Social Media Use and Youth Mental Health: Intervention-Focused Future Directions.

PURPOSE OF REVIEW: The purpose of this review is to highlight the challenges related to the study of the relationship between social media use and youth mental health and propose a path forward in intervention-focused research. RECENT FINDINGS: Recent findings relay the need to conceptualize the effects of social media use on youth mental health in a nuanced way. Unique, discrete social media experiences may either contribute to an individual's well-being, ill-being, or both. Social media use may contribute to well-being for one person, but ill-being for another. Similarly, social media use may contribute to well-being for one person at one point in their life but then contribute to ill-being at a different point in their life. As such, it is difficult to make broad overarching conclusions about this incredibly nuanced relationship. Intervention-focused research include authors' plans to create a social media single session intervention (SSI) designed to promote insight about social media's effects on well- or ill-being, as well as self-efficacy and knowledge to make changes to social media use.

The healthfulness of children's meals when multiple media and devices are present.

Although television viewing during mealtime has been shown to associate with greater consumption of energy-dense foods, little is known about how new technological devices may influence children's food consumption. Because the number and type of media accessible to children continue to increase, this study examines the association between the presence of various media (TVs, mobile devices, video games, laptops) during mealtime and the healthfulness of children's meals. In this study, 61 primary caregivers of children ages 3-5 years and 10-13 years old participated in video-recorded dinner meals, which were reliably coded for media use, including number of media present. The overall healthfulness of the meals was coded using the Healthy Meal Index (HMI). Linear regression models were used to examine associations between number of media devices present during the meal and HMI, adjusting for parental education, income-to-needs ratio, and child race. Results indicate that the number of media present during the meal is inversely associated with HMI Total scores (B = -.29, p < .01; F(4, 53) = 9.97, p < .01). In other words, as the number of mealtime media devices increases, the healthfulness of children's meals decreases. These results suggest that media and device use during mealtime may be an additional childhood risk factor for poor meal quality, and parents should make efforts to limit mealtime media and device use.

The association of adolescents' television viewing with Body Mass Index percentile, food addiction, and addictive phone use.

Television (TV) viewing remain a popular forms of screen time for adolescents. Greater TV viewing is associated with a number of negative consequences for adolescent health. In a changing media landscape, it is important to understand adolescents' overall and commercial TV exposure, and how TV viewing is linked to health risks (e.g., obesity, food addiction, and phone addiction). The purpose of this study was to: 1) examine differences by age, gender, race/ethnicity, and parental education in overall TV and commercial TV viewing and 2) investigate whether adolescents who watch more overall TV and commercial TV programming were more likely to have a higher BMI percentile, more addictive eating, and more addictive phone use. A sample of 190 adolescents (13-16 years of age) completed Time-Use Diaries (TUDs) in 2015-2017. We found that girls had more overall weekday TV time than males. No other gender differences were detected for weekend TV time or commercial TV time. Higher BMI percentile was not correlated with greater overall or commercial TV viewing. However, we did identify a positive association between overall TV viewing and commercial TV viewing with addictive-eating and addictive phone use. This effect was mainly driven by boys. To our knowledge, this is the first study to investigate patterns of television viewing and addictive-like eating and addictive phone use. We conclude that adolescents, particularly boys, with higher TV viewing may be more likely to present with problems with addictive eating behavior and phone use. Our findings add to the research on the behavioral health correlates of TV viewing among adolescents.

Positive and Negative Online Experiences and Loneliness in Peruvian Adolescents During the COVID-19 Lockdown.

Global COVID-19 lockdowns have disrupted adolescents' in-person social networks, increasing likelihood of loneliness. Social media can help adolescents maintain and develop peer relationships across distance. In this short longitudinal study with 735 Peruvian adolescents (ages: 11-17) from low-to-middle-income urban settings, we investigated whether online experiences relate to loneliness during initial stages of lockdown. Loneliness remained constant between week 6 and 11 of lockdown, was higher for females and similar across school-grades. Positive and negative online experiences were more frequent for older students, and females experienced more negative online experiences than males. Greater positive online experiences related to lower loneliness, with the reverse pattern for negative online experiences. Our results suggest that positive online experiences may mitigate loneliness during physical isolation.

Mother-daughter negative body talk as a moderator between body surveillance and body shame in adolescent girls.

