The Rise of “Dr. Google”: Youth and Online Health Information

00:00 Introduction

Kris Perry, MSW, Executive Director of Children and Screens: Institute of Digital Media and Child Development, introduces the webinar and panel moderator, Jennifer Manganello, PhD, MPH, a Professor at the University at Albany, SUNY School of Public Health. Jennifer sets the stage by providing an overview of the use of online health resources among youth, as well as the definition of digital health literacy. She stresses the importance of skill development around not only health literacy but other literacies such as media literacy, health topic literacies and science literacy.

07:40 Emily Vraga, PhD

Emily Vraga, PhD, is the Don and Carole Larson Professor in Health Communication at the University of Minnesota’s Hubbard School of Journalism and Mass Communication. She offers insights on the prevalence of and exposure to health misinformation on social media, and how youth may be impacted. Sharing vivid examples and identifying key features of health misinformation, she proposes strategies for helping youth navigate health information online.

18:22 Paul Weigle, MD

Paul Weigle, MD, is a Child and Adolescent Psychiatrist at the Natchaug Hospital of Hartford Healthcare, and teaches on the clinical staff at UConn School of Medicine and Quinnipiac Medical School. He unpacks mental health contagion on social media and the increasing “sick role identity” among young people. He discusses recent research and clinical practices addressing teen self-diagnosis, and offers advice for parents and professionals to respond to children’s mental health misidentification.

34:22 Robin Stevens, PhD, MPH

Robin Stevens, PhD, MPH, is an Associate Professor of Communication at the University of Southern California Annenberg School of Communication and Journalism and the Director of the Health Equity & Media Lab. Dr. Stevens describes the social media environment as “a digital neighborhood,” detailing its role in youth’s lives and what this means for its impact on social and health information. She shares some trusted online resources where youth can acquire useful information on sexual health and mental health, and discusses how some social media content can help initiate conversation between parents and children.

46:15 Jessica Willoughby, PhD

Jessica Willoughby, PhD, is an associate professor of Strategic Communication in the Edward R. Murrow College of Communication at Washington State University. She discusses both the benefits and barriers of social media platforms as health promotion channels, and emphasizes key ways to promote health information that resonate with youth. She suggests three main considerations for best practices, including content, placement, and format. She concludes with strategies that parents can use to collaboratively seek information online, building skills together along the way.

58:15 Group Q&A

Dr. Manganello guides the panelists into a conversation addressing questions from the audience. The panelists comment on future directions of social media influences and technology’s role in health communication among youth, including considerations for youth with disabilities or neurodiverse youth. The panelists provide additional recommendations of useful sites and resources for youth, parents, school and health providers, and conclude with suggestions to foster healthy screen habits and balance social media use for health promotion among children and teens.

[Kris Perry]: Welcome to the first Ask the Experts webinar of 2023. The Rise of Dr. Google: Youth and Online Health Information. I am your host, Kris Perry, Executive Director of Children and Screens Institute of Digital Media and Child Development. As we start a new year, you and your family may have set New Year’s resolutions, and for many of you, improved health, whether physical or mental, may have been high on the list. For those who are seeking more information on how to achieve their goals, you may not have to look farther than the screen at the end of your fingertips. The availability and accessibility of health information online has skyrocketed in recent decades, and more and more individuals are tuning to their devices to seek essential information they may have previously sought out from their direct care providers. This is true of youth as well. Perhaps even more true than older generations as they grow up surrounded by digital media and technology and all of the information it has to offer. But do teens and younger children understand how to differentiate between accurate information provided by real experts and misinformation or trends that rapidly proliferate across social media? How are youth accessing health information online and how does this compare to information they may receive from their doctors or parents? How can youth, families, and schools identify trustworthy sources or evidence based programs to optimize digital health literacy and positive health outcomes? These are just a few of the questions our panelists will answer in the next 90 minutes. They have reviewed your pre submitted questions  and you may submit additional questions throughout the webinar in the Q&A box at the bottom of your Zoom screen. The panel will answer as much as they’re able to during the discussion today. We are recording this webinar and will share it on our YouTube channel in the coming days. All registrants will receive a link to our channel where you can also watch all of our past 55 webinars. Now, I am pleased to introduce you to today’s moderator, Dr. Jennifer Manganello. Dr. Manganello is a professor at the University at Albany School of Public Health. She is a health communications scholar who uses theories, concepts and methods from the fields of public health and communication. Her research focuses on health policy literacy, as well as the effects of media on attitudes, behaviors, and policies that put young people at risk for negative health outcomes. Welcome, Jennifer.

 

[Dr. Jennifer Manganello]: Thanks so much, Kris. And thanks to all of you who are here joining us today. I’m really excited for this session and I think you’re going to really enjoy it. I’m going to just start out with a very quick overview of some of the key ideas that we’ll be talking about today just to set the stage for everybody. I’m going to go ahead and share my screen and go through just a few slides just to get us thinking about these things. One thing we all know, I think at this point, is that our youth of today are a very connected population. Just some very recent data to show you. I mean, you look at this and you can see almost all teens in the U.S. have access to a smartphone, which has dramatically increased our access to online information. And nearly half of teens say that they’re on the Internet almost constantly. So that’s a lot of access. We also know that almost all youth who are teenagers use social media as well. And even though youth under 13 are not technically supposed to have social media accounts, many do. And again, we can see here the different kinds of social media that teens talk about using the most. And such a large percentage of teens are saying they’re on these social media almost constantly or several times a day, especially YouTube. I know YouTube’s a favorite in my own house with my two boys, and we see quite a few, or I hear quite a few, YouTube videos on a daily basis. Really quickly, when we talk to teens about what they do with online health resources, going online for health information is a very common activity. Again, nearly all teens are saying that that’s something they do. And there’s also other health related activities they use technology for as well. Just a few of the kinds of things that we’ll be talking about today is that while the online environment is a great resource, we know that there’s a lot of information out there. And while we will find some really useful things, there’s a lot of unintentional exposure and negative health messages as well. And if you just put any kind of health term into YouTube or Tik Tok, I’m sure you will be very surprised at some of the things that you might see. The other thing to keep in mind is that unlike the original Internet, where it was mostly a reading technology, now we can also create information. So another thing to consider is that teens may not just be looking for information, but also putting their own health information out there, creating TikTok videos about their own health. And so that’s a whole other element to think about. And the other thing to remember is that there are some health websites specifically designed for youth. And so those are great resources and we’ll talk about those at the end. So really quickly, what do we mean when we talk about digital health literacy? Well, first, it’s important to understand what health literacy is itself. So health literacy is basically the degree to which people can get, process, understand and communicate about health related information to make informed health decisions. So that’s great. We measure health literacy in a lot of ways and we find it very useful in research. And health literacy is also very important in terms of navigating the health care system. But given today’s connected world, health literacy is also heavily tied to the online environment and electronic information sources. And so a commonly used term, which used to be referred to as e-health literacy, and now the more common term is digital health literacy, is really applying that idea of health literacy to digital information sources. And so this is basically a similar definition, but it’s specific to electronic sources of information. It’s important to think about this as a skill that people may have different degrees of and some of us may feel that we have high digital health literacy, but then we may get to a complicated website or app we haven’t used before and we need a little bit more skill development around that. So these skills are very important for us to have. There are some other literacies as well that are very relevant to our online environment. Media literacy is specific to the ability to get and create media in different formats. There’s also topic literacies, which would be things like nutrition literacy or diabetes literacy. Do we have the skills and knowledge to understand what it is we’re reading about nutrition and then be able to apply that to our own health? And then science literacy is also quite important because that really gets at the scientific process. Do people understand how we get this information that we’re using and what research is all about? So really, we need to have digital health literacy skills to navigate the environment, but we can also use the online environment to help build health literacy skills. So that’s really important to remember. There are actually national health education standards so almost all schools are supposed to be teaching these skills in their health classes. I thought that was important to point out as well. Primarily kids will learn some of these skills at school, but there’s also other learning opportunities that come from libraries and other kinds of resources and parents. We’ll, again, talk about that today. So let us move on now to get to our panelists and our discussion. I’m going to stop sharing my screen and introduce our first speaker. Coming to you first is Dr. Emily Vraga. She is the Dean and Carol Lawson professor in health communication at the University of Minnesota’s Hubbard School of Journalism and Mass Communication. Her research tests methods to identify and correct misinformation on social media, to build news, literacy, to improve news habits and resilience to misinformation, and to encourage attention to more diverse content online. Thank you.

