After a grueling evening waiting tables in a restaurant, a 17-year-old boy blogs about how much he hates his job and writes disparaging comments about his boss. He shows up to work the next day and is fired; afterward he learns that a coworker read the blog last night and showed it to his manager.
While driving to her after-school job, an 18-year-old high school senior's smartphone alerts her that a text message has arrived from one of her friends. She starts to reply to the message and doesn't realize that the car in front of her has stopped at a red light. She hits it while going about 20 miles per hour. Fortunately, no one is injured; however, the police report indicates (accurately) that she was texting while driving. Subsequently, the state suspends her driver's license for 1 year and her father receives a call from the insurance company indicating that the family rates will increase by $900.
"Texting," "tweeting," "friending," "IMing." Many physicians have heard their teenaged patients use these terms to describe how they communicate with their peers. Since the personal computer explosion of the 1980s, adolescents have been early adopters of new developments in the digital world. Over the past decade, tech-savvy teens have embraced the digital revolution in a way that astounds (and can intimidate) parents, teachers, and other members of earlier generations. A recently published Kaiser Family Foundation study demonstrated that older children and teenagers spend an average of 6.58 hours a day exposed to computers, video games, music, and TV content (much of which is delivered via a mobile electronic device or computer).1 A substantial portion of that media time involves social networking with their peers.
Although some (frequently younger) practitioners may use these social networking tools, others have only a passing familiarity with the technology and its implications for adolescent safety. (For those who feel "technologically challenged," I've provided a primer on the electronic communication modes most frequently used by teens [Box]).
Some may object that busy pediatricians barely have enough time to counsel teenaged patients about substance abuse, sexual health, sports safety, and sleep—let alone add a discussion of online activity to this list. However, given the extent to which adolescent patients are communicating electronically, it behooves clinicians to have sufficient familiarity with these modes of communication to be able, when appropriate, to counsel teens on the benefits and perils of living in cyberspace.
THE PLACE OF ELECTRONIC MEDIA IN THE LIFE OF TEENS
Adolescent electronic communication use cannot be viewed as all good or all bad. In many ways, social networking sites and online communication venues can provide a healthy way for adolescents to globally connect with peers. Even teens living in the most rural or remote areas can find peers with similar interests and can expand their social horizons beyond their immediate locality. In addition, the anonymity of the online communication world can help provide a "safe" venue for socially isolated teenagers to relate with peers who may be experiencing similar difficulties in their adolescence. For example, a teenager who is struggling with loneliness or family issues may be able to access a chat room for adolescents and there find (anonymously) peers with whom he or she can relate and problem-solve.
The downside of teen media use: its developmental origins. That said, to understand the issues in adolescent electronic communications, one must first consider teenagers' social and developmental maturation. The development of abstract formal thought from concrete thinking processes is an important goal during adolescence. A key aspect of this maturation process is acquisition of the ability to conceptualize how one's actions in the present can lead to "big picture" consequences in the future. Like most developmental processes, this occurs slowly throughout the teen years. Thus, many teens are still relatively concrete thinkers who fail to see the long-term consequences of their online activities. Even older adolescents— who can understand implications and consequences of their online behaviors—may still execute poor judgment in deciding what to write on a blog, whom to engage in a chat room, or what types of photos are appropriate to post on a social networking site.
Issues with online media. Some adolescents may need additional guidance to help them make safe and healthy decisions regarding their use of electronic communication. They may need to be reminded that anonymity should not necessarily be equated with safety in the online arena, since adult predators frequently use chat rooms and the like as a vehicle for identifying and grooming victims. In one survey, 15% of 10- to 15-year-olds reported an online sexual solicitation in the previous year (43% of which were via instant messaging, while 32% occurred in chat rooms).2
In addition, adolescents (and many adults) frequently overestimate the degree of privacy they may have online. They probably don't realize that in many instances, their online activities can be viewed by relatives, school administrators, potential employers, and even college-admissions officers. Furthermore, corporations such as Google often save posted information and media in a "cache" that can be retrieved by online surfers for years, even if the poster has removed the information. (See the Patient Information Guide on staying safe online.)
"Sexting," a relatively new phenomenon, began making headlines after 3 teenaged girls used their cell phone cameras to take and send nude self-photos to 3 male friends. The adolescents were charged with the creation, dissemination, and possession of child pornography. As news of the case unfolded, news reports indicated that sexting was more widespread than previously imagined.
