Social Media and Kids: The Next Settlement?

In January, my colleague Mindy Klowden accurately predicted that pediatric behavioral health would be top of mind in 2022. Six months later, that prediction is accurate. This Spring, the New York Times ran a series examining the youth mental health crisis. One article in particular shared alarming youth mental health data:

• There was a 60 percent increase between 2007 and 2019 in adolescents who reported having a major depressive episode.
• Youth emergency department visits rose sharply for anxiety, mood disorders, and self-harm during that same period.
• Suicide rates for ages 10-24 rose almost 60 percent by 2018.

These statistics are even more alarming because they represent data collected before the COVID-19 pandemic took hold globally and locally. As recently as May 31, President Biden released a new fact sheet noting that two in five American adults report symptoms of anxiety and depression, and more than half of parents express concern over their children’s mental well-being. Over 40 percent of teenagers state they struggle with persistent feelings of sadness or hopelessness. 

One area that has come under scrutiny is the impact of social media on youth mental health. Congress has held numerous hearings on the effects of social media on our culture, collective well-being, and the platforms’ corrupt algorithms that intentionally spread misinformation, perpetuate hate crimes, exploit youth, deteriorate self-esteem, and more. In September, Senator Richard Blumenthal, Chairman of the Senate Consumer Protection Subcommittee, stated that Instagram has “… hidden its own research on addiction and the toxic effects of its products. It has attempted to deceive the public and us in Congress about what it knows, and it has weaponized childhood vulnerabilities against children themselves. It’s chosen growth over children’s mental health and well-being, greed over preventing the suffering of children.”

In his December 2021 advisory, Surgeon General Vivek Murthy urged us to pay close attention to online harm and the impact of social media on young people’s mental health. To that end, the U.S. Department of Health and Human Services (HHS) recently announced $2 million in funding to establish the new Center of Excellence (COE) on Social Media and Mental Wellness, which will develop and disseminate information, guidance, and training on the impact of children and youth social media use, especially the potential risks social media platforms pose to mental health.

Just last week, HHS posted a readout of Secretary Xavier Becerra’s roundtable discussions on the impact of social media on youth mental health. During the roundtable, local policymakers, students, and parents discussed how social media platforms could promote unhealthy social comparisons and enable harassment and cyberbullying.

I applaud the administration for taking a hard look at the impact of social media on youth mental health. Research is already emerging linking the use of social media to depression, and still, more studies are finding similar brain responses to social media as other addictive substances or behaviors. Yet, the global social media market is expected to grow from $159.68 billion in 2021 to $223.11 billion in 2022. With an industry growing nearly 40 percent in one year, how can we expect $2 million to counteract the negative impacts? 

While the Surgeon General’s advisory and HHS’ new COE on social media and mental wellness draw attention to the need for training and guidance regarding the negative impacts of social media and mental health, they don’t get at the root of the problem – social media platforms targeting youth. Arguably, social media platforms have greater protection under the law than their users. With one in seven Americans engaging on social media, the time has come to consider how we better regulate social media to protect users, particularly youth. 

To that end, I propose we take a page from our history – the historic tobacco Master Settlement Agreement (MSA). The MSA required the tobacco industry to pay states $206 billion over 25 years and make vast changes to advertising and other products targeting youth, including:

• Permanent limitations on cigarette advertising
• A ban on the use of cartoon characters (such as Joe Camel) in advertising
• A ban on cigarette “branded” merchandise
• Limits on tobacco industry sponsorship of sporting events (such as the Virginia Slims tennis tournament)

The MSA also created a nonprofit national foundation (the American Legacy Foundation – now known as the Truth Initiative) to support research on effective tobacco programs and to fund an antismoking advertising campaign with a total of $1.45 billion over five years. Another 1.5 billion was directed to support state antismoking measures, and $250 million was allocated to fund research into reducing youth smoking. Lastly, the MSA dissolved tobacco trade organizations.

Like tobacco manufacturers, social media platforms have arguably engaged in questionable targeting practices aimed at youth and efforts to enhance their platforms to make them more addictive. There are also crucial differences, such as the fundamental right to free speech – and the balance of regulating a communications medium without limiting our freedom. As we look back at how we tackled “Big Tobacco,” we can and should consider some of the key settlement provisions such as increased funding for research on social media and youth, public health campaigns on “safer” usage of social media platforms, limits on deceptive advertising practices and finally, increased funding to address youth mental well-being to counteract these negative influences.

The tobacco MSA took years to finalize – time we cannot afford to waste today. We must collectively raise our voices for more robust oversight and regulations, along with increased resources to address this escalating crisis.  Federal advocacy efforts need to be matched at the state level. Attorneys general were instrumental in the MSA and have a consumer protection role. We must engage them now so we can create policies and opportunities to tackle the social media giants today. Perhaps we can learn from our past and bypass needing another MSA.