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In recent, times, social media apps such as "TikTok", "Instagram reels", or even "Youtube shorts" are a design to keep us strapped down. These apps specifically target you to keep scrolling and scrolling to get that small dose of dopamine. We're searching for a rush, a reward when scrolling. This also doesn't help, as the factor of the algorithm plays into this. The algorithm is essentially a robot that tries to find your interests and shows you more of that specific content. However, they can show you things you might not like, as things people dislike get a lot of engagement.

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Why we cant stop mindlessly scrolling and 7 tips to beat it

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Why are our phones so addictive? The human psychology behind why you can’t put your phone down. Plus, 7 easy tips to help you stop doomscrolling.

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Our attention spans are so low that we depend on instant gratification. Social Media has to be quick and engaging or else users will lose their focus and go elsewhere for that gratification.
One example we thought about was TikTok, there is always something for you, and it's video after video, so if you don't like one video you can just keep scrolling. And now there are even more sponsors and advertisements that can seem like actual videos and grab our attention even more while making money in the process.

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HERE IT IS!! Capturing Attention in Social Media

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What does it take to keep your attention? Whether its in day to day life, T.V. shows, or social media; what will keep you focused? Capturing and keeping one's attention especially in the world of...

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"we put deceit and sneakiness into the absolute center of everything we do"
- The Social Dilemma

Both users and and tech companies participate in lying and deceit, its human nature. However, this can be disastrous for democracy. Fake ads can be created, and tech companies will put them up for the right price, thus misinforming users, making it so they can't make a well informed decision.

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They were able to get more people to vote - the social dilemma

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Imagine if you had to use the internet as responsibly as you had to with alcohol. Some restrictions like no phone use while driving in the state of Maine are already showing our addictions are becoming as intensive as drug use. But you do not do the phone, you just browse on it- how does it change the chemical formatting of your brain?

Fun fact: Internet addiction is a newer term than PTSD by about 15 years. To show the importance of how long the DSM has been around, many psychologists are rediscovering the DSM V today in 2023. We consider misdiagnosis a mistake of the past when we revolutionize, and today we find much of ourselves addicted and depressed because of the convenience of technology. The age of technology is new, so we are suffering today to no avail or answer until we can no longer help ourselves.

In addition to damaging a person’s social capital as clarified in my last post, social media creates an addiction and withdrawal similar to hard drugs for its users. Dopamine is the chemical released to the brain as an award, and lack of dopamine causes depressive effects. When the brain learns to link dopamine to an activity, such as smoking or browsing the web, the user will seek out their happy high to avoid the deficits of addiction- depression and anxiety. Considering dopamine is critical for thinking, carrying, attentiveness, motivation, mood and more, a considerable lack of it can ruin a person’s drive to live. Or, for many addicts, their new addiction IS their drive to live.

Cited:

Macit, H. B. , Macit, G. & Güngör, O. (2018). A RESEARCH ON SOCIAL MEDIA ADDICTION AND DOPAMINE DRIVEN FEEDBACK . Mehmet Akif Ersoy Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi , 5 (3) , 882-897 . DOI: 10.30798/makuiibf.435845

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As we use the internet, information is being pushed onto us (ie. advertisements, etc). While it may seem as though we are in control of our own attention, other people are in fact the ones who are “hacking” our attention and using it for their own benefit. Technology is stealing our attention simply by being in our presence — by having our phone nearby, our attention automatically is lowered in comparison to if technology was not present.

In the article above, it is suggested that, due to the instant gratification given through technology and social media, perception of time has been warped and has consequentially lowered our attention span.

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Students have spent more time online this year than ever before, from online lectures and seminars to online society socials and catching up with friends over lockdown. But with revision and exam season approaching, do studies show that using technology reduces our attention span significantly? Are we so used to instant gratification that we can no longer focus on longer-term tasks?
In the past year, my screen time has increased significantly, and I have noticed myself getting distracted very easily. Sometimes it is hard to even finish an episode on Netflix without having the urge to skip to the end and inevitably, I don't have the patience to watch lectures at normal speed. There are numerous factors influencing my shrinking attention span, and it is not certain that technology is entirely to blame.

Studies have reached conflicting conclusions in response to this question. It is claimed that over-reliance on technology has shortened our attention span from twelve minutes to five minutes.

On the other hand, some academics have expressed doubt over the validity of such claims. It is stated that our attention span is dependent on the tasks we undertake, meaning the idea of an 'average attention span' is rather artificial and meaningless. Therefore, it seems there is no definite conclusion on whether technology has indeed shortened our attention span.

However, it could be argued that the instant gratification we get from using our devices has warped our perception of time. Our brains have been trained to expect almost instant results, an expectation that cannot be fulfilled consistently when we have become increasingly interconnected and therefore dependent on the actions of others.

Companies have competed for our attention through digital marketing. Websites have been crammed with adverts which have become bolder, larger and more colourful. The sight of comic sans in a word document is rather boring in comparison and it is often difficult to transition from the stimulating content within social media to the black and white pages of a textbook.

It is hard to mitigate the issue of losing focus when we are surrounded by notifications and updates, yet there are some simple measures which can help:

1. Pay attention to your screen time
You can make a personal decision on whether any changes need to be made, and then you can set realistic, measurable targets.

2. A social media detox
A typical solution, but one which could genuinely have a positive impact. Simply switch your phone off for a couple of hours and substitute the time you would have spent in front of the screen with alternative activities that may prove to be more enriching.

3. Allocating times to use social media
Rather than scrolling on your screen for an uncontrolled number of hours, save time by allocating certain times during the day when you can use social media as you please.

4. Watch longer videos or read longer posts
By doing this, you will be able to persevere when engaging with content that takes a longer time to digest. Therefore, you will get used to focusing on a particular piece for a longer period of time.

Building a PC on a student budget

Bristol based start-up leading the way in changing the gaming landscape

It particularly difficult to limit screen time when a lot of activities have been moved online, yet it is possible to use technology in a more constructive way to prevent ourselves from getting overly distracted.

Have you found your attention span shrinking this year?
Featured Image: Epigram / Jasmine Cundiff

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Is technology causing our attention-span to shrink?

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One study has shown that over-reliance on technology has shortened our attention span from twelve minutes to five minutes.

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Having your phone present decreases our attention to what is happening in the real world. Social Media platforms are competing for our attention.

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Nicholas Carr thoughts on thinking ability

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Nicholas Carr thoughts on thinking ability

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We are sacrificing the ability to determine what our minds are really thinking about. We are basically being told what our minds should be thinking about and not letting us think deeper due to an overload of information.

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An effective way to release our minds of this false and harmful info, is cutting ourselves off completely from it. We also need to take a step back and analyze what we have just read online.

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Happiness thrives when we learn more information about others and about what others think of us.

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Knowing what other people think about us boosts our happiness. Therefore, figures such as likes and follows are correlated with boosts in our dopamine.

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We have a desire to know everything—having the world at your fingertips makes delayed gratification a useless thing of the past.
Dopamine is released when we learn new info—pulling out your phone is almost an automatic response at this point.

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by Trevor Haynes figures by Rebecca Clements
"I feel tremendous guilt," admitted Chamath Palihapitiya, former Vice President of User Growth at Facebook, to an audience of Stanford students. He was responding to a question about his involvement in exploiting consumer behavior. "The short-term, dopamine-driven feedback loops that we have created are destroying how society works," he explained. In Palihapitiya's talk, he highlighted something most of us know but few really appreciate: smartphones and the social media platforms they support are turning us into bona fide addicts. While it's easy to dismiss this claim as hyperbole, platforms like Facebook, Snapchat, and Instagram leverage the very same neural circuitry used by slot machines and cocaine to keep us using their products as much as possible. Taking a closer look at the underlying science may give you pause the next time you feel your pocket buzz.

Never Alone

If you've ever misplaced your phone, you may have experienced a mild state of panic until it's been found. About 73% of people claim to experience this unique flavor of anxiety, which makes sense when you consider that adults in the US spend an average of 2-4 hours per day tapping, typing, and swiping on their devices-that adds up to over 2,600 daily touches. Most of us have become so intimately entwined with our digital lives that we sometimes feel our phones vibrating in our pockets when they aren't even there.

While there is nothing inherently addictive about smartphones themselves, the true drivers of our attachments to these devices are the hyper-social environments they provide. Thanks to the likes of Facebook, Snapchat, Instagram, and others, smartphones allow us to carry immense social environments in our pockets through every waking moment of our lives. Though humans have evolved to be social-a key feature to our success as a species-the social structures in which we thrive tend to contain about 150 individuals. This number is orders of magnitude smaller than the 2 billion potential connections we carry around in our pockets today. There is no doubt that smartphones provide immense benefit to society, but their cost is becoming more and more apparent. Studies are beginning to show links between smartphone usage and increased levels of anxiety and depression, poor sleep quality, and increased risk of car injury or death. Many of us wish we spent less time on our phones but find it incredibly difficult to disconnect. Why are our smartphones so hard to ignore?

The Levers in Our Brains - Dopamine and social reward

Dopamine is a chemical produced by our brains that plays a starring role in motivating behavior. It gets released when we take a bite of delicious food, when we have sex, after we exercise, and, importantly, when we have successful social interactions. In an evolutionary context, it rewards us for beneficial behaviors and motivates us to repeat them.

The human brain contains four major dopamine "pathways," or connections between different parts of the brain that act as highways for chemical messages called neurotransmitters. Each pathway has its own associated cognitive and motor (movement) processes. Three of these pathways-the mesocortical, mesolimbic, and nigrostriatal pathways-are considered our "reward pathways" and have been shown to be dysfunctional in most cases of addiction. They are responsible for the release of dopamine in various parts of the brain, which shapes the activity of those areas. The fourth, the tuberoinfundibular pathway, regulates the release of a hormone called prolactin that is required for milk production.

While the reward pathways () are distinct in their anatomical organization, all three become active when anticipating or experiencing rewarding events. In particular, they reinforce the association between a particular stimulus or sequence of behaviors and the feel-good reward that follows. Every time a response to a stimulus results in a reward, these associations become stronger through a process called long-term potentiation. This process strengthens frequently used connections between brain cells called neurons by increasing the intensity at which they respond to particular stimuli.

Although not as intense as hit of cocaine, positive social stimuli will similarly result in a release of dopamine, reinforcing whatever behavior preceded it. Cognitive neuroscientists have shown that rewarding social stimuli-laughing faces, positive recognition by our peers, messages from loved ones-activate the same dopaminergic reward pathways. Smartphones have provided us with a virtually unlimited supply of social stimuli, both positive and negative. Every notification, whether it's a text message, a "like" on Instagram, or a Facebook notification, has the potential to be a positive social stimulus and dopamine influx.

The Hands that Pull - Reward prediction errors and variable reward schedules

Because most social media platforms are free, they rely on revenue from advertisers to make a profit. This system works for everyone involved at first glance, but it has created an arms race for your attention and time. Ultimately, the winners of this arms race will be those who best use their product to exploit the features of the brain's reward systems.

Reward prediction errors

Research in reward learning and addiction have recently focused on a feature of our dopamine neurons called reward prediction error (RPE) encoding. These prediction errors serve as dopamine-mediated feedback signals in our brains (). This neurological feature is something casino owners have used to their advantage for years. If you've ever played slots, you'll have experienced the intense anticipation while those wheels are turning-the moments between the lever pull and the outcome provide time for our dopamine neurons to increase their activity, creating a rewarding feeling just by playing the game. It would be no fun otherwise. But as negative outcomes accumulate, the loss of dopamine activity encourages us to disengage. Thus, a balance between positive and negative outcomes must be maintained in order to keep our brains engaged.

Variable reward schedules

How do social media apps take advantage of this dopamine-driven learning strategy? Similar to slot machines, many apps implement a reward pattern optimized to keep you engaged as much as possible. Variable reward schedules were introduced by psychologist B.F. Skinner in the 1930's. In his experiments, he found that mice respond most frequently to reward-associated stimuli when the reward was administered after a varying number of responses, precluding the animal's ability to predict when they would be rewarded. Humans are no different; if we perceive a reward to be delivered at random, and if checking for the reward comes at little cost, we end up checking habitually ( e.g. gambling addiction). If you pay attention, you might find yourself checking your phone at the slightest feeling of boredom, purely out of habit. Programmers work very hard behind the screens to keep you doing exactly that.

The Battle for Your Time

If you've been a Facebook user for more than a few years, you've probably noticed that the site has been expanding its criteria for notifications. When you first join Facebook, your notification center revolves around the initial set of connections you make, creating that crucial link between notification and social reward. But as you use Facebook more and begin interacting with various groups, events, and artists, that notification center will also become more active. After a while, you'll be able to open the app at any time and reasonably expect to be rewarded. When paired with the low cost of checking your phone, you have a pretty strong incentive to check in whenever you can.

Other examples highlight a more deliberate effort to monopolize your time. Consider Instagram's implementation of a variable-ratio reward schedule. As explained in this 60 Minutes interview, Instagram's notification algorithms will sometimes withhold "likes" on your photos to deliver them in larger bursts. So when you make your post, you may be disappointed to find less responses than you expected, only to receive them in a larger bunch later on. Your dopamine centers have been primed by those initial negative outcomes to respond robustly to the sudden influx of social appraisal. This use of a variable reward schedule takes advantage of our dopamine-driven desire for social validation, and it optimizes the balance of negative and positive feedback signals until we've become habitual users.

Question Your Habits
Trevor Haynes is a research technician in the Department of Neurobiology at Harvard Medical School.
Smartphones and social media apps aren't going anywhere anytime soon, so it is up to us as the users to decide how much of our time we want to dedicate to them. Unless the advertisement-based profit model changes, companies like Facebook will continue to do everything they can to keep your eyes glued to the screen as often as possible. And by using algorithms to leverage our dopamine-driven reward circuitry, they stack the cards-and our brains-against us. But if you want to spend less time on your phone, there are a variety strategies to achieve success. Doing things like disabling your notifications for social media apps and keeping your display in black and white will reduce your phone's ability to grab and hold your attention. Above all, mindful use of the technology is the best tool you have. So the next time you pick up your phone to check Facebook, you might ask yourself, "Is this really worth my time?"

For more information:

Tips for building a healthier relationship with your phone

A list of stories from NPR about smartphone addiction

A high-level primer on dopamine and how it affects your brain, body, and mood

An updated overview of trends in screen addiction, including the impact of COVID-19

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Dopamine, Smartphones & You: A battle for your time - Science in the News

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by Trevor Haynes figures by Rebecca Clements "I feel tremendous guilt," admitted Chamath Palihapitiya, former Vice President of User Growth at Facebook, to an audience of Stanford students. He was responding to a question about his involvement in exploiting consumer behavior. "The short-term, dopamine-driven feedback loops that we have created are destroying how society works," he explained.

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Dangers of Dopamine (Nicholas Carr inspired) 

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Dangers of Dopamine (Nicholas Carr inspired) 

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Just like tobacco and alcohol use, screen time can become an addiction that can damage your health and relationships if it's not kept it check.

"Screen addiction is a group of behaviors that are negative, some negative outcomes, that can happen when we use too much technology during our day," says Kathryn Lorenz, MD. "Prolonged use of watching TV, video games, scrolling through social media - all of that use acts like a digital drug for our brain."

Screen use releases dopamine in the brain, which can negatively affect impulse control. Dr. Lorenz says studies have shown screen time affects the frontal cortex of the brain, similar to the effect of cocaine.

Similar to drugs, screen time sets off a pleasure/reward cycle that can have a negative impact of your life.

Screen Time and Kids

Screen time recommendations for children have shifted over the years. The most recent recommendations set these limits:

Up to 6 months old: no screen time

6 months to 2 years old: use screen time only for interactive social play with an adult or to video chat with loved ones

2 to 5 years old: no more than one hour of screen time

School-aged kids: no set time limit, but parents should limit social media use and gaming

"We want to still encourage an hour a day at least of physical activity," Dr. Lorenz says. She recommends face-to-face play with other kids, reading books, playing non-video games, playing with toys, and learning life skills, like cooking with parents - all without screens.

"If our children are relying on screens for their entertainment, that could be a warning sign that they're addicted to screens," Dr. Lorenz says. "If there's a struggle over stopping screen use, that's usually a warning sign that they're fairly addicted to it and their brains are really craving it." Another concern, she says, is when children routinely choose screens over books, non-video games, and toys that they used to play with.

Increased aggressive behavior can also be a sign of screen time addiction in kids, especially in children younger than 6 who can't yet tell the difference between reality and what's virtual.

Set a Good Example

Part of limiting kids' screen time is setting a good example as a parent.

Dr. Lorenz recommends monitoring and limiting your own screen usage. She adds, "Don't have TV on in the background, behind all of our activities. If I do that my kids are staring off between questions of their homework. So, model turning the TV off."

Long-term Effects

In children, effects of screen addiction may include:

Speech delay

Cognitive impairment

Difficulty with problem-solving and creative thinking

Cyber bullying and exposure to predators

Body weight issues and poor bone health due to lack of physical activity, which later in life can add up to heart disease and other health conditions

Depression and anxiety

Being Involved in Your Kids' Screen Time

Lorenz recommends that parents set screen time limits with their kids. And she advises staying involved in your kids' screen use. This gives you the opportunity to teach what is appropriate and what to avoid.

"We can certainly play video games with our kids so we know what's actually in the content of them, because not all of the ratings equate to what we think our kids should really be viewing."

She says, "Interacting with your kids (including during screen time) is going to make them more likely to talk to you, to tell you what they've learned from the internet or from their games."

Click play to watch the video or read video transcript.

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Screen Addiction Affects Physical and Mental Health | Premier Health

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Spending too much time staring at screens can have negative effects on your physical and mental health, Dr. Kathryn Lorenz advises. Learn more!

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According to carr's ted talk, Dopamine is released in our brains when we seek out information on our cell phones.  This is the same chemical that is released when we use drugs. It is what encourages us to do something over and over again.;

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"we have deep instincts to go out and gather as much information as possible"

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"We have this desire deep in our biology to know what is going on around us."

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Creators protect their own family than others from tech the make. 

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Creators protect their own family than others from tech the make. 

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For example, Chamath Palihapitiya ( former VP of user growth at Facebook) doesn’t allow his own kids to use tech.

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Impacts of Social Media Addiction for the Mind

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Impacts of Social Media Addiction for the Mind

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The augmentation hypothesis describes the internet has its own existing social capital offline. Receiving and giving social support that the user can recognize as positive effects. A really great way to hook someone into an addiction.
The displacement hypothesis lies in opposition to the augmentation hypothesis; internet use diminishes offline social capital. This creates negative side effects for the human behind the user.
Social media cannot replace face to face contact as a means of gaining social capital. The internet is a subjective source, and feeds the user what their mutuals and what they desire to see. This is interpreted as the addiction, and disturbs the user’s overall mental health.
In the journal article below by Glaser et al., “Results showed that social media use for networking's relationship with anxiety and depression was mediated by both offline social capital and internet addiction. Anxiety and depression were lower when mediated by offline social capital, and higher when mediated by internet addiction, (Glaser et al., 2018).” When users engaged in face to face offline contact, levels of anxiety, stress, and depression were augmented by addiction to social media.

It’s in a balance between offline and online interaction. Our ability to use new media in this generation is new, but with the future and present comes the ability for it to harm us in ways the user does not notice. It is a privilege to use the internet, so use it responsibly.
Cyprian Dove, 2023

Citations:

Glaser, P., Liu, J. H., Hakim, M. A., Vilar, R., & Zhang, R. (2018). Is Social Media Use for Networking Positive or Negative? Offline Social Capital and Internet Addiction as Mediators for the Relationship between Social Media Use and Mental Health. New Zealand Journal of Psychology, ⁴⁷(3), 12+. https://link-gale-com.wv-o-ursus-proxy02.ursus.maine.edu/apps/doc/A568973088/HRCA?u=maine_orono&sid=summon&xid=cd763b19

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Study Finds Fake News Spreads Faster Than Real News on Twitter

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Study Finds Fake News Spreads Faster Than Real News on Twitter

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Massachusetts Institute of Technology’s (MIT) recent research, ... delved into 126,000 stories tweeted by around 3 million accounts from 2006 to 2017. The researchers, Soroush Vosoughi, Deb Roy, and Sinan Aral, found that fake news stories spread faster and were more likely to be retweeted than true stories. Fake news cascade down to between 1,000 and 100,000 Twitter users. True or verified stories, however, take six times longer to reach 1,500 people. They also note that fake news was frequently retweeted more by humans than bots.

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Study Finds Fake News Spreads Faster Than Real News on Twitter - Noticias de seguridad

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MIT’s recent research delved into 126,000 stories tweeted by around 3 million accounts from 2006 to 2017 and found that fake news spread faster and were more likely to be retweeted than true stories.

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Children are showing incapability of delayed gratification. Due to small amounts of dopamine hits people receive every few seconds with phone notifications, they don't have a reason to pursue delayed gratification.

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Dr. Bavelier: (Disclosure: Dr. Bavelier is a scientific advisor to Akili Interactive and Red Bull, and also has relationships with Riot Games and Logitech.)

Content, context, and delivery interfaces matter. So do features of the interaction. A recent study by Rich Meyer compared classroom learning through normal computer interaction and through a VR headset. The VR interaction produced much more engagement, but less learning. We need to match the technologies we use to the outcomes we seek. Even among video games, different games have different effects.

A meta-analysis has been performed on research regarding how voluntarily playing first- and third-person shooter games - action video games - impacts cognition. Habitual action video game players showed about a one-half standard deviation improvement in cognition over those who don't generally play a lot of video games. In training studies, if you force subjects to play an action game, and compare them to a control group playing an active control game, there is also positive cognitive effect. It is a smaller effect (about a third of a standard deviation), but still better than those produced by most interventions.

Action video game play changes the top-down frontoparietal network of attention. This network becomes more efficient in the service of switching or maintaining attention depending on the task goals. No one game component seems responsible for producing this effect. It seems to come from the combined effect of multiple game components. When it comes to learning and brain plasticity, game components fall into two main categories. First, enabling factors or shared factors across video games that facilitate learning, including variable entry learning; incremental learning; reward (rather than punishment); building self-mastery and self-confidence; and motivation and arousal. Second, what we term action factors: pacing (making decisions under time constraints ); load on divided attention (such a dynamic, multi-target display); flexible shift of focus; need for prediction and error monitoring; and a rich environment that prevent automatization. Layering these game elements in the right way within an educational video game explains why it is so hard to create a good video game.

Delayed gratification is one subdomain of cognition. There is some correlational evidence that our digital media habits are producing a society (and more particularly, a society of children) incapable of delayed gratification. They are immediacy-oriented and unable to plan for the future. A lab study combined objective measures of smartphone use time and subjective reports of smart phone checking and weekly minutes on social media. Heavier phone users were more likely to discount the value of a reward over time.

Neuroimaging is being used to look for the mechanisms behind this pattern. It has revealed both that time spent using media correlates positively with certain specific neurological characteristics, and correlates negatively with others. There is not, however, any reliable evidence on directionality. We don't know if media behaviors are changing our inclination to hold out for larger, later rewards, or whether our pre-existing preference for near-term rewards is leading us to engage more with media.

Memory is another area of concern. There is compelling, and even causally compelling, evidence that while we are engaged with digital media technologies, we are less able to form memories of experiences. For example, the Betsy Sparrow labs study in Science showed that when people were handed information, but knew that they could access it on a computer later, they tended to remember the information's location but not its content. This has been described as "digital amnesia" or "the Google Effect". Other research shows that people who rely on GPS systems tend not to form very strong cognitive maps or learn the routes they follow. Another study found that people who toured a museum and took pictures of certain objects remembered those objects less well than the ones they saw only with their eyes. Despite these examples of an acute effect, there is no evidence that digital media use causes deficits in working memory or long-term memory.

Some claim that digital media use may adversely impact attention. At least in specific cases, evidence suggests that the opposite is true. Some video game literature supports this contention. Research on training and multi-tasking indicates that subjecting someone to multi-task training can generalize to broader attentional performance. Several labs have explored the use of computerized tasks to teach people how to hold information in the face of interference. On the other side of this argument, there is correlational (and thus, non-causal) evidence that heavy media multitaskers perform less well on attentional tasks.
Dr. Lee: Attention deficit hyperactivity disorder ("ADHD") consists of both naturally occurring individual differences and hyperactivity and impulsivity. More broadly, it is the latent construct reflected by the nine symptoms of inattention and nine symptoms of hyperactivity with which it is conventionally associated. It is best conceptualized as a continuum (across which genetic and environmental influences operative continuously). The disorder of ADHD is the quantitative extreme of this latent construct. That being said, there are important decisions (for example, about clinical services and educational accommodations) that are contingent upon a categorical diagnosis being made. Risk factors in this area must reflect both the dimensional and categorical perspectives.
A small, but important, meta-analysis in developmental psychology showed positive correlations between digital media usage and attention problems, and a smaller correlation with impulsivity in particular. Longitudinal studies produced smaller effect sizes than cross-sectional ones. Studies included in the meta-analysis also varied substantially with respect to sample, the use of co-variants, and other methodological attributes. Nevertheless, this is a benchmark in the literature.

In a recent study of about 150 high-risk adolescents with at least one symptom of DSM-4 conduct disorder, digital media usage was inversely associated with anxiety and depression, and positively associated with ADHD and conduct problems. (Baseline digital media usage predicted conduct and poor self-regulation, but not ADHD specifically.) The effects were small, but significant. Note, however, that the findings were very time-sensitive. Detailed scrutiny is needed to understand the specific findings with respect to concurrent effects, effects occurring within a short period of time after digital media usage, and longer-term predictions.

Another recent study used data from about 2500 high school students in metropolitan Los Angeles to look at the prospective association between digital media usage and adolescents' self-reported ADHD. Any student who satisfied the diagnostic criteria for ADHD was excluded from the study. Of the 2500 initial study subjects, 2300 were followed for 24 months.

In that study, the participants were asked to describe their digital media usage in terms of 14 different behaviors. Their responses generated a score that reflected the frequency of each of those behaviors. The study was controlled for youth depression, delinquency, and family history of substance abuse. Various methodological limitations (reliance on self-reporting, absence of parent interviews, lack of norms for rating scales) limited the predictive power of the story. It could not predict whether a student without ADHD would develop it. It could, however, predict a discrete outcome: whether an adolescent would self-report six or more symptoms of inattention and/or six or more symptoms of hyperactivity and impulsivity. High-frequency digital usage did positively predict positive ADHD symptom criteria status. It also predicted the number of ADHD symptoms and their severity.

This field needs greater methodological diversity. It needs to identify likely causal mechanisms and plausible mediators the underlie cross-time predictions. Only then can we directly answer the question of whether the things that digital media does to children may be causing ADHD.

Dr. Baumgartner: In a 2009 study, twenty Stanford students who were identified as high media multi-taskers performed worse on various cognitive tasks than their low media multi-tasker counterparts. This proved nothing about causation. It only identified the fact that media multitasking is related to cognitive problems. It could be that people who already had particular cognitive problems are more likely to be media multitaskers .

A recent meta-analysis tried to replicate the findings of the 2009 study. It found a small effect between media multitasking and some (but not all) specific cognitive processing styles; that is, potential cognitive disadvantages for some tasks, but not for others. Some studies actually have shown positive effects. None of them indicated anything about causality.

A longitudinal study of almost 1500 Dutch adolescents (ages 12-15) tried to do just that. Researchers assessed study participants three times in the course of one year. Cross-sectional analysis basically supported previous studies. Adolescents who multitask have more attention problems, experience more distraction in academic contexts, and perform worse academically. They also had more self-reported sleep problems. As to the longitudinal dimension of the study, the central question was whether media multitasking would lead to an increase or decrease in problems. A very small longitudinal effect appeared with respect to distractibility (but not grades, and only among early adolescents ages 12-13). There was also a small adverse longitudinal effect on sleep, too, but only among early adolescent girls.
So, multiple studies provide compelling evidence of mostly negative associations between media multitasking and a wide variety of attention and cognitive processes. They establish nothing about causation. We must look at different content, media types, and outcome variables in our search for causal connections. We also must look at specific individuals, because the phenomena we study are developmentally sensitive.
Dr. Cain: Does this field's broad reliance on self-reporting have an effect on what researchers are able to see?

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The Relationship Between Cognition and Media Behavior - Children and Screens

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The Relationship Between Cognition and Media Behavior October 17, 2018 ModeratorMatthew Cain, PhD Research Psychologist, U.S. Army Natick Soldier Research, Development, & Engineering Center; Visiting scientist in the Gabrieli Lab, MIT Department of Brain and Cognitive Sciences Susanne Baumgartner, PhD Assistant Professor and Researcher, Amsterdam School of Communication Research, ASCoR, Center for Research on Children, Adolescents, and the Media, University of AmsterdamDaphne ...

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Tech Leaders are more strict than others when it comes to technology.

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Tech Leaders are more strict than others when it comes to technology.

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Tony Fadell, inventor of the iPod, said" We’ve unleashed a beast, but there’s a lot of unintended consequences" stating that these leaders don't know the long-term effect these technologies will have on us. What concerns me is how cautious they are with their own families and yet, when they are at work their mindset shifts and they only think about how they can profit and keep people addicted.

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Creators are willing to harm others for profit

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Creators are willing to harm others for profit

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Certain creations have an impact on people, and the creators of these creations know about it, yet continue to market and sell their products. The point of a creation is obviously to make profit, but it is also to have a positive effect on individuals. A lot of creations have had a negative impact, which can sometimes be hard to see, that the creator knows about, an example being Steve Jobs of Apple, who limited the amount of time his kids could use technology, even though he created a major piece of it.

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Online Ad Targeting Using Racial Stereotypes

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Online Ad Targeting Using Racial Stereotypes

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Reportedly 92% of ads that appeared when searching for a black identified name on google mentioned the word "arrest." Compare that to 80% of ads for white identified names.

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Over 10,000 twitter users were actively involved and spreading hate towards a specific group of female game developers thanks to twitter's trending feature. The if the algorithm sees that enough people are tweeting about the same thing it will add that topic to the trending page. If its something positive, its a good thing. But something like gamergate makes this feature an easy way for people with the same bad ideas to communicate and spread hate.

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The Next Generations

From developmental delays to suicide, children face a host of physical, mental and social challenges

Evidence

Making Sense of the World

Misinformation, conspiracy theories, and fake news

Evidence

Attention and Cognition

Loss of crucial abilities including memory and focus

Evidence

The level of social media use on a given day is linked to a significant correlated increase in memory failure the next day. Assessing nearly 800 people aged 25-75, research showed similar effects irrespective of age and of the user's memory levels on previous days. These effects occur in one direction only: levels of social media use predict later memory failure, but levels of memory failure do not predict social media use on subsequent days.

Our memory systems automatically prioritize superficial social text over more complex forms of text. For example, after reading news online, people are significantly better at remembering other readers' comments rather than sentences from the article itself or even its headline; this is in part due to the social ("gossipy") nature of posted comments. Similarly, users remember Facebook posts significantly better than sentences from a book or even human faces, on the same scale as the memory difference between amnesics and non-amnesics.

A meta-analysis of several dozen research studies indicates that higher levels of switching between different media channels is significantly linked to lower levels of both working memory and long-term memory. Given the current Extractive Attention Economy, and the increasing number of social media platforms and apps competing to capture our attention, basic human capacities - such as our memories - are increasingly under attack.

Physical and Mental Health

Stress, loneliness, feelings of addiction, and increased risky health behavior

Evidence

of 18-44 year olds feel anxious if they haven't checked Facebook in the last 2 hours, according to a recent survey of over 2,000 American adults that indicates a high incidence of potential Facebook addiction warning signs. In fact, many are so hooked that 31% report checking it while driving and 16% while making love.

away from Facebook leads to a significant improvement in emotional well-being. In an experimental study of over 1,600 American adults (who normally used Facebook for up to an hour each day), deactivating Facebook accounts led to a significant increase in emotional well-being (including a reduction in loneliness and an increase in happiness), as well as a significant reduction in political polarization.

Social Relationships

Less empathy, more confusion and misinterpretation

Evidence

Politics and Elections

Propaganda, distorted dialogue & a disrupted democratic process

Evidence

pieces of disinformation were slipping through daily on Facebook and less than 5% of hate speech was being deleted, a few weeks ahead of the Capitol attacks, according to staff leaving the company. Raising this and similar issues, at least 4 members of Facebook's integrity team resigned between May and December 2020, stating "it's an embarrassment to work here".

Spaniards are estimated to have received disinformation and hate speech via WhatsApp ahead of the 2019 national elections, with WhatsApp delivering more disinformation and hate speech than Twitter, YouTube, & Instagram combined, and almost as much as that spread by Facebook.

Americans were reached by Russian propaganda posts on Facebook during the 2016 US elections, according to Facebook's estimates.

Systemic Oppression

Amplification of racism, sexism, homophobia and ableism

Evidence

of the most shared Facebook posts about Black Lives Matter in June 2020 were critical of the movement, despite the fact that the majority of Americans support BLM, according to research by data analysis company CrowdTangle. Such fake representations of public opinion can play a significant role in distorting the basis for democratic dialogue and diminishing the momentum for social change. Even as societies take action to challenge racism and other forms of systemic oppression, social media platforms are being hijacked to discourage or even deny change.

Twitter users were actively involved in Gamergate at its peak, with the hashtag #Gamergate being tweeted hundreds of thousands of times per month, mostly supporting the campaign of abuse and violent threats against specific female game designers and those who spoke up to support them. Gamergate played out primarily on Twitter, whose platform design and administration, according to researchers, make the platform particularly adaptable for online abuse- due to the highly public nature of tweets, the potential for mass targeting of individuals, and the fact that abusive responses can't be removed.

Do Unto Others

Many people who work for tech companies - and even the CEOs - limit tech usage in their own homes

Evidence

WOULD YOU RECOMMEND THIS LEDGER TO A FRIEND OR COLLEAGUE? YES NO

Have a study, article, or correction to contribute?

The goal of the Ledger of Harms is to list compelling studies and articles that show clear effects, documented by relatively unbiased researchers and writers. If there's a key study or article missing, or if you see methodological problems with anything listed here, please let us know via the link below. We will update this page if the new information passes our review process.

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From developmental delays to suicide, children face a host of physical, mental and social challenges Evidence Misinformation, conspiracy theories, and fake news Evidence Loss of crucial abilities including memory and focus The level of social media use on a given day is linked to a significant correlated increase in memory failure the next day.

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Bassam Al-Naami, Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing, 1,* Bashar E. A. Badr, Methodology, Software, Validation, Writing - original draft, ² Yahia Z. Rawash, ¹ Hamza Abu Owida, Investigation, Methodology, Writing - review & editing, ³ Roberto De Fazio, Conceptualization, Funding acquisition, Supervision, Validation, Writing - original draft, Writing - review & editing, 4,* and Paolo Visconti, Formal analysis, Funding acquisition, Supervision, Validation, Writing - review & editing ⁴

Giuseppe Placidi, Academic Editor, Mrinal Mandal, Academic Editor, and Mustapha Bouhrara, Academic Editor

Abstract

The prevalence of neck pain, a chronic musculoskeletal disease, has significantly increased due to the uncontrollable use of social media (SM) devices. The use of SM devices by younger generations increased enormously during the COVID-19 pandemic, being-in some cases-the only possibility for maintaining interpersonal, social, and friendship relationships. This study aimed to predict the occurrence of neck pain and its correlation with the intensive use of SM devices. It is based on nine quantitative parameters extracted from the retrospective X-ray images. The three parameters related to angle_1 (i.e., the angle between the global horizontal and the vector pointing from C7 vertebra to the occipito-cervical joint), angle_2 (i.e., the angle between the global horizontal and the vector pointing from C1 vertebra to the occipito-cervical joint), and the area between them were measured from the shape of the neck vertebrae, while the rest of the parameters were extracted from the images using the gray-level co-occurrence matrix (GLCM). In addition, the users' ages and the duration of the SM usage (H.mean) were also considered. The decision tree (DT) machine-learning algorithm was employed to predict the abnormal cases (painful subjects) against the normal ones (no pain). The results showed that angle_1, area, and the image contrast significantly increased statistically with the time of SM-device usage, precisely in the range of 2 to 9 h. The DT showed a promising result demonstrated by classification accuracy and F1-scores of 94% and 0.95, respectively. Our findings confirmed that the objectively detected parameters, which elucidate the negative impacts of SM-device usage on neck pain, can be predicted by DT machine learning.