 

[Dr. Emily Vraga]: Thank you. And I’m very happy to be joining you here today. Alright. So I’m going to really focus on the social media piece of this. How much misinformation there is, what it can look like, and a few different skills that we can give our teens and youth to help navigate these environments. So the first thing to just stress is there’s a lot of misinformation. There’s not just a lot of information, a lot of misinformation. One study, for example, found that about a third of all vaccine content on social media is actually inaccurate. And that can range and differ by different platforms. So, for example, YouTube tended to be a little bit higher in terms of misinformation where Twitter was lower, but there’s a lot of it out there. So that’s the bad news. The good news is just because it’s there doesn’t mean that everyone is seeing it or that we’re seeing it all that often. So there are a lot of people who see misinformation, but we also can go days and days or we can scroll our social media feeds and see none of it. There are various reasons for that and why it spreads and why some people see it rather than others. I’m going to focus on just four that are particularly relevant to young adults. First is one that applies to all of us, but social media is a place where there’s a lot of different stuff competing for our attention. The idea that there’s 254 million sites when you search something, or billion sites when you search something, is true on social media as well. There’s more content that we can ever consume. And so good news and bad news, good information and bad information, is all kind of jumbled up together, competing for our eyes. Social media is a place where there’s both so much information, but sometimes not the information we want. And because there’s so much, we’re in these kind of scanning habits, not the critical consumption habits. And when we can’t find exactly what we’re looking for, we’re more likely to trust just what is there. Whether it’s true or not. So both too much and not enough of exactly what we want. For our teens, there are fewer trusted gatekeepers and more influencers. So it’s not like they are going to the CDC for their health information or some of these websites that are designed for kids. Instead, what they’re often doing is following influencers, peers who look like them or who can speak their language, who might not be beholding to the same accuracy standards, who might be presenting information in order to gain attention, to gain notoriety, to gain money, rather than presenting the best available information. This can also lead people to fall into echo chambers and filter bubbles. Places where they’re seeing a lot of misinformation being repeated from a lot of different sources. So if our general social media feed doesn’t necessarily contain a lot of misinformation, there are spaces that we can get into where it is extremely prevalent, where everyone is kind of saying the same inaccurate thing, and it can be really hard to break into those filter bubbles when they do arise. Youth are particularly susceptible to this because they feel excluded from traditional news. A lot of young people don’t go to some of the standard news sources that we’ve long relied upon to give us the best available health information. They instead are relying on social media, going to it daily, multiple times a day, or almost constantly. They trust their peers much more than they trust elites. Any parent of teens probably can tell you, they don’t need me here just to reinforce it. And then lastly, even some of our best efforts to build media literacy actually can backfire and create cynicism, if not done carefully. The idea that you need to be skeptical and careful about information means that we should be applying a critical lens. But that message, reinforced over and over again, can actually lead people to think that all information on social media is bad and therefore they don’t trust anything. And that can be dangerous as well. That, just because there is misinformation on social media and sometimes a lot of it doesn’t mean that it is completely valueless. So what does this misinformation look like? Well, it takes a lot of forms, but there’s a few kind of simple rules. Here’s just a couple examples of misinformation related to vaccines that were on Pinterest. You can see the link if you want more information. You can see a couple of the examples that they’re using, for example, correlation versus causation. Talking about the rise in autism diagnoses and the rise in vaccination rates, implying that these two things are related even though there is no scientific evidence to support that. Using emotion or appeals, a very compelling picture that grabs our attention. Destroying the lives of children one injection at a time. It’s memorable. It breaks through the clutter. So some of those techniques include, like I said, emotional emotions. So really, again, trying to break through to help us notice that to pay attention to that. A common strategy is just asking questions. So you’re not exactly saying something is inaccurate. You’re just asking a question that strongly implies, or questions, best available evidence. You’re implying something is causal rather than correlational. These two things go together, but that does not mean one causes the other. And then a lot of fear images and implicit misinformation. So that same study found that a lot of vaccine misinformation shows a really large needle, much larger than you would ever put in a child’s arm, with brightly colored fluid that’s not actually what vaccines look like, but it’s very visually appealing and it’s very frightening. All of this matters, of course, because social media use in general is related to health misperceptions on a variety of topics. So most recently, we found that people who use social media a lot tended to have higher misperceptions about COVID 19, its causes, what you can do to prevent it, and how you can respond if you do have it. Of course, seeing misinformation leads you to have misperceptions on that topic. This is especially true for young people and for video misinformation. So the fact that YouTube and Tik Tok are two of the most commonly used sources of social media for young people, and the fact that young people tend to be more likely to be drawn in by misinformation, is especially troubling. They’re seeing the spaces where misinformation spreads and they’re more likely to believe it. So I want to conclude with just a few things that we can do to help mitigate this when our teens are going on social media. The first is kind of simple. It’s nudging people to think about accuracy. So when we’re on social media, we’re there for social reasons, and accuracy might not be our top goal. Just reminding people that accuracy is important. Asking them to reiterate to you that, yeah, I think information should be accurate. Giving them news literacy tips or invoking social norms. In this House, we really want to only share accurate information. We really only want to see accurate information. All of those things can make people less likely to share misinformation and to respond to it. Misinformation relies, often, on a common playbook. A lot of misinformation uses what we call logical fallacies to trick our brains into thinking something is true that’s not. One acronym for Remembering this is FLICC. These are five simple strategies that a lot of misinformation uses. So if we teach young people about these strategies, they’re going to recognize them when they see them in the future. Just like false experts were used to claim that smoking didn’t cause cancer, we see false experts being used to make other claims related to climate change and related to COVID-19. Teaching people these common strategies in the classroom and at home can be helpful. There are media literacy skills, including source verification. This one’s really important because, although there’s a lot of misinformation on social media, a lot of it originates from just a few really bad actors. One study found that 65% of all anti-vaccine misinformation on social media came from just 12 accounts, most of whom had a financial or political gain associated with that misinformation. We can teach young people to be looking outside of where they are for verification, but not necessarily just clicking the top source that they see, but looking at lots of different information, checking their bearings. If no prominent expert or news organization is reporting on it, it might not be true. The last thing, of course, we’re talking about young people. We need to make it a game and there’s lots of efforts to do that. So here are two examples of really good games that are designed to have a fun, interactive way to teach people about those common misinformation strategies. This one is designed for teens, specifically a card game you can play to, again, teach them some of those skills. Now, it might be because I’m from Wisconsin, but I always think of these things in terms of cheese when it comes to pandemics, we need lots of layers of protection. When it comes to social media misinformation, we need lots of layers of protection as well. So teaching people these skills, helping them remember that accuracy matters, and teaching them about social norms. Thank you.

 

[Dr. Jennifer Manganello]: Thanks so much, Emily. That was great. And you know, you mentioned some great strategies to use. Someone had mentioned that they have three teen daughters who often trust non-credible, Internet sources for health and beauty information. How can you get the kids to think before they trust them to even start to use these strategies?

