Adolescence is an essential time for health promotion (Viner et al. 2012, WHO 2012). Lifestyle and health related behaviors adapted during adolescence most often continue through later life and strongly effects future health. Social factors at individual, family, school, community and national level strongly effect health as well as health related behaviors and lifestyles adapted by the adolescents. The role of these factors strongly correlates to the future health of the whole population and the development of nations. Worldwide the strongest determinants of adolescent health are structural and related to the poverty: national wealth, income inequality, access to education, safe and supportive families, schools and peers. The most effective interventions to promote health in adolescents are suggested to relate to the general well-being in every day family life. Also factors, such as addressing risks in adolescents´ social and physical environments, access to education and employment as well as preventing injuries, consumption of alcohol and unsafe sex have been suggested as most relevant factors for promoting the health in adolescence. (Gore et al.2011, Viner et al. 2012.)
Health promotion is strongly based on values and the core question lies in the justification of the content as well as the actions (Leino-Kilpi 2009). Respect for general human rights, doing good and avoiding harm, justice, honesty, reliability, equality and empowerment are strongly related to the justification of health promotion. (Cribb & Duncan 2002, WHO 2011). The Ottawa Charter for Health Promotion (1986) is often addressed as the ethical cornerstone for health promoters around the world. According to the Ottawa Charter, health is defined as a resource for everyday life. Education, peace, food, income, social justice, and equity are presented as prerequisites for health and basic foundations for health promotion. (The Ottawa Charter for Health Promotion).
As main factors and ethical consideration regarding health promotion in adolescents have shortly been discussed, we now move to an excessively growing and extremely challenging environment of health promotion; the social media. Social media is part of the life of most present day adolescents and they use online social media, such as social networking sites (eg. Facebook and MySpace), blogs and status updating sites (eg. Twitter) and chat rooms (Pujazon-Zazik & Park 2010). The social media includes online activities and virtual communities where people share information and interact using words, pictures, videos and audio material based on shared interests (Safko & Brake 2009). Social media can be categorized into: forums and message boards, review and opinion sites, social networks, blogging and micro blogging, bookmarking and media sharing (Sterne 2010).
Purposes and effects of social media
There are potential positive effects of online socializing. These positive effects have been suggested to relate to building and maintaining social contacts, learning and refining the ability to exercise self-control, express sentiments in a normative manner, develop tolerance, respect to others, critical thinking and decision making (Berson et al.2002). There are also potential negative effects of the online social media, such as cyberbullying, online risk-taking behavior, sexual predators (Pujazon-Zazik & Park 2010), promotion of unhealthy lifestyles (Seidenberg et al. 2012) and sharing of misleading health-related information (Betch 2011).
Several researchers have addressed serious concern about the emotional well-being of present day adolescents (Sourander et al. 2008, Laaksonen et al. 2008, 2010). Additionally there have been suggestions about the social media creating a new, potential mental health problem, the ‘addiction’ to social networks and online games. The research evidence addressing the addictive qualities of the social networks are however still relatively scarce. The social media and networking sites are mostly used for quite common social purposes. Extraverts have been suggested to use social networking sites for social communication whereas introverts tend to use the sites for compensation for “real life” social connections. The negative effects of the social media usage include decreased engagement in “real life” social connections and participation which are reduced academic performance and problems in personal relationships, factors generally related to addictions. (Kuss & Griffiths 2011). As the negative effects of the social media on the real life social relations and school performance have been addressed, some concerning results are reported in the Finnish results of the 2010-2011 School Health Promotion (SHP) Study. According to the 2010-2011 SHP results about 5% of adolescents report use of internet reducing the quality of their social relations, 20-30% report using internet negatively effecting school performance and about 25% report using internet causing disruption in circadian rhythm. (School Health Promotion Study).
In the context of health promotion, social media has been described to be used for five main purposes: 1) communicating with consumers, 2) establishing positive brand pictures, 3) disseminating information, 4) expanding the reach of health promotion to broad and diverse audiences and 5) fostering partnership and engagement (O’Mara 2012, Neiger 2012). The health promoters should utilize the social media for what it potentially can deliver but not as a solution to complexities in health behavior and lifestyles. The social media may carry the potential for evidence based, ethically solid health promotion but also as an environmental for contradictive purposes (Neiger et al. 2012). Next we´ll be presenting few examples of studies describing social media in the context of health promotion.
Importance of online decision making
Research on the effects of internet and social media on health-related decision making is rare but as the use of these new environments are increasing; the body of literature and research on these topics is rapidly growing. People in general report that internet does not affect their decision making but according to Betch (2011) the internet may in fact play a very important role in the persons´ health-related decision making processes. It has been suggested that a person can use information in several phases of the decision making process and that information selected and processed from internet and the social media may significantly affect the current as well as future decisions.
