Epidemiology Counts – Episode 33 – Social Media, Youth Mental Health

The media landscape has changed dramatically in the past decade. Social media platforms are a major part of many people's day-to-day lives. If you are a business owner, you may rely on it for connecting to potential customers. If you are a researcher, you might use it to communicate your newest findings to the public or fellow researchers. And if you are a politician, you are considered a fossil if you don't engage with it. If you are listening to this podcast, you likely heard about it on Twitter and I likely promoted it there. Social media platforms are subject to little content regulation. It is generally up to the companies to decide what can be posted and by whom. The practices of companies like Facebook are largely hidden from the public and thus we know little to nothing about their potential impacts on public health. As the companies conduct all their research internally. In October of 2021, a former Facebook data scientist testified to Congress that their internal research showed potential harms the social media platform can inflict on youth mental health, including increasing suicidal thoughts and encouraging eating disorders, especially among girls. The former employee called on Congress to regulate the tech giant and others like it, much like they do tobacco companies. However, there are certainly potential benefits to social media for many, including encouraging engagement with family and friends more easily, especially in times of, say, a pandemic. I'm your host, Cassandra, assistant professor at Johns Hopkins Bloomberg School of Public Health and this is Epidemiology Counts from the Society for Epidemiologic Research, a podcast that gives you up-to-date information on the state of health science straight from researchers who are deeply involved with this work. Today I'm joined by Epidemiology Counts host, Brian James, associate professor at Rush University Medical Center. Hi, Brian. Hey, how are you doing? I'm excited for this conversation. Same here. And we're joined by an expert in the area of youth mental health research, Kira Reem. Kira is a recent graduate of Johns Hopkins University and is currently a postdoctoral fellow at the Columbia Mailman School of Public Health. Thanks for joining us, Kira. Thanks so much for having me. It's really a pleasure to be here. So we are both pretty excited about this episode. Brian and I both have young children and inevitably the topic of what their future in the world of media and social media is going to look like. And I can only imagine there are a handful of days left before my son is asking me about a TikTok account or Instagram or anything like that. So I'm very excited about the content of this episode. Got to get ready. Yeah. It's exactly right. We're scared, Kira. We're scared. A little bit. Just a smidge. Just a smidge. So before we dive in on media and social media, what are generally regarded as major threats to youth mental health? For example, what would a pediatrician say to keep an eye out for in day-to-day life? So I think there are a variety of things that we can think about when we're thinking about youth mental health these days. One of the first things I want to start off with is that we do have robust evidence now that depressive symptoms have increased amongst youth, specifically in the past decade. There's kind of, if you look at different studies, there's sort of an inflection point around 2010 or 2011, where a pretty steady rise in depressive symptoms has really taken off since then. And so there's definitely been a lot written in the literature about why this might be happening and what are possible things we can do to curb it. I think, obviously, the topic of this podcast is social media use. I think that might be one factor that's contributing to a rise in mental health problems among teens, but it's certainly not the only one, and it's not the only one that researchers have focused on. I think there's a variety of things that teens have to worry about these days. And I think there's varying degrees of evidence available in the literature for some of these different factors, but things that I see talked about all the time are things like exposure to both the stress of climate change occurring itself, but also just the harm of a changing climate and hotter temperatures, what that might mean for mental health. Generally declining sleep quality and quantity, exposure to bullying, exposure to possible violence at school, and in the community, we see these very highly publicized school shootings that have occurred, and so that can have implications for mental health. There's also just a rapidly changing substance use landscape where we have these different forms of substance use that teens are using more and more. And finally, there's just dramatically rising wealth and equality. And so together, I think these form a lot of different stressors for adolescents, both in terms of how they view themselves in the moment, but also sort of their prospects for the future, like what is their adulthood going to look like. And I think that a lot of these things can weigh on teens these days. So I think you just gave me like six ideas for a follow up episode, I mean, the climate change one really struck me especially, my wife is reading that Naomi Klein's climate or I think capitalism versus the climate or something like that came with the title. But now, now, now I'm going to spend the rest of my day thinking about this and I'm not going to tell her about this conversation because that's going to stress her out even more. So yeah, we didn't say anything about that. That's sort of like a more burgeoning field than something I'm getting involved with more and more during my postdoc, just via some some advisors I have at Columbia. And so it's been, yeah, it's been really great, good exposure for me. Yeah, we had a climate change episode and we talked a little bit about how it affects mental health, but specifically on, you know, the future for the youth. That's a really interesting, you know, focus, but all right. So basically, adolescence in the modern world is a landmine is basically the takeaway there. Great. So focus it, you know, we got to talk, we only have an hour here, so let's talk about social media. So, you know, what is it about social media? Like what's the, well, first of all, I have a two-part question, I do this often, sorry. What is it specifically about social media that you, you mentioned