Surgeon General’s advisory on social media

On Tuesday, May 23, U.S. Surgeon General Dr. Vivek Murthy issued an advisory titled Social Media and Youth Mental Health. 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.”

As such, the advisory briefly summarizes current evidence on the role of social media in youth mental health, outlines gaps in our current knowledge, and offers recommendations for policymakers, technology companies, parents, children, and researchers.

What does the advisory say?

Nearly every headline that’s come out in reference to the advisory uses the phrase “profound risk of harm,” as in Surgeon General warns of “profound risk of harm” of social media for adolescent mental health.

As usual, there’s more to the advisory than the headlines might have us believe. Here are the key takeaways:

• More research is needed to fully understand the impact of social media on adolescent mental health.
• Social media has benefits, like for maintaining friendships, developing social connections, and supporting identity development
• It also has risks, summarized in two categories: (1) exposure to inappropriate or harmful content, and (2) excessive use that disrupts important healthy behaviors
• The effects of social media on mental health are shaped by “many complex factors” including: time spent, type of content consumed, activities engaged in, degree to which it disrupts activities like sleep, and individual adolescents’ strengths and vulnerabilities
• We should take a “safety-first” approach, where protections are put in place until safety is demonstrated with rigorous evidence. We already do this with cars, medications, and toys (i.e., toys must undergo third-party testing and be safety certified before hitting the market).
• There are things policymakers, tech companies, researchers, and families can and should do to maximize benefits and minimize risks

Okay, and here is the paragraph with that “profound risk of harm” statement, so you can see it for yourself:

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 benefits 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 sufficiently safe for children and adolescents.

As usual, let’s start with the punchline

I’m glad the Surgeon General

is calling attention to this issue, and that we’re seeing some reasonable guidance for all parties involved. I agree with much of what’s stated in the advisory, including that, at this time, it’s difficult to draw firm conclusions about the role of social media in youth mental health [see my recent summary of the research with Katelyn Jetelina of Your Local Epidemiologist]. As the advisory states, social media has both risks and benefits, its influence on mental health depends on how it’s used, it has different effects on different kids, and there are many remaining questions and gaps in the research evidence.

Even so, it makes sense to be cautious—to take a “safety-first” approach. The toy comparison is a good one. No matter what the overall evidence has to say about the well-being impacts of toys, it makes sense to take precautions due to potential risks of harm (as long as those precautions don’t do more harm than good). I’m glad, for example, to live in a world where I can buy my son a bubble-spraying toy leaf blower, and know with reasonable certainty that it’s not spewing out toxic chemicals.

So the advisory is perfect?

Well, no. There are places where this advisory overstates the data. Would we call the current evidence “ample”? I don’t think so. Should we use the words “profound risk of harm”? Eh. There’s also a bit of selective study inclusion (i.e., including RCTs that show benefits of limiting social media use, without citing those that show no effects), and, of course, our old friend “treating correlational studies as causal evidence.” Playing verrry fast and loose with the word “predicted” here, OSG (Office of the Surgeon General).

It’s also worth zeroing in on one of the report’s key takeaways: At this time, we do not yet have enough evidence to determine if social media is sufficiently safe for children and adolescents. This is technically true. In fact, it’s almost impossible to argue with. Here, by the way, is a list of other things for which we “do not yet have enough evidence” to determine if they are “sufficiently safe”:

• Crocs
• Reading the Wikipedia entry for the Pepsi fruit juice flood of 2017
• High school physics classes
• When your spouse asks “What do you want for dinner?” responding with “I don’t know, what are you in the mood for?” in perpetuity
• Sweater vests

No research to prove the safety of any of these things, as far as I’m aware.

Obviously, there are differences between social media and these things. Ultimately, though, I worry the “evidence for sufficient safety” framing may do more to scare parents than to actually convey what we know about social media’s effects on mental health.

All that said, here’s what I think is important to take away from the advisory: We do have some evidence, even if flawed or limited, that social media can be harmful for youth, and because of that, we should take action to mitigate its potential risks. Although many questions remain, this should not stop us from acting.

Surgeon General, please tell us what to do

Here are some of the advisory’s recommendations:

• For tech companies: Prioritize kids’ safety and health when designing products, including through privacy standards, adhering to age minimums, and transparently assessing products’ effects on well-being.
• For policymakers: Develop safety standards for platforms; support digital literacy curricula in schools; fund more research
• For parents: Create tech-free zones (e.g., before bed), model responsible social media behavior, talk to kids about both benefits and risks of social media, create a family media plan
• For kids: Get help when needed, set boundaries, be cautious about what you share, don’t participant in harassment or cyberbullying
• For researchers: Prioritize research on youth social media use and mental health; improve measures of social media use; collaborate with healthcare providers, parents, and youth

These are reasonable steps, and my hope is that this advisory will prompt renewed consideration of what to actually do about social media (rather than, simply, directionless panic).

At the same time, this advisory is focused on youth mental health. And—I’ve said it once, and I’ll say it again—mental health issues have many, complex causes. For example: violence (including sexual violence and bullying), poverty, unsafe home or school environments, poor relationships with peers or parents, exposure to adversity, and discrimination, to name just a few.

Adopting these recommendations could certainly help make social media a safer and healthier place. Might this improve mental health for some kids, too? Of course. But the biggest risk of the advisory, and its overstating of the data, is that it continues to narrow our focus, to put on our blinders to the many other causes of (and solutions to) the youth mental health crisis. Fixing social media is a start, but it will never be enough.