 

[Dr. Emily Vraga]: So one of those things is building the social norm. So having these conversations starting at a young age and all the way through as they get older, having more and more conversations. I talk to my six year old when she tells me we need to go to Disney World because Elsa is real there. And I said, well, where did you hear that? And why do you believe that? And so when she’s older, I’ll have those conversations as well. But just keeping the idea that we need to think about the sources and stressing that accuracy is important is a helpful reminder for all of us as we go online.

 

[Dr. Jennifer Manganello]: Great. Thank you so much, Emily. I’m sure we’ll hear more from you at the end in our Q&A. Thank you. So up next, we have Dr. Paul Weigle. He is a child and adolescent psychiatrist at Now Child Hospital of Hartford HealthCare and teaches on the clinical staff at UConn School of Medicine and Quinnipiac Medical School. Dr. Weigle is a distinguished fellow of the American Academy of Child and Adolescent Psychiatry and serves as co-chair of the Academy’s media committee, as well as on the National Scientific Advisory Board for Children and Screens. Thanks so much, Dr. Weigle.

 

[Dr. Paul Weigle]: Thank you, Dr. Manganello. A pleasure to join everyone today to talk about what has really become a hot topic in child and adolescent psychiatry. In recent years, we’re seeing more and more evidence of mental health contagion on social media. And of course, humankind distinguishes ourselves from other animals, in part by the complexity of our social interactions. And this was very important for our ancestors, and our 2 million year evolutionary history, who had to coordinate activities such as hunting and defense, as well as compete with one another for food, for mates, and compete in between groups. And nowhere in our lifespan is our social mind more relevant than we’re talking about adolescence. The adolescent mind is primed towards peers and primed towards peer response, social response, more than at any other time in our lives. And this was a time in our evolutionary history when young people would establish a social hierarchy and affiliation and it was literally a matter of life and death for our ancestors, whether they were accepted into the group or not. So when teens have the sense that this is a life and death matter, there is some reason. It is literally in their DNA. It goes even beyond humankind. Studies show that adolescent rats actually prefer the company of other adolescent rats as opposed to adults. So this is something that is really a part of who we are. And one part of our social mind is social imitation. Very important for assimilation into groups to be able to practice group customs and be accepted into groups as well as survival, you know, sort of imitating behaviors allows us to avoid dangerous situations, or certainly did for our ancestors. And it plays a part in what is the cumulative culture of mankind that allows us to pass down knowledge from generation to generation. Which has really been the secret to humankind’s success. If we all had to learn how to make fire on our own, well, of course we’d still be living in caves. Social imitations, you know, that can be imitation of phrases or speech, certain behaviors. But it can also be an imitation of roles and the roles we play with one another. Now, social media really takes advantage of our social nature by offering adolescents a chance to experiment with self-presentation and really control the presentation that they present to the world. And a lot of that is, of course, trying to present themselves in the best possible light. And yet, even in a false light in order to impress peers. But we’re seeing more and more often that young people are presenting themselves as ill. In particular as mentally ill on social media. Now, why might this be? This is a topic that was sort of brought to the forefront by Dr. Jane Harness when she wrote on Tik Tok’s sick role subculture. And that really matched what we were seeing clinically. But why might this be? Why might young people want to take on the role of being mentally ill? Well, it turns out there is significant reinforcement for young people in that when they post about their own mental illness, you know, real, imagined, or falsified, it generates interest of their peers, which is very valuable. Likes and clicks. It can engender support of their peers. Their peers, who feel for them, can try to help them. This peer support is so, so valuable to adolescents. The stick identity can help them with group affiliation. They can connect with a group of peers who are gathered together because of their interest in eating disorders or depression or so on and so forth. So it can help with group affiliation. It can also help with avoidance of unwanted activities. A lot of times, young people will affiliate, for example, with being depressed, and that serves to help them avoid something they don’t like, like schoolwork. And I hear this a lot from my patients, “I’m depressed, so I shouldn’t have to do my homework.” And sometimes they’re able to get adults, teachers or parents to sort of help support this avoidance, which can also reinforce the sick role. Now, sometimes this can be conscious thing that they’re putting on and imitating one another, but it also can be subconscious and it can be a self-fulfilling prophecy as well. Young people will often take the role of acting as therapists to one another online, and this can be a sort of a positive way for young people to show caring, to experiment with intimacy, and sharing secrets. And it can be a positive thing. However, oftentimes it becomes a negative, as peers expect one another to be there for them in a way that really surpasses healthy boundaries. So are you going to be there for me at 3 a.m. when I’m having a panic attack and I need someone there? And of course, peers sometimes offer good advice to one another, but oftentimes offer poor advice as well. It can be a double edged sword. And oftentimes I see young people, especially young girls, really acting as more of a parent or a caretaker to one another than a therapist, with regard to boundaries. We also see a lot of illness competition on social media. We see young people sort of competing to have this identity. In other words, “those other people who say they’re depressed, they’re just fakers or they’re fooling themselves. I’m the real deal.” We see that aspect as well. Now, mental health contagion is something that has been recognized for centuries, it often happens in groups, localized groups, such as a group at a school. The first example of media mental health contagion was the book, “The Sorrows of Young Werther,” in which poor werther, who we can see here, he failed to win the affection of his true love, and he dealt with this by committing suicide. Now, this book was all the rage among adolescents in the seventies, and that’s the 1770s I’m referring to, when there was actually a rash of copycat suicides all throughout Europe among readers of this popular book. And of course, this phenomenon has been repeated throughout history on news programs showing suicide, for example. And this is why there are media restrictions in place that media outlets aren’t supposed to talk about details of suicide, especially adolescent suicide, because of this contagion or copycat effect. There is research on mental health contagion and contagion of mental illness. It is rather limited. It’s a hard thing to study, but there’s evidence of eating disorder behavior spreading on social media, self-harm, like cutting, suicidality, which is perhaps most concerning, and the phenomenon of Tourette’s disorder. During the pandemic, videos of young people showing their tics, or their Tourette’s, became immensely popular on social media. We also saw a huge rise in young people presenting for treatment of tics. Although the tics on these videos and that young people were presenting with really didn’t match typical tics. It was thought to represent a mass contagion effect There is even some evidence on whether gender dysphoria might be a subject of social media contagion. Although this is very controversial. In clinical practice, I often see young people, especially young tween or teen girls, who come to me convinced that they have a diagnosis. And of course, sometimes they’re right. Sometimes they diagnose correctly. But oftentimes I see young people coming to me, diagnosing themselves with autism, with multiple personality disorder, with bipolar disorder, or with tics in a way that does not seem accurate to me when I take a history. In the beginning, I was rather naive. I thought if I reassured them, “I really don’t think that you suffer from autism, and here’s the reasons why,” I thought that they would be relieved by hearing that news. But this actually can be a real attack, because oftentimes they’re very invested in this identity for a number of reasons. Me challenging that is not necessarily welcome. So, how can we address this as professionals and of course, as parents? Of course, it’s so important to provide structure for young people so that social media and screen media don’t take time to take over their day, allowing enough time for a healthy sleep and a balance of healthy activities. And this can mean tech free times like no screens at the dinner table. Banning screens from the bedroom can be a really healthy intervention. Grandma’s rule, which is, first we do the work and then we have fun. So first we do our chores or homework, and then maybe there’s time for social media. And of course, as parents, we need to recognize our own relationship with screen media and achieve a healthy balance so that we can role model that for our kids. But as kids get older, we need to be less of a cop with regard to their screen media use and more of a guide. This means maintaining an open dialog about screen media and social media. This, of course, is easier said than done. There’s a few pointers that can help us along the way. When kids talk to us about their social media habits and experiences, we need to be curious and interested, but not judgmental. And we definitely don’t want to freak out because if we do, that will end the conversation. The purpose of us having a conversation about social media experiences is for us to have another one in the future. And if we impose consequences on them, you know, they tell us they looked at online pornography and we consequence them by taking their phone away, that just ends the conversation. So we need to make sure they know that there will not be negative consequences from what they share. And also, I find as a parent of teens, it can be helpful for me to start the conversation with self-disclosure and talk about some of my own experiences on social media. That can grease the wheels of dialog as well. A nice bit of advice is what Burr offered to Hamilton in the musical. Talk less and smile more when you’re having conversations with young people about their screen media experiences. So what do we do when a young teen self-diagnoses? Well, we do want to take it seriously and we do want to try to assess this, find out where do they learn about their diagnosis? What do their friends think? Do the symptoms of this diagnosis match up with our own experiences? If not, we want to listen for unmet needs that they might have that might get filled by this self diagnosis. For instance, might be something that they’re reaching out to get our attention or or to affiliate with a peer group, as I mentioned. It’s oftentimes helpful to get collateral information. What are their teachers seeing at school? Now, of course, if we think they may be correct, then consulting a qualified mental health professional is important. If we think that they may be incorrect, we want to sort of reassure them, but don’t get into arguments. We want to be understanding, but not enable by allowing their identification with a mental health problem to avoid responsibilities. We want to look at addressing their unmet needs in other ways. If they’re looking for peer approval, maybe connecting them with peers in a more healthy way. That’s all I have. Thank you for your attention. 

