@Article{info:doi/10.2196/69609, author="Adegboyega, Adebola and Wiggins, Amanda and Wuni, Abubakari and Ickes, Melinda", title="The Impact of a Human Papillomavirus Facebook-Based Intervention (\#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy", journal="JMIR Form Res", year="2025", month="Apr", day="2", volume="9", pages="e69609", keywords="human papillomavirus vaccination", keywords="HPV vaccination", keywords="Facebook-based intervention", keywords="young Black adults", keywords="social media", abstract="Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults. Objective: This study aimed to assess the impact of a Facebook-based intervention (\#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years. Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (\#HPVVaxTalks). \#HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis Results: Overall, 32 of the 43 (74\%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30\%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness. Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities. ", doi="10.2196/69609", url="https://formative.jmir.org/2025/1/e69609" } @Article{info:doi/10.2196/64672, author="DuPont-Reyes, J. Melissa and Villatoro, P. Alice and Tang, Lu", title="Health Information Scanning and Seeking in Diverse Language, Cultural and Technological Media Among Latinx Adolescents: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Mar", day="5", volume="27", pages="e64672", keywords="adolescent behaviors", keywords="mental health", keywords="Latino", keywords="social media", keywords="adolescent", keywords="media use", keywords="internet use", keywords="health information seeking", keywords="health information scanning", keywords="mobile phone", abstract="Background: Continuous scientific and policy debate regarding the potential harm and/or benefit of media and social media on adolescent health has resulted, in part, from a deficiency in robust scientific evidence. Even with a lack of scientific consensus, public attitudes, and sweeping social media prohibitions have swiftly ensued. A focus on the diversity of adolescents around the world and their diverse use of language, culture, and social media is absent from these discussions. Objective: This study aims to guide communication policy and practice, including those addressing access to social media by adolescent populations. This study assesses physical and mental health information scanning and seeking behaviors across diverse language, cultural, and technological media and social media among Latinx adolescent residents in the United States. This study also explores how Latinx adolescents with mental health concerns use media and social media for support. Methods: In 2021, a cross-sectional survey was conducted among 701 US-based Latinx adolescents aged 13-20 years to assess their health-related media use. Assessments ascertained the frequency of media use and mental and physical health information scanning and seeking across various media technologies (eg, TV, podcasts, and social media) and language and cultural types (ie, Spanish, Latinx-tailored English, and general English). Linear regression models were used to estimate adjusted predicted means of mental and physical health information scanning and seeking across diverse language and cultural media types, net personal and family factors, in the full sample and by subsamples of mental health symptoms (moderate-high vs none-mild). Results: Among Latinx adolescents, media and social media use was similar across mental health symptoms. However, Latinx adolescents with moderate-high versus none-mild symptoms more often scanned general English media and social media for mental health information (P<.05), although not for physical health information. Also, Latinx adolescents with moderate-high versus none-mild symptoms more often sought mental health information on Latinx-tailored and general English media, and social media (P<.05); a similar pattern was found for physical health information seeking. In addition, Latinx adolescents with moderate-high versus none-mild symptoms often sought help from family and friends for mental and physical health problems and health care providers for mental health only (P<.05). Conclusions: While media and social media usage was similar across mental health, Latinx adolescents with moderate-high symptoms more often encountered mental health content in general English media and social media and turned to general English- and Latinx-tailored media and social media more often for their health concerns. Together these study findings suggest more prevalent and available mental health content in general English versus Spanish language and Latinx-tailored media and underscore the importance of providing accessible, quality health information across diverse language, cultural, and technological media and social networks as a viable opportunity to help improve adolescent health. ", doi="10.2196/64672", url="https://www.jmir.org/2025/1/e64672", url="http://www.ncbi.nlm.nih.gov/pubmed/40053766" } @Article{info:doi/10.2196/71897, author="Lewis, C. Callum and Taba, Melody and Allen, B. Tiffany and Caldwell, H.Y Patrina and Skinner, Rachel S. and Kang, Melissa and Henderson, Hamish and Bray, Liam and Borthwick, Madeleine and Collin, Philippa and McCaffery, Kirsten and Scott, M. Karen", title="Authors' Reply: ``Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders''", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e71897", keywords="adolescent health", keywords="digital health literacy", keywords="adolescents", keywords="online health information", keywords="co-design", keywords="health education", keywords="eHealth literacy", keywords="social media", doi="10.2196/71897", url="https://www.jmir.org/2025/1/e71897" } @Article{info:doi/10.2196/70020, author="Yang, Alina", title="Adolescent Cocreation in Digital Health: From Passive Subjects to Active Stakeholders", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e70020", keywords="adolescent health", keywords="digital health literacy", keywords="adolescents", keywords="online health information", keywords="co-design", keywords="health education", keywords="eHealth literacy", keywords="social media", doi="10.2196/70020", url="https://www.jmir.org/2025/1/e70020" } @Article{info:doi/10.2196/59338, author="Zhang, Xinyu and Zhu, Jianfeng and Kenne, R. Deric and Jin, Ruoming", title="Teenager Substance Use on Reddit: Mixed Methods Computational Analysis of Frames and Emotions", journal="J Med Internet Res", year="2025", month="Feb", day="19", volume="27", pages="e59338", keywords="teenager", keywords="substance use", keywords="Reddit", keywords="emotional analysis", keywords="bidirectional encoder representations from transformers", keywords="BERT", keywords="frame approach", abstract="Background: Adolescent substance use disorder is a pressing public health issue, with increasing prevalence as individuals age. Social media platforms like Reddit (Reddit Inc) serve as significant venues for teenagers to discuss and navigate substance use. Social media platforms, such as Reddit, serve as increasingly important spaces where teenagers discuss, share, and navigate their experiences with substance use, presenting unique opportunities and challenges for understanding and addressing this issue. Objective: This study aims to explore how teenagers frame substance-use discussions on the r/teenagers subreddit, focusing on their personal interpretations, causal attributions, and the social and psychological contexts that shape these online support groups. By identifying these interpretive frames, we aimed to better understand the complex drivers of adolescent substance use behavior and their potential interventions. Methods: Using natural language processing techniques, we analyzed 32,674 substance use--related posts from 2018 to 2022. A framing approach was used to identify and categorize prevalent themes, supplemented by emotional profiling using the EmoLLaMA-chat-13B model developed by Liu and colleagues. Results: In total, 7 primary frames emerged: normalization, risk awareness, social integration, autonomy and rebellion, coping mechanisms, media influence, and stigmatization. These frames varied in prevalence and were associated with distinct emotional profiles, highlighting the complex interplay between substance use and adolescent experiences. We observed that, for example, the normalization frame was often associated with a mix of sadness and anxiety, while the coping frame exhibited elevated levels of anger, sadness, and anxiety. These distinctive emotional landscapes associated with each frame reveal unique insights into the mental state of adolescents navigating substance use. Conclusions: The findings underscore the multifaceted nature of adolescent substance-use discussions on social media. Interventions must address underlying emotional and social factors as well as identity to effectively mitigate substance use disorder among adolescents. By understanding the frames teenagers use to interpret substance use, we can pave the way for more effective and personalized public health campaigns, and support services designed to resonate with adolescents' unique lived experiences. ", doi="10.2196/59338", url="https://www.jmir.org/2025/1/e59338" } @Article{info:doi/10.2196/66448, author="Kim, I. Sol and Jin, Jae-Chan and Yoo, Seo-Koo and Han, Hyun Doug", title="Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="11", volume="8", pages="e66448", keywords="coronavirus pandemic", keywords="internet use pattern", keywords="internet games", keywords="short-form videos", keywords="social network system", keywords="depressed mood", keywords="internet use", keywords="pandemic", keywords="internet", keywords="COVID-19", keywords="video", keywords="internet behavior", keywords="social media", keywords="internet addiction", keywords="depression", keywords="anxiety", keywords="digital platforms", keywords="mobile phone", abstract="Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 ($\chi$23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. ", doi="10.2196/66448", url="https://pediatrics.jmir.org/2025/1/e66448" } @Article{info:doi/10.2196/62955, author="Chemnad, Khansa and Aziz, Maryam and Al- Harahsheh, Sanaa and Abdelmoneium, Azza and Baghdady, Ahmed and Alsayed Hassan, Diana and Ali, Raian", title="Assessing the Relationship Between the Type of Internet Use and Internet Addiction in Early and Middle Adolescents: Cross-Sectional Study From Qatar", journal="JMIR Hum Factors", year="2025", month="Feb", day="10", volume="12", pages="e62955", keywords="internet addiction", keywords="internet use", keywords="early adolescence", keywords="middle adolescence", keywords="mobile phone", abstract="Background: With the increasing prevalence of digital technology, adolescent internet addiction (IA) has become a global concern. Excessive internet use, especially among adolescents, has been linked to various negative outcomes such as poor academic performance, social isolation, and mental health issues. Conducted among adolescents of Arab origin, our study addressed the limitations of the literature, which predominantly focuses on Western, educated, industrialized, rich, and democratic populations. Objective: This study aimed to differentiate between essential and nonessential internet use and how they relate to IA in early and middle adolescents, as well as the relationship between subjective happiness with the amount of time spent on nonessential internet use and IA. Methods: A cross-sectional survey was conducted among 377 students from 16 schools in Qatar. The survey measured essential and nonessential internet use, subjective happiness with nonessential use, and IA symptoms using the Internet Addiction Diagnostic Questionnaire, as well as participant demographics. To explore age-specific associations, participants were categorized into early (age 11-13 years) and middle (age 14-17 years) adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis. Results: Nonessential internet use significantly predicted IA in both early (P<.001) and middle (P<.001) adolescents, with early adolescents showing a stronger association. Subjective happiness with nonessential internet use negatively predicted IA only in middle adolescents (P<.001) as greater dissatisfaction led to a higher IA risk. Essential internet use did not predict IA in either group. Conclusions: Differentiating between essential and nonessential internet use is crucial in understanding IA. This study highlights the importance of developmental differences in shaping IA symptoms. The findings suggest that interventions aimed at addressing IA should be age specific and focus on addressing nonessential use specifically rather than considering internet use and screen time in general as a single entity. Cultural and regional factors also play a role in shaping internet use patterns and IA in the Middle East, necessitating context-specific, culturally sensitive approaches to IA prevention. ", doi="10.2196/62955", url="https://humanfactors.jmir.org/2025/1/e62955" } @Article{info:doi/10.2196/52083, author="Li, Sihong and Jin, Xingyue and Song, Lintong and Fan, Tianqing and Shen, Yanmei and Zhou, Jiansong", title="The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study", journal="J Med Internet Res", year="2025", month="Jan", day="3", volume="27", pages="e52083", keywords="adolescents", keywords="pathological internet use", keywords="internet addiction", keywords="suicide attempts", keywords="risk factors", keywords="cohort study", abstract="Background: Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. Objective: This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. Methods: A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants' demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale--21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale--Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. $\chi$2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. Results: The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01\%) and more than half being male (426/782, 54.48\%). Most participants had no previous history of depression (541/782, 69.18\%), anxiety (415/782, 53.07\%), or stress (618/782, 79.03\%). The rate of newly reported suicide attempts was 