PURPOSE: The purpose of this study was to examine the influence of mother-daughter communication about their bodies on adolescent girls' and mothers' body shame. METHODS: The Actor-Partner Interdependence Model was utilized to estimate relationships between individuals' body surveillance and their own body shame (actor effect), individuals' body surveillance and the other member's body shame (partner effect), and negative body talk and both members' body shame (relationship effect) in a sample of 100 mother-daughter dyads. RESULTS: For both mothers and daughters, individuals who had higher body surveillance reported higher body shame. Negative body talk emerged as a significant moderator: girls with higher body surveillance experienced greater body shame when they engaged in more negative body talk with their mothers. CONCLUSION: The findings highlight the need for clinicians to address mothers' own surveillance and body shame, as well as negative body talk between mothers and daughters, in interventions that seek to reduce the impact of objectification on body shame in adolescents. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Parent-child joint media engagement in infancy.

Early conversations are an important source in shaping children's cognitive and emotional development, and it is vital to understand how parents use media as a platform to engage in conversations with their young children and what might predict the quality of these interactions. Thus, in the current study we explored the nature of parent-child discourse while engaging in media (i.e., joint media engagement) with infants, and how parent (empathic concern and responsiveness) and child (negative emotionality and regulatory capacity) variables might be associated with the quality of engagement. The current study consisted of 269 infants (50% female, Mage  = 17.09 months, SD = 3.93; 59% White) and their primary caregiver (98% mothers) who engaged in a variety of in-home tasks and parental questionnaires. Results established three meaningful codes for both parent and child that assessed positive and negative joint media engagement. Further, results suggested that parental empathic concern was associated with positive parent and child media engagement, while child negative emotionality was associated with lower levels of distraction. Discussion focuses on the importance of studying parent-child discourse in the context of joint media engagement and recommends limiting media exposure before 18 months of age.

Coparenting in the feeding context: perspectives of fathers and mothers of preschoolers.

PURPOSE: This study examined how fathers and mothers coparent around child feeding. METHODS: Father-mother pairs (N = 30) of preschool-aged children (M child age = 4.1 years old) participated in joint or group interview sessions. RESULTS: Three themes emerged from the qualitative analysis: (1) couples' division of labor regarding feeding tasks seemed to align with stereotypical gender roles; (2) couples noted that they attempted healthier family eating habits in comparison to families of origin and recognized the influence of extended family on their attempts at healthier feeding; (3) couples agreed on the importance of family mealtime, routines, and healthy meals, yet disagreed on strategies to limit unhealthy foods and achieve harmonious family meals. CONCLUSIONS: This study identified processes of coparenting and child feeding areas that were particularly challenging to manage among parents, which could be important targets for childhood obesity interventions. LEVEL OF EVIDENCE: V, descriptive study.

Weight status moderates stress-eating in the absence of hunger associations in children.

OBJECTIVE: The association between stress and eating remains unclear in children potentially due to factors that may moderate the association. We examined whether weight status or sex moderated associations between response to a stress induction and eating in the absence of hunger (EAH), among low-income children. METHOD: Children (n = 223; M age = 7.8 years, SD = 0.7 years) participated in a stress induction protocol (modified Trier Social Stress Test for Children [TSST-C]) during which behavioral coding of observed anxiety and change in self-reported distress were measured. Afterwards, participants completed a standardized EAH protocol where they were offered palatable foods. Total kilocalories consumed during the EAH protocol was calculated. Weight and height were measured and weight status calculated as overweight (BMI ≥ 85th percentile for age and sex) vs. not overweight. Multivariate linear regression models adjusting for covariates were conducted to test whether child weight status or sex moderated the stress response-EAH association, for both stress response variables. RESULTS: Weight status moderated the association between observed stress response and EAH such that children with overweight engaged in more EAH as observed anxiety increased, whereas children without overweight engaged in less EAH as observed anxiety increased (ßinteraction = 0.48; p = .010). Weight status did not moderate associations between self-reported distress and EAH. Child sex was not a significant moderator. CONCLUSIONS: After exposure to stress, children with overweight in middle childhood may eat more palatable food compared to children without overweight, possibly due to hypersensitization to food cues or weight stigma experienced by youth with overweight. It may be helpful to encourage youth with overweight to engage in stress-management techniques that do not involve eating as a response to stress.

Development and Validation of the Therapist Barriers to Engaging Parents (TBEP) Measure.