Issues with text messaging. In the past 2 years, the dangers of "texting while driving" has generated considerable attention both in the media and in various legislative bodies. A number of government reports suggest that the action of sending and receiving texts easily distracts a driver and increases his risk of a motor vehicle accident. In one Pew Research Center survey, 26% of teenagers reported that they have texted their friends while driving.3 Qualitative findings in the survey suggest that many of these adolescents feel that despite the known risks of this activity, they underestimate the dangers and think that they have developed methods (albeit flawed) for simultaneously texting and driving.3 To date, 19 states have enacted bans on text messaging while driving.
THE ROLE OF THE PEDIATRICIAN
In the 21st century, Internet use and online communication are becoming as universal as television viewing was becoming 50 years ago. A pediatrician who counsels families about appropriate television "screen time" and programming can also incorporate Internet use and electronic communication into that discussion. Below are some key points, adapted from recommendations of the American Academy of Pediatrics, that might be discussed with adolescents and their parents:
| • | Parents should purchase and install parental control software on their home computers. The computer should be in a public area of the house so that they can personally monitor what transpires online. |
| • | Encourage parents to experience these technologies themselves. Parents should create a Facebook or MySpace page (and "friend" their teen), and they should understand how "texting" and "tweeting" work. In addition, they should network with other parents in their teen's peer group to help keep tabs on the group's online activities. |
| • | Remind your adolescent patients and their parents that privacy is a fragile thing in the online arena and that any personal text message, e-mail, photo, blog, or social media post can be—whether accidentally or intentionally—broadcast to the entire online world with a simple keystroke. A good rule of thumb is this: "Do not blog, post, text, or e-mail anything that you wouldn't want your friends, teachers, or employers to read or see." |
| • | Empower parents to exercise some control when it comes to their teen's online "private life." Parents should strategize ahead of time with their teen regarding ways in which they will be monitoring online blogs, texts, and e-mails. Many families find that an effective monitoring strategy includes random checks of computer records, cell phone messages, blogs, and social networking pages. |
| • | Remind teens who drive of the dangers of texting—or even talking on a cell phone—while driving. Underscore the importance of refraining from all use of electronic devices while behind the wheel. You might also want to gently remind parents of the importance of their setting a good example in this area. |
E-mail: E-mail is one of the oldest modes of electronic communications still used today. Although its overall popularity with adolescents has declined over the past decade, most teenagers have at least 1 e-mail address, accessed through a personal computer, mobile phone, or smartphone (ie, mobile phone that also functions as a wireless Internet device).
Chat rooms: Chat rooms allow teens to communicate with peers in real time. After adopting a "screen name" (akin to an online pseudonym) they enter an online virtual "room" to "talk" about interests and concerns. The anonymity of chat rooms may help teens discuss concerns or feelings that they would not feel comfortable discussing with known peers. Unfortunately, chat rooms are usually unmonitored and may provide opportunities for sexual predators, who can infiltrate a group chat and get to know the youths in the chat room intimately.
Instant messaging (IMing): Similar to using a chat room, IMing involves a private, real-time "conversation" between 2 persons. Depending, on the situation, the real identities of the 2 parties may or may not be known. IMing can be used to trade photos, data files, or music, as well as for text-based communication.
Blogs: A blog is an online journal that a teen can use to write about his or her thoughts, opinions, experiences, life events, or news. A blog might be publically accessed via the World Wide Web, or viewings may be restricted to persons who have the blogger's permission to access the blog. Many blogs offer viewers the opportunity to post written responses to the author's entries. Approximately 28% of online teens frequently use blogs to write about personal experiences or feelings and almost 20% of online boys use blogs to post photos and videos.4
Social networking sites: Social networking sites (eg, Facebook and MySpace) combine e-mail, IMing, chat rooms, and blogs into one comprehensive Web page. As of 2009, social networking sites are the venues that adolescents most commonly use for online communication. An estimated 55% of online teenagers frequent these sites from a personal computer, mobile phone, or smartphone.5 "Friending" refers to the act of letting someone new into your online social network and, in turn, being granted access to that person's network.
Texting: Using a mobile phone or smartphone, teens (or adults) send short (usually less than 160 characters) text messages to each other. Photos and videos may be attached to these messages. Over the past 5 years, this mode of communication has increased in popularity, and an estimated 76% of teenaged mobile phone users send text messages daily. In fact, a 2009 Nielson report indicated that teenagers send an average of 2899 text messages per month (which equals about 95 texts per day)!6
Twitter: This application, frequently used on a handheld device, allows users to broadcast a text message to a large number of other Twitter users. Teens often send "tweets"—which are akin to mini blog entries—providing updates on what they are doing or thinking.