4.6\% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95\% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95\% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. Conclusions: This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention. ", doi="10.2196/52083", url="https://www.jmir.org/2025/1/e52083" } @Article{info:doi/10.2196/48627, author="Lazard, J. Allison and Vereen, N. Rhyan and Zhou, Jieni and Nichols, B. Hazel and Pulido, Marlyn and Swift, Catherine and Dasgupta, Nabarun and Fredrickson, L. Barbara", title="Designing Positive Psychology Interventions for Social Media: Cross-Sectional Web-Based Experiment With Young Adults With Cancer", journal="JMIR Cancer", year="2024", month="Dec", day="20", volume="10", pages="e48627", keywords="young adult", keywords="cancer survivors", keywords="social media", keywords="positive psychology", keywords="acceptability", keywords="feasibility", keywords="youth", keywords="cancer", keywords="psychosocial", keywords="self-efficacy", keywords="social connection", keywords="positive emotion", keywords="emotion", keywords="social engagement", abstract="Background: Young adults (ages 18?39 years) with cancer face unique risks for negative psychosocial outcomes. These risks could be lessened with positive psychology interventions adapted for social media if intervention messages encourage intentions to do the activities and positive message reactions and if young adults with cancer perceive few downsides. Objective: This study aimed to assess whether social media messages from evidence-based positive psychology interventions encouraged intentions to do the intervention activities and intended positive message reactions, overall and among sociodemographic or cancer characteristic subgroups. We also aimed to identify perceived downsides of the activity that would negatively impact the interventions' feasibility. Methods: Young adults (ages 18?39 years, cancer diagnosis ages 15?39 years) were randomized to a between-persons web-based experiment. Participants viewed a social media message with social context cues (vs not) for 1 of 2 types of intervention (acts of kindness vs social connectedness). Participants reported intentions to do the activity, along with their perceived social presence in the message (how much they felt the sense of others) and forecasted positivity resonance (whether they would experience socially connected positive emotions when doing the activity), with 5-point items. Participants also reported their self-efficacy (how certain they can do the intervention activity) with a 0?100 item and potential downsides of the activity categorically. Results: More than 4 out of 5 young adults with cancer (N=396) reported they ``somewhat'' (coded as 3) to ``extremely'' (5) intended to do the intervention activity (336/396, 84.8\%; mean ranged from 3.4?3.6, SD 0.9-1.0), perceived social presence in the messages (350/396, 88.4\%; mean 3.8, SD 0.7), and forecasted positivity resonance (349/396, 88.1\%; mean 3.8?3.9, SD 0.8). Participants reported having self-efficacy to complete the activity (mean 70.7\% of possible 100\%, SD 15.4\%?17.2\%). Most (320/396, 80.8\%) did not think of the downsides of the interventions. Messages with social context cues (vs not) and both intervention types were rated similarly (all P>.05). Black young adults reported lower intentions, perceived social presence, and forecasted positivity resonance than White young adults (all P<.001). Participants in active treatment (vs completed) reported greater intentions to do the activities (P<.001). Conclusions: Positive psychology intervention messages adapted for social media were perceived as acceptable and feasible among young adults with cancer. The social media--based messages encouraged increasing one's social connectedness and performing acts of kindness. Young adults with cancer also predicted they would have feelings of positive social engagement (positivity resonance) when doing the interventions---the key ingredient for experiencing the health benefits of these activities. This study provides promising evidence for the development of age-appropriate, highly scalable interventions to improve psychosocial health among young adults with cancer. ", doi="10.2196/48627", url="https://cancer.jmir.org/2024/1/e48627" } @Article{info:doi/10.2196/57154, author="Mabaso, Siza Wakithi and Hein, Sascha and Pavarini, Gabriela and and Fazel, Mina", title="Exploring the Relationship Between Public Social Media Accounts, Adolescent Mental Health, and Parental Guidance in England: Large Cross-Sectional School Survey Study", journal="J Med Internet Res", year="2024", month="Dec", day="17", volume="26", pages="e57154", keywords="social media", keywords="adolescent health", keywords="privacy", keywords="parental guidance", keywords="mood disorders", keywords="adolescent", keywords="anxiety", keywords="depression", keywords="cross-sectional", keywords="mental health", keywords="public", keywords="account", keywords="school-going", keywords="school", keywords="England", keywords="survey", keywords="logistic regression", keywords="observational", abstract="Background: Although associations between social media use and adolescent mental health have been described, more information is needed on the potential components characterizing this complex exposure, in particular, those related to maintaining a public social media account. Objective: This study aims to investigate the association between having a public social media account and anxiety and depression in school-going adolescents. Methods: Overall, 80 secondary schools and further education colleges in England were sampled using a cross-sectional web-based survey as part of the 2023 OxWell Student Survey. Social media exposure was categorized among the adolescents as having a public social media account versus not having a public social media account. The risk of clinical anxiety and depression was determined using the Revised Child Anxiety and Depression Scale-11. Adolescents self-reported the content and platforms accessed in the previous 24 hours. Associations between having a public social media account and symptoms of anxiety and depression were assessed using logistic regression controlling for age, sex, the experience of being bullied, parental guidance of online behavior (describing perceived parental approaches to adolescents' online activity), the proportion of close friendships engaged with online, poverty status, and placement in statutory care. Age, sex, and parental guidance of online behavior were assessed for primary association effect modification. Results: Data collected from 16,655 adolescents (aged 11-18 y) were analyzed. Of these 16,655 adolescents, 6734 (40.43\%) had a public social media account, while 9921 (59.57\%) either had a private social media account or no social media account. Moreover, 32.6\% (5429/16,655) of the adolescents screened positive for symptoms of anxiety and depression. Those with a public social media account had higher odds of anxiety and depression (odds ratio [OR] 1.41, 95\% CI 1.32-1.50) than those without a public social media account in an unadjusted and fully adjusted model (OR 1.39, 95\% CI 1.29-1.49). Adolescents reporting active parental guidance had lower odds of anxiety and depression (OR 0.85, 95\% CI 0.75-0.93) than those reporting no parental guidance, and these parental approaches to online behaviors significantly modified the association between having a public social media account and symptoms of anxiety and depression (P=.004; $\chi$22=11.1). Conclusions: Our OxWell study findings suggest a potential mental health risk for adolescents with a public social media account. We show evidence indicating some protection from anxiety and depression among adolescents who do not have a public social media account and those reporting some form of parental guidance of their online behavior. This was pronounced in adolescents reporting active parental guidance compared to stricter regulatory approaches or no guidance at all. The specific roles that social media account choices and parental guidance of online behavior may play in supporting the mental health of adolescents are highlighted for further investigation. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-052717 ", doi="10.2196/57154", url="https://www.jmir.org/2024/1/e57154", url="http://www.ncbi.nlm.nih.gov/pubmed/39688898" } @Article{info:doi/10.2196/62919, author="Raeside, Rebecca and Todd, R. Allyson and Barakat, Sarah and Rom, Sean and Boulet, Stephanie and Maguire, Sarah and Williams, Kathryn and Mihrshahi, Seema and Hackett, L. Maree and Redfern, Julie and Partridge, R. Stephanie and ", title="Recruitment of Adolescents to Virtual Clinical Trials: Recruitment Results From the Health4Me Randomized Controlled Trial", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="16", volume="7", pages="e62919", keywords="adolescents", keywords="clinical trial", keywords="recruitment", keywords="digital health", keywords="prevention", keywords="adolescent health", keywords="health behavior change", keywords="health promotion", keywords="social media", abstract="Background: Preventive interventions are needed to provide targeted health support to adolescents to improve health behaviors. Engaging adolescents in preventive interventions remains a challenge, highlighting the need for innovative recruitment strategies. Given adolescents' lives are intertwined with digital technologies, attention should be focused on these avenues for recruitment. The evolving nature of clinical trials, including the emergence of virtual clinical trials, requires new recruitment approaches, which must be evaluated. Objective: This study aimed to examine the effectiveness and cost of various digital recruitment strategies for recruiting adolescents to a virtual clinical trial, evaluate the progression of participants from screening to enrollment, and explore factors associated with nonparticipation. This was conducted using data from the Health4Me Study, a preventive digital health intervention to improve physical activity and nutrition behaviors among adolescents aged 12 to 18 years. Methods: Participants were recruited into the Health4Me Study via social media advertisements on various contemporary platforms, emails to schools, emails to contacts within known networks, and emails to relevant youth organizations. Data were collected from social media advertisements, screening, and recruitment logs. Data analysis included summary and descriptive statistics, as well as chi-square tests to explore factors associated with nonparticipation. Results: From 2369 expressions of interest, 390 (16.4\%) participants were enrolled. A total of 19 advertisements were placed on social media, and 385 promotional emails were sent to schools, contacts within known networks, and relevant youth organizations. Social media advertisements reached 408,077 unique accounts. Advertisements mostly reached those living in populous states in Australia (306,489/408,077, 75.11\% of unique accounts) and those identifying as female (177,698/408,077, 43.55\% of unique accounts). A total of 24.97\% (101,907/408,077) of advertisements were delivered to accounts with uncategorized genders. The total cost per participant enrolled was Aus \$3.89 (approximately US \$2.58). Most participants (1980/2305, 85.90\%) found out about this study through Instagram. Differences in screening characteristics between eligible participants who did and did not enroll were found to be statistically significant for gender (P=.02), with fewer males and more individuals reporting their gender as ``other'' enrolling than expected by chance alone. The recruitment method also differed (P<.001), with fewer participants enrolling through Instagram and more enrolling through other methods (eg, known networks or word of mouth) than expected by chance alone. Conclusions: This study found that virtual clinical trial recruitment was found to be low-cost, with the potential to increase trial participation. Social media was the most effective recruitment method, reaching all states and territories, including hard-to-reach populations. Future action is needed to explore recruitment methods that are more effective for males and to build trust among adolescents regarding clinical trial recruitment via social media. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12622000949785; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383576\&isReview=true ", doi="10.2196/62919", url="https://pediatrics.jmir.org/2024/1/e62919" } @Article{info:doi/10.2196/59585, author="Hall, A. Jeffrey", title="Ten Myths About the Effect of Social Media Use on Well-Being", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e59585", keywords="social media", keywords="well-being", keywords="health promotion", keywords="depressive disorder", keywords="depression", keywords="anxiety", keywords="adolescent", keywords="mental health", doi="10.2196/59585", url="https://www.jmir.org/2024/1/e59585" } @Article{info:doi/10.2196/55555, author="Tran, Thao Thi Phuong and Vu, Trang Thu and Li, Yachao and Popova, Lucy", title="Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis", journal="J Med Internet Res", year="2024", month="Nov", day="8", volume="26", pages="e55555", keywords="risk", keywords="risk factor", keywords="tobacco content", keywords="alcohol content", keywords="tobacco", keywords="alcohol", keywords="tobacco portrayal", keywords="alcohol portrayal", keywords="music video", keywords="Vietnam", keywords="Vietnamese", keywords="YouTube", keywords="social media", keywords="socials", keywords="youth", keywords="adolescent", keywords="teen", keywords="teenager", keywords="young adult", abstract="Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8\%) contained tobacco-related content and 136 (33.2\%) featured alcohol-related content. Additionally, 28 (6.8\%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30\%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8\%), and smoking scenes were often depicted at parties (n=13, 36.1\%) and during dancing and singing scenes (n=12, 33.3\%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7\% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6\%). Among 87 MVs containing drinking scenes, 60.9\% (n=53) involved groups of young adults of both sexes, and 64\% (n=56) depicted singers drinking. Additionally, only 2 (5.6\%) MVs included health warnings about tobacco harm, and 2 MVs (1.5\%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. ", doi="10.2196/55555", url="https://www.jmir.org/2024/1/e55555" } @Article{info:doi/10.2196/51594, author="Zhou, Xinyi and Hao, Xinyu and Chen, Yuhang and Deng, Hui and Fang, Ling and Zhang, Lingyun and Yan, Xiaotao and Zheng, Pinpin and Wang, Fan", title="Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts", journal="J Med Internet Res", year="2024", month="Nov", day="7", volume="26", pages="e51594", keywords="e-cigarette", keywords="marketing strategy", keywords="social media", keywords="teenagers", keywords="content analysis", abstract="Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52\%) mentioned product characteristics. In 313 (36.3\%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3\%) posts, and purchase channels were not mentioned in 790 (98.3\%) posts. Social interaction--related posts received attention (n=548, 63.5\%), particularly those featuring hashtag content (n=538, 62.3\%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6\%) or information on health warnings (n=839, 97.2\%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. ", doi="10.2196/51594", url="https://www.jmir.org/2024/1/e51594" } @Article{info:doi/10.2196/58127, author="Bowen-Forbes, Camille and Khondaker, Tilovatul and Stafinski, Tania and Hadizadeh, Maliheh and Menon, Devidas", title="Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="5", volume="12", pages="e58127", keywords="children", keywords="youth", keywords="personal safety apps", keywords="smartphones", keywords="mobile apps", keywords="violence", keywords="bullying", keywords="suicide prevention", keywords="youth support", keywords="homeless support", keywords="mobile phone", abstract="Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be ``at risk.'' Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users' experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1\%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44\% of apps), bullying and school violence prevention (n=2, 22\% of apps), self-harm and suicide prevention (n=2, 22\% of apps), and homeless youth support (n=1, 11\% of apps). Of the 41 articles, 25 (61\%) provided data solely on app descriptions and features, while the remaining 16 (39\%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users' experiences, and effectiveness. Four articles reported on app use, 3 (75\%) of which reported relatively high app use. Data on users' experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40\% dating and sexual violence prevention; n=2, 40\% self-harm and suicide prevention; and n=1, 20\% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95\% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. ", doi="10.2196/58127", url="https://mhealth.jmir.org/2024/1/e58127" } @Article{info:doi/10.2196/64626, author="McAlister, L. Kelsey and Beatty, C. Clare and Smith-Caswell, E. Jacqueline and Yourell, L. Jacqlyn and Huberty, L. Jennifer", title="Social Media Use in Adolescents: Bans, Benefits, and Emotion Regulation Behaviors", journal="JMIR Ment Health", year="2024", month="Nov", day="4", volume="11", pages="e64626", keywords="adolescent social media", keywords="social media bans", keywords="emotion regulation", keywords="youth", keywords="adolescent", keywords="media use", keywords="social platform", keywords="social network", keywords="self-regulation", keywords="behavioral health", keywords="mental health", keywords="digital health", keywords="technology", keywords="digital literacy", doi="10.2196/64626", url="https://mental.jmir.org/2024/1/e64626" } @Article{info:doi/10.2196/60541, author="Albert, L. Stephanie and Massar, E. Rachel and Cassidy, Omni and Fennelly, Kayla and Jay, Melanie and Massey, M. Philip and Bragg, A. Marie", title="Body Positivity, Physical Health, and Emotional Well-Being Discourse on Social Media: Content Analysis of Lizzo's Instagram", journal="JMIR Form Res", year="2024", month="Nov", day="4", volume="8", pages="e60541", keywords="weight stigma", keywords="body positivity", keywords="health at every size", keywords="emotional well-being", keywords="social media", keywords="qualitative content analysis", keywords="well-being", keywords="influencers", keywords="mental health outcomes", keywords="psychological health", keywords="body shaming", keywords="bullying", abstract="Background: Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. Objective: We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. Methods: We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo's posts and Instagram users' comments for their sentiments on the 3 domains. Replies to Instagram users' comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of ``likes,'' were also collected. Results: The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo's content included body positive sentiments (34\%) and emotional well-being (18\%); no posts dealt explicitly with physical health. A substantial amount Instagram users' comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo's body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo's health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. Conclusions: This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies. ", doi="10.2196/60541", url="https://formative.jmir.org/2024/1/e60541" } @Article{info:doi/10.2196/49779, author="Pravosud, Vira and Ling, M. Pamela and Halpern-Felsher, Bonnie and Gribben, Valerie", title="Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="21", volume="7", pages="e49779", keywords="adolescents", keywords="social media use", keywords="e-cigarette use", keywords="mental health", keywords="COVID-19 shelter-in-place orders", keywords="remote schooling", keywords="smoking", keywords="vape", keywords="e-cigarette implications", keywords="COVID-19", keywords="anxiety", keywords="depression", abstract="Background: Little is known about the role of exposure to e-cigarette--related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling. Objective: The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette--related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants' e-cigarette use. Methods: A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46\% identified as female and 37/85, 44\% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother's education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration. Results: Almost all respondents (83/85, 98\%) reported using social media more since shelter-in-place, and 74\% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54\%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83\%) compared to those who did not increase e-cigarette use (25/39, 64\%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95\% CI 0.71?8.46). Respondents who felt lonely (AOR 3.33, 95\% CI 1.27?9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95\% CI 1.39?13.41), or had ?2 family members aware of participants' e-cigarette use (AOR 6.42, 95\% CI 1.29?39.49) were more likely to report increased e-cigarette use. Conclusions: Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic. ", doi="10.2196/49779", url="https://pediatrics.jmir.org/2024/1/e49779" } @Article{info:doi/10.2196/53101, author="Li, Juanjuan and Sun, Weidi and Luo, Zeyu and Liu, Yi and Huang, Xuanyin and Jiang, Denan and Li, Shuting and Meng, Jia and Gu, Fang and Zhang, Ronghua and Song, Peige", title="Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="23", volume="10", pages="e53101", keywords="internet use", keywords="internet addiction", keywords="depression", keywords="children", keywords="adolescents", keywords="China", keywords="depressive symptoms", abstract="Background: Children's lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2\%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95\% CI 1.34?1.74) and girls using internet for 1.1?2 hours/day (OR 1.22, 95\% CI 1.06?1.39) and >2 hours/day (OR 1.70, 95\% CI 1.50?1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95\% CI 1.83?2.21; 2 IA behaviors: 2.91, 95\% CI 2.57?3.29; and ?3 IA behaviors: 4.72, 95\% CI 4.26?5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. ", doi="10.2196/53101", url="https://publichealth.jmir.org/2024/1/e53101" } @Article{info:doi/10.2196/55591, author="Jung, Sungwon and Murthy, Dhiraj and Bateineh, S. Bara and Loukas, Alexandra and Wilkinson, V. Anna", title="The Normalization of Vaping on TikTok Using Computer Vision, Natural Language Processing, and Qualitative Thematic Analysis: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Sep", day="11", volume="26", pages="e55591", keywords="electronic cigarettes", keywords="vaping", keywords="social media", keywords="natural language processing", keywords="computer vision", abstract="Background: Social media posts that portray vaping in positive social contexts shape people's perceptions and serve to normalize vaping. Despite restrictions on depicting or promoting controlled substances, vape-related content is easily accessible on TikTok. There is a need to understand strategies used in promoting vaping on TikTok, especially among susceptible youth audiences. Objective: This study seeks to comprehensively describe direct (ie, explicit promotional efforts) and indirect (ie, subtler strategies) themes promoting vaping on TikTok using a mixture of computational and qualitative thematic analyses of social media posts. In addition, we aim to describe how these themes might play a role in normalizing vaping behavior on TikTok for youth audiences, thereby informing public health communication and regulatory policies regarding vaping endorsements on TikTok. Methods: We collected 14,002 unique TikTok posts using 50 vape-related hashtags (eg, \#vapetok and \#boxmod). Using the k-means unsupervised machine learning algorithm, we identified clusters and then categorized posts qualitatively based on themes. Next, we organized all videos from the posts thematically and extracted the visual features of each theme using 3 machine learning--based model architectures: residual network (ResNet) with 50 layers (ResNet50), Visual Geometry Group model with 16 layers, and vision transformer. We chose the best-performing model, ResNet50, to thoroughly analyze the image clustering output. To assess clustering accuracy, we examined 4.01\% (441/10,990) of the samples from each video cluster. Finally, we randomly selected 50 videos (5\% of the total videos) from each theme, which were qualitatively coded and compared with the machine-derived classification for validation. Results: We successfully identified 5 major themes from the TikTok posts. Vape product marketing (1160/10,990, 8.28\%) reflected direct marketing, while the other 4 themes reflected indirect marketing: TikTok influencer (3775/14,002, 26.96\%), general vape (2741/14,002, 19.58\%), vape brands (2042/14,002, 14.58\%), and vaping cessation (1272/14,002, 9.08\%). The ResNet50 model successfully classified clusters based on image features, achieving an average F1-score of 0.97, the highest among the 3 models. Qualitative content analyses indicated that vaping was depicted as a normal, routine part of daily life, with TikTok influencers subtly incorporating vaping into popular culture (eg, gaming, skateboarding, and tattooing) and social practices (eg, shopping sprees, driving, and grocery shopping). Conclusions: The results from both computational and qualitative analyses of text and visual data reveal that vaping is normalized on TikTok. Our identified themes underscore how everyday conversations, promotional content, and the influence of popular figures collectively contribute to depicting vaping as a normal and accepted aspect of daily life on TikTok. Our study provides valuable insights for regulatory policies and public health initiatives aimed at tackling the normalization of vaping on social media platforms. ", doi="10.2196/55591", url="https://www.jmir.org/2024/1/e55591" } @Article{info:doi/10.2196/58739, author="Donisi, Valeria and Salerno, Laura and Delvecchio, Elisa and Brugnera, Agostino", title="Problematic Social Media Use Among Italian Midadolescents: Protocol and Rationale of the SMART Project", journal="JMIR Res Protoc", year="2024", month="Sep", day="9", volume="13", pages="e58739", keywords="adolescents", keywords="social media", keywords="problematic social media use", keywords="psychological distress", keywords="wellbeing promotion", keywords="eHealth interventions", keywords="co-creation", keywords="qualitative research", keywords="biomarkers", abstract="Background: Social media (SM) use constitutes a large portion of midadolescents' daily lives as a way of peer interaction. A significant percentage of adolescents experience intense or problematic social media use (PSMU), an etiologically complex behavior potentially associated with psychological distress. To date, studies longitudinally testing for risk or protective factors of PSMU, and collecting qualitative data are still scarce among midadolescents. Self-help interventions specifically targeting PSMU in this population and involving midadolescents in co-creation are needed. Objective: The 2-year SMART multicenter project aims to (1) advance knowledge on PSMU; (2) co-design an unguided self-help app for promoting awareness and functional SM use; and (3) test feasibility and provide preliminary findings on its effectiveness to further improve and adapt the app. Methods: The SMART project is organized in 3 phases: phase 1 will focus on knowledge advancement on PSMU and its risk and protective factors using a longitudinal design; phase 2 will explore adolescents perspectives using qualitative approach and will co-design an unguided self-help app for reducing PSMU, which will be evaluated and adapted in phase 3. Around 1500 midadolescents (aged 14-18 years) will be recruited in northern, central, and southern Italy to investigate the potential intra- and interpersonal psychological risk and protective factors for PSMU and define specific PSMU profiles and test for its association with psychological distress. Subjective (self-report) PSMU's psychosocial risk or protective factors will be assessed at 3 different time points and Ecological Momentary Assessment (EMA) will be used. Moreover, focus groups will be performed in a subsample of midadolescents to collect the adolescents' unique point of view on PSMU and experiences with SM. Those previous results will inform the self-help app, which will be co-designed through working