Exposure to Sexually Explicit Materials and Feelings after Exposure among Adolescents in Nine European Countries: The Role of Individual Factors and Social Characteristics.

Research on adolescents' sexual exposure has mostly focused on negcative outcomes using a risk-based lens, and there is little work on the factors that may predict exposure, as well as youths' emotional responses to sexual content. Using a cross-national sample, the present study examined the associations of individual (sensation seeking and emotional problems) and social characteristics (the quality of family environment, including active and restrictive parental mediation) with adolescents' exposure to sexually explicit materials and their feelings after exposure. The survey included 8,820 11- to 16-year-olds (Mage = 13.36 years, SD = 1.62, 48.0% male) from nine European countries (Czech Republic, Finland, Malta, Poland, Portugal, Romania, Serbia, Spain, Switzerland). The results revealed that although there were differences in the prevalence of youths' sexual exposure by country, there were also similarities in the characteristics underlying exposure and subsequent feelings across different country contexts. No significant relationship was found between active parental mediation and exposure in most countries, and the findings regarding restrictive parental mediation were mixed. Although the majority of the participants reported neutral feelings, there were gender differences in feeling happy and upset after exposure. Overall, the results suggest that exposure may not be as distressing to youth as prevalent risk-focused narratives have suggested.

Advantages and Disadvantages of Internet Use: The Perspective of Women with Eating Disorders Experience.

Even though the internet is a common source of information and treatment for people with eating disorder (ED) experience, the motives for illness-related searches have rarely been investigated beyond the perceived negatives. This study explores how women with ED experience reflect upon the advantages and disadvantages of their ED-related internet use. We expand the framework of the Uses and Gratifications Theory (U&G) into the context of users with ED experience through 30 semi-structured interviews with women with ED experience, aged 16 to 28, who live in the Czech Republic. Thematic analysis revealed four themes related to the pros and cons of their internet usage: ED-related Information Content; Internet Features Important to Users; Body Image; and Social Interaction. The results challenge the binary view of ED-related internet use and question some presumptions of U&G Theory within the specific context of users with ED experience.

Who Is Exposed to Harmful Online Content? The Role of Risk and Protective Factors Among Czech, Finnish, and Spanish Adolescents.

Although adolescents' exposure to harmful online content has been linked to decreased subjective well-being and offline risky behaviors, there is limited research on the factors that underlie such problematic online behavior. Using the conceptual framework of Problem Behavior Theory, this study examined the role of risk (i.e., emotional problems, sensation seeking) and protective (i.e., the quality of family environment, social support from friends) factors in exposure to harmful online content among 4473 12- to 16-year-olds (M = 13.9, SD = 1.3, 49% girls) in the Czech Republic, Finland, and Spain. Individual country samples included 1848 adolescents from the Czech Republic (age: M = 14, SD = 1.4; 51% girls), 788 from Finland (age: M = 13.9, SD = 1.3; 52% girls), and 1837 from Spain (age: M = 13.5, SD = 1.2; 47% girls). In all of the sampled countries, emotional problems and sensation seeking served as risk factors, whereas good family relationships were protective. In some countries, the effects of emotional problems and sensation seeking were moderated by the quality of the family environment and social support from friends. These moderating effects suggest that individual risk factors for exposure to harmful online content may be buffered by a positive family environment and friends' support. The findings revealed similarities in the risk and protective factors underlying online problem behavior across three different countries. They demonstrate that the mechanisms proposed by Problem Behavior Theory can help to understand the etiology of adolescent problem behavior across different countries as well as offline and online contexts.

Internet Usage by Women with Eating Disorders during Illness and Recovery.

Internet usage may have both positive and negative impacts on people with eating disorders. In research to date, most of the focus has been put on the harms connected with platforms that support people in continuing their disorder. Less studied have been the benefits of other technology platforms used by people with eating disorders. When these different platforms were investigated, users were rarely interviewed about their experience. To fill this gap, we conducted 30 interviews with participants aged 16 to 28, all female, living in the Czech Republic. The interviews focused on their experiences with the harmful and helpful impacts of the internet on the course of their eating disorders. The data were analyzed via thematic analysis. The results provided insight into the participants' experience with the following online environments: 1) nonprofessional pro-eating disorder platforms; 2) nonprofessional pro-recovery platforms; 3) social networking sites (SNS); 4) platforms for counting calories and setting weight goals; 5) platforms about food, exercise, and lifestyle; and 6) platforms providing professional help. The participants noted many benefits these platforms could provide; however, their ability to achieve the benefits was affected by their motivation for treatment. As a result, even platforms designed to support recovery could be used for illness maintenance. The results are discussed in the context of research on the changing motivations for recovery in people with eating disorders and the theory of different processes connected to the course of the eating disorders according to the differential interactivity of digital platforms.