Keywords: social media usage, smartphones, neck pain, GLCM, decision tree algorithm

1. Introduction

Many social media (SM) users enjoy using many smartphone applications in everyday life and are linked in for a long time to social media such as Facebook, Twitter, LinkedIn, Instagram, Snapchat, Tik Tok, Pinterest, Reddit, YouTube, and WhatsApp. During the browsing routine, users tend to lower their heads and place the smartphone device close to their waist or lap while travelling, such as in a car, bus, or subway train. Using a smartphone for a long time in such a posture will cause a strained spine, neck, and eye fatigue.

Daily, worldwide social media usage in the years 2012-2020 has already been published by the Statista Research Department [ 1] and the World Health Organization (WHO) [ 2]. Considering the years 2019 and 2020, the average, daily, worldwide social media usage by smartphones and internet users was 145 min per day in 2020, which was up from 142 min in the previous year. Currently, the country with the most time spent daily on social media is the Philippines, with online smartphone users spending an average of three hours and fifty-three minutes daily on social media. For comparison, the daily time spent on social media in the United States (US) was just two hours and three minutes.

Currently, the global social network penetration rate is nearly 54%. Western Europe has the highest social media penetration rate at 79%, topping the global social media usage by region; Eastern and middle Africa close the ranking with 10% and 8% usage, respectively [ 3]. People access social media for a variety of reasons. Users like to find funny or entertaining content and enjoy sharing photos and videos with friends, but they mainly use social media to stay in touch with current events and friends.

Social media profoundly affects smartphone use, interpersonal relationships, and everyday life. According to an online survey conducted in February 2019, social media has improved access to information, ease of communication, and freedom of expression. On the other hand, some respondents also reported that social media had negatively affected their privacy, increased their political polarization, and heightened daily distractions [ 4]. Social media has such a large global impact on daily life that many internet and smartphone users believe that social media platforms have strongly affected certain aspects of daily life. In this survey, 44% of respondents stated that social media platforms have led to increased political polarization [ 5, 6].

The COVID-19 pandemic has involved the entire world population, putting a strain on national health systems and profoundly changing our lifestyles. Specifically, technology made it possible to carry out essential services required by the population (teaching, communications, public administration, etc.) and support health systems during the pandemic. In this context, wearable devices represent powerful tools for gathering information related to the user's condition directly from home. These tools were widely employed during the COVID-19 pandemic to avoid the overload of health systems [ 7, 8].

Few studies show a statistical analysis, a model or index relating to the use of SM, the ages and real usage times of users, and how these factors are linked to the onset of pain or pathologies in the neck. Most studies linking neck pain to social media use are statistical questionnaires based on many questions that are addressed to social media users and cross-sectional surveys. A significant study that related SM usage, users' ages, and neck pain to a certain index or model was presented by H. Yang et al. [ 9]. This study explored the researcher's predictive relationship of social media on smartphone use to body esteem in female adolescents and the mechanism underlying these relations. A cognitive-affective framework was investigated, and the relationship between the SM and smartphone use and body esteem was determined by the cognitive internalization of an ideal body image, own aspect comparisons, and social-appearance anxiety. A sample of ( N = 100) female adolescents aged 13 to 18 was studied. The results were as follows: repetitive SM use tended to cause unhealthy body esteem via intensified cognitive internalization, which triggers appearance comparisons and anxiety regarding negative appearance evaluation. In addition, the time spent in front of the smartphone screen negatively affected the body estimate. This study underestimated the multifactor mechanism that explains the negative impacts of social media and smartphone activities on body esteem in female adolescents who will have low body esteem in the future [ 10].

An example of neck-pain distribution caused by different factors, including worldwide SM usage, is provided below. A total of 15% of the adult population in Brazil, 4% in China, 20% in the European Union, 5% in Japan, 12% in Russia, and 24% in the US had been diagnosed with a neck pain condition. Moreover, neck pain has an annual prevalence rate exceeding 30% among adults in the US; nearly 50% of individuals will continue to experience chronic neck pain or frequent occurrences. Among adults, between 20% and 70% will experience neck pain that interferes with their daily activities during their lifetime [ 11, 12]. In 1995, the US Department of Defense issued a guideline on the use of computers and tablets in military settings. They recommended that hand-held equipment should not weigh more than 2.3 kg; should be small enough to be held and operated with one hand; and should be no larger than 100 mm high, 255 mm long, and 125 mm wide [ 13].

Many questions may arise as a result of the reported studies. One of these questions is: Is there any quantitative approach among the subjective-basis approaches to predict muscles' neck pain associated with SM technology usage? Second, what qualitative basis (criteria) or measurable parameters may enable us to build a new formula or rule to describe or predict the neck pain that may occur? Holding a smartphone device to browse applications and SM at a close distance will cause headaches and eye strain problems. To avoid these health risks and consequences, SM users must use the smartphone device at eye level, change their posture continually, keep an appropriate viewing distance, and reduce the use time of the smartphone device. Some smartphone users do not pay enough attention to their posture while using a smart device.

This research therefore attempts to find an approach or a quantitative method for studying the effect of using SM (i.e., with mini displays) on neck pain and avoiding muscle fatigue with future use. The proposed method uses:

1. The extracted features from X-ray retrospective images using the gray level co-occurrence matrix (GLCM);

2. The two angles measured, and the related area controlled by these angles according to the inclination of the neck vertebrae for normal and abnormal cases (i.e., patients with perceived neck pain);

3. Information about the SM-usage period in hours correlated with the users' ages. Nine inputs or information were provided to the decision tree (DT) to predict the conditions that may lead to muscle fatigue or produce neck pain;

4. The DT classifier (provided by the Weka package, University of Waikato, New Zealand) can reduce the bias (noise) produced by unbalanced samples. The final phase of this framework is a new, predictive mathematical model utilizing a gene-expression programming (GEP) tool to define the class (normal or abnormal) to which each patient belongs using a MATLAB-based, graphical user interface to support the orthopedic doctor.

Related Works

The impact of SM usage on neck pain prevalence during the spread of COVID-19 pandemic has been reported in many survey-based studies [ 14, 15, 16, 17, 18].

Access to working at home and distance learning were the most significant factors that imposed neck and shoulder pain. For example, the study reported in Ref. [ 14] on a sample of 26126 students confirmed neck pain occurrence. In particular, this study aimed to demonstrate the prevalence of neck pain, mainly in medical students, that could be ascribed to electronic device usage during the COVID-19 pandemic. Most students reported a rise in neck aches; the majority noted an increase in neck aches ( n = 1002-72.3%), whereas n = 384 (equal to 26.7%) students indicated the same pain before and during the pandemic. Another work (Ref. [ 15]) focused on the study of the home use of smartphones in 1045 participants in whom neck-pain symptoms appeared. Demographic and descriptive analyses, a Pearson correlation analysis, reliability tests, and a linear regression analysis were used to process the questionnaire data. The obtained results revealed no correlation between the selected variables; namely, e-learning, online classes, physical fitness, and body pain; and the time spent with smartphones. However, the collected data were affected by personal perception.

In a survey of 2044 Italian students conducted before and after the COVID pandemic, 43.5% of students reported neck pain and 33.5% had lower-back disease [ 16]. The obtained results demonstrated that musculoskeletal pain in young students could be ascribed to the reduction in physical activity during the COVID-19 lockdown. In a questionnaire study, 129 computer users were asked about functional disability [ 17]. It was found that 42.9% had neck and upper back pain. In addition, some participants had mild, moderate, and severe functional limitations due to neck and back pain occurrences. This study increased the awareness of having a correct, ergonomic work space. Similarly, in [ 19], the authors investigated a possible correlation between back pain and COVID-19 infection by analyzing different scientific works presented in the literature. They identified neurological damages induced by disease as a factor of post-COVID-19 chronic pain syndrome. Particularly, the same receptors mediating the access of SARS-CoV-2 into the respiratory systems were present in the neural tissues, thus attributing post-COVID joint pain to neurologic implications due to infection [ 20].

The alterations to the neurologic system caused by COVID-19 infection are not well understood. However, their effects are evident, such as chronic aches and altered pain sensibilities. Additionally, the extended lockdown periods-actuated to limit the pandemic spread-have exposed the population to risk factors that lead to neck pain mainly due to the prolonged use of electronic devices such as smartphones and tablets [ 21]. Indeed, the limited display size induces head and neck flexion, causing a postural alteration and resulting in the dysfunction of muscular activity and increasing the cervical load. Several studies have demonstrated a direct correlation between musculoskeletal pain, the number of hours of electronic device usage, and the positive impact of physical exercise on the user's condition. In particular, the prevalence of neck pain was significantly related to age, sex, health status, job satisfaction, and length of employment. In addition, an increased sedentary lifestyle and incorrect posture appear to promote the onset of musculoskeletal disorders [ 22]. The main prevention strategies for avoiding these consequences are: reducing smartphone usage time, maintaining correct posture, performing exercise regularly, and teaching healthy habits. In addition to the posture issues, psychological stress is also a cause of neck pain, especially for students and teachers [ 23, 24]. In Ref. [ 25], the authors investigated the lockdown effect on psychological stress and neck pain (NP). They studied a population of 265 college students by submitting to them a questionnaire related to sociodemographic features, the neck disability index (NDI), self-perceived stress, the visual analogue scale (VAS), and neck pain (NP) frequency. The results demonstrated that 35.6% of students suffered from mild NP impairment during the lockdown, a higher occurrence than before. Students expressed moderate self-perceived stress, whereas 59.3% reported study-related stress. Higher rates of self-perceived, study-related stress, sitting for more than 3 h per day, and a higher VAS score were linked to an increased risk of an NDI ≥ 15 (Nagelkerke's R ² = 0.513, p < 0.001).

Similarly, M. Houle et al. analyzed the factors affecting headache and neck pain as well as the effect of wearing a headset on headache and neck-pain intensity in telecommuters over five days [ 26]. Sixty-two participants were involved, gathering data related to the NBQ (Neck Bournemouth Questionnaire), headache and neck frequency, and wearing a headset (i.e., typology and number of hours). Using a multivariate regression model, the study revealed that only the headache-related disability score was an associated factor of headache occurrence, and only neck-pain-related disability was an associated component of neck-pain occurrence. Headset usage was not linked to increased neck discomfort or headache intensity. In addition, therapists in the United States (US), United Kingdom (UK), and Canada have reported that continuous repetitive and regular usage of a smartphone device for browsing applications and SM may lead to cumulative damage for musculoskeletal and eye users [ 27]. The studies warned that many static postures of the shoulders, upper spine, and neck could cause physical disorders and diseases later in life. Many optometry and vision-science studies have also shown the same results [ 20].

Many researchers and scientists suggest some systems and methods that measure the postures of a person and their effects on the neck, shoulder, spine, and eye while using SM on smartphones. For example, S. Arteaga et al. suggested a posture-monitoring system using an accelerometer for stroke survivors [ 27]. The proposed system consists of a three-axis accelerometer, beeper, light emitting diode (LED), and vibrator and uses many monitoring devices above body parts such as the knees, necks, shoulders, and wrists of subjects. The proposed system warns SM users and stores data when the appropriate posture is detected. In the next study, Farra et al. [ 13, 28] developed a novel system to monitor spine-normal and abnormal positions by measuring the inclination of the SM users' upper backs and the subsequent stress effect on the spines. Many different sensors have been used to measure this effect, such as an inclinometer and load cells placed around the neck and on the foot of the SM user, identifying a static setting that leads to the lower back pain of the user. Although this model was appropriate for indoor situations such as offices, it could not be applied to the case of SM smartphone users. Another close system of SM monitoring was developed by Baek et al. [ 29]. They used a two-axis accelerometer to study postures while sitting, standing, and walking. The suggested method divides postures into three groups as a function of the tilt angle between the device and Earth surface.

Some of the researchers in the ergonomics literature studied the effects of different display screens on neck and shoulder pain when compared to a single display. These studies investigated the smartphone screen's height, viewing angle, and distance from the face [ 30, 31, 32, 33, 34]. Many studies have suggested that a smartphone screen with a lower height and a gaze angle of about 15 degrees is suitable for visual comfort [ 30, 32, 33]. However, the most accepted recommendation nowadays is to position the smartphone screen at eye level. In other published studies, positioning the display screen of a personal computer (PC) or a smartphone in a central position was compared with placing the screen at a position angled to the left and to the right [ 31]. It was found that the angled position was associated with a significant increase in neck and shoulder muscle activity and head movements. Finally, Straker et al. studied the flexion angle differences between adolescent computer users and non-computer users while using social media. They found that computer users demonstrated increased neck flexion and pelvic tilt [ 35]. They also showed that more time spent on the computer while using social media was associated with an increased bending of the head and neck, especially in boys, and of the lower back in girls (leading to lumbar lordosis) [ 36].

This manuscript is organized as follows: Section 1 contains the introduction to SM usage. Section 2 presents the method and materials, including the results of the decision-tree classifier and statistical analysis. In Section 4, the discussion of the obtained results is conducted. The final section is the conclusion.

2. Materials and Methods

2.1. Data Collection and Study Design

Based on retrospective X-ray neck images, a cross-sectional study was conducted on 46 patients with neck-pain occurrences in the Arab Medical Centre (Amman, Jordan). The data collection took place between 15 February 2020, and 18 April 2020, during which 46 X-ray neck images were captured using an X-ray imaging machine (i.e., the Definium Tempo TM fixed X-ray system (GE HealthCare, Chicago, IL, USA)), with a matrix size of 2000 × 2500. For a 35 cm × 43 cm cassette, this digital matrix corresponds to a pixel size of 175 μm and a limiting resolution of three line pairs per millimeter (namely, a spatial resolution of 0.1 mm). First, participants completed a short survey before undergoing the orthopedic examination.

Table 1 briefly illustrates the survey content provided to the patients; the age, gender, duration of time spent using SM devices (in hours), presence of chronic pathologies such as diabetes or high blood pressure, and the pain type for which the orthopedic visit was necessary were the information requested from the participants.

X-ray neck images were acquired under the supervision of an orthopedic doctor, with patients seated on chairs in front of the X-ray machine. Patients with many healthcare problems, such as blood pressure and diabetes, were also considered in the research study. The orthopedic doctor questioned all patients about the time duration of their use of SM devices. Prior to visiting the doctor, patients thought they had ear pain, not neck-muscle tension; therefore, the X-ray imaging was essential. The proposed approach relating to the image-processing and subsequent extraction of GLCM parameters in order to determine the neck-pain pathology due to the intensive use of SM devices is illustrated in Figure 1 .

2.2. Ethical Approval

This research study was approved by the Institutional Review Board (IRB) of the Hashemite University (No. 26/7/2021/2022). Informed consent was obtained from patients; it was reported on the first page of the questionnaire submitted to them, written in both Arabic and English. It explained the study's aims and emphasized the confidentiality of given information. The participants were able to withdraw from the study at any point. No identifying information was obtained through the study, and all data collected were solely used for the statistical analysis.

2.3. Inclusion and Exclusion Criteria

The research study was conducted on 46 patients in the Arab Medical Centre (Amman, Jordan). All the participants declared in the completed questionnaires ( Table 1 ) that they used SM devices or smartphones intensively every day. Patients with any long-term pathologies, musculoskeletal diseases or anomalies, or those who had previous surgeries on the neck or shoulders were not included in our study.

Table 2 reports the pathology types or painful parts of the body, as declared by the patients in the questionnaires, and the number of patients for each pathology. The demographics of the patients who participated in the study are presented in Table 3 . The number of female patients was twenty-seven, with a mean age ± STDev (standard deviation) equal to 33.70 ± 6.82, respectively, and the number of male patients was nineteen, with a mean age ± STDev equal to 41.42 ± 8.10, respectively.

Table 2

Pain Location

Number of Pained Patients Suffering from a Given
Disease (Total Number of
Patients N = 46)

Percentage of Participants
Suffering from a Specific
Disease Compared to the Total
Number N = 46 of Participants (%)

Table 3

Age of the Participants
(Years)

Number of Participants

Percentage with Respect to the Total Number of
Participants (N = 46)

Gender

Subject Situation

Neck Flexion

As can be observed, imbalanced datasets are a regular occurrence in healthcare applications. In this work, the class ratio between the majority (38 abnormal) and minority (8 normal) samples is only five to one and does not represent a significant imbalance. The machine learning literature on this problem has given three primary solution possibilities:

(i) To restore balance in the training set and avoid the creation of bias in the first place, it is possible to under-sample the large class or to over-sample the small class [37];

(ii) Alternately, one can change the costs (shift matrix) associated with misclassification in order to prevent any bias [37];

(iii) A further precaution is to replace precision with so-called balanced accuracy [37].

In this study, the first and second solutions were evaluated by choosing new parameters for the "weka.classifiers.trees.J48" package (from the University of Waikato, Hamilton, New Zealand) that was applied to our dataset [ 38]. The dataset resampling procedure was implemented as follows: in the Weka software version 2022 [ 38], regarding the oversampling feature (to increase the minority group), we used the function "classifiers.meta.CostSensitiveClassifier" in default mode, which reweights the training instances to take a given misclassification cost matrix into account and then uses the classifier built from the reweighted data. The weighted average of the receiver operating characteristic (ROC) area and the F-measure (provided later in Section 3.2) demonstrate that the results obtained after the oversampling procedure are extremely close to the previous resampling.

2.4. Angles and Area Measurement

Often, the practical approach to distinguishing between normal neck conditions and pathological cases due to the use of SM devices is to measure only one angle (i.e., angle_1, the angle between the global horizontal and the vector pointing from the C7 vertebra to the occipito-cervical joint). Instead, in this study, two angles were measured; angle_1 and angle_2 (namely, the angle between the global horizontal and the vector pointing from C1 vertebra to the occipito-cervical joint), together with the area between them. The procedure of measuring angles and the area between them is shown in Figure 2 . The X-ray images showed that a curve can be drawn through the neck vertebrates, from C1 to C7 vertebrae, using the Bezier curve tool. Next, the angle between the horizontal line and the curve at the C1 vertebra was measured using the angle tool (named angle_2, as shown in Figure 2 ). The angle_1 was detected using the angle tool between the horizontal line and the curve at C7 vertebra (as shown in Figure 2 ). Finally, the area between the two angles was measured by drawing the line between these ends (the C1 and C7 vertebrae). All parameters, including angle_1, angle_2, and area, were measured for all patients with pathological (declared pain) and normal conditions (no declared pain). With the use of the image analysis software Image J version 1.801 (NIH, Bethesda, MD, US), the angles and area parameters were determined.

2.5. Features Extraction from the Gray Level Co-Occurrence Matrix

The X-ray images of the human neck with or without muscle tension or painful pathology have the same specifications; however, they are different from the X-ray images of an abnormal lung affected by coronavirus or with the presence of tumor lesions. The X-ray images of lungs can be easily applied to deep-learning machine algorithms to predict abnormalities. In the case of X-ray images of the neck, there are no tumors or infections to be detected by the machine-learning algorithm; thus, finding specific statistical features through an image-based analysis is very important. The attempt to use the GLCM method may be a suitable solution.

The parameters that can be extracted by means of the GLCM method depend on the image quality that may be accordingly correlated with the neck shapes. GLCM was applied to the X-ray images to extract four additional parameters [ 39, 40], which are valuable for evaluating neck muscle pain. The GLCM functions characterize an image texture by calculating how often pairs of pixels with specific values and specified spatial relationships occur in an image, creating a GLCM, and then extracting the statistical measures from this matrix. The GLCM method calculates how often a pixel with the intensity (gray level) value i occurs in a specific spatial relationship to a pixel with the value j (cell value). The GLCM parameters extracted in this research work are:

Contrast: the separation between the brightest and darkest image area; namely, the difference between the highest and lowest values of the adjacent set of pixels.

c o n t r a s t=∑i,j=0 N−1 P i,j(i−j) 2

where N stands for the number of gray levels and P( i, j) is the normalized value of the gray-scale at positions i and j of the kernel with a sum equal to 1. V is the value in the cell i, j of the image window; if i and j are equal ( i − j) = 0, the cell is on the diagonal.

Homogeneity: the closeness of the distribution of elements in the GLCM to the GLCM diagonal. It is defined as:

In general, the cell or pixel value attribute can have a variety of display formats, including empty, numeric, text, Boolean, or error; in this case, it is at a a gray-scale intensity level. Windowing is a certain size of resolution with a cell format that can be applied to the original image in the form of gray-level mapping, contrast stretching, histogram modification, or contrast enhancement such as a filter, mask, or kernel, etc. [ 41].

(iii) Correlation: the linear dependency of gray levels on those of neighboring pixels. This indicates that there is a predictable and linear relationship between two neighboring pixels within the window, expressed by the regression equation. The correlation can be represented mathematically as:

c o r r e l a t i o n=∑i,j=0 N−1 P i,j[(i−µ i)(j−µ j)(σ i 2 )(σ j 2 ) ]

where μ a n d σ are the GLCM mean and variance, respectively.

(iv) Energy: computed as the square root of an angular second moment:

For pre-GLCM employment, the images need to be enhanced or pre-processed. The pre-processing steps aim to remove the background, eliminate the noise, and to visualize the edges of the vertebrae (bones), as is shown in Figure 3 . The overall flow of image pre-processing implemented in this research work is reported below.

Adjusting the contrast and brightness of the image; cropping to specify the position of the neck;

Magnification of the image and freehand selection of the vertebrae;

Smoothing many times and improving the image sharpness;

Finding the edges of the vertebrae using the image edge detection method;

Adjusting the brightness and contrast of the image (0-108 pixels);

Applying the fast Fourier transform (FFT) bandpass filter to remove low and high spatial frequencies responsible for image blurring [ 42]. This filter has been designed to smooth variations of the X-ray image (bright or dark patches) with sizes larger than 40 pixels and to strongly attenuate insignificant spots smaller than 3 pixels. Note that these values are half the spatial frequencies of the actual cutoff frequency. The cutoff frequency is very soft, so the bandpass filter will also significantly attenuate the spatial frequencies in the center of the bandpass unless the difference between the two values is greater than a factor of five or so. It can also suppress the horizontal or vertical stripes created by scanning an image line by line with a direction tolerance of 5%;

Further adjusting to the brightness and contrast of the image;

Resizing the image size to 256 × 256 pixels and completing a gray-scale conversion;

Applying the GLCM method using Matlab software (version. R2022a, MathWorks, Inc., Natick, MA, US) to extract contrast, homogeneity, correlation, and energy parameters.

2.6. Descriptive Variables

The time duration of the neck-pain-causing use of SM devices in hours (H.mean) was categorized into five groups, with a width of each group up to 4 h. These groups were: (1) no perceived pain (normal subject); (2) pain after 2-3 h; (3) pain after 3-6 h; (4) perceived pain after 6-9 h; and (5) perceived pain after more than 9 h. The descriptive variables used in this study were the age, H.mean, angle_1, angle_2, area, contrast, homogeneity, correlation, and energy. These are presented in Table 4 , where statistics contain the mean, standard deviation (STDeviation), minimum (Min), maximum (Max), and standard error (Std. Error) values. The standard error provides the precision of a sample mean by accounting for sample-to-sample variability; it represents the predicted measurement error in a single individual's score. The used formula to calculate the Std. Error is S T D e v i a t i o n/n , where n is the number of samples [ 43].

Table 4

Parameter (Unit)

N

Minimum

Maximum

Mean

Std.
Deviation

Statistic

Std. Error

Statistic

Area (mm ²)

46

269.00

1305.00

1007.35

26.29

178.30

It is important to point out that the deterministic data reported in Table 4 related to age, H.mean, angle_1, angle_2, area, contrast, homogeneity, correlation, and energy have no random components. The same input values generate the same output. As a result, the standard-error values from statistical data models do not have their usual meanings. A high statistical significance (namely, a low standard-error value) is an indication of an effect due to a model term. However, it is not possible to construct valid confidence intervals for effects or model predictions.

2.7. Decision Trees

Decision trees (DTs) are standard machine-learning methods used in classification [ 44]. The DTs are usually known for their simplicity, reliability, and classification performance [ 45]. They have been used for a variety of biomedical applications. The DT's generation depends on performing entropy [ 46] and information gain (IG) calculations [ 47]. The DT algorithm named C4.5, introduced by Quinlan [ 48], was used as a data classifier in this work known as the "weka.classifiers.trees.J48" package (developed by the University of Waikato, Hamilton, New Zealand). The entropy calculations were performed to determine the information gain as described by Shannon in the following equation [ 49]:

The information gain calculations include the comparison between the entropy of each attribute with the total entropy of the dataset. These calculations are performed on each node of the decision tree, as is illustrated and discussed below in Section 3.2. The attribute is selected for that node according to the highest information gain calculation. The calculations are then repeated recursively for each branch of the DT.

2.8. Mathematical Predictive Model for the Neck Pain Diagnosis

A mathematical, predictive model with a MATLAB graphic interface has been developed to help the orthopedic doctor predict the onset of neck pain. The gene expression programming (GEP) technique has been used to create the model [ 50]; the genes are made up of numerous linked chromosomes that look like trees and have several variables structured in a start and end point. These trees are known as GEP expression trees and can be expressed mathematically; an example is shown in Figure 4 .

The GEP method involves several mechanisms, including building and expressing chromosomes for the dataset, running the framework, evaluating fitness criteria such as the root-mean-square error (RMSE) or the coefficient of determination (R-squared), and terminating the programming process if the fitness requirements are met. Otherwise, the gene expression must be replicated through variable crossover or mutation. Figure 4 depicts a GEP algorithm as an expression tree (ET). The algorithm starts by implementing the GEP process, which comprises the creation of the chromosomes with the required function settings and fitness criteria for the variables a, b, c, and d ( Figure 4 a). The chromosomes are then executed and transformed into the tree expressions (TEs). The framework processing terminates if the TEs meet the fitness criteria. However, if the fitness criteria are not met, the variables are altered by performing one or more genetic operations (crossover or mutation) on selected TEs. The TEs are eventually transformed into mathematical expressions to make them more convenient for design applications.

In this work, the experimental database was processed with GeneXproTools 5.0 software (developed by Gepsoft Lda, Capelo, Portugal) to create the GEP model for class prediction (normal or abnormal). The database was separated into training and testing categories to ensure the generalization and validity of the constructed model across a wide range of variables and to minimize overfitting. The training data were only utilized to create the GEP model, whereas the testing data were used to test the model validity and accuracy. In this study, 31 points (67% compared to the total of 46 patients participating in the study) were selected at random for the training data category, whereas 15 points (equal to 33%) were used for the testing data category.

Several GEP process settings are critical to developing the most efficient model. Table 5 summarizes the GEP settings used in this study. The data population consisted of 46 individuals and the fitness criteria are based on the least receiver-operating characteristic (ROC) value. There were ten independent variables: gender, age, time spent on social media (H.mean), angle_1, angle_2, area, contrast, homogeneity, correlation, and energy. Table 5 displays the parameters chosen for the GEP algorithm; there are five genes with a maximum tree depth of eight levels, and the three trees are linked together by multiplication.

Figure 5 depicts the developed GEP model in the ET form, consisting of five sub-trees (sub-ET1, 2, 3, 4, and 5) linked by multiplication (Equation (7)). Out of the total of ten parameters reported in Table 6 , only six variables (i.e., d ₀, d ₂, d ₆- d ₉) were employed in the developed mathematical model, chosen by the fitness function ROC. If the fitness conditions were not met, the variables were modified by performing one or more genetic operations on the selected TEs (crossover or mutation).

The product of the five sub-trees yielded the predicted classification. The GEP model represented in Figure 5 as an ET was transformed into the mathematical expression of Equation (7). After further simplification, Equation (9) was obtained, relating to the H-parameter that establishes which class the patient belongs to. The values of the constants t1 and t2 (shown in the general expression of the parameter H in Figure 4 c) were obtained from the GEP model and were equal to −1797.29 and 7.28, respectively. As is reported in Figure 4 d, if H assumes values greater than or equal to 0.5, it is a normal condition (namely, no perceived pain). If H is less than 0.5, it belongs to the abnormal class, which means the presence of pain perceived by the user.

Equation (7) (i.e., y) represents the GEP mathematical model, in which each mathematical term corresponds to an expression tree (ET). The multiplication function connects these terms. The highlighted parameters taken from the X-images and optimized based on the ROC fitness function are the variables d ₂, and d ₆- d ₉. In Table 6 these variables have been defined.

y=(e d 8 4 ) 4×e e d 6 ×d 9 4 ×d 2 1 27 ×d 7 1 12 d 2 4 +L n(d 8 )+d 6

y=(e C o r r e l a t i o n 4 ) 4×e e C o n t r a s t ×E n e r g y 4×T i m e 1 27 ×H o m o g e n e i t y 1 12 T i m e 4+L n(C o r r e l a t i o n)+C o n t r a s t

The term H is the transformed expression using the sigmoid function [ 50]; its numerical limit and related class were determined as is shown in Figure 4 d.

3. Results

This research aimed to define a quantitative approach for predicting conditions that lead to neck pain resulting from the intensive use of SM devices by considering the duration of their use, in hours, as a variable. The proposed method, presented in Figure 1 , is able to find the appropriate parameters for predicting the SM effects. Figure 2 shows the first step of the proposed approach of finding the appropriate angles and the area between them associated with the variability of SM-device usage. With the advantages of the Bezier curve tool, the Image J version 1.801 software (NIH, Bethesda, MD, U.S.A.) was employed to draw the line via the vertebrae and then draw the tangent line at the level of the C1 and C7 vertebrae. Maintaining an accurate performance during the measurement is essential because the difference between the condition of no perceived pain (normal) and that of perceived pain (abnormal condition) is very sensitive.

Figure 3 shows the second part of the SM parameters detection; namely, the steps of image quality enhancement before extracting the features (parameters) of contrast, homogeneity, correlation, and energy through the GLCM method. All the steps in Figure 3 were performed to visualize the vertebrae edges that reflect the quality of the features. The statistical description for all the obtained parameters is presented in Table 4 ( Section 2.6).

3.1. Results of Statistical Validation for the Objectively Calculated Parameters

The Statistical Product and Service Solutions (SPSS) statistics software, version 21.0 (developed by IBM Software Group, Chicago, IL, USA), was used to analyze the data. A one-way ANOVA test and an independent-sample t-test were used to analyze the differences in age, use duration, neck-pain duration, and GLCM features. Some studies used both multiple linear regression and binary logistic regression analyses [ 51, 52, 53]. In this work, however, the same testing protocol used in other works [ 49, 54, 55] was applied, but with a new machine-learning model known as the decision tree. The decision tree can predict the occurrence of neck pain better than logistic regression based on the calculated entropy and the if-then rules. The redeployment of machine learning and genetic expression as predictive models will allow for improved rapid diagnostic tools in this field. The obtained progress may end with developing an in-cloud application in which physicians scan the X-ray image while entering the patient's gender and age to predict the neck condition, especially for those with excessive SM-device usage.

Table 7 demonstrates the correlation between all parameters (−1≤r≤+1 ) and the response to neck condition (i.e., no perceived pain-normal condition or perceived pain-abnormal condition). In contrast, the graphical representation for correlation vs. response is shown in Figure 6 . In Figure 7 and Figure 8 , a comprehensive analysis was performed, taking into account all parameters: age, angle_1, angle_2, area, contrast, homogeneity, correlation, and energy by H.mean, utilizing the box-plot, while the central value was 95%.

3.2. Results of Using the Decision Tree Method

The dataset has eleven attributes and two classes. These attributes are gender, age, Social_Media_Use (H.mean), angle_1, angle_2, area, contrast, homogeneity, correlation, energy, and diagnosis. The attribute "diagnosis" formed the two classes. Figure 9 shows an unpruned DT built using 46 instances; two-thirds (66.7%) of the dataset were used to build the DT, and one-third (33.3%) of the dataset was used for testing purposes to assess the performance of the learning approach (16 samples). The size of the DT generated was thirteen nodes with seven leaves in total, as is shown in Figure 9 .

In this study, the confusion matrix of the test dataset was maintained by combining normal and abnormal patients (34%; 16 samples). The next phase involved reducing the disparity (unbalanced ratio) between abnormal and normal samples. Thus, the DT classifier's new function, the cost matrix, was activated with entries weighted [(0, 1); (5, 0)] (brought by the Weka package). Consequently, the relative costs of misclassifying true positives and true negatives were calculated. Note that the steps provided earlier had an effect on the confusion matrix that resulted in the following prediction parameters: TP = 13, TN = 2, FN = 1, and FP = 0 (as are reported in Table 8 ).

Table 8

Confusion Matrix

* Precision

* Recall

Accuracy

* F1-Score

13 ( TP)

1 ( FN)

0.96

0.94

94%

0.95

0 ( FP)

2 ( TN)

Cost Matrix

Cross Validation

Percentage Split

ROC Area

Total Number of Instances

0

1

9-fold

66%

0.98

16

5

0

The results show that 13 out of 16 instances were classified correctly, with an accuracy of around 94%. Furthermore, a good accuracy of class abnormal (perceived neck pain) was obtained with an F1-score equal to 0.95. The results of the DT performance (shown in Table 8 ) have been calculated using Equations (10)-(13):

F 1−S c o r e=2×P r e c i s i o n×R e c a l l P r e c i s i o n+R e c a l l

A c c u r a c y=T P+T N T P+T N+F P+F N

TP stands for true positive, FP for false positive, TN for true negative, and FN for false negative. The expression "perceived neck pain" refers to abnormal samples; "perceived no pain" refers to normal cases. The confusion matrix reflects these terms as follows:

In addition, the 9-fold cross-validation setup was applied during the run of the new "CostSensitiveClassifier" settings of the DT, resulting in the successfully classified instance and the weighted F-score being 93.75% and 0.94, respectively.

Noteworthily, the selection of the DT to be applied to this dataset was a successful choice because, while the DT algorithm is suitable for large and small datasets, it may not be suitable for large-scale metadata. If the dataset is too large, the algorithm may become too complex, leading to an overfitting issue (a major risk). In this work, the training-testing split protocol was selected as 70%-30% or approximately 30 samples for training vs. 16 samples for testing. On the other hand, the dataset is unbalanced-i.e., with 38 (corresponding to 82.61%) abnormal cases and 8 (corresponding to 17.39%) normal ones ( Table 3 )-which facilitates decision-making. Information gain (IG) helps measure the uncertainty reduction of a certain feature. It also helps to decide which feature is good as a root node. Therefore, detecting 13 (TP) out of 16 samples during the test algorithm validation indicates very efficient decision-making. In the DT, the wrong decision is usually related to the last leaf in one of the branches; it can be avoided if the DT is trained with a larger dataset. Overall, the DT technique is considered one of the easiest techniques in machine learning, with the capability of being applied even in real-time situations where speed and simplicity are an advantage.

The DT shown in Figure 9 indicates that the more time is spent on social media, the more abnormality and neck pain occurs. A set of classification rules generated by the DT are summarized in Table 9 .

Table 9

1

Social_Media_use "=1_hours" Diagnose "Normal"

2

Social_Media_use "=2_hours" Diagnose "Normal"

3

Social_Media_use "=8_10_hours" AND Age "<=27" Diagnose "Abnormal"

4

Social_Media_use "<8_10_hours" AND Age "<=27" Diagnose "Normal"

5

Social_Media_use ">2_hours and <8_10_hours" AND Age ">27" AND Contrast "<=0.1455" AND angle_1 "<=72.42" Diagnose "Normal"

6

Social_Media_use ">2_hours" AND Age ">27" AND Contrast "<=0.1455" AND angle_1 ">72.42"Diagnose "Abnormal"

7

Social_Media_use ">2_hours" AND Age ">27" AND Contrast ">0.1455"Diagnose "Abnormal"

3.3. Results from the Developed Graphical GEP Predictive Model

The MATLAB graphical user interface (GUI) for the developed mathematical prediction model based on Equations (7)-(9) is shown in Figure 10 a. The MATLAB GUI's functionality begins with the selection, directly by the common user or by the orthopedic doctor, of the pre-processed X-ray neck image (by the Select Image button) from the specific folder. After that, the user must enter the d ₃- d ₅ geometrical parameters' values (i.e., angle_1, angle_2, and area) previously obtained from the orthopedic doctor by viewing the X-ray image with a specific software. Thereafter, by clicking the "GLCM" button on the left of Figure 10 a (green box), the d ₆- d ₉ parameters are automatically determined using the GLCM function (variables defined in Table 6 ). The geometrical and GLCM data are then combined with additional information, such as the user's gender, age, and time duration of SM usage (H.mean) to predict the patient condition (i.e., no perceived neck pain-normal condition or perceived pain-abnormal condition) by the obtained H-value. The predicted class will be displayed on the GUI as "Normal" (if the H parameter value is greater than 0.5) or "Abnormal;" that is, perceived pain from the patient for H values less than 0.5 (orange box in Figure 10 ). The GUI also features an expanded function for archiving the patient information by transferring all the data in an excel sheet for later use (storage and printing). For further clarity, Figure 10 b illustrates the different steps of the MATLAB application, as are described above. An MP4 video illustrating the various operating steps of the developed MATLAB application is available to the reader as Supplementary Materials.

