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Purpose: The purpose of our study was to identify whether different aspects of social media use were associated with substance use among middle- and high school-aged youth. Methods: Participants were recruited from four Northeast U.S. middle schools and invited to complete an online survey in Fall 2019 and Fall 2020. We conducted separate adjusted logistic mixed effects models the substance use outcomes: ever use of alcohol, cannabis, e-cigarettes, tobacco cigarettes, prescription drugs, and multiple substances. Our sample included N = 586 participants (52.7% female, 58% White). Results: Seeing a social media post about drugs/alcohol in the past-12-months was significantly associated with higher odds of ever using alcohol, cannabis, e-cigarettes, and multiple substance use. Total number of social media sites ever used was significantly associated with higher odds of ever using cannabis, cigarettes, e-cigarettes, and multiple substances. Checking social media every hour or more was significantly associated with higher odds of ever using alcohol. Higher problematic internet use score was significantly associated with higher odds of ever using cannabis, e-cigarettes, and multiple substances. Online social support seeking score was not associated substance use. Conclusions: Our findings support the need for substance use prevention and social media literacy education and screening to begin early, ideally in elementary school before youth are using social media and substances.

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BACKGROUND: Increasing youth mental health problems over time correlate with increasing rates of social media use (SMU); however, a proposed contributory relationship remains unproven. To better understand how SMU impacts mental health requires a more nuanced understanding of the relationship between different patterns of SMU and specific individual factors. Studies suggest that more active forms of SMU may offer mental health benefits when compared with more passive forms. Furthermore, the literature suggests important differences in patterns of SMU and affective states among those identifying as racial and ethnic minorities. OBJECTIVE: Using ecological momentary assessment (EMA), this study aims to investigate potential differences in affective states during active and passive forms of SMU and whether such differences vary by race and ethnicity. METHODS: We recruited patients seeking care at a large urban adolescent medicine clinic who exhibited at least mild depressive symptoms based on Patient Health Questionnaire-9 (PHQ-9) scores. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day, which assessed real time SMU behaviors and affective states using the Positive and Negative Affect Schedule-Expanded form subscales. To correct for nonindependent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the individual level to examine associations between EMA-reported SMU and affective states while adjusting results for age, gender, race and ethnicity, PHQ-9 score, and EMA response rate. RESULTS: A racially and ethnically diverse group of 55 adolescents aged 14 to 19 years provided a total of 976 EMA responses, averaging 17.76 (SD 8.76) responses per participant, with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F1,215=3.86; SE 0.05; t1,215=1.96; P=.05) and lower mean levels of positive affect during passive SMU (F1,369=3.90; SE 0.09; t1,369=-1.98; P=.049). However, within different racial and ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black non-Hispanic participants: F1,81=6.31; SE 0.05; t81=2.51; P=.01). Similarly, lower levels of positive affect during passive SMU were seen only among White non-Hispanic participants (F1,295=10.52; SE 0.13; t295=-3.24; P=.001). CONCLUSIONS: Although in aggregate, adolescents with depressive symptoms experienced more negative affect during active SMU and less positive affect during passive SMU, these mean outcomes were driven solely by greater negative affect during active SMU by Black non-Hispanic participants and lower positive affect during passive SMU by White non-Hispanic participants. Differences in intentionality, content, context, and expectations of SMU among youths across racial and ethnic groups may result in different affective outcomes. Exploration of the interactions among cultural differences in SMU strategies and characteristics will be critical to furthering our understanding of the impact of SMU on youth mental health.

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BACKGROUND: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people's mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. OBJECTIVE: This study aims to determine the effectiveness of the Screenshots program in increasing participants' knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males' and females' conflict and bullying resolution strategies. METHODS: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. RESULTS: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. CONCLUSIONS: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students' increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students' high ratings of the relevance of Screenshots' content reinforce the need for this type of intervention.

