skip navigation nih record
Vol. LXVI, No. 23
November 7, 2014

previous story

next story

Online Candor Yields Health Clues
Moreno Uses Social Media to Explore Adolescent Health

On the front page...

Dr. Megan Moreno
Dr. Megan Moreno
Adolescents take outlandish risks.

“O brave new world,” says Shakespeare’s Miranda, “that has such people in it!”

“‘Tis new to thee,” her father quips.

And the old gent was not even on Facebook.

Teens need years—until age 25 or so—for the brain’s executive function to mature. Until then, how do we keep them safe and healthy in the borderless terrain of the Internet?

And what do they have to teach us?


Now, Dr. Megan Moreno of Seattle Children’s Research Institute is leading the way in “Using social media to investigate adolescent health,” which was the title of her talk for a recent Wednesday Afternoon Lecture Series in Masur Auditorium. She reviewed key adolescent health issues, the social media (SM) landscape and research opportunities SM provides.

“Our vision is to provide education to adolescents and their families toward safe Internet use,” she said. “We also focus on developing tools to assess and define problematic Internet use.”

Motor vehicle accidents, homicide and suicide are the three leading causes of death and injury in the adolescent population ages 12-19, according to the Centers for Disease Control and Prevention. These events carry red flags, or precursors, said Moreno.

Because SM is interactive, it opens a window into the world of teens. Over 90 percent of adolescents use SM, where they may display risky behaviors and describe their health attitudes, intentions and behaviors in ways that can be measured—individually, in groups and across time.

Moreno uses observational studies, with emergency protocols in place, aimed at populations ages 10 to 26.

That cohort is “a moving target, but a lot of our studies focus on the transition out of high school into college,” she said. “What I’m really interested in is the independence that adolescents are developing.

“There’s a couple challenges when it comes to adolescents,” she said. “One of them is that they don’t go to the doctor. If they are worried about confidentiality they won’t always seek care for a problem.”

And she shared this surprising finding: “When adolescents show up at the doctor, many are not screened about these risks. So in some studies, less than half of teens are screened for substance use and depression when seeing a pediatrician.

“These are the fundamentals that really drove me to be interested in social media,” she continued, “and to ask whether social media could offer new opportunities for early identification of risky health behaviors, for prevention or intervention.”

Her Social Media and Adolescent Health Research Team (SMAHRT) is conducting a NIDA-sponsored longitudinal multisite study of college students’ SM use as a mechanism of behavior change for substance use.

A few early study results:

1. A sample of 500 users of MySpace showed that when adolescents display references to one risk behavior, they are more likely to display others, which mirrors previous studies of self-report that show these same patterns when adolescents report about risk behaviors on surveys.

Moreno said, “I want to emphasize I’m not talking about diagnosis. I’m talking about red flags that might prompt someone to seek appropriate clinical care, intervention or resources.”

Moreno said, “I want to emphasize I’m not talking about diagnosis. I’m talking about red flags that might prompt someone to seek appropriate clinical care, intervention or resources.”

Photos: Bill Branson

2. 300 profiles of 18-year-olds on Facebook revealed:

  • 76 percent displayed references to substances (among this cohort, 73 percent displayed alcohol).

  • 24 percent displayed references to risky sexual behavior.

3. In individual patterns over a 2-week period, 2.5 percent chose to display depressive symptoms on SM.

“This doesn’t mean that Facebook is diagnostic, but it gives a sense of adolescent experience and what they’re willing to reveal,” said Moreno.

“We also examined peer responses to these disclosures,” she continued.

Some supported their depressed friends in compassionate ways. Yet, Moreno said, in the case of anorexia nervosa, some anorexics encouraged the disease by making flattering remarks.

An example of a pro-eating-disorder Twitter account would be this handle: SexyAnorexy.

The reality is harsher: According to NIMH, anorexia nervosa has the highest mortality rate of any psychiatric disorder, around 10 percent.

4. In an analysis of 50 YouTube videos, including 892 comments, Moreno’s team also followed SM displays at the population level.

“Because SM provided open access,” said Moreno, “it’s important to realize the information that our adolescents might be seeking about major social movements of health issues may be biased.”

5. Her team compared two groups on SM to detect the first time they chose to display about alcohol:

  • 20 percent displayed before coming to college the first year

  • Another 40 percent chose to display a first reference to alcohol around Halloween, which coincided with a campus party for over-21s. Data suggests the age restriction was not necessarily adhered to.

“I want to emphasize I’m not talking about diagnosis,” Moreno stressed. “I’m talking about red flags that might prompt someone to seek appropriate clinical care, intervention or resources.”

Young people seeking advice and care are using many of the same SM platforms as adults. “Parents are one of the fastest growing populations on Facebook,” Moreno stressed, as are “dormitory resident advisors, peer leaders, trusted adults…and the ‘cool aunt phenomenon.’”

When we recall that, according to some studies, less than half of teens being seen by a pediatrician are being screened for substance use and depression, SM seems like a brave new world indeed.

“Adolescent health issues need to be prevented and addressed outside of the clinical setting,” said Moreno. “Adolescents are present and engaged on social media, so can we meet them where they are?”

On Oct. 17, NIH announced that more than $11 million over 3 years will be used to support research exploring the use of social media to advance the scientific understanding, prevention and treatment of substance use and addiction.

“Social media has the potential to fill important gaps in our current understanding of tobacco, alcohol and drug use and to improve the efficacy of substance abuse interventions,” said Dr. Wen-ying (Sylvia) Chou, program director in NCI’s Health Communications and Informatics Research Branch. “For example, user-generated social media interactions can reveal important insights into substance use patterns and various social factors.”

Moreno’s talk is archived at

back to top of page