 

[Dr. Jennifer Manganello] Great. Thank you so much. I thought it was interesting you mentioned tics because I saw a college student video come across my For You Page on TikTok about tics she was experiencing and she was posting a lot of videos of herself in her classes with tics. And I was amazed at the large following she developed so quickly and the interactions, the comments. It was really an interesting phenomenon. So it was funny you mentioned that. You talked a little bit about the self-diagnosis that some teens will do through online health searches and social media. What about kid to kid therapy where they are diagnosing and treating each other? 

 

[Dr. Paul Weigle]: Yeah, so I do think, you know that, again, social media is a good place to sort of practice friendships and intimacy and kids trying to help each other with their problems is only natural and can be a positive thing. I often do see it goes too far. We want to educate our kids that, to have boundaries with help, that they can try to help other people and that can be a positive thing. But it’s so important to have boundaries. And this means not being expected to be available in the middle of the night or immediately, you know, even if they have something else going on. I think that that can be very important. And also, if young people have any concerns about the safety of their peers, then it’s vital to let an adult know, usually a parent or a teacher, so that they can address the issue. That they do not try to take that on themselves. 

 

[Dr. Jennifer Manganello]: Okay, great. Thank you so much. Now we’re going to move on to our next speaker, Dr. Robin Stevens. Robin is an associate professor of communication at the Annenberg School for Communication, The University of Southern California, and the director of the Health Equity and Media Lab. She also serves as an expert for the Instagram Wellness Collective. Dr. Stevens uses digital epidemiology to investigate sexual health, mental health and substance use in the context of the digital neighborhood, leveraging social media and digital tools. Thank you.

 

[Dr. Robin Stevens]: Good morning everyone. Thank you for having me. Today I’m going to share a little bit of what I’ve learned in working with young people around social media use for more than a decade and how I try to think about the space and their health broadly. My work is primarily with black and Latinx or Latin youth, typically living in urban areas, across various sexual identities, in different parts of the United States. Sometimes I do some national stuff. So this is the framing of my understanding of social media and health. And I think that’s important because, even though they may all be using the same platforms as they trend, they are not experiencing the same content. I like to use this example of the neighborhood. All young people typically live in some type of neighborhood. There is some type of dwelling and there’s maybe a library, a sidewalk, a trash compactor place. I mean, all these things typically are hallmarks of what a neighborhood has. This is the same for platforms. So everybody might be on Tik Tok, a lot of people are on Whatsapp, people are on Instagram, some are using it for Messenger. So we have the same platform technology, but every neighborhood can look very different. A young person experiencing social media in my hometown, inner city, Philadelphia, Go Eagles, may have a very different experience than young people who are using social media, the same platforms in rural California, for example. It’s not a monolith. That’s why it sort of behooves us as caregivers, as providers, as people who work with young people, we actually have to have them let us into their version, into their digital environment, into their digital neighborhood, to even begin to see what they’re experiencing. Because what I found is sometimes what’s trending as to the most dangerous thing happening on social media with teens is not what’s being experienced in my community. So their experiences are not mirrored just by what’s covered by NPR or on ABC. So the digital neighborhood also is similar to a geographic neighborhood because it’s interpersonal relationships but it’s also people in your neighborhood who you know of but don’t know. There’s popular culture mixed in. So social media is grabbing traditional media and new tech and remixing it and creating it. It’s performative sometimes, which can be difficult to navigate or to interpret, especially for younger youth who don’t necessarily fully grasp the level of performance that is happening and commerce that is behind social media. Though I do find my older teens are like, they’re just doing this for life, they’re trying to sell you something. They seem to be more cognizant of the commercial end of different platforms and different creators. It’s also, though, a third space outside of school and home where young people can connect. So your old school coffee shop, your old school bowling alley or bar, hopefully they’re not at the bar yet. Social media platforms can provide this space for young people. When we think about their health, it is much bigger than any one risk behavior or problem behavior problem assess than we may be thinking. Their health is also their full well-being, right? And so in many ways, social media, particularly during COVID for many youth, provided an outlet for one of the most important things for young people, which is peer connection. And it continues to do that. So some of the platforms we see that have high popularity are actually are not people consuming content as much as they are as connecting with peers. In thinking about how do we monitor, support and guide, it’s also like, how much do I want you hanging out with your friends or meeting new people or being in that social milieu? It’s not always just receiving content. I focus quite a bit on one. I looked at social media and sexual health behavior, and we know it’s a source of modeling and establishing norms. It teaches other teens, teens teach other teens, or older teens teach other teens, what are the normative behaviors. What’s expected out of a romantic relationship? When you get in a romantic relationship, what are the expectations around sex? That is absolutely what teens can glean not from one creator, but from meta messages that they see and what’s reinforced by other teens. We know that social media is one of the most dominant forums where kids go to look for sexual health information. Word of mouth is also very important. But here you’ll see that this chart shows how high social media is. We ran another analysis and found that youth who are using condoms, who are practicing safe sex, named word of mouth and social media as their primary sources. So here in this study, we found that social media actually was more related to taking less risk and using positive sexual health behaviors. I know, right? We also find that young people are exposed on social media to all kinds of risk behaviors. So if you think they’re not going to see nudity, alcohol, drugs, violence, it’s really hard to miss. Each of these, the tall bars are if they’ve seen it. So that’s the bad news, is all there. They’re exposed. More than half report seeing these nudity, alcohol, drugs. But the small bar at the end shows that less than 10% are actually posting it. So young people are seeing, they are passive voyeurs many times, but they are not necessarily liking, posting, reposting it. We see much more strategic involvement with risk behavior. Clearly I cannot advance slides correctly. Some things to think about. It is where young people are looking for sexual health information. So getting back to Emily’s earlier point, we have to be really concerned about misinformation, because what are they going to find when they get there? But it is a space where I did development, creation, and community building and it gives us a window into niche communities. You can now think how my young theater kids are talking about these topics, right? You can really focus in on diverse and niche communities and get access to their attitudes, norms and beliefs. And I think we have to talk about some of the algorithms and the way platforms are built to reinforce negative content. Algorithms behind Tik Tok, they will reshow you everything that you already liked. So if you find a teen who is hooked into content creators that may not be providing accurate information or pushing lifestyles that are not healthy, they’re going to see that content more than a teen who has never really engaged with that. So it can be almost invisible if you’re outside of it. So there are some great resources online though, that rise. I just really briefly want to show you. I send many people to Bedsider. When kids need to know about sexual health. For mental health, I send a lot of people to crisis text line and it works from their phones and they can text a counselor at any time, 24 hours a day anonymously, which is a step up from a peer, I think, because they can escalate services. Then we have great content creators. Here is the Period Doctor, and she just has, obviously she’s an extremely beautiful physician, but she’s also really accessible to young people. And she talks about things that maybe it’s not easy to talk about with a parent. The last thing I wanted to share, sorry, really briefly, is some platforms are actively trying to build safe and supportive content in their platforms, like introducing quiet mode for teens. Okay. That’s all. I’m over time. Thank you!