groups with adolescents. Subsequently, the SMART app will be deployed and adapted, after testing its feasibility and potential effectiveness in a pilot study. Results: The project is funded by the Italian Ministry of University and Research as part of a national grant (PRIN, ``Progetti di Rilevante Interesse Nazionale''). The research team received an official notice of research funding approval in July 2023 (Project Code 2022LC4FT7). The project was preregistered on Open Science Framework, while the ethics approval was obtained in November 2023. We started the enrollments in December 2023, with the final follow-up data to be collected within May 2025. Conclusions: The innovative aspects of the SMART project will deepen the conceptualization of PSMU and of its biopsychosocial antecedents among midadolescents, with relevant scientific, technological, and socioeconomic impacts. The advancement of knowledge and the developed self-help app for PSMU will timely respond to midadolescents' increased loneliness and psychological burden due to COVID-19 pandemic and humanitarian crisis. Trial Registration: OSF Registries; https://osf.io/2ucnk/ International Registered Report Identifier (IRRID): DERR1-10.2196/58739 ", doi="10.2196/58739", url="https://www.researchprotocols.org/2024/1/e58739" } @Article{info:doi/10.2196/58371, author="Ariana, Hanifa and Almuhtadi, Ikmal and Natania, Jacey Nikita and Handayani, Wuri Putu and Bressan, St{\'e}phane and Larasati, Dwi Pramitha", title="Influence of TikTok on Body Satisfaction Among Generation Z in Indonesia: Mixed Methods Approach", journal="JMIR Hum Factors", year="2024", month="Sep", day="6", volume="11", pages="e58371", keywords="body satisfaction", keywords="social media", keywords="TikTok", keywords="Indonesia", keywords="cyber-bullying", keywords="cyberbullying", keywords="cyberbully", keywords="cyber-harassment", keywords="bullying", keywords="harassment", keywords="body shaming", keywords="objectify", keywords="objectifying", keywords="social media use", keywords="social media usage", keywords="socials", keywords="social network", keywords="social networks", keywords="social networking", keywords="Tik Tok", keywords="GenZ", keywords="Gen-Z", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="young-adult", keywords="young-adults", abstract="Background: As social media platforms gain popularity, their usage is increasingly associated with cyberbullying and body shaming, causing devastating effects. Objective: This study aims to investigate the impact of social media on Generation Z users' body image satisfaction. More specifically, it examines the impact of TikTok on body image satisfaction among TikTok users aged between 17 years and 26 years in Indonesia. Methods: The methodology used mixed-method approaches. Quantitative data were obtained from 507 responses to a questionnaire and analyzed using covariance-based structural equation modeling. Qualitative data were obtained from the interviews of 32 respondents and analyzed through content analysis. Results: This study reveals that upward appearance comparison is influenced by video-based activity and appearance motivation. Conversely, thin-ideal internalization is influenced by appearance motivation and social media literacy. Upward appearance comparisons and thin-ideal internalization comparisons detrimentally impact users' body image satisfaction. Conclusions: The results of this study are expected to provide valuable insights for social media providers, regulators, and educators in their endeavors to establish a positive and healthy social media environment for users. ", doi="10.2196/58371", url="https://humanfactors.jmir.org/2024/1/e58371" } @Article{info:doi/10.2196/49453, author="Lewis, C. Callum and Taba, Melody and Allen, B. Tiffany and Caldwell, HY Patrina and Skinner, Rachel S. and Kang, Melissa and Henderson, Hamish and Bray, Liam and Borthwick, Madeleine and Collin, Philippa and McCaffery, Kirsten and Scott, M. Karen", title="Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology", journal="J Med Internet Res", year="2024", month="Aug", day="7", volume="26", pages="e49453", keywords="Adolescent health", keywords="digital health literacy", keywords="adolescents", keywords="online health information", keywords="co-design", keywords="health education", keywords="eHealth literacy", keywords="social media", abstract="Background: Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. Objective: This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. Methods: Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. Results: In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Conclusions: Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL. ", doi="10.2196/49453", url="https://www.jmir.org/2024/1/e49453" } @Article{info:doi/10.2196/51957, author="Varaona, Andrea and Alvarez-Mon, Angel Miguel and Serrano-Garcia, Irene and D{\'i}az-Mars{\'a}, Marina and Looi, L. Jeffrey C. and Molina-Ruiz, M. Rosa", title="Exploring the Relationship Between Instagram Use and Self-Criticism, Self-Compassion, and Body Dissatisfaction in the Spanish Population: Observational Study", journal="J Med Internet Res", year="2024", month="Aug", day="1", volume="26", pages="e51957", keywords="Instagram", keywords="self-compassion", keywords="self-esteem", keywords="self-criticism", keywords="self-worth", keywords="body dissatisfaction", keywords="dissatisfaction", keywords="satisfaction", keywords="appearance", keywords="psychological", keywords="social media", keywords="body", keywords="mental health", keywords="mental wellbeing", keywords="Spain", keywords="Spanish", keywords="Hispanic", keywords="depression", keywords="depressive", keywords="usage", keywords="correlation", keywords="association", abstract="Background: The widespread use of online social networks, particularly among the younger demographic, has catalyzed a growing interest in exploring their influence on users' psychological well-being. Instagram (Meta), a visually oriented platform, has garnered significant attention. Prior research has consistently indicated that Instagram usage correlates with heightened levels of perfectionism, body dissatisfaction, and diminished self-esteem. Perfectionism is closely linked to self-criticism, which entails an intense self-scrutiny and is often associated with various psychopathologies. Conversely, self-compassion has been linked to reduced levels of perfectionism and stress, while fostering greater positive affect and overall life satisfaction. Objective: This study investigates the relationship between Instagram usage (time of use and content exposure) and users' levels of self-compassion, self-criticism, and body dissatisfaction. Methods: This study comprised 1051 adult participants aged between 18 and 50 years, either native to Spain or residing in the country for at least a decade. Each participant completed a tailored questionnaire on Instagram usage, along with abbreviated versions of the Self-Compassion Scale, the Body Shape Questionnaire, and the Depressive Experiences Questionnaire, spanning from January 23 to February 25, 2022. Results: A positive correlation was observed between daily Instagram usage and self-criticism scores. Participants of all age groups who spent over 3 hours per day on Instagram exhibited higher self-criticism scores than users who spent less than 1 hour or between 1 and 3 hours per day. Contrary to previous findings, no significant relationship was detected between Instagram usage time and levels of self-compassion or body dissatisfaction. Furthermore, content centered around physical appearance exhibited a positive correlation with self-criticism and body dissatisfaction scores. Among younger participants (aged 18-35 years), those who primarily viewed beauty or fashion content reported higher self-criticism scores than those consuming science-related content. However, this association was not significant for participants aged 35-50 years. Conversely, individuals who predominantly engaged with sports or fitness or family or friends content exhibited higher levels of body dissatisfaction than those focusing on science-related content. No significant associations were observed between self-compassion scores and daily Instagram usage or most-viewed content categories. Conclusions: The findings of this study underscore the considerable impact of Instagram usage on self-criticism and body dissatisfaction---2 variables known to influence users' psychological well-being and be associated with various symptoms and psychological disorders. ", doi="10.2196/51957", url="https://www.jmir.org/2024/1/e51957", url="http://www.ncbi.nlm.nih.gov/pubmed/39088263" } @Article{info:doi/10.2196/51307, author="Grahlher, Kristin and Morgenstern, Matthis and Pietsch, Benjamin and Gomes de Matos, Elena and Rossa, Monika and Lochb{\"u}hler, Kirsten and Daubmann, Anne and Thomasius, Rainer and Arnaud, Nicolas", title="Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="23", volume="12", pages="e51307", keywords="prevention", keywords="vocational students", keywords="adolescents", keywords="mobile intervention", keywords="voluntary commitment", keywords="substance use", keywords="internet-related problems", keywords="mobile phone", keywords="adolescent", keywords="youths", keywords="student", keywords="students", keywords="use", abstract="Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (``Meine Zeit ohne'') has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (``congruent use'': eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6\%; mean age 19.0, SD 3.5 years; 830/1458, 56.9\% male) of them provided full data. Of these 1458 students, 894 (61.3\%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6\% female). Of these 894 students, 466 (52.1\%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1\%). A total of 407 (45.5\%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x ", doi="10.2196/51307", url="https://mhealth.jmir.org/2024/1/e51307" } @Article{info:doi/10.2196/56919, author="Ma, Yanan and Law, Kate and Hassan, Lamiece and Nenadic, Goran and van der Veer, N. Sabine", title="Experiences and Views of Young People and Health Care Professionals of Using Social Media to Self-Manage Type 1 Diabetes Mellitus: Thematic Synthesis of Qualitative Studies", journal="JMIR Pediatr Parent", year="2024", month="May", day="29", volume="7", pages="e56919", keywords="adolescents", keywords="health care professionals", keywords="social media", keywords="thematic synthesis", keywords="type 1 diabetes", keywords="type 1 diabetes mellitus", keywords="T1DM", keywords="young people", abstract="Background: Social media have shown the potential to support type 1 diabetes self-management by providing informational, emotional, and peer-to-peer support. However, the perceptions of young people and health care professionals' (HCPs) toward the use of social media for type 1 diabetes self-management have not been systematically reviewed. Objective: The aim of this study is to explore and summarize the experiences and views of young people with type 1 diabetes and their HCPs on using social media for self-management across qualitative findings. Methods: We searched MEDLINE, Embase, PsycINFO, and CINAHL from 2012 to 2023 using Medical Subject Heading terms and text words related to type 1 diabetes and social media. We screened and selected the studies according to the inclusion and exclusion criteria. We quality appraised and characterized the included studies and conducted a thematic synthesis. Results: We included 11 studies in our synthesis. A total of 9 of them were qualitative and 2 were mixed methods studies. Ten focused on young people with type 1 diabetes and 1 on HCPs. All used content analysis and were of moderate to high quality. Thirteen descriptive themes were yielded by our thematic synthesis, contributing to five analytic themes: (1) differences in how young people interact with social media, (2) characteristics of social media platforms that influence their use and uptake for type 1 diabetes self-management, (3) social media as a source of information, (4) impact on young people's coping and emotional well-being, and (5) impact on support from and relationships with HCPs and services. Conclusions: The synthesis suggests that we should consider leveraging social media's peer support capabilities to augment the traditional services for young people with type 1 diabetes. However, the patients may have privacy concerns about HCPs' involvement in their online activities. This warrants an update of existing guidelines to help young people use social media safely for self-managing their diabetes. ", doi="10.2196/56919", url="https://pediatrics.jmir.org/2024/1/e56919", url="http://www.ncbi.nlm.nih.gov/pubmed/38809591" } @Article{info:doi/10.2196/47984, author="Weisblum, Margaret and Trussell, Emma and Schwinn, Traci and Pacheco, R. Andrea and Nurkin, Paige", title="Screening and Retaining Adolescents Recruited Through Social Media: Secondary Analysis from a Longitudinal Clinical Trial", journal="JMIR Pediatr Parent", year="2024", month="Feb", day="28", volume="7", pages="e47984", keywords="adolescents", keywords="attrition prevention", keywords="Instagram", keywords="LGBQ", keywords="online recruitment", keywords="retention", keywords="screening", keywords="sexual minority", keywords="social media", keywords="youth", abstract="Background: Social media has become a popular method to recruit participants, particularly for studies with hard-to-reach populations. These studies still face challenges in data quality and, for longitudinal studies, sample retention. However, in addition to aiding in recruitment, social media platforms can help researchers with participant verification and tracking procedures during the study. There is limited previous research describing how longitudinal studies can use social media to screen and retain participants. Objective: This paper describes strategies implemented to screen and retain a nationwide sample of sexual minority youth who were recruited through social media platforms for a longitudinal study testing a drug abuse prevention program. Methods: Our screening strategies for participants included collecting necessary demographic information (name, phone, email, and social media accounts), verifying this information using publicly available web-based records, and sending confirmation emails to