1800 words essay 10 hrs

Mini-Review

The Impact of Social Media on the Sexual and Social Wellness of Adolescents

Lisa M. Cookingham MD, Ginny L. Ryan MD, MA * Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA

a b s t r a c t

For most adolescents in the United States, the use of social media is an integral part of daily life. While the advent of the Internet has enhanced information dispersal and communication worldwide, it has also had a negative impact on the sexual and social wellness of many of its adolescent users. The objective of this review is to describe the role of social media in the evolution of social norms, to illustrate how online activity can negatively impact adolescent self-esteem and contribute to high-risk adolescent behaviors, to elucidate how this activity can result in real-world consequences with life-long results, and to provide guidance regarding social media use for those who care for adolescents. Although research is now aimed at use of social media for positive health and wellness interventions, much work needs to be done to determine the utility of these programs. Adolescent healthcare providers are important contributors to this new field of study and must resolve to stay informed and to engage this up-and-coming generation on the benefits and risks of social media use. Key Words: Adolescent health, Sexuality, Social media, Internet

Introduction

Adolescence is a time of self-discovery, increased social independence, and transformation into a unique individual. While peers, parents, and educators have a direct impact on adolescents during daily face-to-face interactions, Internet- based entities are playing an increasingly large role during this critical life stage.1 Internet use for social purposes has increased dramatically over recent years, with 95% of US adolescents between the ages of 12 and 17 regularly ‘going’ online, and 80% participating in some type of social media website.2

Social networking sites (SNS) are a relatively new phe- nomenonandincreasingly popularamong adolescents.These are websites that permit social interaction among users3 and allow users to create online profiles that may (or may not) represent the user's real-life identity. Users personalize pro- file pages with images, audio, and text, and can designate ‘friends’ and otherrelationships. Thesewebsitesare attractive to adolescents because they allow for individualized self- promotion as well as inclusion into a group that may not be attainable in physical reality. During a time when it is as important to be unique as it is to fit in, SNSs allow adolescents to manufacture an image they want the world to see.

One model proposed to explain how adolescents inte- grate media into their development of self is the Media Practice Model.4 This model assumes 3 key features in un- derstanding the effect of media on adolescents: (1) that most media use is active or interactive; (2) that media use

The authors indicate no conflicts of interest. * Address correspondence to: Ginny L. Ryan, MD, MA, Department of Obstetrics &

Gynecology, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 31332 PFP, Iowa City, IA 52242; Phone: (319) 384-9170; fax: (319) 384-9367

E-mail address: [email protected] (G.L. Ryan).

1083-3188/$ - see front matter � 2015 North American Society for Pediatric and Adole http://dx.doi.org/10.1016/j.jpag.2014.03.001

and its effects are in an active reciprocal relationship with the user; and (3) that the adolescent's current and evolving sense of identity is the basis for how media is chosen and applied in daily life.4 The ‘media diet’ chosen by the adolescent, therefore, is a reflection of who they believe they are and who they want to be.4 While an SNS may seem to provide the ideal venue for adolescent identity explora- tion without committing to real-world consequences, this model supports the notion that SNS behavior truly reflects real-life behaviors or intent.

As this model suggests, social media use may have a sig- nificant impact on the social and sexual well-being of ado- lescents. Many adolescents display limited self-regulation and judgment skills that are not yet fully mature, which lead to risky behaviors, especially on SNSs.5 Adolescents can fall easy prey to the ‘online disinhibition effect,’ meaning that personal details and private information are more readily released into the public domain than they would be face-to- face interactions due to the dissociative anonymity SNSs provide.6 SNSs provide an all too attractive outlet for adolescents during a time in development where self- expression and validation are important, and this expres- sion may translate into risky social and sexual behavior.

Well before the advent of SNS popularity, adolescents have been vulnerable to negative outcomes from poor sexual choices. Adolescents are the highest risk group for contracting a sexually transmitted infection (STI)7 and nearly 3 million adolescents are infected annually.8 Several common practices contribute to this high risk of contracting an STI, including: concurrent sexual partners, multiple sexual partners, and lack of consistent condom use.9 We are now beginning to see that social media may be increasing these risky sexual behaviors and decreasing the overall social and sexual wellness in adolescents.

scent Gynecology. Published by Elsevier Inc.