really kind of adds to this pressure on adolescence and this stress? What is it about social media that does that? And then on top of that, you know, what are the primary concerns for youth mental health that are associated with social media that has emerged from the research? So I'm actually going to answer your questions in the reverse order, I think that's a little bit easier for me. So I think for your second question, you were asking about just the general concerns related to social media and mental health for youth. I think there's a variety of concerns and this probably came through in my first answer, but depression is probably the one that we see most commonly talked about in the literature and I think that's what's covered probably most in the media as well. But there are a variety of other issues related to social media and digital media that could have implications for mental health and these include things like possible anxiety symptoms, poor body image symptoms of ADHD. So sorry, ADHD is attention deficit hyperactivity disorder. So symptoms like inattention and just related constructs there. There's also issues related to possible substance use. And then finally on more serious note, there's also been concerns raised about possible exposure to self harm as well as suicidal behaviors. So it's really, it's really like quite a vast number of things that people have looked at in the literature and as possible harms of social media use. Right. And those harms are pretty, have been there for a long time. Yeah, as you said, they've gotten worse recently, but you know, adolescents have been struggling with a lot of these harms for a long time. So what is it about social media that this is the first part of my question that you're probably about to answer that exacerbates that? Like what do we think is going on there? Yeah. So I think there's a number of things going on there. If social media is interesting because it's about what happens on social media when teens are using it. But I think it's also about what teens could be doing instead, like teens only have so much time. And if they're spending time on social media, well, that's taking the place of other activities that could be beneficial for mental health instead. And so I think in terms of things that are actually happening on social media, we can think about just the sort of idealized and sensationalized images that teens are seeing on social media. A lot of times what we see discussed is related to body image, particularly for girls. And these things can translate into things like reduced self-esteem. So those are kind of mechanisms that have been discussed related to social media. In terms of what social media could be taking away from in terms of what adolescents could be doing instead. One thing that comes up a lot is definitely reduced sleep quality and quantity. We know that sleep over time has declined in adolescence. And sleep is so intimately tied with mental health. And actually poor sleep is a symptom of many mental health disorders themselves. And so that's kind of been tied in there about how teens might be using social media instead of getting enough sleep or it might be just heavy use might be contributing to poor sleep quality. And finally, again, when teens are using social media, there's things that they're not doing in person. So these can include things like in person social interactions that could be good for their mental health as well as things that we know that things that we've known for decades are good just generally for well being like physical activity. Yeah, we did a previous episode on screen time specifically and kind of the takeaway I took from it is that exactly what you just said the worst thing about screen time seems to be if you're in front of a screen, you're not doing all the other things that are good for you as a kid, being active, all that. And there's not that much evidence that actually looking at the screen is bad for you. It's more the negative aspects of what you're not doing. So that's interesting. Social media may be a similar thing where it could be the content and what you're exposed to. And it also could be you're just sitting there on social media until 2 AM instead of sleeping or doing all things you're supposed to do. Yeah, and I think the design of a lot of social media websites and this is probably purposefully done but can really pull people in and it's hard to break that once you're just just if you think about the way that a social media app works like the infinite scrolling, like it just it never ends that you don't get to the end like it will just keep feeding you more and more content and so it's really easy to just get to get stuck in that cycle. Yeah, and I remember the gram hole all the time. Oh, yeah, I remember I remember an interview with someone from the New York, it wasn't from the individual wasn't from the New York Times, but they were one of the former head of development at one of the major companies. I can't remember if it was Twitter, Instagram, whatever, but they're the whole point of the article was that you think this is about choice, but there you don't realize that these companies design these software packages and their algorithms to remove your choice to like encourage you further and further like they like they have they've spent millions and millions developing these things to engage you as much as possible. So it's like it doesn't it's it's not even that you know you can't even just like write it off and saying like oh well you just you can just stop looking at your phone. Yeah, it's like it's actually like much deeper like in terms of psychology of and for a developing mind like a like an adolescence you know that doesn't have that decision making capacity that you know or that that was the you know the frontal lobe development. It may just keep going and going and going, yeah sleep be damned, you know, yeah, 100%. And I think I think is actually this discussion brings up an interesting point. We might talk about this later in the in this episode, but I know that probably some questions you have are related to what what what parents and what teachers can be doing to to sort of reduce the possible negative impact of social media use. But I also think it's important to hold people who like work in tech companies responsible for these kinds of things and just ask them to design better social media platforms that minimize the potential for possible harms. And I think I think there's there's big questions