National Academies Press: OpenBook

Social Media and Adolescent Health (2023)

Chapter: Front Matter

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Social Media and Adolescent Health. Washington, DC: The National Academies Press. doi: 10.17226/27396.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Social Media and Adolescent Health. Washington, DC: The National Academies Press. doi: 10.17226/27396.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Social Media and Adolescent Health. Washington, DC: The National Academies Press. doi: 10.17226/27396.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Social Media and Adolescent Health Sandro Galea, Gillian J. Buckley, and Alexis Wojtowicz, Editors Committee on the Impact of Social Media on Adolescent Health Board on Population Health and Public Health Practice Health and Medicine Division Consensus Study Report PREPUBLICATION COPY—Uncorrected Proofs

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the Democracy Fund, the Ford Foundation, the William and Flora Hewlett Foundation, Luminate Projects Limited, the John D. and Catherine T. MacArthur Foundation, the Open Society Foundations, and the National Academy of Sciences W.K. Kellogg Foundation Fund. 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-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/27396 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334- 3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Social media and adolescent health. Washington, DC: The National Academies Press. https://doi.org/10.17226/27396. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

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, 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 v PREPUBLICATION COPY—Uncorrected Proofs

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Reviewers This Consensus Study Report was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments 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: DAVID BRENT, University of Pittsburgh MATTHEW GENTZKOW, Stanford University CATHERINE A. HARTLEY, New York University WOODROW HARTZOG, Boston University SUNNY XUN LIU, Stanford University DHIRAJ MURTHY, The University of Texas at Austin CANDICE ODGERS, University of California, Irvine SUNNY PATEL, Substance Abuse and Mental Health Services Administration RAFI SANTO, Stanford University PIOTR SAPIEZYNSKI, Northeastern University vii PREPUBLICATION COPY—Uncorrected Proofs

viii REVIEWERS Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclu- sions 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. PREPUBLICATION COPY—Uncorrected Proofs

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 partici- pated in committee meetings, as well as others who provided informa- tion, 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 Cher- kin; 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 ix PREPUBLICATION COPY—Uncorrected Proofs

x ACKNOWLEDGMENTS 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 William and Flora Hewlett Foundation, Luminate Proj- ects Limited, the John D. and Catherine T. MacArthur Foundation, the Open Society Foundations, and the National Academy of Sciences W.K. Kellogg Foundation Fund for generously funding this project. PREPUBLICATION COPY—Uncorrected Proofs

Contents PREFACE xv ACRONYMS AND ABBREVIATIONS SUMMARY 1 1 INTRODUCTION 15 The Charge to the Committee, 21 References, 26 2 HOW SOCIAL MEDIA WORK 31 Social Media Affordances, 32 Platform Operations, 34 Adolescents and Social Media, 47 The Social Media Business Model, 54 References, 59 3 POTENTIAL BENEFITS OF SOCIAL MEDIA 69 Why Adolescents Use Social Media, 70 References, 82 xi PREPUBLICATION COPY—Uncorrected Proofs

xii CONTENTS 4 THE RELATION BETWEEN SOCIAL MEDIA AND HEALTH 89 The Committee’s Approach to the Evidence Review, 90 Health Effects, 92 Guidelines and Recommendations from Other Authoritative Bodies, 111 References, 120 5 DESIGN FEATURES 135 Age-Appropriate Design Code, 136 Greater Transparency and Accountability, 138 Adopting the Standards, 142 Using the Standards, 147 References, 149 6 TRAINING AND EDUCATION 153 Comprehensive Digital Media Literacy Education, 153 Integrating Digital Media Competency into Professional Education, 158 References, 166 7 ONLINE HARASSMENT 171 Cyberbullying, 171 Sexual Offenses, 176 Support for Victims and Momentum for Prosecution, 184 References, 186 8 RESEARCH 193 A Research Agenda, 194 Encouraging the Use of Real-World Data, 204 References, 212 APPENDIXES A Committee Member Biosketches 217 B Open Session Meeting Agendas 225 C Table of Recent Systematic Reviews of the Association Between Social Media and Adolescent Health 233 PREPUBLICATION COPY—Uncorrected Proofs

