Social Media
and Youth
Mental Health
The U.S. Surgeon General’s Advisory
2023
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 2
Contents
About the Advisory 3
Social Media and Youth Mental Health 4
Social Media Has Both Positive and Negative Impacts
on Children and Adolescents
5
The Potential Benets of Social Media Use Among Children and Adolescents 6
The Potential Harms of Social Media Use Among Children and Adolescents 6
What Drives Mental Health and Well‑Being Concerns: 8
A Snapshot of the Scientic Evidence
Potential Risk of Harm from Content Exposure 8
Potential Risk of Harm from Excessive and Problematic Use 9
Critical Questions Remain Unanswered 11
Known Evidence Gaps 11
We Must Take Action: A Way Forward 13
What Policymakers Can Do 15
What Technology Companies Can Do 16
What Parents and Caregivers Can Do 17
What Children and Adolescents Can Do 18
What Researchers Can Do 19
Acknowledgments 20
Endnotes 21
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 3
A Surgeon General’s Advisory is a public statement that calls the
American people’s attention to an urgent public health issue and provides
recommendations for how it should be addressed. Advisories are reserved
for signicant public health challenges that require the nation’s immediate
awareness and action.
This Advisory calls attention to the growing concerns about the effects of social
media on youth mental health. It explores and describes the current evidence on
the positive and negative impacts of social media on children and adolescents,
some of the primary areas for mental health and well-being concerns, and
opportunities for additional research to help understand the full scope and
scale of social media’s impact. This document is not an exhaustive review of the
literature. Rather, it was developed through a substantial review of the available
evidence, primarily found via electronic searches of research articles published
in English and resources suggested by a wide range of subject matter experts,
with priority given to, but not limited to, meta-analyses and systematic literature
reviews. It also offers actionable recommendations for the institutions that can
shape online environments—policymakers and technology companies—as well
as for what parents and caregivers, young people, and researchers can do.
For additional background and to read other Surgeon General’s Advisories, visit
SurgeonGeneral.gov
About the Advisory
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 4
Social media
1
use by youth is nearly universal. Up to 95% of youth ages 13–17
report using a social media platform, with more than a third saying they use
social media “almost constantly.”
2
Although age 13 is commonly the required
minimum age used by social media platforms in the U.S.,
3
nearly 40% of children
ages 8–12 use social media.
4
Despite this widespread use among children and
adolescents, robust independent safety analyses on the impact of social media
on youth have not yet been conducted. There are increasing concerns among
researchers, parents and caregivers, young people, healthcare experts, and
others about the impact of social media on youth mental health.
5, 6
More research is needed to fully understand the impact of social media;
however, the current body of evidence indicates that while social media may
have benets for some children and adolescents, there are ample indicators
that social media can also have a profound risk of harm to the mental health
and well-being of children and adolescents. At this time, we do not yet have
enough evidence to determine if social media is sufciently safe for children
and adolescents. We must acknowledge the growing body of research about
potential harms, increase our collective understanding of the risks associated
with social media use, and urgently take action to create safe and healthy digital
environments that minimize harm and safeguard children’s and adolescents’
mental health and well-being during critical stages of development.
Social Media and
Youth Mental Health
Up to 95% of youth ages
13–17 report using a
social media platform,
with more than a third
saying they use social
media “almost constantly.”
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 5
Social Media Has Both Positive and Negative
Impacts on Children and Adolescents
The inuence of social media on youth mental health is shaped by many
complex factors, including, but not limited to, the amount of time children
and adolescents spend on platforms, the type of content they consume or are
otherwise exposed to, the activities and interactions social media affords,
and the degree to which it disrupts activities that are essential for health like
sleep and physical activity.
6
Importantly, different children and adolescents are
affected by social media in different ways, based on their individual strengths
and vulnerabilities, and based on cultural, historical, and socio-economic
factors.
7, 8
There is broad agreement among the scientic community that social
media has the potential to both benet and harm children and adolescents.
6, 9
Brain development is a critical factor to consider when assessing the risk for
harm. Adolescents, ages 10 to 19, are undergoing a highly sensitive period of
brain development.