Parent engagement is a well-documented challenge when delivering child and adolescent mental health treatments. Therapists' internal experiences, and how they respond to parents, may create a barrier to the parent engagement process. The current study developed the 13-item Therapist Barriers to Engaging Parents measure (TBEP) to assess providers' internal and external experiences that operate as barriers to parent engagement. The TBEP was completed by 148 child and family therapists across the United States. The TBEP demonstrated strong internal reliability (Cronbach α = .86), and was negatively correlated with counselor efficacy, and significantly positively correlated with burnout, indicating convergent validity. Incremental validity of the subscales of the TBEP was also demonstrated. The TBEP appears to be a psychometrically sound measure of the internal barriers mental health providers experience when trying to engage parents.

How do Adolescents Learn Cyber-victimization Coping Skills? An Examination of Parent and Peer Coping Socialization.

Recently, cyber-victimization has become an ever increasing concern for adolescents. Given the negative consequences of cyber-victimization, it is important to understand how adolescents learn strategies to cope (i.e., "coping socialization") with cyber-victimization. The purpose of this study is to understand common coping strategies reported by adolescents, identify from whom youth learn cyber-victimization coping strategies (coaching), and explore how coaching is associated with adolescents' self-reported use of coping. In a sample of 329 adolescents (49% male; 70% white), we found that positive coping strategies (e.g., problem solving, seeking social support) are used most frequently, and adolescents' perceptions of both parent and peer coping socialization is associated with self-reported use of coping. Interventionists can use this information to adapt interventions to include influential positive socializers.

Validation of the Children's Eating Behaviour Questionnaire in a low-income preschool-aged sample in the United States.

The Children's Eating Behaviour Questionnaire (CEBQ; Wardle, Guthrie, Sanderson, & Rapoport, 2001) is a widely used measure of child eating behaviors. Yet, only one study has examined the factor structure of the CEBQ among low-income children. In the current study, we examined the internal consistency, factor structure, and validity of the CEBQ among 1002 low-income preschool-age children recruited from Head Start locations in the United States. Confirmatory Factor Analysis indicated the CEBQ evidenced a reasonable fit to the data. Results also indicate that CEBQ subscales demonstrate good internal reliability (α's ≥ .70) and validity, with 7 of the 8 subscales associated with children's BMI z-scores in the expected directions. Equivalent factor loadings and indicator means across White and Black non-Hispanic participants were found, supporting measurement invariance between these two groups. In sum, our study supports the factor structure of the CEBQ among low-income preschool-aged children in the United States.

Effects of Ayahuasca on Gratitude and Relationships with Nature: A Prospective, Naturalistic Study.

Qualitative studies and anecdotal reports suggest that experiences with ayahuasca, a psychedelic brew found in Central and South America, may be followed by individuals enduringly feeling more grateful and connected to nature. Yet, to date, these changes have been understudied. Here, participants (N = 54) completed validated surveys related to gratitude, nature relatedness, and nature appreciation one-week before, one-week after, and one-month after attending an ayahuasca retreat center. Compared to baseline, there was a significant increase in gratitude, nature relatedness, and nature appreciation at the one-week and one-month follow-ups. Ratings of mystical-type experiences and awe, but not ego dissolution, during participants' ayahuasca sessions were weakly-to-moderately correlated with these increases. The number of ayahuasca ceremonies attended at the retreat was not related to change in outcomes, underscoring the importance of the quality rather than the quantity of the experiences in post-acute change. Lastly, participant age was negatively related to the occurrence of mystical-type experiences and awe, supporting literature indicating blunted psychedelic effects with increased age. In the context of study limitations, the results suggest that mystical-type experiences and awe occasioned by ayahuasca may be linked to prosocial changes in gratitude and relationships with nature that may be beneficial to mental health.

Peer substance use and homelessness predicting substance abuse from adolescence through early adulthood.

Adolescents who experience homelessness are at higher risk for abusing substances, and for being exposed to substance-using peers. The current study used a longitudinal design to track substance abuse, affiliation with substance-using peers, and episodes of homelessness among a sample of 223 adolescents who were housed at the baseline data collection and 148 adolescents who were housed at baseline. Participants were interviewed at six waves over 6.5 years, covering an age range from 13 to 25. Many participants experienced a recurrence of homelessness during follow-up, with 64.6 % of the baseline homeless group and 22.6 % of the baseline housed group reporting an additional episode of homelessness. Both alcohol abuse and other drug abuse symptoms showed an increase in adolescence followed by slowing in early adulthood. Recent homelessness and friend alcohol use predicted alcohol abuse symptoms, and the strength of the influence of friend use decreased over time. Recent homelessness and friend drug use predicted other drug abuse symptoms. Duration of the initial episode of adolescent homelessness showed no influence on substance abuse over time, or the effects of other predictors, highlighting the importance of conceptualizing the experience of homelessness as a recent stressor rather than an enduring personal characteristic.