ensure working email addresses and correct dates of birth. Retention strategies included communications designed to develop positive participant relationships, incentives for survey completion, regular updating of participant contact information, targeting hard-to-reach participants, and using social media as an alternative means of contacting participants. Results: During enrollment, although the only demographic data required were a phone number and an email address, 87.58\% (1065/1216) of participants provided their Instagram as an alternative means of contact. This form of alternative communication remains the most preferred with 87.40\% (1047/1198) of participants continuing to provide an Instagram username as of January 2023, about 3 years after recruitment began. In comparison, other alternative means of contact (eg, Facebook and alternative email) were provided by only 6.43\% (77/1198) to 56.18\% (673/1198) of participants. Direct messaging on Instagram was used to successfully confirm participant identity, remind participants to take annual follow-up surveys, and update lost participant contact information. Screening and retention strategies used in the study have helped achieve 96.30\% (1171/1216) to 96.79\% (1177/1216) sample retention across 3 waves of data collection. Conclusions: Though social media can be a helpful tool to recruit participants, attrition and participant authenticity difficulties may be associated with this method. Screening and retention strategies can be implemented to improve retention. Internet searches are effective for screening youth to ensure they meet eligibility requirements. Additionally, social media---Instagram in this study---can help to track and locate participants who do not respond to traditional contact methods. Trial Registration: ClinicalTrials.gov NCT03954535; https://clinicaltrials.gov/study/NCT03954535 ", doi="10.2196/47984", url="https://pediatrics.jmir.org/2024/1/e47984", url="http://www.ncbi.nlm.nih.gov/pubmed/38416559" } @Article{info:doi/10.2196/50984, author="Cascio, N. Christopher and Selkie, Ellen and Moreno, A. Megan", title="Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study", journal="JMIR Res Protoc", year="2023", month="Sep", day="13", volume="12", pages="e50984", keywords="social media", keywords="adolescents", keywords="teenagers", keywords="health", keywords="well-being", keywords="risk behavior", keywords="brain", keywords="functional magnetic resonance imaging", keywords="fMRI", keywords="mobile phone", abstract="Background: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as ``digital natives,'' since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM's connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. Objective: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. Methods: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non--sexual and gender minority adolescents. Results: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. Conclusions: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. International Registered Report Identifier (IRRID): DERR1-10.2196/50984 ", doi="10.2196/50984", url="https://www.researchprotocols.org/2023/1/e50984", url="http://www.ncbi.nlm.nih.gov/pubmed/37703071" } @Article{info:doi/10.2196/36132, author="Kulandaivelu, Yalinie and Hamilton, Jill and Banerjee, Ananya and Gruzd, Anatoliy and Patel, Barkha and Stinson, Jennifer", title="Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review", journal="JMIR Pediatr Parent", year="2023", month="Jul", day="20", volume="6", pages="e36132", keywords="adolescents", keywords="digital health intervention", keywords="food literacy", keywords="health literacy", keywords="nutrition", keywords="peer education", keywords="peer support", keywords="social media", abstract="Background: Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media--based nutrition education interventions to inform the implementation of future social media--based nutrition education interventions. Objective: A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions for adolescents was conducted. Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media--based nutrition education interventions was extracted. Results: A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied. Conclusions: Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media--based nutrition interventions and the need for user-centered design of the interventions. ", doi="10.2196/36132", url="https://pediatrics.jmir.org/2023/1/e36132", url="http://www.ncbi.nlm.nih.gov/pubmed/37471119" } @Article{info:doi/10.2196/43961, author="Alatorre, Selenne and Schwarz, G. Aviva and Egan, A. Kelsey and Feldman, R. Amanda and Rosa, Marielis and Wang, L. Monica", title="Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="8", volume="6", pages="e43961", keywords="social media", keywords="adolescents of color", keywords="obesity disparities", keywords="disparity", keywords="disparities", keywords="healthy weight management", keywords="health education", keywords="child health", keywords="mHealth", keywords="mobile health", keywords="weight", keywords="obese", keywords="obesity", keywords="child", keywords="pediatric", keywords="adolescent", keywords="adolescence", keywords="preference", keywords="health behavior", keywords="mobile phone", abstract="Background: Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity. Objective: This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media. Methods: This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach. Results: A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet. Conclusions: Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media--based interventions to engage adolescents of color in healthy weight management content. ", doi="10.2196/43961", url="https://pediatrics.jmir.org/2023/1/e43961", url="http://www.ncbi.nlm.nih.gov/pubmed/37155230" } @Article{info:doi/10.2196/38297, author="Thompson, L. Erika and Preston, M. Sharice and Francis, R. Jenny K. and Rodriguez, A. Serena and Pruitt, L. Sandi and Blackwell, James-Michael and Tiro, A. Jasmin", title="Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey", journal="JMIR Pediatr Parent", year="2022", month="Sep", day="14", volume="5", number="3", pages="e38297", keywords="HPV vaccination", keywords="human papillomavirus", keywords="social media", keywords="decision-making", keywords="vaccination", keywords="teens", keywords="adolescents", keywords="parent", keywords="USA", keywords="United States", keywords="misinformation", keywords="internet", keywords="survey", keywords="unvaccinated", keywords="child", keywords="online", keywords="health", keywords="literacy", keywords="decision", keywords="health care", keywords="teen", keywords="vaccine", abstract="Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7\% (n=533) had an HPV-vaccinated child, 38.8\% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4\% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be ``undecided/not wanting the vaccine'' if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95\% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95\% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95\% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. ", doi="10.2196/38297", url="https://pediatrics.jmir.org/2022/3/e38297", url="http://www.ncbi.nlm.nih.gov/pubmed/36103216" } @Article{info:doi/10.2196/39450, author="Perkins, C. Ryan and Sawicki, S. Gregory", title="Author Reply to: Empowering Without Misinforming Adolescents and Young Adults with Cystic Fibrosis. Comment on ``Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study''", journal="JMIR Pediatr Parent", year="2022", month="May", day="25", volume="5", number="2", pages="e39450", keywords="Cystic fibrosis", keywords="Social media", keywords="mobile health", keywords="adherence", keywords="adolescents", keywords="young adults", keywords="Medical misinformation", doi="10.2196/39450", url="https://pediatrics.jmir.org/2022/2/e39450", url="http://www.ncbi.nlm.nih.gov/pubmed/35612884" } @Article{info:doi/10.2196/33457, author="Thumber, Navandeep and Bhandari, Prerana", title="Empowering Without Misinforming Adolescents and Young Adults with Cystic Fibrosis. Comment on ``Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study''", journal="JMIR Pediatr Parent", year="2022", month="May", day="25", volume="5", number="2", pages="e33457", keywords="cystic fibrosis", keywords="social media", keywords="mobile health", keywords="adherence", keywords="adolescents", keywords="young adults", keywords="medical misinformation", doi="10.2196/33457", url="https://pediatrics.jmir.org/2022/2/e33457", url="http://www.ncbi.nlm.nih.gov/pubmed/35612889" } @Article{info:doi/10.2196/38340, author="Basch, H. Corey and Donelle, Lorie and Fera, Joseph and Jaime, Christie", title="Deconstructing TikTok Videos on Mental Health: Cross-sectional, Descriptive Content Analysis", journal="JMIR Form Res", year="2022", month="May", day="19", volume="6", number="5", pages="e38340", keywords="TikTok", keywords="mental health", keywords="adolescent", keywords="social media", keywords="short video apps", keywords="content analysis", keywords="digital health", keywords="online health", keywords="visual media", keywords="descriptive content analysis", keywords="mental distress", keywords="health professional", keywords="health care professional", abstract="Background: Social media platforms that are based on the creation of visual media, such as TikTok, are increasingly popular with adolescents. Online social media networks provide valuable opportunities to connect with each other to share experiences and strategies for health and wellness. Objective: The aim of this study was to describe the content of the hashtag \#mentalhealth on TikTok. Methods: This cross-sectional, descriptive content analysis study included 100 videos with the hashtag \#mentalhealth on TikTok. All videos that included the hashtag \#mentalhealth were analyzed and coded for the presence of content categories. Additionally, the comments to each video were viewed and coded for content in the following themes: offering support or validation; mentioning experience with suicide or suicidal ideation; mentioning experience with self-harm; describing an experience with hospitalization for mental health issues; describing other mental health issues; and sharing coping strategies, experiences of healing, or ways to feel better. Results: Collectively, the 100 videos studied received 1,354,100,000 views; 266,900,000 likes; and 2,515,954 comments. On average, each video received 13,406,930.69 (SD 8,728,095.52) views; 2,657,425.74 (SD 1,449,920.45) likes; and 24,910.44 (SD 21,035.06) comments. The only content category observed in most (51/100, 51\%) of the videos included in the sample was ``general mental health.'' The remaining content categories appeared in less than 50\% of the sample. In total, 32\% (32/100) of the videos sampled received more than the overall average number of likes (ie, more that 2.67 million likes). Among these 32 videos, 23 (72\%) included comments offering support or validation and 20 (62\%) included comments that described other mental health issues or struggles. Conclusions: With over 1 billion cumulative views, almost half of the assessed TikTok videos included in this study reported or expressed symptoms of mental distress. Future research should focus on the potential role of intervention by health care professionals on social media. ", doi="10.2196/38340", url="https://formative.jmir.org/2022/5/e38340", url="http://www.ncbi.nlm.nih.gov/pubmed/35588057" } @Article{info:doi/10.2196/36858, author="Douglass, H. Caitlin and Borthwick, Aidan and Lim, C. Megan S. and Erbas, Bircan and Eren, Senem and Higgs, Peter", title="Social Media and Online Digital Technology Use Among Muslim Young People and Parents: Qualitative Focus Group Study", journal="JMIR Pediatr Parent", year="2022", month="May", day="10", volume="5", number="2", pages="e36858", keywords="Muslim", keywords="social media", keywords="young adult", keywords="qualitative research", keywords="social connection", keywords="parenting", keywords="pediatrics", keywords="digital health", keywords="youth", keywords="adolescent", keywords="parent", keywords="digital technology", keywords="user experience", keywords="mental health", keywords="psychological effect", keywords="diverse population", keywords="COVID-19", abstract="Background: Digital technology and social media use are common among young people in Australia and worldwide. Research suggests that young people have both positive and negative experiences online, but we know little about the experiences of Muslim communities. Objective: This study aims to explore the positive and negative experiences of digital technology and social media use among young people and parents from Muslim backgrounds in Melbourne, Victoria, Australia. Methods: This study involved a partnership between researchers and a not-for-profit organization that work with culturally and linguistically diverse communities. We adopted a participatory and qualitative approach and designed the research in consultation with young people from Muslim backgrounds. Data were collected through in-person and online focus groups with 33 young people aged 16-22 years and 15 parents aged 40-57 years. Data were thematically analyzed. Results: We generated 3 themes: (1) maintaining local and global connections, (2) a paradoxical space: identity, belonging and discrimination, and (3) the digital divide between young Muslims and parents. Results highlighted that social media was an important extension of social and cultural connections, particularly during COVID-19, when people were unable to connect through school or places of worship. Young participants perceived social media as a space where they could establish their identity and feel a sense of belonging. However, participants were also at risk of being exposed to discrimination and unrealistic standards of beauty and success. Although parents and young people shared some similar concerns, there was a large digital divide in online experiences. Both groups implemented strategies to reduce social media use, with young people believing that having short technology-free breaks during prayer and quality family time was beneficial for their mental well-being. Conclusions: Programs that address technology-related harms must acknowledge