Table 10 presents the results of testing the prediction GEP model (described in Section 2.8) on 46 real patients (the total number of participants to the research work, numbered in Table 10 ). All the X-ray images were saved in the specific folder and named with the same identification number, to be selected (by the "Select Image" button) and then processed. The normal class (that is, no perceived pain corresponding to H values greater than 0.5) is indicated with value 1; instead, the zero indicates belonging to the abnormal class (that is, perceived pain from the patient for H values less than 0.5). After the model validation/testing, the obtained accuracy calculated by Equation (13) was 91.30%, in which:

Table 10

Patient N.

Input
Class

GEP Model (H)

Predicted Class

Class Matching

The trained model learns from the training database repeatedly until the predicted neck pain achieves performance criteria such as RMSE, R-squared, or ROC. Based on the ROC, the variables enrolled in the GEP mathematical model are d ₀, d ₂, and d ₆- d ₉. If the parameters (variables) with a proportional relationship do not meet the fitness function, they are not considered. For this reason, other parameters such as d1, d ₃, d ₄, and d ₅ were left out of the model (namely, they are not present in Equation (7)). The obtained testing accuracy equal to 91.30% is less than that of the DT (equal to 94%, as reported in Table 8 ). This is supported by the different fitness functions; the entropy function was utilized in DT, while the ROC function was utilized in the ETs. The four errors present in Table 10 ("Wrong FP" in class matching), corresponding to 8.69%, indicate that the abnormal condition's variables (parameters) were incorrectly predicted, and thus the resulting H value (>0.5) led to the incorrect classification (as normal).

3.4. Further Comorbidities

Comorbidities are the association of several diseases and health problems that can lead to the onset of a progressive or chronic disease. The co-occurrence of new diseases might disappear and occasionally progress. However, the engagement and reliance on SM entertainment and smartphones has become a kind of obsessive lifestyle over the last decade. Researchers have attempted to investigate this contentious fact from a new perspective. For example, 159 adults from Midwestern University took part in a research study on smartphone dependency (nomophobia) [ 56]. It was discovered that using a phone while driving and being female are strong positive indicators of smartphone dependency.

Much research, such as the current study, have suggested that patients using SM devices adopt forward postures. At the same time, web browsing, video-game playing, emailing, and texting are linked to a variety of health issues including kyphosis, which is associated with pulmonary and cardiovascular disorders. Furthermore, new research indicates that when patients stare down at a smartphone, personal computer, or tablet, they lower their heads and rotate their shoulders while looking down. As a result, rib muscular limitation or tightness, as well as inappropriate posture during movement, make normal breathing difficult [ 57]. Neck flexion and weight have a substantial proportional relationship, which is most likely owing to decreased physical activity [ 36, 58]. Headaches, such as migraines, have been examined in school-age children and adolescents, and they vary by age and gender [ 59]. One study discovered a 48% prevalence of headaches among school-aged children aged 7 to 18 years, while another discovered that headaches are the most prevalent discomfort among schoolgirls (42%) [ 60].

4. Discussion

This work is a new attempt to study the effects of social media entertainment usage that may lead to serious neck pain. Patients complained of neck pain during their visit to the orthopedic doctor before undergoing X-ray radiography; at the same time, they reported through the questionnaires that they used SM devices for a significant number of hours (H.mean). To develop a reliable approach to assessing SM impacts on the neck muscles, a quantitative method was performed on 46 retrospective, neck-vertebral X-ray images. Thus, the studied parameters were detected based on two syncretized steps: (1) three parameters, angle_1, angle_2, and the area between them, were measured by drawing a Bezier curve through the vertebral neck path; (2) the second step relayed the image quality in which the GLCM was applied to extract four features of contrast, homogeneity, correlation, and energy. The progress of the neck-muscle fatigue was classified as normal (no pain) and abnormal (pain), and all parameters were examined by the time duration of SM usage known as H.mean.

Table 7 shows the correlation between all parameters and the response, whether normal (no perceived pain) or abnormal (perceived pain) cases. The absolute correlation changes from −1 to +1 (i.e., −1 ≤ r ≤ +1) were considered, while in Figure 6 , the best correlation was calculated for the angle_1, area, and contrast of −0.34512, −0.36956, and 0.306127, respectively. This result was proven in Figure 7 b, in which the value of angle_1 in normal subjects is the smallest if the user interacted with SM devices for an average of only two hours. It is worth noting that the greater the interaction with SM devices, the greater the increase in angle_1. In other words, dealing with SM devices for more than 2 h may lead to neck muscle tension. In correlation with the patient age ( Figure 7 a), it is obvious that candidates aged less than 30 years were qualified to develop neck pain if they interacted with SM for more than 6 h.

Concerning angle_2, as is shown in Figure 7 d, a slight increase, with times ranging from 3 to 9 h, is observed. Also, notably, the area is not proportional to the angles increasing, which means that area is affected (becoming smaller) by the angles increasing in the time interval of 3-9 h and above, according to Figure 7 c. Image quality may be affected by fatigue and stress levels, as is shown by the GLCM features in Figure 8 . For example, a significant difference was observed related to the images' contrast for normal (no perceived pain) and pain conditions after more than 6 h usage, as shown in Figure 8 a. The energy parameter clearly differentiates between no pain and suffering claims. Alternatively, the average values for the energy indicator remain constant with a temporal correlation (2-9 h), indicating that neck pain was unaffected, as is shown in Figure 8 d. However, given that the change rate for these values for a time between 3 and 9 h is similar, it appears that the difference between no pain and discomfort in terms of correlation and homogeneity cannot be counted. ( Figure 8 c,d).

In this study, the DT classifier was employed successfully. Understanding and predicting the neck pain caused by SM devices can be modelled using the DT classifier's advantages over other classifiers. These if-then rules are presented in Table 9 . They show that participants with only 2 h of social media usage (or below this threshold) were classified as normal regardless of their age. Furthermore, participants aged 27 and below with less than 8 h of daily social media usage were still classified as normal. On the other hand, participants over 27 with an image contrast greater than 0.15 were classified as abnormal, meaning that they probably suffered from neck pain, regardless of the severity. In this regard, more details can be found in Table 9 .

GLCM-based feature extraction combined with machine-learning (ML) algorithms is being applied to many medical applications such as mammograms for breast cancer detection, magnetic resonance imaging (MRI) for brain cancer detection, and unlimited non-medical applications. The numerical values of GLCM always depend on the pre-processing techniques used, such as thresholding, filtering types, and the angle rotation on the processed images. Contrast measures the special frequency of the image and is a different moment of GLCM; it can measure the variations between the highest and lowest values of the adjacent set of pixels. Therefore, in this study, contrast complied with DT branches of all ages and angle_1 very positively ( Figure 9 ). To make the decision, it did not work alone with the pixels' units; entropy was calculated with the significant parameters in the branches mentioned.

Further, the eight parameters calculated from 46 subjects were fed into the DT classifier with a training-test protocol of 66%-34%. The number of leaves was seven, and the size of the tree was thirteen. After evaluating the test split, the achieved accuracy and the F1-score were 94% and 0.94%, respectively. The result of the testing performance is illustrated in Table 8 . This approach may be considered a new attempt to evaluate the influence of SM devices (i.e., with different neck postures) based on the achieved results.

Therefore, this research work could present the following contributions:

New quantitative parameters have been proposed for studying or evaluating the effect of SM devices on their users' neck muscles;

The ability to use the DT rules increases the prediction of neck pain;

The geometric measures of neck postures may increase the pain prediction;

As is shown in Figure 10 and Table 10 , the developed, MATLAB-based GUI implementing the mathematical GEP model can be employed as a reliable diagnostic tool to assist the orthopedic doctor;

This research activity was approached objectively rather than subjectively. The number of input parameters received from retrospective X-ray images was seven (angle_1, angle_2, area, contrast, homogeneity, correlation, and energy), while the remaining parameters (age and H.mean-just two) were gathered through patient questionnaire (survey) forms. In percentage terms, compared to the total number of parameters considered (nine), they correspond to 77.7% and 22.2%, respectively.

It is important to note that the ETs were created using the ROC fitness function, and that six variable parameters were chosen ( d ₀, d ₂ and d ₆- d ₉). In other words, the gender, H.mean, and GLCM characteristics were strongly implicated in the predictive mathematical model (as are reported in Equations (7)-(9)). The model was successful in determining the categorized limits (normal and abnormal classes) with an accuracy of 91.30%. GEP models have several advantages over other machine-learning techniques: they are closed-form solutions, making it easy for engineers and specialists to incorporate the models for solving various engineering issues, and GEP models are assumed more reliable than numerical and analytical solutions in neck-pain prediction, which are being used for the first time, to the best of our knowledge. Nonetheless, the accuracy is fairly acceptable, but increasing the samples and modifying the technique for acquiring new attributes (variables) that describe neck pain is fundamental for optimizing the method and obtaining higher-accuracy values.

Based on the scientific articles reported in Table 11 , it is evident that all research works related to the effects of SM usage on neck muscles from 2008 to the present were conducted by using surveys (questionnaire only) [ 51, 54, 61]. Scientific approaches based on images analyses and related processing are quite limited; for example, D. David et al. analyzed the premature and inappropriate use of personal computers and cell phones and the related development of clinical symptoms commonly defined as "text-neck syndrome." The authors studied the underlying causes and risk factors of musculoskeletal discomfort or pain by observing and processing the cervical-spine MRI images [ 62].

Table 11

First Author, Ref. n., Year

Method Survey-Based (Subjective) or Quantitative (Objective)

Samples (Male/Female)

Evaluation Approach

Parameters #

Target of Study

Machine-Learning Type

Statistics

F. Al-Hadidi [ 51], 2019

Online Questionnaire
(Subjective)

500

None

Significant test
( p < 0.001)

Two: duration, neck pain

To investigate the association between neck pain and the duration of device use, taking into consideration gender, age, and the most frequent position in which students use their devices.

D. David [ 62], 2021

MRI of the cervical spine (Objective)

1 case
reported

None

None

One: neck flexion angle

To analyze the new phenomenon of the "text-neck syndrome"

E. Gustafsson [ 65], 2011

Angle measuring system
(Objective)

56

None

Significant test
( p < 0.05)

Three: symptomatic, asymptomatic, head angle

To investigate differences in technique between young adults with and without musculoskeletal symptoms when using a mobile phone for texting, and differences in muscle activity and kinematics between different texting techniques.

H. Ping Chiu [ 66], 2015

Angle measuring system
(Objective)

30

Electromyography measurement

Significant test
( p < 0.000)

Three: tilt angle, task type, neck muscle activity

To investigate the musculature load and comfort perception of the engaged upper extremity for three angles of viewing, and common task types performed at a computer workstation.

H. Lee [ 55], 2013

Three-axis accelerometer
(Objective)

12

Built-in sensors, front- faced camera, three-axis accelerometer

None

One: angle

To monitor the posture of smartphone users by built-in sensors.

This work

Angles measurement and X-ray images analysis
(Objective)

46

Decision tree.
Classification accuracy = 94%

Significant test

Nine: age, H.mean, angle_1, angle_2, area, contrast, homogeneity, correlation, energy

To detect neck pain by:
(i) Using two angles and the area between them instead of just one angle;
(ii) Applying the image statistical features (GLCM) in the same procedure;
(iii) Utilizing DT algorithm;
(iiii) Using a MATLAB- based GUI to help the doctor in the diagnosis of neck pain in an immediate way.

A few studies using angle measurement systems such as three-axis accelerometers were reported in [ 55, 63, 64, 65, 66]. The main disadvantages of these studies were that they became old and were not in sync with current SM devices (mainly smartphones) that have progressively developed to cover large populations of adults. On the other hand, the current studies from 2018 are all survey-questionnaire-based and do not objectively determine the pain neck symptoms [ 51, 54, 61]. Previously, the machine-learning applications have not been applied to this research area to the best of our knowledge. Thus, the quantitative analysis of neck postures combined with machine-learning techniques (e.g., decision trees) may improve the early prediction of neck-pain occurrences. This problem became a serious source of neck-pain prevalence during the COVID-19 pandemic. Patterns of online distance learning in pre-schools, schools, and universities push the authorities in charge to make new rules and guidelines for the long-term use of SM technology, especially by children and teens.

5. Conclusions

This research work developed a new approach for studying the influence of using SM devices or mini displays on neck-pain occurrences. This approach was performed on 46 retrospective X-ray images (subjects) through two measurement steps. First, three geometrical parameters were detected from the neck vertebral shapes associated with SM use for different time categories of three-hour bands. The first category (0-2 h) belonged to the normal cases (no pain). The next bands changed from 3 to more than 9 h and belonged to the abnormal cases (after pain). The parameters obtained in this step were angle_1, angle_2, and the area between them. In the second step, the GLCM was employed to extract four parameters depending on the image quality: contrast, homogeneity, correlation, and energy. Decision trees' if-then rules were used to acknowledge which combination of the detected parameters may be applied to predict the abnormal occurrence of neck pain. The obtained classification accuracy of 94% and the F1-score of 0.95 both show that the DT machine-learning algorithm works well with fully satisfactory results [ 67].

The DT classifier proved its ability to handle unbalanced datasets, which are always a source of error in the healthcare domain. "CostSensitiveClassifier" parameters enable the classifier algorithm (Weka package) to regulate the over- and under-sampling methods. The DT algorithm demonstrated that the ratio of 5:1 between normal and abnormal participants did not have a significant impact on the classification accuracy. Improving such prediction and diagnosis techniques is extremely important for healthcare-service development. This research should be carried out to develop a new tool for measuring musculoskeletal neck-pain disease and symptoms.

The developments proposed in this research work will aid in the early prediction of neck pain, especially for people who use SM devices extensively. In this regard, based on the mathematical predictive model (Equations (7)-(9) discussed in the Section 2.8), a MATLAB-based graphical user interface (GUI) was developed, in which the orthopedic doctor or a generic user is able to select a specific X-ray neck image and enter the geometrical parameter (angles and area) values as well as the age, gender, and duration of SM usage related to the patient. Then, the MATLAB tool will be able to determine the other parameters/variables by means of GLCM method (as shown in Figure 10 ). As a result, the patient would be informed whether he/she is a candidate for neck pain or not. Furthermore, the user will be able to use the developed GUI directly on the smartphone to receive information in a timely manner.

Abbreviations

List of the abbreviations and related meaning.

Acronym

Meaning and Definition

Angle_1

The neck-flexion angle between the global horizontal and the vector pointing from C7 vertebra to the occipito-cervical joint.

Angle_2

The neck-flexion angle between the global horizontal and the vector pointing from C1 vertebra to the occipito-cervical joint.

C1, C7

Neck vertebrae

C4.5

DT algorithm named C4.5

DT

Decision tree

E

Entropy

FFT

Fast Fourier transform

FN

False negative

FP

False positive

GLCM

Gray-level co-occurrence matrix (GLCM)

IG

Information gain

ML

Machine learning

NDI

Neck disability index

NP

Neck pain

RMSE

Root mean square error

ROC

Receiver operating characteristic

SM

Social media

Std. Error

Standard error

STDev

Standard deviation

TN

True negative

TP

True positive

VAS

Visual analogue scale

WHO

World health organization

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, B.A.-N. and R.D.F.; methodology, B.A.-N., B.E.A.B., Y.Z.R. and H.A.O.; software, B.A.-N. and B.E.A.B.; validation, B.A.-N., B.E.A.B., R.D.F. and P.V.; formal analysis, B.A.-N. and P.V.; investigation, B.A.-N., Y.Z.R. and H.A.O.; resources, B.A.-N.; data curation, B.A.-N. and P.V.; writing-original draft preparation, B.A.-N., B.E.A.B., Y.Z.R., R.D.F. and P.V.; writing-review and editing, B.A.-N., H.A.O., R.D.F. and P.V.; visualization, B.A.-N.; supervision, B.A.-N., R.D.F. and P.V.; project administration, B.A.-N.; funding acquisition, R.D.F. and P.V. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The study was approved by the Institutional Review Board (IRB) of the Hashemite University (No. 26/7/2021/2022, approval date: 6 June 2022).

Informed Consent Statement

Informed consent was obtained from all involved subjects by filling out the questionnaire, explaining the study aim and emphasizing the confidentiality of filled information. The participants were able to withdraw from the study at any point. No identifying information was obtained through the study, and all collected data were solely used for statistical analysis.

Data Availability Statement

Data from our study are available upon request.

Conflicts of Interest

The authors declare no conflict of interest.

Footnotes

Disclaimer/Publisher's Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

References

3. Smith L. Computer-Related Musculoskeletal Dysfunction among Adolescent School Learners in the Cape Metropolitan Regionle, Stellenbosch University. 2007. [(accessed on 1 September 2021)]. Available online: https://scholar.sun.ac.za/handle/10019.1/1545

17. Shah M., Desai R. Prevalence of Neck Pain and Back Pain in Computer Users Working from Home during COVID-19 Pandemic: A Web-Based Survey. Int. J. Health Sci. Res. 2021;11:26-31. [ Google Scholar]

27. Arteaga S., Chevalier J., Coile A., William Hill A., Sali S., Sudhakhrisnan S., Kurniawan S. Low-cost accelerometry-based posture monitoring system for stroke survivors; Proceedings of the 10th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS 2008; Halifax, NS, Canada. 13-15 October 2008; pp. 243-244. [[ CrossRef] Google Scholar]

28. El-Sayed B., Farra N., Moacdieh N., Hajj H., Haidar R., Hajj Z. A novel mobile wireless sensing system for realtime monitoring of posture and spine stress; Proceedings of the 2011 1st Middle East Conference on Biomedical Engineering; Sharjah, United Arab Emirates. 21-24 February 2011; [[ CrossRef] Google Scholar]

37. Brodersen K.H., Ong C.S., Stephan K.E., Buhmann J.M. The Balanced Accuracy and Its Posterior Distribution; Proceedings of the 2010 20th International Conference on Pattern Recognition; Istanbul, Turkey. 23-26 August 2010; pp. 3121-3124. [[ CrossRef] Google Scholar]

39. Lu M., Liu Y., He W., Li X. Proceedings of the 2019 Chinese Control and Decision Conference (CCDC), Nanchang, China, 3-5 June 2019. IEEE; Piscataway, NJ, USA: Skin Roughness Evaluation Method Based on gray level co-occurrence matrix. [[ CrossRef] Google Scholar]

54. Widhiyanto A., Munawir A., Prayitno H. The Effect of Duration of Smartphone Usage on Neck Pain. Dama Int. J. Res. (DIJR) 2017;2:54-61. [ Google Scholar]

55. Lee H., Lee S., Choi Y.S., Seo Y., Shim E. A new posture monitoring system for preventing physical illness of smartphone users; Proceedings of the 2013 IEEE 10th Consumer Communications and Networking Conference (CCNC); Las Vegas, NV, USA. 11-14 January 2013; [[ CrossRef] Google Scholar]

61. Azizur Rahman S., Al Marzouqi A., Variyath S., Rahman S., Rabbani M., Iqbal Ahamed S. Effects of Social Media Use on Health and Academic Performance among Students at the University of Sharjah; Proceedings of the IEEE 44th Annual Computers, Software, and Applications Conference (COMPSAC 2020); Madrid, Spain. 13-17 July 2020; [[ CrossRef] Google Scholar]

Articles from Journal of Imaging are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

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Social Media Devices' Influence on User Neck Pain during the COVID-19 Pandemic: Collaborating Vertebral-GLCM Extracted Features with a Decision Tree

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The prevalence of neck pain, a chronic musculoskeletal disease, has significantly increased due to the uncontrollable use of social media (SM) devices. The use of SM devices by younger generations increased enormously during the COVID-19 pandemic, being-in ...

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Lasting effects of organized  misinformation

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Lasting effects of organized  misinformation

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When the rumors of election rigging, exasperated by our then president, grew to a head, the following riot at the capitol changed how we see our government. If someone with a lot of followers can do this, and follow almost no repurcussions, what else could famous people and politicians do? Now that that floodgate is open, it's likely other politicians will try to follow suit, with differing levels of success.

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On January 6, supporters of U.S. President Donald Trump stormed the Capitol in Washington, D.C. As people not only in the U.S. but around the world try to understand the event and its ramifications, University of Northern Colorado Professor of History Fritz Fischer, Ph.D., offers context from a historical perspective.

"What happened on January 6 was an unprecedented insurrection; it was a riot, and it's debatable whether we can call it a coup, but it resembled a coup," Fischer said. "The reason we are so shocked and appalled is because what happened has never really happened before."

Fischer, whose research includes 20 th-century U.S. political history as well as teacher education, also said that people are comparing the January 6's events to the War of 1812 when Great Britain invaded the U.S. "But it was a totally different thing because in that case, it was a foreign country that attacked our capital city and burned it to the ground."

History - and recent events - can help contextualize what happened and why. And it can provide understanding for the reactions people experienced during and after the riots.

"The riot itself wasn't the most shocking thing; the most shocking thing was that it was our own president who directed an attack on our Congress, and that has no precedent in U.S. history and surprisingly few in world history," he said. "To have one part of our government attack another part of the government is totally insane, and it was dangerous and antithetical to any traditional understanding of how our government should work."

Fischer shared historical context and background for the events we are seeing unfold in the Capitol:

Newburgh Conspiracy, 1783

In the 1780s, the newly formed U.S. was still in the midst of the Revolutionary War with Great Britain. The then-Confederation Congress had not paid the Continental Army for some time, which caused unrest among the troops and officers. Eventually, this led to the army planning to march on Philadelphia, the city where the capitol was located at that time and demanding their pay.

General George Washington defused the situation in the end, which led to saving the fate of the new government.

"Washington got wind of this, and it's a very famous scene where he stands in front of his officers who were going to go with the troops to Philadelphia, and he pulls out his spectacles, puts them on and apologizes to the officers by saying something to the effect of, 'I'm sorry. I have actually gone nearly blind in the service of my country,'" Fischer said. "And what that suggested right then is what sources say ended the conspiracy: Washington was saying this is what we give for our country and it's not about the pay. He and his troops weren't getting paid or receiving credit for their actions during the war, but, in the end, their ideas were bigger than those complaints."

Election of 1876

During the election of 1876, election fraud ran rampant. This election event was important because the law on how the process for accepting electoral college votes stemmed from it, which is the law that members of Congress use to object to electoral college votes.

Civic Religion

There are numerous places, monuments and historically relevant symbols that were built throughout U.S. history that many Americans view as deeply rooted in the U.S. government's foundations, such as the Lincoln Memorial, the Capitol and many others. Many analysts described the insurrectionists who raided the Capitol on January 6 as "desecrating" the building, which has such a connection to the nation's overall history and government.

"There are numerous aspects of American history and the American governmental system that many Americans take as a kind of civil religion, and many of the words that people used on Wednesday, such as desecration, show how many Americans felt about an attack on the Capitol," he said. "There were a number of symbolic aspects of what happened on January 6 that are especially jarring, symbols in direct opposition to the beliefs of this American civil religion."

Fischer listed examples of such "jarring" symbolism including photos of participants carrying the Confederate battle flag, pro-Nazi clothing, the "Don't Tread on Me" flag and others.

Fischer said this "American civic religion" is the difference between this and other riots that have occurred, because having such symbols considered anti-American in a place that is deeply rooted in American values and history was "hurtful to many."

"Stop the Steal" Campaign

When the mob broke into the Capitol on January 6, Congress was in session in the process of certifying the electoral college and 2020 election results. Many chants and signs from the mob included "Stop the Steal" - a movement that, built on unsubstantiated accusations made by President Trump, believes the 2020 election results were false, along with other conspiracy theories.

"States worked hard to prevent election fraud, and, because of their efforts, there is no evidence of widespread fraud; however, the rioters apparently believe that the only legitimate government can be one that they support, which is clearly a problem," Fischer said. "From the point of view of a historian, one of the biggest problems stemming from this is the idea of the need for evidence to create an argument. President Trump and his followers created their argument, which is that they should win and, therefore, they searched and searched for evidence to support their argument.

"One of the central ideas that I teach as a historian is that it has to be the other way around: First, find the evidence and then create the argument. The phrase that I use with my students is 'there has to be a there ... there,' or, in other words, there must be something to work from. You can't just come up with an argument, narrative or story, and then find the evidence to support it.' And in this case, they have no evidence to support it."

Black Lives Matter Protests vs. Insurrectionists

Another topic making headlines in relation to the January 6 events compares the amount of force used on the pro-Trump mob versus a far larger number of troops and more force used when confronting Black Lives Matter (BLM) protesters in the past.

"In some ways what happened has heightened the lament of those who support the Black Lives Matter movement because of the difference in the way those protesters were treated versus the rioters," Fischer said. "There's a series of divisions and wounds that were potentially opened larger and are going to be more difficult to heal."

How to Teach Controversial Topics in the Classroom

Many UNC alumni are educators, and some of them have reached out to Fischer and his colleagues for advice on teaching subjects like social studies, civics or history in K-12 schools during such a chaotic, divisive time.

According to Fischer, the "key is to always keep this historical method" upfront where you teach using the facts as well as how to find appropriate evidence online and use it.

"We must start with evidence because that's what historians do; social studies teachers don't teach myth, we teach history, and it's rooted in evidence," he said.

Fischer recommends that teachers be honest, unbiased and transparent about the January 6 events and says that it's "so important that teachers make clear that they're not stating an opinion, and that, instead, they're using the historical method and sticking to the facts" regarding how the U.S. government works based on the Constitution.

"The idea that America is exceptional, meaning the best, is not what social studies teachers should be teaching. They should just say what happened: some of it was good and some of it wasn't good or exceptional, and in the case of Wednesday's events, it wasn't good," he said "The largest number of social studies teachers in the state have graduated from UNC, so it is a central part of our mission and a central issue that a number of our graduates and current students have to grapple with in the future."

As time moves on and factual information is gathered and analyzed, the events of January 6 will become clearer in terms of planning, motives and short- and long-term impacts on American society and its citizens. Fischer believes this event is something that we can learn from as we move forward.

"The past is a mirror that we can look into and learn and make judgements from, and, in my personal opinion, because it was such a stark and jarring event, it is going to stay in people's memories, and, therefore, have an impact."
-Written by Katie Corder

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UNC Expert: The Capitol Riot and its Lasting Impacts

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On January 6, supporters of U.S. President Donald Trump stormed the Capitol in Washington, D.C. As people not only in the U.S. but around the world try to understand the event and its ramifications, UNC Professor of History Fritz Fischer, Ph.D., offers context from a historical perspective.

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Stress, Hypertension, and Early Mortality

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Stress, Hypertension, and Early Mortality

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People have become vain and have developed an idealized appearance that is both unrealistic and incredibly ugly.

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Research has shown that social media can be also linked to memory deficits. The type of memory that is impacted is the transactive memory.

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The average person spends over 3 hours on their phone each day, including approximately 2 and a half hours on social media. While it may seem like a harmless pastime, research shows that doing anything repeatedly for extended amounts of time can cause physiological changes in the brain. This begs the question, what is social media actually doing to our brains?

Changes in Attention

Social media has the ability to both capture and scatter your attention. With a simple "refresh," constant new information is at your fingertips. Through a process called "variable-ratio reinforcement," you are constantly excited and rewarded to see fresh new posts.

Studies show this ability to capture your attention has an adverse effect on your brain. Two and a half hours of social media is about the same amount of time it would take to drive to New York from Philadelphia, run a half marathon, or watch any of the Harry Potter movies. While the thought of seeing Harry, Ron, and Hermione every single day might sound like a good thing to you, what you do each day can change your brain's structure and how it processes information.

Heavy social media users perform worse on cognitive tests, especially those that examine their attention and ability to multitask. Compared to moderate to light social media users, heavy users need to exert more effort to remain focused in the face of distraction. Researchers hypothesize that since social media is easily accessible and competes for your attention with the promise of perpetual new content, heavy social media users become less able to ignore distraction in general. Not only does this lead to poorer cognitive performance, but it shrinks parts of the brain associated with maintaining attention. This ability of the brain to change is called neuroplasticity, and it has a big effect on your attention and cognitive function.

C hanges in Reward Pathways

Beyond lowering your ability to maintain your attention on any one selected topic, social media makes you addicted to your screens. It provides immediate rewards in the form of a dopamine release (the happy hormone) every time you post or get a notification from the app. This constant barrage of shallow rewards rewires your brain to want more of what caused that dopamine release, which leads to social media addiction. Studies show that the brain scans of heavy social media users look very similar to those addicted to drugs or gambling.

Changes in Memory Processes

Research also shows that heavy social media use is linked with memory deficits, especially in your transactive memory. This kind of memory involves deciding what information is important enough to store in your brain and what information can be outsourced.

Social media's central feature, the sharing and storing of your experiences, may actually be altering which memories you keep and which ones you don't. In one study, the participants were asked to record an experience using their notes or social media, and other groups were asked to simply experience the event without recording it. At the end of the study, those who had recorded or shared the event performed worse and showed more of a memory deficit than those who experienced the event without recording it. Externalizing an experience worsened participants' memory because their brain received the message that it didn't need to hold onto information that was stored elsewhere. Consequently, not only did the individuals lose some memory of their original experience, but they may also experience longer-term deficits in the size and function of their brains.

There are myriad positive aspects to social media including new friendships, career opportunities, exposure and connection to new cultures and movements, just to name a few. However, science tells us how important it is to be aware of, and guard against, social media's negative impacts as they are, quite literally, shrinking your brain. The takeaway? Despite how social media may have changed your life for the better and no matter how much you enjoy carrying around a mini dopamine dispenser, moderation is key.

If you're interested in learning more about improving your own memory and brain function, please visit us at www.neurogrow.com.

This blog was written by Lizzie Lewis, and edited by Dr. Majid Fotuhi.

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Dr. Fotuhi | Best Neurologist | Author | Speaker

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What you do each day can change our brain's structure and how it processes information. So what is social media actually doing to our brains?

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How does social media affect teenagers? Like any form of technology, social media has both an upside and a downside. And when it comes to the social media effects on teens, there are significant pros and cons to take into account.

On the plus side, platforms like TikTok, Twitter, Instagram, and Snapchat can be lifesavers for teens who feel isolated or marginalized, particularly LGBTQ teens. In addition, social media helped teens feel more connected and not as lonely during the pandemic.

But the impact of social media on youth can also be significantly detrimental to mental health. In particular, social media and teen depression are closely linked. Furthermore, overuse of the apps exposes teens to cyberbullying, body image issues, and tech addiction, and results in less time spent doing healthy, real-world activities. And while the majority of parents believe they know what their child is posting on social media, according to a Pew Research poll, a survey of teens found that 70 percent of them are hiding their online behavior from their parents.

Are teens and social media platforms a good mix, or does social media use lower teen well-being? Why is social media bad? This has become one of the more controversial questions regarding social media's effects on teens, with studies showing varied results.

According to a recent report released by Common Sense Media on social media's effects on teens, about half of the 1,500 young people surveyed said social media is very important for them in order to get support and advice, feel less alone, and express themselves creatively, as well as for staying in touch friends and family members. And 43 percent said that using social media makes them feel better when they are depressed, stressed, or anxious. Among LGBTQ youth, 52 percent said social media helps them feel better when they are experiencing these difficult emotions.

On the other hand, the report also showed a strong association between social media and teens feeling depressed. Youth with moderate to severe depressive symptoms were nearly twice as likely to say they used social media almost constantly: One-third of teens with depression reported constant social media use, as compared to 18 percent of young people who did not have depressive symptoms. Furthermore, the more severe their symptoms were, the more anxious, lonely and depressed they felt after using social media. Clearly, social media does not help teens who are already feeling depressed and seems to contribute to their negative outlook.

Is social media part of the reason that teen depression has drastically increased over the last decade? Surveys of US adolescents show that teen depressive symptoms and suicide rates showed marked increases between 2010 and 2015, especially among females.

Some researchers theorize that the increase in social media and overall screen use between those years could account for these changes. The adolescents surveyed who spent more time on social media sites were more likely to report mental health issues. Those who spent more time on real-life activities, such as in-person social interaction, sports, exercise, homework, and print media, were less likely to report these issues.

Over the last decade, this theory has been borne out by a large body of research linking teenagers' use of social media with increased teen depression. These studies show that the frequency of a teen's use of social media has a clear correlation to their mental health.

For example, in a 2018 study, 14- to 17-year-olds who used social media seven hours per day were more than twice as likely to have been diagnosed with depression, treated by a mental health professional, or taken medication for a psychological or behavioral issue during the last year. This was compared to those who used screens only about an hour a day.

Many experts believe that the constant overstimulation of social networking shifts the nervous system into fight-or-flight mode. As a result, this makes disorders such as ADHD, teen depression, oppositional defiant disorder, and teen anxiety worse. However, some research on social media and teen depression shows that the causality goes the other way-i.e., when teens are depressed, they look at social media more often. In one study of 600 young people, researchers found that social media use did not predict depressive symptoms, but greater depressive symptoms predicted more social media use over time.

"Some experts argue that young people's use of social media is adding to their depression; others that their depression leaves them so uninterested in other activities that they turn to social media by default. [Our] research suggests a third possibility: that many young people who are experiencing depression- whatever the cause-are purposely and proactively using social media and other digital tools to protect and promote their own well-being."
- Common Sense Media report

Additional Psychological Effects of Social Media on Youth

A study by researchers at University College London tracked three years of social media use by 13,000 teenagers, starting when they were 13. The teens also self-reported about their social media experiences and their mood and well-being.

After compiling the data, the study authors concluded that the social media effect on youth is driven by three primary factors:

Inadequate sleep-teens stayed up late to continue scrolling through their social media feeds

Exposure to cyberbullying-having harmful, false, or private content about them posted on social media

Lack of physical activity-scrolling social media on their phones or other devices meant that teens sat for longer periods of time and had less time for exercise. As a result, they missed out on the beneficial impact of exercise on mental health.

According to the study, which was published in the journal Lancet, 27 percent of the teens who frequently used social media reported high psychological stress. For teens who used social media less frequently, only 17 percent reported high psychological stress.

The Impact of Social Media on Youth Social Comparison

One way in which social media impacts teen mental health is through negative social comparison-what media psychologist Don Grant, PhD, Newport Director of Outpatient Services, calls "compare and despair." Teenagers on social media spend much of their time observing the lives and images of their peers. This leads to constant comparisons, which can damage self-esteem and body image, exacerbating depression and anxiety among adolescents.

As with other types of social comparison, teens report lower self-esteem and self-evaluation and peer pressure to look a certain way when looking at their friends on social media sites. For example, this includes looking at profiles on which peers post curated images about their significant others, social events, or accomplishments. And teens felt better about themselves when they make so-called "downward comparisons"-looking at profiles of peers with fewer friends and achievements. According to a Pew Research Center report on the negative effects of social media on teenagers, 26 percent of teens say these sites make them feel worse about their own life.
Read "Teen Mental Health and the Theory of Social Comparison."
The Negative Psychological Effects of Social Media on Teen Body Image

Body image is one primary area in which teen social comparison leads to negative emotions-not only for teen girls, but for all genders. When tees compare themselves to curated and filtered photographs of their peers and of celebrities, they often feel inferior. This can lead to lower self-esteem and negative body image. In addition, Facebook use has also been linked to a higher risk of eating disorders.

According to a survey by Common Sense Media:

35 percent of teenagers on social media worry about being tagging in unattractive photos

27 percent are stressed out about how they look when they post pictures

22 percent feel bad about themselves when nobody comments on or "likes" their photos.

