Tag Archives: Adolescent

Two girls kissing

Do sexual minority teenagers have greater health risks?

People who identify as gay or bisexual have long been known to be more likely than others to be at risk from behaviour which can affect their health, such as drug-taking, drinking and not doing enough exercise. But how does this affect today’s teenagers? In an era of greater social liberalism might these differences be disappearing? Professor Yvonne Kelly and Dr Cara Booker discuss new research which sheds light on the issue.

Numerous studies have shown people from sexual minorities tend to suffer disproportionately from a range of health issues, yet until now there has been a paucity of up-to-date, comprehensive evidence about the level of risk faced by this group in the UK. A recent report by the Equalities and Human Rights Commission called for more research.

Two studies have been able to shed new light on the issue. Evidence from Understanding Society, the UK Household Longitudinal Study, examines its impact on adults and suggests problems still persist despite recent social change. And research based on the Millennium Cohort Study (MCS), which has followed almost 12,000 children since their birth between 2000 and 2002, has presented an ideal opportunity to look at the health outcomes of young people while they are still growing up. 

Sexual minority adolescents

MCS is a birth cohort study which has followed up children born in the UK just after the Millennium, and it has followed up its participants at nine months, 3, 5, 7, 11 and 14 years. So using this last sweep, it was possible to look at whether sexual minority adolescents experienced more adverse outcomes than their heterosexual peers. 

Between January 2015, and April 2016, 9885 adolescents in the MCS provided a response about their sexual attraction. Six per cent identified themselves as experiencing same-sex or bisexual attraction. Of these, the large majority were female – particularly among those who said they were bisexual.

Among the 629 respondents in this group, 50 (29 female and 21 male) reported same-sex attraction only and 576 (451 female and 125 male) reported bisexual attraction – this was not the case in the samples taken for Understanding Society, where the gender split was more even.

This may be because there is a lot of fluidity in sexual orientation at younger ages – so girls who say they are bisexual at this age may not say so in the future. But the rates of young people who identify as non-heterosexual have increased over time and so we may expect more young people to be bisexual or non-heterosexual in the MCS sample, who are younger than those in the Understanding Society study.

In order to assess mental health, MCS respondents were asked if they had self-harmed in the past year; how they rated their self-esteem and their subjective wellbeing, and about their general life satisfaction. They were asked if they experienced depressive symptoms, and if they felt they were bullied or victimised. They were also asked if they had been involved in anti-social behaviour such as stealing or violence, how close they felt to their parents, whether they smoked, drank or took illegal drugs, and whether they had had unprotected sex. Their levels of physical activity and diet were also assessed.

Range of problems

The findings suggested sexual minority adolescents were more likely to suffer from a range of problems including high depressive symptoms, self-harm, lower life satisfaction, lower self-esteem and all forms of bullying and victimisation. Young people from sexual minorities also had higher odds of being less physically active, of perceiving themselves as overweight and of having dieted to lose weight. And they were more likely to suffer from more than one of these issues than their heterosexual peers were. 

However, they were no more likely to engage in violence using a weapon, regular smoking, regular cannabis use, regular drinking, or other drug use. Sexual minority adolescents did not have increased odds of engaging in sexual activity or of engaging in risky sexual behaviour, and there was no difference between sexual minority adolescents and heterosexual adolescents regarding whether they had close friendships.

It has been suggested in the past that disparities may occur because sexual minorities experience stress factors such as bullying as well as facing the stress of navigating their identity. Their experience of prejudice and possible absence of support from family and others may be linked to mental distress, and this may lead to potentially risky behaviours such as substance misuse. However, activities such as drinking, smoking, drugs and sex are also part of normal adolescent development – so we would not want to suggest they’re always a major problem.

The teenage years are a time for experimenting and pushing boundaries, something discussed in an earlier Child of our Time blog on sexual behaviour.

Sexual minorities in adulthood

All this has implications for lifelong health and social outcomes. Recent research led by Dr Cara Booker used Understanding Society data from over 40,000 individuals aged 16 and over to explore the health inequalities of sexual minority UK adults. 

Unlike the MCS study, this research included respondents who identified as ‘other’ and those who preferred not to say. And a distinction was drawn between those who identified as gay and those who identified as bisexual. Participants were asked about their physical and mental functioning, minor psychological distress, self-rated health, substance use and disability. 

Overall, heterosexual respondents had the best health while bisexual respondents had the worst. Gay and lesbian respondents reported poorer health than heterosexuals, specifically with regard to mental functioning, distress and illness. 

There were no differences in either mental or physical health between lesbian and gay respondents once socio-demographic characteristics were controlled for, and there were also some indicators on which bisexuals did not differ from other groups.

Those who were ‘other’ or preferred not to say were similar to each other and generally experienced fewer health inequalities than gay and lesbian respondents, but still had poorer health than heterosexuals. This suggests that health promotion interventions are needed for these individuals, who might not participate in interventions targeted toward known sexual minority groups. 

Range of disparities

In conclusion, these two pieces of research suggest that a range of disparities based on sexual attraction are visible as early as 14 years of age, and are likely to persist through adult life.

These results highlight the need for further prevention efforts and intervention at the school, community, and policy level to ensure that sexual minority adolescents do not face lifelong negative social, economic, and health outcomes.