10, 11
This is a period when risk-taking behaviors reach their
peak, when well-being experiences the greatest uctuations, and when mental
health challenges such as depression typically emerge.
12, 13, 14
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.
11, 13
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.
15, 16
As such, adolescents
may experience heightened emotional sensitivity to the communicative and
interactive nature of social media.
16
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.
17
Because
adolescence is a vulnerable period of brain development, social media exposure
during this period warrants additional scrutiny.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 6
The Potential Benets of Social Media Use Among
Children and Adolescents
Social media can provide benets for some youth by providing positive
community and connection with others who share identities, abilities, and
interests. It can provide access to important information and create a space
for self-expression. The ability to form and maintain friendships online and
develop social connections are among the positive effects of social media use
for youth.
,
These relationships can afford opportunities to have positive
interactions with more diverse peer groups than are available to them ofine
and can provide important social support to youth. The buffering effects
against stress that online social support from peers may provide can be
especially important for youth who are often marginalized, including racial,
ethnic, and sexual and gender minorities.
,
For example, studies 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-afrming 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%), and more connected to
what’s going on in their friends’ lives (80%). In addition, research suggests that
social media-based and other digitally-based mental health interventions may
also be helpful for some children and adolescents by promoting help-seeking
behaviors and serving as a gateway to initiating mental health care.
, , 28, 29 27,268
25
24
23
22 21,20
18
1918
9
The Potential Harms of Social Media Use Among
Children and Adolescents
Over the last decade, evidence has emerged identifying reasons for concern
about the potential negative impact of social media on children and adolescents.
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.
30
Social Media Has Both Positive and Negative Impacts on Children and Adolescents
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 7
As of 2021, 8th and 10th graders now spend an average of 3.5 hours per day
on social media. In a unique natural experiment that leveraged the staggered
introduction of a social media platform across U.S. colleges, the roll-out of the
platform 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.
,
If such sizable effects occurred in college-aged youth, these ndings raise
serious concerns about the risk of harm from social media exposure for children
and adolescents who are at a more vulnerable stage of brain development.
33
32
32
31
Limits on the use of social media have resulted in mental health benets for
yo
ung adults and adults. A small, randomized controlled trial in college-aged
youth found that limiting social media use to 30 minutes daily over three
weeks led to signicant improvements in depression severity. This effect was
particularly large for those with high baseline levels of depression who saw an
improvement in depression scores by more than 35%. Another randomized
controlled trial among young adults and adults found that deactivation of
a social media platform for four weeks improved subjective well-being (i.e.,
self-reported happiness, life satisfaction, depression, and anxiety) by about
25–40% of the effect of psychological interventions like self-help therapy,
group training, and individual therapy.
36
35
34
In addition to these recent studies, correlational research on associations
between social media use and mental health has indicated reason for concern
and further investigation. These studies point to a higher relative concern of
harm in adolescent girls and those already experiencing poor mental health,
,
as well as for particular health outcomes like cyberbullying-related
depression, body image and disordered eating behaviors, and poor sleep
quality linked to social media use. For example, 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%).
44
43
42
4140
39
3837,
Social Media Has Both Positive and Negative Impacts on Children and Adolescents
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 8
Scientic evidence suggests that harmful content exposure as well as excessive
and problematic social media use are primary areas for concern.
Potential Risk of Harm from Content Exposure
Extreme, inappropriate, and harmful content continues to be easily and widely
accessible by children and adolescents. This can be spread through direct
pushes, unwanted content exchanges, and algorithmic designs. 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 difculties. Despite social media providing a sense
of community for some, 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 signicant
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.
48
47
46 45
Social media may also perpetuate body dissatisfaction, disordered eating
behaviors, social comparison, and low self-esteem, especially among adolescent
girls.
51,
A synthesis of 20 studies demonstrated a signicant 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.
, 55, 56
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.
57
54,53
41
52
50,49,
Additionally, roughly 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
58
What Drives Mental Health and Well‑Being
Concerns: A Snapshot of the Scientic Evidence
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 9
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.
59, 60
Nearly 75% of adolescents
say social media sites are only doing a fair to poor job of addressing online
harassment and cyberbullying.