Social Media Effects on Teens: Health Hazard or Healthy Inspiration?

Along with providing ways to seek help and support, social media also provides forums in which teens can encourage each other in unhealthy and dangerous behaviors. Hence, teens with eating disorders or those who self-harm can connect with others to talk about their self-destructive routines. In these online forums, obsessive calorie counting, fasting, or over-exercising are accepted and encouraged. As a result, young people may learn ways to hide or intensify the behavior, putting them at greater risk.

On the flip side, a teen social network can inspire teenagers to develop healthy habits. Thus, seeing peers eating nutritious food, doing something creative, or getting outside in nature can encourage other teens to do the same. Social networks can create peer motivation, inspiring young people to try something new, follow their dreams, and speak up about things that matter to them. Teens can also find positive role models online. Hence, the effect of social media on teenagers might actually result in more unplugged time and increased self-care behaviors.

The Negative Effects of Social Media on Teens' Identity Formation

The impact of social media on youth extends to an important part of adolescent development: the formation of one's unique identity. Hence, social media provides a forum for teens to practice skills related to identity development. These include self-presentation and self-disclosure-sharing their opinions, beliefs, and preferences.

In a longitudinal survey of 219 freshmen at a state university, researchers found that teens who expressed their opinions on social media experienced increased well-being. In addition, another study found that adolescents who communicated more online had greater "self-concept clarity"-a clearer idea of who they were. This self-awareness supports mental health. Furthermore, a research article on teens and social media concluded that social media gives teens the "autonomy to explore and experiment with their identities in a space of their own, where they have control over what, how, and with whom they share information."

Friendships, Teens, and Social Media

Friendship and social skills are additional areas in which the impact of social media on youth can be positive and negative. In the Pew Research Center report, 81 percent of teens in the survey said social media makes them feel more connected to what's going on in their friends' lives. In addition, two-thirds of teens said these platforms make them feel as if they have people who will support them through tough times.

During the pandemic, of course, social media became one of the most frequent-and sometimes the only-way in which teens socialized with peers. But there's a difference between teens' social media friends vs. their real friends: The Pew survey found that 60 percent of teens say they spend time with their friends online on a daily or nearly daily basis, but only 24 percent spent time with their friends that often in person. These stats highlight how online connections may not translate into IRL relationships.

In addition, the more time teens spend plugged in and on social media platforms, the more cyberbullying increases. A 2020 report by the organization L1ght found a 70 percent uptick in hate speech among kids and teens across communication channels on social media and popular chat forums. More time on social media provides enhanced access to both the beneficial and detrimental aspects, further driving the negative effects of social media on teenagers.

The Addictive Quality of Social Media for Teens

Scientists have found that teen social media overuse creates a stimulation pattern similar to the pattern created by other addictive behaviors. Hence, the brain responds to social media the same way it responds to other "rewards"- with a release of dopamine. These dopamine rushes are catalyzed when a teen posts something online and is met with likes, shares, and positive comments from their peers.

"Social media use targets our limbic system through its susceptibility to intermittent variable rewards-the same basic idea behind slot machine design-that get us 'hooked' and coming back from more. Our brains keep seeking the dopamine hit that comes with the next post we see on our feed or the next reaction to something we've posted. Research also suggests that these rituals may prime the brain for other future unhealthy dependencies or addictions."
-Don Grant, PhD, Newport Director of Outpatient Services

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As the research shows, teen social media overuse is often linked with underlying issues, such as depression, chronic stress, anxiety, or low self-esteem. Hence, treatment at Newport Academy includes addressing these root causes while unplugging from phones and social media.

After just a few days, teens begin to reawaken to their IRL environment. During treatment with us, they form strong friendships, explore their inner life through journaling and meditation, spend time in nature, and experience creative offline activities.

Newport's clinical team specializes in helping teens gain the skills and self-knowledge to heal from the maladaptive behaviors, underlying causes, and negative consequences associated with teens and social media. Contact us today to learn more about our teen treatment programs and our approach to healthy device management.

Key Takeaways

The impact of social media on youth can be significantly detrimental to mental health, exposing teens to cyberbullying, body image issues, and tech addiction, and results in less time spent doing healthy, real-world activities.

Some researchers theorize that the increase in social media and overall screen use between 2010 and 2015 could account for marked increases in teen depressive symptoms and suicide rates beginning in that same time period.

Many experts believe that the constant overstimulation of social networking shifts the nervous system into fight-or-flight mode, exacerbating disorders such as ADHD, anxiety, depression, and oppositional defiant disorder.

Teenagers on social media platforms spend much of their time observing the lives and images of their peers, leading to constant comparisons, which can damage self-esteem and body image.

Mental health treatment can help teens gain the skills and self-knowledge to heal from the underlying causes and negative consequences associated with social media overuse.

Frequently Asked Questions About the Effects of Social Media on Teens

How does social media affect teenagers?

What are five negative effects of social media?

What impact does social media have on teenagers' self-esteem?

Does social media cause depression, or does depression increase social media use?

Is social media really addictive?

Sources
Curr Opin Psychol. 2022 Apr; 44: 58-68. Nature Human Behaviour. 2019(3): 173-182. Prev Med Rep. 2018 Oct 18;12: 271-283. Clinical Psych Sci. 2019, 2017. Comput Human Behav. 2015; 52: 49-58.

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The Effect of Social Media on Teenagers | Newport Academy

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How does social media affect teenagers? Discover the negative impact of social media on adolescents and its effect on their mental health.

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“If I was to continue using social media, I had to learn what would trigger my anxiety and how using different platforms made me feel,” says Michelle.

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Here's How Social Media Affects Your Mental Health | McLean Hospital

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Using social media can directly impact emotional wellness, physical, and mental health. Here are the signs that you are affected.

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During the 2020 election there were a lot of people spread the false narrative that voter fraud was occurring during the midterms. The event caused a lot of distrust and confusion surrounding the government. The lessons that we can take away from this event is that government officials need to do a better job of stopping misinformation from spreading before it happens. Even worse, some political figures were even promoting the spread of misinformation. It's also important for people to understand how misinformation is spread on different apps, and the article does a good way of describing the differences.

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Election-related falsehoods corrode American democracy. Since 2020, lies about a stolen presidential election cropped up in dozens of campaigns for election administrator positions and spurred unprecedented threats to election officials. The result has been a deluge of resignations that drained expertise from election offices across the country. Further, public trust in elections has plummeted amid disinformation promoted by Donald Trump and other prominent election deniers.

The health of our democracy depends in part on our success in guarding against damage from election misinformation. That's why last year, we launched the Midterm Monitor interactive tool to better understand the online conversation about the election. Our research surfaced striking patterns in election misinformation. It also revealed that certain strategies are likely to be more effective in combatting election falsehoods than others.

Starting in September, the Midterm Monitor collected posts and information from Facebook, Instagram, Twitter, and YouTube accounts affiliated with candidates for the House, Senate, governor, and secretary of state. The monitor also collected posts and information from the accounts of influential national media outlets and pundits, top local media outlets in 10 battleground states, Spanish-language U.S. media outlets, and state media and diplomats associated with the Chinese, Iranian, and Russian governments.

Using the Midterm Monitor, we confirmed that high-profile election deniers rely on the same core false election-related narratives that are repeated time and time again. This pattern shows that internet and social media companies, election officials, journalists, and civic groups can "prebunk" many of the central elements of false stories ahead of Election Day.

Our research also showed that networks of important influencers and online communities helped election falsehoods spread in the midterms, demonstrating the usefulness of network analysis as a tool to track indicators of harm and slow the spread of election lies. And we unearthed key differences in the way election deniers use each social media platform that should be accounted for in crafting a comprehensive strategy to combat election misinformation.

Lesson #1: Election denial relies on core false narratives that recur and evolve.

Between mid-August and the end of November, a team of analysts read through thousands of social media posts captured by the monitor and conducted an automated analysis of tens of thousands of posts. We found that a large share of misinformation reflected themes that were the same or similar to those in the 2020 election. Our research empirically showed a phenomenon that others have observed: prominent election deniers rely on a core set of false narratives around voting machines, mail voting, and voter fraud. This pattern allows for potentially effective prebunking of these central themes.

These core false narratives are "sticky" - they recur, repeat, and evolve. Throughout the four-month tracking period, certain misinformation tropes turned up again and again: conspiracy theories depicting voting machines as vehicles for widespread voter fraud, false claims that mail voting and drop boxes are insecure, baseless accusations of votes cast by noncitizens or with the names of dead people, and false claims of fraud in vote counting.

To recycle these core themes, spreaders of misinformation often latched onto breaking news events to spread falsehoods. In the lead-up to the election, for example, some candidates exploited the news that a Dominion voter assist system for printing ballots ended up for sale on eBay to cast doubt on vote totals from voting machines.

On Election Day, influencers evoked the same deceptive theme in connection with an unfolding news story in Maricopa County, Arizona, where a printing issue affected a number of vote-counting machines for some time. The later-resolved technical glitch - which interrupted operations at about one in four poll sites - ignited a firestorm of false claims about voting machines. Some individuals cast doubt on whether ballots would be properly counted and accused election officials of changing ballots after the ballots were deposited in secure collection boxes. A widely shared video featuring a poll worker promoting the false claims got 4.5 million views in under a day.

Our election system has checks in place to prevent fraud in vote counting and to guarantee that machines count votes accurately. In Maricopa County, officials confirmed that all eligible voters had safe options to cast ballots throughout Election Day. However, the recipe of a familiar false trope combined with a specific, late-breaking event provided fertile ground for misinformation to thrive.

On Election Day, influential election deniers also seized on a quickly resolved technical glitch in Detroit to misrepresent, extrapolate, and connect the isolated issue to a major misinformation narrative. At the polls, some Detroit voters were issued ballot ID numbers that electronic poll books initially showed as matching an absentee ballot. This problem stemmed from a data issue with some poll books that officials quickly addressed, and all eligible voters were able to cast ballots. But Michigan secretary of state candidate Kristina Karamo (R) and other influential accounts capitalized on the issue to baselessly argue that mail voting leads to widespread fraud.

In our preelection tracking, we saw numerous social media posts falsely claiming that drop boxes, voting by mail, or absentee voting are vehicles for mass voter fraud. In fact, mail ballots have been successfully used in the United States for over 150 years, and in that time, states have developed multiple layers of security to protect against malfeasance.

The common arsenal of themes is part of the information infrastructure that election deniers operate in. Instead of having to start from scratch, they often hark back to the same themes and link them to the news of the day. Election deniers do not reinvent the wheel - and efforts to combat misinformation do not have to either.

Recommendation: Companies, officials, and organizations should more effectively "prebunk" core misinformation themes.

Our Midterm Monitor analysis offers lessons for effective and efficient prebunking and debunking of misinformation in future elections. In future elections, election officials, civic groups, news organizations, and social media and internet companies - including Facebook and Google - can get ahead of the curve and help stem the tide of election misinformation. In so doing, they can build on existing efforts to educate the public in timely and strategic ways.

Before elections, officials and organizations should take action to inoculate against common misinformation tropes. Social media sites should pin or host "information boxes" containing content from authoritative sources, including election offices, to explain existing election security safeguards, the reliability of voting and vote-counting machines, the trustworthiness of mail ballots, and the timeline for counting votes and certifying elections. News outlets can publish more stories on voting machines, mail ballots, and election results early and with important context. Civic groups should facilitate digital literacy trainings that prepare constituents to recognize common conspiracy themes.

Across party lines, election officials largely remain highly trusted sources of election information. They too can take proactive steps to rebut core conspiracies and stave off rumors and lies. In the lead-up to elections, these officials can run voter education campaigns and maintain tip lines and rumor-control pages where possible. They can build contact lists and relationships in secretary of state offices, within the media, in community groups, and with candidates of all affiliations to amplify accurate information. Internet companies should offer trainings to election officials on search engine optimization and keyword use to help boost critical information.

In the past election cycle, some election offices provided early, accessible, and transparent information to the public to prebunk core false narratives. Their actions offer a roadmap for officials who seek to preempt viral lies and rumors on or after Election Day and prepare the public to meet common election myths with a skeptical eye.

For example, the Ohio secretary of state created a detailed video about how absentee ballots are printed, mailed, and counted. In depicting election workers inside an election office, it reminded the public that election administration is a process conducted by community members in a professional setting, not a secretive sham unfolding behind closed doors.

In some Texas counties, election administrators invited members of the public to tour their offices and participate in accuracy testing for voting machines. And just before the polls closed on Election Day, the Michigan Department of State posted an infographic to Twitter with a timeline for vote counting. The post explained that absentee ballots take longer to process than votes cast in person and that voters could expect unofficial results 24 hours after polls closed.

On Election Day, crisis preparation is also key when innocent glitches occur and core false narratives evolve and take on new elements, as in Maricopa County and Detroit. Election workers in Los Angeles, for example, developed a crisis communications plan ahead of the 2021 gubernatorial recall election, identifying worst-case scenarios and stakeholders who could help share accurate information with specific communities. For election offices with fewer resources, standardized planning tools are available. For instance, the federal Cybersecurity and Infrastructure Security Agency offers incident response plans, infographics, and simulated disinformation scenarios.

Lesson #2: Networks facilitate the spread of falsehoods.

Our analysis showed that the dissemination of some election lies and falsehoods clusters around several online communities and important influencers. We used network analysis - a process that examines the relationships between individuals and groups - to show how many times each election denier in our data retweeted others between mid-August and the end of November. The result was a map in which each connection represented a retweet and clustering reflected key spreaders who retweet at the highest rates. Our network analysis showed that communities are clustered around notable "misinformation spreaders" who fuel viral rumors as they travel and grow online. The major nodes in the networks are also election deniers in different states - Mayra Flores in Texas, Mark Finchem in Arizona, and Doug Mastriano in Pennsylvania - pointing to the centrality of high-profile state messengers in networks that spread misinformation.

Recommendation: Social media platforms, public figures, and civic groups should push back against networks that peddle election misinformation and amplify content from election officials.

Our research shows how critical it is to pay attention to networks that nurture viral rumors and lies. It builds on Facebook's finding in the wake of the January 6, 2021, attack on the Capitol that the social media giant had done too little to identify coordinated networks of actors peddling lies and calls for violence.

In future election cycles, social media platforms can analyze networks to better track misinformation trends and early indicators of harm. If an isolated election issue occurs on Election Day, platforms can limit false stories' spread early in the viral process by slowing down related shares and reposts until information is checked for accuracy.

Political leaders, public figures, civic groups, and social media companies should also amplify accurate content from election officials so that it breaks through information silos and networks. If a local election issue spurs misstatements or turns into a false national narrative on or after Election Day, social media companies should amplify corrections from local election officials - even when local officials have low follower counts online. Platforms should promote and elevate content from local governments, secretary of state offices, and other authoritative election sources. The companies should also maintain open channels of communication with election workers as on-the-ground developments occur.

Lesson #3: Election deniers use different social media platforms in different ways.

The differences between the ways social media platforms are used underscore the importance of accounting for each platform's distinct features and user base in devising a strategy to combat misinformation.

Our comparison of different social media platforms showed key differences in content and communities of users reflected in data from the Midterm Monitor. Compared with Twitter, YouTube, and Facebook, we found that Instagram had less election content, fewer false narratives, and less discussion of fraud. YouTube had the highest volume of discussions of fraud. Twitter and Facebook, meanwhile, both had a relatively high volume of false narratives about elections. The variation demonstrates that certain platforms play a greater role in misinformation about elections.

We also saw important differences in the kinds of content and candidates on platforms. Because of the nature of the platform, Twitter tended to feature shorter posts, but content was more likely to be reshared by a wider group. On Facebook, posts were longer in form, which allowed space for longer rants with more falsehoods. This suggests a difference in the way misinformation spreaders weaponize each of the platforms and the role that difference plays in perpetuating election falsehoods.

The conversation around elections on each of these platforms featured slightly different communities. Twitter had the most secretary of state candidates and seemed to be the center of the election security discussion. Each platform, moreover, has a different primary audience. According to other research, Democrats are more likely than Republicans to use Instagram and Twitter. Afro-Latino and Hispanic communities are more likely to use Instagram than the general population. These variations suggest that the content on each platform has different social implications.

Recommendation: A comprehensive strategy to combat misinformation should assess social media platforms' distinct user communities and content, and it should incorporate news and civic organizations to reach broader groups.

The differences in the amount of false election content, user base, and content on each social media platform should be accounted for in crafting a comprehensive strategy for combatting misinformation on social media.

News and civic organizations can also reach broader groups and help stop rumors and lies from emerging and taking root. Journalists - including those with local, regional, and ethnic news outlets - can connect with local election offices and give voters context for innocent but disheartening glitches. Civic groups should give the public information in suitable languages and formats and act as a bridge between vulnerable communities, officials, and the media. When addressing lies and rumors, journalists and civic groups can provide accurate context, consult election experts, and use "no-follow" links to avoid boosting misinformation in search results.

* * *

Accurate voting information and trust in elections are critical to our democracy. A whole-of-society approach is needed to defend elections against the scourge of misinformation.

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3 Lessons on Misinformation in the Midterms Spread on Social Media

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The Brennan Center has developed recommendations on how to fight misinformation based on analysis of how it takes root and circulates.

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UK Chiropractors Find Correlation Between Social Media and Back Problems

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UK Chiropractors Find Correlation Between Social Media and Back Problems

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"200 social media users in a recent study revealed the Internet has put us out of touch with
our bodies
74% reported backache, a headache or eyestrain due to their extended computer use.
94% of users are spending up to 15 hours in front of their computers
Nearly six in ten (58%) aren’t taking any precautions to protect their posture and back
Bloggers admit to accessing the Internet in front of the TV (95%) or even in bed (94%)
allowing poor posture and serious damage to their backs."

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The 2020 Presidential election made voters confidence in our political system decrease, due to the fake news/misinformation that was "deliberately aimed at disrupting the democratic process".

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Misinformation is eroding the public's confidence in democracy | Brookings

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Democracy in the United States is in serious trouble.

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"seeing an increase in patients with neck and upper back pain which is likely to be related to poor posture when using mobile phones"

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Here's a game to play the next time you are stuck in a queue.

Try to spot somebody not looking down at their phone. Then ignore that person and examine the others. You don't need to be a doctor to recognise that most of them will be holding their necks at a strange angle that makes them look almost like giraffes as they push their heads forward.

This awkward positioning would not be a problem were it not that our heads are rather heavy, weighing 4.5kg (10lbs) on average, and our necks are not particularly muscly.

We are designed to hold our heads upright. When we push our heads forward, whether to look down at the phone in our hands or forward to focus on a computer screen, neck strain is increased. The farther forward we push our heads, the more strain is put on the spine.

A recent report in The Spine Journal, the official publication of the North American Spine Society, says surgeons there are seeing an increase in patients with neck and upper back pain which is likely to be related to poor posture when using mobile phones. It even has a name: tech neck. The neck naturally curves backwards, but surgeons are seeing that curve reversed, giving patients disc or alignment problems. The authors of the report are concerned that today's children may need surgery by the time they reach their late 20s if they do not curb their social media use.

Lorraine O'Reilly, a physiotherapist with Physiofusion in Ranelagh, Dublin, agrees with the report's suggestion that the simplest solution is to put down the device regularly. "It makes logical sense to take regular breaks, to hold the phone up at eye height rather than bending at our necks which would increase the loads through discs and neck structures," she says, adding the use of voice-activated technology, such as Apple's Siri, can reduce some of the touch interactions on handheld devices.

"From a practical physiotherapy perspective, regular simple large upper limb movements such as shoulder shrugging, neck side bend stretches, upper back twists and arm circles may all help to deload the tissues and desensitise the pain system," she says.

Most people carry the head too far forward, according to Frank Kennedy, an Alexander technique practitioner in Mount Merrion, Co Dublin. "This knocks the body out of kilter and has a big impact on posture. It imposes wear and tear on the joints and can make you look an inch or two shorter than your natural height," he says.

The Alexander technique involves learning to move naturally so as to put less strain on the body. "We need to expand our awareness of how we move," he says. "Look at the screen with your eyes, rather than locking onto it. Concentrate with your mind, rather than jutting your head forward."

Our tendency to be reactive does not help, he adds. "We jump up at everything from a text message to a door bell. Overreaction triggers tension pathways in the body. If we can create a gap between stimulus and response, then we can learn to stop tension. You don't have to wait for the weekend or for a holiday to relax. We look for relaxation in each action."

Part of the difficulty in helping people to change is that harmful posture over time feels normal

When under pressure, we tend to hold our breath. "Holding the breath sends the wrong signal to the brain," says Kennedy. "We can learn to relax, breathe and send a message to feel at ease."

Part of the difficulty in helping people to change is that harmful posture over time feels normal. When Kennedy gets a client with particularly turtle-like stance, he will gently guide the head back into a natural position and then show the client in the mirror.

"People say it feels formal or weird as they are not accustomed to it, but the mirror shows it looks natural. That's why you need someone else to guide you."

Acupuncturist Cyrille Bonnard regularly sees clients suffering from tightness and stiffness in the neck and upper back typically caused by bad posture. "When it is more chronic, a patient can have severe pain in the neck, shoulders and arms," he says.

In the long term, it can contribute to a bulging disc

"When bad posture is repeated again and again, and the head's weight is not distributed equally on the cervical spine, then the musculature becomes unbalanced making the neck fragile and unstable. In the long term, it can contribute to a bulging disc, due to degeneration of the cervical spine, or cervical radiculopathy, which is a condition where a nerve leaving the neck is compressed or pinched."

Acupuncture can provide pain relief and - combined with tui na (Chinese massage) and specific exercises to stretch the spine and release the pressure on vertebral discs - are a good way to prevent or address problems, he says.

People whose problems return are those who do not address the root of the problem, which is a bad posture

One exercise he uses with patients involves imagining you are being pulled up from the top of the head. "We have to make ourselves slightly taller leading up with the head and by feeling the stretch on the spine," says Bonnard. "It's important to keep the head straight (chin in) and not to move the head backward so that can we feel the stretch in the neck. When stretching is attained, we just need to relax our pelvis 'sitting' on it."

That helps clients to release pressure on the spine and readjust to a relaxed posture without slumping. "In general, people whose problems return are those who do not address the root of the problem, which is a bad posture," says Bonnard.

Sign up for one of The Irish Times' Get Running programmes (it is free!).

First, pick the programme that suits you.
- Beginner Course: This programme is an eight-week course that will take you from inactivity to being able to run 30 minutes non-stop.
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Best of luck!

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Why our social media habits are a pain in the neck

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US surgeons seeing increase in patients with neck and upper back pain likely to be related to poor posture when using mobile phones

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Neurological damage, sleep, and eye health

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Neurological damage, sleep, and eye health

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The impacts of technology on physical health are vast and complicated. Some claims are based on studies whiles others are based on interpretations of data and understandings of how the human body works. Here is our attempt to summarize the overwhelming amount of information, recommendations and opin…

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Is excessive social media use linked to poorer health? Researchers say yes

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Researchers in the US have measured social media usage of 251 undergraduate students and their health, finding a link between high social media usage and poor physical health.

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"Of students who report spending a lot or some time on social media 50% found out what is happening in the world"

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Social media is a big part of many teens' lives. A 2018 Pew Research Center survey of nearly 750 13- to 17-year-olds found that 45% are online almost constantly and 97% use a social media platform, such as YouTube, Facebook, Instagram or Snapchat.

But what impact does social media use have on teens?

Social media benefits

Social media allows teens to create online identities, communicate with others and build social networks. These networks can provide teens with valuable support, especially helping those who experience exclusion or have disabilities or chronic illnesses.

Teens also use social media for entertainment and self-expression. And the platforms can expose teens to current events, allow them to interact across geographic barriers and teach them about a variety of subjects, including healthy behaviors. Social media that's humorous or distracting or provides a meaningful connection to peers and a wide social network might even help teens avoid depression.

Social media harms

However, social media use can also negatively affect teens, distracting them, disrupting their sleep, and exposing them to bullying, rumor spreading, unrealistic views of other people's lives and peer pressure.

The risks might be related to how much social media teens use. A 2019 study of more than 6,500 12- to 15-year-olds in the U.S. found that those who spent more than three hours a day using social media might be at heightened risk for mental health problems. Another 2019 study of more than 12,000 13- to 16-year-olds in England found that using social media more than three times a day predicted poor mental health and well-being in teens.

Other studies also have observed links between high levels of social media use and depression or anxiety symptoms. A 2016 study of more than 450 teens found that greater social media use, nighttime social media use and emotional investment in social media - such as feeling upset when prevented from logging on - were each linked with worse sleep quality and higher levels of anxiety and depression.

How teens use social media also might determine its impact. A 2015 study found that social comparison and feedback seeking by teens using social media and cellphones was linked with depressive symptoms. In addition, a small 2013 study found that older adolescents who used social media passively, such as by just viewing others' photos, reported declines in life satisfaction. Those who used social media to interact with others or post their own content didn't experience these declines.

And an older study on the impact of social media on undergraduate college students showed that the longer they used Facebook, the stronger was their belief that others were happier than they were. But the more time the students spent going out with their friends, the less they felt this way.

Because of teens' impulsive natures, experts suggest that teens who post content on social media are at risk of sharing intimate photos or highly personal stories. This can result in teens being bullied, harassed or even blackmailed. Teens often create posts without considering these consequences or privacy concerns.

Protecting your teen

There are steps you can take to encourage responsible use of social media and limit some of its negative effects. Consider these tips:

Set reasonable limits. Talk to your teen about how to avoid letting social media interfere with his or her activities, sleep, meals or homework. Encourage a bedtime routine that avoids electronic media use, and keep cellphones and tablets out of teens' bedrooms. Set an example by following these rules yourself.

Monitor your teen's accounts. Let your teen know that you'll be regularly checking his or her social media accounts. You might aim to do so once a week or more. Make sure you follow through.

Explain what's not OK. Discourage your teen from gossiping, spreading rumors, bullying or damaging someone's reputation - online or otherwise. Talk to your teen about what is appropriate and safe to share on social media.

Encourage face-to-face contact with friends. This is particularly important for teens vulnerable to social anxiety disorder.

Talk about social media. Talk about your own social media habits. Ask your teen how he or she is using social media and how it makes him or her feel. Remind your teen that social media is full of unrealistic images.

If you think your teen is experiencing signs or symptoms of anxiety or depression related to social media use, talk to your child's health care provider.

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Show references

1. Viner RM, et al. Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: A secondary analysis of longitudinal data. The Lancet. Child & Adolescent Health. 2019; doi:10.1016/S2352-4642(19)30186-5.

2. Riehm KE, et al. Associations between time spent using social media and internalizing and externalizing problems among US youth. JAMA Psychiatry. 2019; doi:10.1001/jamapsychiatry.2019.2325.

3. Woods HC, et al. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence. 2016; doi:10.1016/j.adolescence.2016.05.008.

4. LeBourgeois MK, et al. Digital media and sleep in childhood and adolescence. Pediatrics. 2017; doi:10.1542/peds.2016-1758J.

5. Hoge E, et al. Digital media, anxiety, and depression in children. Pediatrics. 2017; doi:10.1542/peds.2016-1758G.

6. Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics. 2016; doi:10.1542/peds.2016-2592.Brown A, et al. Beyond 'turn it off': How to advise families on media use. AAP News. 2015; https://www.aappublications.org/content/36/10/54. Accessed Dec. 19, 2019.

7. Kross E, et al. Facebook use predicts declines in subjective well-being in young adults. PlOS One. 2013; doi:10.1371/journal.pone.0069841.

8. Verduyn P, et al. Passive Facebook usage undermines affective well-being: Experimental and longitudinal evidence. Journal of Experimental Psychology. General. 2015; doi:10.1037/xge0000057.

9. Talking to kids and teens about social media and sexting - Tips from the American Academy of Pediatrics. American Academy of Pediatrics. https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Talking-to-Kids-and-Teens-About-Social-Media-and-Sexting.aspx. Accessed Nov. 19, 2019.

10. Teens, social media & technology 2018. Pew Research Center. https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/. Accessed Nov. 11, 2019.

11. Nesi J, et al. Using social media for social comparison and feedback-seeking: Gender and popularity moderate associations with depressive symptoms. Journal of Abnormal Child Psychology. 2015; doi:10.1007/s10802-015-0020-0.

12. Chou HT, et al. "They are happier and having better lives than I am": The impact of using Facebook on perceptions of others' lives. Cyberpsychology, Behavior and Social Networking. 2012; doi:10.1089/cyber.2011.0324.

13. Bieber ED (expert opinion). Mayo Clinic. Dec. 4, 2019.

See more In-depth

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How to help your teen navigate social media

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Find out how to help limit the negative impact of social media use on your teen.

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The U.S. Surgeon General's 2023 Social Media and Youth Mental Health advisory outlines the latest scientific evidence regarding social media's effects on youth mental health. The report recommends actions that policymakers, technology companies, parents and others can take to ensure the online safety of young people. This post highlights key findings from the advisory.

Current Levels of Teen Social Media Use

Virtually all teens (95%) ages 13 to 17 use social media, with more than 1 in 3 reporting that they use it ​"almost constantly." While most U.S. social media platforms require users to be at least 13 years old, nearly 40% of kids ages 8 to 12 use social media. The advisory also noted:

Adolescents who use social media more than three hours per day face twice the risk of experiencing poor mental health outcomes.

A recent survey found that eighth and 10 th grade students spend an average of 3.5 hours per day on these platforms.

Negative Effects of Social Media on Mental Health and Well-Being

Numerous studies show that higher levels of social media use among children and adolescents are linked to adverse effects, including depression and anxiety, inadequate sleep (which can disrupt neurological development and lead to depression and suicidal behaviors), low self-esteem, poor body image, eating disorder behaviors and online harassment. These risks are greater for girls versus boys and for those already experiencing mental health issues. Additional risks include:

Nearly 2 in 3 adolescents are ​"often" or ​"sometimes" exposed to hate-based content on social media.

Studies have found a connection between social media cyberbullying and depression among young people.

Teen girls and LGBTQ youth are more likely to experience cyberbullying and online harassment, which can lead to negative emotions.

Adolescence Is a Vulnerable Phase of Development

The mounting evidence regarding social media's adverse effects on youth is especially concerning given that adolescence is a critical period of development, when different areas of the brain begin to integrate and the prefrontal cortex develops at an accelerated pace. In this phase, the brain is especially open to learning and growing, and teens may have intensified sensitivity to the nature of social media, according to the Surgeon General's advisory. Adolescence also involves profound physiological changes - these young people are simultaneously navigating increasing autonomy, forming their identities, developing relationships and more. Thus, the potential effects of social media during this vulnerable phase warrant particular attention.

Are There Benefits to Using Social Media?

In some cases, social media can provide social support from peers or others, which may be especially beneficial for marginalized young people, such as sexual and gender minorities. For instance, according to the Surgeon General's advisory, social media may boost the mental health of LGBTQ youth by fostering connections with peers, facilitating identity development and enabling social support.

Research also indicates that social media-based mental health interventions may be useful tools for kids and teens, and they may help young people learn to seek help or professional care when needed. In this sense, social media platforms could serve as a gateway to mental health care or at least online social support as a buffer against stressors.

How to Protect Teens on Social Media

While social media offers benefits for some, growing evidence of its potential harm to many children and youth has led the Surgeon General to issue an urgent, cross-sector call to action:

For policymakers

Strengthen protections to ensure greater safety for children interacting with all social media platforms, such as developing age-appropriate health and safety standards, requiring a higher standard of data privacy for children and strengthening and enforcing age minimums.

Ensure technology companies share data relevant to the health effects of their platforms.

Support increased funding for future research on both the benefits and harms of social media use and other technology and digital media use for children, adolescents and families.

For technology companies

Conduct and facilitate transparent and independent assessments of the impact of social media products and services on children and adolescents.

Prioritize user health and safety in the design and development of social media products and services to minimize harm to children and adolescents.

Create effective and timely systems and processes to investigate requests and complaints from young people, families, educators and others.

For parents and caregivers

Create a family media plan with agreed-upon expectations to establish healthy social media boundaries at home.

Create tech-free zones and encourage in-person interactions, which may involve limiting use of devices around bedtime and mealtimes, prioritizing family relationships and building social bonds.

Model responsible social media behavior, as children often learn from what they see around them.

Overall, policymakers, tech companies, researchers, funders, families, advocates and others must work together on multi-pronged strategies to create safe and healthy social media environments for young people.

Learn More About Social Media and Teen Mental Health
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The U.S. Surgeon General's Social Media and Youth Mental Health advisory outlines the effects of social media on teens' well-being. Read the findings.

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“Ergonomically, smartphones weren’t designed with the hands and wrists in mind.”

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As a longtime emergency department physician, I have a case study I'd like to share with you. The patient's right thumb knuckle is inflamed, swollen and often painful, especially toward the end of the day, and the inside part is a little numb. Her grip is slightly weakened, and her palm aches. Her middle finger intermittently has a new "catch" to it when bent. The second and third fingers are slightly swollen.

I'll get to the diagnosis in just a moment. For now, let me just say that this is a patient I know quite well-so well, in fact, that I'm not sure how I didn't see this coming.

For a decade, I have used my smartphone to hammer out voluminous emergency medicine reports that highlight various medical conditions, which I then share with a broad array of doctors each week, the better to stay on top of important trends and topics in our field. Then came the pandemic, which ratcheted up my phone game to staggering new levels.

I followed top scientists on Twitter, pored over COVID-19 literature, ordered goods and services, caught up with breaking news, messaged friends, wrote e-mails, composed longer notes and full letters, and of course produced those long reports. I swiped up, highlighted, bolded, copied, pasted, collated-all of it on a mobile device that fits in one hand, albeit awkwardly.

So yes, the patient is me. And yes, my dominant hand has taken a beating. Swelling in my index and long fingers-my swiping fingers-is affecting my ability to fully close my fist. Additionally, my long finger is catching some when I bend it. It becomes stuck sometimes when bent and then straightens with a snap.

Score: Technology 1, User 0.

"You are not alone," Jeffrey Stone assures me. Stone, an upper extremity surgeon at the Florida Orthopedic Institute, says he has long seen these injuries from texting, computer work, gaming, doctors recording information online, surgeons holding retractors or forceps, and so on. "But now it's everybody," he says, "because people are constantly between their phones, [electronic] pads and computers. They're constantly banging away."

" Texting thumb," which you may also hear called "smartphone thumb," may not be an official medical diagnosis. But it is a real phenomenon, if somewhat ill-defined, and stems from overuse and subsequent inflammation. Trigger thumb ( or trigger finger), which some providers are beginning to associate with phone users who constantly swipe and text, is another real thing. We are dwelling here within the broader category of repetitive stress injuries, which may occur in any body part being asked to do the same thing repeatedly. And when I say "we," I mean it.

"Texting thumb is a way for me to say to somebody, 'It appears to me that you're doing too much of this,'" says Stone. "It's a garbage can all-inclusive term to say, 'It appears that the biggest culprit to this continuing to be a problem for you-and continuing to inhibit your life-is the amount of time you're spending texting.'"

As John Erickson, a hand and upper extremity surgeon at the Raleigh Hand to Shoulder Center, tells me, "Ergonomically, smartphones weren't designed with the hands and wrists in mind." Stone says smartphone users are "running marathons with their thumbs every day," and because the joints are very small in your hands, the amount of force transmitted is tremendous. Stone says that one pound of pressure at the tip of the thumb can translate to about 12 to 14 pounds of pressure at the base of the thumb joint.

"I consider texting thumb as more of a repetitive stress injury," says David Bozentka, chief of hand surgery at the University of Pennsylvania. High-velocity texting, hands held in awkward positions, fingers stretched to reach faraway keys-all of these contribute to the problem alongside other predisposing factors, experts say.

Trigger finger occurs when the flexor tendon becomes thickened and inflamed inside a narrow tunnel, or sheath, sometimes causing the finger to be stuck in a bent position. It is often seen in people who use their hands for repetitive movements, such as frequent gripping or pinching, or after forceful use of the fingers and thumb. Sound familiar?

In my own case, I've developed inflammation and mild arthritis in my right thumb metacarpal joint, which my doctor and I suspect was exacerbated by excessive smartphone use. The pain and the degenerative arthritic changes are present only in my right (texting) thumb, which is significantly larger than my left thumb. The pain resolves completely at night after resting it, but recurs the next day when I resume pecking and swiping-and I do resume.

