Surgeon General's Advisory on Teens and Social Media

[MUSIC PLAYING] Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. How much time do your teens spend on social media? How do you know when it's too much? Is it good, or is it bad to be spending that amount of time that many teens do?

Well, joining me to discuss his concerns about the amount of time that teens utilize social media is my good friend, Dr. Vivek Murthy, the United States surgeon general. Dr. Murthy, thanks for joining me.

I'm so glad that we're having this conversation. It's nice to do this again.

Well, with everything, whether it's a drug, it's a device, anything in life has risks versus benefits. I want to start off with a little bit about the benefits of social media. Because last year, you talked about how in some ways, social media platforms can be of particular help to marginalized communities, that are helping them find other people like them. But now, you're raising concerns about what might be too much. So let's talk a little bit about the benefits first.

John, in the advisory I issued last year, I talked to actually about both benefits and harms. And some of the benefits that I pointed to were that some kids, when they use social media, can use it to actually find community they may not otherwise find in person, community that can help them with difficult experiences they're going through, or managing, or processing, or making sense of a set of experiences or background that might be different from kids in person. So that can be helpful.

It can also be useful to help keep you connected with old friends from high school or from college. But there also are a series of harms that we've got to keep in mind as well. And one of my worries is that in real life, what we do is we're generally assessing risks and benefits and then seeing where they net out for us.

But I worry that sometimes in our discussion of social media, we have allowed ourselves to think because there are benefits for some, that, that somehow means that we should tolerate all of the harms that we're seeing, which doesn't really comport with how we generally approach other products that kids use.

And you have a very interesting statistic in the advisory, and I want to read it. You talk about teens who spend more than 3 hours a day, just 3 hours a day, on social media faced a significantly higher risk of mental health problems. And that 46%, nearly half of all adolescents, said social media made them feel worse about their bodies.

That's right. And this is part of a growing body of evidence that has concerned me about the negative health impacts, specifically mental health impacts of social media on our kids. Look, the whole reason I started on this journey, John, was because of parents and because of kids, what they were telling me when I was on the road. The number one question parents were asking me is social media safe for my kids? It's a very reasonable question.

Yet, the answer wasn't as easy for them to discern. Many have said to me, "If there were harms, why would this be freely available for our kids to use without really any safeguards? So it must be safe, right?" And that got me to dig into this question more deeply.

And that's when I understood two things very clearly from the data. Number one, there isn't evidence telling us that social media is safe for our kids in the way that you would think that the food that your children eat, or the toys they play with, or the car seats you put them into, or ultimately the cars that they drive when they get older have all been looked at with a lens towards safety. That has not happened when it comes to social media.

The second thing that I found, though, is that there was growing evidence of harm. You cited two of the statistics from a report that deeply concerned me. And the stat about the 3 hours a day, by the way, that statistics showed that on average, adolescents who are spending 3 or more hours a day on social media face double the risk of anxiety and depression symptoms. But you have to look also at what young people are telling us.

They're telling us, in no small numbers, that social media is making them feel worse about their body image, that they feel addicted to it, and it's hard for them to get off. It's keeping them up past midnight on weeknights, which is taking away from sleep, both quality and quantity of sleep. I just want to put this in perspective for a moment.

If you think about what just happened earlier this year when a door plug came off of Boeing airplane, we grounded hundreds of planes. There was another outbreak of listeria among a set of dairy products, which led to two deaths and many, many units across the country were pulled off the shelf. We react with urgency when there are signals that there may be an adverse safety consequence or adverse health consequence to people.

And we especially take this seriously when it comes to our kids. Which is why I am curious and concerned about why it is that we have treated social media so differently. There are hundreds, if not more, cases of young people, who have taken their own lives after being harassed or bullied mercilessly on social media, after having the algorithm suggest videos to them about how they could in fact harm themselves and take their own lives.

Any one of these, you would think, would have prompted an investigation and safety measures. Yet, we have somehow continued as if it's business as usual. And that has to stop because we've seen the mental health impact on our kids. We've got to do something differently when our kids well-being is at stake.

