Key points

Introduction

Throughout the past decade, adolescent use of new age technology has increased dramatically. A 2009 survey found that on average, adolescents spend 11 hours of each day using technology. However, heavy technology use is associated with poor academic performance, increased aggression, and low-quality relationships with parents and peers. In general, increased new age technology use among adolescents has been related to poor mental and physical health. As youth exposure to new age technology continues to expand, it is vital that the health implications of Internet, cell phone, and video game use are noted and understood so that preventive measures can be taken to minimize their negative impact. This review examines the health implications of new age technology use among adolescents.

Introduction

Throughout the past decade, adolescent use of new age technology has increased dramatically. A 2009 survey found that on average, adolescents spend 11 hours of each day using technology. However, heavy technology use is associated with poor academic performance, increased aggression, and low-quality relationships with parents and peers. In general, increased new age technology use among adolescents has been related to poor mental and physical health. As youth exposure to new age technology continues to expand, it is vital that the health implications of Internet, cell phone, and video game use are noted and understood so that preventive measures can be taken to minimize their negative impact. This review examines the health implications of new age technology use among adolescents.

Internet addiction

Since its origin in the 1990s, use of the Internet has rapidly become a commonplace activity among adolescents. According to a 2012 nationally representative phone survey of 812 teens aged 12 to 17 years, 80% have their own desktop or laptop computer, and of the 20% who do not, 67% have access to a computer they can use at home. Given this dramatic increase in Internet use, many now view the Internet as potentially addictive.

Internet addiction (IA) describes a loss of control over Internet use, which results in personal distress and symptoms of psychological dependence. The proposed criteria for IA include the presentation of at least 5 of the 6 following criteria :

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  Spending an increasing amount of time online

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  Failure to reduce use with concomitant feelings of restlessness and depression

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  Staying online longer than originally intended

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  Running the risk of losing a relationship or other opportunities due to Internet use

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  Lying to conceal the extent of Internet use

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  Using the Internet to escape negative feelings

Most studies suggest that male individuals have a higher frequency of IA, which is likely due to their increased engagement in games, pornography, and gambling, all of which have been associated with IA.

IA among adolescents has been found to be associated with depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder (ADHD), anxiety, stress, negative self-perception, and suicidal ideation. Adolescents with IA are 2.5 times more likely to be depressed, and 2 times more likely to engage in self-injurious behavior than typical adolescents. Already-existing depression and hostility increase when adolescents become addicted to the Internet. Furthermore, in a 2007 study of Korean adolescents, Ha and colleagues found that a strong association between depression and IA existed even after controlling for differences in biogenetic temperament. These results suggest that adolescents with no history of mental health problems can develop depression due to excessive Internet use.

Adolescents with IA also tend to develop poor eating habits, including skipping meals, snacking, and loss of appetite. These adolescents do not consume enough of the recommended food groups; they also consume more than the recommended daily quantities of salt, fatty foods, fried foods, and foods high in simple sugars. Unsurprisingly, studies have revealed an association between IA and a high body mass index (BMI). The opposite is true as well; media plays a role in the development, maintenance, prevention, and treatment of eating disorders. Time spent on the Internet is significantly related to body surveillance, internalization of the thin ideal, and drive for thinness.

Last, IA is related to microstructural changes in adolescent brains, such as decreased gray matter volume. Genetic polymorphisms, impairment of neurotransmitter systems, and anatomic and functional changes have been found in brains of individuals with IA. However, these studies fail to determine the causality of this relationship and further longitudinal research should be conducted.

As it has been proven that IA leads to many health-related consequences among adolescents, it is essential that pediatricians and other health care professionals are aware of the implications of Internet addiction. Equipped with this knowledge, they can work toward the implementation of preventive, diagnostic, and treatment strategies. For example, there is evidence that promoting positive parent–adolescent interaction and attending to adolescent psychological needs should be included in preventive programs for future IA cases. In addition, adolescents’ own increased awareness and education regarding IA may prevent or at least mitigate the many negative consequences of such behavior.