Boxes, Figures, and Tables BOXES 1-1 Statement of Task, 22 2-1 Overview of Prominent Social Media Platforms’ Posted Content Moderation Policies, 40 3-1 Seven Characteristics of Distributed Mentoring in Fan Fiction Communities, 78 4-1 Notes for Parents, 120 6-1 Standards to Inform a Digital Media Curriculum, 1457 FIGURES 1-1 Percentage of female and male students who experience persistent feelings of sadness or hopelessness 2011 to 2021, 17 1-2 Percentage of female and male students who seriously considered suicide 2011 to 2021, 17 1-3 Percentage of high school students who attempted suicide during the past year by demographic characteristics, 2021, 18 1-4 Suicide rate among teens 15 to 19 per 100,000 from 1970 to 2020, 20 xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv BOXES, FIGURES, AND TABLES 2-1 Percentage of U.S. teens who say they “ever use this app or site” or “almost constantly use this app or site,” 48 2-2 Percentage of U.S. teens who say they use the internet almost constantly either on a computer or a cellphone, 49 2-3 States privacy legislation as of mid-2023, 58 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, 72 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?,” 139 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, 173 7-2 Percentage of respondents ages 13 to 17 who say they have ever experienced cyberbullying when online or on their cell phone, 173 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, 174 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, 180 TABLES 3-1 Types of Creative Production on Social Media, 81 4-1 Authoritative Bodies’ Guidance on Social and Digital Media Use and Adolescents, 112 5-1 Operationalizing Standards for Social Media Operations, Transparency, and Data Use, 145 8-1 Conceptual Mechanisms Linking Social Media Use and Wellbeing, 200 8-2 Recent Legislative Proposals on Social Media Platform Research, 209 C-1 Select Recent Systematic Reviews and Meta-Analyses on Social Media Exposure and Adolescent Health Outcomes, 234 PREPUBLICATION COPY—Uncorrected Proofs

Preface Every age has its particular folly; some scheme, project, or phantasy into which it plunges, spurred on either by the love of gain, the necessity of excitement, or the mere force of imitation. Charles Mackay, Memoirs of Extraordinary Popular Delusions and the Madness of Crowds (1841) This committee’s work emerged from public concern about two phe- nomena: the growing ubiquity of social media use by children and ado- lescents, and the increase in poor mental health also among children and adolescents. The co-occurrence of these two phenomena has served, cor- rectly, 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 infer- ence 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. xv PREPUBLICATION COPY—Uncorrected Proofs

xvi PREFACE 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 oppor- tunities where youth can be abused of 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 he experience will be helpful. This suggested to the committee a judicious approach to protect youth mental health is warranted 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 con- versation 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 PREPUBLICATION COPY—Uncorrected Proofs

Acronyms and Abbreviations ABCD adolescent brain and cognitive development ADHD attention-deficient/hyperactivity disorder AI artificial intelligence APA American Psychological Association API application program interface CAEP Council for the Accreditation of Educator Preparation CDC Centers for Disease Control and Prevention CFAA Computer Fraud and Abuse Act COPPA Children’s Online Privacy Protection Act COVID-19 coronavirus disease of 2019 ESEA Elementary and Secondary Education Act ESSA Every Student Succeeds Act FTC Federal Trade Commission GDPR General Data Protection Regulation GIFECT Global Internet Forum to Counter Terrorism HIPAA Health Insurance Portability and Accountability Act xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii ACRONYMS AND ABBREVIATIONS ICD-11 International Classification of Diseases, 11th edition IEEE Institute for Electrical and Electronics Engineers IRB institutional review board ISO International Organization for Standardization LCME Liaison Committee on Medical Education LGBTQ+ lesbian, gay, bisexual, trans, questioning, and more LGBQ lesbian, gay, bisexual, and questioning NCTSI National Child Traumatic Stress Initiative NIH National Institutes of Health NSF National Science Foundation NTIA National Telecommunications and Information Administration P3P Platform for Privacy Preferences SAMHSA Substance Abuse and Mental Health Services Administration UNICEF United Nations Children’s Fund PREPUBLICATION COPY—Uncorrected Proofs

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Social media has been fully integrated into the lives of most adolescents in the U.S., raising concerns among parents, physicians, public health officials, and others about its effect on mental and physical health. Over the past year, an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine examined the research and produced this detailed report exploring that effect and laying out recommendations for policymakers, regulators, industry, and others in an effort to maximize the good and minimize the bad. Focus areas include platform design, transparency and accountability, digital media literacy among young people and adults, online harassment, and supporting researchers.

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