Consensus Study Report

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This activity was supported by contracts between the National Academy of Sciences and the Democracy Fund, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, Luminate Projects Limited, the National Academy of Sciences W.K. Kellogg Foundation Fund, the Open Society Foundations, and the William and Flora Hewlett Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-71316-0
International Standard Book Number-10: 0-309-71316-1
Digital Object Identifier: https://doi.org/10.17226/27396
Library of Congress Control Number: 2023952318

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Social media and adolescent health. Washington, DC: The National Academies Press. https://doi.org/10.17226/27396.

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COMMITTEE ON THE IMPACT OF SOCIAL MEDIA ON ADOLESCENT HEALTH

SANDRO GALEA (Chair), Dean, Robert Knox Professor, School of Public Health, Boston University

CEREN BUDAK, Associate Professor of Information, School of Information, Associate Professor of Electrical Engineering and Computer Science, College of Engineering, Faculty Associate, Center for Political Studies, Institute for Social Research, University of Michigan

MUNMUN DE CHOUDHURY, Associate Professor, Director, Social Dynamics and Wellbeing Lab, Georgia Tech University

DOUGLAS GENTILE, Professor of Psychology, Iowa State University

AMANDA GUYER, Associate Director, Center for Mind and Brain, Professor, Human Development and Family Studies, University of California, Davis

JEFF HANCOCK, Professor of Communication, Founding Director, Stanford Social Media Lab, Stanford University

JULIANNE HOLT-LUNSTAD, Professor of Psychology and Neuroscience, Brigham Young University

STEPHANIE REICH, Professor, Education, School of Education, University of California, Irvine

MIGUEL SARZOSA, Assistant Professor of Economics, Purdue University Krannert School of Management

LESLIE WALKER-HARDING, Professor and Ford/Morgan Endowed Chair, Department of Pediatrics, and Associate Dean, University of Washington; Chief Academic Officer and Senior Vice President, Seattle Children’s Hospital

CHRISTOPHER YOO, John H. Chestnut Professor of Law, Communication, and Computer and Information Science, Founding Director, Center for Technology, Innovation, and Competition, University of Pennsylvania Carey Law School

Study Staff

GILLIAN J. BUCKLEY, Study Director

ALEXIS WOJTOWICZ, Associate Program Officer

GRACE READING, Senior Program Assistant

MISRAK DABI, Senior Finance Business Partner

ROSE MARIE MARTINEZ, Senior Board Director

ANNE MARIE HOUPPERT, Senior Librarian

REBECCA MORGAN, Senior Librarian

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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by TRACY A. LIEU, Kaiser Permanente Northern California, and BERNADETTE M. MELNYK, The Ohio State University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Acknowledgments

This report is a product of the cooperation and contributions of many people. The committee and staff are grateful for the support of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division (HMD) staff who contributed to producing this report. The committee and staff thank Monica Feit, Lori Brenig, Samantha Chao, Annalee Espinosa Gonzales, Leslie Sim, and Taryn Young in the HMD Executive Office; Anne Marie Houppert and Rebecca Morgan in the National Academies Research Center; Amber McLaughlin, Ben Hubbard, Mimi Koumanelis, Sadaf Faraz, and Marguerite Romatelli in the Office of the Chief Communications Officer; Megan Lowry in the Office of News and Public Information; Julie Eubank and Nicole Cohen in the Office of Congressional and Government Affairs; Mandy Enriquez, Dempsey Price, and Ahmir Robinson in the Office of Conference Management; Connie Citro in her role as chair of the Institutional Review Board; and Mattie Cohan in the Office of General Counsel.

The committee thanks all the speakers and moderators who participated in committee meetings, as well as others who provided information, input, and assistance. They include the following:

Sun Joo Grace Ahn, Monica R. Anderson, Mitchell Baker, Hector Balderas, Alvaro Bedoya, Francesca Borgonovi, Marie Bragg, Emily Cherkin, Sarah Coyne, Evelyn Douek, Matthew Gentzkow, Ysabel Gerrard, Jonathan Haidt, Lauren Hale, Amy Hasinoff, Frances Haugen, Jonathan S. Hausmann, Brittan Heller, Mimi Ito, Girard Kelly, Aleksandra Korolova, Sonia Livingstone, Damon McCoy, Katina Michael, Tijana Milosevic, Kathryn C. Montgomery, Megan Moreno, Laurie Moskowitz, Dhiraj

Murthy, Candice Odgers, Amy Orben, Margarita Panayiotou, Laura Quinn, Jenny Radesky, Tom Romanoff, Gus Rossi, Piotr Sapiezynski, Amanda E. Staiano, Joe Turow, Ari E. Waldman, James Williams, Jean Twenge, and Jonathan Zittrain.

In addition, the committee sincerely thanks the youth who provided valuable input for this report. Thank you to Armand Davidson, Angel A. Deleon, Zach Gottlieb (Talk With Zach), Kenny Jackson, Eva King, Arianna M., Garrick Pane, Henry R., and Margot Teh, who joined public sessions with the committee and staff to provide valuable insight into their own experiences with social media.

Finally, we extend special thanks to the Democracy Fund, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, Luminate Projects Limited, the National Academy of Sciences W.K. Kellogg Foundation Fund, the Open Society Foundations, and the William and Flora Hewlett Foundation for generously funding this project.

