Defensive responses to the U.S. Surgeon General’s alcohol-cancer advisory: A topic modeling analysis of TikTok comments

Objective On January 3, 2025, the U.S. Surgeon General, Dr. Vivek Murthy, released a report on alcohol and cancer risk. Because public awareness of the alcohol-cancer link remains low, the report is likely to elicit defensive responses. This study aimed to identify the types of defensive responses that emerged on TikTok, a popular social media platform. Method This study used TopicGPT, a state-of-the-art, prompt-based topic modeling technique, to analyze comments and replies posted under videos that directly referenced the advisory or discussed alcohol-related cancer risks. To enhance topic representation and interpretation, a human-in-the-loop approach was integrated throughout the topic modeling process. Results Eighteen distinct topics were identified and grouped into seven types of defensive responses and one message acceptance category. The most prevalent defensive responses were issue derogation and source derogation , reflecting skepticism toward the message content and source. Users questioned the biological mechanisms of alcohol-cancer links, cited anecdotal experiences to contest population-level risk claims, and expressed distrust of government intentions and concerns about alcohol industry influence. Blunting and fatalism were also common, reflecting distraction from the message or normalization of cancer risk as inevitable. Additional defensive responses included boomerang effect , humor/sarcasm-based dismissal , and message fatigue , reflecting reactance, trivialization, and exhaustion with repeated warnings. Although less frequent, some comments reflected message acceptance , such as showing support for sobriety. Conclusions Social media users exhibited a range of defensive responses to alcohol-cancer messages. Understanding these responses can inform communication strategies designed to reduce defensiveness and improve public understanding of alcohol-related cancer risks.