61
40
24
In addition, social 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 nancially extort them
through the threat or actual distribution of intimate images, or to sell illicitly
manufactured fentanyl).
64
Adolescent girls and transgender youth are
disproportionately impacted by online harassment and abuse, which is
associated with negative emotional impacts (e.g., feeling sad, anxious or
worried).
65, 66
62, 63,
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.
24
Potential Risk of Harm from Excessive and
Problematic Use
Excessive and problematic use of social media can harm children and
adolescents by disrupting important healthy behaviors. Social media
platforms are often designed to maximize user engagement, which has the
potential to encourage excessive use and behavioral dysregulation.
69,
70
Push notications, autoplay, innite scroll, quantifying and displaying
popularity (i.e., ‘likes’), and algorithms that leverage user data to serve content
recommendations are some examples of these features that maximize
engagement. According to one recent model, nearly a third (31%) of social
media use may be attributable to self-control challenges magnied by habit
formation.
Further, some researchers believe that social media exposure can
overstimulate the reward center in the brain and, when the stimulation becomes
excessive, can trigger pathways comparable to addiction.
72
Small studies
have shown that people with frequent and problematic social media use can
experience changes in brain structure similar to changes seen in individuals
with substance use or gambling addictions.
74
In a nationally representative
survey of girls aged 11–15, one-third or more say they feel “addicted” to a social
media platform.
Over half of teenagers report that it would be hard to give
24
73,
68,
71
67,
68,
What Drives Mental Health and Well‑Being Concerns: A Snapshot of the Scientic Evidence
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 10
up social media. Nearly 3-in-4 teenagers believe that technology companies
manipulate users to spend more time on their devices. In addition, according to
a survey of 8th and 10th graders, the average time spent on social media is 3.5
hours per day, 1-in-4 spend 5+ hours per day and 1-in-7 spend 7+ hours per day
on social media.
31
68
2
Excessive and problematic social media use, such as compulsive or
uncontrollable use, has been linked to sleep problems, attention problems,
and feelings of exclusion among adolescents. Sleep is essential for
the healthy development of adolescents. A systematic review of 42 studies
on the effects of excessive social media use found a consistent relationship
between social media use and poor sleep quality, reduced sleep duration,
sleep difculties, and depression among youth. Poor sleep has been linked to
altered neurological development in adolescent brains, depressive symptoms,
and suicidal thoughts and behaviors.
On a typical weekday, nearly 1-in-3
adolescents report using screen media until midnight or later. While screen
media use encompasses various digital activities, social media applications are
the most commonly used applications by adolescents.
58
58
8078, 79,
42
43, 75, 76,
77
In a recent narrative review of multiple studies, problematic social media use
has also been linked to both self-reported and diagnosed attention-decit/
hyperactivity disorder (ADHD) in adolescents, although more research is
necessary to understand whether one causes the other. A longitudinal
prospective study of adolescents without ADHD symptoms at the beginning
of the study found that, over a 2-year follow-up, high-frequency use of digital
media, with social media as one of the most common activities, was associated
with a modest yet statistically signicant increased odds of developing ADHD
symptoms (OR 1.10; 95% CI, 1.05-1.15). Additionally, social media-induced fear
of missing out, or “the pervasive apprehension that others might be having
rewarding experiences from which one is absent,” has been associated with
depression, anxiety, and neuroticism.
84
83
82
81
What Drives Mental Health and Well‑Being Concerns: A Snapshot of the Scientic Evidence
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 11
Nearly every teenager in America uses social media, and yet we do not have
enough evidence to conclude that it is sufciently safe for them. Our children
have become unknowing participants in a decades-long experiment. It is critical
that independent researchers and technology companies work together to
rapidly advance our understanding of the impact of social media on children and
adolescents. This section describes the known gaps and proposes additional
areas for research that warrant urgent consideration.