 

[Dr. Jennifer Manganello]: Thank you so much, Robin. That was great. You got it at this a little bit, and I know we’ve gotten a few questions about filters and parental controls, which can be a touchy subject. When we have our youth accessing health information online, which is a great resource for them, too many suggestions about using filters or controls to try to prevent access to inappropriate sexual or other health content that we might not want them seeing. 

 

[Dr. Robin Stevens]: Okay, so I have three teens. I’ve been working this for a long time, and I want to be honest. I think the Internet is full of pornography. I’ve done some research and the amount, and it’s not just happened upon, we know that the porn industry’s market uses health related search terms. Your child could be searching for safe sex or condoms and end up in a portal. So there’s an active goal to try to pull them away from healthy sexual content. One thing I will say is I don’t have a master answer, but I do know that teens are typically much more savvy than we are around technology. So even when you put filters and blocks on their accounts, which may be helpful as they’re younger, as they age into it, they have other accounts like you’re following your kid on Instagram, but that’s not their real Instagram. You know what I mean? I think you cannot lose the human conversation. I would love to hear other thoughts. It’s a real challenge. And I think it is not accidental. There’s a market there to try to reach teens in these areas with misinformation.

 

[Dr. Jennifer Manganello]: Yeah, those are such great points. And I do agree. I think that ongoing conversation is so important because that can have such an impact when you have these conversations with your kids. So thanks for reminding us of that. Up next, we have Dr. Jessica Willoughby. Jessica is an associate professor of strategic communication in the Edward Murrow College of Communication at Washington State University. Her research examines how adolescents and young adults use digital and mobile media and how that impacts their health and how such media can also be used for health communication efforts. So we will transition now to Dr. Willoughby. Thank you.

 

[Dr. Jessica Willoughby]: Thank you so much. Thank you for the opportunity to be here today. As we know from the previous presentations, youth are frequently online and they’re seeing a lot of content on social media, including information about health. That can have an impact on their health and well-being. Today, I’m going to be talking about how we can use digital health communication to promote positive health behaviors among youth, including recommendations and evidence-based strategies. As you might guess, there’s a lot of information that could go into this, so I won’t be able to cover everything in the time I have this morning. But I hope to give an overview that will give you some good ideas. If you’re thinking about how to translate health communication efforts to digital formats or if you’re a parent, some pieces of information about the types of resources and interventions that may be out there for the benefit of the young people in your life. So to turn this off a little bit, I wanted us to think through some of the considerations of using social media for health promotion. When we’re thinking about social media, for health promotion efforts, there are a number of benefits for us to think about as well as potential barriers. One of the key takeaways that I hope you’ll have from my discussion today is the importance of reaching youth where they are at and in a way that resonates with them. Youth don’t often use social media because they necessarily want to be taught about something. They’re using social media for entertainment, they’re using it for connection, and they’re using it for a number of other reasons in their life. And so it’s important to think through how we can get our information across in a way that will help us resonate with youth and cut through some of that digital clutter that’s also potentially there. Now, before we can answer specifically that question, which I want us to go back to, I think we need to consider those benefits and barriers that I mentioned previously. Social media and digital interventions can offer a lot of features. One of the nice things social media has is that two way back and forth platform where we can be posting information and seeing what others are also sharing. However, that two way piece of information can also potentially be problematic for us, sometimes. The idea of a message going viral, for example, can be very exciting and also somewhat terrifying. So we need to kind of weigh the benefits of having that two way interaction with also the potential cons of putting our message out there and then losing control of that message. Once we put a message out on social media, we don’t necessarily have control over how that message gets adopted, adapted, shared, or changed in different ways. And that can make for some scary times when we’re thinking through social media and what we want to use it for. One of the other benefits of social media is the curation of content. It’s actually really nice that we can find content in certain topic areas that people might be interested in. We know that youth in particular are actually seeking health information from social media sites. It’s not even just Google anymore. It’s also going to Tik Tok, right. And searching for that health information. And so that curation of content can provide a lot of information in one space. But then it’s also difficult if you’re from a health organization or you’re a health educator, in figuring out how to get that information seen among the other pieces of information that might be out there. There are also some things to think about with social media in terms of our audience, and that’s really reaching the audience where they’re at. So you want to be thinking through which platforms would get your message to the youth that you’re really trying to reach with your efforts in health promotion. This can be challenging because social media change frequently. And so I often encourage people to think about the content they’re placing and then the social media as a platform because that social media can shift rather quickly where we’re using one thing that’s really popular and not too long from now, we might actually be away from that and focusing on other areas of social media. So thinking through what the content is that you want to convey and how the different platforms allow you opportunities to do that within the affordances that they have can be really beneficial. So as I mentioned, I wanted us to go back to this question a bit, which is how can we share health information in a way that resonates with youth? And unfortunately, there is no one right way to answer this question. However, there are some strategies and tips that we can use to help guide us. I like to think of these sort of pieces as an interlocking puzzle. I’m going to talk about three here today, and the reason they’re really interlocking is because you can’t really have one without the other. It’s difficult. You can’t really prioritize one above the other. So while I have them listed here, content, placement, and format as a list, I don’t necessarily think of it as a hierarchy because all of these need to work together for people to be able to see and pay attention to your messaging. The first that I wanted us to discuss today is related to content. I think this is often where we think about putting our effort in our digital health communication interventions. We want to make sure we’re conveying content that is important, that is evidence based, that is relevant to the audience and all of those pieces. And you want to have good information that you’re putting out there. There are a number of strategies that we can consider when we’re thinking about how to create the most useful and effective content. Past research tells us, for example, that identifying the audience you want to focus on and conducting work with them prior, called formative research, can be really helpful in some of your interventions. This means really taking the time to listen to youth. What is it they want to hear? What is it they want to see? How can you get that information in a way that resonates with them? Past research also tells us that theory can be helpful in guiding our message development. We can use a couple of different types of theory depending on the messages we’re trying to create here. If you’re trying to change health behaviors, health behavior theory can be useful, where we look at different constructs that might influence behaviors such as the attitudes people have, norms which is something Robin had mentioned in her presentation previously. These different constructs can help us lead people towards thinking about a behavior potentially in a different way. Using theory as a guide for any of our development of messaging can be really useful. We can also think through how we might want to develop our messages related to communication theory. Which things are going to grab more attention? Which type of processing are people going to be engaging in with those messages that we are presenting? And those can all be helpful as well in the construction of our messaging. So the second consideration I wanted us to talk about was this idea of placement of messages. And as I mentioned before, different platforms have different benefits and can serve different purposes for youth. Does your message lend itself to short videos, for example? Is it something that needs a back and forth to really be understood? Are visuals necessary, or could a text-based intervention sufficiently convey that information you want to share alone? And then back to the big one: where will you see your messages? Which placement is going to reach the people that you’re really hoping to reach? Now additionally, you also want to consider the format that you’re going to deliver your message through. And here, I mean more than where the text goes or which platform you’re using, but strategies that go into that message development itself. Does the message that you want to share lend itself to a narrative or a story approach? We know from past research that youth in particular, one of the things they like about searching on social media and digital media for health information, is user generated stories or user testimonials. So sometimes health information that we want to convey also doesn’t have to come in the form of a list of facts, but we could convey it in a story version. And is this something that you could use here where maybe a story or testimonials or narratives that individuals provide could provoke the thought and the information that you’re trying to convey? We found in some of our work that you can even convey these types of narrative or story messages in short spaces as small as text messages, or a few different Instagram posts, depending on the information you’re trying to put out there. So another practice that can also be useful here, especially, is to highlight the voices of youth, but in different ways. Thinking through what the youth want to hear and what is helpful to them based on that formative research can really inform our efforts. And there are a number of different ways that you can involve youth in the creation of messaging that is designed for youth to really make that messaging empowering and helpful. So the last point I wanted to cover was to talk a little bit about how you might find resources that you think are worthy of sharing. There are a number of national resources as well as resources at the state and local level, and helping youths really decipher which resources may be beneficial for them is something important that we can do. If you’re a health educator or a parent who’s looking to curate a list of sources, for example, there are some things that we could consider. One of the first, I think, is encouraging methods of communication that really fit with youth in their lives today. So, for example, as we’ve talked about in Robin’s presentation, a text line for example, for crisis type issues. Youth really aren’t going to call on the telephone anymore to talk to individuals. So finding the resources in a format that are going to reach youth where they’re hoping to be heard and talked to, I think is really useful. And in addition to national resources, I think it’s also beneficial to look at resources in your community. So in some cases it can be helpful because you might have resources available to you nearby that may provide more immediate assistance for topics or needs if they were to arise. We also know from some past research and information seeking that a number of things factor into whether or not you feel comfortable seeking information. So this includes their attitudes towards seeking information. Is it a good or bad thing? This includes the norms they have around that. Are others thinking that seeking information is a good idea? Are people thinking that if I seek information, it’s a good idea? These different factors can influence whether or not a youth seeks information. Additionally, though, emotions play a role here and their affective response to whatever that topic is. And so one of the reasons it’s useful to think about resources available to youth and how to give them resources in advance of when they might actually need them is because of that emotional element that can come into play with some of our information seeking. If we’re at a moment where we’re really having a lot of affective feelings, where we’re worried about something, we’re concerned, and then we’re going on and seeking information, it might make it so that we have more trouble deciphering the good sources from the bad or really understanding that content in the context of the things that we need to be thinking through. Overall, it’s important for us to think about how we can give them the sources of information that might be helpful before maybe they actually have a need for that specific resource at that moment. So I think one of the best things we can continue to do is consider how we can use digital communication tools to help meet the needs of youth and how to meet them where they’re at with information they see as relevant and useful at the time that they need it. Thank you.