Multiple studies have shown the cumulative effects of smartphone use on the musculoskeletal system, with up to two thirds of mobile device users in one study having such complaints, associated with the frequency of making phone calls, texting and gaming. Another study found the highest prevalence of complaints in the upper neck, back, and wrists and hands.

Let's face it: our hands weren't really made for all of this.Experts describe another painful tendonitis at the thumb base called "gamer's thumb" or De Quervain's disease. It seems to be associated with frequent texting on smartphones or gaming, among other causes, though more research is needed.At a more anatomical level, ultrasound studies have shown thickening and changes in thumb tendons of frequent texters-and the thickness paralleled the numbers of messages per day.

"And there's other smartphone overuse injuries that we see," says Brandon Donnelly, a hand surgeon with Pontchartrain Orthopedics and Sports Medicine in Metairie, La. "'Text claw,' or pain and cramping in the fingers, is one along with carpal tunnel and 'cell phone elbow,' which is caused by prolonged bending. Users may bend their wrist or elbow while watching the latest viral video, streaming television and scrolling through social media content," Donnelly says. Experts agree that more research is needed to better understand and detail technology's role in all of these conditions.

"I advise people to at least put their phone on the table when they can," says Stone. "The mere act of holding it involves gripping it with your thumb and small finger, so your intrinsic muscles are straining and your palm hurts." As you've no doubt noticed, they're making many smartphones bigger, not smaller. That's an issue, especially for someone with smaller hands.

Smartphone addiction has been increasing worldwide, particularly among young adults, and those age groups are not immune from injury. "It's not like an epidemic, but it's certainly a steady flow of these kinds of patients coming in," says Erickson.

Most cases of texting thumb can be treated conservatively by simply resting the thumb. Given the trend toward more phone use, that's easier said than done. Still, Erickson says, "The most obvious thing is activity modification."

Trysome of these measures to give your thumb a break: Use your index finger or different fingers to text and swipe. Employ voice recognition software on devices when possible. Use a desktop or laptop when composing longer notes. Limit gaming time.Consider anti-inflammatory medication, if not contraindicated.

For the overwhelming majority of high-tech sufferers, such conservative actions should do the trick. Erickson says that if things aren't improving in a few weeks, one should seek medical attention. That may mean a thumb brace or splint, oral or topical nonsteroidal medications, hand therapy, referral to occupational therapy, and perhaps a cortisone shot. In my case, I'm hoping that a recent steroid injection will reduce the inflammation and swelling in my trigger finger. My hand surgeon estimates that the treatment is effective in roughly 70 percent of cases. Occasionally, surgery is necessary for recalcitrant conditions.

Physician awareness will be important going forward. We sometimes diagnose conditions and treat patients without fully considering the cause-which, in this case, is nearly completely reversible once corrective measures are taken. I suspect we underdiagnose smartphoneuse as at least an important contributor to various repetitive stress injuries. In 20 years in the ER, I can tell you this etiology for various musculoskeletal complaints never crossed my mind. I simply didn't know. I do now.

More broadly, it's probably wise for all of us to spend a little more time unplugged. (Guilty as charged, over here.) Take a walk. Pocket your phone. And give your tweetingdigits the break they deserve.

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Texting Thumb, Trigger Finger, Gamer’s Thumb and Other Smartphone Injuries

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What causes them and how to protect yourself

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Australian children see and interact with a large number of promotions for unhealthy foods that come from a variety of sources. Australian children of 5 to 8-years-old are exposed to at least 827 unhealthy food advertisements on television each year. Australian adolescents are exposed to almost 100 promotions each week coming from online sources. The majority of food and drink advertisements near schools and on children's journeys to schools feature unhealthy products. A study from Perth showed that schools have an average of 36 food advertisements within 500 m of the grounds. There is also evidence of a social inequality in the marketing of unhealthy foods in Australia. More food advertisements and a higher proportion of unhealthy food advertisements are found near schools in lower socioeconomic areas. The highest proportion of advertisements for unhealthy foods in Australian train stations occurs in areas with the lowest socioeconomic status.

Food marketing takes advantage of the developmental vulnerabilities of children and adolescents. When viewing television, for example, children younger than about 5 years are unable to tell the difference between a program and an advertisement. Even older children who can identify advertising lack the cognitive skills and experience to critically interpret marketing messages. Adolescent brains are biased towards rewards and they are more likely to respond to cues in the environment, such as marketing. When rating the riskiness of everyday situations, young adolescents are heavily influenced by the opinions of their peers, suggesting they place high importance on conformity.

Unhealthy food marketing targets children as consumers in their own right, and as intermediaries who can influence other consumers, particularly their parents ('pester power') and peers.

Researchers have described a "cascade of effects" in which exposure to unhealthy food marketing influences children's brand awareness and preferences, and consequent purchases and consumption.Exposure to unhealthy food advertisements increases food intake in children. For example, an Australian study showed that children aged 7 to 12 years increased food intake following exposure to unhealthy food marketing, and did not compensate for this by reducing food intake at a subsequent meal.How often children consume unhealthy foods may be associated with the level of emotional arousal (positive feelings of happiness and satisfaction) that they experience after exposure to marketing.

Television advertising of unhealthy food

Commercial television viewing is independently associated with obesity in children (not just because it is a sedentary activity) and researchers conclude this link is likely due to advertising of unhealthy foods. The promotion of unhealthy products not only encourages brand switching within a product category but increases consumption of particular categories of foods including fast food and soft drinks. It attracts new customers and establishes societal norms around acceptable and desirable foods.

Studies from many countries have shown that marketing of unhealthy foods on television frequently targets children. Internationally, unhealthy food advertisements are more frequent during children's typical viewing times, during school holidays, on children's channels and around children's programming. In Australia, unhealthy food and drink advertisements are more common during children's peak viewing times, but less common during school holidays. A wide range of creative strategies are used that are likely to appeal to young people. These include celebrity endorsements, animations and promotional characters. International studies of television and other media have shown that these creative strategies were more common in the marketing of food to children than to adults.

A study of English children aged 6 to 13 years found that children had a greater preference for high-fat and high-carbohydrate foods (both branded and unbranded) after being exposed to food advertisements, compared to when the same children were shown control advertisements on a separate occasion. The effect was greatest in children who had high regular levels of television viewing.

Researchers have calculated that the average Australian 5 to 8-year-old, who watches around 80 minutes of television each day, is exposed to at least 827 advertisements or four hours of unhealthy food advertising on television each year. An Australian study of children aged 10 to 16 years found exposure to television advertising - not just the amount of time spent watching television - was associated with increased consumption of unhealthy food and drinks. The study found that the link between television viewing and poor diet was strongest for children who watched the most commercial television and were exposed to advertisements at the time of broadcast or did not skip through advertisements in television recordings. Australian children with a lower socioeconomic position are more likely to watch television and for longer periods of time than those with a higher socioeconomic position.

Online marketing of unhealthy food

Digital marketing is becoming an increasingly important tool to market unhealthy food to children and teenagers. On a typical weekday, Australian 15-year-olds spend about two hours online when they are not at school, and a quarter of them are online for more than four hours. Research by the Australian Communications and Media Authority involving children aged 8 to 17 found children spend longer periods of time online as they grow older. Digital media becomes central to their lives, particularly through social media platforms such as Instagram and YouTube.

Australian adolescents spend increasingly large amounts of time online. This time is spent on activities such as watching videos or online streaming services, using social media, gaming, listening to music and talking with friends using services such as Discord. Unhealthy food marketers can take advantage of these trends to target children and teenagers using digital media in various ways, including through advertisements, product placement, influencer marketing, brand owned content and branded apps and 'advergames' created or sponsored by companies to embed products into a game. Marketing on social media encourages teenagers to like and share brand posts with their friends, thereby harnessing the influence of peer networks.

A recent study of Australian children aged 10 to 16 years found that watching food-branded video content on YouTube and seeing favourite food brands advertised online were significantly associated with higher consumption of unhealthy food and drinks. A UK study found an increased intake of unhealthy snacks among children who viewed images of social media 'influencers' with unhealthy snacks on Instagram, compared to children who had viewed images of influencers with healthy snacks or non-food products.

A US study found that playing food-branded 'advergames' increased children's consumption of unhealthy snack foods, compared to playing advergames featuring healthy foods and non-food advergames. Within advergames, the technique of 'rewarded video advertising' in which players are shown an ad before progressing to a new level has been shown to be particularly effective. An Australian study of children aged 7 to 12 found that children exposed to rewarded video advertising within an advergame chose the promoted brand significantly more than children in other arms of the study, when offered a choice of snacks afterwards. Children exposed to the rewarded video advertising were far more likely to choose the promoted brand even compared to children who played an advergame with the promoted brand included as high-value game pieces, highlighting the sophisticated nature of advertising techniques being used to market unhealthy food to children online.

Other marketing of unhealthy food

While television and online advertising of unhealthy food to children forms a large part of the evidence base for the impact of advertising on children, the effect of other types of marketing has also been studied. Product packaging that includes the presence of cartoon characters has been found to influence taste perceptions in young children. In one US study of children aged 4 to 6 years they believed a product with a cartoon character tasted better than the same food in a package without the character. In another US study, children aged 3 to 5 years tasted identical pairs of food and drink but felt they tasted better if they were in McDonald's branded packaging.

Collectible toys are another means of altering children's food preferences, and research has shown they can be used to encourage healthy choices. A US study of children aged 3 to 5 years found a collectible toy increased preference for unhealthy meals, but had the same effect when paired with healthy meals. A similar Australian study of 5 to 9-year-olds found children were significantly more likely to select a healthier meal over an unhealthy meal when only the healthier meals were accompanied by a collectible toy.

Sports sponsorship also has an effect on children's preferences. An Australian study of 10 to 14-year-olds involved in local sport found high awareness of their clubs' sponsors, particularly when they were food and beverage companies. A majority of children in the study thought their club's food and beverage sponsors were 'cool', and liked to return the favour to these sponsors by buying their products. Many of the children had received a voucher from a food or beverage company to reward good sport performance (86%), or a sporting certificate displaying a food or beverage company logo (76%).

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Impact of unhealthy food marketing on children | Obesity Evidence Hub

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Unhealthy food marketing through advertising on television, digital media content, sports sponsorship, product packaging and collectible toys, takes advantage of the developmental vulnerabilities of children and adolescents.

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Child and Adolescent Psychiatry and Mental Health 17, Article number: 48 (2023) Cite this article

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Abstract

Background

while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides. The current study aimed to inform digital suicide prevention strategies by examining the meaning of social media in the lives of young suicide victims and elucidating the harmful and supportive effects of social media use on their wellbeing and distress.

Methods

data were analyzed from a psychological autopsy study of 35 adolescents who died by suicide in the Netherlands (43% of all adolescents who died by suicide in that year). These were 18 girls and 17 boys. All were under the age of twenty years, with an average of seventeen years. Interpretative Phenomenological Analysis was performed of 55 semi structured interviews with peers and parents of the decedents.

Results

young people benefitted from peer support and recovery stories. However, various themes were discussed relating to the harmful effects of social media, including dependency, triggers and imitation, challenges, cybervictimization and psychological entrapment. The themes of dependency and triggers and imitation were more salient in young females. A group of girls cultivated an online identity around their suicidal thoughts and behaviours. Next-of-kin, particularly parents, faced various challenges to talk to the adolescents about social media use, including technological illiteracy, online anonymity, and the youths' closedness.

Conclusions

based on the findings, we recommend education to stimulate the digital literacy of parents, health workers and educators, supporting conscientious social media use in young people, and extending the prevention of cyberbullying. We encourage future research to examine how virtual social networks may sustain suicidal thoughts and behaviour, and to further investigate the effectiveness of digital interventions, like moderated peer support and the use of positive role models.

Background

Suicide of young people is a major public health concern. On average, one young person under 20 dies by suicide every week in the Netherlands. It is a leading cause of death among adolescents aged 15-29 worldwide [ 1]. Increasing attention is directed towards identifying psychosocial risk factors of adolescent suicide. Cha and colleagues [ 2] report that the strongest lines of evidence are found for childhood maltreatment and bullying. Several psychological autopsy studies have additionally provided insights into psychosocial risk factors, including adverse life events and childhood trauma, and discussed the interplay between these factors [ 3, 4, 5, 6]. The lives of youth are characterised by their family life, school, and social relations. Over the last decades, social media had played an increasingly prominent role in the development and lives of young people.

Social media is ubiquitous and intricately interwoven with the lives of people. For the purpose of this study, we adopted the definition of social media use provided by Ahmed and colleagues [ 7], whereby social media includes web and mobile platforms that allow individuals to connect with others within a virtual network, where they can share, co-create, or exchange various forms of digital content, including information, messages, photos, or videos. There are an estimated three billion social media users worldwide [ 8]. Whereas in adults, there is a clear dichotomy of online and offline social interactions, this distinction is less evident in young people. They grow up with plentiful online resources to interact and communicate with others, making them digital natives [ 9].

Literature is equivocal about the relation between social media use and mental health of adolescents. Earlier research by Mérelle and colleagues [ 10] in 21.053 Dutch adolescents indicates that problematic social media behaviour, defined by means of the Compulsive Internet Use Scale [ 11], is associated with conduct problems, hyperactivity, and sedentary behaviour. International evidence reports associations between the frequency and volume of social media use and sleep disturbance [ 12] as well as loneliness and depression [ 13, 14], and highlights the risks of upward social comparison [ 15, 16, 17]. Interestingly, in a recent study, adolescents themselves described social media as a key contributing factor to depressive thoughts [ 18]. Mental health problems, including depression, are among the strongest risk factors for suicide in adolescents [ 2]. There is also growing evidence for the relation between social media use and suicidal behaviours. Research from the US suggests that an increase in suicidal behaviours among adolescents may be partly attributed to an increase in new media screen time [ 19, 20]. Two meta-analyses by John and colleagues [ 21] and Nesi and colleagues [ 22] concluded that being the victim of cyberbullying is associated with self-harm, suicide ideation and suicide attempt. Several experts lastly express their worries about social media involvedness with suicide clusters [ 23, 24, 25].

Social media may conversely be beneficial to the wellbeing of young individuals, for example by increasing a sense of community and belonging [ 26, 27, 28], facilitating self-expression [ 29], and through peer support and the sharing of coping and recovering strategies [ 30]. Moreover, experts have discussed how social media platforms can be used to support adolescents suffering from suicidal thoughts. In a systematic review, Marchant and colleagues [ 31] urge that we exploit the benefits of social media, for example by facilitating crisis support, combatting isolation and loneliness, and delivering therapy. Some progress has been made in this regard. For example, Robinson and colleagues [ 32, 33] provide a tool to support young people to safely communicate about suicidal thoughts online, harnessing the potential of online peer support while mitigating the risk of harmful content and imitation of suicidal behaviours.

While several studies add to our understanding of the relation between social media, self-harm and even suicidal behaviours, there has been a paucity of empirical evidence for the relationship between social media use and suicide death in adolescents [ 34]. In previous work, we have touched on the topic of social media use among other risk factors for suicide, indicating that social media use had both positive and negative effects on the wellbeing of the deceased youths [ 6]. However, we are convinced that in depth analyses are warranted for a better understanding. The current study aimed firstly to elucidate the meaning of social media in the lives of adolescents who died by suicide, and to examine its effect on their wellbeing and distress. Secondly, we aimed to identify the needs of adolescents and next-of-kin relating to digital suicide prevention strategies by addressing how next-of-kin engaged young people about safe social media use, and the challenges they faced to talk to them about it.

Methods

Study design

This study used data from an observational, psychological autopsy study concerning adolescent suicide in the Netherlands [ 6]. The perceptions of individuals bereaved by the suicide of a young person provide a unique empirical perspective that is currently absent. As this field of enquiry is relatively unexplored, a qualitative approach can help support new theories and provide directions for future research [ 35]. One or both parents of the adolescent were the primary informants. Secondary proxy informants were family members and peers (next-of-kin), teachers and health care professionals. In the current research we did not include interviews with teachers and healthcare professionals, as their day-to-day contact with the adolescents was limited. In total, 81 adolescents aged 10-20 years old who lived in the Netherlands died by suicide in 2017. The sample included full word transcripts of 37 interviews with parents and 18 interviews with peers of 35 deceased adolescents. These were 18 girls and 17 boys. The age of the victims ranged from 14 to 19 years, with a mean age of 17 years. Participants were recruited through their general practitioner. Secondary informants were recruited through the primary informants. The sampling strategy is further detailed in the previous work [ 6].

Materials

Interviews were semi-structured and had an average duration of two-and-a-half hours. The interview instrument was largely adapted from instruments of international psychological autopsy studies in Belgium, Norway, and the United Kingdom [ 3, 4, 5, 36, 37] and consisted of two parts. The first part involved a narrative description of the youth's life, focusing on the respondents' narrative and perceptions about key factors contributing to the suicide. The second part entailed five pre-identified topics: [ 1] adolescence, [ 2] physical and mental health and healthcare use, [ 3] social media use, series, games and imitation, [ 4] sexual orientation and gender identity, and [ 5] religion and ethnicity. These topics were informed by the research group and an advisory committee and supported by an extensive body of evidence concerning risk factors for suicide. While social media use was specifically addressed in one section of the interview, we expected the topic to be interwoven with other topics throughout the interview. Therefore, full word transcripts of the entire psychological autopsy interview were coded for the purpose of the current study. The interview has been attached with this article (additional file 1).

Analysis

We performed post hoc explorative analyses on the psychological autopsy data. Interpretative Phenomenological Analysis was employed [ 38]. IPA was developed to investigate how individuals make sense of particular experiences and events. In this study, we analyzed the observations and experiences of next-of-kin, specifically the way they made sense of the meaning of social media to the lives and the suicides of the adolescents. We also address their perceptions about the impact of social media on the wellbeing and distress of the adolescents, and the challenges they faced to monitor and engage the adolescent about social media use. The choice of analysis was informed by two central research questions.

What are the perceptions of bereaved individuals about supportive and harmful influences of social media use on the wellbeing and distress of adolescents who died by suicide? How did next-of-kin talk to adolescents about safe social media use and what challenges did they face in engaging them?

In the previous work, emphasis was placed on clustering and imitation, as opposed to the broader meaning of social media in the lives of the young people who died by suicide and its relation to the suicide. Post hoc analyses therefore progressed from the original coding. Deductive coding was used to determine the type of use and the different social media platforms frequented by the adolescents. Type of use was divided broadly into communication, lurking (looking at content without posting), and sharing content. We categorized social media platforms in line with the work of Chan-Olmsted and colleagues [ 39]. These are Social Networking sites (Facebook, Myspace, LinkedIn), blogging, and publishing media (Pinterest, WordPress), microblogging (Twitter), forums or message boards (Reddit, 4Chan, 9Gag), and media-sharing communities (YouTube, Instagram, Snapchat, Flickr). While we acknowledge that most media allow a form communication, we included communication media as a separate platform (WhatsApp, Facebook Messenger) because of the popularity of these media and their specific features.

Subsequent coding was inductive. Codes were formulated to reflect key themes relating to the meaning of social media to the young people, such as a way to meet likeminded people or a place to share feelings, the perceived effect of social media use, like feeling understood by peers or becoming isolated and, lastly, the dynamics between next-of-kin and the adolescent concerning social media use, such as open conversation or restricting use. The involved researchers [EB, IB, SM] reflected weekly on the coding approach, whereby the code list was discussed and edited. After coding approximately fifteen interviews, no major changes were made to the code list, and a definitive version of the list received consensus from the research team. The final code list is added as a supplement to this research (additional file 2).

Results

Social media use

All [35] deceased adolescents in our sample used social media. For fifteen adolescents, of whom twelve boys, social media was used primarily as a practical tool; to stay up to date about events or birthdays, or for school. They communicated through messenger apps but spent little time on social networking sites. For many young people [ 20], however, social media played an important role in their day-to-day lives. It was a way to stay in touch with peers, find people with similar interests, read about experiences of other young people, watch funny content, a safe space to (anonymously) vent their feelings, or to establish popularity by getting many friends or followers. All adolescents used communication media like WhatsApp and Facebook Messenger. Social networks [31 adolescents], and media sharing platforms [22 adolescents] were popular as well. Nine young persons frequented discussion forums or message boards. Eight out of these nine were girls visiting forums specifically related to mental health or eating disorders. Only a few [3 adolescents] used blogging and microblogging media.

Harmful effects of social media use

Themes relating to the harmful effects of social media were dependency and excessive social media use, social comparison and distorted perceptions about mental health, triggers and imitation, cultivation of a suicidal identity, challenges and impulsive behaviours, and victimization and entrapment.

Dependency and excessive social media use

Fourteen young individuals, who were often described by respondents as socially insecure, developed a dependency towards social media because they were anxious to be offline and miss out on conversations with peers or online content. Moreover, interactions with peers on social media affected their mood as much as real-life interactions, and they could become upset and distressed when they did not receive positive reinforcement from peers online.

Insecurity and dependency were linked to excessive social media use. Eleven out of the fourteen adolescents actively responded to notifications throughout the entire day, even during dinnertime and late at night. Some spent up to eight hours a day browsing social media. While respondents did not attribute a direct effect of excessive social media use on suicidal thoughts or behaviours, they noted that it contributed to sedentary behaviours, feelings of anxiousness and loneliness, a decrease in face-to-face interactions, sleeping problems, and school problems.

Social comparison and perceptions about mental health

The content posted by peers and role models presented norms for mental health and happiness that distorted some of the decedents' perceptions about their own mental health. The emphasis on achievements, events and positive emotions presented a stark contrast with suffering from suicidal thoughts and created pressure. By consistently comparing their lives with the seemingly perfect lives of peers and influencers online, feelings of being different were reinforced.

Triggers and imitation of suicidal behaviours

For a group of thirteen adolescents, of whom twelve girls, there was a thin line between supportive and triggering online networks. By trigger we refer to online content that elicited feelings of distress in the adolescent. These adolescents actively looked for recognition and support in online communities but became entangled in communities where triggering content was openly shared. Content ranged from depressing quotes and memes to graphic depictions of self-harm and suicide. Parents berated how easy it was to find information about how to die by suicide on discussion forums and social networking platforms. Some respondents feared that adolescents may have become preoccupied with self-harm and suicidal behaviours by being consistently confronted with other peoples' experiences in the matter.

Parent: "There is a world of websites filled with negative content. Experiences of people. [...] And then there are these algorithms. If you frequently search for negative things on Instagram, then Instagram will show you more negative content. That not just makes it harder; it makes it look like that is all there is. Because that is the only thing that comes up." Parent: "On Instagram, you can follow a certain topic. She was taken in with depression as a topic. All these posts and memes about depression, she read those a lot. It occupied her. She also searched for 'suicide.' Continuously feeding those negative thoughts through social media. [...] It is a downward slope. If you only surround yourself with negativity, that is all you can feel."

This theme was most salient in eight girls who had been admitted into a healthcare facility. The girls were exposed to suicidal behaviours of fellow residents in real life. Parents described that WhatsApp groups were formed to support fellow residents, but that these channels were often used by young persons to vent; to share their thoughts and feelings. There was insufficient engagement and moderation of social media use in inpatient settings. While we found no conclusive evidence of clustering of youth suicides in our sample, next-of-kin warned that suicide-related content on social networking and media sharing platforms may promote imitation of suicidal behaviours.

Parent: "She also had this recovery account on Instagram. A lot of girls with an eating disorder or what not have these accounts. She allowed me to watch it from time to time, but I wasn't allowed to follow her. She regularly showed me things. [...] That they show each other wounds from self-harming, but also posts like 'I don't feel like living anymore, I quit.' The things they had done. I saw all those things." Peer: "Sometimes it becomes a competition. Everything is competitive. How thin can you become? How deep can you cut? Those things. Who is the most disturbed? I think [name] did not feel a need to be the most disturbed one. But I believe she was the most disturbed one without even trying."

Cultivation of a suicidal identity

Another theme emerged for a small group of adolescents who communicated often and openly about their suicidal thoughts. They developed what a peer referred to as a suicidal identity. This transcended frequent suicide-related communication, as it maintained that the young person became so entangled with their own suicidal thoughts and behaviours, that they found it hard to imagine their life without them. The adolescents for whom this theme applied were afraid of who they would be once they recovered because their mental health problems provided them with a sense of belonging and identity. The peer of a young girl explained.

Peer: It can be quire harmful, when you've built a life like that, because who will you be when that's gone? [...] Who will I be once I recover? If I just complete an education, who am I, what will it be that makes me interesting, what will it be that defines me? [...] But I think that social media, like Tumblr and Instagram and all those platforms that [name] was on, that those helped her hang on to that identity, anchored it. 'This is what I am, and this is what makes me, me.' While there was so much more that made her, her.
Young people cultivated this identity through online peer-to-peer interactions and reinforcement, seeking either sympathy or disapproval. Next-of-kin worried that cultivating an identity around suicidal thoughts and behaviours, and specifically the fear of letting go of this identity, aggravated suicidal thoughts and hampered help seeking and openness to treatment and recovery.

Challenges

Challenges are online phenomena where (often young) people challenge one another to carry out specific tasks, sometimes sharing videos of themselves performing these tasks through social media. Five adolescents in our sample had participated in challenges. Three of these challenges involved physical harm. One girl suffered from intoxication following excessive water intake, following a challenge to drink as much water as possible to lose weight. One boy participated in a choking challenge, where a person asphyxiates themselves until nearly passing out for the thrill.

A young girl was known to have shown interest in a suicide-related challenge: the Blue Whale challenge. This challenge entails that a person follows a set of activities, imposed upon them by a curator. The activities are harmless at first, like setting an alarm in the middle of the night, but gradually evolve to tasks such as instigated self-harm. The final task is to end one's own life. A girl talked about taking part in this challenge with a friend and had reached out to a curator online. As far as the respondents know, however, she never completed any of the more dangerous tasks in the challenge.

None of the respondents believed that the suicide could be attributed to participating in challenges, but they did acknowledge how challenges may incentivize impulsive behaviours in at-risk adolescents, resulting in a disregard for the consequences of potentially harmful behaviours.

Victimization and entrapment

Cyberbullying was reported in four cases. These adolescents received harmful messages or were threatened with violence through online media. Bullying could include the encouragement of suicidal behaviours. Two young people were pressed by peers to engage in self-harm or a suicide attempt. A young girl made a reference to the bully briefly before her suicide, while the event took place many years before, suggesting a lasting impact.

Five girls and one boy were victim of cybervictimization, specifically online sexual transgressive behaviour. Online relations with the perpetrators started mutually but quickly developed into an unequal relation. The adolescents received unsolicited proposals, pictures, or videos, or were themselves forced to send pictures or videos involving nudity or sexual acts. In most cases, these were single events, and not associated with the suicide of the adolescents. However, two adolescents had traumatic experiences following cybervictimization which the respondents associated with the suicide. One boy had been the victim of online catfishing and was sexually assaulted by an older man. A young girl was the victim of sextortion by fellow residents of a care facility. They threatened to release nude pictures and videos of her on the web. Feelings of entrapment were often reported for bullied and victimized adolescents.

Supportive use of social media

Next-of-kin of ten adolescents emphasized the supportive aspects of social media. Supportive elements of social media as perceived by respondents were recognition and understanding, peer support, recovery stories and coping strategies, and healthy networks.

For adolescents, social media presented a tool to seek recognition and understanding, which they found more easily in communities of peers with similar problems. Notably, the feeling of not being understood in the offline world strengthened their urge to seek interactions with peers online. They sought help and support from role models and peers to deal with their psychological problems, like coping strategies that helped others and recovery stories. It helped normalize their suicidal thoughts and made them feel less alone in their struggles. Some adolescents felt empowered when using social media to share their experiences to help others.

A specific theme relating to supportive effects was found in a group of girls in inpatient settings. Social media were a necessity for them to sustain relations with friends and family outside of the care facility. These adolescents witnessed the daily distress of peers, and many had witnessed suicidal behaviours of fellow residents. Online interactions with friends and family outside the clinic firstly made them feel looked after and, secondly, counterbalanced the exposure to psychiatric problems and systematic suicidal behaviours of fellow residents.

Experiences with monitoring and engaging adolescents about social media

Interestingly, although five peer respondents expressed worries about the impact of social media to vulnerable adolescents in the interviews, none of them reported to have engaged their fellow peers about such concerns. By contrast, at least nineteen parents had often tried to engage the adolescents about their social media activities because they worried about the harmful effects and the impact on the youth's mental health. Adolescents were naturally reserved about their social media use towards their parents, which caused parents to be ill informed about online behaviours. Several parents mentioned feeling frustrated that while they started the conversation with an unjudgmental attitude, adolescents refrained from open conversation. They furthermore experienced various challenges that made them feel inapt to address the issue properly. Common themes included unfamiliarity, secrecy and anonymity, and restriction and resistance.

Unfamiliarity

Most parents were not familiar with the functionalities of social media platforms and unaware about developments and trends on social media. Consequently, engaging an adolescent was difficult because parents did not know what kind of questions would incite open conversation. Illiteracy towards the gaming community and associated media platforms was specifically addressed, including game chat servers and forums.

Parent: That was an unknown world to us. I learned about it. 'Are you behind your computer again? See some friends!', I would say. But that's just what they do with each other. He had a lot of friends online, including neighbourhood friends. [...] They organize tourneys. They would game the whole weekend. His tiredness was a problem because they would go on all night".
Parent: There are other chat programs for gaming about which we know little. He was on the dark web, those kinds of places. He had a vast number of chat communities with gamers from all over the world."

Online anonymity

Respondents of twelve cases reflected on the secrecy and anonymity of social media behaviours. Young persons were adept at hiding their online activities, ranging from simply deleting their browser or search engine history to using virtual private networks. Several adolescents created a second account on social media platforms, under another name. At least five young girls used this account to enter communities anonymously and to share explicit suicide-related communications. Respondents note that these young girls wanted to prevent that suicide-related content would reach next-of-kin in real life because they were afraid of judgment or consequences. A few parents were so anxious to be knowledgeable, that they created a secret account themselves to monitor the youth or asked a sibling to provide them with information about suspicious online activities of the youth.

Restriction and resistance

To maintain control and involvement, parents monitored online activities, or set time limits for internet use. However, active restricting often did more harm than good, explained parents. Restriction triggered a strong, emotional response, and adolescents took extensive measures to stay connected. To illustrate, one girl bought a new phone every time her parents took her phone.

Discussion

The current study revealed how bereaved individuals made sense of the meaning of social media in the lives of adolescents who died by suicide, and how they perceived its impact on the youth's wellbeing and distress. Notably, a direct relation between social media and the adolescents' suicide was only perceived for victims of severe cyberbullying or victimization. The major impact of bullying on youth wellbeing has been stressed before [ 21]. Particularly concerning is a form of bullying that involves the encouragement of suicidal behaviours. Adolescents felt they could not escape their bullies and were simultaneously pressed towards a deadly end of their victimization. A parallel may be observed with psychological entrapment, which has been proposed by O'Connor and Kirtley [ 40] as an important psychological risk factor for suicide. Experts of law have debated whether cyberbullying should be criminalized but acknowledged that proper education has more merit [ 41, 42].

Most of the other identified themes align findings from earlier research about the relation between social media use and suicidal behaviours, including triggers and imitation [ 5, 23, 24, 25] and upward social comparison and distorted perceptions about mental health [ 15, 16]. While next-of-kin associated participation in challenges with impulsive traits and risk behaviours, no relation with the suicide was assumed in any case. Social media was predominantly perceived not to cause but to amplify negative thoughts and behaviours in adolescents, particularly in those who were described as insecure, vulnerable, and lonely. Huang and colleagues [ 43] propose in their displacement hypothesis that social media use can be deteriorative when the user perceives little social support in their own environment and follows strangers online to seek understanding and recognition there instead. Indeed, some of the identified harmful effects of social media use for adolescents in our sample could be traced back to the motivation to use social media and the manner of use. Girls in our sample also appeared to be at higher risk for the harmful dynamics of social media use. They frequented social networking sites because they felt misunderstood or unheard by family and friends. Many boys instead used social media as a practical extension of their offline life. Moreover, the themes dependency, triggers and imitation, and suicidal identity were most salient in the female decedents. While they reportedly did find recognition online, they were consequently exposed to suicide-related content, such as graphic images of self-harm, and detailed information about how to end their life. These findings corroborate earlier research, indicating that harmful dynamics on social media affect the mental health of young females more strongly [ 44, 45].

Bereaved individuals worried that technological features of social media that produce depression or suicide-related content based on former online behaviours through algorithms may facilitate the development and cultivation of a suicidal identity. Constructing an identity that is informed by mental health problems has been described in other contexts, including substance addiction [ 46] and eating disorder [ 47], and a cross-sectional study indicates that a minority of adolescents reported to self-harm to reinforce their group identity [ 48]. Online reinforcement of an identity around suicidality may sustain suicidal thoughts and behaviours and have profound implications for help-seeking and treatment, but this requires further enquiry. Moreover, consistent confrontation with graphic content of self-harm and suicide on social media might increase what is called acquired capability for suicide through desensitization. Acquired capability refers to the degree to which an individual is able to enact a lethal suicide attempt [ 49]. Developing acquired capability results from repeated exposure to painful and provocative life events which habituate an individual. Most evidence points out that an acquired capability is increased by physical experiences with pain, particularly suicide attempts [ 50, 51, 52]. However, Smith and Cukrowicz [ 53] suggest that visual stimuli may also affect acquired capability through neuropsychological processes habituating fear.

This study offers first empirical findings about the experiences and challenges faced by next-of-kin to monitor and address social media use of adolescents who died by suicide. Peers were knowledgeable and had a nuanced perspective towards social media use compared to parents but typically did not engage their peers about the risks of social media use, even though they did discuss harmful effects in the interviews. Parents tried to engage the adolescents about their concerns, but the interviews revealed the various challenges faced by them. Restriction was reported to be counterproductive for adolescents in our sample. Recent evidence is equivocal about social media restriction. Fardouly and colleagues [ 54] report that children whose parents reported greater control over social media behaviours reported better mental health. However, Hampton and colleagues [ 55] warn that " restrictive media parenting practices or digital inequalities may rob adolescents of experiences that would otherwise be protective of self-esteem." Either way, the implications and recommendations of earlier research have often suggested that we equip parents with the knowledge and skills to engage their children about harmful social media use (see for example Procentese et al. [ 56]). While this is both understandable and important, we must also acknowledge that adolescents may never be completely open towards parents about their online activities and its impact on their wellbeing because they value their autonomy. Furthermore, adolescents are adept at hiding their online activities as digital natives and have mobile phones which allow their online activities to take place outside home settings. We therefore recommend exploring additional strategies that appeal to the youth's own advocacy and self-efficacy instead, like the #chatsafe initiative, which was co-designed together with adolescents [ 32, 33]. Additionally, we may generate awareness about harmful social media use through peer networks and equip adolescents with handles for conscientious, responsible social media use.

Limitations

Some limitations of this study must be noted. Firstly, no control sample has been included. Therefore, we cannot conclude if the themes addressed in this research are unique to adolescents who died by suicide, or that other adolescents experience similar problems. Secondly, in the psychological autopsy [ 6] we focused on factors contributing to the suicide and prioritized risk factors as opposed to protective factors. Next-of-kin respondents may have therefore overestimated the negative impact of social media out of a desire to find reasons why their loved one died by suicide, prompted by the questions in the instrument. This could have obscured supportive effects of social media use and its potential for prevention [ 30, 31]. Thirdly, earlier research has stressed the risk of recall bias in psychological autopsy studies. As we interviewed proxy informants up to 2.5 years after the suicide, it is reasonable to assume they have forgotten some details relating to the suicide [ 57]. However, during the interview, several respondents showed and scrutinized the social media activities of the decedent on their phone, to illustrate the nature of their perceptions. Moreover, we found that respondents provided detailed accounts of day-to-day activities, including what they knew about social media use. This may be explained by research of Assink [ 58] who suggest that negative life events can be more consistently recollected compared to neutral or positive events. Triangulation can further reduce the risk of recall bias. Peers of eighteen deceased adolescents were interviewed. Looijmans and colleagues [ 59] have shown that including peers in psychological autopsies is recommendable when examining those facets of deceased young people's lives about which parents have less in-depth knowledge, including relationships, school problems, and social media use. Lastly, this study has not specifically addressed the role of online influencers, who may effectively reach youths with positive reinforcement, sensitize young people about mental health problems in the online environment, and challenge the negative effects of upward social comparison [ 60].