Known Evidence Gaps
The relationship between social media and youth mental health is complex
and potentially bidirectional. There is broad concern among the scientic
community that a lack of access to data and lack of transparency from
technology companies have been barriers to understanding the full scope and
scale of the impact of social media on mental health and well-being. Most prior
research to date has been correlational, focused on young adults or adults, and
generated a range of results. Critical areas of research have been proposed
to ll knowledge gaps and create evidence-based interventions, resources,
and tools to support youth mental health. Thus, there is an urgent need for
additional research including on, but not limited to, the following questions:
86
85
19
•
How do in-person vs. digital social interactions differ in terms of the impact
on health, and what are the unique contributions of social media behavior to
social connectedness, social isolation, and mental health symptoms?
•
What are the potential pathways through which social media may cause harm
to children’s and adolescents’ mental health and well-being? For example:
»
How does social comparison affect one’s sense of life satisfaction and
in-person relationships?
»
How does the use of social media, including specic designs and features,
relate to dopamine pathways involved in motivation, reward, and addiction?
•
What type of content, and at what frequency and intensity, generates the
most harm? Through which modes of social media access (e.g., smartphone,
computer) and design features? For which users and why?
Critical Questions Remain Unanswered
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 12
•
What are the benecial effects of social media? For whom are the benets
greatest? In what ways, and under what circumstances?
•
What individual-, community-, and societal-level factors may protect youth
from the negative effects of social media?
•
What types of strategies and approaches are effective in protecting the
mental health and well-being of children and adolescents on social media
(e.g., programs, policies, design features, interventions, norms)?
•
How does social media use interact with a person’s developmental stage
for measuring risk of mental health impact?
Critical Questions Remain Unanswered
Known Evidence Gaps
It is critical that independent
researchers and technology
companies work together
to rapidly advance our
understanding of the impact
of social media on children
and adolescents.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 13
Our children and adolescents don’t have the luxury of waiting years until we
know the full extent of social media’s impact. Their childhoods and development
are happening now. While social media use can have positive impacts for some
children, the evidence noted throughout this Surgeon General’s Advisory
necessitates signicant concern with the way it is currently designed, deployed,
and utilized. Child and adolescent use of platforms designed for adults
places them at high risk of “unsupervised, developmentally inappropriate,
and potentially harmful” use according to the National Scientic Council on
Adolescence. At a moment when we are experiencing a national youth mental
health crisis, now is the time to act swiftly and decisively to protect children and
adolescents from risk of harm.
87
To date, the burden of protecting youth has fallen predominantly on children,
adolescents, and their families. Parents face signicant challenges in managing
children and adolescents’ use of social media applications, and youth are
using social media at increasingly earlier ages. Nearly 70% of parents say
parenting is now more difcult than it was 20 years ago, with technology and
social media as the top two cited reasons. While nearly all parents believe
they have a responsibility to protect their children from inappropriate content
online, the entire burden of mitigating the risk of harm of social media cannot
be placed on the shoulders of children and parents. Nearly 80% of parents
believe technology companies have a responsibility to protect children from
inappropriate content as well.
89
89
89
4,
88
We must provide children and their families with the information and tools
to navigate the changing digital environment, but this burden to support our
children must be further shared. There are actions technology companies can
take to make their platforms safer for children and adolescents. There are
actions researchers can take to develop the necessary research base to support
further safeguards. And there is a role for local, state, and federal policy to
implement protections for our children and adolescents.
The U.S. has a strong history of taking action in such circumstances. In the
case of toys, transportation, and medications—among other sectors that have
We Must Take Action: A Way Forward
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 14
widespread adoption and impact on children—the U.S. has often adopted a
safety-rst approach to mitigate the risk of harm to consumers. According
to this principle, a basic threshold for safety must be met, and until safety is
demonstrated with rigorous evidence and independent evaluation, protections
are put in place to minimize the risk of harm from products, services, or
goods. For example, the Consumer Product Safety Commission requires toy
manufacturers to undergo third-party testing and be certied through a
Children’s Product Certicate as compliant with the federal toy safety standard
for toys intended for use by children. To reduce the risk of injury from motor
vehicle accidents, the National Highway Trafc Safety Administration requires
manufacturers to t new motor vehicles with standard airbags and seat belts,
among other safety features, and conduct crash tests to be compliant with the
Federal Motor Vehicle Safety Standards. Medications must demonstrate safety
to the Food and Drug Administration before being made available and marketed
for use. Given the mounting evidence for the risk of harm to some children and
adolescents from social media use, a safety-rst approach should be applied in
the context of social media products.
