A Social Media prescription from America’s top doctor

Imagine sending your teen-aged kid or grandkid out every day to a full-time job in the tech industry.

The hours are flexible, and they say they like it … sort of. In fact, they seem obsessed with it.

You start to notice they’re not the happy kid you once knew. And no wonder, they’re balancing this new full-time job alongside school and everything else in a busy teen’s life.

Then you find out how much they’re being paid.

Zero dollars and zero cents.

But the social media companies they’re working for are making billions.

And the kids — we’re starting to discover — are actually paying big time, for what amounts to an average of eight and a half hours every day on social media.

What’s a parent or grandparent to do?

The nation’s top doctor — the surgeon general of the United States — has some ideas.

He says his scrutiny of the increasing research on platforms like Facebook, Tik-Tok, Instagram, Twitter, YouTube, and more indicates they have major upsides for connecting people. This can be a boon for those who have been marginalized in modern society.

But social media also pose big threats to the mental health, physical safety, and well-being of their users, especially the young. The rise of this tech has coincided with plummeting self-esteem among the young, as well as alarming spikes in depression, anxiety, bullying, shaming, and sexual exploitation.

The surgeon general is urging lawmakers, regulators, and tech companies to prevent individual and societal harm from social media. He has a prescription, too, for grownups and kids.

As a new school year launches, it’s a good time to take a close look at how we can help our kids cope with social media.

Correlation does not equal causation. So experts say they are not ready to issue sweeping judgments about social media, partly because they cannot even decide which of the booming platforms provide the most demonstrable benefits or harms.

Still, Vivek Murthy, the U.S. surgeon general, has examined the available evidence and decided, as the New York Times reported, to sound the alarms about social media, especially the “harm to the mental health and well-being of children and adolescents.” Using the bully pulpit* available to him as “America’s doctor,” he issued a 19-page advisory that found studies on social media to be both wanting and disturbing. Better research is sorely needed.

But, his document argued, Americans cannot ignore that, as they have become slavish social media users, big problems have followed:

“A longitudinal cohort study of U.S. adolescents aged 12–15 (n=6,595) that adjusted for baseline mental health status found that adolescents who spent more than 3 hours per day on social media faced double the risk of experiencing poor mental health outcomes including symptoms of depression and anxiety.

“[In a] unique natural experiment that leveraged the staggered introduction of a social media platform across U.S. colleges, [its] roll-out … was associated with an increase in depression (9% over baseline) and anxiety (12% over baseline) among college-aged youth (n = 359,827 observations). The study’s co-author also noted that when applied across the entirety of the U.S. college population, the introduction of the social media platform may have contributed to more than 300,000 new cases of depression.

“[A ]study conducted among 14-year-olds (n = 10,904) found that greater social media use predicted poor sleep, online harassment, poor body image, low self-esteem, and higher depressive symptom scores with a larger association for girls than boys. A majority of parents of adolescents say they are somewhat, very, or extremely worried that their child’s use of social media could lead to problems with anxiety or depression (53%), lower self-esteem (54%), being harassed or bullied by others (54%), feeling pressured to act a certain way (59%), and exposure to explicit content (71%).”

Need more indicators of the detrimental aspects of online experiences? The advisory also reported:

“Extreme, inappropriate, and harmful content continues to be easily and widely accessible by children and adolescents … In certain tragic cases, childhood deaths have been linked to suicide- and self-harm-related content and risk-taking challenges on social media platforms. This content may be especially risky for children and adolescents who are already experiencing mental health difficulties.

“[A] systematic review of more than two dozen studies found that some social media platforms show live depictions of self-harm acts like partial asphyxiation, leading to seizures, and cutting, leading to significant bleeding. Further, these studies found that discussing or showing this content can normalize such behaviors, including through the formation of suicide pacts and posting of self-harm models for others to follow.

“A synthesis of 20 studies demonstrated a significant relationship between social media use and body image concerns and eating disorders, with social comparison as a potential contributing factor. Social comparison driven by social media is associated with body dissatisfaction, disordered eating, and depressive symptoms. When asked about the impact of social media on their body image, nearly half (46%) of adolescents aged 13–17 said social media makes them feel worse, 40% said it makes them feel neither better nor worse, and only 14% said it makes them feel better.

