People have flocked to TikTok in droves over the past few years — but research into the social media giant’s potential health impacts hasn’t kept up. Despite the fact that TikTok now has over 1 billion users, public health researchers know very little about the health effects it might be having on the platform’s (mostly young) users. That’s concerning, because researchers know social media platforms can be harmful, especially to the health of some groups of teens and adolescents.

“The platform is so massive, but there’s almost no scholarly investigation into it,” says Marco Zenone, a health policy researcher at the London School of Hygiene & Tropical Medicine.

Zenone believes it’s urgent for researchers to start figuring out if TikTok has similar issues to other platforms, like eroding the mental health of some teen girls and failing to slow conspiracy theories. That’s why, along with collaborators, earlier this month he published a proposed research agenda outlining the areas experts need to investigate. They include the way alcohol use and vaping are presented on the platform, the medical advice given by users — made more urgent in light of COVID-19 misinformation — and moderation policies. They’re also worried about what happens to users when videos sharing personal, sensitive stories go viral, and if the platform has similar impacts on teen mental health as Instagram.

“The research is very behind, considering how much reach TikTok has,” Zenone says.

The Verge spoke with Zenone about his proposed agenda and why research into TikTok’s health effects matters.

This interview has been lightly edited for clarity.

Why don’t we know much about TikTok’s health impacts?

I think it rose to prominence so quickly, and research hasn’t been able to catch up. So right now we know that TikTok has 1 billion users, and we see a lot of the research coming out is still on Facebook, Instagram, and related platforms but hasn’t shifted in TikTok yet. That’s kind of concerned us as public health researchers because we’ve seen what happened in the past when it’s left unchecked.

What did you end up identifying as the important areas to study, and why are they so key?

Some of the things that we’ve flagged are just some of the issues that we’ve dealt with on other social media platforms, and have been documented issues on other platforms, but that we haven’t looked at yet on TikTok. So, for example, the promotion of health-harming products — products like Juul spread on Instagram spread faster than health researchers could study how the conversation was expanding. That’s one reason we need to be proactive with this kind of research and document what’s happening around the platform.

A lot of people also give health advice on the platform, but we don’t really know the quality of the health advice. What research is available tells us that when someone has a credential to speak on a topic, they’re usually accurate. But if you introduce a conflict of interest, like someone selling a product, the quality goes down. And that can be concerning depending on how someone is using that health information.

We also know misinformation is a problem on social media, but we don’t know the extent of it on TikTok. We also need to look into the dissemination of hateful or sensitive content on TikTok. With a billion users, we have to ask how good its moderation actually is.

Are these questions similar to the ones we ask around other social media platforms, or is there something unique about TikTok here?

The main difference I see is that TikTok really has the opportunity to learn from Facebook, Instagram, and other social media platforms. The shortcomings have been documented. So the big thing is the newness. Social media usually faces the same problems across platforms, even if on different scales. That’s one of the reasons we need to do the research and see what’s happening.

The user base of TikTok is also a bit different. There are a lot of young people on the platform, and I think we have to keep that in mind as we do research.

Why is understanding TikTok so important?

Our view is that TikTok is going to be here for quite a while. And we know that the majority of people who use it are younger people. So it’s just about making TikTok as safe as possible.

I believe that we have to keep TikTok accountable. And one of the ways that we can do that is making sure that we’re keeping up to date with what’s happening on the platform