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Impact on Self-Esteem

In this digital age, popularity is measured by how many ‘friends’ or ‘likes’ are collected on a SNS. Social media encourage adolescents to compete for attention in order to increase their ‘likes’ and enhance their self-worth. If a ‘post’ or a ‘pic’ doesn't garner enough comments, the adolescent is encouraged to ‘share’ it to make it more newsworthy. Bolder and more daring behavior is rewarded when the audience applauds the actions of the performer, and the cycle per- petuates. These seemingly innocuous online behaviors can be quite damaging themselves, and they are easily trans- lated into a risky offline reality.10

While individual conduct can damage self-esteem, so too can the actions of an online adversary or ‘cyberbully.’ This era's equivalent of a schoolyard bully, a cyberbully is some- one who deliberately uses social media to perpetuate false, humiliating, or malevolent information about another in- dividual.3 Similar to traditional offline bullying, studies have shown cyberbullying can lead to depression, anxiety, severe isolation, and poor self-esteem for the bullied individual.11

Cyberbullying can be even more pervasive, however, because SNSs provide a forum any time of the day or night for anyone and everyone to see.12 Perhaps not surprisingly, it has also been shown that individuals who participate in cyberbullying are more likely to participate in offline bullying.13

Changing Social Norms and Promotion of High-Risk Behavior

Social norms that evolve over time and are peculiar to a culture and behaviordeemed unacceptable 50 years agomay now be conventional. Psychological theorists suggest behavior is strongly influenced by the perception of peers' actions, whether or not this is the reality. As such, subjective norms contribute significantly to behavioral intentions and subsequent actions.14 Research supports the normative in- fluence that social media, specifically SNSs, have on today's adolescents. It has been suggested, for example, that SNSs mayactually serve as a “media super-peer” by endorsing and establishing social and behavioral norms of an adolescent's peers.15,16 If an adolescent believes that her peers are participating in a particular behaviordeven high-risk behaviordshe is more likely to participate in it as well because it is perceived as ‘normal.’

Much research is being done to highlight the influence of SNSs on evolving social norms and promotion of high-risk behavior. In a recent study assessing the relationship be- tween the perception and the reality of high-risk sexual behavior among peers using SNSs, the authors found that adolescents consistently over-report high-risk sexual behavior and under-report protective behaviors of their peers.17 This suggests that adolescents overestimate their peers' high risk behaviors.17 Another study demonstrated that adolescents who viewed SNS photos with minimal or no sexually suggestive content perceived that their peers were participating in safer sex practices, such as condom use, and reported that it would influence their future behavior to do the same.14 In the same study, adolescents who viewed sexually-suggestive SNS photos perceived that their peers

were having sex without protection or with strangers, and they were more likely to report personal engagement in these same high-risk behaviors.14 These findings suggest that high-risk behavior displayed on SNSs may encourage similar high-risk behavior in others and simultaneously endorse such behavior as ‘normal.’

While high-risk behavior by adolescents is not new, SNSs allow for a new manifestation of this behavior that has been labeled “self-exploitation” by some.18 This refers to the “creation and distribution of explicit or inappropriate” materialdphotos, comments, suggestionsdon SNSs, social media websites, other Internet sites, or through personal cell phones.18 There are several specific types of self- exploitation common to adolescent SNS profiles. In a cross- sectional study evaluating risk behavior promotion on SNSs, for example, 54% of profiles were found to contain 1 or more references to a high-risk behavior such as sexual activity, substance abuse, or violence.15 These practices may open the door for similar behavior in both online and offline relationships.

Studies show it is common for adolescents to self-report high-risk sexual behavior on personal SNS profiles, with references to sex displayed on 24% of profiles reviewed in 1 study.15 Other adolescents may not directly reference sexual behavior but will partake in a practice known as ‘sexting.’ This refers to the sending, receiving, or forwarding of sexually explicit messages, photographs, images, or videos via the Internet, a cell phone, or another digital device.3 One survey found that 20% of adolescents between 13-19 years old have sent or posted a nude or semi-nude photo or video of themselves to another adolescent.19 In a more recent longitudinal study, the authors reported that 28% of their subjects had received a ‘sext’ and 57% had been asked to send a ‘sext.’20 More disconcerting was the finding that male and female adolescents who engaged in sexting were more likely to have had sex, and that sexting was associated with high-risk sexual behaviors in females (this association was not seen in males).20

Adolescents also engage in risk-taking related to sub- stance abuse and SNS profiles have become a popular site for the promotion of this behavior. In a study examining the prevalence of risky behaviors displayed on an SNS, substance abuse was the most frequently cited high-risk behavior, with 41% of profiles having some reference to alcohol, tobacco, or drug use.15 A more recent study measuring online and offline influences on adolescent smoking and alcohol use demon- strated that exposure to SNS images of partying or drinking increased both smoking and alcohol use in study subjects.21

These data again highlight the concern that online behavior can readily translate into real world behavior and potential repercussions.