there about how we can hold tech companies accountable that we need to look more at in the future but I do think that that's that they are a key stakeholder in this conversation that I think needs to be needs to be spoken to directly. That's a very good point and we probably won't ask you a lot of questions about that but that overall statement is very well taken. And also, you know, the government, the government has to regulate these companies. So you know, the tech companies and the government have to do something can't be left up to us parents and teachers to flounder through this on our own. Yeah. So, so before we go on to other questions, one thing that struck me in terms of threats to youth health that you've mentioned with regarding social media that I didn't think about with substance use, that's that that one kind of struck me and I'm kind of curious what are the pathways or mechanisms there because it's not when they came to my head immediately but I have an idea after we hear myself. Yeah, I want I want to know how like how does social media potentially encourage substance use in youth or adolescents after we hear the experts take on this I'll tell you my exposure to this but yeah fair enough. So I can answer this question from the perspective of I did a study that was looking at social media use in relation to alcohol use specifically so I can't I don't know if I can speak to substances generally but at least with regards to alcohol I can speak to that. I think I think probably the primary mechanism that's been looked at in the literature is just exposure to marketing just exposure to these types of ads that can can can pop up on different social media websites for different different substance use outlets and so that's probably the main mechanism that's been studied is really exposure to advertising. Other possible mechanisms are just exposure to peer use. If you see or if you see your peers online using substances you might think that though that's that's the cool thing to do these days and so that's another that's another pathway via which time spent on social media could contribute to substance use. And here's the third one that I was going to bring up exposure to celebrities and influencers partying thinking when I'm flipping through Instagram. I can't tell you the amount of rappers and you know like it's not even people I'm following it's just people sharing videos of of rappers or celebrities partying you know smoking you know whatever drinking and I know for a fact that kids are are are you know magnetized to that content you know like that looks cool to them right and they're going to seek that out and they're going to look for it and that's what being cool looks like to a lot of people so yeah yeah I absolutely agree and I'm well out on that is I think that I think that the the sort of realm of people and celebrities who have been featured in these advertisements before has kind of expanded and like for example I follow a lot of I follow some professional athletes on Instagram and quite a few of them are sponsored by different alcohol companies and I and I've seen that more but it's ultra so it's only 80 to 80 calories right right right and I've seen that and that's kind of alarming because that sort of departs from I think I think it's more I think it's easier to probably probably for parents to just to regulate their child's use around like following celebrities on social media and kind of draw a line there but but it's harder when you have these role models who are who are primarily like athletes like who could be a really positive role model for a lot of teenagers and it's difficult for me as an adolescent researcher to see these types of to see these types of things popping up on my Instagram and wondering wondering which teens are also seeing this and which ones are changing their behavior in response to it yeah before before he was shamed out of the cycling world I think you know Lance Armstrong was probably highly regarded by by younger athletes in that area and I think he was sponsored by Mikolov and I think there is I can't remember for sure but I'm pretty sure that there is an ad of him with like a Mikolov ultra just like you mentioned literally the one that I thought of immediately as well yeah yeah I mean this is a really good point but I you know I think the advertising is definitely a major issue but I think it's also just videos of concerts and interactions and parties that that I am seeing like the most substance use is going on with with with these influencers and and you know not as much athletes but more like musicians and stuff like that right I just wanted to bring up an anecdote and you know he won't listen to this so he won't care but I have a nephew who's about 13 to spend a bunch a couple weeks with him and it was such an interesting insight into the world of how an adolescent interacts with social media that both alarmed me and also kind of gave me some comfort but I don't but this is where I'm getting at with it where he was seeing a lot of content that I don't necessarily think he should have been seen right and he would show it to me like look at this this is hilarious and I'm like you know that's not that's pretty adult like I don't think you should think that's funny and he's like well I understand that this is ridiculous like you know he was trying to explain to me like this is people being absurd and I would not behave like that so I'm like okay that I guess he kind of gets that but at the same time I'm like when I was 13 I wasn't exposed to all those images flooding my brain and kind of normalizing that behavior you know every now and then we'd see in a movie and you know the 80s like you know where they're doing ridiculous stuff but like that would really stand out to you like I went to a movie and I saw people doing crazy stuff they're seeing this like on an hourly basis you know so it's just that flood of imagery that even if someone like my nephew who's a responsible kid can say I get it I shouldn't be doing this how do you believe that you know how do you as a parent say okay I'm alright with you seeing this right it's it's it's just constant and it's hitting teens at a really vulnerable time these are kids these are kids who are trying to come into their own and develop their own self-image and figure out who they are and that the types of things that they're flooded with on social media like could play a role in that yeah yeah so in terms of the evidence for all this like you