the benefits of social media for young Muslims across identity, belonging, representation, and social connection. Further research is required to understand how parents and young people can create environments that foster technology-free breaks to support mental well-being. ", doi="10.2196/36858", url="https://pediatrics.jmir.org/2022/2/e36858", url="http://www.ncbi.nlm.nih.gov/pubmed/35536616" } @Article{info:doi/10.2196/34466, author="Rajanala, Susruthi and Wilson, K. Jennifer and Mitchell, D. Paul and Garvey, C. Katharine and Fishman, N. Laurie", title="Contrasting Social Media Use Between Young Adults With Inflammatory Bowel Disease and Type 1 Diabetes: Cross-sectional Study", journal="JMIR Pediatr Parent", year="2022", month="Apr", day="25", volume="5", number="2", pages="e34466", keywords="social media", keywords="inflammatory bowel disease", keywords="type 1 diabetes", keywords="internet", keywords="young adult", keywords="children", keywords="Instagram", keywords="Facebook", keywords="type 1", keywords="diabetes", abstract="Background: Social media is used by young adult patients for social connection and self-identification. Objective: This study aims to compare the social media habits of young adults with inflammatory bowel disease (IBD) and type 1 diabetes (T1D). Methods: This is a cross-sectional study of subjects from Boston Children's Hospital outpatient IBD and diabetes clinics. Patients above 18 years of age were invited to complete a brief anonymous survey, which asked about the various ways they use several social media platforms. Results: Responses were received from 108 patients (92.5\% response rate), evenly split across disease type. We found that 83\% of participants spent at least 30 minutes per day on social media, most commonly on Instagram and Facebook. Although the content varied based on the platform, patients with IBD posted or shared content related to their disease significantly less than those with T1D (23\% vs 38\%, P=.02). Among Instagram users, patients with IBD were less likely to engage with support groups (22\% vs 56\%, P=.04). Among Twitter users, patients with IBD were less likely to seek disease information (77\% vs 29\%, P=.005). Among Facebook users, patients with IBD were less likely to post about research and clinical trials (31\% vs 65\%, P=.04) or for information seeking (49\% vs 87\%, P=.003). Patients with IBD were also less likely to share their diagnosis with friends or family in person. Conclusions: Young adults with IBD were less willing to share their diagnosis and post about or explore the disease on social media compared to those with T1D. This could lead to a sense of isolation and should be further explored. ", doi="10.2196/34466", url="https://pediatrics.jmir.org/2022/2/e34466", url="http://www.ncbi.nlm.nih.gov/pubmed/35139484" } @Article{info:doi/10.2196/35067, author="Fleary, A. Sasha", title="Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach", journal="JMIR Pediatr Parent", year="2022", month="Apr", day="15", volume="5", number="2", pages="e35067", keywords="adolescents", keywords="health communications", keywords="health literacy", keywords="measurement", keywords="media health literacy", keywords="Rasch", keywords="mobile phone", abstract="Background: High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. Objective: This study aimed to develop and validate test-based scales of adolescents' MHL. Methods: The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy--related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. Results: The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. Conclusions: The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings. ", doi="10.2196/35067", url="https://pediatrics.jmir.org/2022/2/e35067", url="http://www.ncbi.nlm.nih.gov/pubmed/35436219" } @Article{info:doi/10.2196/27852, author="Jee, Muhammad and Khan, Alsa and Nazneen, Nazneen", title="Understanding Adolescents' Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study", journal="JMIR Form Res", year="2021", month="Dec", day="23", volume="5", number="12", pages="e27852", keywords="adolescents' perceptions", keywords="personal technology", keywords="technology relationship", keywords="adolescents as technology users", keywords="adolescents as technology bystanders", abstract="Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95\% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others' relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: ``Essential,'' ``Distractive,'' and ``Addictive'' were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1\%; distractive: 105/619, 17\%; addictive: 88/619, 14.2\% ) and others' relationship as well (essential: 96/619, 15.6\%; distractive: 88/619, 14.3\%; addictive: 90/619, 14.5\%). Adolescents selected ``Provides an escape'' more to describe their own relationship with technology. Whereas, they selected ``It's just a tool'' and ``Creates Barrier'' more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was ``best friend'', 16 to 17-year olds' top choice was ``I don't believe in personal connection with mobile technology,'' and 18 to 19-year olds' top choice was ``My personal assistant.'' Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. ", doi="10.2196/27852", url="https://formative.jmir.org/2021/12/e27852", url="http://www.ncbi.nlm.nih.gov/pubmed/34941556" } @Article{info:doi/10.2196/28689, author="Bragg, Marie and Lutfeali, Samina and Greene, Tenay and Osterman, Jessica and Dalton, Madeline", title="How Food Marketing on Instagram Shapes Adolescents' Food Preferences: Online Randomized Trial", journal="J Med Internet Res", year="2021", month="Oct", day="22", volume="23", number="10", pages="e28689", keywords="food marketing", keywords="traditional media", keywords="social media", keywords="adolescents", keywords="Instagram", abstract="Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children's exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents' preferences. Objective: This study examined whether adolescents could identify food companies' Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents' preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame---which includes the logo, comments, and ``likes.'' In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the ``labeled ad condition.'' In the ``unlabeled ad condition,'' however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. ", doi="10.2196/28689", url="https://www.jmir.org/2021/10/e28689", url="http://www.ncbi.nlm.nih.gov/pubmed/34677136" } @Article{info:doi/10.2196/17811, author="Mayoh, Joanne and Jones, Ian", title="Young People's Experiences of Engaging With Fitspiration on Instagram: Gendered Perspective", journal="J Med Internet Res", year="2021", month="Oct", day="4", volume="23", number="10", pages="e17811", keywords="social media", keywords="gender", keywords="physical fitness", keywords="women's health", keywords="men's health", keywords="body ideals", abstract="Background: Fitness inspiration or fitspiration is a term used to describe web-based images of fit people, people in the gym, health foods, or inspirational quotes relating to diet and fitness being shared and consumed via visual social media. The popularity of this content is most notable via the Instagram platform. Currently, the majority of fitspiration research has focused on women's experiences; however, increasingly, studies have pointed to the need to explore the gendered ways by which people engage with this content. Objective: The aim of this study is to explore how young men and women engage in fitspiration content on Instagram and provide a gendered analysis of how and why they consume this content. Methods: This study used a cross-sectional web-based survey (N=1213) of UK-based fitspiration users aged 18-24 years consisting of closed-ended questions to capture quantitative data. Results: The majority actively using Instagram for fitspiration (therefore eligible participants) were women (826/1175, 70.30\%). Men were more likely to view content posted by athletes ($\chi$21, N=1153=71.8; P=.001) and bodybuilders ($\chi$21, N=1153=32.8; P<.001), whereas women were more likely to view content related to weight loss ($\chi$21, N=1153=36.8; P<.001), diet plans ($\chi$21, N=1153=11.9; P<.001), and celebrities' content ($\chi$21, N=1153=33.5; P<.001). Men were more likely to use fitspiration as a source of inspiration to exercise to gain muscle or get stronger ($\chi$21, N=1147=17.9; P<.001), whereas women were more likely to use fitspiration as inspiration for healthy eating ($\chi$21, N=1147=37.7; P<.001), or to exercise to diet or lose weight ($\chi$21, N=1147=13.5; P<.001). Women were more likely to engage in passive behaviors such as viewing content on their feed ($\chi$21, N=1139=7.9; P=.005) or scrolling through accounts ($\chi$21, N=1139=15.2; P<.001), whereas men were more likely to engage in active consumption by tagging fitspiration accounts in posts ($\chi$21, N=1139=7.2; P=.007), commenting on posts ($\chi$21, N=1139=8.1; P=.004), and posting fitspiration content ($\chi$21, N=1139=6.4; P=.01). Conclusions: Female fitspiration consumers engaged with content that reinforced the feminine thin but shapely ideal, whereas male users sought out content that reinforced the masculine muscular ideal. Male users were more likely to engage actively with content (eg, posting fitspiration content), while female users were more likely to engage passively (eg, scrolling through accounts, posts, or images). Future research should consider how fitspiration consumption reflects and reproduces oppressive gender ideology. ", doi="10.2196/17811", url="https://www.jmir.org/2021/10/e17811", url="http://www.ncbi.nlm.nih.gov/pubmed/34605768" } @Article{info:doi/10.2196/25014, author="Perkins, C. Ryan and Gross, Rachel and Regan, Kayla and Bishay, Lara and Sawicki, S. Gregory", title="Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study", journal="JMIR Pediatr Parent", year="2021", month="Aug", day="16", volume="4", number="3", pages="e25014", keywords="cystic fibrosis", keywords="social media", keywords="mobile health", keywords="adherence", keywords="adolescents", keywords="young adults", abstract="Background: For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. Objective: This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. Methods: A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. Results: YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. Conclusions: AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition. ", doi="10.2196/25014", url="https://pediatrics.jmir.org/2021/3/e25014", url="http://www.ncbi.nlm.nih.gov/pubmed/34232121" } @Article{info:doi/10.2196/20179, author="Moreno, A. Megan and Gaus, Quintin and Wilt, Megan and Arseniev-Koehler, Alina and Ton, Adrienne and Adrian, Molly and VanderStoep, Ann", title="Displayed Depression Symptoms on Facebook at Two Time Points: Content Analysis", journal="JMIR Form Res", year="2021", month="May", day="31", volume="5", number="5", pages="e20179", keywords="adolescents", keywords="content analysis", keywords="depression", keywords="Facebook", keywords="social media", abstract="Background: Depression is a prevalent and problematic mental disorder that often has an onset in adolescence. Previous studies have illustrated that depression disclosures on social media are common and may be linked to an individual's experiences of depression. However, most studies have examined depression displays on social media at a single time point. Objective: This study aims to investigate displayed depression symptoms on Facebook at 2 developmental time points based on symptom type and gender. Methods: Participants were recruited from an ongoing longitudinal cohort study. The content analysis of text-based Facebook data over 1 year was conducted at 2 time points: time 1 (adolescence; age 17-18 years) and time 2 (young adulthood; ages 20-22 years). Diagnostic criteria for depression were applied to each post to identify the displayed depression symptoms. Data were extracted verbatim. The analysis included nonparametric tests for comparisons. Results: A total of 78 participants' Facebook profiles were examined, of which 40 (51\%) were male. At time 1, 62\% (48/78) of the adolescents had a Facebook profile, and 54\% (26/78) displayed depression symptom references with an average of 9.4 (SD 3.1) references and 3.3 (SD 2.3) symptom types. Of the 78 participants, 15 (19\%) females and 12 (15\%) males displayed depression symptom references; these prevalence estimates were not significantly different by gender (P=.59). At time 2, 35 young adults displayed symptoms of depression with an average of 4.6 (SD 2.3) references and 2.4 (SD 1.3) symptom types. There were no differences in the prevalence of symptoms of depression displayed between males (n=19) and females (n=16; P=.63). Conclusions: This content analysis study within an ongoing cohort study illustrates the differences in depression displays on Facebook by developmental stage and symptom. This study contributes to a growing body of literature by showing that using social media to observe and understand depression during the emerging adult developmental period may be a valuable approach. ", doi="10.2196/20179", url="https://formative.jmir.org/2021/5/e20179", url="http://www.ncbi.nlm.nih.gov/pubmed/34057422" } @Article{info:doi/10.2196/22281, author="Schneble, Olivier Christophe and Favaretto, Maddalena and Elger, Simonne Bernice and Shaw, Martin David", title="Social Media Terms and Conditions and Informed Consent From Children: Ethical Analysis", journal="JMIR Pediatr Parent", year="2021", month="Apr", day="22", volume="4", number="2", pages="e22281", keywords="social media", keywords="big data", keywords="ethics", keywords="children", keywords="health data", keywords="terms and conditions", keywords="trusted partnership", keywords="medical ethics", keywords="mobile phone", abstract="Background: Terms and conditions define the relationship between social media companies and users. However, these legal agreements are long and written in a complex language. It remains questionable whether users understand the terms and conditions and are aware of the consequences of joining such a network. With children from a young age interacting with social media, companies are acquiring large amounts of data, resulting in longitudinal data sets that most researchers can