Is it Important to Talk About Technologies with Eating Disorder Clients? The Health-Care Professional Perspective.

Nowadays, the use of digital technology is an important issue that should be addressed during the treatment of people who have eating disorders. The involvement or absence of this issue reflects the understanding, experience, and atttude of health-care professionals toward their clients' use of technology. The aim of the present study was to investigate the perceptions of health-care professionals and their assessment of their clients' usage of digital technology while developing strategies for treatment. Semistructured interviews with 30 professionals were performed from October 2015 to June 2016 and a thematic analysis was used to analyze the data. The health-care professionals' views could be summarized in three thematic groups: (1) technology use is not relevant for the cooperation; (2) technology use is relevant for the cooperation and addressed generally; and (3) technology use is relevant for the cooperation and addressed specifically. The results are discussed in relation to the theoretical model presented by Rodgers about the impact of technology on disordered eating behaviors and the implications for practice.

Sociodemographic, Attitudinal, and Behavioral Correlates of Using Nutrition, Weight Loss, and Fitness Websites: An Online Survey.

BACKGROUND: Nutrition, diet, and fitness are among the most searched health topics by internet users. Besides that, health-related internet users are diverse in their motivations and individual characteristics. However, little is known about the individual characteristics associated with the usage of nutrition, weight loss, and fitness websites. OBJECTIVE: The aim of this study was to examine the individual factors associated with the usage of nutrition, weight loss, and fitness websites. METHODS: An invitation to an online survey was published on 65 websites and discussion forums. In total, we employed data from 623 participants (aged 13 to 39 years, mean 24.11 [SD 5.26]). The measures included frequency of usage of nutrition, weight loss and fitness websites, excessive exercise, eating disorder symptomatology, internalization of the beauty ideal, weight status, and perceived online social support. Participants' data were used as predictors in a base linear regression model. RESULTS: The final model had an acceptable fit (χ210 =14.1; P=.17; root mean square error of approximation=0.03; comparative fit index=0.99; Tucker-Lewis index=0.99). Positive associations were found between usage of (1) nutrition websites and being female, higher levels of excessive exercise, and perceived online social support; (2) weight loss websites and excessive exercise, internalization, being female, eating disorder symptomatology, and being overweight or obese; and (3) fitness websites and levels of excessive exercise, internalization, and frequency of internet use. CONCLUSIONS: The results highlighted the importance of individual differences in the usage of health-related websites.

Mobile Health Interventions for Physical Activity, Sedentary Behavior, and Sleep in Adults Aged 50 Years and Older: A Systematic Literature Review.

We provide a systematic review of interventions utilizing mobile technology to alter physical activity, sedentary behavior, and sleep among adults aged 50 years and older. A systematic search identified 52 relevant articles (randomized control trial [RCT], quasi-experimental, pre/post single-group design). Of 50 trials assessing physical activity, 17 out of 29 RCTs and 13 out of 21 trials assessed for pre/post changes only supported the effectiveness of mobile interventions to improve physical activity, and 9 studies (five out of 10 RCTs and all four pre/post studies) out of 14 reduced sedentary behavior. Only two of five interventions improved sleep (one out of two RCTs and one out of three pre/post studies). Text messaging was the most frequently used intervention (60% of all studies) but was usually used in combination with other components (79% of hybrid interventions included SMS, plus either web or app components). Although more high-quality RCTs are needed, there is evidence supporting the effectiveness of mHealth approaches in those aged 50 years and older.

Children's Experiences and Awareness about Impact of Digital Media on Health.

Previous research has focused on the associations between technology use and children's health, using mainly quantitative designs. This qualitative study describes technology's impact on physical and mental health from children's perspectives. The differences between children's experiences and awareness of the health-related consequences associated with digital media use were examined. Focus groups and interviews were conducted with children between the ages of 9 and 16 in nine European countries (N = 368). Results of this study indicate that children's experiences of health-related technology impacts are different from their awareness of these impacts. Children's direct experiences with media were less extreme in contrast to their awareness of health problems, which typically involved extreme examples of possible consequences, such as killing people, kidnapping, blindness, and developing learning or psychological disorders. The results are discussed in the context of the "media panic" and "third person effect" theories.

Digital skills among youth: A dataset from a three-wave longitudinal survey in six European countries.