Conclusions

This has been one of the first studies to provide empirical evidence for the meaning of social media use to the life and the suicide of adolescents and its impact on their wellbeing and distress. The study thereby delineates some of the needs of young people suffering from suicidal thoughts and next-of-kin in relation to social media use and offers handles for digital prevention strategies. The supportive effects of social media can become overshadowed when social media are used as a replacement, rather than a supplement, of family and friends' support and professional care. To foster safe social media use, we may equip young people and next-of-kin with knowledge and skills but must also bear in mind the responsibility of social media platforms and policy makers to create a safer online environment. Specific attention should be paid to young females who are sensitive to harmful dynamics on social media. Cyberbullying and victimization require rigorous prevention efforts. In doing so, we can harness the potential of social media for suicide prevention efforts and mitigate the risks of social media use for adolescents with suicidal thoughts.

Data availability

Interview data cannot be shared publicly because of ethical restrictions: the dataset contains potentially identifying and sensitive information and the Medical Research Ethics Committee (MREC) of Amsterdam UMC has imposed this restriction (registration number: 2018.651 - NL68348.029.18). Contact information: ln.cmuv@ctem; https://www.vumc.nl/research/overzicht/medisch-ethische-toetsingscommissie.html. Data may be made available upon reasonable request. Contact the author (EB) for enquiries.

References

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Acknowledgements

We would like to express our gratitude to all next of kin who have participated in this study. They have suffered a great tragedy and were willing to share their intimate, insightful stories with us. We believe these stories are of great value in informing suicide prevention strategies.

Funding

This study received no funding from third parties.

Author information

Authors and Affiliations

1. Research department, 113 Suicide Prevention, Amsterdam, the Netherlands

Elias Balt, Saskia Mérelle, Isa van den Brand & Renske Gilissen

2. Orygen, 35 Poplar Road, Parkville, Vic, 3052, Australia

Jo Robinson

3. Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia

Jo Robinson

4. Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Centre (AUMC), Amsterdam, the Netherlands

Arne Popma

5. Child and Adolescent Psychiatry, GGZ Oost Brabant, Boekel, the Netherlands

Daan Creemers & Sanne Rasing

6. Department of Pedagogical and Educational Sciences, Faculty of Behavioural Social Sciences, University of Groningen, Groningen, the Netherlands

Diana van Bergen

7. Youth healthcare, Dutch Centre for Youth Health (NCJ), Utrecht, The Netherlands

Wico Mulder

Contributions

All authors contributed to the realisation of this manuscript. EB conceptualized the study, collected data, performed analyses, and wrote the original draft of the manuscript. SM conceptualized the study, provided guidance and supervision, performed analyses, and contributed to the final article. JR contributed to the final article. AP conceptualized the study, provided guidance and supervision, and contributed to the final article. DC conceptualized the study, provided guidance and supervision, and contributed to the final article. IB performed analyses and contributed to the original draft of the manuscript. DB conceptualized the study and contributed to the final article. SR contributed to the final article. WM contributed to the final article. RG conceptualized the study, provided guidance and supervision, and was a major contributor in writing the final article. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Elias Balt.

Ethics declarations

Ethics approval and consent to participate

The Medical Ethical Committee of Amsterdam UMC approved the study [registration number: 2018.651 - NL68348.029.18]. All participants in this manuscript gave written informed consent.

Consent for publication

All participants in this manuscript provided written informed consent to analyze their data and incorporate them in scientific publications.

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The authors have no competing interests to declare.

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Balt, E., Mérelle, S., Robinson, J. et al. Social media use of adolescents who died by suicide: lessons from a psychological autopsy study. Child Adolesc Psychiatry Ment Health 17, 48 (2023). https://doi.org/10.1186/s13034-023-00597-9
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# data[].attributes.attachment_link.title
Social media use of adolescents who died by suicide: lessons from a psychological autopsy study - Child and Adolescent Psychiatry and Mental Health

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Background while there are many benefits for young people to use social media, adverse effects such as cyberbullying, online challenges, social comparison and imitation may provoke and aggravate suicidal thoughts and behaviors. The influence of social media on mental health and suicidal thoughts and behaviours has been amply studied, but there is little empirical evidence for its potential role in adolescent suicides.

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Watch out! Bots are sneaky, so look for these two red flags: accounts that use the exact same wording as others or that post high volumes of information.

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"50% of parents reported that mobile devices typically interrupted the time they spent with their children 3 or more times each day; only 11% reported that mobile devices did NOT interrupt their time with their children."

A way to solve this could be to give kids a phone at an older age and tell them not to be on their phones during certain times to promote being engaged in whatever activity they are doing.

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Blue light insomnia, Poor immune function 

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Blue light insomnia, Poor immune function 

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2. Augner, C., & Hacker, G.W. (2012). Associations between problematic mobile phone use and psychological parameters in young adults. International Journal of Public Health, 57(2), 437-441.

3. Buboltz, W., Soper, B., Woller, K. M., Johnson, P., & Faes, T. (2009). Sleep habits and patterns of college students: An expanded study. Journal of College Counseling, 12(2), 113-124.

4. Reed, P., Vile, R., Osborne, L.A., Romano, M., & Truzoli, R. (2015). Problematic internet usage and immune function. PloS one, 10(8).

5. Allcott, H., Braghieri, L., Eichmeyer, S., & Gentzkow, M. (2020). The welfare effects of social media. American Economic Review, 110(3), 629-76.

6. Hunt, M.G., Young, J., Marx, R., & Lipson, C. (2018). No more FOMO: Limiting social media decreases loneliness and depression. Journal of Social and Clinical Psychology, 37(10), 751-768.

7. Hunt, M.G, All, K., Burns, B., & Li, K. (2021). Too much of a good thing: Who we follow, what we do, and how much time we spend on social media affects well-being. Journal of Social and Clinical Psychology, 40(1), 46-68.

8. Reed, P., Fowkes, T., & Khela, M. (2023). Reduction in social media usage produces improvements in physical health and wellbeing: An RCT. Journal of Technology in Behavior Science.

9. Kushlev, K., & Leitao, M.R. (2020). The effects of smartphones on well-being: theoretical integration and research agenda. Current Opinion in Psychology, 36, 77-82.

10. Viner, R.M., Gireesh, A., Stiglic, N., Hudson, L.D., Goddings, A.L., Ward, J.L., & Nicholls, D.E. (2019). Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: a secondary analysis of longitudinal data. The Lancet Child & Adolescent Health, 3(10), 685-696.

11. Hamilton, J.L., Hutchinson, E., Evankovich, M.R., Ladouceur, C.D., & Silk, J.S. (2023). Daily and average associations of physical activity, social media use, and sleep among adolescent girls during the COVID‐19 pandemic. Journal of Sleep Research, 32(1), e13611.

12. Mc Carthy, C.M., de Vries, R., Mackenbach, J.D. (2022). The influence of unhealthy food and beverage marketing through social media and advergaming on diet-related outcomes in children-A systematic review. Obesity Review, 23, e13441.

13. Goodyear, V.A., Boardley, I., Chiou, S. Y., Fenton, S.A., Makopoulou, K., Stathi, A., ... & Thompson, J.L. (2021). Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study. BMC Public Health, 21, 1-14.

14. Zhou, X., & Krishnan, A. (2019). What predicts exercise maintenance and well-being? Examining the influence of health-related psychographic factors and social media communication. Health Communication, 34(6), 589-597.

15. Montes, F., Blanco, M., Useche, A., Sanchez-Franco, S., Caro, C., Tong, L., ... & Hunter, R.F. (2022). Exploring the mechanistic pathways of how social network influences social norms in adolescent smoking prevention interventions.

16. Reed, P. (2019). Are echo chambers a threat to intellectual freedom? Psychology Today. Are Echo Chambers a Threat to Intellectual Freedom? | Psychology Today

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The influence of social media on health and lifestyle.

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How Social Media Affects Your Brain | Neuline (neulinehealth.com)
Social Media has links to shortening attention span due to constant new information and can shrink parts of the brain.

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While patient-reported outcomes are becoming increasingly standard in clinical trials, their impact still needs to be fully understood. Clinical trials, like peer-reviewed journals, face scrutiny and require rigorous analysis before results can be considered confirmatory.

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While patient-reported outcomes are becoming increasingly standard in clinical trials, their impact still needs to be fully understood. Clinical trials, like peer-reviewed journals, face scrutiny and require rigorous analysis before results can be considered confirmatory.

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While social media allows people the ability to connect, it is also provides a platform for hatred, ostracization, and misinformation.
One such example being the death of George Floyd, and how a flood of misinformation was spread through Facebook.

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Misinformation About George Floyd Protests Surges on Social Media (Published 2020)

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In the universe of false online information, Mr. Floyd remains alive and George Soros is to blame for the protests.

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"people who frequently use their thumbs to type text messages on cell phones sometimes develop radial styloid tenosynovitis, also called De Quervain syndrome, BlackBerry thumb or texting thumb, a painful affliction that involves the tendons that move the thumb."

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October 17, 2016 12:00 am | Updated December 01, 2016 06:22 pm IST - NEW DELHI:

Here is another reason to stop excessive use of Facebook and WhatsApp - orthopaedic experts have warned against cases of wrist and finger joint pain, arthritis and repetitive stress injuries to the hand, arms and back.

Raju Vaishya, the president of Arthritis Care Foundation (AFC) and orthopaedic surgeon at Indraprastha Apollo Hospitals, said: "We are getting a lot of patients who constantly use smart phones and tablets for texting and come in with complains of aches and pains in their fingers, thumbs and hands. This pain and stiffness may be the result of Repetitive Stress Injury [RSI], which occurs when the same motion is repeated over and over again for a long period of time, causing inflammation to the ligaments and tendons of joints.''

He added that those indulge in too much texting on social media, and gaming on smartphones and tablets can suffer from wrist and finger joint pain and some time crippling arthritis of the fingers.

"In case of children, the longer use of gaming devices is associated with more pain," said Ashwani Maichand , senior consultant and director of the institute of bone and joint, MGS Hospital.

According to Rahul Gupta, senior neuro and spine surgeon, Fortis Hospital, RSI can result from recurrent large or small movements that affect joints, muscles, tendons, and nerves.

For example, people who frequently use their thumbs to type text messages on cell phones sometimes develop radial styloid tenosynovitis, also called De Quervain syndrome, BlackBerry thumb or texting thumb, a painful affliction that involves the tendons that move the thumb. Although the causal link isn't as well established as in the case of patients who suffer from pain due to prolonged desktop keyboard use, there's little doubt that overzealous texting can cause debilitating pain.
Wrong postures
Doctors state that most people use touch screen in unnatural and wrong postures. Stress-related injuries can also occur when people use their bodies in ways that induce physical stress, such as tilting their hands too far inward or outward while tapping or putting force on their wrists while typing. Carpal tunnel syndrome, perhaps the best-known disease in this category, results from pressure on the median nerve in the wrist.

"Your neck and the cervical spine that supports it are highly susceptible to poor posture, which can compress or stretch on the nerves that exit the spinal cord. Resist the temptation to bend your neck forward or backward, and especially avoid turning your head or tilting it to one side or another for prolonged periods. Take frequent breaks, and if you feel pain, numbness, or tingling, stop what you're doing and find a comfortable position,'' added Dr. Gupta.

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October 17, 2016 12:00 am | Updated December 01, 2016 06:22 pm IST - NEW DELHI: Here is another reason to stop excessive use of Facebook and WhatsApp - orthopaedic experts have warned against cases of wrist and finger joint pain, arthritis and repetitive stress injuries to the hand, arms and back.

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Creators only care about profit while knowing the effects.

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Creators only care about profit while knowing the effects.

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The people who create the tech such as Steve Jobs (Creator of Apple) don't allow their own kids to use the products because they know how it effects people yet they do nothing about it, as they only care about the profit.

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"Human beings need face-to-face contact to be mentally healthy. Nothing reduces stress and boosts your mood faster or more effectively than eye-to-eye contact with someone who cares about you."

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Social Media and Mental Health: Social Media Addiction

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Excessive use of social media can fuel anxiety, depression, and other mental health issues. Here’s how to change your habits and improve your mood.

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"Social media use can lead to decreased physical activity levels. This is because people who are engaged in social media are often sitting down and not moving around"

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Instagram, Facebook, Twitter, Snapchat, YouTube... With so many social media platforms out there, it's no wonder that people are spending more time than ever before, scrolling through their feeds. And while social media can be a great way to stay connected with friends and family, new research suggests that there may be a downside to all that screen time. Social media use has been linked to biological and psychological changes that can impact physical health. For example, one study found that people who spend more time on social media are more likely to report symptoms of depression and anxiety ( ). Another study found that people who use social media for more than two hours a day are more likely to have poorer sleep quality and are more likely to be obese ( ). So what's the relationship between social media and physical health? Let's review the research.

How Is Social Media Affecting Physical Health?

The nature of social media can have a negative impact on physical health.

Social media platforms are designed to be addictive, and many people find themselves spending hours upon hours scrolling through their feeds. This can lead to increased screen time, which in turn can lead to several problems.

Several technological factors may lead to eyestrain, such as:

Screen time - The more time you spend looking at a screen, the greater your risk of developing digital eye strain.

Glare - If the light from your screen is too bright, it can cause glare and make it difficult to see.

Viewing too close or too far away - If you hold your device too close to your eyes or too far away, it can cause eye strain.

Poor posture - If you sit or stand in an awkward position while using your device, it can lead to neck and back pain.

Underlying health conditions - If you have an underlying health condition, such as dry eye or allergies, you may be more susceptible to digital eye strain.

There are a few ways to reduce the risk of digital eye strain, such as:

Reducing screen time - Limit your screen time to no more than two hours per day.

Taking breaks - Every 20 minutes, take a 20-second break to look at something 20 feet away.

Adjusting the settings - Make sure the brightness on your device is set to a comfortable level.

Read More: Do You Burn Calories When You Sleep: If You Snooze You Lose...Weight!
Another study found that people who spend more time on social media are more likely to have poorer sleep quality ( ).

There are a few reasons why social media use may interfere with sleep, such as:

Stimulation - The bright lights and stimulating content on social media can make it difficult to fall asleep.

Anxiety - For some people, scrolling through social media can cause anxiety and intrusive thoughts that make it difficult to fall asleep.

FOMO - Fear of missing out (FOMO) is a real phenomenon that can occur when you see others doing things that you're not doing ( ). For example, you may scroll through Instagram and see your friends at a party while you're home alone. This can cause feelings of loneliness and isolation that make it difficult to sleep.

A sedentary lifestyle is one of the leading risk factors for obesity. And social media use is a major contributor to sedentary lifestyles. One study found that people who spend more time on social media are more likely to be obese ( ).

There are a few reasons why social media use may lead to weight gain, such as:

Decreased physical activity - Social media use can lead to decreased physical activity levels ( ). This is because people who are engaged in social media are often sitting down and not moving around.

Unhealthy eating habits - Social media can also lead to unhealthy eating habits. For example, if you see someone post a picture of a delicious-looking meal, you may be more likely to crave that same meal.

There are a few ways to combat the effects of social media on weight gain, but the most effective is to limit screen time and get regular exercise.

Spending too much time hunched over a screen can lead to poor posture ( ). This is because the body is not meant to be in that position for long periods. Poor posture can lead to several problems, such as ( ):

Neck pain - When you're looking down at your phone, your neck is in an unnatural position. This can lead to neck pain and stiffness.

Headaches - Poor posture can also lead to headaches. This is because the muscles in your head and neck are strained when you're not holding your head up properly.

Back pain - Slouching can also cause back pain. This is because the spine is not in its natural position when you're hunched over.

There are a few ways to improve your posture, such as:

Standing up straight - When you're standing, make sure your shoulders are back and your stomach is pulled in.

Sitting up straight - When you're sitting, make sure your back is against the chair and your feet are flat on the floor.

Exercising - Exercise can help to strengthen the muscles that support your posture.

Looking for a way to break the vicious cycle of weight loss and tone up all the jiggly parts? Watch the extra pounds fly off and your muscles firm up with the BetterMe app!
How Is Social Media Affecting Psychological Health?

Some studies have found that social media use is linked to mental health problems, such as anxiety and depression ( ). However, other studies have found that social media use is not linked to mental health problems ( ).

It's important to remember that correlation does not equal causation. This means that just because two things are correlated, it doesn't mean that one thing caused the other.

For example, social media use could be correlated with mental health problems, but it could also be that people who are struggling with mental health problems are more likely to use social media.

There are a few theories about why social media might be linked to mental health problems, such as:

Social media can also lead to comparison. When you see other people's highlight reels, you may compare your life to theirs and feel like you're not good enough. This can lead to feelings of inadequacy and low self-esteem ( ) ( ).

The physical effects of social media use could likely trigger or worsen mental health problems that already exist. For example, if you have anxiety, the physical effects of social media use (e.g., poor sleep, neck pain, etc.) could trigger or worsen your anxiety.
Read More: Meditation For Insomnia: Best Techniques To Ensure A Good Night's Sleep
Improving Your Social Media Habits

If you're concerned about the effects of social media on your health, there are a few things you can do to improve your social media habits, such as:

Limiting Your Screen Time

One of the best things you can do is to limit your screen time. This means setting a time limit for yourself and sticking to it. For example, you may decide to only spend 30 minutes on social media per day.

Being Mindful Of Your Content

When you're scrolling through social media, be mindful of the content you're consuming. If you find that something is making you feel anxious or depressed, stop looking at it.
If you tend to let yourself off the hook, raise the white flag when things get tougher than you expected, send yourself on an unconscious binge-eating trip - BetterMe app is here to help you leave all of these sabotaging habits in the past!
Make sure to take breaks from social media throughout the day. This will give your mind a chance to rest and reset.

The Bottom Line

Social media can have a negative impact on your health if you're not careful. But, by being mindful of your screen time and the content you're consuming, you can mitigate some of the risks. Additionally, regular exercise is a great way to combat the negative effects of social media.

DISCLAIMER:

This article is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional advice or help and should not be relied on to make decisions of any kind. Any action you take upon the information presented in this article is strictly at your own risk and responsibility!

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Social Media And Physical Health: What's The Relationship?

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Do you know the relationship between ★ SOCIAL MEDIA AND PHYSICAL HEALTH? ➤ Check out this article to find out!

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TikTok's algorithm leads users from transphobic videos to far-right rabbit holes

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TikTok's algorithm leads users from transphobic videos to far-right rabbit holes

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https://www.mediamatters.org/tiktok/tiktoks-algorithm-leads-users-transphobic-videos-far-right-rabbit-holes

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With technology becoming more prominent, the need for social interaction will decline. More and more people use technology to setup doctor's appointments and ordering pizza rather than face to face interaction.
A way to avoid this is to limit yourself from using apps like this by creating app restrictions. It will limit screen time in general as well.

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It's no surprise that the world is becoming increasingly digital, but the current pace of digitization is astonishing. From AI chatbots to dating apps, tech is the new real life.

We do our shopping online, build our businesses online, spend our downtime online, and even make life-long friends online. As of 2022, 66 percent of the global population were active internet users (Statista). Bringing us closer to commodities, the internet is set to become an even bigger part of our lives. But can technology help improve social interaction skills?

Technology is a fast-paced market, and every pioneer is in a race for first place on the podium. New innovations are piloted every day in a desperate attempt to sell what the masses will buy-tools to make our daily lives easier. As older generations warm to the idea of utilizing technology in the face of a pandemic, we move eerily closer to a world where social interaction is primarily digital.
How is your org impacted by technology?
Get insights with our freecompany culture climate survey template!
But should we look at this as a positive or negative change? Will human interaction strengthen or suffer as a result of new communication technologies? In this article we will explore the good, the bad, and the ugly truth of technology's impact on social interaction.

THE GOOD

There is no denying that the internet has had a positive impact on human communication. Compared to pre-internet times, we are now more connected than ever before. Here are some of the ways that technology has a positive effect on social interaction.
Instant global communication
How can technology affect social media? Most of us now have the means to contact people on the other side of the world immediately. No waiting for the postman, messenger pigeon, or message in a bottle-technology has broken down the communication barriers that distance once presented. It is a phenomenon that is commonly referred to as globalization.
Virtual connections
Let's look at how technology affects human relationships. Video calling apps like Skype and Zoom mean people can now experience emotional connections without having to be in the same room. This has been especially important throughout the coronavirus crisis, where families from separate households were forced to stay apart. The day the UK lockdown was announced, Zoom was downloaded 2.13m times around the world-up from 56,000 a day two months earlier.

147 minutes: The average time internet users worldwide spent daily on social media in 2022.... Click To Tweet
Online dating
Technology has also made finding love much easier, with online dating increasing in popularity. A report released last year predicted that more than 50% of couples will meet online by 2035. The same report found 47% of people believe online dating makes it easier for introverted people to find love.
Barrier-free interaction
Similarly, people who would otherwise have limited social interaction now have the option to be part of online communities. People with disabilities can forget about their physical boundaries inside a video game universe, while socially anxious people can gain confidence by practicing interaction over the internet instead of face to face. Sending messages allows people the time to process information and formulate a response, whereas face to face is more immediate. On the other hand, this isn't always a good thing.

THE BAD

Of course, as with everything, there is another angle to consider. How does technology affect our social lives negatively? Some would argue that the more anonymous and less immediate interaction associated with digital communication is bad news. Behind the screens of smartphones and the keyboards of computers, there are also more chances for deception-particularly for vulnerable people. Here are some of the ways the technology has a negative impact on social interaction.
Decreased human contact
More and more people are beginning to rely on technology to communicate with their loved ones, friends and associates. The coronavirus lockdown that forced millions of people to work from home also accelerated online communication tools-meaning we get even less human contact than ever before. As of July 2020, 58% of customer interactions were digital.

As remote working becomes the norm, transactional processes are automated with self-service machines too. For many, this can theoretically be a good thing, but it also highlights how technology affects our communication negatively. The same ease of technological-driven interactions leaves some groups behind. The increase in the use of technology to communicate could also cause a rise in loneliness, especially among elderly people who may rely on these transactional encounters as their primary source of social contact.
Are your customers satisfied with your communication? Find out! A rise in bullying
Technology has also made cyberbullying possible, and children are now particularly vulnerable to harassment online. While cyberbullying is a worry for children, it is also becoming a common challenge among adults too. Results from a YouGov poll conducted last year showed that a quarter of adults have experienced cyberbullying. Given the disheartening rise in suicide among victims of cyberbullying, it is clear to see that technology is not always a healthy source of social interaction.
Online deception
Catfishing is the practice of creating a fake online identity with intent to manipulate, stalk, or abuse a specific victim. It has become a scarily common activity among dating sites and social media platforms and is the subject of a popular MTV reality TV show. A 2018 survey saw 9% respondents say that being catfished had affected their mental health.
A platform for predators
Technology has also provided a platform for online predators to pursue their victims. And as UK schools closed during the coronavirus lockdown, children were on their devices a lot more often and faced with a sudden drop in social interaction. While there is not yet any overwhelming evidence to suggest the pandemic caused an increase in predatory activity online, The National Center for Missing & Exploited Children (NCMEC) has said reports to their CyberTipline increased by 106% during the first months of the pandemic.

The ugly truth

Whether we see it in a positive or negative light, or even a mixture of the two, the truth of the matter is that technology has had a huge impact on the way we communicate with each other. While it allows us to make instant connections with people on the other side of the world, it also puts us at risk of loneliness, as well as new forms of harassment and manipulation.

But as new technologies are unveiled to the world, new cybersecurity regulations and other tech safety measures are likely to be put in place, too. These aren't likely to protect everyone from the negative effects of technology, but it also rests on our own shoulders to use the internet with caution. Equally, it is our own responsibility to ensure we get enough real-life human contact in our daily lives, in addition to digital social interaction.

Ready to put technology to work for you? See how Sogolytics can help with a !

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How Has Technology Affected Social Interaction? - Sogolytics Blog

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How is technology affecting social interaction? The truth: technology brings us closer together, but can also drive us further apart.

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Using Instagram has been proven to be associated with eating disorders, which are both a physical and mental issue. A 2017 study found that Instagram is the most harmful social media in this aspect. Some celebrities flaunt photoshopped images of their bodies to create an unrealistic standard. Kim Kardashian goes as far to promote sketchy diet products.

Source: https://pubmed.ncbi.nlm.nih.gov/28251592/

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Kim Kardashian West is under fire for posting ad content on Instagram in which she promoted "appetite suppressant" lollipops, Flat Tummy Co.'s newest product.

She posted the same ad several times but it kept being deleted.

In a statement to INSIDER, a spokesperson for Instagram said they "mistakenly" deleted Kardashian West's posts and has since apologized to her.

People still think the posts are triggering and upsetting.

Kardashian West seemingly attempted to diffuse the situation with a joke on Twitter.

For those of you who might have been too caught up in the great Yanny or Laurel debate to think about anything else on Wednesday, you missed a pretty busy day in the world of one Kim Kardashian West. The reality TV star is currently under fire for repeatedly posting an ad on Instagram in which she promoted "appetite suppressant" lollipops, Flat Tummy Co.'s newest product.

Kardashian West posted three versions of the same ad on Wednesday, but it was deleted each time. The original post, which she first shared on Tuesday night, is now back on Instagram - and a spokesperson for the social media brand told INSIDER that they didn't mean to delete the posts in the first place.

"We mistakenly removed content we shouldn't have and apologized to Kim for the inconvenience caused. We worked quickly to rectify the mistake as soon as we were made aware," a spokesperson said in a statement. "The post has now been restored."

Indeed, the sponsored content is back as it originally appeared.

"#ad You guys... @flattummyco just dropped a new product. They're Appetite Suppressant Lollipops and they're literally unreal," the post's caption says. "They're giving the first 500 people on their website 15% OFF so if you want to get your hands on some... you need to do it quick! #suckit"

People are upset with Kardashian West for using her platform to promote the product - and are sounding off in the comments.

"You have SO much influence in today's world and this is how you use it? Horrible," an Instagram user wrote.

"I'm a huge Kardashian's fan. But this is awful. Kim, you're a role model for young girls and women," another wrote.

"Come on Kim, you can do better. Use your influence in a better way. So many girls deal with food issues and pressure to be skinny. Show them that flat tummy is not everything a girl should desire," a third person added.

A few commenters said they think it's dangerous to encourage people to suppress their natural hunger cues.

"This is so bad oh my god if your body is telling you to eat then go eat," someone wrote.

"This is so awful why are you promoting appetite suppressants??? It is NORMAL to eat. Young girls follow you and look up to you, and this is the example to show them?? What the hell. This makes me sick," another commenter said.

"Appetite is NOT something to suppress. Hunger is your body telling you it needs fuel. Hunger is ok. Hunger is natural. Hunger means your body is working as it should. Hunger is HEALTHY," an Instagram user said.

Some people have alleged that Kardashian West's post perpetuates diet culture and inherently promotes disordered eating.

"Thanks for promoting eating disorders, fake image, depression, discontent with your looks, health problems, and body-shaming. I do not understand how you can actually think advertising appetite suppressants is ok," one person wrote.

"When I was a teenager and anorexic I would've so fallen for this. Now that I'm an adult and healthy, I see this for what it is, and it's truly heartbreaking and frankly disgusting that you would use your platform to promote something like this, you have a young following that is very impressionable. This is not okay," another person added.

On Wednesday, at least one person said they reported Kardashian West's post for promoting "self-injury." She was subsequently notified when the picture was deleted.

-Laura Jane Hicks (@foxandelephant) May 16, 2018

Representatives for Kardashian West didn't immediately return INSIDER's request for comment. At this time, Kardashian West only publicly acknowledged the situation with what appeared to be a joke when she retweeted a fan edit that replaced the lollipop with a KKW beauty product.

-Kim Kardashian West (@KimKardashian) May 17, 2018

-KimKanyeKimYe (@KimKanyeKimYeFC) May 16, 2018
If you or someone you know suffers from an eating disorder, reach out to the National Eating Disorder Association by calling 1-800-931-2237 or e-mailing info@NationalEatingDisorders.org. Sign up here to get INSIDER's favorite stories straight to your inbox.

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Instagram apologized to Kim Kardashian for 'mistakenly' deleting her posts promoting 'appetite suppressant' lollipops

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In a statement to INSIDER, a spokesperson for Instagram said they "mistakenly" deleted Kim Kardashian West's posts and has since apologized to her. People still think the ads, in which Kardashian West promoted "appetite suppressant" lollipops, are triggering and upsetting.

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Fake news, misinformation, clickbait - whatever you choose to call it, it is one of the scourges of our times.

If we are to make it less of a threat to democracy, that effort is going to need to start in schools.

And I have some good news from a comprehensive in South Wales - it looks as though teenagers may be smarter than their parents when it comes to spotting the difference between the real and the fake.

I visited Risca Community Comprehensive School near Newport and put a class of 14 and 15-year-olds through an exercise designed to give them some insights into the way news works.

In the BBC iReporter game, you become a social media journalist faced with a major breaking story.

The storyline goes like this: a cyber-attack has taken down some major social media sites, and all sorts of information about it floods into the newsroom. The young reporters have to make decisions about what to publish, balancing the need for speed and impact with accuracy.

Did the whole thing begin when a satellite crashed to earth in Yorkshire, as someone who's emailed in with a photo claims? Has the cyber-attack caused one brand of mobile phone to catch fire? With cash machines shutting down and planes grounded, is it true, as social media claims, that people are marching on Downing Street?

The students at Risca Comprehensive say they get much of their news from social media and it seems they are not alone.

When the media regulator Ofcom asked 12 to 15-year-olds where they went for news, the BBC came top, and ITV third but Facebook, YouTube and Instagram occupied the other places in the list of top five sources.

Mind you, TV news scored roughly twice as highly as social media when it came to being trustworthy and accurate. And Ofcom found that teenagers were aware of the fake news problem - 78% said they had heard about it and 43% claimed to have seen a fake news story.

Back in the classroom, the Risca reporters are proving a sceptical bunch. When the chief executive of a crashed social media firm in the game gives evasive answers, they keep pressing until she snaps and reveals that this was a major attack.

They chase down the locations and provenance of photos and videos and demand official confirmation of events reported on the internet. Even the heroic teenage coder who claims to have stopped the cyber-attack is treated with scepticism. "She doesn't look sure," says Cody, "she looks very shaky, she didn't look genuine to me."

Assistant head Kate Madden has already talked in the school assembly about the issue of fake news. She says that while some children are gullible, many may be more savvy than the older generation.

"We do hear the students say they've almost become the educators for their parents," she explains. "So their parents may have seen something that's popped up on their Facebook account or similar and then they're relying on their children to tell them that can't be trusted, it's not from a trusted source."

By the end of the iReporter exercise, the class has scored pretty highly for speed, impact and accuracy. The BBC's Huw Edwards has popped up on screen congratulating them for their efforts.

But what is their verdict on what they have learned?

"The most important thing is to be accurate," says Eleanor. "I realise you need to triple and quadruple check everything you read to make sure it's genuine because it's very easy to be fooled," says Brooke.

"Better to be safe than sorry," says Jayden. "I learned you can't trust what you read, you have to check everything very carefully."

And with that off they went for a well-deserved lunch break - and no doubt to check their Instagram and Snapchat.

It is probably too much to hope that they will all now become model internet citizens, but at least they have been given some of the tools they need to navigate an ocean of misinformation.

This story is part of a series by the BBC on disinformation and fake news - a global problem challenging the way we share information and perceive the world around us.

To see more stories and learn more about the series visit www.bbc.co.uk/beyondfakenews

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How do teenagers react to fake news and can they tell it apart from real reporting?

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Eye Irritation, Fatigue, Blurred Vision, & More

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Eye Irritation, Fatigue, Blurred Vision, & More

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"the average American dedicates a staggering ten hours a day to screen time. That’s more time than the average American spends eating and sleeping combined."

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In this age of technology, we live in a world where our screens have become some of our closest friends. But aside from the positives of our devices, there are also a ton of negatives that we rarely talk about. One that makes a huge impact on our bodies is the strain that screen time puts on one of our most important organs, our eyes. We often neglect how much we need our eyes, and eye health often gets put on the backburner.

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According to a 2016 Nielsen Company audience report, the average American dedicates a staggering ten hours a day to screen time. That's more time than the average American spends eating and sleeping combined. This excessive amount of screen time causes side effects like eye irritation, fatigue, blurred vision, and more. But even as our reliance on our devices grows, there are things that we can do to prevent further damage and protect our eyes as much as possible. While screens and digital devices have permeated our work, our schools, and even our early childhood care - there are many practices to ensure that we are doing everything we can in order to protect and care for our eyes. No matter what stage of life we are in it is important to take give our eyes optimal support for clear vision, longevity and overall health.

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Technology in the Workplace & Eye Care for Adults

Technology has changed a multitude of industries and the way that many Americans work. There are over 100 million workers that work in anywhere from a low-digital to a high-digital industry. That's practically a third of the entire United States population. Screens are also a huge part of the modern collegiate system. A computer is often a necessity for anyone who is attending college. More and more textbooks are being offered on the computer, which means more screen time that is required. Even if a person would like to step away from screens, it's often hard to do thanks to the rapid digitalization of our modern lives. Preventing eye strain from the use of digital electronics is an important topic that is rarely talked about. Eyewear specifically manufactured for computer work is a great option for those who work in a high-digital industry, are in college, or simply work in an environment that requires a lot of screen time. These glasses often work in two ways. An anti-reflective coating reduces glare that bounces off screens and light sources. Some of these glasses also use a color tint that is designed to increase the contrast on the screen and reduce the harsh light that often comes from computer screens. When using such protective eyewear, your eyes are able to relax. Usage of computer specific lenses will promote clearer vision and ultimately lead to healthier, and less stressed and fatigued eyes. Although most people are unaware of such a solution, these protective lenses can dramatically effect everyday life and overall eye health of the modern individual who is required to be in front of a screen for any part of their day.

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Increased Screen Time & Teenage Eye Care

When is the last time you saw a teenager without their cell phone? Thanks to the societal integration of the internet and social media, teenagers spend hours upon hours in front of screens each day. Even outside of thier leisure time, places like school often put teenagers in front of screens as method of information delivery. Schools want to prepare teenagers for the rapid digitalization of today's industries, however the unspoken result of this is the affect that this ultimately has on their helath given the additional screen time. There are great benefits to exposing the average teenager to all of the benefits that learning about computers can offer when it comes to different careers. Screen time for teenagers is a necessary component of our modern lives, that will only increase with time. The best thing that teenagers can do is to learn how to introduce breaks into their screen time. A good ratio is often called the 20-20-20 rule. Every 20 minutes look away for twenty seconds at something that's 20 feet away. If you must be on the computer more consistently, take a 5-10 minute break every 50-60 minutes. These breaks will drastically reduce the strain on their your eyes and promote a great habit of caring about your eye health. A simple thing to do is to blink repeatedly. Staring at a screen often dries out our eyes, so blinking is a great way to replenish that moisture. Also, remember to schedule regular checkups with your optometrist. We recommend that both teenagers and adults visit an eye care professional at least once a year!

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Eye Care for Children in the Digital Era

As well as teenagers, small children also get a lot of screen time. Devices are becoming the new babysitters. As a result, this increase in screen time presents as great of a problem for babies and toddlers as it does for adults and teenagers. Along with eye strain, there is a study that has made connections between increased screen time and slower speech development. A toddler's brain is in a stage of rapid growth and excessive screen time has been proven to have a negative effect on that development. But, when it comes to screen time and toddlers, it's not all bad. Even groups such as the AAP (American Academy of Pediatrics) have changed their mind when it comes to the amount of screen time that's appropriate for young children. It's all about moderation, at any age - and good parenting practices to make sure that our children are not only equipped for the modern technological work, but that they have the knowledge and experience necessary to take care of their eyes as they grow and become further immersed in this world.

Given the current climate of technology in modern life, there is no age that is too young for teaching our children about eye health and going to the eye doctor. According to the American Optometric Association, infants should have their first eye exam at 6 months. Children usually only need to get vision tests every two years, unless vision correction is needed. When it comes to screen time and eye health, teach your children about the importance of taking breaks. It is also recommended to introduce a family media use plan that implements intended times and usage of devices. Stick to the rules that you set as a parent and introduce alternatives of staying occupied.