know it it's hard for me to remove myself from this and think that my opinions are fully objective so I'm kind of but you know everything you're saying here here is like and like checking off the marks in my head like yes that's what I thought too yeah for sure totally but in terms of the actual evidence like scientific evidence in publications like what what do we have because and I asked because I've seen I can't remember how far back it was but there was a there's like a back and forth and and it was literally just two articles but they're pretty short like the kind of pithy like social media is bad for you and then the response is like social media is not that bad for you and so it seems like there's certainly even on the scientific end of it like researchers are are equivocal on this so I'm kind of curious in terms of the weight of evidence where where do you find the most compelling evidence or at least what are the factors regarding social media's influence on youth health that are really the most kind of like well established or at least kind of like compelling in terms of what we have scientifically speaking. I'm really glad you asked this because I think I think the word that you used in asking the question equivocal is is a really good way of kind of summarizing the actual hard scientific evidence we have on this I would say that I would say up front that there's definitely no consensus in the literature of the effect of social media on mental health both in adolescence and also in adults I think I think generally my my take my sort of overarching summary of the literature in in youth is that I think that social media probably has some negative implications for some youth and so what I'm trying to imply there is that there's there's moderation going on and and for for our audience moderation is when we see is when we see an effect of something on something else but only in a subgroup so basically I think that social media might be causing some harm just among a certain subgroup of adolescents who have some pre-existing vulnerabilities that might lead them to these more negative outcomes when they use social media I like I said before I think there's a lot of different factors that are contributing to a rise in depressive symptoms among adolescents and I think there's by no means a clear answer to the extent to which social media is one of those factors I think I think it's generally really difficult and if we look at the scientific literature to design studies around this and I'd say in my opinion the largest hurdle is that it's really difficult to measure social media use you can think of all these different types of ways that we could possibly measure it. My phone measures my social media use right I get a little alert you're at your limit buddy and I'm like yeah ignore right and that is that is probably measuring the amount of time you spend on social media and and I have that set up on my phone too and yeah it's it's kind of alarming how much time I find myself spending on it sometimes but but that's right but that's really just one way of measuring of measuring social media you can look at all these other types of indices like what types of platforms you're using are you using Facebook are you using TikTok are you using Instagram those are all designed differently and kind of have different types of information on them and so we could think about why different platforms might have different implications for mental health so that's one way of looking at it another way of looking at it is not not just the amount of time we spend using it but some index of actual engagement with social media so possibly related to like how much you're scrolling how many likes you give out how many likes you receive how many comments you make kind of getting at like what are people actually doing on social media and so and so because of these measurement issues I think generally that just makes it it makes it really hard to summarize the evidence based on social media and youth mental health because studies measure all these constructs very differently and sort of trying to synthesize that and and come up with like a with a unified understanding of what this means for mental health is can be really difficult because it's like what are you actually measure what is the harmful thing you know if you almost put the cart before the horse when you decide what to measure because you may not be measuring the thing that's harmful you know but just to play a little bit of devil's advocate I feel like you know it probably easier to measure a lot of things about social media use than a lot of other things that we're trying to measure in epidemiology like nutrition like I mean gosh like trying to figure out what people actually put in their body is almost like an impossible task whereas everything social media is at least all recorded digitally on your phone so you may you know what you are measuring people may have different opinions on but it's all there so in some ways it could be actually easier to measure this stuff than a lot of other behavioral risk factors that we measure right I think I think what all what I'll counter to that with is we have to measure it we have to measure social media in a way that's relevant to mental health yes and so again it's I think it's hard to come up with summary measures of what teens are actually doing on social media when they're using it and how I think I think sorry well just like we've been talking about you know two kids may see the same image and it could like really put one in a spiral and the other one just laughs it off and so how do you measure that right right and I think that that that gets back at that idea of what I mentioned before of kids with some pre-existing vulnerabilities and that's another measurement issue really that's that comes up in the literature a lot is is is social media causing mental health problems or do people with pre-existing mental health issues are they are they drawn to social media because they're withdrawing from their life in other ways and so it's it's really a causality issue it's we don't know which one is causing the other there could be effects going in both directions and it's it's difficult as an as in any epidemiological study to really parse that out all right so you know at the beginning of this we were I mentioned the fact that a lot of these companies conduct their own internal research constantly they probably hired the best researchers in the world to do this work for