Seidenberg et al. (2011) performed a You Tube video search to analyze the content of the videos related to smokeless tobacco. Description of smell, flavor, social references and interactions were found to be presented in over 50% of the videos. By contrast, references of public health information or the effects of nicotine were identified in only about 10% of the videos. None of the identified videos had restrictions preventing youths from viewing the content. The study suggests that You Tube doesn´t restrict youth from viewing smokeless tobacco videos and calls for attention to prevent social media to become vehicles for promoting smoking in adolescents.
Gold et al. (2011) performed a literature review aiming to examine the extent to which social networking sites (SNS) are used for sexual health promotion. The review identified almost 180 sexual health promotion activities from which only one was identified through a traditional systematic search of the published scientific literature. Most commonly used social networking activities targeted on young people, involved information delivery and were conducted by non-profit organizations. The most commonly used site was Facebook, followed by MySpace and Twitter. The amount of users and posts varied greatly between health promotion activities. The study suggest that social media is used for sexual health promotion but not reported in the scientific literature. Future research is needed to guide the development of health promotion activities in the environments of the social media.
Marketing substance use online
Morgan et al (2010) examined the adolescents´ use of social media web sites to post imagines or videos of themselves describing alcohol consumption, inebriated behavior or use of marijuana. The majority of the identified videos representing use of alcohol depicted females in social situations while videos representing use of marijuana depicted males. The identified videos were quite frequently viewed and gained positive ratings from the viewers. The adolescents´ attitudes toward posting alcohol-related consumption on the social media sites were generally positive and seen as a matter of individual decision making. Marijuana-related posting were however seen more negatively. Future research is needed to provide knowledge about motivation to post images and videos of substance use in the social media as well as the benefits and risks related to these activities. The study however suggests that adolescents in general relatively frequently seem to accept alcohol-related activities.
Moreno et al (2012) examined how the displayed use of alcohol and problematic drinking on Facebook is associated to self-reported problem drinking in adolescents. The adolescents who displayed problematic drinking on Facebook were more likely to score high AUDIT results, suggesting problematic drinking, more likely than the adolescents who did not display such activity. Also the ones who displayed use of alcohol on Facebook were more likely to report alcohol related injuries than the ones who did not display use of alcohol. As a conclusion to the research, it was suggested that Facebook references to problematic use of alcohol was positively associated with high AUDIT scores as well as alcohol related injuries. Further research is suggested to evaluate social media as a tool for targeting populations and send health promoting messages, advertisements or information to selected groups.
The alcohol marketing in the social media use several different strategies. There are real-world-tie-ins that refer to themed night club events across the globe that serve as marketing events of different brands of alcohol. There are interactive games that eg. invite users to suggest alternative endings to commercial videos, sponsored online events that are connected to materials advertising a certain brand. Also encouraging messages to drink have been produced by different alcohol brands. No Facebook posts explicitly recommended responsible or moderate drinking. According to the research social media allows new ways to add marketing to alcohol sales. In additional to the traditional marketing of stimulate conversation about brands but they also allow users to observe, analyze and direct those conversations on a larger scale. Moreover the social media allows embed brand-related activities in the routines of the social media consumptions for excessive amounts of people and encourage real time alcohol use. As a conclusion, social media reaches into new levels of advertising than any previous communications platforms in blurring the boundaries between advertising, consumer interaction and broader social activities (Nicholls 2012).
Adult involvement and research needed
Clearly, there are more than technical skills needed in health promotion in adolescence with social media. The virtual environment has altered the way of communication, learning and socializing for all of its users. The social media consists of, not only interaction between media and other people but also, invisible mental system of the users. In order to promote healthy choices in this unique virtual mental world, adults need to focus on creating and navigating in adolescents’ social environment with them, meaning complex virtual context of multipronged dimensions and approaches to health-related topics.
Evidently adolescents learn more from their peer group online and use social media and online searches as a key source of advice and information than before exploring critical developmental period, social status, friendships and romance. Social media is there for an important environment to empower adolescents´ as in-person contact or with exclusive health content to support health promotion against unhealthy, damaging or traumatizing information and social contacts online. As evidence about the effect of the social media on the health and well-being of adolescents as well as on the content and utilization of methods implemented for health promotion is scarce, future research on this topic is highly recommended.
Authors
Camilla Laaksonen, PhD, Turku University of Applied Sciences (TUAS), the Faculty of Health Care, camilla.laaksonen@turkuamk.fi
Jan Holmberg, Master of Health Care, http://janholmberg.weebly.com
Marjale von Schantz, PhD, R&D Manager, Turku University of Applied Sciences (TUAS), the Faculty of Health Care
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