only dream of. The use of social media by children is highly relevant to their mental and physical health for 2 reasons: their health can be adversely affected by social media and their data can be used to conduct health research. Objective: The aim of this paper is to offer an ethical analysis of how the most common social media apps and services inform users and obtain their consent regarding privacy and other issues and to discuss how lessons from research ethics can lead to trusted partnerships between users and social media companies. Our paper focuses on children, who represent a sensitive group among users of social media platforms. Methods: A thematic analysis of the terms and conditions of the 20 most popular social media platforms and the 2 predominant mobile phone ecosystems (Android and iOS) was conducted. The results of this analysis served as the basis for scoring these platforms. Results: The analysis showed that most platforms comply with the age requirements issued by legislators. However, the consent process during sign-up was not taken seriously. Terms and conditions are often too long and difficult to understand, especially for younger users. The same applies to age verification, which is not realized proactively but instead relies on other users who report underaged users. Conclusions: This study reveals that social media networks are still lacking in many respects regarding the adequate protection of children. Consent procedures are flawed because they are too complex, and in some cases, children can create social media accounts without sufficient age verification or parental oversight. Adopting measures based on key ethical principles will safeguard the health and well-being of children. This could mean standardizing the registration process in accordance with modern research ethics procedures: give users the key facts that they need in a format that can be read easily and quickly, rather than forcing them to wade through chapters of legal language that they cannot understand. Improving these processes would help safeguard the mental health of children and other social media users. ", doi="10.2196/22281", url="https://pediatrics.jmir.org/2021/2/e22281", url="http://www.ncbi.nlm.nih.gov/pubmed/33885366" } @Article{info:doi/10.2196/24988, author="Khasawneh, Amro and Chalil Madathil, Kapil and Zinzow, Heidi and Rosopa, Patrick and Natarajan, Gitanjali and Achuthan, Krishnashree and Narasimhan, Meera", title="Factors Contributing to Adolescents' and Young Adults' Participation in Web-Based Challenges: Survey Study", journal="JMIR Pediatr Parent", year="2021", month="Feb", day="17", volume="4", number="1", pages="e24988", keywords="web-based challenges", keywords="self-injurious behavior", keywords="behavior", keywords="integrated behavioral model", keywords="social media", keywords="challenge", keywords="adolescent", keywords="young adult", keywords="participation", keywords="survey", abstract="Background: Web-based challenges, phenomena that are familiar to adolescents and young adults who spend large amounts of time on social media, range from minimally harmful behaviors intended to support philanthropic endeavors to significantly harmful behaviors that may culminate in injury or death. Objective: This study aims to investigate the beliefs that lead adolescents and young adults to participate in these activities by analyzing the amyotrophic lateral sclerosis (ALS) ice bucket challenge, representing nonharmful behaviors associated with web-based challenges, and the cinnamon challenge, representing web-based challenges that lead to harmful behaviors. Methods: A retrospective quantitative study was conducted with a total of 471 participants aged between 13 and 35 years who either had participated in the ALS ice bucket challenge or the cinnamon challenge, or had never participated in any web-based challenge. Binomial logistic regression models were used to classify those who participated in the ALS ice bucket challenge or cinnamon challenge versus those who did not engage in either challenge using the integrated behavioral model's beliefs as predictors. Results: The findings showed that participants of both the cinnamon challenge and the ALS ice bucket challenge had significantly greater expectations from the public to participate in the challenge they completed in comparison with individuals who never participated in any challenge (P=.01 for the cinnamon challenge and P=.003 for the ALS ice bucket challenge). Cinnamon challenge participants had greater value for the outcomes of the challenge (P<.001) and perceived positive public opinion about the challenge (P<.001), in comparison with individuals who never participated in any challenge. In contrast, ALS ice bucket challenge participants had significantly greater positive emotional responses than individuals who never participated in any challenge (P<.001). Conclusions: The constructs that contribute to the spread of web-based challenges vary based on the level of self-harm involved in the challenge and its purpose. Intervention efforts could be tailored to address the beliefs associated with different types of web-based challenges. ", doi="10.2196/24988", url="http://pediatrics.jmir.org/2021/1/e24988/", url="http://www.ncbi.nlm.nih.gov/pubmed/33595450" } @Article{info:doi/10.2196/22051, author="Hunsaker, Amanda and Hargittai, Eszter and Micheli, Marina", title="Relationship Between Internet Use and Change in Health Status: Panel Study of Young Adults", journal="J Med Internet Res", year="2021", month="Jan", day="13", volume="23", number="1", pages="e22051", keywords="internet use", keywords="health-related internet use", keywords="health status", keywords="panel data", keywords="young adults", keywords="internet", keywords="healthy living", abstract="Background: Using the internet for health information is a widespread phenomenon documented in considerable scholarship. Less common, however, is the analysis of panel data to examine how internet use may relate to change in health status over time. Objective: This study examines whether internet use and internet use related to health are associated with a change in health status among young adults. Methods: We used a unique panel survey data set collected about young adults' internet use in 2012 and 2016 (n=384). We applied logistic regression to examine the relationships between sociodemographics, internet experiences, frequency of health-related internet use, and sharing health content online with change in health status over time. We additionally examined the variables characterizing sharing health content online (via Facebook, Twitter, and email) in separate models. Results: In the second wave, over half (236/384, 61.5\%) of the sample used the internet for health at least weekly. Approximately one-third (141/384, 36.7\%) used Facebook for health-content sharing, while using Twitter and email for sharing health content were far less frequent (14/384, 3.6\%, and 55/384, 14.3\%, respectively). A change in health status occurred for 43.0\% (165/384) of the sample; 18.5\% (71/384) reported an improvement while 24.5\% (94/384) reported a decline. Greater frequency of internet use was associated with health decline over time (B=--0.58, P=.02). We also found that frequent health-related internet use was related to enhanced health or maintained health (B=0.58, P=.03). Sharing health content on social media or email, however, was not related to young adults' health changes. Conclusions: Young adults exhibit a pattern of using the internet for health that influences their health status. Our finding that frequent health-related internet use may promote improved or maintained health suggests that this type of online activity might also support healthy living. ", doi="10.2196/22051", url="https://www.jmir.org/2021/1/e22051", url="http://www.ncbi.nlm.nih.gov/pubmed/33439134" } @Article{info:doi/10.2196/18286, author="Lupton, Deborah", title="Young People's Use of Digital Health Technologies in the Global North: Narrative Review", journal="J Med Internet Res", year="2021", month="Jan", day="11", volume="23", number="1", pages="e18286", keywords="digital health", keywords="young people", keywords="Global North", keywords="social research", keywords="narrative review", abstract="Background: A diverse array of digital technologies are available to children and young people living in the Global North to monitor, manage, and promote their health and well-being. Objective: This article provides a narrative literature review of the growing number of social research studies published over the past decade that investigate the types of digital technologies used by children and young people in the Global North, in addition to investigating which of these technologies they find most useful or not useful. Key findings as well as major gaps and directions for future research are identified and discussed. Methods: A comprehensive search of relevant publications listed in Google Scholar was conducted, supported by following citation trails of these publications. The findings are listed under type of digital technology used for health: cross-media, internet, social media, apps and wearable devices, sexual health support and information, and mental health support and information. Results: Many young people in the Global North are active users of digital health technologies. However, it is notable that they still rely on older technologies, such as websites and search engines, to find information. Apps and platforms that may not have been specifically developed for young people as digital health resources often better suit their needs. Young people appreciate the ready availability of information online, the opportunities to learn more about their bodies and health states, and the opportunities to learn how to improve their health and physical fitness. They enjoy being able to connect with peers, and they find emotional support and relief from distress by using social media platforms, YouTube, and online forums. Young people can find the vast reams of information available to them difficult to navigate. They often look to trusted adults to help them make sense of the information they find online and to provide alternative sources of information and support. Face-to-face interactions with these trusted providers remain important to young people. Risks and harms that young people report from digital health use include becoming overly obsessed with their bodies' shape and size when using self-tracking technologies and comparing their bodies with the social media influencers they follow. Conclusions: Further details on how young people are using social media platforms and YouTube as health support resources and for peer-to-peer sharing of information, including attention paid to the content of these resources and the role played by young social media influencers and microcelebrities, would contribute important insights to this body of literature. The role played by visual media, such as GIFs (Graphics Interchange Format) and memes, and social media platforms that have recently become very popular with young people (eg, Snapchat and TikTok) in health-related content creation and sharing requires more attention by social researchers seeking to better understand young people's use of digital devices and software for health and fitness. ", doi="10.2196/18286", url="http://www.jmir.org/2021/1/e18286/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427684" } @Article{info:doi/10.2196/21886, author="Sobowale, Kunmi and Hilliard, Heather and Ignaszewski, J. Martha and Chokroverty, Linda", title="Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media", journal="J Med Internet Res", year="2020", month="Dec", day="1", volume="22", number="12", pages="e21886", keywords="social media", keywords="digital health", keywords="COVID-19", keywords="adolescent", keywords="public health", keywords="disaster", keywords="communication", keywords="affordances", doi="10.2196/21886", url="https://www.jmir.org/2020/12/e21886", url="http://www.ncbi.nlm.nih.gov/pubmed/33226956" } @Article{info:doi/10.2196/16367, author="Kelleher, F. Erin and Giampietro, F. Philip and Moreno, A. Megan", title="Social Media Use Among Young Adults With Connective Tissue Disorders: Cross-Sectional Pilot Study", journal="JMIR Pediatr Parent", year="2020", month="Oct", day="30", volume="3", number="2", pages="e16367", keywords="connective tissue disorders", keywords="social media", keywords="adolescents", keywords="young adults", keywords="Marfan syndrome", keywords="Ehlers-Danlos syndrome", keywords="Alport hereditary nephritis", keywords="Beals congenital contractual arachnodactyly", keywords="internet", abstract="Background: Young people with genetic conditions often face challenges coping with their health condition. It can be difficult for them to meet someone with a similar condition, which is important for reinforcement of chronic illness management recommendations. Social media is used by 97\% of young people in the United States and may provide those with these disorders a space for emotional expression and support. However, there is a scarcity of literature related to the use of social media among adolescents with genetic conditions as an indicator of their perception regarding their own condition. Objective: The purpose of this pilot study was to obtain preliminary data to assess and understand social media use by young people with connective tissue disorders and determine whether they use social media to connect with patients with similar conditions or whether they would be interested in doing so. Methods: We undertook a pilot study of selected connective tissue disorders occurring in young people between the ages of 11 and 25 years, including Marfan syndrome; Ehlers-Danlos syndrome subtypes classical, classical-like, cardiac-valvular, and vascular; Beals congenital contractual arachnodactyly; and Alport hereditary nephritis. The study took place within one pediatric clinical system. Patients were identified through electronic medical record search and International Classification of Diseases, Ninth Revision, coding at a Midwest university--based clinical system. Study subjects completed a short survey describing their experiences with their connective tissue disorders, their means of self-expression, their existing network of persons to communicate with, and their use of