them but they don't release it to the public so it what kind of data sources do some to someone like you have to study this in the first place and and do do you have even a chance of getting access to the data directly from the companies because it seems like it seems like they're not generally forthcoming right yeah I would agree that that obtaining that type of data is generally difficult I at least in my own research I've relied a lot on different self-report surveys so one of the data sources that I've used is a nationally representative survey of adolescents that is called it's called the population assessment of tobacco and health and I use that in a study I think about three years ago now and I thought I thought this it's funny because this data source was actually designed to collect data primarily on tobacco and health as the name of the survey implies but they had a number of questions and they're about social media use that I hadn't seen anyone use in in actual research and I I was really drawn to those and actually it's funny that I'm bringing this up now because that's what got me into this field in the first place was was was seeing those questions on the survey and thinking huh we could design a study around that and that's what that's what led me to enter into this field and so going back to your question about about data sources I yeah I would say I've generally relied on self-reported use of social media and just the amount of time that people spend on social media and there's obviously going to be massive measurement problems there I think that there's been a few a few validation studies but there's there's no there's no sort of to my knowledge at least there's I don't think there's a validated self-report tool that looks at like the amount of time that you spend on social media a lot of these a lot of these questions that are from surveys are really ad hoc that researchers just write for the purposes of sticking it in their survey they're they're not actually validated ahead of time and so the extent to which answers on these survey questions reflect actual social media use is is still a big question in the literature and it could reflect other things as well we know that there are different biases that people have when they answer survey questions and so that this is a big concern when we're talking about measuring social media use as well are there go ahead I was gonna say it's it's it's such a shame really because you know you're trying you're you're saying that we want to design these surveys to capture all this information as best as possible when we know that it's all there it's just it's just not in our hands that data are all recorded there are there are troves of data on media use because companies need it to train their algorithms or to probably get advertising revenue whatever it is like all that data is actually sitting somewhere and you just don't have access to it well that's what I was gonna ask it do do any researchers health researchers have like has anyone experimented with like an app that you could add to a kids phone that just kind of measures you know some quantitative measure of how often people open Facebook or Instagram you know something something so that it's a more objective digital measure of exposure has anyone gone there I don't know if I'm up to up to date enough on the literature to know whether whether that's been done there's your next grant right there's my next grant yeah I don't know if anyone's done that super recently but I think that's getting into sort of a new emerging method that I've seen used in in other fields of research called ecological momentary assessment which is in our field right right for listeners ecological momentary assessment is where instead of doing a survey at one time point people are sent questions at different points as many as many times as a few times throughout the day and so things are measured really in the moment and answer really quickly as opposed and and that tries to get at this issue with recall bias so you're not reporting on behaviors that have occurred over the past few weeks you're you're you're reporting on something that's happening in the moment yeah I'm wondering there's like you do that ecological momentary assessment and if someone doesn't answer they're probably on social media or you have it just ping the phone and see if it's actually you know if that app is open I don't know I'm I'm spitballing here but I feel like that's a that's a huge like area that could be broken into in terms of health research to you know use those phones to your advantage you know right I agree and I think I think I again I'm I'm not up to date enough to know whether studies have been looking at that recently but I have definitely seen studies that have used sort of this like this idea of like online scrape like scraping where they scrape websites for information and so not not quite getting what you're talking about which is sort of more background metrics of use but more public facing like things like posts and likes and engagement like that and so I know I know studies have leveraged that for sure cool so so you mentioned before that you know one of the things that could be going on is that people could be using all sorts of varieties of different apps and you know you know so do we have any information on you know what which social media is actually harmful like maybe some of it is perfectly fine and some of it isn't you know whether it be you know tiktok whether you're going by the actual app people engage with or actually what they're doing on the app you know we have a tiktok got Instagram we got Facebook I don't think a lot of adolescents are on Twitter God I hope not because it's a cesspool I don't know usually that's not really what how they engage with each other maybe I'm wrong about that I don't know but like is there any measurement of the type of social media and how that harms kids that's another really good question and I think that actually speaks to a really key research issue that it that it that again is something else that I think the field of social media and mental health really struggles with is that the types of social media platforms that adolescents are using changes so rapidly we can't keep up right we really can't keep up with it and so in some of the surveys that I've used for example I think the study that I published in in JAMA psychiatry use data from 2013 to 2015 and it asked about platforms like Facebook I think it asked about