You want to put a warning label on these platforms, and that's really the strongest advisory that you could give. And people know that classically from smoking and the Surgeon General's office, that warning, literally, a label on a package. How would it work on these platforms, which are virtual? And then even just to push back a little bit, Dr. Murthy, that people will say, "We know that smoking has no benefits; there are none."

But on social media, perhaps, there are some benefits, as we talked about. Although it may be outweighed by the risks. So what would this label look like?

Yeah, so here's why. A warning label warns people about the harms that we're seeing. It warns them when we've a lack of evidence of safety. And that's what we can do here. That's what we should do here.

Frankly, this is what we should have done years ago when it comes to social media. A warning label does not mean that there may not be some benefits to some. But what it does is it gives people information so that they can make decisions.

Keep in mind, we don't just have warning labels on tobacco products, we have surgeon general warning labels on alcohol bottles. We also, though, have broader health warnings on a series of other products, including medications, so that people can weigh the risks and benefits. Medications are a great example of where you may have some benefits and some risks.

But sometimes, you put a warning label to warn people about certain hazards or risks that they need to weigh and that their clinicians need to weigh. That's what we need to have here.

But it's important also to note two last things.

One is that there is data that shows us, from tobacco in particular, that warning labels do make an impact on people's behavior and on their awareness. And we actually have one of the studies I cited a few a few weeks ago when I published a New York Times op ed on the subject of a warning label was that there has been, in fact, a recent study showing that when parents were asked whether a Surgeon General's warning about the harms of social media would prompt them to act differently when it came to their managing social media for their kids, 3/4 of them said, yes, it would. And so we both have prior evidence, as well as some recent evidence that shows that these work.

But here's the last thing to keep in mind. Something that I said last year when I issued a Surgeon General's advisory on social media and something I reiterated this year when I called for a warning label is that a warning label is not the entire solution to addressing the harms of social media. It is one part of a broader solution set. I called for many of those other solution pieces last year, including measures that would reduce the harmful content that kids are exposed to, especially extreme sexual content and violent content, that would protect them from harassment and bullying, and that would also protect kids from the manipulative features on social media that seek to lure their brains into excessive use.

I want to go back to the issue of what parents can do. You and I are both parents. Certainly, parents play a key role when we're talking about teens. And let's be honest, parents don't always model behavior well.

Many of them are on their phones scrolling through social feeds all the time. So if it's OK for the parents, then why isn't it OK for the teens? What are some tips that you can give listeners? Here's the opportunity to talk to parents to say, here's x, y, z, that you should be doing with your teens when it comes to social media and their mental health.

So the good news is there are steps parents can take. And many of the steps that you and I have just talked about, including the safety measures they need to be put in place to make the platform safer, the data transparency requirements that need to be put in place to ensure companies share their data about mental health impact on kids, a lot of that are actions that congress needs to take. And I've called on them to do so.

Here's what parents can do. Number one, parents can start by having conversations with your kids about their use of social media and how it affects them. Many parents don't know what platforms their kids may be using. They may not know how much time they're spending on it. They may not also know how it's making their kids feel.

But it's important that kids know that if they're being harassed and bullied, particularly by strangers, if they're being extorted or blackmailed online, as so many kids are on social media, that they raise a hand and come to a parent or a trusted adult and let them know what's happening. The second thing that you can do as a parent is to model responsible use. Many of us as parents struggle with social media use.

We've been talking about the impacts on youth mental health. But almost every time I talk about this, adults raise their hand and say, "Hey, we're struggling too." I know that this is not easy to do, but when we create boundaries around our use of social media, when we put our devices away and when we're talking to our kids, when we're talking to family and friends, we actually help model the kind of behavior we want our kids to take.

Here's a third thing parents can do. If your child has not started using social media, you can delay the use of social media until after middle school. At least that's what I'm planning to do with my wife for my kids. Now, this is because--

It may not make them-- it may not make you popular, but this is a good thing.