This dataset provides longitudinal survey data from a European project, ySKILLS, which was focused on the role of digital skills in youths' development. It contains data from 10,821 participants from Grades 6-10 (in Wave 1) in Estonia, Finland, Germany, Italy, Poland, and Portugal. The data was collected between Spring 2021 and Spring 2023, the participants were recruited through schools, where the data collection also took place, except for online data collections due to restrictions caused by COVID-19. The dataset is novel in its multidimensional approach to the construct of digital literacy. It provides insight into the development of digital skills in youth and the role of digital skills and internet usage in youths' positive and negative online experiences and wellbeing. It also contains data that allows for the analysis of the role of digital skills in class networks. The data are beneficial for researchers interested in the examination of youths' online skills, internet usage, online experiences, and wellbeing from a longitudinal perspective.

Health-related social media use and COVID-19 anxiety in adolescence: health anxiety as covariate and moderator.

Background: Adolescents can benefit from engagement with health-related content on social media (e.g., viewing, commenting, or sharing content related to diseases, prevention, or healthy lifestyle). Nevertheless, such content may be distressing or exaggerated and present a challenge to mental well-being, especially during the COVID-19 pandemic. Rumination about such content may lead to COVID-19 anxiety. Yet, the individual factors that would explain the association between health-related social media use (SMU) and COVID-19 anxiety are understudied. Objective: In the current study, we aimed to fill the gap by investigating the association between health-related social media use (SMU) and COVID-19 anxiety in light of several individual factors: health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection. We (1) studied the relationship between individual factors and health-related SMU, (2) tested health anxiety as a moderator in the association between health-related SMU and COVID-19 anxiety, and (3) explored a direct effect of experience with COVID-19 on COVID-19 anxiety. Methods: Using structural equation modeling, we analyzed cross-sectional data from a representative sample of 2,500 Czech adolescents aged 11-16, 50% girls. Sociodemographic measures, health-related SMU, COVIDCOVID-19 anxiety, health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection were assessed with an anonymous online survey. The data were collected in June 2021. Results: We conducted a path analysis to test the main relationships and an additional simple-slopes analysis to explore the moderating effect of health anxiety. Higher health anxiety and eHealth literacy were associated with increased health-related SMU. The effect of experience with COVID-19 infection on both COVID-19 anxiety and health-related SMU was negligible. Health-related SMU and COVID-19 anxiety were positively associated, however, only for adolescents high in health anxiety. For other adolescents, the two variables were unrelated. Conclusion: Our findings show that adolescents with higher health anxiety and eHealth literacy engage in health-related SMU more intensively. Furthermore, for adolescents high in health anxiety, the frequency of health-related SMU is associated with the risk of COVID-19 anxiety. This is likely due to differences in media use. Adolescents with high health anxiety may use social media for content that is more likely to lead to COVID-19 anxiety compared to other adolescents. We recommend focusing on the identification of such content, which may lead to more precise recommendations regarding health-related SMU compared to cut-back on the frequency of overall SMU.

Individual and Parental Factors of Adolescents' mHealth App Use: Nationally Representative Cross-sectional Study.

BACKGROUND: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. OBJECTIVE: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). METHODS: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample's representativeness. The sociodemographic factors were the adolescents' age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children's online health information-seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). RESULTS: More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information-seeking behaviors and adolescents' mHealth app use. CONCLUSIONS: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents' mHealth app use. We initially showed parents as significant role models for their children's adoption of, and engagement with, mHealth apps when they actively mediate their online health information-seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents' mHealth app use longitudinally.

A moderated mediation model for body-positive online content and body image among adolescents.

Body-positive online content (BPOC) has recently become widespread, yet the factors that explain its association with body satisfaction have scarcely been studied. The current study investigates the indirect association between the self-reported frequency of viewing BPOC and body satisfaction through body appreciation and the moderating roles of body-ideal internalization, self-esteem, intentional searching, and gender. Utilizing survey data from 1530 Czech adolescents aged 13-18 (M=15.4, SD=1.7, 50 % girls), the present study found limited support for an indirect connection between the frequency of viewing BPOC and body satisfaction through body appreciation. Nonetheless, an indirect association appeared among adolescents with average and above-average frequencies for intentional searching for BPOC. Other investigated moderating factors were not significant. The present findings suggest that BPOC may be positively associated with body image, but only for those who deliberately search for it. The study highlights the importance of individual moderating factors in the context of BPOC and the remaining research gaps, such as the examination of its various types and aspects and their relationship with body image.

Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent's Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study.

BACKGROUND: Smartphone ownership has increased among teens within the last decade, with up to 89% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. OBJECTIVE: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. METHODS: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. RESULTS: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. CONCLUSIONS: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35984.