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PURPOSE OF REVIEW: This review describes recent research findings and contemporary viewpoints regarding internet addiction in adolescents including its nomenclature, prevalence, potential determinants, comorbid disorders, and treatment. RECENT FINDINGS: Prevalence studies show findings that are disparate by location and vary widely by definitions being used. Impulsivity, aggression, and neuroticism potentially predispose youth to internet addiction. Cognitive behavioral therapy and medications that treat commonly co-occurring mental health problems including depression and ADHD hold considerable clinical promise for internet addiction. SUMMARY: The inclusion of internet gaming disorder in the DSM-5 and the ICD-11 has prompted considerable work demonstrating the validity of these diagnostic approaches. However, there is also a movement for a conceptualization of the disorder that captures a broader range of media-use behaviors beyond only gaming. Efforts to resolve these approaches are necessary in order to standardize definitions and clinical approaches. Future work should focus on clinical investigations of treatments, especially in the USA, and longitudinal studies of the disorder's etiology.

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Over the past decade, clinicians have observed an increase in adolescents overusing interactive media, resulting in detrimental consequences such as disrupted sleep, inattention to academic tasks, and deterioration of social relationships. The recognition of problematic interactive media use (PIMU), the excessive and dysregulated use of interactive electronic media that affects mental and physical health, resulting in difficulty meeting developmentally appropriate functional capacity, has led to a call for therapeutic interventions. To date, there has been limited research on treatments for adolescents with PIMU. This article documents the therapeutic benefit of dialectical behavior therapy (DBT) adapted to treat PIMU and applied to a 15-year-old male individual with a history of dysregulated use of the Internet in the categories of gaming, pornography, information-bingeing, and social media. Outcomes were measured by diary cards, documenting the patient's affective states, urges to engage in PIMU, the number of times he acted upon these urges, and collateral information provided by both parents and teachers from his school. Over the course of a 7-module DBT intervention covered during 14 sessions, the patient showed improvement in his targeted self-regulation behaviors of reducing nighttime screen use and decreasing frequency of pornography use. The patient showed academic improvement, as he was able to complete homework more effectively without being distracted by devices. We concluded that the application of this adapted DBT is potentially helpful in treating adolescents' excessive and dysregulated use of interactive media and electronic devices, and that this treatment approach deserves further study.

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PURPOSE OF REVIEW: To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU). RECENT FINDINGS: 0.3-1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8-83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction. SUMMARY: With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under 'Conditions for Further Study' and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.

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While media education and reduction programs have been proposed to prevent adverse health and academic outcomes related to heavy electronic media use among school-aged children, few have been formally piloted and evaluated. We used a quasi-experimental design to evaluate the effectiveness of Take the Challenge (TtC), a school-based media education/reduction program for the primary prevention of sleep deprivation, dysfunctional social-emotional behaviors, and poor academic performance. Sixth- to eighth-grade students at a rural Midwestern U.S. middle school received the TtC program, while a similar school in the same district served as the comparison group. Health-related and academic measures were collected from students and teachers at both schools before and after the intervention. The primary outcome measure was student-reported electronic media use (television, video games, Internet). Secondary measures included student health behaviors (student-reported sleep, exercise, and outdoor play) and academic activities (teacher-reported homework and classroom performance). Compared to the comparison group, students receiving TtC slept more and reduced television viewing, background television time, after-school video gaming, and weekend Internet use. Teachers reported increases in the extent to which TtC students completed homework assignments and stayed on task in the classroom. Well-designed school-based programs such as TtC can reduce electronic media use among middle-school children and improve related health and academic outcomes.

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BACKGROUND: Psychiatric disorders, including conduct disturbances, substance abuse, and affective disorders, emerge in approximately 20% of adolescents. In parallel with the rise in internet use, the prevalence of depression among adolescents has increased. It remains unclear whether and how internet use impacts mental health in adolescents. OBJECTIVE: We assess the association between patterns of internet use and two mental health outcomes (depression and anxiety) in a healthy adolescent population. METHODS: A total of 126 adolescents between the ages of 12 and 15 years were recruited. Participants reported their typical computer and internet usage patterns. At baseline and one-year follow-up, they completed the Beck Depression Index for primary care (BDI-PC) and the Beck Anxiety Inventory for Primary Care (BAI-PC). Individual linear regressions were completed to determine the association between markers of internet use at baseline and mental health outcomes at one-year follow-up. All models controlled for age, gender, and ethnicity. RESULTS: There was an inverse correlation between minutes spent on a favorite website per visit and BAI-PC score. No association was found between internet use and BDI-PC score. CONCLUSIONS: There is no relationship between internet use patterns and depression in adolescents, whereas internet use may mitigate anxiety in adolescents with higher levels of baseline anxiety.