Cyberbullying

National studies have found that as many as 1 in 5 adolescents is involved in some type of bullying, and bullying plays a large role in the high adolescent suicide rate. Unfortunately, the Internet serves as an additional medium through which adolescents can bully one another. The Youth Internet Safety Survey (YISS) defines online harassment, or cyberbullying, as “threats or other offensive behavior sent online to the youth or posted online about the youth for others to see.” Similar to traditional bullying, cyberbullying is usually composed of recurring behavior and a power imbalance between the bully and the victim.

Cyberbullying has become increasingly pervasive in the lives of adolescents. In 2010, approximately 11% of adolescents were victims of cyberbullying, compared with 6% of adolescents in 2000. Cyberbullying has increased by 83% throughout the past decade. According to the 2014 YISS, this increase in cyberbullying has been dramatic because “inhibitions that would otherwise restrain youth from engaging in harassment are reduced due to the anonymity and remoteness of online interactions.”

As technology is now being used as a vehicle for bullying, serious attention is warranted to investigate the extent and nature of this new form of aggression and the possible psychosocial effects it has on youth. For example, online harassment is significantly related to depression. The study by Finkelhor and colleagues surveyed 1501 youth ages 10 through 17, and found that 18% of the harassed youth reported 5 or more depressive symptoms, which was more than twice the rate (8%) for the overall sample. Furthermore, similar to traditional bullying, cyberbullying is associated with suicidal ideation and suicidal behavior. In a survey of 1973 middle school students, conducted by Hinduja and Patchin, cyberbully victims were 1.9 times more likely to have attempted suicide, and cyberbully offenders were 1.5 times more likely to have attempted suicide than students who had not experienced online harassment.

Although there are several similarities between traditional bullying and cyberbullying, cyberbullying deserves to be addressed as its own unique risk factor. A 2014 meta-analysis determined that cyberbullying is more strongly related to suicidal ideation than is traditional bullying. This study found that victims of traditional bullying had an increased risk for suicidal ideation by a factor of 2.16, whereas victims of cyberbullying had an increased risk by a factor of 3.12. Unlike traditional bully victims, cyberbully victims often feel that they have been degraded in front of a wider audience. Also, harmful material can be stored online, which can constantly remind victims of the incident.

In an Australian study conducted by Price and Dalgleish, despite the serious impacts of cyberbullying, adolescents often did not seek support from others. The findings in this review stress the importance of instituting school-based programs aimed at reducing cyberbullying. School antibullying policies often do not include prevention of cyberbullying, and in his study Bhat suggests that cyberbullying prevention should be implemented in school antibullying policies. Interventions to prevent cyberbullying warrant much further attention and research.

Pornography

The expansion of the Internet has enabled adolescents to access sexually explicit content easily. As adolescent accessibility to the Internet increases, more youth are exposed to online pornography. According to a 2008 study conducted by Sabina and colleagues, 72.8% of 563 college students surveyed (94% male students, 62% female students) had seen online pornography before turning 18. However, much of this adolescent exposure to pornography is involuntary. In YISS-2, approximately 1 in 3 youth said that they had experienced unwanted exposure to pornography, and 83% of youth were exposed when surfing the Web. Female individuals have been found to report involuntary exposure more often than male individuals. The YISS-2 attributes the increase in youth exposure to pornography to 3 factors: greater Internet accessibility, a change in technology, and more aggressive marketing strategies used by pornographic companies.

Adolescent exposure to pornography has been found to have a variety of adverse health and social implications. For example, one study found that 59% of 15-year-olds to 24-year-olds agreed that exposure to pornography encourages adolescents to have sex before they are ready. In addition, adolescent exposure to pornography has been associated with an increase in risky sexual behaviors. A study of 433 adolescents found that individuals who watched pornography were more likely to have engaged in anal sex, had sex with multiple partners, and used alcohol or drugs during sex. In a 2001 study, 50% of youth surveyed thought that pornography encourages individuals to believe that unprotected sex is acceptable. However, not all research has supported this association. For example, Luder and colleagues found that among Swiss adolescents, risky sexual behaviors were not necessarily related to exposure to pornography.