Health and educational practitioners should be aware of the increased risk for adverse outcomes in sexual minority adolescents.

Schools provide an ideal infrastructure to implement effective public health change and social policies. In light of this, a new UK curriculum that teaches students about gender and relationship diversity has been developed, but the guidance around its implementation currently lacks clarity. Therefore, at the policy level, clearer guidelines for schools are needed. 

Better support for families could help, too, to alleviate tensions between parents and sexual minority adolescents. This needs further investigation. 

In conclusion, despite high-profile UK policies such as the legalisation of same sex marriage in 2013 and the introduction of sexual orientation as a protected characteristic during the lifetime of the young people in this study, the evidence presented here indicates that large inequalities in social and health outcomes still exist for sexual minority adolescents growing up in the 21st century.

Mental health, social adversity, and health-related outcomes in sexual minority adolescents: a contemporary national cohort study, by Rebekah Amos, Eric Julian Manalastas, Ross White, Henny Bos and Praveetha Patalay, was published in Lancet Child Adolescent Health 2020; 4: 36–45 https://doi.org/10.1016/ S2352-4642(19)30339-6

Sexual orientation health inequality: Evidence from Understanding Society, the United Kingdom Household Longitudinal Study, by Cara L Booker, Gerulf Rieger and Jennifer B Unger, was published in Preventive Medicine 101, 2017, 126-132.

Author affiliations: 

Professor Yvonne Kelly, ESRC International Centre for Lifecourse Studies, Institute of Epidemiology and Health Care, University College, London

Dr Cara L Booker, Institute for Social and Economic Research, University of Essex.

Time to help our children get a move on

 World Health Organisation and United States guidelines say adolescents should do at least an hour’s moderate-to-vigorous physical activity each day. But a new global study shows eight out of 10 fail to meet that standard – and there is a widening gender gap. Professor Yvonne Kelly and Fran Abrams outline new research revealing worrying trends which demonstrate the need for political and social choices that will help young people enjoy the social, physical and mental benefits of being active.

Physical activity has many health benefits for young people – and globally,  four in every five adolescents do not benefit from regular physical activity.

 In 2018, the WHO launched a global action plan called More Active People for a Healthier World. It aimed to reduce the proportion of people doing insufficient physical activity by 15 per cent by 2030 among both adolescents and adults. 

Now in a major new study WHO researchers have analysed information on 1.6 million school students aged 11-17 in 146 countries. They found some positive trends but argued much still needed to be done to encourage young people to exercise more.

There was a small reduction over 15 years in the proportion of boys not doing enough, though this still fell well short of the WHO’s target. But the proportion of girls meeting the target remained static and this led to a widening gender gap. 

As has been shown in the UK such gender differences start early with lower levels of physical activity in girls emerging before they become teenagers. 

The authors of a separate investigation using the Millennium Cohort Study (MCS) suggest the main reason for young people not exercising or sleeping enough is the amount of time they spend using screens. This is a hotly contested area, intuitively, ‘too much screen time’ and ‘too little exercise’ might appear to sit side by side.  However, in this kind of study, it is not possible to infer that one causes the other. 

The WHO study showed the majority of adolescents did not meet physical activity guidelines, putting their current and future health at risk. Although there were small reductions in insufficient activity among boys, the prevalence of insufficient physical activity in girls had remained unchanged since 2001.

 

Figure 1 Prevalence of insufficient physical activity among school-going adolescents aged 11–17 years, globally and by World Bank income group, 2001 and 2016

Huge dataset

The dataset used in the WHO study was huge – the young people studied had provided information for at least three years and the analysis covered four World Bank income groups, nine regions, and the globe as a whole for the years 2001–16. Saying that, although  the research data covered more than 80 per cent of the global population, it still didn’t cover every county and region. And the estimates for low-income countries need to be treated with caution as the coverage there was much lower – only 36 per cent.

The overall analysis showed that more than eight out of 10 school-going adolescents aged 11–17 did not meet the recommendations for daily physical activity. The small improvements in boys’ activity levels, combined with the static position in girls’ activity, suggested a target of more than 30 per cent of adolescents meeting the recommended level by 2030 will not be met.

Globally, across all income groups and regions and in nearly all the countries analysed, girls were less active than boys.

And perhaps surprisingly, the research did not find that the problem was worse in higher-income countries. However, this was not the case for girls, for whom there was no clear pattern in relation to country income.

Differences in activity levels

In addition to variations related to gender and affluence, there were also differences in activity levels between different parts of the world. The boys least likely to meet activity targets were in the high-income Asia Pacific region, but the second-least likely were in lower-income Sub-Saharan Africa and particularly in Sudan and Zambia. 

The boys most likely to meet the targets were found in high-income western and south Asian countries with large populations such as the USA, Bangladesh, and India.

These variations might be driven by specific characteristics of particular countries – for example, as the research looked at school children the picture might be skewed in countries where disadvantaged children often do not attend school, or in places where the tradition of school or community sport is strong.

For girls, the largest proportions failing to meet the targets were in Asia Pacific and particularly in South Korea- though in some of those countries girls’ participation in education is low and that might have affected the study’s sample.