my space and like like no teens are using that these days yeah any team listening to this is like Facebook I never use Facebook that's what my mom uses right I was talking to my I have I have two half siblings who are in high school and I was talking to them about it recently and I had to ask them like what what are your what are kids doing these days like I have no idea but I really think that's a that's a key measurement issue because we're asking these questions in surveys and by the time we go to publish it even just as soon as two years later it's already outdated and so yeah I think getting at the types of platforms that are potentially more harmful for mental health is really is really difficult I will say though that I think a lot of the discussion in the media has focused specifically on Instagram these days and just how Instagram can can really portray a really idealized and sensationalized version of people's day to day lives that isn't quite accurate and so this isn't from this isn't me speaking as a researcher but more is just someone who moves throughout the world but that's the one that I see the most talked about on the media as as as harmful well especially it's interesting that Facebook had plans for the under 13 version of Instagram which I was gonna ask you how you felt about it yeah they put that on the back burner after the data scientist Francis Hagen I'm not sure to how to pronounce sir last name but but when Hagen made comments to the Congress it was I think you know however long we later they decided to bench that which I was like why does this even potentially exist in the first place which actually was which actually reminds gets me to the next question I really wanted to ask you which was do we have any ideas at all any evidence about what is a generally safe age for kids to start engaging with social media and I ask this because I have friends who have maybe an 11 or 12 year old and they got their kid their first smartphone and they're like what should we let them use and then I have another friend who has a six year old and they establish an Instagram account for their six year old and I'm like what houses like I'm which is not a criticism I was just like various taken it back I was like I didn't even think to myself to establish any kind of accounts for my six year old because I have a six year old as well I was thinking I was thinking like I guess this is something that maybe I could do but is it even something I should be doing I really have no clue right so I I think I think this question is really difficult because again for a number of the for a number of reasons I've already stated just sort of arriving at a consensus based evidence based age for okay before this age not okay after this age okay I think is really difficult just for a variety of the reasons that I've already listed that said I I actually I'm I'm not a clinician nor my parent so when I write about these things in my articles I tend to refer a lot to the American Academy of Pediatric website because they do have guidelines that are sort of based on clinician clinician opinion regarding regarding screen time and social media use and so I think that the age that they list on their website there is probably around the age of 13 and so again I think I don't think that that's a hard and fast rule that will apply to all children and adolescents I think it's probably different for different children I think one of the most valuable resources that the American Academy of Pediatric has that I think that parents should be aware of is it's called the family media use plan and I think that this plan it really lays out ways that parents can talk to their teams about social media use what what their engagement with social media use means and I think it really helps set guidelines and expectations for reasonable and healthy use and so if there's one resource that I want listeners to sort of sort of take away from this podcast I would that would be the one that I would point to very cool my wife works for the AP so shout out to the AP use those resources that they're providing yeah yeah that's really that's 13 that that's that seems to match up with like what I think but man I've getting your kid to 13 without having a device like good luck there's going to be a lot some kids are going to really be begging you for that for years and then yeah a lot of decisions to make but you know because there's also phones can be good for getting in touch with your kids and being you know making sure you know where they are so how do you regulate the good use of the phone versus the bad use and actually that was going to be my next follow-up question like is there is there a healthy way that you can okay let's say the kid gets a 13 you give him the phone you know you're saying okay I'm okay it's probably all in the guidelines that you that you just pointed us to but just for our listeners who aren't going to open those guidelines like what how do we get our kids to develop a healthy relationship with devices and with their social media and networking with other people that's a great question and I think I think that's probably the first thing that you're getting at is the idea of healthy use of social media and what does that look like and I don't I don't know if we've actually is it is there a healthy use I don't know first of all right and I absolutely I absolutely think that there is I think that there's a number of definite benefits to using social media probably the most probably the most notable ones that I can think of off the top of my head are things like keeping in touch with friends and family keeping up to date with current events and just knowing about what's going on in the world and I think the most notable benefit in my opinion is really providing a sense of community and connection for adolescents who can't find community in their data like data in their day-to-day life and so this can be groups like LGTBQ youth but just as one example and I think that's really I think that can be really essential again going back to that theme of adolescents discovering themselves trying to figure out who they are I think I think this type of connection in community can be really important for some youth especially when they can't get that on a day-to-day basis and so it's a great question how do we how do we ensure these benefits without also possibly exposing youth to harms of social media use and again I don't want to like lean too heavily on the family media use plan