Well, this is what's really interesting about it. I'm glad you brought that up, John. Because initially, a lot of kids, yeah, they don't want to have restrictions around their use of social media. I've had so many parents say to me, my child is coming to me and saying, everybody else in my class is on social media. Why am I going to be the only one who can't be? You want me to be lonely and left out.

And that's incredibly hard to hear as a parent. But one of the things that we've got to keep in mind here is that for young people, the more we bond together with other parents and build shared agreements about how we're going to limit use for our kids, the easier it is for us and for our kids so they know they're not the only ones. And so many of the kids I've talked to, whose parents held off during middle school, later in high school, they look back and said, well, thank god they did that. Actually, I was upset at the time, but it's actually been really beneficial.

I'll give you one last thing that parents can do. If your child's already on social media, one thing you can do is to create tech free zones in your child's life that help protect the activities that are essential for their development. And those are sleep, in-person interaction, and physical activity.

That could look like saying, we're not going to have any devices at the dinner table when we're all together. It could look like taking devices away an hour before bedtime and giving them back in the morning so that kids can enjoy sleep that's both good in quality as well as in quantity. Keep in mind, a lot of kids are not only staying up late using their devices and using social media, but they're getting up in the middle of the night to get a drink of water, or to use the bathroom, and then they end up scrolling again. And that quality and quantity of sleep being impaired really affects the mental health of kids.

What's the role of schools? There is a lot of debate going on right now whether schools should completely ban cell phones. What's your position on that?

Yeah, well, I think schools are in a very difficult position. But I think one of the people who can tell you firsthand how cell phones and social media in particular have affected students are teachers, are educators who see it firsthand. Look, John, I remember how hard it was in high school to learn complicated concepts in history or in english or in economics or in math.

I can't imagine trying to do that while also posting on social, while checking my feed, while messaging other people in the middle of class. We know that social media has an impact on learning, but it also has an impact on how kids socialize in school. I was visiting a high school recently in Nebraska, and the high school had just, not that long ago, put in place a policy, which said no use of phones during class time.

And I asked the students that I had met with, and I met with them alone without any teachers, I said, how did that make you feel? And they said, initially, they were a little skeptical of it. But they said that, eventually, what happened is they started getting to know each other.

I said, what do you mean? They said, well, we had been in class, in some cases, for a couple of years together, but we didn't really get to know each other because when people have a moment that's free, they're just checking their phones. And now, they started talking to one another and they started getting to know each other, building relationships. So I do think that making learning time in schools, phone-free experiences is vital, not just for learning, but for the social development of our kids.

And these may be unpopular decisions at first, either as parents or as school administrators. But as you point out, the potential harm, particularly on mental health of teens, is real. Well, Dr. Murthy, where can people learn more about you and reports and advisories that we just talked about?

Well, our surgeongeneral.gov is our website. It's where people can find all of the advisors we've worked on, whether it's on firearm violence and social media or on loneliness and isolation, youth mental health, misinformation, workplace mental health and well-being. You can also find prior reports from prior surgeons general. So feel free to go there.

And we've tried very hard to make these reports digestible for the public, practical in terms of steps that people can take. And so I'm hopeful that these tools will not only be of use to clinicians, but hopefully to patients, to families, and to others in the health care system.

And you have a podcast as well, don't you?

I do, yes. So I have a podcast called House Calls with Dr. Vivek Murthy, and it's a very fun podcast, where we have conversations about various dimensions of health, often connected to relationships, social connection, addressing loneliness and isolation. And we have a wide variety of guests. Some are in the health arena. Some are not. But all are fundamentally focused on how to enhance health and well-being.

I encourage folks to take a listen. I've enjoyed listening to it. Well, Dr. Murthy, thanks for taking the time today. Thanks for all you're doing to advance the health of Americans.

Well, thank you so much, John. I'm so glad that we had this conversation.

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