Exposure to pornography, particularly violent pornography, may also be indicative of sexually aggressive behavior. In a 2006 study examining 10-year-old to 15-year-old adolescents surveyed nationally in the United States, intentional exposure to violent pornography was found to increase the odds of self-reported sexually aggressive behavior by nearly 6 times. Another longitudinal study found that male adolescents who were exposed to pornography at an early age were more likely to engage in sexual harassment. Adolescents who consume pornography were also found to be more likely to display forms of aggressive behaviors, such as theft, manipulation, and forced sexual intercourse.

Pornography exposure may also affect adolescents’ mental health. In a longitudinal analysis conducted by Mattebo, frequent pornography use was largely associated with psychosomatic symptoms. Although frequent pornography use was less associated with depressive symptoms than psychosomatic symptoms at follow-up, female individuals who frequently used pornography at baseline were found to have depressive symptoms at follow-up. Additional research should be conducted to further understand the effects that pornography consumption has on adolescent mental health.

Many studies have addressed the impact of pornography consumption on adolescents’ social development. Frequent pornography users were found to have weaker ties to social institutions and to have lower degrees of social integration. In a 2010 study, Hunter and colleagues found that early exposure to pornography is related to antisocial behavior. Furthermore, adolescents who use pornography frequently are significantly more likely to have abnormal conduct issues as well as addictive Internet use.

As pornography appears to have a number of negative health effects on adolescents, it is important to educate them about these potential adverse consequences, especially regarding high-risk sexual behaviors. Given the popularity of the Internet, this may be the most influential sex educator for adolescents worldwide.

Texting and driving

According to the National Center for Health Statistics, most adolescent deaths are the result of unintentional injuries. Motor vehicle fatalities are responsible for 73% of these accidental deaths. In 2009, 3365 adolescents in the United States died in motor vehicle crashes and in 2011, 2650 adolescents died in motor vehicle crashes; more than 292,000 suffered major injuries due to these accidents. Although youth ages 15 to 24 represent only 14% of the US population, they represent 30% of the total costs of motor vehicle injuries among male individuals and 28% of the total costs of motor vehicle injuries among female individuals.

The National Highway Traffic Safety Administration found that distracted driving predominantly occurs in the adolescent age-group, and cell phones play a significant role in adolescents’ distracted driving. In a 2009 national survey conducted by the Allstate Foundation, 83% of 1000 teenagers reported using a cell phone while driving. In a 2010 national survey of 1219 drivers, Wilson and Stimpson found that 43% of drivers ages 18 to 24 reported texting while driving. Texting while driving is especially distracting and dangerous. A 2009 study revealed that texting was found to increase the risk of a car accident by 23 times. In comparison, dialing a phone while driving increased the risk by 2.8 times and talking on or listening to the phone increased the risk by only 1.3 times.

Recently, new technology and education programs have been developed to prevent teens from texting while driving. For example, the Safe Texting Campaign developed an application that displays “Please Don’t Text & Drive” on the home screen of cell phones when individuals are driving. The application also replies to text messages when an individual is driving, letting the sender know that the individual is driving. Because of the severe danger of teen texting while driving, effective preventive measures, including advances in technology, revisions of high school health curricula, or the implementation of a zero-tolerance law for cell phone use while driving, should be further researched and promoted.

Texting and sleep

Although there have been limited studies on the topic, a link between texting and sleep problems has been suggested. In a 2011 study, White and colleagues examined the effects of text messages on the sleep length and quality of 350 college students. Problematic cell phone use, addictive text messaging, problematic texting, and pathologic texting were significantly related to sleep quality, but not sleep length. In a study involving 84 first-year college undergraduates, Murdock found that the amount of texting per day was directly associated with sleep problems. Furthermore, Fossum and colleagues recently found that cell phone use was positively associated with insomnia.

In a survey of 346 US pediatricians, pediatricians chose the use of electronic devices and late-night texting/cell phone use as the predominant causes of sleep problems. However, further longitudinal research should be conducted to better define this association.