but I really do think that that is a fantastic resource and what I'll add that I didn't mention before is that I think this plan also discusses beyond things like setting guidelines and expectations the plan also helps parents talk to their kids about just promoting media literacy and being a wise quote-unquote digital citizen and just understanding what it means to be a person online the idea of like what you do online leads a digital footprint like that like that can follow you for a long time and just helping youth understand that their actions online do have consequences this kind of all follows under the umbrella of media literacy and so my hope is that these these types of plans and these other programs that might promote media literacy can help youth use social media in a positive way that's such a good point that I was that we should get into like one of the reasons this is so harmful for teens adolescents specifically is because in general in their life they don't get the consequences of their actions in the way that adults might and don't realize the digital footprint that they leave and how these things can come back to haunt them I'm always shocked by these athletes you know who someone someone digs up some tweet from when they were like in college and they were you know they use a really bad you know slur or something like that and they get in all this trouble I'm like how would you leave that up there well first of all why would you say it in the first place but like I get it you're like a teenager at the time people say stupid things I said stupid things I was a teenager but but now as an adult I'm like I would have gone back into leave I had like a $10 million contract in the NFL I would go weed through my tweets and make sure I don't have a digital footprint but so many people don't right and it's just like that just doesn't stick in people's minds right right something that I'll say I'll say to that like sometimes just you deleting something off of your profile doesn't doesn't mean that it's gone it doesn't mean that it's gone like I've googled I've googled my own name before and the images that come up on Google images I'm like that's 100% me but where is that coming from that's like did I post that on Facebook at some point probably but but who knows I've I mean I've had a Facebook account for over like over 11 years at this point like I just yeah it's it's it's these things that are yeah that are scary for me now and just knowing how much social media has really exploded that makes me really really scared for teens yeah actually yeah I actually wonder if there's a lesson for parents here too because you know as a parent I and I have to I have to really reflect on this I think I post pictures of my kids on Instagram all the time and I wonder I you know in terms of thinking about digital literacy I almost feel like we as parents need some some guidance and I don't even know if there's anything in the literature out there about you know because I'm sure some there are parents out there and I've probably done it and hopefully deleted it but showing up like a video of their kid having a tantrum on Instagram like in 10 years is my is my kid gonna see this or their friends gonna see it and they're gonna just get really resentful or have feelings associated with it I didn't even think about that right I mean I think it's really hard to know and this is kind of the first generation growing up with this kind of exposure right like we just we don't have a precedent for this really would be would be what I have to say you know I I use an app for my family called tiny beans where I take pictures of my kids and I put them up there so that I don't have to send the same picture to like you know 25 different relatives we're all clamoring to see the kids so it's just all right there and it hit me one day that every single day of my daughter's life has has documented digitally has a photo attached at least one photo sometimes like 1015 and anything that she done in her life she'll ask me about I'm like oh yeah let me pull that up I can show you what you did three years ago you know and I'm like that's kind of crazy she doesn't even have to have a memory really like she could just go see it all download that data and she's got every day of her life in digital form right it's super different from how we grew up I like I have I have some very treasured photos of me as as a child and like same with same with my parents as well but yeah kids are growing up these days with like just it's so easy to take a photo now on your cell phone it takes it takes like two seconds you don't even have to you don't even have to at least on my iPhone I don't even have to unlock the screen anymore I can just take I can just hit the photo button and take a photo right there and so yeah it's interesting to speculate about growing up in that environment and what that means my speculation was that she's just not going to develop a memory because she's like why do I got to remember anything I'll just pull up the app so it's all right there yeah well you know as we had this talk is I mean this has been so fascinating that like 45 minutes is just blown by so I don't want to I don't want to miss some very important topics that we need to cover I think we've talked about you know exposure to imagery and how that can be harmful for teenagers but what one thing we haven't talked about is cyber bullying and I know that this is you know and I told some friends or parents that we're we're having this conversation the immediate thing everyone asked about cyber bullying so I want to cover you know I have a number of questions about this and I'm sure Gassan does as well but my initial question was like you know bullying has always been around right you know bullying has just been a thing kids have ever since it's been like a school setting or a group setting for kids like one kid bullies another kid you know unfortunately right but there seems to be something way worse about it now with the digital age and cyber bullying and I don't want to put words in your mouth but I have some ideas as to why that might be but is this really is the research showing that cyber bullying is as bad a problem as we parents think it is or is or is are we just blowing it up in our minds is the media blowing it up I mean I think cyber bullying is certainly a problem and I think probably probably one thing that makes it just like prevalent and just easy for teens to engage in is probably the anonymity