(CNN) — There’s not enough evidence to determine whether social media is safe enough for children and adolescents when it comes to their mental health, according to a new advisory from the US surgeon general.
Tuesday’s advisory notes that although there are some benefits, social media use presents “a profound risk of harm” for kids. It calls for increased research into social media’s impact on youth mental health, as well as action from policymakers and technology companies.
The 25-page advisory comes as a growing number of states are aiming to tighten regulations on social media platforms, including efforts in Montana to ban TikTok.
Surgeon general advisories are designed to call attention to urgent public health issues and provide recommendations for how they should be addressed, the new report notes. Previous advisories have focused on youth mental health more broadly, health misinformation and use of the opioid overdose antidote naloxone.
“We’re in the middle of a youth mental health crisis, and I’m concerned that social media is contributing to the harm that kids are experiencing,” Surgeon General Dr. Vivek Murthy told CNN.
“For too long, we have placed the entire burden of managing social media on the shoulders of parents and kids, despite the fact that these platforms are designed by some of the most talented engineers and designers in the world to maximize the amount of time that our kids spend on them,” he said. “So that is not a fair fight. It’s time for us to have the backs of parents and kids.”
The advisory includes a review of the available evidence on the effects of social media on youth mental health, noting that social media use among kids is “nearly universal”: Up to 95% of kids ages 13 to 17 report using social media, with more than a third saying they use it “almost constantly.” And although 13 is commonly the minimum age to use social media sites in the US (an age Murthy has previously said is too young, the advisory notes that nearly 40% of kids ages 8 to 12 use the platforms, as well.
“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,” the advisory says.
The report cites several ways in which social media may cause harm to youth mental health, noting that the adolescent years are a particularly vulnerable time for brain development. It details studies that found correlations between social media use and depression and anxiety, as well as poor sleep, online harassment and low self-esteem, particularly for girls.
One study of 6,595 US adolescents between ages 12 and 15 found that those who spent more than three hours a day on social media had twice the risk of symptoms of depression and anxiety as non-users, the report notes. It also cites studies that found reducing social media use led to improvements in mental health.
Social media use presents a risk of exposure to dangerous content, including depictions of self-harm, “which can normalize such behaviors,” the advisory says. It also cites 20 studies that found a significant relationship between social media use and body image concerns and eating disorders.
Murthy told CNN that the three most common things he hears from kids about social media are, “number one, it makes them feel worse about themselves; number two, it makes them feel worse about their friendships; but number three, they can’t get off of it.”
Excessive use of social media can disrupt important healthy behaviors, including sleep, the advisory warns, noting that platforms are often designed to keep users engaged with push notifications, autoplay and infinite scroll features, and algorithms that use the user’s data to tailor content recommendations. It cites some researchers’ belief that social media exposure, with excessive stimulation to the brain’s reward centers, “can trigger pathways comparable to addiction.”
The advisory’s summary of potential risks of social media use on youth mental health spans five pages; its description of the potential benefits takes just half a page. It notes that social media can provide positive community and connection with others, which can be especially important for kids who are often marginalized. It cites studies showing mental health benefits from social media use for lesbian, gay, bisexual, asexual, transgender, queer, intersex and other youth through peer connections, and “identity-affirming content” related to race that was positive for adolescent girls of color. Finally, it notes that social media can be helpful by connecting some kids with mental health care.
The advisory includes recommendations for families grappling with social media use, including creating family media plans, encouraging kids to develop in-person friendships and modeling good social media behavior.
Murthy said it’s something he and his wife have discussed for their children, who are now 5 and 6.
Their plan is to delay social media use until at least after middle school; to try to find other families to partner with who are similarly inclined, “because there is strength in numbers”; and to reassess when the kids are in high school to see if better safety standards have been put in place “and are actually enforced,” he said.
“None of this is easy for parents to do,” he acknowledged. “That’s why we’re pushing so hard through this advisory to make the urgent case for action.”
Adam Kovacevich, founder and CEO of the tech coalition Chamber of Progress, said online platforms have heard the concerns from parents and researchers and implemented features to protect younger users, such as limiting nighttime notifications.
“I’m sure that efforts to protect kids are well intentioned, but we shouldn’t trade away teens’ privacy by requiring them to verify their age, or shut off their access to supportive online communities,” Kovacevich said in a statement.
Murthy says he hopes the report will spur action at multiple levels, such as increased research and funding for it, policy changes and particularly increased transparency and action from technology companies.
“Independent researchers tell us all the time that they have a hard time getting full access to the information that they need from technology companies about the health impacts on kids,” he said.
Murthy said social media companies should be held to similar standards for protecting children as other industries are.
“We take this approach of safety first with other products that kids use, from medications to car seats to toys,” Murthy said. “We need to do it here, too.”
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