“[R]oughly two-thirds (64%) of adolescents are ‘often’ or ‘sometimes’ exposed to hate-based content. Among adolescent girls of color, one-third or more report exposure to racist content or language on social media platforms at least monthly. In a review of 36 studies, a consistent relationship was found between cyberbullying via social media and depression among children and adolescents, with adolescent females and sexual minority youth more likely to report experiencing incidents of cyberbullying

“[S]ocial media platforms can be sites for predatory behaviors and interactions with malicious actors who target children and adolescents (e.g., adults seeking to sexually exploit children, to financially extort them through the threat or actual distribution of intimate images, or to sell illicitly manufactured fentanyl). Adolescent girls and transgender youth are disproportionately impacted … Nearly 6-in-10 adolescent girls say they’ve been contacted by a stranger on certain social media platforms in ways that make them feel uncomfortable.”

*Just a reminder, as the New York Times reported: U.S. surgeon generals have campaigned effectively to warn about the cancer-causing damage of cigarettes, the importance of removing stigma and combating HIV-AIDS, against excessive violence on TV and in video games, for life-saving curbs on drunken driving, and warning about the health risks of obesity.

Why do people get sucked in by social media, and how might greater knowledge help us better cope with it?

The young, the surgeon general reported, may be more susceptible to tech’s sway because the teen years bring big changes in the developing brain.  As he wrote:

“Adolescents, ages 10 to 19, are undergoing a highly sensitive period of brain development. This is a period when risk-taking behaviors reach their peak, when well-being experiences the greatest fluctuations, and when mental health challenges such as depression typically emerge. Furthermore, in early adolescence, when identities and sense of self-worth are forming, brain development is especially susceptible to social pressures, peer opinions, and peer comparison. Frequent social media use may be associated with distinct changes in the developing brain in the amygdala (important for emotional learning and behavior) and the prefrontal cortex (important for impulse control, emotional regulation, and moderating social behavior), and could increase sensitivity to social rewards and punishments. As such, adolescents may experience heightened emotional sensitivity to the communicative and interactive nature of social media.

“Adolescent social media use is predictive of a subsequent decrease in life satisfaction for certain developmental stages including for girls 11–13 years old and boys 14–15 years old.”

Adults also may fall prey to social media because of their powerful, hidden technologies, experts say. In brief, the software in many ubiquitous platforms runs with algorithms — complex calculations that record and analyze user reactions to the materials social media sites provide. When users respond to content, sites feed them more and more similar stuff. Critics say this is done chiefly to maximize users’ exposure to advertisers and their wares.

We’ve all seen the creepy effectiveness of this approach. Once you search online for, say, a new backpack or a set of tires, you get barraged all day long with ads for the same.

This has potentially negative aspects, critics say. They note that social media can create closed feedback loops, pushing materials at users, reinforcing their existing thoughts, beliefs — and yes, deep biases and errors. They argue that algorithms detect what content causes the greatest emotional engagement — materials that provoke outrage, anger, and other strong sentiment — and then shovel more and more of it at users.

While users “doom scroll” or gorge on social media, the platforms fuel extreme partisanship, negative views about individuals and groups, and harmful thoughts and ideas about one’s self and others, researchers are finding. Obsessive use of social media isolates users, reducing their real human contact. When folks expend long hours on social media, they engage in the sedentary behaviors that doctors and researchers decry as damaging.

Can we be fair, balanced, and not total fuddy-duddys?

Social media, especially for the young, has its positives. It can be fun and entertaining, offering talents of many different varieties a way to showcase themselves to large audiences. (Just ask the kids or grandkids to share with you their favorite dance, music, comedy, or cooking performances on the social media platforms they adore.)

The technology can be instructive and mind-broadening, exposing users to new ways of expressing ourselves and having fun.  This can be especially valuable when the information is truthful, verifiable, and important.

As much as grownups may have their doubts, young folks’ making friends online, experts say, can help them foster relationships that grow and develop in-person.

For youths in overlooked, underserved, and mistreated groups, social media can provide life-changing and life-saving connections and community, the surgeon general reported. Experts and users have praised how social media can provide information, support, and personal connections for young black, Latino, Asian, LGBTQ, and other people whose differences might otherwise leave them isolated and in despair.

Loneliness and social isolation, doctors and researchers have underscored, inflict staggering damage on the mental and physical health of too many Americans now — and social media can be one way to address these harms. As the surgeon general reported:

“[S]tudies have shown that social media may support the mental health and well-being of lesbian, gay, bisexual, asexual, transgender, queer, intersex, and other youths by enabling peer connection, identity development and management, and social support. Seven out of ten adolescent girls of color report encountering positive or identity-affirming content related to race across social media platforms. A majority of adolescents report that social media helps them feel more accepted (58%), like they have people who can support them through tough times (67%), like they have a place to show their creative side (71%).”

At summer’s end, families often make changes to ensure the upcoming school year is a success. That makes the next few weeks an ideal time to make some social media adjustments.

The surgeon general recommends for best and safest practices:

Families should establish “media plans.” These are drawn up after calm, sustained discussions about acceptable social media sites and frequency of use.