The recent MCS study by academics from Loughborough University and University College London used data from 3899 adolescents. This study, in which young people were fitted with activity monitors, found that while nine out of 10 were getting the recommended amount of sleep, just four in ten met exercise targets and a quarter were keeping to the recommended screen time. These figures were higher than those in the WHO study, which could be explained by the different methods used to measure activity and which show just how important it is to consider HOW activity is measured.

The study looked at  some correlates of physical activity and showed that adolescent girls who had depressive symptoms were less likely to meet all three of these recommendations (8-10 hours of sleep, no more than two hours of screen time and at least an hour a day of physical activity), while those from better-off backgrounds were more likely to meet them. Among boys, those who were obese and those who had depressive symptoms were less likely to meet the recommendations. However, it is not possible to rule out the potential for cyclical associations to be at play here as low levels of physical activity could lead to depressed mood and to weight gain.

What can be done? 

  • More research is needed to understand the causes of non-participation in exercise – social, economic, cultural, environmental and technological. 
  • Policy change should be prioritised and should encourage all forms of physical education – sport, active play, and recreation as well as safe walking and cycling.
  • Social marketing campaigns such as the National Lottery funded #thisgirlcan campaign combined with community-based interventions could be starting points to increase physical activity levels in girls, particularly in countries with wide gender differences. This approach has been identified as cost-effective.
  • Schools, families, sport and recreation providers, urban planners, and city and community leaders all need to become involved.

That four in every five adolescents do not experience the enjoyment and social, physical, and mental health benefits of regular physical activity is not a chance thing – it is the consequence of political  choices. 

Young people have the right to play and should be provided with the opportunities to realise their right to physical and mental health and wellbeing. Urgent action is needed, particularly through targeted interventions to promote and retain girls’ participation in physical activity. Policymakers and stakeholders should be encouraged to act now for the health of this young generation and of future ones.

Yvonne Kelly is Professor of Lifecourse Epidemiology and Director of the ESRC International Centre for Lifecourse Studies at UCL. She is editor of the Child of our Time blog.

Fran Abrams is CEO of the Education Media Centre and freelance journalist who writes for the Child of our Time blog.

Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants, by Regina Guthold, Leanne Riley, Fiona Bull and Gretchen Stevens, is published in The Lancet Child and Adolescent Health.

Regina Guthold, Leanne Riley and Fiona Bull are based at the Department for Prevention of Noncommunicable Diseases, WHO, Geneva, Switzerland and Gretchen Stevens is at the Department for Information, Evidence and Research, WHO, Geneva, Switzerland.  Fiona Bull is also affiliated with the Department of Sport and Exercise Science, University of Western Australia, Perth.

Prevalence and Correlates of Meeting Sleep, Screen-Time, and Physical Activity Guidelines Among Adolescents in the United Kingdom, by Natalie Pearson, Lauren B Sherar and Mark Hamer, is published in JAMA Paediatrics: 

Natalie Pearson and Lauren Sherar are at the School of Sport, Exercise & Health Sciences, Loughborough University, United Kingdom, and Mark Hamer is at the Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, United Kingdom.

I wanna hold your hand: helping young people prepare for happy healthy relationships

The teenage years are a time for experimenting and for pushing boundaries – particularly when it comes to intimate relationships. Such experimentation is a natural part of growing up. But there are potential risks, too – particularly if these early experiences aren’t positive ones. A new study from Professor Yvonne Kelly from UCL’s Department of Epidemiology and Public  Health  and colleagues, investigates what kinds of intimate behaviour 14 year-olds engage in, and asks how this insight can help to ensure  young people are well prepared for healthy and happy adult relationships.

We know teenagers experiment with intimacy, often moving ‘up’ the scale from hand-holding or kissing to more explicitly sexual activity. But we also know teenage pregnancy numbers have been dropping in recent years. And our new study suggests that fewer young teenagers are actually having sexual intercourse than some might previously have thought. 

We’ve all seen the headlines – studies have shown us (links) that 30 per cent of those born in the 1980s and 1990s had sex before the age of 16, and that among those born in the early 1990s a little under one in five had done so by age 15. But our new evidence, based on 14 year-olds born during or just after the year 2000, paints a rather different picture of this latest generation of teenagers.

Our research used data from the Millennium Cohort Study, the most comprehensive survey of adolescent health and development in the UK. It follows children born between September 2000 and January 2002 and has collected information on them at nine months and subsequently at age  three, five, seven, 11, and  14 years. We used information from the most recently available data, when the study’s participants were 14 years old, and were able to look closely at the lives of 11,000 of them.  

Intimate activities

Participants were asked about a range of ‘light’, ‘moderate’ and ‘heavy’ intimate activities. Handholding, kissing and cuddling were classed as ‘light,’ touching and fondling under clothes as ‘moderate’ and oral sex or sexual intercourse as ‘heavy.’

As might have been expected, more than half – 58 per cent – had engaged in kissing, cuddling or hand-holding, while 7.5 per cent, or one in 13, had experienced touching or fondling. But in contrast to other studies, (though our sample was younger than those mentioned above) we found only a very small proportion – 3.2 per cent or fewer than one in 30 – had been involved in ‘heavy’ activities in the year before they were interviewed for the study.