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The Child Development Supplement to the PSID (PSID-CDS) began in 1997 with a cohort of 2,394 households including 3,586 children. Since that auspicious start, three waves of the first cohort were collected - 1997, 2002-03, and 2007-08 - and a new cohort was interviewed in 2014. To date more than 400 journal articles, chapters, books, and dissertations that used the data have been collected in the PSID bibliography. This paper brings together founders and early adopters to summarize important contributions to the child development, time use, media, and health literatures. The purpose of this paper is not a detailed literature review but an overview of the literature and knowledge base to which PSID-CDS researchers have contributed. It points out unique methodological and measurement contributions, summarizes the motivation for research on parental investments in children, reviews findings regarding healthy child development, and examines the role of neighborhoods in children's lives.

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There are growing concerns about the impact of digital technologies on children's emotional well-being, particularly regarding fear, anxiety, and depression. The 2 mental health categories of anxiety and depression will be discussed together because there is significant symptom overlap and comorbidity. Early research has explored the impact of traditional media (eg, television, movies) on children's acute fears, which can result in anxieties and related sleep disturbances that are difficult to remedy. More recent research deals with the interactive nature of newer media, especially social media, and their impacts on anxiety and depression. Key topics of inquiry include the following: anxiety and depression associated with technology-based negative social comparison, anxiety resulting from lack of emotion-regulation skills because of substituted digital media use, social anxiety from avoidance of social interaction because of substituted digital media use, anxiety because of worries about being inadequately connected, and anxiety, depression, and suicide as the result of cyberbullying and related behavior. A growing body of research confirms the relationship between digital media and depression. Although there is evidence that greater electronic media use is associated with depressive symptoms, there is also evidence that the social nature of digital communication may be harnessed in some situations to improve mood and to promote health-enhancing strategies. Much more research is needed to explore these possibilities.

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Using Ecological Momentary Assessment, we explored predictors of adolescents' television (TV) multitasking behaviors. We investigated whether demographic characteristics (age, gender, race/ethnicity, and maternal education) predict adolescents' likelihood of multitasking with TV. We also explored whether characteristics of the TV-multitasking moment (affect, TV genre, attention to people, and media multitasking) predict adolescents' likelihood of paying primary versus secondary attention to TV. Demographic characteristics do not predict TV multitasking. In TV-multitasking moments, primary attention to TV was more likely if adolescents experienced negative affect, watched a drama, or attended to people; it was less likely if they used computers or video games.

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Although research has repeatedly demonstrated that adolescents' use of sexually explicit Internet material (SEIM) is related to their endorsement of permissive sexual attitudes and their experience with sexual behavior, it is not clear how linkages between these constructs unfold over time. This study combined 2 types of longitudinal modeling, mean-level development and cross-lagged panel modeling, to examine (a) developmental patterns in adolescents' SEIM use, permissive sexual attitudes, and experience with sexual behavior, as well as whether these developments are related; and (b) longitudinal directionality of associations between SEIM use on the 1 hand and permissive sexual attitudes and sexual behavior on the other hand. We used 4-wave longitudinal data from 1,132 7th through 10th grade Dutch adolescents (M(age) T1 = 13.95; 52.7% boys) and estimated multigroup models to test for moderation by gender. Mean-level developmental trajectories showed that boys occasionally and increasingly used SEIM over the 18-month study period, which co-occurred with increases in their permissive attitudes and their experience with sexual behavior. Cross-lagged panel models revealed unidirectional effects from boys' SEIM use on their subsequent endorsement of permissive attitudes, but no consistent directional effects between their SEIM use and sexual behavior. Girls showed a similar pattern of increases in experience with sexual behavior, but their SEIM use was consistently low and their endorsement of permissive sexual attitudes decreased over the 18-month study period. In contrast to boys, girls' SEIM use was not longitudinally related to their sexual attitudes and behavior. Theoretical and practical implications of these gender-specific findings are discussed. (PsycINFO Database Record