Developing Healthy Social Media Practices: An Outpatient Caregiver-Adolescent Group Intervention.

Adolescents frequently use social media to connect with peers, develop friendships, and explore their identity. However, some adolescents, particularly those with co-occurring mental health concerns or other vulnerabilities, may experience problems or dysfunction related to their social media use. Navigating online social interactions, regulating one's own use of social media, and being aware of how content of social media may impact users are important skills that youth need to build in today's digital age. The purpose of this paper is to describe the rationale for, and components of, a group therapy intervention (Developing Healthy Social Media Practices) for caregivers and their adolescents that seeks to (a) provide psychoeducation about the risks and benefits of social media use; (b) teach youth and their caregivers online social problem solving skills; (c) facilitate caregiver-adolescent communication about online social interactions and other online risks; and (d) promote motivation to change social media practices that youth and their caregivers identify as impacting functioning.

Risk, Emotional Support, Child Abuse Potential, and Parenting During the First Year of the COVID-19 Pandemic.

The COVID-19 pandemic and associated mitigation efforts created stress that threatened parent and child well-being. Conditions that increase stress within families heighten the likelihood of child abuse, but social support can mitigate the impact. This short-term investigation considered whether cumulative risk, COVID-19 specific risk, and emotional support (one aspect of social support), were associated with child abuse potential during the pandemic. Additionally, we investigated whether emotional support moderated the association between COVID-19 specific risk and child abuse potential, and associations between child abuse potential and emotionally positive and emotionally negative parenting. Participants included 89 parents, from a metropolitan area with a large number of economically distressed families, who completed online questionnaires. COVID-19 specific risk and emotional support each explained additional variance in child abuse potential beyond cumulative risk, but emotional support did not moderate the association between COVID-19 specific risk and child abuse potential. Consistent with expectations, child abuse potential was negatively associated with emotionally positive parenting and positively associated with emotionally negative parenting practices. Results highlight the importance of addressing both risks and supports at multiple levels for parents during times of stress.

Adapting PCIT-Health for Telehealth Delivery: A Case Study.

During the COVID-19 pandemic, children's physical health and access to mental health resources have been two critical concerns. Parent-Child Interaction Therapy-Health (PCIT-Health) is a treatment model aimed at helping parents manage children's general behavior and their behavior in obesogenic contexts (screen time and mealtime). Due to social distancing guidelines, PCIT-Health was adapted for remote delivery through video conferencing. In this article, we describe the experience of implementing virtual PCIT-Health with a family. The family's progress through treatment is described, along with the challenges associated with remote service delivery and how those challenges were addressed. Progress through treatment was measured with questionnaires administered to caregivers and with observational measures of parent-child interactions. The results from these measures indicate that caregivers experienced a reduction in stress and improvements in their child's behavior after PCIT-Health completion. They also reported engaging in healthier management of their child's screen time and mealtime behaviors. As coded from observational assessments, parents increased their use of positive parenting practices. Telehealth-delivered PCIT-Health is a promising treatment modality for increasing parenting skills and improving child behavior.

Reactions to naturalistic smartphone deprivation among psychiatrically hospitalized adolescents.

The standard of care among youth who are psychiatrically hospitalized typically involves smartphone confiscation for the duration of treatment. However, very little is known regarding how youth respond to this period of smartphone "deprivation," factors that may influence this response, and ensuing clinical effects. The present exploratory mixed-methods study sought to elucidate the experience of psychiatrically hospitalized adolescents as it relates to smartphone deprivation, and to evaluate the impact of this widespread treatment approach. Psychiatrically hospitalized adolescents (N = 181; Mean age = 15.29 years) completed qualitative and quantitative measures assessing the experience of smartphone deprivation during hospitalization. Associations among reactions to smartphone deprivation and smartphone and social media use patterns were explored. Analyses additionally evaluated whether reactions to smartphone deprivation were associated with clinical symptom severity (e.g., suicidal ideation, internalizing and externalizing symptoms) and readiness for psychotherapy. Negative reactions to smartphone deprivation were significantly positively correlated with daily smartphone hours, addictive patterns of use, and both negative and positive emotional responses to social media use. Reactions to smartphone deprivation were not associated with clinical symptom severity. However, negative reactions to smartphone deprivation were associated with lower readiness for therapy, while positive reactions were associated with greater readiness. This preliminary work illustrates the complexities of smartphone use in adolescents and the potential positive and negative effects of smartphone deprivation during psychiatric hospitalization. Future prospective research with adolescents should clarify optimal smartphone access during inpatient hospitalization.