And most parents can take comfort from the fact that if their children aren’t participating in other risky activities such as drinking or smoking, they probably aren’t having sex either – there was clear evidence of links between heavier sexual activity and these factors.

We also found those who were most likely to confide worries in a friend rather than a parent, those whose parents didn’t always know where they were and those who stayed out late were more likely than others were to be engaged in heavier forms of sexual activity. Other potential links were found to drug-taking and as well as to symptoms of depression.

Our findings suggest young people who push boundaries may push several at once – that those who drink, smoke or stay out late, for instance, are more likely to engage in early sexual activity.

So, initiatives which aim to minimise risk and promote wellbeing are crucial – and they need to look at intimate activities, health behaviours and social relationships in relation to one another. 

A key point is that if young people can learn about intimacy in a positive way at an early stage, then those good experiences can build foundations which will help them throughout their lives.

Most importantly young people need to know how to ensure their intimate experiences are mutually wanted, protected, and pleasurable. The concept of “sexual competence” – used to refer to sexual experiences characterised by autonomy, an equal willingness of partners, being ‘ready’ and (when relevant) protected by contraceptives – is important at all ages, as are close and open relationships with parents.

Better understanding of this interplay between personal relationships and behaviours are key to better support for young people. The right intervention at the right time can ensure a teenager’s intimate life is set on a positive course.

Partnered intimate activities in early adolescence – findings from the UK Millennium Cohort Study, by Yvonne Kelly. Afshin Zilanawala , Clare Tanton, Ruth Lewis and Catherine H Mercer,is published in the Journal of Adolescent Health.

*Afshin Zilanawala is based at the Research Department of Epidemiology and Public Health, University College London, and Oregon State University, United States.

Clare Tanton is based at London School of Hygiene & Tropical Medicine.

Ruth Lewis is based at the University of Glasgow.

Catherine H Merceris based at University College London.

Teenage depression: The potential pitfalls of too much social media use

A new mobile phone will be in the pockets of many teenagers as they head back to school in the coming days. The period between Xmas and New Year will have been spent signing up for social media apps where they can chat, share photos and videos with friends, all part of the excitement of owning a new device. But how many of these young people and their parents are aware of the potential pitfalls of spending too much time on social media sites?  And what can parents, teachers and young people themselves do to maximize the benefits of life online whilst minimising those pitfalls? It’s a question that Yvonne Kelly, Director of the ESRC International Centre for Life course Studies at UCL and colleagues have been asking as part of a major programme of research on social media use and young people’s wellbeing. Today they publish key new research, which provides much-needed new evidence on the links between heavy social media use and depression in teenagers. The research shines light on the underlying processes that could be at work and that might explain the link between the two. Here, Yvonne explains how their research might help policymakers, educators, parents and young people themselves better understand and prevent the potential pitfalls of living too much of their life on social media platforms.

2018 has seen a growing chorus of voices including those of the former and current Health Secretaries, Jeremy Hunt and Matt Hancock calling for a thorough investigation of the links between social media use and the growing numbers of young people struggling with mental health issues. Indeed Matt Hancock issued “an urgent warning” on the potential dangers of social media on children’s mental health, stating that the threat of social media on mental health is similar to that of sugar on physical health.

The Chief Medical Officer, Dame Sally Davies has been tasked by the Government with leading that investigation and with coming up with evidence based recommendations around what constitutes safe social media use and what changes need to be made and by whom to make that a reality. The Royal College of Paediatrics and Child Health (RCPCH) recently issued the first ever guidance on managing children’s screen time, calling for further research particularly into social media.

In recent months, we and others have submitted written and oral evidence to two Parliamentary inquiries in this area and had discussions with the Royal Society for Public Health which is campaigning actively  to get us all thinking harder about our social media use.

We’ve talked about our early research  showing that 10 year-old girls who used social media sites for chatting had more social and emotional problems at age 15 than their peers who used them less or not at all. Those problems continued to get worse as they got older.

Our new research published in The Lancet’s EClinical Medicine draws stronger links between heavy social media use and depressive symptoms in girls and boys at the age of 14.  We look at the possible ways in which social media use might linked to depressive symptoms. We consider 4 potential pathways – through young people’s sleep patterns, their experiences of online harassment, body image and self-esteem. It is the first research to look at all of these potential pathways at the same time.

Our data for this research came from the Millennium Cohort Study, which has followed the lives of some 19,000 children born at the turn of the century. This piece of research, looked at the social media use and mental health of nearly 11,000 of the study’s participants.

Social media use

In line with our earlier research, we saw that girls were heavier users of social media than boys with two fifthsof them using it for more than 3 hours per day (compared with one fifthof boys). Girls were a lot less likely NOT to use social media at all (4 per cent girls and 10 per cent boys).

Examining the underlying processes that might be linked with social media use and depression, we saw a number of really striking findings including:

  • 40 per cent of girls and 25 per cent of boys had experience of online harassment or cyberbullying
  • 78 per cent of girls and 68 per cent of boys were unhappy with their body/weight and 15 percent girls and 12 per cent of boys were unhappy with their appearance
  • 13 per cent of girls and 9 per cent of boys had low self-esteem
  • 13 per cent of girls and 11 per cent of boys reported getting fewer than 7 hours sleep per night and 40 per cent of girls and 28 per cent of boys said their sleep was often disrupted

Girls, it seems from these findings, are struggling more with these aspects of their lives than boys – in some cases considerably more. When we turned our attention to the signs of depression exhibited by our participants, we could see that here too girls fared worse with scores on average twice as high as those of boys.

