Breaking down the US Surgeon General advisory on social media use among adolescents

When you hear the words ‘public health,’ what first comes to your mind? Is it educational pamphlets on how to stop smoking or combat heart disease? Is it the use of vaccines to eradicate once-deadly diseases? According to the US Surgeon General, Vice Admiral Vivek Murthy, MD, one of the greatest public health threats facing us today is one that may not even have crossed your mind—social media.

On May 23, Dr. Murthy published an advisory titled “Social Media and Youth Mental Health.” While we may not always see or hear of many of our Surgeon General’s advisories to combat arising public health obstacles, when we do, they’re momentous.

Take, for example, President Lyndon B. Johnson’s Surgeon General Luther Terry’s advisory on the consequences of smoking in 1964. Later that same year, the Federal Trade Commission (FTC) required cigarette manufacturers to place a label on their packaging indicating their harmful effects.

Or take President Ronald Reagan’s Surgeon General Everett Koop’s statement in 1986 regarding the HIV/AIDS epidemic. Quickly after, an educational campaign was rolled out that mailed a booklet titled ‘Understanding AIDS’ to all 107 million households in the U.S.

Negative consequences of social media

In Dr. Murthy’s 25-page advisory, he outlines the growing negative impacts of social media on youth mental health. While there may be some benefits as well, Dr. Murthy says, “We do not yet have enough evidence to determine if social media is sufficiently safe for children and adolescents,” noting that there are many indicators that it can pose a profound risk of harm to the mental health and well-being of our youth.

With up to 95% of young Americans ages 13-17 using social media across all platforms, the implications are widespread.

“Brain development is a critical factor to consider,” Dr. Murthy says. “Adolescents, ages 10 to 19, are undergoing a highly sensitive period of brain development. This is a period when risk-taking behaviors reach their peak, when well-being experiences the greatest fluctuations and when mental health challenges, such as depression, typically emerge.”

Dr. Murthy has found that frequent social media use can be associated with changes in the pliable youth brain, particularly in the amygdala (an area important for emotional learning and behavior) as well as the prefrontal cortex (an area regulating impulse control, emotions and social behaviors). Additionally, the excessive use of social media has been linked to sleep problems, attention problems and feelings of exclusion among adolescents.

The brain—especially the adolescent brain—requires sleep for healthy development. Dr. Murthy calls to attention how there has been evidence that shows a relationship between social media use and poor sleep quality and reduced sleep duration. Whether that is because teens are staying up late using social media, or something that occurred on an app is keeping them up—it can impair their proper brain development.

Available content can’t always be controlled

While the excessive use of social media in youth is concerning, what’s arguably even more concerning is the content they are exposed to when they’re logged in. Since most social media companies (notably TikTok, Snapchat, Instagram and Facebook) only require users to be 13 years old to use their apps, the content contained in photos, videos and posts is easily and widely accessible.

“Roughly two-thirds (64%) of adolescents are “often” or “sometimes” exposed to hate-based content,” said Dr. Murthy. “Among adolescent girls of color, one-third or more report exposure to racist content or language on social media platforms at least monthly.”

According to Dr. Murthy, there have been more studies examining social media usage over the past 10 years. For example, a longitudinal cohort study found that adolescents who spend more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, including symptoms of depression and anxiety. Another smaller, randomized controlled trial of college-aged students found that deactivation of a social media platform for four weeks improved subjective well-being.

Call to action

Dr. Murthy concludes his advisory by highlighting a complicated roadblock in the process of safeguarding the social media usage in children—the lack of assistance from these tech conglomerates themselves.

“There is a lack of access to data and a lack of transparency from these technology companies,” Dr. Murthy says, hinting at the idea that these companies are creating a barrier to fully understanding the scale and scope of the issue. “Our children and adolescents do not have the luxury of waiting years until we know the full extent of social media’s impact. Their development is happening now.”

He presents a call to action for lawmakers and scientists alike, encouraging the strengthening and enforcement of age minimums on different platforms, supporting increased funding for future research of social media, and integrating a digital and media literacy curriculum into schools.

Times change and we change with them. Growing up today is astronomically different than it was 20 years ago. By starting with protecting America’s future, we take a drastic step in the right direction to combating the youth mental health crisis.

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