92
91
90
To better safeguard the mental health and well-being of children and
adolescents, policymakers, technology companies, researchers, families,
and young people must all engage in a proactive and multifaceted approach.
Through the recommendations below, we can provide more resources and
tools to children and families, we can gain a better understanding of the full
impact of social media, and we can maximize the benets and minimize the
harms of social media platforms to create safer, healthier online environments
for children.
We Must Take Action: A Way Forward
We can maximize the
benets and minimize
the harms of social media
platforms to create
safer, healthier online
environments for children.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 15
•
Strengthen protections to ensure greater safety
for children interacting with all social media
platforms, in collaboration with governments,
academic organizations, public health experts,
and technology companies.
»
Develop age-appropriate health and safety
standards for technology platforms. Such
standards may include designing technology
that is appropriate and safe for a child’s
developmental stage; protecting children and
adolescents from accessing harmful content
(e.g., content that encourages eating disorders,
violence, substance abuse, sexual exploitation,
and suicide or discusses suicide means);
limiting the use of features that attempt to
maximize time, attention, and engagement;
developing tools that protect activities that
are essential for healthy development like sleep;
and regularly assessing and mitigating risks
to children and adolescents.
»
Require a higher standard of data privacy
for children to protect them from potential
harms like exploitation and abuse. Six-in-ten
adolescents say they think they have little or no
control over the personal information that social
media companies collect about them.
32
»
Pursue policies that further limit access—in
ways that minimize the risk of harm—to social
media for all children, including strengthening
and enforcing age minimums.
•
Ensure technology companies share data
relevant to the health impact of their platforms
with independent researchers and the public in
a manner that is timely, sufciently detailed, and
protects privacy.
•
Support the development, implementation, and
evaluation of digital and media literacy curricula
in schools and within academic standards.
Digital and media literacy provides children and
educators with digital skills to strengthen digital
resilience, or the ability to recognize, manage, and
recover from online risks (e.g., cyberbullying and
other forms of online harassment and abuse, as
well as excessive social media use).
•
Support increased funding for future research on
both the benets and harms of social media use
and other technology and digital media use for
children, adolescents, and families.
•
Engage with international partners working to
protect children and adolescents against online
harm to their health and safety.
What Policymakers Can Do
Policymakers play an important role in addressing the complex and multifaceted
issues related to social media use and in protecting youth from harm.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 16
•
Conduct and facilitate transparent and
independent assessments of the impact of social
media products and services on children and
adolescents. Assume responsibility for the impact
of products on different subgroups and ages of
children and adolescents, regardless of the intent
behind them.
»
Be transparent and share assessment
ndings and underlying data with independent
researchers and the public in a privacy
protecting manner.
»
Assess the potential risks of online interactions
and take active steps to prevent potential
misuse, reducing exposure to harms. When
proactive responses fail, take immediate action
to mitigate unintended negative effects.
»
Establish scientic advisory committees
to inform approaches and policies aimed at
creating safe online environments for children.
Scientic advisory committees should be
comprised of independent experts and members
of user subgroups, including youth.
•
Prioritize user health and safety in the design
and development of social media products
and services.
93, 94, 95, 96
Prioritize and leverage
expertise in developmental psychology and
user mental health and well-being in product
teams to minimize risks of harm to children
andadolescents.
»
Ensure default settings for children are set to
highest safety and privacy standards. Provide
easy-to-read and highly visible information
about policies regarding use by children.
»
Adhere to and enforce age minimums in ways
that respect the privacy of youth users.
•
Design, develop, and evaluate platforms,
products, and tools that foster safe and healthy
online environments for youth, keeping in mind
the needs of girls, racial, ethnic, and sexual and
gender minorities. The platform design and
algorithms should prioritize health and safety as
the rst principle, seek to maximize the potential
benets, and avoid design features that attempt
to maximize time, attention, and engagement.
•
Share data relevant to the health impact of
platforms and strategies employed to ensure
safety and well‑being with independent
researchers and the public in a manner that is
timely and protects privacy.