The link between social media use and depressive symptoms was stronger for girls compared with boys. For girls, greater daily hours of social media use corresponded to a stepwise increase in depressive symptoms and the percent with clinically relevant symptoms. For boys, higher depressive symptom scores were seen among those reporting 3 or more hours of daily social media use.

There was a clear link between social media use and all the pathways we investigated – more time spent on social media related to having poorer sleep, more experiences of on-line harassment, unhappiness with the way they look and low self esteem. In turn, these things were directly related to having depressive symptoms.

A closer look at the pathways was also revealing. The most important routes from social media use to depressive symptoms were shown to be via poor sleep and online harassment.

Social media use linked directly to having poor sleep which in turn was related directly to having more depressive symptoms. The role of online harassment was more complex, with multiple pathways through poor sleep, self-esteem and body image, all of which linked directly to depressive symptoms.

Potential pitfalls and key routes

Our findings add weight to the growing evidence base on the potential pitfalls associated with lengthy time spent engaging on social media. In particular they point to poor sleep and online harrassment as being key routes between social media use and depression.

These findings are highly relevant to current policy development on guidelines for the safe use of social media and calls on industry to more tightly regulate hours of social media use for young people. They add weight to the Screen Time Guidance issued by the RCPCH today, particularly the suggestion to set and agree child appropriate time limits on screen use.

When it comes to social media use specifically, our research indicates that the a similar approach could be useful. Clinical, educational and family settings are all potential points of contact where young people could be encouraged and supported to reflect not only on their social media use, but also other aspects of their lives including on-line experiences and their sleep patterns.

At home, families may want to reflect on when and where it’s ok to be on social media and agree limits for time spent online. Curfews for use and the overnight removal of mobile devices from bedrooms might also be something to consider. School seems an obvious setting for children and young people to learn how to navigate online life appropriately and safely and for interventions aimed at promoting self-esteem. Clearly a large proportion of young people experience dissatisfaction with the way they look and how they feel about their bodies and perhaps a broader societal shift away from the perpetuation of what are often highly distorted images of idealised beauty could help shift these types of negative perceptions.

As we head into 2019, millions of young people will be getting their first experiences of life online using the devices they got for Xmas. They will rapidly become expert at downloading apps, posting photos and interacting with their peers. With the gift there was no instruction manual to help them understand and navigate some of the pitfalls our research outlines. We hope our work brings, at least, some guidance for all those keen to ensure these children continue to thrive and do well, so that they enjoy the benefits that new digital technology brings whilst staying safe and happy.

Social media use and adolescent mental health: Findings from the Millennium Cohort Study is research by Yvonne Kelly, Afshin Zilanawala, Cara Booker and Amanda Sacker and is published in The Lancet’s EClinicalMedicine journal.

Taking time out to scroll free

As the Royal Society for Public Health launches its #ScrollFreeSeptember campaign, encouraging people to take a break from social media, Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL, discusses new research on the negative impacts of social media use on young people’s health. She explains how the findings point to the need to limit the time that young people, especially girls, spend on social media.

The ScrollFreeSeptember campaign accompanies the launch of a second parliamentary inquiry in less than 12 months into the impact of social media use on young people’s mental health and well-being. Our Centre will be submitting a range of important new findings to that inquiry which seeks to grow the evidence base in an area where there is a great deal of hot debate, but where little is really known and understood.

For our team of researchers, the first indication that all was not well in the world of social media and young people’s mental health came in 2015 when we found that children who were heavy users of screen-based media were less happy and had more social and emotional problems than their peers who used it moderately. Children who used social media sites for chatting were also less likely to be happy and more likely to have problems than their peers who did not.

In March this year, our widely covered work on the trends for boys’ and girls’ social media use added weight to recent calls from the Children’s Commissioner for England to, as she put it, call time on a “life of likes”. In her report, Anne Longfield argued that there was clear evidence of children finding it hard to manage the impact of online life. She said children as young as eight were becoming anxious about their identity as they craved social media likes and comments for validation.

Social media and girls

Our research, based on the experiences of 10,000 children aged 10-15 who took part in the Understanding Society study, showed that this seemed to be the case particularly for girls who used social media for more than an hour a day. 10 year-old girls in the study who spent an hour or more on a school day chatting online had considerably more social and emotional problems later on – by age 15 – than girls of the same age who spent less or no time on social media. The number of problems they faced also increased as they got older, which was not the case for boys.

It was interesting to note that more girls than boys were using social media and for greater periods of time. At age 15, 43 percent of girls and 31 per cent of boys were using it for between one and three hours per day, with 16 and 10 per cent using it for more than four hours.

We think this tells us something important about the different ways that girls and boys interact with social media. For example, girls may be more likely than boys to compare their lives with those of friends and peers – whether those are ‘filtered’ selfies or positive posts about friendships, relationships or material possessions – these could lead to feelings of inadequacy, lower levels of satisfaction and poorer wellbeing.