 

[Dr. Jennifer Manganello]: Thank you so much, Jessica. That was great. I’m going to have one question specifically for you and then we’ll move on to our general Q&A and discussion. Do you think that children having access to youth search engines for questions can springboard conversations with parents? And what do you recommend to parents to leverage this opportunity?

 

[Dr. Jessica Willoughby]: That’s such a great question. In some previous work that we did when I was working with a text message service related to sexual health in North Carolina, we found that youth in particular really liked being able to ask questions of the service, but then use it to prompt discussion. And they were often using those questions to prompt discussion with other teens. I found this information, I’d like to talk about it. I think that the search engine option could work in a similar way. Parents could actually ask their youth, what type of questions are you having? Let’s go ahead and search together. Let’s figure out how to look through those results and really navigate to the results that provide the most helpful information for the questions that you have. You’re able to talk about the topic, but you’re also able to talk about the process of searching and really seeking out that information that can be useful.

 

[Dr. Jennifer Manganello]: Okay, great. Thank you so much. As we move into our group discussion, I actually wanted to start with a quick mention of something that we got a few questions about actually before the webinar. That is, how do we think about these issues for youth who may be neurodiverse or have disabilities? And I have to be honest, it’s something that has really not been at the forefront of the research literature. So there’s not a lot of great recommendations out there, unfortunately. I have two children. My older son has multiple disabilities. So this is something that I think about quite a bit and I think, you know, I’ll see what others have to say. But one of my thoughts on this is that we really have to consider accessibility issues. And so first of all, if you’re someone who’s putting out health information, you need to think about how are you making your information accessible? And that can be things like, you know, using plain language and simple text, having a sound button so that people who have challenges with reading can listen to the text, making sure that your website, your app, etc. can be easily used with a screen reader. People with vision problems might be using screen readers to access the content and also video captions. So I know my son, who has hearing loss, really prefers to have video captions on when he’s watching videos. He can hear the videos, but having the captions on really helps him comprehend the information more. I think there’s kind of two elements here. One is as someone who creates health information, keeping those things in mind, but also as a parent, making sure that your child is set up with those tools on their computers or their phones or whatever it is they’re using, so that they can access those kinds of accessibility tools that can be really helpful. I think the other thing to mention is we’ve heard a lot about connecting with others and sharing our health issues with other people. I think especially for kids with disabilities, that can be really critical. A lot of these kids can feel very isolated. They may be the only one they know who’s wearing hearing aids at their school. When we think about the potential for them to be able to search for things like, what do I do, my hearing aid isn’t working or, you know, finding some other kids out there who are in high school with hearing loss so that they have other people they can talk to about what’s going on for them. Those are really important things. I wanted to keep that in mind. The last thing I want to mention is sometimes we get hung up on the negatives of screens or screen time. For some kids, they may be using screens to communicate. That might be their sole source of communication. So I want to make sure that we think about those positives for some of these kids before we jump to demonize, you know, all screens or, you know, the fact that they can access some of this more negative health information online. There’s just so many positives. I wanted to just keep that in the forefront as we move into our discussion. I know we did hear already about a few useful resources for youth. Are there any other good health sites that people want to comment on that they would refer parents to that they think would be especially great to recommend to their children? 

 

[Dr. Paul Weigle]: I do want to mention one wonderful resource online is the American Academy of Child and Adolescent Psychiatry, the ACAP. They have a facts for Families series, which is suitable not only for parents but for children as well. So that is the ACAP.

 

[Dr. Jennifer Manganello]: Anyone else? I know I often tell parents to check out Kids Health, which is run by Nemours Hospital in Delaware. One of the nice things there, they have text but also little audio boards you can click on to hear the sound. And a lot of their information is also translated into Spanish. So that’s a nice site as well. Any others?

 

[Dr. Emily Vraga]: There’s an increased emphasis on gamification. Teaching young people, especially some of these media literacy tips, digital health literacy tips, in more fun, engaging ways. So I mentioned the bad news game is one of them. There are others that are emerging. I like the bad news game in particular. I use it with my students and they really seem to enjoy it and it resonates well with them.

 

[Dr. Jennifer Manganello]: Yeah, go ahead, Robin.

 

[Dr. Robin Stevens]: I would add this is a great place for parents and caregivers and providers to start to look on their own, on Tik-tok and on Instagram, to see what content creators resonate. You’re like, okay, this is a good one. This is who I would, yes, I’m down with this because realistically, young people aren’t likely going to websites as much as we do. It’s a great way to teach, to find people and say, “Hey, have you seen this?” Like, I see my daughter and say “have you seen the period doctor? This is a funny video.” Just start to open, like sort of introduce, different credible sources that are “hip” and “cool.”

 

[Dr. Jennifer Manganello]: Exactly. 

 

[Dr. Paul Weigle]: Which there are positive, you know, accounts on social media like Dr. Ashton Sood, a child and adolescent psychiatrist, has mind media psych where he does psychoeducation for kids.

 

[Dr. Jennifer Managanello]: Yeah, that’s a great suggestion. I know another question we got was what is the difference between misinformation and disinformation? We hear those two terms a lot.

