Trends in Social Media Use in Adolescents

Educational Objectives

The goal of this program is to improve positive social media use among adolescents and children. After hearing and assimilating this program, the clinician will be better able to:

1. Screen adolescents for social media overuse.
2. Recognize the potential harms associated with internet overuse in adolescents.
3. Counsel parents and caregivers on how to control internet use in children and adolescents.

Summary

Introduction: 80% of teenagers use social media; sharing visual content has become a massive popular culture, which can be damaging sometimes; sharing content serves as a communication method, staying updated on trends, celebrities, influencers, families, and friends; it is a prevalent networking system; with the rise of various social media platforms, teenagers are experiencing mental health concerns as they navigate the social media landscape

Trends: 89% of teenagers use social media almost constantly; 97% of boys and 83% of girls play online video games or are on social media platforms, eg, YouTube, Instagram, Snapchat, TikTok, Discord, and Facebook (less used in teenagers); access to smartphones has rapidly increased from 73% to 98%, with children as young as 8 yr of age; an average time of 8 hr and 56 min and 5 hr and 55 min is spent on internet among children 8 to 12 yr of age; TikTok can be stressful, especially for those with eating disorders; it has been detrimental to the mental and behavioral health of children worldwide; data suggest 1 in 5 teenagers visits YouTube almost constantly, with teenage girls more likely to use it than boys; the number of hours per day has increased in the last 5 yr, especially since the COVID-19 pandemic, which led to an exponential increase in screentime and associated sleep deprivation; 72% of parents say that their rules for screentime have become less strict because of the pandemic

The teenage brain: abstract thinking, learning to manage emotions, and decision-making abilities do not fully develop until mid-20s; when teenagers are stressed, they want quick fixes for feeling sad, depressed, anxious, or worried; they use a positive coping strategy (makes them feel better for a long time) vs a negative coping strategy (makes them feel better for a short time), eg, a social media platform or virtual reality

Areas of the personal life affected: face various personal life challenges, eg, recreation, contribution, relationships, and vulnerability factors, particularly because of the fluid nature of social media communication; family issues, substance use, friends, social skills, and other issues that take over during teenage years are common; wanting to fit in is extremely important; learning about self-harm and thoughts of dying by suicide is a concern; body image and gender issues are also important; social media platforms can also be concerning in terms of legal ramifications and recreational activities; if a child has other risk factors, including attention-deficit/hyperactivity disorder, family history of social media issues, environmental pressures, and school problems, more children will let social media take over their lives; adolescents have immature social skills and ineffective relationships, which are fostered by having better social relationships through the internet

Consequences of overusing media: include weight gain, sleep issues, eating disorders, attention problems, lower grades, mood issues, less real-time with friends and family, and cyberbullying; discuss social media use like vaccinations; pediatricians and other caregivers should be aware of the risks and potential dangers of social media use in children and adolescents; be aware of the child’s needs to ensure that their interactions are positive and not negative

Social media and depression: a recent paper suggests the more time spent on social media, the higher the risk for depression in children; reverse studies show the less time spent on social media, the lower the risk for depression; parents need to be aware of the potential harm social media can cause their children

Substance use: sometimes modeled on social media, with numerous pictures and videos of people using substances; this trend has been extensively studied, with findings showing that individuals are more likely to engage in substance use themselves if they see or read about others using substances

Eating disorder behavior: the rise of TikTok posts on lying to medical providers about one’s eating habits has led to an increase in eating disorder behavior; families are generally unaware of what is happening with their children

Cyberbullying: has increased by 26% in recent years; many individuals experience fear and distress when they encounter targeted messages on their phones or social media platforms, which is especially concerning for children; it is important to protect children from such situations; the rise in offensive name-calling, spreading false rumors, and sharing of explicit images of adolescents without their consent is concerning

Other data: literature states that more time spent on social media can negatively impact mental health; female adolescents are more likely to engage in social comparisons than male adolescents, leading to negative views of their body image, reduced life satisfaction, and issues with acceptance; the number of “likes” for posts matters, which is different from other forms of appreciations, eg, a hug or looking someone in the eye while appreciating the work