The pressures associated with having peers like or ‘approve’ status updates and a perceived fall in or lack of popularity could add further pressure at, what for many teenagers is a tricky time in their lives.

Boys are more likely to be gaming than interacting online in the way just described and that wasn’t covered in this research, so it’s possible that for boys, changes in well-being may be more related to gaming success or skill.

But one of the key takeaways of this research is how social media use as a very young person is linked to lower levels of happiness later on – the effects are not short term – they have longer term consequences and

Social media and depression

More recently, we have turned our attention to the social media experiences of the children in the Millennium Cohort Study (MCS), using information on 11,000 14 year-olds to look at how social media use is linked with depression. We’ve also been asking ourselves what the pathways between these two things might look like, something that’s not really been done before. So, for example, are heavier users of social media getting too little sleep or having trouble getting to sleep because they are checking accounts at bedtime; are they experiencing cyberbullying either as victims or perpetrators; do they appear to have low self-esteem or a negative view of how they look? All these questions can help us better understand what’s at play and come up with better approaches to tackling these problems.

Preliminary findings reinforce the message that girls are particularly vulnerable to the negative effects of social media. Once again we see more girls than boys in this study using social media and for longer periods of time.

Does using social media affect literacy?

A follow up piece of research looks at whether there are links between the amount of time young people spend on social media and their levels of literacy. Findings suggest a link and that this is the same for boys and girls.

In this research we look at whether the more time young people spend on social media, the less time they have for the things that might improve their literacy such as reading for enjoyment and doing homework.

There are some clear messages from our research so far:

  1. Heavy users of social media are less happy and have more problems at school and at home – interventions to help them limit and manage their social media use better are likely to be important
  2. Girls are particularly vulnerable to the negative effects of social media and may be an important group to focus on among those looking to mitigate thse effects
  3. More hours spent on social media appear to impact negatively on young people’s wellbeing and could have knock on effects for their longer term prospects at school and work

Social media companies have been accused by the former Health Secretary Jeremy Hunt among others of turning a blind eye to the problem and the chief medical officer Dame Sally Davies has been asked to recommend healthy limits for screen time.

Our research indicates that it may indeed be time for recommended healthy and safe limits of social media use, that a focus on girls, especially initiatives to boost their mental health could help mitigate some of the negative effects.

The RSPH is hoping that going scroll free this September might give us all a chance to get our social media use a little more balanced, to think about the benefits to be enjoyed and the negatives to be avoided.

As well as pausing to think about our social media use and how it affects us, it will be an opportunity to examine the facts of the matter, a time to digest new, solid evidence that these large scale studies can help us with and consider the potential longer term costs and consequences of doing nothing.

The forthcoming inquiry hopes to inform “progressive and practical solutions”, including a proposed industry Code of Practice and tools for educators, parents and young people themselves to help them enjoy the benefits and eliminate the negative effects of their social media. We wholly support those efforts and hope they result in positive changes that will make campaigns like ScrollFreeSeptember unnecessary in the future.

Calling time on a life of likes could be key to girls’ happiness

There have been increasing calls in recent months for more to be done to prepare children for the emotional demands of social media. Just a few weeks ago, the Government’s Science and Technology Committee announced an inquiry into the impact of social media on the health of young people. But do girls and boys use social media as much as each other and is all this time spent Facebooking, Whatsapping and Snapchatting having a detrimental effect on their happiness and well-being? Cara Booker from the University of Essex, in collaboration with collleagues from UCL, has been looking at trends in social media interaction and well-being in nearly 10,000 10-15 year-olds in the UK over a 5 year period. Their findings indicate that girls may be at greater risk and therefore a focus for those looking to intervene to protect and promote children’s happiness.

The Government’s inquiry into the impact of social media on the health of young people comes hard on the heels of a report from the Children’s Commissioner for England, which says that children between the ages of 8 and 12 find it hard to manage the impact of online life and become anxious about their identity as they crave ‘likes’ and comments for validation. 

An explosion in digital and social media platforms has revolutionised the way we all consume media with a recent report showing that young people aged 12-15 spending more time online than they do watching TV. Indeed, it seems a long time ago that parents’ prime concern around media was how much or what kind of TV their child was watching.

All these major developments have taken place at a time when we also know that young people are becoming less and less happy. In the most recent United Nations Children’s Fund report, UK adolescents are ranked in the bottom third on overall well-being, below Slovenia, the Czech Republic and Portugal.

Of course, it’s important to remember that the internet has done a great deal of good for children: connecting them with friends and family who may be far away, providing great opportunities to widen horizons and learn new things. These things have been shown in other studies to be linked with increased levels of happiness and well-being in children

On the negative side, social media use has been linked with obesity, cyberbullying, low self-esteem and lack of physical activity, all things that can affect the lives of children as they move through school and into adulthood and work.

Social media experiences

Young people who took part in the Understanding Society survey, were asked if they belonged to a social web-site and then how many hours they spent ‘chatting’ or ‘interacting with friends’ on a normal school day. They could select a range of responses from none to more than 7 hours.

At age 10, 50 per cent of girls and 55 per cent of boys said they had no internet access or spent no time on social media. At 15 years, this dropped to 8 and 10 per cent respectively.