•
Create effective and timely systems and
processes to adjudicate requests and complaints
from young people, families, educators, and
others to address online abuse, harmful content
and interactions, and other threats to children’s
health and safety. Social media platforms should
take these complaints seriously, thoroughly
investigate and consider them, and respond in
a timely and transparent manner.
What Technology Companies Can Do
Technology companies play a central role and have a fundamental responsibility
in designing safe online environments and in preventing, minimizing, and
addressing the risks associated with social media.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 17
•
Create a family media plan. Agreed-upon
expectations can help establish healthy
technology boundaries at home – including social
media use. A family media plan can promote open
family discussion and rules about media use and
include topics such as balancing screen/online
time, content boundaries, and not disclosing
personal information. For information on creating
a family media plan, visit www.healthychildren.
org/MediaUsePlan.
97
•
Create tech-free zones and encourage children to
foster in-person friendships. Since electronics
can be a potential distraction after bedtime and
can interfere with sleep, consider restricting
the use of phones, tablets, and computers for
at least 1 hour before bedtime and through the
night. Consider keeping family mealtimes and
in-person gatherings device-free to build social
bonds and engage in a two-way conversation.
Help your child develop social skills and nurture
his or her in-person relationships by encouraging
unstructured and ofine connections with others
and making unplugged interactions a daily priority.
See the American Academy of Pediatrics (AAP)
guidelines for media use.
98
•
Model responsible social media behavior.
As children often learn behaviors and habits
from what they see around them, try to model
the behavior you want to see. Parents can
set a good example of what responsible and
healthy social media use looks like by limiting
their own use, being mindful of social media
habits (including when and how parents share
information or content about their child), and
modeling positive behavior on your social
media accounts.
97, 99
•
Teach kids about technology and empower
them to be responsible online participants at
the appropriate age. Discuss with children the
benets and risks of social media as well as the
importance of respecting privacy and protecting
personal information in age-appropriate ways.Have
conversations with children about who they are
connecting with, their privacy settings, their online
experiences, and how they are spending their time
online. Empower and encourage them to seek help
should they need it. Learn more about the benets
and risks of social media use and get guidance
from experts at AAP’s Center of Excellence on
Social Media and Youth Mental Health and from
the American Psychological Association‘s Health
Advisory on Social Media Use in Adolescence.
100
•
Report cyberbullying and online abuse and
exploitation. Talk to your child about theirreporting
options, and provide support, without judgment,
if he or she tells or shows you that they (a) are
being harassed through email, text message,
online games, or social media or (b) have been
contacted by an adult seeking private images or
asking them to perform intimate or sexual acts.
You or your child can report cyberbullying to the
school and/or the online platform, or your local law
enforcement. Visit CyberTipline, Take it Down, or
contact your local law enforcement to report any
instances of online exploitation.
101
•
Work with other parents to help establish shared
norms and practices and to support programs
and policies around healthy social media use.
Such norms and practices among parents
facilitate collective action and can make it easier
to set and implement boundaries on social media
use for children.
What Parents and Caregivers Can Do
The onus of mitigating the potential harms of social media should not be placed
solely on the shoulders of parents and caregivers, but there are steps they can
take to help protect and support children and adolescents against the risk of harm.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 18
•
Reach out for help. If you or someone you
know is being negatively affected by social
media, reach out to a trusted friend or adult for
help. For information from experts, visit AAP’s
Center of Excellence on Social Media and Youth
Mental Health. If you or someone you know is
experiencing a mental health crisis, contact
the 988 Suicide and Crisis Lifeline by calling or
texting 988 for immediate help.
•
Create boundaries to help balance online and
ofine activities. Limit the use of phones, tablets,
and computers for at least 1 hour before bedtime
and through the night to enable sufcient and
quality sleep. Keep mealtimes and in-person
gatherings device-free to help build social bonds
and engage in two-way conversations with
others. Nurture your in-person relationships by
connecting with others and making unplugged
interactions a daily priority.