Who Is Smart with Their Smartphones? Determinants of Smartphone Security Behavior.

Smartphones have recently become a major target for cybercriminals due to large amounts of sensitive data and credentials being stored on the devices. To protect themselves against cyberthreats, users can employ a range of security behaviors. Although research has largely focused on computer security, relatively little is known about personal smartphone security behavior. The goal of our study was to evaluate determinants of smartphone security behavior based on the combination of the Health Belief Model and Protection Motivation Theory. We extended the models by including the construct of general security orientation. We also developed a smartphone security behavior scale that measured various aspects of this behavior. The sample included 331 Czech Android smartphone users aged between 26 and 81 years who were not IT specialists by employment or education. Path analysis showed that individuals who perceived a potential smartphone security threat as more severe, had higher smartphone self-efficacy, and general orientation and interest in digital security, and less personal experience with a digital security incident reported more secure behavior on their smartphones. Perceived susceptibility to security threats and family and friends' previous experience with digital security incidents did not predict smartphone security behavior. General security orientation affected smartphone security behavior also indirectly through perceived severity. These findings have theoretical implications for the models and also emphasize the importance of general digital security awareness as well as smartphone training to increase smartphone security behavior.

Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment.

BACKGROUND: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. OBJECTIVE: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years. METHODS: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants' perceptions of their experience in the study. RESULTS: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. CONCLUSIONS: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies.

The Direct and Indirect Effects of Online Social Support, Neuroticism, and Web Content Internalization on the Drive for Thinness among Women Visiting Health-Oriented Websites.

One of the debates about media usage is the potential harmful effect that it has on body image and related eating disturbances because of its representations of the "ideal body". This study focuses on the drive for thinness among the visitors of various health-oriented websites and online platforms because neither has yet been sufficiently studied in this context. Specifically, this study aims to bring more insight to the risk factors which can increase the drive for thinness in the users of these websites. We tested the presumption that web content internalization is a key factor in this process, and we considered the effects of selected individual factors, specifically the perceived online social support and neuroticism. We utilized survey data from 445 Czech women (aged 18-29, M = 23.5, SD = 3.1) who visited nutrition, weight loss, and exercise websites. The results showed a positive indirect link between both perceived online social support and neuroticism to the drive for thinness via web content internalization. The results are discussed with regard to the dual role of online support as both risk and protective factor. Moreover, we consider the practical implications for eating behavior and weight-related problems with regard to prevention and intervention.

Social relational factors of excessive internet use in four European countries.

OBJECTIVES: Adolescents who deal with more emotional problems have been found to seek escape online, and struggle with excessive internet use (EIU). Poor social relationships have been linked with emotional problems. The current study investigated positive family and school relationships as protective factors against emotional problems and a preference for online social interaction (POSI), both specified as mediators of the association of family and school relationships with EIU. Cross-cultural differences in the model were tested. METHODS: A multi-group SEM was tested on representative samples of 4104 adolescents (Mage = 14.40 years, SD = 1.65, range 12-17, 50% female) from four European countries from Southern, Northern, Central, and Eastern Europe (Italy, Norway, Czech Republic, and Serbia, respectively). RESULTS: Results suggested consistent associations across countries. Positive family relationships and positive school relationships were associated with lower EIU, with 63-64% of the effect of family, and 91-93% of the effect of school relationships mediated by emotional problems and POSI. CONCLUSIONS: Positive family and school relationships protect adolescents against excessive internet usage, regardless of culture and indirectly-through emotional problems and POSI.

Functions of mHealth applications: A user's perspective.

The usage of mobile health (mHealth) applications is rapidly increasing. This research has been aimed mostly at reviewing existing mHealth apps and their functionality. However, studies from users' perspectives are rather scarce. This exploratory study addresses that gap and, using cross-sectional survey data, seeks to reveal the socio-demographic and individual characteristics of users who utilize specific functions of mHealth apps. The data were collected via an online survey through websites oriented toward eating habits, exercising, dieting, and weight loss. From the original sample (1002 users; M = 24.8, standard deviation = 6.9; 81.6% females), the final sub-sample of 406 participants aged from 13 to 39 years (M = 23.8, standard deviation = 5.3, 86.9% females) who reported usage of mHealth apps was examined. The analyses revealed demographic and individual differences in predicting usage of various functions of mHealth apps. The drive for thinness was associated with functions for weight monitoring and planning functions. Excessive exercise was associated with weight monitoring, socializing functions, and functions for planning and monitoring goals. These findings imply that mHealth apps should be individually tailored to incorporate components such as risk-specific warnings or the provision of information related to seeking professional help for at-risk audiences.