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OBJECTIVES: To determine the longitudinal and cross-sectional associations between different types of electronic media use (mobile phones, TV, computers, video games, and music) and young adolescents' depressive symptoms, and to explore the potential for household media rules to reduce young people's depression. METHODS: 126 young adolescents were recruited from the Northeastern USA. Each type of media use was assessed using survey questions, time use diaries, and ecological momentary assessment. The Beck Depression Index for Primary Care was administered at baseline and 1 year later as part of a questionnaire that also included items assessing the presence of household rules about TV and video games. RESULTS: Baseline use of mobile phones and TV viewing were associated with higher levels of depression 1 year later controlling for demographic information and baseline depression score. Having household rules about TV at baseline predicted lower levels of depression at follow-up. CONCLUSIONS: Both TV viewing and mobile phone use may contribute to the development of depressive symptoms. Implementing household rules about the duration and content of TV could help reduce depression in young adolescents.

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BACKGROUND AND OBJECTIVE: This study investigated: (1) the prevalence and development of 2 receptive (sexually explicit Internet material [SEIM] use and sexual information seeking) and 2 interactive (cybersex and general social networking site [SNS] use) online behaviors in adolescence; (2) whether development of these behaviors predict adolescents' body and sexual self-perceptions; and (3) whether parental strategies regarding adolescents' Internet use reduce engagement in sex-related online behaviors. METHODS: Four-wave longitudinal data among 1132 seventh- to 10th-grade Dutch adolescents (mean age at wave 1: 13.95 years; 52.7% boys) were collected. Developmental trajectories of sex-related online behaviors were estimated by using latent growth curve modeling. Self-perception outcomes at wave 4 and parental strategies predicting online behaviors were investigated by adding regression paths to growth models. RESULTS: Boys occasionally and increasingly used SEIM. Patterns for girls' SEIM use and boys' and girls' sexual information seeking and cybersex were consistently low. SNS use, however, was a common, daily activity for both. Higher initial levels and/or faster increases in sex-related online behaviors generally predicted less physical self-esteem (girls' SNS use only), more body surveillance, and less satisfaction with sexual experience. Private Internet access and less parental rule setting regarding Internet use predicted greater engagement in sex-related online behaviors. CONCLUSIONS: Although most sex-related online behaviors are not widespread among youth, adolescents who engage in such behaviors are at increased risk for developing negative body and sexual self-perceptions. Particular attention should be paid to adolescents' SNS use because this behavior is most popular and may, through its interactive characteristics, elicit more critical self-evaluations. Prevention efforts should focus on parents' role in reducing risky sex-related online behaviors.

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INTRODUCTION: Native American children experience greater disparities in the number and magnitude of health-related diseases than White children. Multimedia-based health interventions may afford valuable opportunities for reaching this underserved demographic; however, limited data are available describing the use of media technologies among Native Americans. This study characterized diverse media access and use between rural Native American and White children. METHODS: Surveys were administered to students (n=477) aged 10-15 years in grades 6-8 across four public middle schools in the rural Upper Peninsula of the Midwestern USA state of Michigan. RESULTS: Native American children (n=41) were more likely than White children (n=436) to have a video game system in their bedroom (65.9% vs 45.4%; p=0.01) and watch more minutes of television on Saturdays (110.3±91.7 vs 80.7±80.8; p=0.03). Native American children also had fewer computers within the home (1.20±0.81 vs 1.68±1.21; p=0.01) than White children and less household internet access (75.6% vs 87.1%; p=0.04), but demonstrated more use in minutes after school (79.9±97.9 vs 51.1±71.6; p=0.02) and on Saturdays (92.6±107.4 vs 60.0±85.1; p=0.02). CONCLUSIONS: This represents the first cross-cultural comparison of media access and use between Native American and White children from rural Michigan. Greater computer and internet use observed among the Native American children surveyed in this study supports the use of web-based public health initiatives aimed at reducing health disparities within this vulnerable group.