•
Develop protective strategies and healthy
practices such as tracking the amount of time
you spend online, blocking unwanted contacts
and content, learning about and using available
privacy and safety settings, learning and utilizing
digital media literacy skills to help tell the
difference between fact and opinion, and ensuring
you are connecting with peers in-person. See this
Tip Sheet on Social Media Use and Mental Health
for healthy social media use created for and by
young people.
•
Be cautious about what you share. Personal
information about you has value. Be selective with
what you post and share online and with whom, as
it is often public and can be stored permanently.
If you aren’t sure if you should post something, it’s
usually best if you don’t. Talk to a family member
or trusted adult to see if you should.
•
Protect yourself and others. Harassment
that happens in email, text messaging, direct
messaging, online games, or on social media is
harmful and can be cyberbullying. It might involve
trolling, rumors, or photos passed around for
others to see – and it can leave people feeling
angry, sad, ashamed, or hurt. If you or someone
you know is the victim of cyberbullying or other
forms of online harassment and abuse:
»
Don’t keep online harassment or abuse a secret.
Reach out to at least one person you trust, such
as a close friend, family member, counselor, or
teacher, who can give you the help and support
you deserve. Visit
stopbullying.gov
for helpful
tips on how to report cyberbullying. If you have
experienced online harassment and abuse by
a dating partner, contact an expert at Love is
Respect for support or if your private images
have been taken and shared online without your
permission, visit Take it Down to help get them
removed.
»
Don’t take part in online harassment or abuse.
Avoid forwarding or sharing messages or images
and tell others to stop. Another way is to report
offensive content to the site or network where
you saw it.
What Children and Adolescents Can Do
The burden of mitigating the potential harms of social media does not rest solely
on the shoulders of children and adolescents, but there are measures they can
take to navigate social media in a safe and healthy way.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 19
•
Establish the impact of social media on youth
mental health as a research priority and develop
a shared research agenda. Research should
include but not be limited to:
102
»
Rigorous evaluation of social media’s impact
on youth mental health and well-being,
including longitudinal and experimental studies.
This could also include research on specic
outcomes and clinical diagnoses (e.g., sleep
duration and quality, attention, depression,
anxiety, and body image), among specic
populations (e.g., racial, ethnic, and sexual
and gender minorities), and based on specic
aspects of social media (e.g., designs, features,
and algorithms).
»
Role of age, developmental stage, cohort
processes, and the in-person environment
in inuencing the onset and progression of
poor mental health outcomes among social
media users.
»
Benets and risks associated with specic
social media designs, features, and content.
»
Long-term effects on adults of social media
use during childhood and adolescence.
•
Develop and establish standardized denitions
and measures for social media and mental
health outcomes that are regularly evaluated
and can be applied across basic research,
population surveillance, intervention evaluation,
and other contexts.
•
Evaluate best practices for healthy social media
use in collaboration with experts including
healthcare providers, parents, and youth.
94, 103, 104
•
Enhance research coordination and collaboration.
Example opportunities include developing an
accessible evidence database and forming a
consortium of researchers focused on examining
the positive and negative effects of social media
on mental health and well-being. Researchers
should work with community partners to
make research ndings publicly accessible
and digestible.
What Researchers Can Do
Researchers play a critical role in helping to gain a better understanding of the
full impact of social media on mental health and well-being and informing policy,
best practices, and effective interventions.
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 20
We are grateful to all of the experts, academic researchers, associations, and
community-based organizations across the country who shared their insights.
The U.S. Surgeon General’s Advisory on Social Media and Youth Mental Health
was prepared by the Ofce of the Surgeon General with valuable contributions
from partners across the U.S. Government, including but not limited to:
Ofce of the Assistant Secretary for Health (OASH)
Ofce of the General Counsel (OGC)
Ofce of the Assistant Secretary for Planning and Evaluation (ASPE)
Centers for Disease Control and Prevention (CDC)
Ofce of the Director
National Center for Injury Prevention and Control (NCIPC)
National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division
of Adolescent and School Health (DASH)
Health Resources and Services Administration (HRSA)
National Institutes of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
National Institute of Mental Health (NIMH)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Acknowledgments
Social Media and Youth Mental Health: The U.S. Surgeon General’s Advisory 21
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in this document based on the methods used in each study.
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