Child Media Use During COVID-19: Associations with Contextual and Social-Emotional Factors.

OBJECTIVE: The aim of this study was to test associations between (1) contextual factors and types of digital media use and (2) types of digital media use and children's social-emotional and sleep outcomes during COVID-19. METHODS: In February to March 2021, 303 parents of elementary schoolers participated in this cross-sectional survey gathering information on demographics, child school format, contextual factors, duration of types of digital media use, social-emotional outcomes, and sleep. Multivariable regressions examined associations outlined in the objective, adjusting for school format, only child, race/ethnicity, and parental stress, depressive symptoms, education, and material hardship. RESULTS: Children were aged 5 years to younger than 11 years and spent approximately 4 hours on screen media daily. In multivariable analyses, remote school format; greater material hardship; Black, Indigenous, and people of color child race/ethnicity; lower parenting stress; and parent depressive symptoms were associated with longer duration of various digital media. Longer daily duration of streaming video and video chat were associated with higher prosocial scores, while console games, mobile apps/games, and video-sharing platforms were associated with greater problematic media use (PMU) (defined as interfering with adaptive functioning). More time on mobile apps/games, video-sharing platforms, and video streaming was linked with shorter sleep. CONCLUSION: Lower parenting stress predicted greater digital media use. Greater digital media use during the pandemic may have enabled parents to focus on other needs. Use of media for social connection predicted greater prosocial behaviors. Engagement-prolonging digital media predicted PMU. Pediatric providers may wish to consider family context when addressing digital media use and encourage socially oriented digital media.

Adverse Childhood Experiences and Problematic Media Use: Perceptions of Caregivers of High-Risk Youth.

Youth with a history of adverse childhood experiences (ACEs) are more likely to develop risky health behaviors. With the increase of media use in the general population, it is likely that these high-risk youth are developing maladaptive behaviors associated with media use (i.e., problematic media use). The goals of this article are (1) to describe symptoms of problematic media use in high-risk youth and (2) to determine whether ACEs are related to problematic media use in this population. Data were collected through online questionnaires from 348 parents or legal guardians of children ages 5 to 18 years, the majority of whom had been adopted. Parents and guardians reported on the child's history of ACEs and completed the Problematic Media Use Measure-Short Form (PMUM-SF). Almost half of the participants reported that their child had a history of four or more ACEs (48.9%). Caregivers of foster or adopted children reported more symptoms of problematic media use than those reporting on their biological children. After adjusting for covariates, the number of ACEs predicted problematic media use above and beyond variance explained by demographic factors or screen time amount. Children with a history of ACEs had higher problematic media use compared to children without ACEs.

Prevalence and Predictors of Children's Persistent Screen Time Requests: A National Sample of Parents.

Child screen media use may cause family conflict, and risk factors for such conflict are not well characterized. This study examined risk factors of persistent requesting to use screen media among preschool-age children, focusing on parent-reported characteristics of parent and child screen media use. Data was collected through an online survey completed in 2017 by a nationally recruited sample of 383 parents of 2-5-year-old children. Parents reported on their child's and their own screen media use, household/sociodemographic measures, and child requests to use screen media. Persistent requesting was defined as exhibiting "bothersome" or "very bothersome" behaviors to use screen media. Poisson regression with robust standard errors computed the prevalence risk ratio of persistent requests on parent and child screen media use characteristics, adjusted for household and sociodemographic characteristics. Overall, based on parents' reports, 28.7% of children exhibited persistent requesting, which was often accompanied by whining, crying, gesturing, or physically taking a device. In an adjusted regression model, higher amounts of parental time spent using social media, but not parental time spent using other screen media, was associated with a greater prevalence of children's persistent requests. In latter models, children's use of smartphones and engagement with online videos were independently related to persistent requests. Across all models, children's total quantity of screen media use was unrelated to persistent requests. Practitioners advising families on managing conflict around child screen media use should consider characteristics of both child and parent screen media use.