Contents

PREFACE

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

The Charge to the Committee

References

2 HOW SOCIAL MEDIA WORK

Social Media Affordances

Platform Operations

Adolescents and Social Media

The Social Media Business Model

References

3 POTENTIAL BENEFITS OF SOCIAL MEDIA

Why Adolescents Use Social Media

References

4 THE RELATION BETWEEN SOCIAL MEDIA AND HEALTH

The Committee’s Approach to the Evidence Review

Health Effects

Guidelines and Recommendations from Other Authoritative Bodies

References

5 DESIGN FEATURES

Age-Appropriate Design Code

Greater Transparency and Accountability

Adopting the Standards

Using the Standards

References

6 TRAINING AND EDUCATION

Comprehensive Digital Media Literacy Education

Integrating Digital Media Competency into Professional Education

References

7 ONLINE HARASSMENT

Cyberbullying

Sexual Offenses

Support for Victims and Momentum for Prosecution

References

8 RESEARCH

A Research Agenda

Encouraging the Use of Real-World Data

References

APPENDIXES

A Committee Member Biosketches

B Open Session Meeting Agendas

C Table of Recent Systematic Reviews of the Association Between Social Media and Adolescent Health

Boxes, Figures, and Tables

BOXES

1-1 Statement of Task

2-1 Overview of Prominent Social Media Platforms’ Posted Content Moderation Policies

3-1 Seven Characteristics of Distributed Mentoring in Fanfiction Communities

4-1 Notes for Parents

6-1 Standards to Inform a Digital Media Curriculum

FIGURES

1-1 Percentage of female and male students who experience persistent feelings of sadness or hopelessness 2011 to 2021

1-2 Percentage of female and male students who seriously considered suicide 2011 to 2021

1-3 Percentage of high school students who attempted suicide during the past year by demographic characteristics, 2021

1-4 Suicide rate among teens 15 to 19 per 100,000 from 1970 to 2020

2-1 Percentage of U.S. teens who say they “ever use this app or site” or “almost constantly use this app or site”

2-2 Percentage of U.S. teens who say they use the internet almost constantly either on a computer or a cellphone

2-3 States privacy legislation as of mid-2023

3-1 Percentage of U.S. teens (age 13 to 17 years) who say social media has had a (mostly positive, neutral, or mostly negative) effect on them personally

5-1 Response to the question, “How much do you trust each of the following companies or services to responsibly handle your personal information and data on your internet activity?”

7-1 Percentage of respondents ages 13 to 17 who have favorable or unfavorable impressions of the efforts various authority figures are taking to stop online harassment and bullying

7-2 Percentage of respondents ages 13 to 17 who say they have ever experienced cyberbullying when online or on their cell phone

7-3 Percentage of respondents ages 13 to 17 who have experienced the listed form of disruptive behavior in online multiplayer games in the last 6 months

7-4 Monthly volume of child sexual abuse images, log scale, received by the National Center for Missing and Exploited Children since the creation of its cyber tipline in 1998

TABLES

3-1 Types of Creative Production on Social Media

4-1 Authoritative Bodies’ Guidance on Social and Digital Media Use and Adolescents

5-1 Operationalizing Standards for Social Media Operations, Transparency, and Data Use

8-1 Conceptual Mechanisms Linking Social Media Use and Well-being

8-2 Recent Legislative Proposals on Social Media Platform Research

C-1 Select Recent Systematic Reviews and Meta-Analyses on Social Media Exposure and Adolescent Health Outcomes

Preface

This committee’s work emerged from public concern about two phenomena: the growing ubiquity of social media use by children and adolescents, and the increase in poor mental health also among children and adolescents. The co-occurrence of these two phenomena has served, correctly, to catalyze concern that the former is causing the latter and that, as such, there is an urgent need for action to check social media spread and its use to protect child and adolescent mental health. A series of high-profile events, including leaking of internal Facebook documents that suggest social media companies’ awareness of some links between social media use and adverse mental health further added fuel to the fire.

The committee recognized that the temptation to draw causal inference and to call for rapid action around social media is strong, and heard, during public session, from a range of academics and activists who feel strongly that causal links between social media and mental health have been unequivocally established and that there is an urgent need for action.

And yet, in careful deliberation and review of the published literature, the committee arrived at more measured conclusions.

The science suggests that some features of social media function can harm some young people’s mental health. These include, but are not limited to, algorithmically driven distortions of reality exacerbating harmful content and disinformation, the distraction away from time that can otherwise be used in more healthy ways, and the creation of opportunities where youth can be abused or exploited. However, there are also several ways in which social media improve the lives of youth, including the creation of opportunities for community among more marginalized youth, and the opportunity for fun and joy for the vast majority of users. This balance lies at the heart of the relation between social media and mental health. While some users, using social media in particular ways, may have their mental health adversely affected, for many others there will be no such harm, and for others still the experience will be helpful. This suggested to the committee a judicious approach to protect youth mental health is warranted rather than some of the more broad-stroke bans that have been proposed by other entities in recent years.

The committee’s recommendations include recommendations to develop industry standards that can ensure social media use protects mental health in the long term, the engagement of educators and health care providers in highlighting the benefits, and minimizing the harms of social media use, and specific measures to protect youth from online abuse. The committee also recommends a doubling down on research that can lead to better clarity about the causal links between aspects of social media and mental health, to the end of pointing to more specific actions that can mitigate the harms, and accentuate the positives, of social media.

It is the committee’s hope that this work can ground the public conversation around this issue and serve as a platform for better science and targeted action that protects youth’s mental health, while preserving a technology that brings joy and connections to so many.

Sandro Galea, Chair
Committee on the Impact of Social Media on Adolescent Health

Acronyms and Abbreviations