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PURPOSE OF REVIEW: Adolescents have increasingly turned to the Internet as a resource for insight into their health questions and concerns. However, the extent to which adolescents will benefit from using the Internet as a source for health information will be determined in great part by their level of media literacy and health literacy. The purpose of this review is to explore challenges that adolescents face when using the Internet to access health information and opportunities for intervention. RECENT FINDINGS: Adolescents must be able to access, understand, analyze, and evaluate health information on the Internet and then apply this information to make appropriate health decisions. Challenges faced by adolescents fall into the realm of functional literacy (e.g., not being able to spell a medical term needed in a search), critical literacy (e.g., not being able to differentiate accurate from inaccurate online health information), and, lastly, interactive literacy (e.g., translating online health information to appropriate health behaviors). SUMMARY: More research is needed in this field to better understand the challenges and to propose effective solutions. However, a multifaceted approach that engages policymakers, educators, healthcare providers, online health information providers, and parents may be positioned to make the largest impact.

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OBJECTIVE: Increased prevalence and penetration of cellphone and mobile Internet use have raised significant concerns about children's health and safety by offering new spaces for cyberbullying, harassment, and sexual misconduct. "Cyberhero Mobile Safety" is a videogame-based education program designed using tenets of the capacity model with the goal of instilling the knowledge and skills necessary to safely and productively navigate the mobile online environment. This study evaluates its usability, appeal, and perceived impact and usefulness. MATERIALS AND METHODS: Six educational videogames were part of a program delivered to 3rd-6th grade students (n=108) across six public schools in Upstate New York. Videogame play was electronically captured to evaluate usability. Likeability, acceptability, and perceived usefulness of videogame content were evaluated through postgame questionnaires. RESULTS: Videogame usability criteria were achieved on 82.7 percent of the students' gameplays. On a scale from 1 (low) to 5 (high), mean ratings were 4.09 (standard deviation [SD]=1.28) for likeability, 3.54 (SD=1.61) for acceptability, and 4.16 (SD=1.33) for perceived message usefulness. CONCLUSIONS: The "Cyberhero Mobile Safety" program is a feasible and potentially effective platform for delivering information about safe and healthy cellphone and Internet use to children. Results support the use of the capacity model to design educational videogames because games that aligned with theory principles were reported as having the most impact and being the most useful at shifting children's online behaviors. Future research should directly test the individual components of the capacity model to inform educational game design.

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To understand obese adolescent girls' perspectives regarding their weight and health we studied video intervention/prevention assessment audiovisual narratives created by 14 obese girls ages 12 to 20 years. The narratives included interviews, monologues, and daily activities. Themes included illness conceptualizations, health concerns, health misinformation, and distress regarding appearance deriving from both within and without. The predominant theme was ambivalence about obesity. Close examination of these themes revealed potential footholds for intervention. Sensitive exploration of issues such as appearance and psychosocial distress might strengthen the patient-clinician partnership in identifying a patient's strengths and motivating weight loss.

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OBJECTIVES: This study investigates how characteristics of young adolescents' screen media use are associated with their BMI. By examining relationships between BMI and both time spent using each of 3 screen media and level of attention allocated to use, we sought to contribute to the understanding of mechanisms linking media use and obesity. METHODS: We measured heights and weights of 91 13- to 15-year-olds and calculated their BMIs. Over 1 week, participants completed a weekday and a Saturday 24-hour time-use diary in which they reported the amount of time they spent using TV, computers, and video games. Participants carried handheld computers and responded to 4 to 7 random signals per day by completing onscreen questionnaires reporting activities to which they were paying primary, secondary, and tertiary attention. RESULTS: Higher proportions of primary attention to TV were positively associated with higher BMI. The difference between 25th and 75th percentiles of attention to TV corresponded to an estimated +2.4 BMI points. Time spent watching television was unrelated to BMI. Neither duration of use nor extent of attention paid to video games or computers was associated with BMI. CONCLUSIONS: These findings support the notion that attention to TV is a key element of the increased obesity risk associated with TV viewing. Mechanisms may include the influence of TV commercials on preferences for energy-dense, nutritionally questionable foods and/or eating while distracted by TV. Interventions that interrupt these processes may be effective in decreasing obesity among screen media users.

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