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Risk of Social Media for Teens in an Urban Setting

Purpose. To describe the self-reported risky behaviors associated with adolescent social media use. Methods. Adolescents ages 13 to 21 years were recruited from a large, urban academic center to complete a written survey regarding social media use. Results are presented as frequencies and percentage; nominal variables were compared using χ2 analysis. Results. Almost all participants (93%) reported belonging to a social media site. The majority of adolescents (72%) access the Internet with a phone. Nearly half (49%) of participants accept friend requests from strangers, 42% send friend requests to strangers, and 55% of participants report meeting people from social media sites in person. Conclusion. Adolescents self-report engaging in a number of risky behaviors when they use social media. Teenagers’ use of social media is an additional behavior that requires attention and monitoring.


Background and Objectives
People of all ages and backgrounds use social media sites (SMS), such as Facebook or Twitter. Social media is taking an increasingly important part and function in the teenager's life; a recent survey reported that of teens with access to the Internet, 73% are members of SMS. 1 There are several positive aspects to social media; it can provide a venue of expression or a network to seek out social support and connect with peers that share similar interests, backgrounds, or chronic illnesses. Social media communities can help adolescents expand their social capital, the concept that adolescents can develop direct benefits from their relationships with others. 2 However, social media can also present an unsuspected danger to adolescents. A recent study asking physicians at a pediatric clinic if they would search for their patients on SMS found that physicians were uncertain of the truthfulness of information posted online by patients. 3 This raised the question about how teens, young adults, and their parents use social media in our patient population.
Adolescence is a time of increased risk taking and thrill seeking with a shift from a parent-centered existence to a predominance of peer affiliation in the process of developing identity. 4 Teens strive for connection and acceptance with their peers. The ability to think past initial consequences and potential risks involved in their behaviors is variable and depends on age, cognitive abilities, and their psychosocial developmental stage. Social media can be a powerful tool for teens to connect with each other, but it is not without the opportunity for significant risk taking behaviors. Often, teens can be more technologically savvy than their parents, which can make supervision on the Internet even more challenging. However, more adults are joining SMS; approximately 73% of adults who use the Internet belong to at least one SMS. 5 The objective of this study is to describe the risky behaviors associated with social media use reported by adolescents and young adults in our urban patient population. Additionally, this study aims to describe parental use of social media and their awareness of their children's Internet behaviors.

Adolescent Participants
Institutional review board approval was obtained. Participants were recruited from a large urban clinic at an academic center. Adolescents ages 13 to 17 with a parent present and young adults ages 18 to 21 presenting for a well physical or a sick visit were approached to participate. Written consent and assent were obtained in the examination room. Participants were asked to complete a written survey with questions about age, sex, and grade in school. Participants were then asked about their use of social media, including access to the Internet, topics they post about, and topics they were interested in viewing online. Participants were also asked about online bullying and viewing posts about bringing weapons to school. Additional questions asked about meeting people in person after meeting on SMS.

Parent Participants
Consenting parents were recruited to complete a parent questionnaire. Parental consent was obtained in the examination room. The parent survey included questions about age, sex, highest level of education, and sources for accessing the Internet. Questions about SMS membership and whether they are friends with their child were included. Parents were also asked if they were aware if their children had been bullied online and if they would be interested in their child's doctors discussing Internet safety.

Data Analysis
Incomplete surveys were included. Data analysis is reported as frequencies and percentages. Nominal variables were compared using χ 2 analysis. Data analysis was completed using SAS.

Adolescent Population Characteristics
Of the 123 adolescents approached, 114 agreed to participate. Sixty-six percent of participants were female, and 47% were less than 16 years old. Ninety-three percent of participants report being members of an SMS.

Adolescent Responses
The most commonly reported SMSs include Facebook (76%) and Twitter (52%) (Figure 1). Seventy-two percent of participants access the Internet from a smartphone, 39% from a school computer, 33% from a public computer, and 30% from a personal computer (Figure 2). See Table 1 for a summary of reported risk taking behaviors.
Age is related to accepting friend requests from strangers; 63% of participants greater than or equal to 16 years old versus 40% of those less than 16 years old have accepted a friend request from a stranger (P = .007). Adolescents involved in school activities were more likely to report meeting people from the Internet in person (65% vs 40%; P = .02).

Parent Population Characteristics
Ninety-seven percent of the parent participants were female. Eighty-five percent reported having access to the   Internet. Home computers were reported most often (62%) to access the Internet, followed by smartphones at 44%.

Parent Responses
Sixty percent of parents report having a Facebook account, and 6.7% have a Twitter account. Sixty-seven percent of parents have viewed their child's social media page, and 59.5% report that they are friends with their child on Facebook. When asked if their child had experienced Internet bullying, 15.7% responded with yes and another 20.5% reported that their child had problems with peers posting false information about them on a SMS. Only 44.7% of parents responded with yes when asked if they would want their pediatrician to discuss Internet safety during a visit. See Table 2 for a summary of parent responses.

Discussion
The majority of teens in our study reported accessing the Internet via smartphones, likely with minimal supervision, and a large number also reported risky behaviors. Lack of supervision may increase the potential for risky behaviors. SMSs have security options, and Internet browsers have parental controls that can be applied; however, it can be challenging to monitor adolescent Internet activity for a number of reasons such as lack of adult familiarity with ever-changing technology. This may be compounded by the fact that there are many social media communities that parents may not be aware of; Dowdell et al found that almost 30% of high school and college students reported being members of an SMS other than Facebook or Twitter. 6 Not only do parents need to keep up on the technology their adolescents are using but also the number of ever changing sites and communities they explore. It is interesting that teens that are involved in school activities are more likely to report meeting people in public that they met on SMS. Perhaps they are meeting other teens from competing schools or clubs, or they have more unsupervised downtime between the end of the school day and practice. Another hypothesis is that participating in school events increases confidence and decreases their fear, compounding their adolescent sense of invincibility and thus making them more likely to take risks. However, this is not an outcomes study, so the results of the reported behaviors are unknown.
Parents appear to be aware of some of the struggles that their children face on the Internet. Sixteen percent of parents report that their child had experienced bullying, and 20% report instances in which other people had posted false information about their child. In our sample, 19% of teens report feeling bullied online. A third of parents surveyed had not viewed their child's social media page, which might impact their ability to monitor their teen's well-being or social standing.
There are several limitations to this study. These are self-reported behaviors. Adolescents completed the surveys while waiting in the examination or waiting room with their parent, which could contribute to underreporting of risk taking behaviors. Also, with regard to the questions about bullying on the Internet, it is possible that the wording in our survey underestimated the prevalence of cyberbullying. According to a Pew Internet research project, 7 behaviors that adults would label as "bullying" may be considered "drama" by teens. It would be interesting to ask about cyberbullying again with a different vocabulary to determine if this changed the response.
There are many risks involved with social media; however, it has become an integral part of adolescence. Approximately half of parents reported they would be interested in having their doctors discuss Internet and social media safety during a visit. Although there are several topics to be covered in a well physical, the risks of social media should be acknowledged. 8 While adolescents may be more experienced with technology than their parents, they lack the maturity and insight to anticipate consequences that have the potential to lead to negative outcomes. 9 It is important that parents, teens, and young adults are aware of the consequences involved with the use of social media. It is essential that parents know if their child has a social media account and view the content that is posted on their page.