Educational content consistently showed the highest quality scores across all periods. In multivariable regression, GQS was the strongest predictor of perceived usefulness (OR for moderate vs. low = 38.9, p = 0.001). The logistic regression model demonstrated excellent discriminative performance, with an AUC of 0.912 (95% CI: 0.879-0.946; p < 0.001), effectively distinguishing useful from non-useful videos. CONCLUSION: The COVID-19 pandemic led to a transient improvement in the quality of smoking cessation content on YouTube, driven largely by contributions from healthcare professionals. However, the post-pandemic decline in content quality underscores the need for sustained digital health strategies and greater professional engagement to promote reliable online health information.