Ten per cent of ten year old girls reported spending one to three hours a day (compared with 7 per cent of boys) and this increased to 43 per cent of girls at age 15 (and 31 per cent of boys).

At age 10 only a very small percent of girls/boys were spending 4 hours plus a day on social media. But by the age of 15, that rose to 16 per cent of girls and 10 percent of boys.

Levels of happiness 🙂 🙁

Young people who took part in the survey were asked about satisfaction with schoolwork, friends, family, appearance, school and life as a whole and this was used to create an overall happiness score for them.

They were also asked about any social and emotional difficulties they might be facing using the well-established Strengths and Difficulties Questionnaire (SDQ) with a higher score indicating more problems.

For both boys and girls, levels of happiness decreased between the ages of 10 and 15, however the decrease was greater for girls than for boys. Additionally, whilst SDQ scores increased for girls between the ages of 10 and 15, they decreased for boys.

10 year-old girls who spent an hour or more on a school day chatting online had higher SDQ scores (more social and emotional problems) than girls of the same age who spent less or no time on social media. In addition, the score (number of problems) increased as they got older.

Why the gender difference?

So why the gender difference? This is hard to unpick and not something we were able to look at specifically in our research. It may say something about the different ways that girls and boys interact with social media. For example, girls may be more likely than boys to compare their lives with those of friends and peers – whether those are ‘filtered’ selfies or positive posts about friendships, relationships or material possessions – these could lead to feelings of inadequacy, lower levels of satisfaction and poorer wellbeing.

The pressures associated with having peers like or ‘approve’ status updates and a perceived fall in or lack of popularity could add further pressure at, what for many teenagers is a tricky time in their lives.

Boys are more likely to be gaming than interacting online in the way just described and that wasn’t covered in this research, so it’s possible that changes in well-being may be more related to gaming success or skill.

What needs to change?

It’s clear that social media is no short-lived phenomenon and our research indicates that girls, possibly because of the way in which they interact online and the amount of time they spend doing so could be at greater risk.

In her report, A Life of Likes, the Children’s Commissioner Anne Longfield has called for more to be done to check and stop underage use and to prevent children becoming over dependent on likes and comments and “adapting their offline lives to fit an online image”, something she believes can lead to an anxiety about ‘keeping up appearances ‘ as they get older.

Our research really adds weight to recent calls for the technology industry to look at in-built time limits. Young people need access to the internet for homework, for watching TV and to keep in touch with their friends of course, but a body of evidence is emerging to show that substantial amounts of time spent chatting, sharing, liking and comparing on social media on school days is far from beneficial especially for girls.

Gender differences in the association between age trends of social media interaction and wellbeing among 10-15 year olds in the UK, is research by Cara Booker (University of Essex), Yvonne Kelly (University College London) and Amanda Sacker (University College London) and is published in BMC Public Health.

An equal start: longitudinal evidence to support children’s healthy development

Using longitudinal evidence to support children’s healthy development and give them an equal start in life is the subject of our editor Yvonne Kelly’s keynote address at the Growing up in Ireland Annual Conference in Dublin today.

Her talk discusses findings from the most recent of the British ‘birth ‘ cohort studies – the Millennium Cohort Study that have so far informed policy development. They include work by researchers at the ESRC Centre for Lifecourse Studies where Yvonne is based on alcohol consumption during pregnancy, breastfeeding and the introduction of solid foods, the physical punishment of children , childhood obesity, reading to children in the early years, and sleep patterns throughout childhood.

She will also share work with the potential to inform future policy challenges such as young people’s drinking, social media use and mental health.

Ahead of her talk, she said:

“It is well established that what happens in the early years of life has long-lasting consequences for health and social success across the lifespan. Stark social inequalities in children’s health and development exist and emerge early in life. It is therefore crucial to identify potential tipping points and opportunities for intervention   during childhood with the potential to affect change and improve life chances.”

 

 

Why reading is key to giving our kids a great start in life

A growing body of research is pointing to how important and valuable reading is in giving children the best possible start in life, not just for academic success but more broadly including for a child’s mental health and happiness.

In this special episode of the Child of our Time Podcast, Professor Yvonne Kelly is joined by Jonathan Douglas, CEO of the National Literacy Trust and researcher Christina Clark, also from the  Trust. They discuss important new evidence about the benefits of reading for individual children and in addressing social inequalities.

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Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army

 

Why mental health is not your average problem

There have been numerous reports in recent months of a growing crisis in children and young people’s mental health. From increased suicide attempts and incidents of self-harm to reports of a complete lack of appropriate services, it’s said that young people are facing unprecedented social pressures and that society’s response has been inadequate. When it comes to trends over time in the mental wellbeing of young people, the evidence to date is conflicting. Meanwhile, new research by Andy Ross and colleagues at the ESRC International Centre for Lifecourse Studies at UCL shows that the way we look at those trends may be masking an important story that could help those trying to tackle the problem to identify those most at risk of serious mental health problems.

There are few more high profile health issues at the moment than the mental health crisis among young people. The younger Royals may have helped raise public awareness about the need for more open conversations, but they agree the job is far from done. From a policy perspective, there are pledges of mental health legislation reform in the Queen’s Speech promises from Teresa May that her Government will “ensure that mental health is prioritised in the NHS in England”. But a recent report from NHS Providers says the government’s commitment to parity of esteem between mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline.