Positives effects of the internet: can be helpful for finding people with similar interests and connecting with people globally, which could not be done in social circles locally; suggest finding a happy medium when shutting off the phone, eg, introducing alternative activities like board games; parents should model the same behavior for their child and make it a positive experience; internet use can be helpful for people who may have difficulty interacting with others face to face (due to personal reasons or triggering situations); be mindful of what people need and support them, even if the internet requires some monitoring

Balancing media use: preventing addiction is important; screening for excessive internet use is similar to screening for any substance use; screen-free zones — set rules ahead of time, eg, no screentime during meals, no screentime until homework completion, or conversation with family members; screen-free times — turn off all media devices during a set time period (parents should challenge themselves too); balance online and offline activity; try to get enough sleep (with all devices off and not in the room)

Tips: the American Academy of Pediatrics website offers a free family media plan that can help; pediatricians and pediatric societies offer safe digital programs, eg, Bright Futures; education is important; use media mindfully, eg, when giving a child a vaccination, consider bubbles instead of phone; there are other things that can be done to prevent young children’s constant exposure to screens; adolescents should be cautious about their content, as it is public and can be viewed forever; they should not engage in actions that could affect their chances of acceptance into a desired school, team, or job; awareness and action against abusive content that children consume daily through social media is needed

Parental control: adults should monitor their children’s phone usage and be aware of the child’s online activities; parents often ask for parental control apps on their children’s phones, but these apps can be easily circumvented; taking the phone away is the best parental control method; ≈40% of parents try to use some kind of technical control over their children (expensive and not very effective); these apps only manage text or web browsing, not app usage; the speaker does not recommend using them

Considerations: discuss these issues with schools; the Internet Addiction Test (developed in 1998) can be used to identify and address internet addiction; it includes questions about one’s preoccupation with the internet, the need to use it more, unsuccessful attempts to control it, longer online stays, restlessness, jeopardized or lost relationships, lying about internet use, and using the internet to escape from problems; educate children and families to be mindful of shutting off internet devices for a few hours daily; IMPACT is an intervention media tool that can help prevent and reduce the effect of cyberbullying; numerous studies have shown that using this tool can help prevent cyber conflict; data on the long-term effects of social media use on teenagers’ brains are limited

Readings

Anderson CA, Bushman BJ, Bartholow BD, et al. Screen violence and youth behavior. Pediatrics. 2017;140(Suppl 2):S142-S147. doi: 10.1542/peds.2016-1758T; Anderson M, Faverio M, Gottfried J. Teens, social media and technology 2023: YouTube, TikTok, Snapchat and Instagram remain the most widely used online platforms among U.S. teens. Pew Research Center. 2023 Dec; Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics. 2016;138(5):e20162592. doi: 10.1542/peds.2016-2592; Davis J, Hart JL. Role of social media in adolescent-parent relationships among at-risk youths. Journal of Social, Behavioral, and Health Sciences. 2023;17(1):181–195; Kutok ER, Dunsiger S, Patena JV, et al. A cyberbullying media-based prevention intervention for adolescents on Instagram: Pilot randomized controlled trial. JMIR Ment Health. 2021;8(9):e26029. Published 2021 Sep 15. doi:10.2196/26029; Seo H, Houston JB, Knight ANT, et al. Teens’ social media use and collective action. New Media & Society. 2014;16(6):883-902. https://doi.org/10.1177/14614448134951; Vidal C, Lhaksampa T, Miller L, et al. Social media use and depression in adolescents: a scoping review. Int Rev Psychiatry. 2020;32(3):235–253. doi: 10.1080/09540261.2020.1720623.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Breuner was recorded at Pediatric Potpourri: State of the Art 2024, held February 24 to March 1, 2024, in Maui, HI, and presented by the Children’s Hospital Los Angeles Medical Group. For information on future CME activities from this presenter, please visit https://www.chla.org/chla-medical-group/cme-conferences. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

PD711802

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.