 

[Dr. Emily Vraga]: Yeah. So I mentioned that briefly in my talk. The difference is really about intent. So misinformation is just sharing something that’s inaccurate. And I promise you everyone has done it because all it means is you got it wrong. We all do that. Disinformation is people who are doing it knowingly, who are spreading something they know to be false, and they usually have some kind of financial or political gain that they’re getting from it. And what we know about that is that disinformation creators are really seeding a lot of that disinformation, and then the rest of us pick it up unwittingly and share it more broadly.

 

[Dr. Jennifer Manganello]: Thank you so much. Another question is around this idea of, we talked a little bit about this mental health contagion, but how do you balance that with the value in destigmatizing mental health issues?

 

[Dr. Paul Weigle]: Yeah, that’s a great question. I mean, we have seen a wonderful sort of destigmatization of mental health issues among young people who are less and less avoidant of treatment, such as counseling. Those do have to be a balance. I’m not sure I have a more complex answer than that, but social media is a double edged sword.

 

[Dr. Jennifer Manganello]: That is true. And along with that, I think, I know even as an adult this has happened with me, you know, where you search some symptom you’re having and then you instantly are like, “Oh my gosh!” What is your recommendation for teens where their social media usage might actually increase their anxiety in some way?

 

[Dr. Paul Weigle]: Yeah, So, you know, there is a phenomenon that the more you research health concerns, the more you seem to accumulate. We call that “Medical Students’ Disease.” back when I was in medical school. Of course, human beings, we’re not very good at self-diagnosis. You know, a couple of years ago I had terrible abdominal pain. I was convinced, with my expertise, that I had appendicitis. I go to the E.D. and they correctly diagnosed me with a kidney stone within 2 minutes. So I think that young people, you know, oftentimes, even though it’s good that they’re exploring their health concerns online, we do want to recognize that even adults are not necessarily good at diagnosing themselves.

 

[Dr. Jennifer Manganello]: Yes, that is true. What about, you know, we talked a little bit about where kids can learn some of these digital health literacy skills. I know, Emily, you mentioned a couple of games. You know, we also talked about things parents can do to build digital health literacy skills for their kids. What do we think about what schools could or should be doing to handle some of this?

 

[Dr. Emily Vraga]: Schools play a really important role. There’s increasing emphasis on, especially media literacy, which has a lot of relevance to health literacy as you laid out so nicely for us at the beginning. What I really want to stress is it is a communal effort, right? The schools need to be doing this, but it needs to be reinforced and talked about and valued in the home as well. And there’s a lot of places where we can be reinforcing building these skills together. So the last thing I also want to stress is that even if we had media literacy in our educational experiences, I went to school before there was social media. And so that’s another reason why we all need to be thinking about what skills we need now and what skills are going to endure for the social media platform we haven’t envisioned yet, or the new digital technology we just don’t know, that’s around the corner.

 

[Dr. Jennifer Manganello]: Yeah, that’s a great point. And actually someone else asked a question and they said, you know, given what youth are seeing now, what do we think about how they might view information in the future as adults? And I think about what you just said, Emily, you know, our parents, us, you know, people who did not grow up with this kind of technology, we view things very differently. And we can only imagine how things might change when the current youth, you know, get to our age. So does anyone have any thoughts about that? It’s hard to predict what will happen. If you had told me about Tik Tok many years ago I would not even understand what you were talking about.

 

[Dr. Jessica Willoughby]: I was just going to say, sorry, Robin. I was going to say I think it really is, you know, tricky to think through what that might look like in the future, but it’s also really about trying to understand where everybody’s coming from, I think, in some ways. Right? And so we recognize that we might have these limitations because of the way we grew up or the experiences we’ve had. But then it’s really also hearing from youth, you know, what are they seeing now and what are they experiencing with it and what challenges do they see? Because, like we’ve talked about, their interpretation of content is different, but so is their understanding with technology and resources. So I think it’ll be interesting to see where that goes.

 

[Dr. Robin Stevens]: I think that I’m encouraged. I’m discouraged when I look at content or the platforms often, but I’m encouraged when I talk to teenagers. I think they are becoming more and more savvy and strategic. And so the more they understand the business behind the platforms, I think the better off they are at interpreting them. Even though, of course, it feeds into teen needs to center the self and always understand our viewers. Right? So it feeds right into that developmental stage. But I do also think they’re more savvy. And I’m actually really, if we think about help globally, I am encouraged by the amount of exposure to different cultures, ethnicities, impressions that young people have that I certainly didn’t. And the empathy that it creates for this generation. I think they’re going to be a much more empathetic and inclusive group, many of them, not the ones who fall in that other pipeline that we worry about. But many of them, I think it’s positive.

 

[Dr. Paul Weigle]: I’d like to add that it is important to hold the social media platforms themselves accountable. I do think that these platforms could very easily make changes that would encourage healthy use and limit toxic use. But the truth is that the platforms are not really motivated to do so. And that’s where a potential legislation might play a role. It could really help out with the cigarette industry. And I think that that analogy applies in the social media industry as well. So there are organizations like Children and Screens that advocate for that type of change.

 

[Dr. Jennifer Manganello]: Yeah, that’s also a great point. Thank you. And I want to respond to what Robin was talking about regarding inclusivity. I also think that’s another element of the disability piece. And so, you know, for teens who don’t know what it’s like to have autism, for instance, if they are exposed to what people’s experiences are like, it might build some empathy or encourage them to be more inclusive of those with differences who are in their schools and in their communities. So I think that’s a really important point. Did anyone else have any other thoughts about the disability piece? I didn’t open it up for any other comments there. Yeah, Robin?

 

[Dr. Robin Stevens]: I would say that I think in terms of accessible content, I did a recent content analysis of health and wellness content creators and they actually use a variety of accessibility tools in their creation. So it’s usually a side caption, a written caption, music, sometimes there’s no music. I think as we create health communication, they’re actually leading the way. Some of the content creators in making sure their messages are seen and understood 14 different ways, extremely brief content, longer form content, panels, or carousels. So I think there’s some good stuff we could borrow.

 

[Dr. Jennifer Manganello]: That’s such a great point. I mean, I’m just astounded by some of the creativity I see in terms of how youth of today are delivering messages about their own health and their health experiences. It’s just really phenomenal to me, actually. So I think that’s such a great point. I do think there’s a lot for us to learn who work in this field and area to consider what changes we can make to the information we’re creating. I think another thing someone had asked about was how do we make some of the risks tangible for our kids? So whether this has to do with the risk coming across misinformation or the risk of being exposed to content that could impact their health, if that they may not be thinking about, I’m thinking about one particular example of some of these TikTok challenges that come up where, you know, it might seem like a fun thing, and I’ve seen this happen with my own community. You know, it seems fun, but then maybe you’re not understanding the health risks of some of these challenges. And that information is not included in the content. So what are people’s thoughts about how we can get kids to better understand some of these risks that might be present?

 

[Dr. Paul Weigle]: It is a great challenge. And so it’s a wonderful question, especially when you’re working with teenagers, because it’s important to understand that the adolescent mind is very good at assessing risks for other people. But very poor at assessing the risks for themselves. They tend to underestimate risk in that type of situation. It’ll happen to the other people, but it won’t happen to me. So that’s why I think that as others have mentioned, maintaining that sort of open dialogue where kids feel free to talk about what’s going on in social media is so vital.

 

[Dr. Jennifer Manganello]: I think another question I have is, you know, sometimes we might encourage our kids, I think someone mentioned this in their discussion. You know, if you see something, say something. Right? You know, if you see someone struggling. What would you say to kids who may be concerned about saying something because they don’t want someone to know? “Well, I told my mom” and then they got back to the school or whatever, you know. What are your thoughts on that?