What can we do to take care of our eyes?

We can't draw back the hands of time. As a society, we are knee deep in the technological age, and we are only moving deeper into it with each and every day. We are all responsible for the way in which we work with screens in order to protect ourselves and our eyes. Simple things that we can do such as taking breaks, investing in computer eyewear, or just turning the devices off can do a lot for preserving our eye health. Also, now more than ever is a great time to schedule regular eye care checkups. Meeting with an optometrist can only help you to take care of your eyes and catch any possible problems before they get worse. All these things facilitate a healthy use of technology so we can evolve and grow in this modern society and protect our eyes and our care for our health in the process!

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In this age of technology, we live in a world where our screens have become some of our closest friends. But aside from the positives of our devices, there are also a ton of negatives that we rarely talk about.

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How Social Media Rewards Misinformation 

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How Social Media Rewards Misinformation 

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In the early months of the COVID-19 pandemic, posts and videos promoting natural remedies for the virus-everything from steam inhalation to ginger- proliferated online. What explains the storm of likes and shares that propels online misinformation through a social media network?

It's not that people are lazy or don't want to know the truth. The platforms' reward systems are wrong.

Some scholars suggest that people share falsehoods out of bias, while others argue that failures of critical thinking or media literacy are to blame. But new research from Gizem Ceylan, a postdoctoral scholar at Yale SOM, suggests that these explanations miss something important. In a new study co-authored by Ian Anderson and Wendy Wood of the University of Southern California, Ceylan found that the reward systems of social media platforms are inadvertently encouraging users to spread misinformation.

By constantly reinforcing sharing-any sharing-with likes and comments, platforms have created habitual users who are largely unconcerned with the content they post. And these habitual users, the research shows, spread a disproportionate share of misinformation.

"It's not that people are lazy or don't want to know the truth," Ceylan says. "The platforms' reward systems are wrong."

The researchers conducted several experiments to test how different kinds of social media users interact with true and false headlines. In the first, they asked participants to review eight true and eight false headlines and decide whether to share them to a simulated Facebook feed. They also asked several questions designed to assess how habitually participants used Facebook-that is, how much time they spent on the platform and how automatically they shared content.

The results showed that, overall, participants shared many more true headlines than false ones. However, the patterns were markedly different for the most habitual Facebook users. These participants not only shared more headlines overall, but also shared a roughly equal percentage of true (43%) and false (38%) ones. Less frequent users, by contrast, shared 15% of true and just 6% of false headlines.

Ceylan and her co-authors calculated that the 15% most habitual Facebook users were responsible for 37% of the false headlines shared in the study, suggesting that a relatively small number of people can have an outsized impact on the information ecosystem.

But why do the heaviest users share the most misinformation? Is it because the misinformation is in line with their beliefs? Not so, a subsequent experiment found. Habitual users will even share misinformation that goes against their political beliefs, the researchers discovered.

In this experiment, Ceylan and her colleagues asked participants to consider headlines that reflected partisan bias. Then, they examined concordant sharing (that is, liberals sharing liberal headlines or conservatives sharing conservative headlines) and discordant sharing (Iiberals sharing conservative headlines and vice-versa) among both habitual Facebook users and less frequent ones.

Interestingly, while less frequent users showed a stark preference for sharing concordant as compared to discordant headlines (that is, reflecting the partisan bias found in prior research), the pattern was less marked among the heaviest users. These habitual users shared more overall and also showed a less strong preference for concordant as compared to discordant information-another indication that habit was driving their behavior.

To Ceylan, this does not suggest that heavy Facebook users are not ideologically motivated or lazy in their processing when they spread misinformation. Instead, when users' sharing habits are activated with cues from the social platform, the content they are sharing-its accuracy and partisan slant-is largely irrelevant to them. They post simply because the platform rewards posting with engagement in the form of likes, comments, and re-shares.

"This was kind of a shocker for the misinformation research community," she says. "What we showed is that, if people are habitual sharers, they'll share any type of information, because they don't care [about the content]. All they care about is likes and attention. The content that gets attention become part of habitual users' mental representations. Over time, they just share content that fits this mental representation. Thus, rewards on a social platform are critical in shaping people's habits and what they are attuned to share with others."

It's a system issue, not an individual issue. We need to create better environments on social media platforms to help people make better decisions.

The study also suggests a potential way out of this trap. In their last experiment, the researchers simulated a new structure that rewarded participants for accuracy. When they share accurate information, participants were awarded points that were redeemable for an Amazon gift card.

"In this simulation, everyone shared lots of true headlines and few false headlines. Their previous social media habits did not matter," Ceylan explains. "What this means is that, when you reward people for accuracy, people learn the type of content that gets rewards and build habits for sharing that content (i.e., accuracy in this case)." What's more, surprisingly, the users continued to share accurate headlines even after the researchers removed the reward for accuracy. These results show that users can be incentivized to develop a new habit: accuracy.

To Ceylan, the research demonstrates how powerfully social media has shaped our habits. Platforms aim for more profit and engagement -i.e., more users spending longer hours using them. By rewarding and amplifying any type of engagement regardless of its quality or accuracy, platforms have created users who will share indiscriminately. "It's a system issue, not an individual issue. We need to create better environments on social media platforms to help people make better decisions. We cannot keep on blaming users for showing political biases or being lazy for the misinformation problem. We have to change the reward structure on these platforms."

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A majority of false stories are spread by a small number of frequent users, suggests a new study co-authored by Yale SOM's Gizem Ceylan. But they can be taught to change their ways.

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The more time you spend on instagram, the more likely you are to develop an eating disorder.  It is proven that it distrorts people's opinion on food

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The Next Generations

From developmental delays to suicide, children face a host of physical, mental and social challenges

Evidence

Making Sense of the World

Misinformation, conspiracy theories, and fake news

Evidence

Attention and Cognition

Loss of crucial abilities including memory and focus

Evidence

The level of social media use on a given day is linked to a significant correlated increase in memory failure the next day. Assessing nearly 800 people aged 25-75, research showed similar effects irrespective of age and of the user's memory levels on previous days. These effects occur in one direction only: levels of social media use predict later memory failure, but levels of memory failure do not predict social media use on subsequent days.

Our memory systems automatically prioritize superficial social text over more complex forms of text. For example, after reading news online, people are significantly better at remembering other readers' comments rather than sentences from the article itself or even its headline; this is in part due to the social ("gossipy") nature of posted comments. Similarly, users remember Facebook posts significantly better than sentences from a book or even human faces, on the same scale as the memory difference between amnesics and non-amnesics.

A meta-analysis of several dozen research studies indicates that higher levels of switching between different media channels is significantly linked to lower levels of both working memory and long-term memory. Given the current Extractive Attention Economy, and the increasing number of social media platforms and apps competing to capture our attention, basic human capacities - such as our memories - are increasingly under attack.

Physical and Mental Health

Stress, loneliness, feelings of addiction, and increased risky health behavior

Evidence

of 18-44 year olds feel anxious if they haven't checked Facebook in the last 2 hours, according to a recent survey of over 2,000 American adults that indicates a high incidence of potential Facebook addiction warning signs. In fact, many are so hooked that 31% report checking it while driving and 16% while making love.

away from Facebook leads to a significant improvement in emotional well-being. In an experimental study of over 1,600 American adults (who normally used Facebook for up to an hour each day), deactivating Facebook accounts led to a significant increase in emotional well-being (including a reduction in loneliness and an increase in happiness), as well as a significant reduction in political polarization.

Social Relationships

Less empathy, more confusion and misinterpretation

Evidence

Politics and Elections

Propaganda, distorted dialogue & a disrupted democratic process

Evidence

pieces of disinformation were slipping through daily on Facebook and less than 5% of hate speech was being deleted, a few weeks ahead of the Capitol attacks, according to staff leaving the company. Raising this and similar issues, at least 4 members of Facebook's integrity team resigned between May and December 2020, stating "it's an embarrassment to work here".

Spaniards are estimated to have received disinformation and hate speech via WhatsApp ahead of the 2019 national elections, with WhatsApp delivering more disinformation and hate speech than Twitter, YouTube, & Instagram combined, and almost as much as that spread by Facebook.

Americans were reached by Russian propaganda posts on Facebook during the 2016 US elections, according to Facebook's estimates.

Systemic Oppression

Amplification of racism, sexism, homophobia and ableism

Evidence

of the most shared Facebook posts about Black Lives Matter in June 2020 were critical of the movement, despite the fact that the majority of Americans support BLM, according to research by data analysis company CrowdTangle. Such fake representations of public opinion can play a significant role in distorting the basis for democratic dialogue and diminishing the momentum for social change. Even as societies take action to challenge racism and other forms of systemic oppression, social media platforms are being hijacked to discourage or even deny change.

Twitter users were actively involved in Gamergate at its peak, with the hashtag #Gamergate being tweeted hundreds of thousands of times per month, mostly supporting the campaign of abuse and violent threats against specific female game designers and those who spoke up to support them. Gamergate played out primarily on Twitter, whose platform design and administration, according to researchers, make the platform particularly adaptable for online abuse- due to the highly public nature of tweets, the potential for mass targeting of individuals, and the fact that abusive responses can't be removed.

Do Unto Others

Many people who work for tech companies - and even the CEOs - limit tech usage in their own homes

Evidence

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The goal of the Ledger of Harms is to list compelling studies and articles that show clear effects, documented by relatively unbiased researchers and writers. If there's a key study or article missing, or if you see methodological problems with anything listed here, please let us know via the link below. We will update this page if the new information passes our review process.

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From developmental delays to suicide, children face a host of physical, mental and social challenges Evidence Misinformation, conspiracy theories, and fake news Evidence Loss of crucial abilities including memory and focus The level of social media use on a given day is linked to a significant correlated increase in memory failure the next day.

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Pew Research Center: Internet, Science & Tech

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In late 2016, Oxford Dictionaries selected "post-truth" as the word of the year, defining it as "relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief."

The 2016 Brexit vote in the United Kingdom and the tumultuous U.S. presidential election highlighted how the digital age has affected news and cultural narratives. New information platforms feed the ancient instinct people have to find information that syncs with their perspectives: A 2016 study that analyzed 376 million Facebook users' interactions with over 900 news outlets found that people tend to seek information that aligns with their views.

This makes many vulnerable to accepting and acting on misinformation. For instance, after fake news stories in June 2017 reported Ethereum's founder Vitalik Buterin had died in a car crash its market value was reported to have dropped by $4 billion.

When BBC Future Now interviewed a panel of 50 experts in early 2017 about the " grand challenges we face in the 21st century " many named the breakdown of trusted information sources. "The major new challenge in reporting news is the new shape of truth," said Kevin Kelly, co-founder of Wired magazine. "Truth is no longer dictated by authorities, but is networked by peers. For every fact there is a counterfact and all these counterfacts and facts look identical online, which is confusing to most people."

Americans worry about that: A Pew Research Center study conducted just after the 2016 election found 64% of adults believe fake news stories cause a great deal of confusion and 23% said they had shared fabricated political stories themselves - sometimes by mistake and sometimes intentionally.

The question arises, then: What will happen to the online information environment in the coming decade? In summer 2017, Pew Research Center and Elon University's Imagining the Internet Center conducted a large canvassing of technologists, scholars, practitioners, strategic thinkers and others, asking them to react to this framing of the issue:
The rise of "fake news" and the proliferation of doctored narratives that are spread by humans and bots online are challenging publishers and platforms. Those trying to stop the spread of false information are working to design technical and human systems that can weed it out and minimize the ways in which bots and other schemes spread lies and misinformation. The question: In the next 10 years, will trusted methods emerge to block false narratives and allow the most accurate information to prevail in the overall information ecosystem? Or will the quality and veracity of information online deteriorate due to the spread of unreliable, sometimes even dangerous, socially destabilizing ideas?
Respondents were then asked to choose one of the following answer options:

The information environment will improve - In the next 10 years, on balance, the information environment will be IMPROVED by changes that reduce the spread of lies and other misinformation online.

The information environment will NOT improve - In the next 10 years, on balance, the information environment will NOT BE improved by changes designed to reduce the spread of lies and other misinformation online.

Some 1,116 responded to this nonscientific canvassing: 51% chose the option that the information environment will not improve, and 49% said the information environment will improve. (See " About this canvassing of experts " for details about this sample.) Participants were next asked to explain their answers. This report concentrates on these follow-up responses.

Their reasoning revealed a wide range of opinions about the nature of these threats and the most likely solutions required to resolve them. But the overarching and competing themes were clear: Those who do not think things will improve felt that humans mostly shape technology advances to their own, not-fully-noble purposes and that bad actors with bad motives will thwart the best efforts of technology innovators to remedy today's problems.

And those who are most hopeful believed that technological fixes can be implemented to bring out the better angels guiding human nature.

More specifically, the 51% of these experts who expect things will not improve generally cited two reasons:

The fake news ecosystem preys on some of our deepest human instincts: Respondents said humans' primal quest for success and power - their "survival" instinct - will continue to degrade the online information environment in the next decade. They predicted that manipulative actors will use new digital tools to take advantage of humans' inbred preference for comfort and convenience and their craving for the answers they find in reinforcing echo chambers.

Our brains are not wired to contend with the pace of technological change: These respondents said the rising speed, reach and efficiencies of the internet and emerging online applications will magnify these human tendencies and that technology-based solutions will not be able to overcome them. They predicted a future information landscape in which fake information crowds out reliable information. Some even foresaw a world in which widespread information scams and mass manipulation cause broad swathes of public to simply give up on being informed participants in civic life.

The 49% of these experts who expect things to generally inverted that reasoning:

Technology can help fix these problems: These more hopeful experts said the rising speed, reach and efficiencies of the internet, apps and platforms can be harnessed to rein in fake news and misinformation campaigns. Some predicted better methods will arise to create and promote trusted, fact-based news sources.

It is also human nature to come together and fix problems: The hopeful experts in this canvassing took the view that people have always adapted to change and that this current wave of challenges will also be overcome. They noted that misinformation and bad actors have always existed but have eventually been marginalized by smart people and processes. They expect well-meaning actors will work together to find ways to enhance the information environment. They also believe better information literacy among citizens will enable people to judge the veracity of material content and eventually raise the tone of discourse.

The majority of participants in this canvassing wrote detailed elaborations on their views. Some chose to have their names connected to their answers; others opted to respond anonymously. These findings do not represent all possible points of view, but they do reveal a wide range of striking observations.

Respondents collectively articulated several major themes tied to those insights and explained in the sections below the following graphic. Several longer additional sets of responses tied to these themes follow that summary.

The following section presents an overview of the themes found among the written responses, including a small selection of representative quotes supporting each point. Some comments are lightly edited for style or length.

Theme 1: The information environment will not improve: The problem is human nature

Most respondents who expect the environment to worsen said human nature is at fault. For instance, Christian H. Huitema, former president of the Internet Architecture Board, commented, "The quality of information will not improve in the coming years, because technology can't improve human nature all that much."

These experts predicted that the problem of misinformation will be amplified because the worst side of human nature is magnified by bad actors using advanced online tools at internet speed on a vast scale.

Tom Rosenstiel, author, director of the American Press Institute and senior fellow at the Brookings Institution, commented, "Whatever changes platform companies make, and whatever innovations fact checkers and other journalists put in place, those who want to deceive will adapt to them. Misinformation is not like a plumbing problem you fix. It is a social condition, like crime, that you must constantly monitor and adjust to. Since as far back as the era of radio and before, as Winston Churchill said, 'A lie can go around the world before the truth gets its pants on.'"

Michael J. Oghia, an author, editor and journalist based in Europe, said he expects a worsening of the information environment due to five things: "1) The spread of misinformation and hate; 2) Inflammation, sociocultural conflict and violence; 3) The breakdown of socially accepted/agreed-upon knowledge and what constitutes 'fact.' 4) A new digital divide of those subscribed (and ultimately controlled) by misinformation and those who are 'enlightened' by information based on reason, logic, scientific inquiry and critical thinking. 5) Further divides between communities, so that as we are more connected we are farther apart. And many others."

Leah Lievrouw, professor in the department of information studies at the University of California, Los Angeles, observed, "So many players and interests see online information as a uniquely powerful shaper of individual action and public opinion in ways that serve their economic or political interests (marketing, politics, education, scientific controversies, community identity and solidarity, behavioral 'nudging,' etc.). These very diverse players would likely oppose (or try to subvert) technological or policy interventions or other attempts to insure the quality, and especially the disinterestedness, of information."

Subtheme: More people = more problems. The internet's continuous growth and accelerating innovation allow more people and artificial intelligence (AI) to create and instantly spread manipulative narratives

While propaganda and the manipulation of the public via falsehoods is a tactic as old as the human race, many of these experts predicted that the speed, reach and low cost of online communication plus continuously emerging innovations will magnify the threat level significantly. A professor at a Washington, D.C.-area university said, "It is nearly impossible to implement solutions at scale - the attack surface is too large to be defended successfully."

Jerry Michalski, futurist and founder of REX, replied, "The trustworthiness of our information environment will decrease over the next decade because: 1) It is inexpensive and easy for bad actors to act badly; 2) Potential technical solutions based on strong ID and public voting (for example) won't quite solve the problem; and 3) real solutions based on actual trusted relationships will take time to evolve - likely more than a decade."

An institute director and university professor said, "The internet is the 21st century's threat of a 'nuclear winter,' and there's no equivalent international framework for nonproliferation or disarmament. The public can grasp the destructive power of nuclear weapons in a way they will never understand the utterly corrosive power of the internet to civilized society, when there is no reliable mechanism for sorting out what people can believe to be true or false."

Bob Frankston, internet pioneer and software innovator, said, "I always thought that 'Mein Kampf' could be countered with enough information. Now I feel that people will tend to look for confirmation of their biases and the radical transparency will not shine a cleansing light."

David Harries, associate executive director for Foresight Canada, replied, "More and more, history is being written, rewritten and corrected, because more and more people have the ways and means to do so. Therefore there is ever more information that competes for attention, for credibility and for influence. The competition will complicate and intensify the search for veracity. Of course, many are less interested in veracity than in winning the competition."

Glenn Edens, CTO for technology reserve at PARC, a Xerox company, commented, "Misinformation is a two-way street. Producers have an easy publishing platform to reach wide audiences and those audiences are flocking to the sources. The audiences typically are looking for information that fits their belief systems, so it is a really tough problem."

Subtheme: Humans are by nature selfish, tribal, gullible convenience seekers who put the most trust in that which seems familiar

The respondents who supported this view noted that people's actions - from consciously malevolent and power-seeking behaviors to seemingly more benign acts undertaken for comfort or convenience - will work to undermine a healthy information environment.

An executive consultant based in North America wrote, "It comes down to motivation: There is no market for the truth. The public isn't motivated to seek out verified, vetted information. They are happy hearing what confirms their views. And people can gain more creating fake information (both monetary and in notoriety) than they can keeping it from occurring."

Serge Marelli, an IT professional who works on and with the Net, wrote, "As a group, humans are 'stupid.' It is 'group mind' or a 'group phenomenon' or, as George Carlin said, 'Never underestimate the power of stupid people in large groups.' Then, you have Kierkegaard, who said, 'People demand freedom of speech as a compensation for the freedom of thought which they seldom use.' And finally, Euripides said, 'Talk sense to a fool and he calls you foolish.'"

Starr Roxanne Hiltz, distinguished professor of information systems and co-author of the visionary 1970s book " The Network Nation," replied, "People on systems like Facebook are increasingly forming into 'echo chambers' of those who think alike. They will keep unfriending those who don't, and passing on rumors and fake news that agrees with their point of view. When the president of the U.S. frequently attacks the traditional media and anybody who does not agree with his 'alternative facts,' it is not good news for an uptick in reliable and trustworthy facts circulating in social media."

Nigel Cameron, a technology and futures editor and president of the Center for Policy on Emerging Technologies, said, "Human nature is not EVER going to change (though it may, of course, be manipulated). And the political environment is bad."

Ian O'Byrne, assistant professor at the College of Charleston, replied, "Human nature will take over as the salacious is often sexier than facts. There are multiple information streams, public and private, that spread this information online. We can also not trust the businesses and industries that develop and facilitate these digital texts and tools to make changes that will significantly improve the situation."

Greg Swanson, media consultant with ITZonTarget, noted, "The sorting of reliable versus fake news requires a trusted referee. It seems unlikely that government can play a meaningful role as this referee. We are too polarized. And we have come to see the television news teams as representing divergent points of view, and, depending on your politics, the network that does not represent your views is guilty of 'fake news.' It is hard to imagine a fair referee that would be universally trusted."

Richard Lachmann, professor of sociology at the State University of New York at Albany, replied, "Even though systems [that] flag unreliable information can and will be developed, internet users have to be willing to take advantage of those warnings. Too many Americans will live in political and social subcultures that will champion false information and encourage use of sites that present such false information."

There were also those among these expert respondents who said inequities, perceived and real, are at the root of much of the misinformation being produced.

A professor at MIT observed, "I see this as problem with a socioeconomic cure: Greater equity and justice will achieve much more than a bot war over facts. Controlling 'noise' is less a technological problem than a human problem, a problem of belief, of ideology. Profound levels of ungrounded beliefs about things both sacred and profane existed before the branding of 'fake news.' Belief systems - not 'truths' - help to cement identities, forge relationships, explain the unexplainable."

Julian Sefton-Green, professor of new media education at Deakin University in Australia, said, "The information environment is an extension of social and political tensions. It is impossible to make the information environment a rational, disinterested space; it will always be susceptible to pressure."

A respondent affiliated with Harvard University's Berkman Klein Center for Internet & Society wrote, "The democratization of publication and consumption that the networked sphere represents is too expansive for there to be any meaningful improvement possible in terms of controlling or labeling information. People will continue to cosset their own cognitive biases."

Subtheme: In existing economic, political and social systems, the powerful corporate and government leaders most able to improve the information environment profit most when it is in turmoil

A large number of respondents said the interests of the most highly motivated actors, including those in the worlds of business and politics, are generally not motivated to "fix" the proliferation of misinformation. Those players will be a key driver in the worsening of the information environment in the coming years and/or the lack of any serious attempts to effectively mitigate the problem.

Scott Shamp, a dean at Florida State University, commented, "Too many groups gain power through the proliferation of inaccurate or misleading information. When there is value in misinformation, it will rule."

Alex "Sandy" Pentland, member of the U.S. National Academy of Engineering and the World Economic Forum, commented, "We know how to dramatically improve the situation, based on studies of political and similar predictions. What we don't know is how to make it a thriving business. The current [information] models are driven by clickbait, and that is not the foundation of a sustainable economic model."

Stephen Downes, researcher with the National Research Council of Canada, wrote, "Things will not improve. There is too much incentive to spread disinformation, fake news, malware and the rest. Governments and organizations are major actors in this space."

An anonymous respondent said, "Actors can benefit socially, economically, politically by manipulating the information environment. As long as these incentives exist, actors will find a way to exploit them. These benefits are not amenable to technological resolution as they are social, political and cultural in nature. Solving this problem will require larger changes in society."

A number of respondents mentioned market capitalism as a primary obstacle to improving the information environment. A professor based in North America said, "[This] is a capitalist system. The information that will be disseminated will be biased, based on monetary interests."

Seth Finkelstein, consulting programmer and winner of the Electronic Freedom Foundation's Pioneer Award, commented, "Virtually all the structural incentives to spread misinformation seem to be getting worse."

A data scientist based in Europe wrote, "The information environment is built on the top of telecommunication infrastructures and services developed following the free-market ideology, where 'truth' or 'fact' are only useful as long as they can be commodified as market products."

Zbigniew Łukasiak, a business leader based in Europe, wrote, "Big political players have just learned how to play this game. I don't think they will put much effort into eliminating it."

A vice president for public policy at one of the world's foremost entertainment and media companies commented, "The small number of dominant online platforms do not have the skills or ethical center in place to build responsible systems, technical or procedural. They eschew accountability for the impact of their inventions on society and have not developed any of the principles or practices that can deal with the complex issues. They are like biomedical or nuclear technology firms absent any ethics rules or ethics training or philosophy. Worse, their active philosophy is that assessing and responding to likely or potential negative impacts of their inventions is both not theirs to do and even shouldn't be done."

Patricia Aufderheide, professor of communications and founder of the Center for Media and Social Impact at American University, said, "Major interests are not invested enough in reliability to create new business models and political and regulatory standards needed for the shift. ... Overall there are powerful forces, including corporate investment in surveillance-based business models, that create many incentives for unreliability, 'invisible handshake' agreements with governments that militate against changing surveillance models, international espionage at a governmental and corporate level in conjunction with mediocre cryptography and poor use of white hat hackers, poor educational standards in major industrial countries such as the U.S., and fundamental weaknesses in the U.S. political/electoral system that encourage exploitation of unreliability. It would be wonderful to believe otherwise, and I hope that other commentators will be able to convince me otherwise."

James Schlaffer, an assistant professor of economics, commented, "Information is curated by people who have taken a step away from the objectivity that was the watchword of journalism. Conflict sells, especially to the opposition party, therefore the opposition news agency will be incentivized to push a narrative and agenda. Any safeguards will appear as a way to further control narrative and propagandize the population."

Subtheme: Human tendencies and infoglut drive people apart and make it harder for them to agree on "common knowledge." That makes healthy debate difficult and destabilizes trust. The fading of news media contributes to the problem

Many respondents expressed concerns about how people's struggles to find and apply accurate information contribute to a larger social and political problem: There is a growing deficit in commonly accepted facts or some sort of cultural "common ground." Why has this happened? They cited several reasons:

Online echo chambers or silos divide people into separate camps, at times even inciting them to express anger and hatred at a volume not seen in previous communications forms.

Information overload crushes people's attention spans. Their coping mechanism is to turn to entertainment or other lighter fare.

High-quality journalism has been decimated due to changes in the attention economy.

They said these factors and others make it difficult for many people in the digital age to create and come to share the type of "common knowledge" that undergirds better and more-responsive public policy. A share of respondents said a lack of commonly shared knowledge leads many in society to doubt the reliability of everything, causing them to simply drop out of civic participation, depleting the number of active and informed citizens.

Jamais Cascio, distinguished fellow at the Institute for the Future, noted, "The power and diversity of very low-cost technologies allowing unsophisticated users to create believable 'alternative facts' is increasing rapidly. It's important to note that the goal of these tools is not necessarily to create consistent and believable alternative facts, but to create plausible levels of doubt in actual facts. The crisis we face about 'truth' and reliable facts is predicated less on the ability to get people to believe the *wrong* thing as it is on the ability to get people to *doubt* the right thing. The success of Donald Trump will be a flaming signal that this strategy works, alongside the variety of technologies now in development (and early deployment) that can exacerbate this problem. In short, it's a successful strategy, made simpler by more powerful information technologies."

Philip J. Nickel, lecturer at Eindhoven University of Technology in the Netherlands, said, "The decline of traditional news media and the persistence of closed social networks will not change in the next 10 years. These are the main causes of the deterioration of a public domain of shared facts as the basis for discourse and political debate."

Kenneth Sherrill, professor emeritus of political science at Hunter College, City University of New York, predicted, "Disseminating false rumors and reports will become easier. The proliferation of sources will increase the number of people who don't know who or what they trust. These people will drop out of the normal flow of information. Participation will decline as more and more citizens become unwilling/unable to figure out which information sources are reliable."

What is truth? What is a fact? Who gets to decide? And can most people agree to trust anything as "common knowledge"? A number of respondents challenged the idea that any individuals, groups or technology systems could or should "rate" information as credible, factual, true or not.

An anonymous respondent observed, "Whatever is devised will not be seen as impartial; some things are not black and white; for other situations, facts brought up to come to a conclusion are different that other facts used by others in a situation. Each can have real facts, but it is the facts that are gathered that matter in coming to a conclusion; who will determine what facts will be considered or what is even considered a fact."

A research assistant at MIT noted, "'Fake' and 'true' are not as binary as we would like, and - combined with an increasingly connected and complex digital society - it's a challenge to manage the complexity of social media without prescribing a narrative as 'truth.'"

An internet pioneer and longtime leader at ICANN said, "There is little prospect of a forcing factor that will emerge that will improve the 'truthfulness' of information in the internet."

A vice president for stakeholder engagement said, "Trust networks are best established with physical and unstructured interaction, discussion and observation. Technology is reducing opportunities for such interactions and disrupting human discourse, while giving the 'feeling' that we are communicating more than ever."

Subtheme: A small segment of society will find, use and perhaps pay a premium for information from reliable sources. Outside of this group "chaos will reign" and a worsening digital divide will develop

Some respondents predicted that a larger digital divide will form. Those who pursue more-accurate information and rely on better-informed sources will separate from those who are not selective enough or who do not invest either the time or the money in doing so.

Alejandro Pisanty, a professor at UNAM, the National University of Mexico, and longtime internet policy leader, observed, "Overall, at least a part of society will value trusted information and find ways to keep a set of curated, quality information resources. This will use a combination of organizational and technological tools but above all, will require a sharpened sense of good judgment and access to diverse, including rivalrous, sources. Outside this, chaos will reign."

Alexander Halavais, associate professor of social technologies at Arizona State University, said, "As there is value in accurate information, the availability of such information will continue to grow. However, when consumers are not directly paying for such accuracy, it will certainly mean a greater degree of misinformation in the public sphere. That means the continuing bifurcation of haves and have-nots, when it comes to trusted news and information."

An anonymous editor and publisher commented, "Sadly, many Americans will not pay attention to ANY content from existing or evolving sources. It'll be the continuing dumbing down of the masses, although the 'upper' cadres (educated/thoughtful) will read/see/know, and continue to battle."

An anonymous respondent said, "There will be a sort of 'gold standard' set of sources, and there will be the fringe."

Theme 2: The information environment will not improve because technology will create new challenges that can't or won't be countered effectively and at scale

Many who see little hope for improvement of the information environment said technology will not save society from distortions, half-truths, lies and weaponized narratives. An anonymous business leader argued, "It is too easy to create fake facts, too labor-intensive to check and too easy to fool checking algorithms.'' And this response of an anonymous research scientist based in North America echoed the view of many participants in this canvassing: "We will develop technologies to help identify false and distorted information, BUT they won't be good enough."

Paul N. Edwards, Perry Fellow in International Security at Stanford University, commented, "Many excellent methods will be developed to improve the information environment, but the history of online systems shows that bad actors can and will always find ways around them."

Vian Bakir, professor in political communication and journalism at Bangor University in Wales, commented, "It won't improve because of 1) the evolving nature of technology - emergent media always catches out those who wish to control it, at least in the initial phase of emergence; 2) online social media and search engine business models favour misinformation spreading; 3) well-resourced propagandists exploit this mix."

Many who expect things will not improve in the next decade said that "white hat" efforts will never keep up with "black hat" advances in information wars. A user-experience and interaction designer said, "As existing channels become more regulated, new unregulated channels will continue to emerge."

Subtheme: Those generally acting for themselves and not the public good have the advantage, and they are likely to stay ahead in the information wars

Many of those who expect no improvement of the information environment said those who wish to spread misinformation are highly motivated to use innovative tricks to stay ahead of the methods meant to stop them. They said certain actors in government, business and other individuals with propaganda agendas are highly driven to make technology work in their favor in the spread of misinformation, and there will continue to be more of them.

A number of respondents referred to this as an "arms race." David Sarokin of Sarokin Consulting and author of "Missed Information," said, "There will be an arms race between reliable and unreliable information." And David Conrad, a chief technology officer, replied, "In the arms race between those who want to falsify information and those who want to produce accurate information, the former will always have an advantage."

Jim Hendler, professor of computing sciences at Rensselaer Polytechnic Institute, commented, "The information environment will continue to change but the pressures of politics, advertising and stock-return-based capitalism rewards those who find ways to manipulate the system, so it will be a constant battle between those aiming for 'objectiveness' and those trying to manipulate the system."

John Markoff, retired journalist and former technology reporter for The New York Times, said, "I am extremely skeptical about improvements related to verification without a solution to the challenge of anonymity on the internet. I also don't believe there will be a solution to the anonymity problem in the near future."

Scott Spangler, principal data scientist at IBM Watson Health, said technologies now exist that make fake information almost impossible to discern and flag, filter or block. He wrote, "Machine learning and sophisticated statistical techniques will be used to accurately simulate real information content and make fake information almost indistinguishable from the real thing."

Jason Hong, associate professor at the School of Computer Science at Carnegie Mellon University, said, "Some fake information will be detectable and blockable, but the vast majority won't. The problem is that it's *still* very hard for computer systems to analyze text, find assertions made in the text and crosscheck them. There's also the issue of subtle nuances or differences of opinion or interpretation. Lastly, the incentives are all wrong. There are a lot of rich and unethical people, politicians, non-state actors and state actors who are strongly incentivized to get fake information out there to serve their selfish purposes."

A research professor of robotics at Carnegie Mellon University observed, "Defensive innovation is always behind offensive innovation. Those wanting to spread misinformation will always be able to find ways to circumvent whatever controls are put in place."

A research scientist for the Computer Science and Artificial Intelligence Laboratory at MIT said, "Problems will get worse faster than solutions can address, but that only means solutions are more needed than ever."

Subtheme: Weaponized narratives and other false content will be magnified by social media, online filter bubbles and AI

Some respondents expect a dramatic rise in the manipulation of the information environment by nation-states, by individual political actors and by groups wishing to spread propaganda. Their purpose is to raise fears that serve their agendas, create or deepen silos and echo chambers, divide people and set them upon each other, and paralyze or confuse public understanding of the political, social and economic landscape.

This has been referred to as the weaponization of public narratives. Social media platforms such as Facebook, Reddit and Twitter appear to be prime battlegrounds. Bots are often employed, and AI is expected to be implemented heavily in the information wars to magnify the speed and impact of messaging.

A leading internet pioneer who has worked with the FCC, the UN's International Telecommunication Union (ITU), the General Electric Co. (GE) and other major technology organizations commented, "The 'internet-as-weapon' paradigm has emerged."

Dean Willis, consultant for Softarmor Systems, commented, "Governments and political groups have now discovered the power of targeted misinformation coupled to personalized understanding of the targets. Messages can now be tailored with devastating accuracy. We're doomed to living in targeted information bubbles."

An anonymous survey participant noted, "Misinformation will play a major role in conflicts between nations and within competing parties within nation states."

danah boyd, principal researcher at Microsoft Research and founder of Data & Society, wrote, "What's at stake right now around information is epistemological in nature. Furthermore, information is a source of power and thus a source of contemporary warfare."

Peter Lunenfeld, a professor at UCLA, commented, "For the foreseeable future, the economics of networks and the networks of economics are going to privilege the dissemination of unvetted, unverified and often weaponized information. Where there is a capitalistic incentive to provide content to consumers, and those networks of distribution originate in a huge variety of transnational and even extra-national economies and political systems, the ability to 'control' veracity will be far outstripped by the capability and willingness to supply any kind of content to any kind of user."

These experts noted that the public has turned to social media - especially Facebook - to get its "news." They said the public's craving for quick reads and tabloid-style sensationalism is what makes social media the field of choice for manipulative narratives, which are often packaged to appear like news headlines. They note that the public's move away from more-traditional mainstream news outlets, which had some ethical standards, to consumption of social newsfeeds has weakened mainstream media organizations, making them lower-budget operations that have been forced to compete for attention by offering up clickbait headlines of their own.

An emeritus professor of communication for a U.S. Ivy League university noted, "We have lost an important social function in the press. It is being replaced by social media, where there are few if any moral or ethical guidelines or constraints on the performance of informational roles."

A project leader for a science institute commented, "We live in an era where most people get their 'news' via social media and it is very easy to spread fake news. The existence of clickbait sites make it easy for conspiracy theories to be rapidly spread by people who do not bother to read entire articles, nor look for trusted sources. Given that there is freedom of speech, I wonder how the situation can ever improve. Most users just read the headline, comment and share without digesting the entire article or thinking critically about its content (if they read it at all)."