Having a full and clear grasp of the scale of the problem and how young people’s mental wellbeing is changing over time will be key to any policies that may be developed to tackle it.

One of the main problems facing those trying to better understand the extent of the problem and whether the situation is getting better or worse, is that the evidence presented to date has been somewhat conflicting and, in some cases, doesn’t give the whole picture.

Some research has shown young people’s mental health deteriorating in the nineties and then stabilising and slightly improving in the early 2000s, whilst other work has evidenced a steady decline. Findings have also been different depending on whether it is teachers, parents or the young person themselves who are asked to report the symptoms.

Trends over time

We wanted to see whether we could add to and improve on the available evidence and show a more nuanced picture of mental health problems among young people by looking at trends over time, not just in respect of average levels of mental health, but also across the spectrum in levels of mental health. In simple terms, we were looking to see whether there were increases in the number of young people with unusually low levels of mental distress at the same time as increases in the numbers of those with very high levels of distress over an 18-year period.

Making use of information collected between 1991-2008 from more than 6,000 young people who took part in the British Household Panel Survey, we looked closely at their self-reported psychological distress. Once a year, young people between the ages of 16-24, were asked whether and how often, for example, they had experienced the loss of sleep through worry, a loss of confidence, felt constantly under strain, unhappy or depressed. They were also asked about positive symptoms such as their ability to concentrate and face up to their problems.

All this information was then combined to create an overall psychological distress score on a scale of 0-36, with high scores indicating high levels of psychological distress.

When we looked at the average psychological distress scores for young women in the study, we saw a small but significant increase over the 18-year period, indicating that, for this group, the situation worsened – in other words, their mental health deteriorated.

No increase was detected in the average scores for young men, which could be interpreted as a sign that levels of mental health among this group remained fairly stable.

At every time point, scores for women were worse than they were for men and this gap increased over time.

A story of polarisation

When we drilled deeper into the scores, however, the story changed a little. For young women there was a very clear and consistent increase in high and very high scores, following the overall increase in average scores mentioned above. The prevalence of those with high scores (17 and higher) increased from 12.8 per cent in 1991 to 18.8 per cent in 2008, and the prevalence of those with very high scores (20 and higher) from 6.6 per cent to 11.9 per cent. At the same time, however, there was also a small increase in the prevalence of those with scores much lower than average (5 and lower) from 10.6 per cent to 13.0 per cent.

It seems that when we move beyond looking only at average mental health scores over time, we identify two very different yet concurrent pictures of young women’s mental health. An increase in the number of young women presenting very poor levels of psychological distress, whilst at the same time an increase in young women with far better levels of mental health than average. In other words, over time, the mental wellbeing of young women appears to have become polarised.

Previously, our findings suggested that levels of mental health among young men had remained stable. However, when we look at both low and high scores over time, we find a very clear and consistent increase in low and very low scores, suggesting an overall improvement in levels of mental health among young men.

The prevalence of those with low and very low scores increased from 8.1 per cent to 15.6 per cent and from 2.1 per cent to 5.9 per cent respectively. At the other end of the scale however, whilst there was an increase in prevalence of those with high and very high scores, this increase was too small for us to consider it statistically significant[1]. Nevertheless, by considering trends at both ends of the spectrum we identified an improvement in young men’s mental health, which was otherwise ‘hidden’ when we only looked at average scores over time.

Although our study did not delve deeply into the backgrounds and circumstances of the young people with low and high scores, we did look at income levels to see if increasing levels of inequality might explain what we were seeing. It doesn’t appear to.

What we did find was evidence to support earlier research, which suggests that girls might feel increased pressure to achieve academically, which could contribute to increased levels of psychological distress.

Doing it for themselves

We are yet to explore causes for these trends, however one area that remains significantly under researched is the idea that we are becoming a more individualistic society, in which there are increased expectations placed on young people and an emphasis on them “doing it for themselves”. This includes increased pressure to take responsibility not just for one’s successes, but also for one’s failures, previously thought of as misfortunes, such as unemployment, illness and addiction. It is easy to imagine how the personalising of one’s failings could contribute to a young person’s poor mental health, or how they might develop a fear of failure even.

On the other hand, taking more responsibility for their own destiny could be empowering when things go well, boosting their self-esteem and confidence.

Evidence of polarising trends in young women’s mental health could be the first step in linking time trends to the sort of cultural and societal individualization that is being increasingly talked about amongst those concerned with the health and wellbeing of the UK’s young people.

For young women, continuing gender inequalities (some legislative, some cultural), which serve to frustrate women’s dreams of self-realisation, might also help to explain the differences in poor levels of mental health in particular that we see between them and young men.

By 2020, the NHS has promised that 70,000 more young people will be able to access services for their mental health problems. Robust evidence on trends and how the story of young people’s mental health is changing over time will be key to ensuring those services are provided effectively and efficiently.

Time trends in mental well-being: the polarisation of young people’s psychological distress is research by Andy Ross, Amanda Sacker and Yvonne Kelly and is published in the Journal of Social Psychiatry and Psychiatric Epidemiology

Photo credit: Allan Bergman