Should social media come with a health warning?

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Earlier this week, the US surgeon general, also known as the nation's doctor," authored an article making the case that health warnings should accompany social media. The goal: to protect teenagers from its harmful effects. Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms," Vivek Murthy wrote in a piece published in the New York Times. Additionally, nearly half of adolescents say social media makes them feel worse about their bodies."

His concern instinctively resonates with me. I'm in my late 30s, and even I can end up feeling a lot worse about myself after a brief stint on Instagram. I have two young daughters, and I worry about how I'll respond when they reach adolescence and start asking for access to whatever social media site their peers are using. My children already have a fascination with cell phones; the eldest, who is almost six, will often come into my bedroom at the crack of dawn, find my husband's phone, and somehow figure out how to blast Happy Xmas (War Is Over)" at full volume.

But I also know that the relationship between this technology and health isn't black and white. Social media can affect users in different ways-often positively. So let's take a closer look at the concerns, the evidence behind them, and how best to tackle them.

Murthy's concerns aren't new, of course. In fact, almost any time we are introduced to a new technology, some will warn of its potential dangers. Innovations like the printing press, radio, and television all had their critics back in the day. In 2009, the Daily Mail linked Facebook use to cancer.

More recently, concerns about social media have centered on young people. There's a lot going on in our teenage years as our brains undergo maturation, our hormones shift, and we explore new ways to form relationships with others. We're thought to be more vulnerable to mental-health disorders during this period too. Around half of such disorders are thought to develop by the age of 14, and suicide is the fourth-leading cause of death in people aged between 15 and 19, according to the World Health Organization. Many have claimed that social media only makes things worse.

Reports have variously cited cyberbullying, exposure to violent or harmful content, and the promotion of unrealistic body standards, for example, as potential key triggers of low mood and disorders like anxiety and depression. There have also been several high-profile cases of self-harm and suicide with links to social media use, often involving online bullying and abuse. Just this week, the suicide of an 18-year-old in Kerala, India, was linked to cyberbullying. And children have died after taking part in dangerous online challenges made viral on social media, whether from inhaling toxic substances, consuming ultra-spicy tortilla chips, or choking themselves.

Murthy's new article follows an advisory on social media and youth mental health published by his office in 2023. The 25-page document, which lays out some of known benefits and harms of social media use as well as the unknowns," was intended to raise awareness of social media as a health issue. The problem is that things are not entirely clear cut.

The evidence is currently quite limited," says Ruth Plackett, a researcher at University College London who studies the impact of social media on mental health in young people. A lot of the research on social media and mental health is correlational. It doesn't show that social media use causes mental health disorders, Plackett says.

The surgeon general's advisory cites some of these correlational studies. It also points to survey-based studies, including one looking at mental well-being among college students after the rollout of Facebook in the mid-2000s. But even if you accept the authors' conclusion that Facebook had a negative impact on the students' mental health, it doesn't mean that other social media platforms will have the same effect on other young people. Even Facebook, and the way we use it, has changed a lot in the last 20 years.

Other studies have found that social media has no effect on mental health. In a study published last year, Plackett and her colleagues surveyed 3,228 children in the UK to see how their social media use and mental well-being changed over time. The children were first surveyed when they were aged between 12 and 13, and again when they were 14 to 15 years old.

Plackett expected to find that social media use would harm the young participants. But when she conducted the second round of questionnaires, she found that was not the case. Time spent on social media was not related to mental-health outcomes two years later," she tells me.

Other research has found that social media use can be beneficial to young people, especially those from minority groups. It can help some avoid loneliness, strengthen relationships with their peers, and find a safe space to express their identities, says Plackett. Social media isn't only for socializing, either. Today, young people use these platforms for news, entertainment, school, and even (in the case of influencers) business.

It's such a mixed bag of evidence," says Plackett. I'd say it's hard to draw much of a conclusion at the minute."

In his article, Murthy calls for a warning label to be applied to social media platforms, stating that social media is associated with significant mental-health harms for adolescents."

But while Murthy draws comparisons to the effectiveness of warning labels on tobacco products, bingeing on social media doesn't have the same health risks as chain-smoking cigarettes. We have plenty of strong evidence linking smoking to a range of diseases, including gum disease, emphysema, and lung cancer, among others. We know that smoking can shorten a person's life expectancy. We can't make any such claims about social media, no matter what was written in that Daily Mail article.

Health warnings aren't the only way to prevent any potential harms associated with social media use, as Murthy himself acknowledges. Tech companies could go further in reducing or eliminating violent and harmful content, for a start. And digital literacy education could help inform children and their caregivers how to alter the settings on various social media platforms to better control the content children see, and teach them how to assess the content that does make it to their screens.

I like the sound of these measures. They might even help me put an end to the early-morning Christmas songs.

Now read the rest of The CheckupRead more from MIT Technology Review's archive:

Bills designed to make the internet safer for children have been popping up across the US. But individual states take different approaches, leaving the resulting picture a mess, as Tate Ryan-Mosley explored.

Dozens of US states sued Meta, the parent company of Facebook, last October. As Tate wrote at the time, the states claimed that the company knowingly harmed young users, misled them about safety features and harmful content, and violated laws on children's privacy.

China has been implementing increasingly tight controls over how children use the internet. In August last year, the country's cyberspace administrator issued detailed guidelines that include, for example, a rule to limit use of smart devices to 40 minutes a day for children under the age of eight. And even that use should be limited to content about elementary education, hobbies and interests, and liberal arts education." My colleague Zeyi Yang had the story in a previous edition of his weekly newsletter, China Report.

Last year, TikTok set a 60-minute-per-day limit for users under the age of 18. But the Chinese domestic version of the app, Douyin, has even tighter controls, as Zeyi wrote last March.

One way that social media can benefit young people is by allowing them to express their identities in a safe space. Filters that superficially alter a person's appearance to make it more feminine or masculine can help trans people play with gender expression, as Elizabeth Anne Brown wrote in 2022. She quoted Josie, a trans woman in her early 30s. The Snapchat girl filter was the final straw in dropping a decade's worth of repression," Josie said. [I] saw something that looked more me' than anything in a mirror, and I couldn't go back."

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