social media. Data analysis included nominal and bivariate regressions to compare social media use in relation to age. Results: Our 31 participants (42\% response rate) were 55\% female (17/31) and their average age was 18 years (SD 5). All participants used social media and there were no statistically significant differences between social media use and age. The majority of participants (25/30, 83\%) reported that they never used social media to discuss their condition (P=.09), and only 17\% (5/30) knew someone online with a similar condition (P=.50). Most participants (19/30, 63\%) said they would communicate with someone with a similar disorder (P=.64). Conclusions: We found that young individuals with connective tissue disorders use at least one type of social media. A majority did not use social media to discuss their condition or know someone online with a similar condition. However, many persons were interested in finding others similarly affected. Social media could serve as a platform for young people with connective tissue disorders to connect. Peer support is important in disease management and adolescent development. Future studies should aim at understanding social media use among young people with connective tissue disorders and helping them connect with other people who have similar conditions. ", doi="10.2196/16367", url="http://pediatrics.jmir.org/2020/2/e16367/", url="http://www.ncbi.nlm.nih.gov/pubmed/33124992" } @Article{info:doi/10.2196/16388, author="Arias-de la Torre, Jorge and Puigdomenech, Elisa and Garc{\'i}a, Xavier and Valderas, M. Jose and Eiroa-Orosa, Jose Francisco and Fern{\'a}ndez-Villa, Tania and Molina, J. Antonio and Mart{\'i}n, Vicente and Serrano-Blanco, Antoni and Alonso, Jordi and Espallargues, Mireia", title="Relationship Between Depression and the Use of Mobile Technologies and Social Media Among Adolescents: Umbrella Review", journal="J Med Internet Res", year="2020", month="Aug", day="26", volume="22", number="8", pages="e16388", keywords="mobile technologies and social media", keywords="depression", keywords="adolescents", keywords="review", abstract="Background: Despite the relevance of mobile technologies and social media (MTSM) for adolescents, their association with depressive disorders in this population remains unclear. While there are previous reviews that have identified the use of MTSM as a risk factor for developing depression, other reviews have indicated their possible preventive effect. Objective: The aim of this review was to synthesize the current evidence on the association between MTSM use and the development or prevention of depressive disorders in adolescents. Methods: An umbrella review was conducted using information published up to June 2019 from PubMed/MEDLINE, PsycINFO, Web of Science, and The Cochrane Library. Systematic reviews focusing on the adolescent population (up to 20 years old) and depression and its potential relationship with MTSM use were included. Screening of titles, abstracts, and full texts was performed. After selecting the reviews and given the heterogeneity of the outcome variables and exposures, a narrative synthesis of the results was carried out. Results: The search retrieved 338 documents, from which 7 systematic reviews (3 meta-analyses) were selected for data extraction. There were 11-70 studies and 5582-46,015 participants included in the 7 reviews. All reviews included quantitative research, and 2 reviews also included qualitative studies. A statistically significant association between social media and developing depressive symptoms was reported in 2 reviews, while 5 reviews reported mixed results. Conclusions: Excessive social comparison and personal involvement when using MTSM could be associated with the development of depressive symptomatology. Nevertheless, MTSM might promote social support and even become a point of assistance for people with depression. Due to the mixed results, prospective research could be valuable for providing stronger evidence. ", doi="10.2196/16388", url="http://www.jmir.org/2020/8/e16388/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663157" } @Article{info:doi/10.2196/15973, author="Khasawneh, Amro and Chalil Madathil, Kapil and Dixon, Emma and Wi?niewski, Pamela and Zinzow, Heidi and Roth, Rebecca", title="Examining the Self-Harm and Suicide Contagion Effects of the Blue Whale Challenge on YouTube and Twitter: Qualitative Study", journal="JMIR Ment Health", year="2020", month="Jun", day="5", volume="7", number="6", pages="e15973", keywords="suicide", keywords="suicidal ideation", keywords="self-mutilation", keywords="mental health", keywords="self-injurious behavior", keywords="behavioral symptoms", abstract="Background: Research suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves. Objective: This paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. Methods: We first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. Results: The thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50\% of the SPRC safe and effective messaging guidelines. Conclusions: These posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects. ", doi="10.2196/15973", url="https://mental.jmir.org/2020/6/e15973", url="http://www.ncbi.nlm.nih.gov/pubmed/32515741" } @Article{info:doi/10.2196/18043, author="Vente, Teresa and Daley, Mary and Killmeyer, Elizabeth and Grubb, K. Laura", title="Association of Social Media Use and High-Risk Behaviors in Adolescents: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2020", month="May", day="26", volume="3", number="1", pages="e18043", keywords="self-harm", keywords="social media", keywords="nonsuicidal self-injury", keywords="sexting", abstract="Background: Previous studies have demonstrated the prevalence of social media use and identified the presence of high-risk behaviors among adolescents, including self-harm and sharing of sexually explicit messages. Objective: This study aimed to identify patterns in the amount of time spent on social media by adolescents who engage in high-risk behavior and the extent to which they use social media as a platform for sharing such behaviors. Methods: This was a descriptive cross-sectional study of 179 adolescents seen in a pediatric clinic at an urban medical center. We used an anonymous self-report survey to obtain demographic characteristics, rates of self-harm thoughts and behaviors, sharing of sexually explicit messages, and social media use as determined by total hours spent on social media per day and the number of applications used. Results: Most adolescents reported spending 3 to 5 hours on social media each day and using 3 or more social media applications. Almost 1 in 8 (22/179, 12.3\%) adolescents self-reported having ever engaged in self-injury with a mean age of onset of 11.8 years. Over a quarter (49/179, 27.4\%) of adolescents reported sharing sexually explicit messages. Relative risk of engaging in self-injury and or sharing sexually explicit messages increased with the use of 4 or more social media applications (1.66; CI 1.11-2.48). Conclusions: Results show a relationship between the number of social media applications used and increased rates of high-risk behaviors. We identified relevant risk factors that clinicians can use to screen for high-risk behavior and parents can monitor to encourage education about healthy online practices. ", doi="10.2196/18043", url="http://pediatrics.jmir.org/2020/1/e18043/", url="http://www.ncbi.nlm.nih.gov/pubmed/32452820" } @Article{info:doi/10.2196/17165, author="Kerr, Bradley and D'Angelo, D. Jon and Diaz-Caballero, Ali and Moreno, A. Megan", title="College Student Problematic Internet Use and Digital Communication Medium Used With Parents: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2020", month="Apr", day="23", volume="3", number="1", pages="e17165", keywords="parents", keywords="young adults", keywords="social media", abstract="Background: Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12\% of young adults. Few studies have explored potential influences of parent--college student digital communication on college students' risk of PIU. Objective: This study sought to understand the relationship between parent--college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students. Methods: Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants' daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent--college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables. Results: A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6\% (90/151) were female, 62.3\% (94/151) were from the midwestern university, and 78.8\% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student--parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=--0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student--parent Facebook friendship and PIU risk (b=--0.04; 95\% CI --0.11 to 0.04). Conclusions: This study did not find support for a relationship between parent--college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages. ", doi="10.2196/17165", url="http://pediatrics.jmir.org/2020/1/e17165/", url="http://www.ncbi.nlm.nih.gov/pubmed/32324140" } @Article{info:doi/10.2196/14866, author="D'Alfonso, Simon and Phillips, Jessica and Valentine, Lee and Gleeson, John and Alvarez-Jimenez, Mario", title="Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System", journal="JMIR Ment Health", year="2019", month="Dec", day="4", volume="6", number="12", pages="e14866", keywords="Web-based intervention", keywords="social network", keywords="well-being", keywords="eudaimonia", keywords="persuasive technology", keywords="ethical design", doi="10.2196/14866", url="https://mental.jmir.org/2019/12/e14866", url="http://www.ncbi.nlm.nih.gov/pubmed/31799937" } @Article{info:doi/10.2196/14303, author="Cho, Hyunyi and Li, Wenbo and Shen, Lijiang and Cannon, Julie", title="Mechanisms of Social Media Effects on Attitudes Toward E-Cigarette Use: Motivations, Mediators, and Moderators in a National Survey of Adolescents", journal="J Med Internet Res", year="2019", month="Jun", day="27", volume="21", number="6", pages="e14303", keywords="adolescents", keywords="e-cigarettes", keywords="motivation", keywords="affordances", keywords="agency", keywords="realism", keywords="self-expression", keywords="social comparison", keywords="social learning", keywords="social media", keywords="filter", keywords="uses and gratifications", abstract="Background: Exposure to risk behavior on social media is associated with risk behavior tendencies among adolescents, but research on the mechanisms underlying the effects of social media exposure is sparse. Objective: This study aimed to investigate the motivations of social media use and the mediating and moderating mechanisms of their effects on attitude toward electronic cigarette (e-cigarette) use among adolescents. Methods: Using data from a national sample survey of adolescents (age=14-17 years, N=594), we developed and validated a social media use motivation scale. We examined the roles of motivations in the effect of social media use on risk exposure and risk attitude. Results: Motivations for social media use included agency, self-expression, realism, social learning, social comparison, and filter. These motivations were associated differentially with the frequency of use of Facebook, Instagram, Snapchat, and YouTube. Frequency of social media use was positively associated with exposure to e-cigarette messages across the four platforms (Ps<.001). Exposure to e-cigarette messages on Instagram (P=.005) and Snapchat (P=.03) was positively associated with attitude toward e-cigarette use. Perceived social media realism moderated the effects of e-cigarette message exposure such that when realism was high, the exposure effect was amplified, but when realism was low, the effect was mitigated (P<.001). A three-way interaction effect (P=.02) among exposure, social learning motivation, and social norm on attitude toward e-cigarette use was found. When perceived social norm was high, the moderating effect of social learning motivation on e-cigarette use attitude was amplified, but when social norm was low, the social learning motivation effect was attenuated. Conclusions: Because perceived social media realism moderates the effect of exposure to e-cigarette messages on attitude toward e-cigarette use, future intervention efforts should address the realism perceptions. The three-way interaction among exposure, social learning motivation, and social norm indicates the importance of addressing both the online and offline social environments of adolescents. The social media use motivation scale, reflecting perceived affordances, is broadly applicable. Understanding social media use motivations is important, as they indirectly influence attitude toward e-cigarette use via frequency of social media use and/or frequency of exposure to e-cigarette messages on social media. ", doi="10.2196/14303", url="http://www.jmir.org/2019/6/e14303/", url="http://www.ncbi.nlm.nih.gov/pubmed/31250830" } @Article{info:doi/10.2196/11014, author="Moreno, A. Megan and D'Angelo, Jonathan", title="Social Media Intervention Design: Applying an Affordances Framework", journal="J Med Internet Res", year="2019", month="Mar", day="26", volume="21", number="3", pages="e11014", keywords="social media", keywords="health", keywords="adolescent", keywords="research", doi="10.2196/11014", url="http://www.jmir.org/2019/3/e11014/", url="http://www.ncbi.nlm.nih.gov/pubmed/30912754" } @Article{info:doi/10.2196/11404, author="Leary, P. Miriam and Clegg, N. Emily and Santella, E. Madison and Murray, J. Pamela and Downs, S. Julie and Olfert, D. Melissa", title="Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study", journal="JMIR Form Res", year="2019", month="Mar", day="01", volume="3", number="1", pages="e11404", keywords="adolescent", keywords="female", keywords="social media", keywords="health information", keywords="health behaviors", abstract="Background: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. Objective: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. Methods: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. Results: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. Conclusions: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information. ", doi="10.2196/11404", url="http://formative.jmir.org/2019/1/e11404/", url="http://www.ncbi.nlm.nih.gov/pubmed/30821696" }