 

[Dr. Paul Weigle]: Yeah, I’d like to answer that because I’ve encountered that in many iterations. So many of the young people now, who come for treatment of depression, self-harm, suicidality, they came to me because they posted something about it on social media, a peer saw it, and informed either a teacher or the parent. And I think that the kids don’t know that this is normal, that kids do involve parents in these types of situations. And so I think trying to educate kids about that is really important in order to help promote a safe atmosphere online.

 

[Dr. Jennifer Manganello]: Any other thoughts on that?

 

[Dr. Emily Vraga]: I think one other thing to stress is that we know when people are willing to respond to misinformation, which is a little bit different than what we’ve been talking about. If you see somebody sharing something that’s patently false on social media, if you reply gently and offer the truth, that could actually be very effective for the community seeing that interaction. So I think it’s something you have to be really cautious about and especially with teens. You don’t want them getting into spaces where they feel unsafe. But if they feel safe talking to their friends, we’re sharing that, we’re seeing that, and just saying, “I saw this on social media, but I don’t think that’s right. This is what the CDC says” or something. That can be another source of really good information because they’re going to trust each other and to trust their peers. Sometimes a lot more than they’re trusting us.

 

[Dr. Jennifer Manganello]: Yeah, those are some great ideas also. Another person asked, they were interested in our ideas on the fact that a lot of these social media sites and websites, you know, they try to use strategies to pull us in and reach those pleasure centers of our brains so we keep scrolling, keep clicking, you know, keep coming back. They want the eyes on the content, right. Do we feel like we’re trying to hold back a river here in terms of trying to teach these skills to our teens about how to effectively and safely use all of this great information that’s available to them? And, you know, how do we compete with that?

 

[Dr. Paul Weigle]: I think that’s a great question and that’s a wonderful analogy. Many parents feel like they’re fighting a constant battle to help their kids have healthy sort of relationships with screen media. I think of the movie I sometimes watch with my patients in group therapy, The Social Dilemma, which is on Netflix and talks about, I think is  wonderful for teens to kind of understand how social media works. However, I see kids who think, “wow, I never knew that and I think I really need to change my relationship with social media and I’m going to do this.” And then when I follow up with them a couple of weeks later, they’ve slid right back into the same behavior. So it really is a balance between education and parents providing structure. But again, you know, advocating for social media companies to play a role in this as well, I think is very important.

 

[Dr. Jennifer Manganello]: Yeah, Robin?

 

[Dr. Robin Stevens]: Two things. One, I do think that there are some things we as parents can do, like removing a phone after a certain hour. Like, phones are charged downstairs. It’s hard to navigate around not having a device. I don’t know, I used to have a phone curfew back in the day and it worked. You’d get caught, but you know, it helps to have it because it gives teens a reason to say, I can’t talk to you, my mom took my phone, you know, my mom’s going to take my phone. It gives them a way out from why I’m not responding to your DMs. Two, I do know some platforms, specifically I know Instagram just released a bunch of parental and user supports around some bullying and blocking and quiet modes. I think part of us teaching kids to use social media is helping them say, “Hey,” I just did this with my daughter, “your social media is curated by you so you can just kick out anyone who doesn’t make you feel good, right? So let’s do this, let’s do it together, let’s curate it because it gets to be your perfect version of the world.” So helping teens know, “oh, I can block, oh, I can mute this person, but they won’t know that I block them. I can do these things.” And then I think with the quiet mode is to deal with fear of missing out. What they’ve added is and I’ll look learn no person is in quiet mode. So it’s not that you’re ignoring me. It is that owned by my parents has been put in quiet mode, right? So I think figuring out what the platforms are doing and how to use them. Not all platforms are actually are doing it. So it’s kind of a challenge because the ones that are most popular with teens are not always the most invested in protections.

 

[Dr. Jennifer Manganello]: Yeah, that’s a great point. And also, Jessica, did you want to add to that?

 

[Dr. Jessica Walloughby]: Yeah, I was just going to say, I think this also goes back to your question about the future a bit. This is one area that I’m really optimistic about too. We were doing some work when the COVID-19 lockdowns were happening in Washington State with young adults and talking to them about their media use. After kind of a media literacy piece. A lot of them were talking about how they were muting content. They were turning content off. It was because it was upsetting them. It was making them anxious or upset or frustrated. I think this is a generation, like we’ve talked about, that’s more tech savvy. As they continue to learn these pieces and the ways to control the things they’re seeing, I think there’s a lot of hope there for how they can respond to things, too.

 

[Dr. Jennifer Manganello]: Yes, that’s a great point. So we’re going to move now to final thoughts. I just wanted to start with a quick one, which is, you know, I have two kids and they are very different children. I just want to emphasize some of what we already heard about keeping the conversations open. I have found that to be one of the most successful strategies that I use. My kids will come to me about things they see or questions they have because they found something online that they wanted to talk to me about. And they know that they can do that. So I think that is a really good strategy. And I also think, you know, when we’re talking about some of these rules or filters or whatever strategies that you might want to implement, you have to remember that you want to use things that you feel are a right fit for your family and your kids. In my case, my kids are so different. I have very different ways that I approach technology use with them. They have different rules from each other and that has to be okay. And I explain to them why that is. I think that’s also important, thinking about the context for your kids. So I wanted to just add that to the conversation. Jessica, do you want to go next with your final thoughts?

 

[Dr. Jessica Willoughby]: I really enjoyed this discussion. I think, like we’ve talked about, there is a lot of potentially problematic out there, but it’s really interesting and exciting to see how youth are taking that information in and moving forward. I’m curious to see what the future does hold.

 

[Dr. Jennifer Manganello]: Great. Thank you so much. Emily?

 

[Dr. Emily Vraga]: I would just reinforce what you were saying, Jen, but also try and make it fun. It doesn’t always have to be lecturing, “you should do this, you shouldn’t do this. This is terrible.” Try and make a game out of it. Try and teach them things in ways that they’re going to find enjoyable because that’s going to stick so much better than a lecture on “you should do this.”

 

[Dr. Jennifer Manganello]: Yeah, that’s great. I actually will text little helpings or something to my kids, you know, or Tik tok that, you know, and that does help keep things flowing and keep it a little bit more fun. So that’s great.

 

[Dr. Paul Weigle]: So I do want to encourage parents that, as we said, it can be such a challenge to curate healthy relationships and screen media for our kids. But research shows that it is worth it. That parents who do this, their kids are much healthier in a number of different ways. And remember that we as parents, we don’t need to be perfect. Our parents weren’t either. And so it’s okay to make mistakes and you’re not in this alone.

 

[Dr. Jennifer Manganello]: Thank you so much. And Robin?

 

[Dr. Robin Stevens]: If you feel like you are too old to learn every new platform, this is where you bring the aunties, the older cousins. Let the 20 pluses help you with your teenagers.

 

[Dr. Jennifer Manganello]: That is also a great tip. Great. Well, thank you all so much for your final thoughts. And Kris, I will pass this back to you.

 

[Kris Perry]: Thank you, Jennifer. And thank you, Emily, Paul, Robin, and Jessica for sharing your diverse expertise and advice and helping us all better understand the varied experiences youth have with health information online. The many insights and recommendations shared today are very helpful. I also want to thank all of you in our Zoom audience for joining us today. As you leave,you will be prompted to complete a feedback survey. Please take a few minutes to share your thoughts on today’s workshop and suggestions for future events. To learn more about this and other topics related to child development and digital media, check out our website at www.childrenandscreens.com. Follow us on these platforms and subscribe to our YouTube channel. We hope you will join us again in two weeks for our next Ask the Experts Webinar: Social Media, Drugs and Youth: What Parents Need to Know. Thank you.