Subtheme: The most-effective tech solutions to misinformation will endanger people's dwindling privacy options, and they are likely to limit free speech and remove the ability for people to be anonymous online

The rise of new and highly varied voices with differing agendas and motivations might generally be considered to be a good thing. But some of these experts said the recent major successes by misinformation manipulators have created a threatening environment in which many in the public are encouraging platform providers and governments to expand surveillance. Among the technological solutions for "cleaning up" the information environment are those that work to clearly identify entities operating online and employ algorithms to detect misinformation. Some of these experts expect that such systems will act to identify perceived misbehaviors and label, block, filter or remove some online content and even ban some posters from further posting.

An educator commented, "Creating 'a reliable, trusted, unhackable verification system' would produce a system for filtering and hence structuring of content. This will end up being a censored information reality."

An eLearning specialist observed, "Any system deeming itself to have the ability to 'judge' information as valid or invalid is inherently biased." And a professor and researcher noted, "In an open society, there is no prior determination of what information is genuine or fake."

In fact, a share of the respondents predicted that the online information environment will not improve in the next decade because any requirement for authenticated identities would take away the public's highly valued free-speech rights and allow major powers to control the information environment.

A distinguished professor emeritus of political science at a U.S. university wrote, "Misinformation will continue to thrive because of the long (and valuable) tradition of freedom of expression. Censorship will be rejected." An anonymous respondent wrote, "There is always a fight between 'truth' and free speech. But because the internet cannot be regulated free speech will continue to dominate, meaning the information environment will not improve."

But another share of respondents said that is precisely why authenticated identities - which are already operating in some places, including China - will become a larger part of information systems. A professor at a major U.S. university replied, "Surveillance technologies and financial incentives will generate greater surveillance." A retired university professor predicted, "Increased censorship and mass surveillance will tend to create official 'truths' in various parts of the world. In the United States, corporate filtering of information will impose the views of the economic elite."

The executive director of a major global privacy advocacy organization argued removing civil liberties in order to stop misinformation will not be effective, saying, "'Problematic' actors will be able to game the devised systems while others will be over-regulated."

Several other respondents also cited this as a major flaw of this potential remedy. They argued against it for several reasons, including the fact that it enables even broader government and corporate surveillance and control over more of the public.

Emmanuel Edet, head of legal services at the National Information Technology Development Agency of Nigeria, observed, "The information environment will improve but at a cost to privacy."

Bill Woodcock, executive director of the Packet Clearing House, wrote, "There's a fundamental conflict between anonymity and control of public speech, and the countries that don't value anonymous speech domestically are still free to weaponize it internationally, whereas the countries that do value anonymous speech must make it available to all, [or] else fail to uphold their own principle."

James LaRue, director of the Office for Intellectual Freedom of the American Library Association, commented, "Information systems incentivize getting attention. Lying is a powerful way to do that. To stop that requires high surveillance - which means government oversight which has its own incentives not to tell the truth."

Tom Valovic, contributor to The Technoskeptic magazine and author of "Digital Mythologies," said encouraging platforms to exercise algorithmic controls is not optimal. He wrote: "Artificial intelligence that will supplant human judgment is being pursued aggressively by entities in the Silicon Valley and elsewhere. Algorithmic solutions to replacing human judgment are subject to hidden bias and will ultimately fail to accomplish this goal. They will only continue the centralization of power in a small number of companies that control the flow of information."

Theme 3: The information environment will improve because technology will help label, filter or ban misinformation and thus upgrade the public's ability to judge the quality and veracity of content

Most of the respondents who gave hopeful answers about the future of truth online said they believe technology will be implemented to improve the information environment. They noted their faith was grounded in history, arguing that humans have always found ways to innovate to overcome problems. Most of these experts do not expect there will be a perfect system - but they expect advances. A number said information platform corporations such as Google and Facebook will begin to efficiently police the environment to embed moral and ethical thinking in the structure of their platforms. They hope this will simultaneously enable the screening of content while still protecting rights such as free speech.

Larry Diamond, senior fellow at the Hoover Institution and the Freeman Spogli Institute (FSI) at Stanford University, said, "I am hopeful that the principal digital information platforms will take creative initiatives to privilege more authoritative and credible sources and to call out and demote information sources that appear to be propaganda and manipulation engines, whether human or robotic. In fact, the companies are already beginning to take steps in this direction."

An associate professor at a U.S. university wrote, "I do not see us giving up on seeking truth." And a researcher based in Europe said, "Technologies will appear that solve the trust issues and reward logic."

Adam Lella, senior analyst for marketing insights at comScore Inc., replied, "There have been numerous other industry-related issues in the past (e.g., viewability, invalid traffic detection, cross-platform measurement) that were seemingly impossible to solve, and yet major progress was made in the past few years. If there is a great amount of pressure from the industry to solve this problem (which there is), then methodologies will be developed and progress will be made to help mitigate this issue in the long run. In other words, if there's a will, there's way."

Subtheme: Likely tech-based solutions include adjustments to algorithmic filters, browsers, apps and plug-ins and the implementation of "trust ratings"

Many respondents who hope for improvement in the information environment mentioned ways in which new technological solutions might be implemented.

Bart Knijnenburg, researcher on decision-making and recommender systems and assistant professor of computer science at Clemson University, said, "Two developments will help improve the information environment: 1) News will move to a subscription model (like music, movies, etc.) and subscription providers will have a vested interest in culling down false narratives; 2) Algorithms that filter news will learn to discern the quality of a news item and not just tailor to 'virality' or political leaning."

Laurel Felt, lecturer at the University of Southern California, "There will be mechanisms for flagging suspicious content and providers and then apps and plugins for people to see the 'trust rating' for a piece of content, an outlet or even an IP address. Perhaps people can even install filters so that, when they're doing searches, hits that don't meet a certain trust threshold will not appear on the list."

A longtime U.S. government researcher and administrator in communications and technology sciences said, "The intelligence, defense and related U.S. agencies are very actively working on this problem and results are promising."

Amber Case, research fellow at Harvard University's Berkman Klein Center for Internet & Society, suggested withholding ad revenue until veracity has been established. She wrote, "Right now, there is an incentive to spread fake news. It is profitable to do so, profit made by creating an article that causes enough outrage that advertising money will follow. ... In order to reduce the spread of fake news, we must deincentivize it financially. If an article bursts into collective consciousness and is later proven to be fake, the sites that control or host that content could refuse to distribute advertising revenue to the entity that created or published it. This would require a system of delayed advertising revenue distribution where ad funds are held until the article is proven as accurate or not. A lot of fake news is created by a few people, and removing their incentive could stop much of the news postings."

Andrea Matwyshyn, a professor of law at Northeastern University who researches innovation and law, particularly information security, observed, "Software liability law will finally begin to evolve. Market makers will increasingly incorporate security quality as a factor relevant to corporate valuation. The legal climate for security research will continue to improve, as its connection to national security becomes increasingly obvious. These changes will drive significant corporate and public sector improvements in security during the next decade."

Larry Keeley, founder of innovation consultancy Doblin, predicted technology will be improved but people will remain the same, writing, "Capabilities adapted from both bibliometric analytics and good auditing practices will make this a solvable problem. However, non-certified, compelling-but-untrue information will also proliferate. So the new divide will be between the people who want their information to be real vs. those who simply want it to feel important. Remember that quote from Roger Ailes: 'People don't want to BE informed, they want to FEEL informed.' Sigh."
Anonymous survey participants also responded:

"Filters and algorithms will improve to both verify raw data, separate 'overlays' and to correct for a feedback loop."

"Semantic technologies will be able to cross-verify statements, much like meta-analysis."

"The credibility history of each individual will be used to filter incoming information."

"The veracity of information will be linked to how much the source is perceived as trustworthy - we may, for instance, develop a trust index and trust will become more easily verified using artificial-intelligence-driven technologies."

"The work being done on things like verifiable identity and information sharing through loose federation will improve things somewhat (but not completely). That is to say, things will become better but not necessarily good."

"AI, blockchain, crowdsourcing and other technologies will further enhance our ability to filter and qualify the veracity of information."

"There will be new visual cues developed to help news consumers distinguish between trusted news sources and others."

Subtheme: Regulatory remedies could include software liability law, required identities, unbundling of social networks like Facebook

A number of respondents believe there will be policy remedies that move beyond whatever technical innovations emerge in the next decade. They offered a range of suggestions, from regulatory reforms applied to the platforms that aid misinformation merchants to legal penalties applied to wrongdoers. Some think the threat of regulatory reform via government agencies may force the issue of required identities and the abolition of anonymity protections for platform users.

Sonia Livingstone, professor of social psychology at the London School of Economics and Political Science, replied, "The 'wild west' state of the internet will not be permitted to continue by those with power, as we are already seeing with increased national pressure on providers/companies by a range of means from law and regulation to moral and consumer pressures."

Willie Currie, a longtime expert in global communications diffusion, wrote, "The apparent success of fake news on platforms like Facebook will have to be dealt with on a regulatory basis as it is clear that technically minded people will only look for technical fixes and may have incentives not to look very hard, so self-regulation is unlikely to succeed. The excuse that the scale of posts on social media platforms makes human intervention impossible will not be a defense. Regulatory options may include unbundling social networks like Facebook into smaller entities. Legal options include reversing the notion that providers of content services over the internet are mere conduits without responsibility for the content. These regulatory and legal options may not be politically possible to affect within the U.S., but they are certainly possible in Europe and elsewhere, especially if fake news is shown to have an impact on European elections."

Sally Wentworth, vice president of global policy development at the Internet Society, warned against too much dependence upon information platform providers in shaping solutions to improve the information environment. She wrote: "It's encouraging to see some of the big platforms beginning to deploy internet solutions to some of the issues around online extremism, violence and fake news. And yet, it feels like as a society, we are outsourcing this function to private entities that exist, ultimately, to make a profit and not necessarily for a social good. How much power are we turning over to them to govern our social discourse? Do we know where that might eventually lead? On the one hand, it's good that the big players are finally stepping up and taking responsibility. But governments, users and society are being too quick to turn all of the responsibility over to internet platforms. Who holds them accountable for the decisions they make on behalf of all of us? Do we even know what those decisions are?"

A professor and chair in a department of educational theory, policy and administration commented, "Some of this work can be done in private markets. Being banned from social media is one obvious one. In terms of criminal law, I think the important thing is to have penalties/regulations be domain-specific. Speech can be regulated in certain venues, but obviously not in all. Federal (and perhaps even international) guidelines would be useful. Without a framework for regulation, I can't imagine penalties."

Theme 4: The information environment will improve, because people will adjust and make things better

Many of those who expect the information environment to improve anticipate that information literacy training and other forms of assistance will help people become more sophisticated consumers. They expect that users will gravitate toward more reliable information - and that knowledge providers will respond in kind.

Frank Kaufmann, founder and director of several international projects for peace activism and media and information, commented, "The quality of news will improve, because things always improve." And Barry Wellman, virtual communities expert and co-director of the NetLab Network, said, "Software and people are becoming more sophisticated."

One hopeful respondent said a change in economic incentives can bring about desired change. Tom Wolzien, chairman of The Video Call Center and Wolzien LLC, said, "The market will not clean up the bad material, but will shift focus and economic rewards toward the reliable. Information consumers, fed up with false narratives, will increasingly shift toward more-trusted sources, resulting in revenue flowing toward those more trusted sources and away from the junk. This does not mean that all people will subscribe to either scientific or journalistic method (or both), but they will gravitate toward material the sources and institutions they find trustworthy, and those institutions will, themselves, demand methods of verification beyond those they use today."

A retired public official and internet pioneer predicted, "1) Education for veracity will become an indispensable element of secondary school. 2) Information providers will become legally responsible for their content. 3) A few trusted sources will continue to dominate the internet."

Irene Wu, adjunct professor of communications, culture and technology at Georgetown University, said, "Information will improve because people will learn better how to deal with masses of digital information. Right now, many people naively believe what they read on social media. When the television became popular, people also believed everything on TV was true. It's how people choose to react and access to information and news that's important, not the mechanisms that distribute them."

Charlie Firestone, executive director at the Aspen Institute Communications and Society Program, commented, "In the future, tagging, labeling, peer recommendations, new literacies (media, digital) and similar methods will enable people to sift through information better to find and rely on factual information. In addition, there will be a reaction to the prevalence of false information so that people are more willing to act to assure their information will be accurate."

Howard Rheingold, pioneer researcher of virtual communities, longtime professor and author of "Net Smart: How to Thrive Online," noted, "As I wrote in 'Net Smart' in 2012, some combination of education, algorithmic and social systems can help improve the signal-to-noise ratio online - with the caveat that misinformation/disinformation versus verified information is likely to be a continuing arms race. In 2012, Facebook, Google and others had no incentive to pay attention to the problem. After the 2016 election, the issue of fake information has been spotlighted."

Subtheme: Misinformation has always been with us and people have found ways to lessen its impact. The problems will become more manageable as people become more adept at sorting through material

Many respondents agree that misinformation will persist as the online realm expands and more people are connected in more ways. Still, the more hopeful among these experts argue that progress is inevitable as people and organizations find coping mechanisms. They say history validates this. Furthermore, they said technologists will play an important role in helping filter out misinformation and modeling new digital literacy practices for users.

Mark Bunting, visiting academic at Oxford Internet Institute, a senior digital strategy and public policy advisor with 16 years of experience at the BBC and as a digital consultant, wrote, "Our information environment has been immeasurably improved by the democratisation of the means of publication since the creation of the web nearly 25 years ago. We are now seeing the downsides of that transformation, with bad actors manipulating the new freedoms for antisocial purposes, but techniques for managing and mitigating those harms will improve, creating potential for freer, but well-governed, information environments in the 2020s."

Jonathan Grudin, principal design researcher at Microsoft, said, "We were in this position before, when printing presses broke the existing system of information management. A new system emerged and I believe we have the motivation and capability to do it again. It will again involve information channeling more than misinformation suppression; contradictory claims have always existed in print, but have been manageable and often healthy."

Judith Donath, fellow at Harvard University's Berkman Klein Center for Internet & Society and founder of the Sociable Media Group at the MIT Media Lab, wrote, "'Fake news' is not new. The Weekly World News had a circulation of over a million for its mostly fictional news stories that are printed and sold in a format closely resembling a newspaper. Many readers recognized it as entertainment, but not all. More subtly, its presence on the newsstand reminded everyone that anything can be printed."

Joshua Hatch, president of the Online News Association, noted, "I'm slightly optimistic because there are more people who care about doing the right thing than there are people who are trying to ruin the system. Things will improve because people - individually and collectively - will make it so."

Many of these respondents said the leaders and engineers of the major information platform companies will play a significant role. Some said they expect some other systematic and social changes will alter things.

John Wilbanks, chief commons officer at Sage Bionetworks, replied, "I'm an optimist, so take this with a grain of salt, but I think as people born into the internet age move into positions of authority they'll be better able to distill and discern fake news than those of us who remember an age of trusted gatekeepers. They'll be part of the immune system. It's not that the environment will get better, it's that those younger will be better fitted to survive it."

Danny Rogers, founder and CEO of Terbium Labs, replied, "Things always improve. Not monotonically, and not without effort, but fundamentally, I still believe that the efforts to improve the information environment will ultimately outweigh efforts to devolve it."

Bryan Alexander, futurist and president of Bryan Alexander Consulting, replied, "Growing digital literacy and the use of automated systems will tip the balance towards a better information environment."

A number of these respondents said information platform corporations such as Google and Facebook will begin to efficiently police the environment through various technological enhancements. They expressed faith in the inventiveness of these organizations and suggested the people of these companies will implement technology to embed moral and ethical thinking in the structure and business practices of their platforms, enabling the screening of content while still protecting rights such as free speech.

Patrick Lambe, principal consultant at Straits Knowledge, commented, "All largescale human systems are adaptive. When faced with novel predatory phenomena, counter-forces emerge to balance or defeat them. We are at the beginning of a largescale negative impact from the undermining of a social sense of reliable fact. Counter-forces are already emerging. The presence of largescale 'landlords' controlling significant sections of the ecosystem (e.g., Google, Facebook) aids in this counter-response."

A professor in technology law at a West-Coast-based U.S. university said, "Intermediaries such as Facebook and Google will develop more-robust systems to reward legitimate producers and punish purveyors of fake news."

A longtime director for Google commented, "Companies like Google and Facebook are investing heavily in coming up with usable solutions. Like email spam, this problem can never entirely be eliminated, but it can be managed."

Sandro Hawke, technical staff at the World Wide Web Consortium, predicted, "Things are going to get worse before they get better, but humans have the basic tools to solve this problem, so chances are good that we will. The biggest risk, as with many things, is that narrow self-interest stops people from effectively collaborating."
Anonymous respondents shared these remarks:

"Accurate facts are essential, particularly within a democracy, so this will be a high, shared value worthy of investment and government support, as well as private-sector initiatives."

"We are only at the beginning of drastic technological and societal changes. We will learn and develop strategies to deal with problems like fake news."

"There is a long record of innovation taking place to solve problems. Yes, sometimes innovation leads to abuses, but further innovation tends to solve those problems."

Consumers have risen up in the past to block the bullshit, fake ads, fake investment scams, etc., and they will again with regard to fake news."

"As we understand more about digital misinformation we will design better tools, policies and opportunities for collective action."

"Now that it is on the agenda, smart researchers and technologists will develop solutions."

"The increased awareness of the issue will lead to/force new solutions and regulation that will improve the situation in the long-term even if there are bound to be missteps such as flawed regulation and solutions along the way."

Subtheme: Crowdsourcing will work to highlight verified facts and block those who propagate lies and propaganda. Some also have hopes for distributed ledgers (blockchain)

A number of these experts said solutions such as tagging, flagging or other labeling of questionable content will continue to expand and be of further use in the future in tackling the propagation of misinformation

J. Nathan Matias, a postdoctoral researcher at Princeton University and previously a visiting scholar at MIT's Center for Civic Media, wrote, "Through ethnography and largescale social experiments, I have been encouraged to see volunteer communities with tens of millions of people work together to successfully manage the risks from inaccurate news."

A researcher of online harassment working for a major internet information platform commented, "If there are nonprofits keeping technology in line, such as an ACLU-esque initiative, to monitor misinformation and then partner with spaces like Facebook to deal with this kind of news spam, then yes, the information environment will improve. We also need to move away from clickbaity-like articles, and not algorithmically rely on popularity but on information."

An engineer based in North America replied, "The future will attach credibility to the source of any information. The more a given source is attributed to 'fake news,' the lower it will sit in the credibility tree."

Micah Altman, director of research for the Program on Information Science at MIT, commented, "Technological advances are creating forces pulling in two directions: It is increasingly easy to create real-looking fake information; and it is increasingly easy to crowdsource the collection and verification of information. In the longer term, I'm optimistic that the second force will dominate - as transaction cost-reduction appears to be relatively in favor of crowds versus concentrated institutions."

A past chairman of a major U.S. scientific think tank and former CEO replied, "[The information environment] should improve because there are many techniques that can be brought to bear both human-mediated - such as collective intelligence via user voting and rating - and technological responses that are either very early in their evolution or not or not deployed at all. See spam as an analog."

Some predicted that digital distributed ledger technologies, known as blockchain, may provide some answers. A longtime technology editor and columnist based in Europe, commented, "The blockchain approach used for Bitcoin, etc., could be used to distribute content. DECENT is an early example." And an anonymous respondent from Harvard University's Berkman Klein Center for Internet & Society said, "They will be cryptographically verified, with concepts."

But others were less confident that blockchain will work. A leading researcher studying the spread of misinformation observed, "I know systems like blockchain are a start, but in some ways analog systems (e.g., scanned voting ballots) can be more resilient to outside influence than digital solutions such as increased encryption. There are always potential compromises when our communication networks are based on human-coded technology and hardware; this [is] less the case with analog-first, digital-second systems."

A professor of media and communication based in Europe said, "Right now, reliable and trusted verification systems are not yet available; they may become technically available in the future but the arms race between corporations and hackers is never ending. Blockchain technology may be an option, but every technological system needs to be built on trust, and as long as there is no globally governed trust system that is open and transparent, there will be no reliable verification systems."

Theme 5: Tech can't win the battle. The public must fund and support the production of objective, accurate information. It must also elevate information literacy to be a primary goal of education

There was common agreement among many respondents - whether they said they expect to see improvements in the information environment in the next decade or not - that the problem of misinformation requires significant attention. A share of these respondents urged action in two areas: A bolstering of the public-serving press and an expansive, comprehensive, ongoing information literacy education effort for people of all ages.

A sociologist doing research on technology and civic engagement at MIT said, "Though likely to get worse before it gets better, the 2016-2017 information ecosystem problems represent a watershed moment and call to action for citizens, policymakers, journalists, designers and philanthropists who must work together to address the issues at the heart of misinformation."

Michael Zimmer, associate professor and privacy and information ethics scholar at the University of Wisconsin, Milwaukee commented, "This is a social problem that cannot be solved via technology."

Subtheme: Funding and support must be directed to the restoration of a well-fortified, ethical and trusted public press

Many respondents noted that while the digital age has amplified countless information sources it has hurt the reach and influence of the traditional news organizations. These are the bedrock institutions much of the public has relied upon for objective, verified, reliable information - information undergirded by ethical standards and a general goal of serving the common good. These respondents said the information environment can't be improved without more, well-staffed, financially stable, independent news organizations. They believe that material can rise above misinformation and create a base of "common knowledge" the public can share and act on.

Susan Hares, a pioneer with the National Science Foundation Network (NSFNET) and longtime internet engineering strategist, now a consultant, said, "Society simply needs to decide that the 'press' no longer provides unbiased information, and it must pay for unbiased and verified information."

Christopher Jencks, a professor emeritus at Harvard University, said, "Reducing 'fake news' requires a profession whose members share a commitment to getting it right. That, in turn, requires a source of money to pay such professional journalists. Advertising used to provide newspapers with money to pay such people. That money is drying up, and it seems unlikely to be replaced within the next decade."

Rich Ling, professor of media technology at the School of Communication and Information at Nanyang Technological University, said, "We have seen the consequences of fake news in the U.S. presidential election and Brexit. This is a wake-up call to the news industry, policy makers and journalists to refine the system of news production."

Maja Vujovic, senior copywriter for the Comtrade Group, predicted, "The information environment will be increasingly perceived as a public good, making its reliability a universal need. Technological advancements and civil-awareness efforts will yield varied ways to continuously purge misinformation from it, to keep it reasonably reliable."

An author and journalist based in North America said, "I believe this era could spawn a new one - a flight to quality in which time-starved citizens place high value on verified news sources."

A professor of law at a major U.S. state university commented, "Things won't get better until we realize that accurate news and information are a public good that require not-for-profit leadership and public subsidy."

Marc Rotenberg, president of the Electronic Privacy Information Center, wrote, "The problem with online news is structural: There are too few gatekeepers, and the internet business model does not sustain quality journalism. The reason is simply that advertising revenue has been untethered from news production."

With precarious funding and shrinking audiences, healthy journalism that serves the common good is losing its voice. Siva Vaidhyanathan, professor of media studies and director of the Center for Media and Citizenship at the University of Virginia, wrote, "There are no technological solutions that correct for the dominance of Facebook and Google in our lives. These incumbents are locked into monopoly power over our information ecosystem and as they drain advertising money from all other low-cost commercial media they impoverish the public sphere."

Subtheme: Elevate information literacy: It must become a primary goal at all levels of education

Many of these experts said the flaws in human nature and still-undeveloped norms in the digital age are the key problems that make users susceptible to false, misleading and manipulative online narratives. One potential remedy these respondents suggested is a massive compulsory crusade to educate all in digital-age information literacy. Such an effort, some said, might prepare more people to be wise in what they view/read/believe and possibly even serve to upgrade the overall social norms of information sharing.

Karen Mossberger, professor and director of the School of Public Affairs at Arizona State University, wrote, "The spread of fake news is not merely a problem of bots, but part of a larger problem of whether or not people exercise critical thinking and information-literacy skills. Perhaps the surge of fake news in the recent past will serve as a wake-up call to address these aspects of online skills in the media and to address these as fundamental educational competencies in our education system. Online information more generally has an almost limitless diversity of sources, with varied credibility. Technology is driving this issue, but the fix isn't a technical one alone."

Mike DeVito, graduate researcher at Northwestern University, wrote, "These are not technical problems; they are human problems that technology has simply helped scale, yet we keep attempting purely technological solutions. We can't machine-learn our way out of this disaster, which is actually a perfect storm of poor civics knowledge and poor information literacy."

Miguel Alcaine, International Telecommunication Union area representative for Central America, commented, "The boundaries between online and offline will continue to blur. We understand online and offline are different modalities of real life. There is and will be a market (public and private providers) for trusted information. There is and will be space for misinformation. The most important action societies can take to protect people is education, information and training."

An early internet developer and security consultant commented, "Fake news is not a product of a flaw in the communications channel and cannot be fixed by a fix to the channel. It is due to a flaw in the human consumers of information and can be repaired only by education of those consumers."

An anonymous respondent from the Harvard University's Berkman Klein Center for Internet & Society noted, "False information - intentionally or inadvertently so - is neither new nor the result of new technologies. It may now be easier to spread to more people more quickly, but the responsibility for sifting facts from fiction has always sat with the person receiving that information and always will."

An internet pioneer and rights activist based in the Asia/Pacific region said, "We as a society are not investing enough in education worldwide. The environment will only improve if both sides of the communication channel are responsible. The reader and the producer of content, both have responsibilities."

Deirdre Williams, retired internet activist, replied, "Human beings are losing their capability to question and to refuse. Young people are growing into a world where those skills are not being taught."

Julia Koller, a learning solutions lead developer, replied, "Information is only as reliable as the people who are receiving it. If readers do not change or improve their ability to seek out and identify reliable information sources, the information environment will not improve."

Ella Taylor-Smith, senior research fellow at the School of Computing at Edinburgh Napier University, noted, "As more people become more educated, especially as digital literacy becomes a popular and respected skill, people will favour (and even produce) better quality information."

Constance Kampf, a researcher in computer science and mathematics, said, "The answer depends on socio-technical design - these trends of misinformation versus verifiable information were already present before the internet, and they are currently being amplified. The state and trends in education and place of critical thinking in curricula across the world will be the place to look to see whether or not the information environment will improve - cyberliteracy relies on basic information literacy, social literacy and technological literacy. For the environment to improve, we need substantial improvements in education systems across the world in relation to critical thinking, social literacy, information literacy, and cyberliteracy (see Laura Gurak's book ' Cyberliteracy ')."

Su Sonia Herring, an editor and translator, commented, "Misinformation and fake news will exist as long as humans do; they have existed ever since language was invented. Relying on algorithms and automated measures will result in various unwanted consequences. Unless we equip people with media literacy and critical-thinking skills, the spread of misinformation will prevail."

Responses from additional key experts regarding the future of the information environment

This section features responses by several of the top analysts who participated in this canvassing. Following this wide-ranging set of comments is a much more expansive set of quotations directly tied to the five primary themes identified in this report.

Ignorance breeds frustration and 'a growing fraction of the population has neither the skills nor the native intelligence to master growing complexity'

Mike Roberts, pioneer leader at ICANN and Internet Hall of Fame member, replied, "There are complex forces working both to improve the quality of information on the net, and to corrupt it. I believe the outrage resulting from recent events will, on balance, lead to a net improvement, but viewed with hindsight, the improvement may be viewed as inadequate. The other side of the complexity coin is ignorance. The average man or woman in America today has less knowledge of the underpinnings of his or her daily life than they did 50 or a hundred years ago. There has been a tremendous insertion of complex systems into many aspects of how we live in the decades since World War II, fueled by a tremendous growth in knowledge in general. Even among highly intelligent people, there is a significant growth in personal specialization in order to trim the boundaries of expected expertise to manageable levels. Among educated people, we have learned mechanisms for coping with complexity. We use what we know of statistics and probability to compartment uncertainty. We adopt 'most likely' scenarios for events of which we do not have detailed knowledge, and so on. A growing fraction of the population has neither the skills nor the native intelligence to master growing complexity, and in a competitive social environment, obligations to help our fellow humans go unmet. Educated or not, no one wants to be a dummy - all the wrong connotations. So ignorance breeds frustration, which breeds acting out, which breeds antisocial and pathological behavior, such as the disinformation, which was the subject of the survey, and many other undesirable second order effects. Issues of trustable information are certainly important, especially since the technological intelligentsia command a number of tools to combat untrustable info. But the underlying pathology won't be tamed through technology alone. We need to replace ignorance and frustration with better life opportunities that restore confidence - a tall order and a tough agenda. Is there an immediate nexus between widespread ignorance and corrupted information sources? Yes, of course. In fact, there is a virtuous circle where acquisition of trustable information reduces ignorance, which leads to better use of better information, etc."

The truth of news is murky and multifaceted

Judith Donath, fellow at Harvard University's Berkman Klein Center for Internet & Society and founder of the Sociable Media Group at the MIT Media Lab, wrote, "Yes, trusted methods will emerge to block false narratives and allow accurate information to prevail, and, yes, the quality and veracity of information online will deteriorate due to the spread of unreliable, sometimes even dangerous, socially destabilizing ideas. Of course, the definition of 'true' is sometimes murky. Experimental scientists have many careful protocols in place to assure the veracity of their work, and the questions they ask have well-defined answers - and still there can be controversy about what is true, what work was free from outside influence. The truth of news stories is far murkier and multi-faceted. A story can be distorted, disproportional, meant to mislead - and still, strictly speaking, factually accurate. ... But a pernicious harm of fake news is the doubt it sows about the reliability of all news. Donald Trump's repeated 'fake news' smears of The New York Times, Washington Post, etc., are among his most destructive non-truths."

"Algorithms weaponize rhetoric," influencing on a mass scale

Susan Etlinger, industry analyst at Altimeter Research, said, "There are two main dynamics at play: One is the increasing sophistication and availability of machine learning algorithms and the other is human nature. We've known since the ancient Greeks and Romans that people are easily persuaded by rhetoric; that hasn't changed much in two thousand years. Algorithms weaponize rhetoric, making it easier and faster to influence people on a mass scale. There are many people working on ways to protect the integrity and reliability of information, just as there are cybersecurity experts who are in a constant arms race with cybercriminals, but to put as much emphasis on 'information' (a public good) as 'data' (a personal asset) will require a pretty big cultural shift. I suspect this will play out differently in different parts of the world."

There's no technical solution for the fact that 'news' is a social bargain

Clay Shirky, vice provost for educational technology at New York University, replied, "'News' is not a stable category - it is a social bargain. There's no technical solution for designing a system that prevents people from asserting that Obama is a Muslim but allows them to assert that Jesus loves you."

'Strong economic forces are incentivizing the creation and spread of fake news'

Amy Webb, author and founder of the Future Today Institute, wrote, "In an era of social, democratized media, we've adopted a strange attitude. We're simultaneously skeptics and true believers. If a news story reaffirms what we already believe, it's credible - but if it rails against our beliefs, it's fake. We apply that same logic to experts and sources quoted in stories. With our limbic systems continuously engaged, we're more likely to pay attention to stories that make us want to fight, take flight or fill our social media accounts with links. As a result, there are strong economic forces incentivizing the creation and spread of fake news. In the digital realm, attention is currency. It's good for democracy to stop the spread of misinformation, but it's bad for business. Unless significant measures are taken in the present - and unless all the companies in our digital information ecosystem use strategic foresight to map out the future - I don't see how fake news could possibly be reduced by 2027."

Propagandists exploit whatever communications channels are available

Ian Peter, internet pioneer, historian and activist, observed, "It is not in the interests of either the media or the internet giants who propagate information, nor of governments, to create a climate in which information cannot be manipulated for political, social or economic gain. Propaganda and the desire to distort truth for political and other ends have always been with us and will adapt to any form of new media which allows open communication and information flows."

Expanding information outlets erode opportunities for a 'common narrative'

Kenneth R. Fleischmann, associate professor at the School of Information at the University of Texas, Austin, wrote, "Over time, the general trend is that a proliferation of information and communications technologies (ICTs) has led to a proliferation of opportunities for different viewpoints and perspectives, which has eroded the degree to which there is a common narrative - indeed, in some ways, this parallels a trend away from monarchy toward more democratic societies that welcome a diversity of perspectives - so I anticipate the range of perspectives to increase, rather than decrease, and for these perspectives to include not only opinions but also facts, which are inherently reductionist and can easily be manipulated to suit the perspective of the author, following the old aphorism about statistics Mark Twain attributed to Benjamin Disraeli ['There are three kinds of lies: lies, damned lies and statistics.'], which originally referred to experts more generally."

'Broken as it might be, the internet is still capable of routing around damage'

Paul Saffo, longtime Silicon-Valley-based technology forecaster, commented, "The information crisis happened in the shadows. Now that the issue is visible as a clear and urgent danger, activists and people who see a business opportunity will begin to focus on it. Broken as it might be, the internet is still capable of routing around damage."

It will be impossible to distinguish between fake and real video, audio, photos

Marina Gorbis, executive director of the Institute for the Future, predicted, "It's not going to be better or worse but very different. Already we are developing technologies that make it impossible to distinguish between fake and real video, fake and real photographs, etc. We will have to evolve new tools for authentication and verification. We will probably have to evolve both new social norms as well as regulatory mechanisms if we want to maintain online environment as a source of information that many people can rely on."

A 'Cambrian explosion' of techniques will arise to monitor the web and non-web sources

Stowe Boyd, futurist, publisher and editor-in-chief of Work Futures, said, "The rapid rise of AI will lead to a Cambrian explosion of techniques to monitor the web and non-web media sources and social networks and rapidly identifying and tagging fake and misleading content."

Well, there's good news and bad news about the information future ...

Jeff Jarvis, professor at the City University of New York's Graduate School of Journalism, commented, "Reasons for hope: Much attention is being directed at manipulation and disinformation; the platforms may begin to recognize and favor quality; and we are still at the early stage of negotiating norms and mores around responsible civil conversation. Reasons for pessimism: Imploding trust in institutions; institutions that do not recognize the need to radically change to regain trust; and business models that favor volume over value."

A fear of the imposition of pervasive censorship

Jim Warren, an internet pioneer and open-government/open-records/open-meetings advocate, said, "False and misleading information has always been part of all cultures (gossip, tabloids, etc.). Teaching judgment has always been the solution, and it always will be. I (still) trust the longstanding principle of free speech: The best cure for 'offensive' speech is MORE speech. The only major fear I have is of massive communications conglomerates imposing pervasive censorship."

People have to take responsibility for finding reliable sources

Steven Miller, vice provost for research at Singapore Management University, wrote, "Even now, if one wants to find reliable sources, one has no problem doing that, so we do not lack reliable sources of news today. It is that there are all these other options, and people can choose to live in worlds where they ignore so-called reliable sources, or ignore a multiplicity of sources that can be compared, and focus on what they want to believe. That type of situation will continue. Five or 10 years from now, I expect there to continue to be many reliable sources of news, and a multiplicity of sources. Those who want to seek out reliable sources will have no problems doing so. Those who want to make sure they are getting a multiplicity of sources to see the range of inputs, and to sort through various types of inputs, will be able to do so, but I also expect that those who want to be in the game of influencing perceptions of reality and changing the perceptions of reality will also have ample means to do so. So the responsibility is with the person who is seeking the news and trying to get information on what is going on. We need more individuals who take responsibility for getting reliable sources."

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The Future of Truth and Misinformation Online

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Experts are split on whether the coming years will see less misinformation online. Those who foresee improvement hope for technological and societal solutions. Others say bad actors using technology can exploit human vulnerabilities.

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How to Spot Fake News

Consider the Source - Click away from the story to investigate the site, its mission and its contact info.

Read Beyond - Headlines can be outrageous in an effort to get clicks. What's the whole story?

Check the Author - Do a quick search on the author. Are they credible? Are they real?

Supporting Sources? - Click on those links. Determine if the info given actually supports the story.

Check the Date - Reposting old news stories doesn't mean they're relevant to current events.

Is it a Joke? - If it is too outlandish, it might be satire. Research the site and author to be sure.

Check your Biases - Consider if your own beliefs could affect your judgment.

Ask the Experts - Ask a librarian or consult a fact-checking site.

Infographic Source

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LibGuides: Misinformation, Disinformation, and Propaganda: Fake News Infographic

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"Everyone is entitled to his own opinion, but not his own facts." --Daniel Patrick Moynihan, Newsweek, 25 August 1986, p. 27. Tips for evaluating news sources. Infographic from IFLA.