Offline Consequences of Online Behavior

While the cost of risky online behavior is clearly high when it comes to social and sexual health, there are also potential legal ramifications. Laws originally created to protect children are being used to criminalize them as por- nographers in many states.22 One disturbing illustration in- volves a 14-year-old girl who posted nude photos of herself

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on a SNS and was subsequently charged with possession and distribution of child pornography.23 Another example in- volves a teen who received unsolicited explicit photos of his girlfriend via text message and then mass-e-mailed the nude photos after their breakup to “get back at her.”24 This teen was subsequently convicted of transmitting child pornog- raphy and labeled a sex offender.24 While it seems right that some punishment should be incurred for such unwise and often hurtful decisions, few adolescents are aware that the act of simply hitting ‘send’ can cause serious ramifications.

Inappropriate online behavior can lead to lifelong repercussions, whether or not the actions are prosecuted. Images and commentary posted on SNSs arefreelyaccessible and leave a digital footprint, allowing college admission committees and employers to pre-screen their applicants.25

More distressing than the potential negative impact of SNS personal disclosure on professional success is the fact that sexual predators troll SNSs for vulnerable adolescents who don't understand the effects of haphazard Internet use. While recent studies suggest that sexual solicitation is more likely to occur between 2 adolescents (versus an adult soliciting an adolescent), the threat very much exists.25

Utilization of Social Media for Education

Notwithstanding these potential negative outcomes of SNS use, new research has discovered some positive health outcomes attributable to SNS use. From studies utilizing SNSs to prevent the decline of condom use among adoles- cents26 to investigators utilizing SNSs to provide accurate and age-appropriate STI information,5 educators are work- ing to take advantage of SNS popularity in adolescents. SNSs should be considered valuable tools for adolescent care providers, especially when it comes to dissemination of sensitive information that adolescents may not feel comfortable discussing in face-to-face interactions, such as those issues mentioned above. However, because online resources may be unreliable or biased, utilization of these outlets for dispersal of health information should not replace comprehensive sexual education programs or individualized education by health care providers. Media literacy should also be taught to adolescents in schools and at home to help them identify balanced and medically ac- curate educational resources to fill in the gaps and continue their life-long learning.27

How Adults Can Stay Engaged and Prevent Harm

Inquiring about adolescents' online participation in activities such as sexting will provide valuable insight into intention and/or engagement in high-risk behaviors and afford an opportunity to intervene before irreparable dam- age occurs. The American Academy of Pediatrics (AAP) rec- ommends that health care providers ask parents/guardians two specific media history questions at every well-child visit28:

1. How much recreational screen time does your child or teenager consume daily?

2. Is there a television set or Internet-connected device in the child's bedroom?

The AAP also encourages providers to recommend the following to parents/guardians of adolescents (as summa- rized by the authors)28:

� Total entertainment screen time should be limited to less than 2 hours per day

� Television sets and Internet-connected devices should be kept out of the bedroom

� Use of Web sites and social media sites should be monitored

� A plan for media use should be established and rules for inappropriate use enforced (ie, at mealtime, bedtime)

It is important for adolescent care providers to not only teach parents/guardians about thebenefits andrisksof social media use, but to remain engaged and educated themselves. In a rapidly changing world of technology, they must stay up to date on Internet-based exposures and trends in order to support adolescents and their parents/guardians as they navigate this challenging time of development.

Conclusion

Social media have become an integral part of today's culture and have helped define the latest generation of youth. Despite the promise of enhanced socialization, communication, and education, however, many adoles- cents' lived experience of social media use has been nega- tive on balance. From lowering self-esteem to creating new social norms that encourage increasingly risky behavior, SNS use jeopardizes the sexual and social wellness of ado- lescents. New research is aimed at utilizing social media for positive and effective health and wellness interventions, but much more work needs to be done to enhance the positive and mitigate the negative potential of this resource. One thing is certain: as healthcare providers for this newest technologically savvy population, it is imperative that we keep up with the rapid evolution of social media and are pro-active in managing health outcomes for adolescents.

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