Parents should have accounts on all the platforms their kids use and should have access to youths’ online activities, both their public posts and “private” conversations. Most sites, for legal reasons, don’t allow users younger than 13, but parents should know that many kids still start online as young as 8.

The discussions may not be easy. But parents must set limits for their kids, capping the total time spent on social media and preventing long spans of scrolling and trolling.

Certain times should be tech-free: No social media during family meals and meetings, for at least an hour before sleep, and perhaps other times when parents see that social media and devices prove disruptive, distracting, and even risky (trips in the car, for example).

Parents should talk with their kids often and in detail about social media and what they do on various platforms. Grownups can help young folks learn to think critically about information they’re exposed to online, especially helping them sort out if it is true, verifiable, useful — and safe. It’s better to teach teens to laugh and reject online nonsense than to deal with the consequences of failing to do so — whether that might be grappling with serious injury caused by fads, social media challenges, or the radicalization of youths to extreme beliefs.

Keeping the communication open, unforced, and calm will help kids reach out to grownups when problems arise. They should know to report cyber bullying, harassment, and inappropriate sexual or other exploitative approaches from others. They should not be perpetrators of negative behaviors. Kids need to learn boundaries on what they share and post online, keeping private financial, personal, medical, and other information from malicious actors. Parents should respond to problems quickly and fully, enlisting the help of teachers, schools, other adults, law enforcement and regulators as needed.

Young people already struggle to sort out emotions, so parents and other grownups must put in extra effort to ensure kids don’t let what they see and do online make them feel too good — or bad. Sure, a lot of “likes” or other social media affirmations can be buoying to youths. Are those equivalent, though, to praise earned in person for playing a musical instrument or sport well, or acing an exam, or helping an ailing sibling or neighbor? Parents must help young folks achieve balance in their lives, so if they are feeling down they don’t automatically dive into social media to find distraction. How about a walk, instead, or a visit to a museum, the grandparents, or church?

Relationships are fraught for younger folks, as moms and dads know all too well. But human interactions can be even more complicated and difficult when conducted online. Users try to convey complex emotions on social media, for example, with emojis, different typefaces, colors, and slang. But misunderstandings occur too easily in cyberspace — and kids need help from mature adults in sorting out interpersonal communications, especially online. Grownups must help them develop their social skills, so they have relationships with real people not just online but also in person.

Adults can do themselves a favor by modeling best social media practices, so kids see that what parents say is not just empty preaching.

The surgeon general’s warnings should be broadened for all online users, experts say.

The Washington Post, for example, reported that parents and other caregivers are experiencing mental health stresses as grievous as those among kids. The newspaper quoted Richard Weissbourd, a family psychologist on the faculty of Harvard’s Graduate School of Education, director of Making Caring Common, and author of recent studies on adults’ psychological distress:

“[P]arents are suffering from anxiety and depression at roughly the same rate as teens, according to new research [by Weissbourd and colleagues …Though the study does not definitively answer why parents are reporting such high rates of mental health conditions, Weissbourd suggests that many of the same stressors known to be affecting teens also affect parents: polarizing public dialogue, school shootings, climate change, social media, and loneliness.”

Lawmakers and regulators at the federal and state levels (and, indeed, internationally) have taken aim at social media companies, investigating how they abet extremist views, undercut democracy, radicalize too many users, run roughshod over individuals’ privacy, put kids at risk — and more. Political partisans find themselves riven as to whether and how social media purportedly favor ideas and initiatives of leaders on one side or the other.

As the debate rages, adults must be wary of technology disrupting their well-being. As the New York Times and other groups reported on recommendations for grownups:

Be aware of the frequency and duration of social media access and use. Double-check with loved ones, friends, and colleagues to determine if you are what the American Psychological Association describes as an over-stressed “constant checker” of social media, texts, and work emails.

Set limits on use of electronic screens, especially with social media and work-related tech, during mealtimes, before sleep, and in regular and scheduled “detox” periods.

Be super careful what you share online. Know that scam artists and other bad actors scour social media to learn how to take advantage of you. Miscommunication also occurs easily, and once something goes up in cyberspace, it can be impossible to pull down.

Try to be “mindful” and not reflexive with social media and technology. Consider what appropriate role they should play in your life and with your time — and the tradeoffs they require (e.g., scrolling on a site versus talking with family, exercising, or reading). Take careful notice of how you react when using social media, especially if it agitates you and if you find yourself diving from item to item (racing down rabbit holes, as wags describe it). Be aware, too, if you find that those you connect with via social media and the views they espouse are a turn-off to loved ones, friends, and colleagues IRL (in real life).