associated with it it's it's very easy to be anonymous online and as I'm saying that's I'm actually remembering something that was it was like an add-on that you could get on Facebook when I was in high school and I don't know if any listeners remember this but I think it was called honesty box and it basically allowed you to message your if other people had all box right you could message people and just leave an anonymous comment for them and I remember like getting nasty things in mind and now I'm like like obviously I'm doing doing fine these days but at the time it felt really awful and I'm just looking back and I'm remembering like I thought that that was a good idea like how could you possibly think that that was going to have any positive benefit you know yeah that's pretty outrageous and that's obviously like a pretty extreme like example of cyberbullying online but yeah definitely a problem that teens these days have to deal with yeah the anonymity and also the the you know as I think about this it's like the lack of repercussions like even if even if someone's a pretty bold brash bully in a school setting they got to do it when there's no like teachers looking they got to do it when there's not a lot of other people that'll jump in and be like stopping but like when you're it's just one on one in a cyber digital space it's like really easy to just lay it on someone with no repercussions right yeah there's no regulation there's no there's no adult eyes on that that interaction you know right it's really easy I think like I think it's easier probably for cyberbullying compared to traditional bullying to really stay between two kids yeah like two or more kids and it just it won't be noticed by parents and teachers and then I think even when it is noticed by parents and teachers the question the next question is who's responsible for this like whose responsibility is it step in because if it's all occurring online then like whose lap does that fall into well these are in these major court cases about that you know like cyberbullying and like whether the schools are responsible for it if it happened between students but it wasn't on the school ground but how does something digitally happen on a ground or not on a ground you know there's a lot of questions about that but there's so there's the one-on-one aspect but there's also the amplification aspect right you know the fact that you could just take a picture of someone that some that you know would be really private to them and then just blast it to the entire school didn't that happen on what was the name of that at Netflix show 13 questions 13 reasons why 13 reasons why that's exactly what happened right they blasted out a picture and then and then the girl committed suicide which is awful it was a story obviously but I think there's a lot of truth to that something like that that could never have happened before you know a picture to get passed around right but to but now you can blast it to the entire school right yeah I have complicated feelings about 13 reasons why I think a lot of people do yeah yeah we're running out of time here but yeah I feel like we could just keep going but we should we have to limit ourselves a little bit one thing I did want to touch on before we left and we've kind of we've kind of tinkered around this topic is the disparities in in health consequences or potential mental health concerns of youth between between sex or gender and I'm just curious what kind of you know it's it's kind of one of the things that feels intuitive but is not necessarily and I'm wondering what kind of evidence we have regarding that out there right so I think I think there's kind of two two issues to talk about here related to related to sex and gender and so the first relates to that that rise in depressive symptoms over time that I mentioned before we do see that that that increase is higher in females and so that that's that's the first piece of the puzzle to note here I think the second piece is that there are some studies and not not my research actually but some other studies that have that have looked at sex differences in terms of social media use and their and their consequences for for mental health and again not every study shows this but some studies have found that the effect is stronger among females and so I think I think taken it face value I think this sort of like fits into this narrative that is really driven by the media that social media is terrible for girls it's causing all these problems in girls and my my take on that message is that that's a little bit sensationalized certainly not all studies support this conclusion and and again like I said before I think that there are are other things that are going on in teens lives that would affect that that sex disparity in depressive symptoms that we're seeing and so it could possibly be a piece of the puzzle but I don't think I don't think that that's the only reason why we're why we're seeing disparities in mental health by sex right yeah well I feel like a lot of these episodes we're you know we're talking about a topic like climate change it's it's bad tobacco you see kind of a lot of work at you but I'm very glad to have people like you doing that right I really appreciate your uh I really appreciate you taking the time to speak with us I think all of us I think all of us in the field of adolescent mental health at the end of the day we all we all want to figure out what's what's driving things and what we can do to help and so yeah I'm happy to be a part of that and really motivated to keep generating research that that helps us answer these big questions and get us to a point where we can really promote better mental health among teens great that's awesome thank you and before before we go if you're an epidemiologist I recommend you consider becoming a member of the society for epidemiologic research membership gets you a discounted fee for the annual meeting which is scheduled to be held in June 2022 in Chicago fingers crossed uh-huh membership also gets you access to the ser library which has some great learning materials seminars and activities you can find out more at every research dot org also just a quick statement that the views expressed in this podcast by both the hosts and any of our guests are ours and their views alone and do not represent the views or opinions of the society for epidemiologic research really appreciate you listening and we'll be back with another episode soon thanks again Kira