The Journal of School Nursing2023, Vol. 39(3) 248–261© The Author(s) 2020Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/1059840520983286journals.sagepub.com/home/jsn
Social media may promote health and social connectedness, but its misuse and frequency of use may pose risks. Social media use during adolescence requires parental monitoring and mediation to mitigate potentially harmful effects such as depression, anxiety, and risk-taking behaviors. While parents and health care professionals convey concern surrounding exposure to inappropriate content, prolonged screen time, and cyberbullying, appropriate social media monitoring remains challenging. The purpose of this study was to explore parental monitoring and mediation of social media use in adolescents. Online recruitment yielded a nationwide sample (n = 836) of parents of adolescents. The results of the online survey indicated that parents are concerned about adolescent social media use and endorse positive attitudes toward monitoring. Yet parents perceived little control over monitoring. Findings from this study support the school nurse in promoting healthy social media use, media literacy among parents and adolescents, and the use of screening tools.
Keywords
parent/family, social media, school-based clinics, middle/junior/high school, mental health
Social media may promote health and social connectedness (Odgers & Jensen, 2020), but its misuse and frequency of use pose considerable risk. Children, aged 8–12 years, report spending a daily average of 4 hr on various screen activities, while 13- to 18-year-olds report a daily average of 7 hr, and this is excluding time for school and homework (Rideout & Robb, 2019). The majority (63%) of 13- to 18-year-olds use social media every day (2019). With the onset of COVID-19 and the switch to online learning, adolescents are spending even more time on screens (Nagata et al., 2020).
Negative impacts on adolescent health and risky behavior related to social media including—prolonged screen time, poor sleep quality, cyberbullying, and sexting—have garnered the attention of media, parents, and the American Academy of Pediatrics (AAP; AAP Council on Communications and Media, 2016a, 2016b; ABC News, 2017; Byrne et al., 2018; CNN, 2015; Twenge, 2017a). Moreover, a disturbing increase in suicide rates among adolescents and young adults occurring between 2000 and 2016 (Miron et al., 2019) has led some researchers to attribute the simultaneous launch and increase use of the smartphone and social media with the increase in depression and suicide rates (Twenge, 2017b).
Social media is defined as “forms of electronic communication (such as website for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos)” (Merriam-Webster, n.d.). The AAP recommends children and adolescents spend no more than 2 hr a day on screens (AAP Council on Communications and Media, 2016b). The U.S. federal government addressed the amount of screen time children were viewing in the Healthy People 2020 campaign including an objective to advocate for adolescents to limit their screen time to less than 2 hr, excluding school and homework (U.S. Department of Health and Human Services, 2010).
Late-night social media use and emotional investment in social media in adolescence have been associated with poor sleep quality, anxiety, and depression (Kelly et al., 2018; Woods & Scott, 2016). Furthermore, girls report more negative consequences of social media use including low selfesteem, body dissatisfaction, and depressive symptoms and are more likely to be a victim of cyberbullying than boys (Kelly et al., 2018). According to the 2019 Youth Risk Behavior Surveillance System, 15.7% of high school students in the United States have reported being bullied electronically through texting or some type of social media (Centers for Disease Control and Prevention, 2020). Of those who reported being bullied, 20.4% were female compared to 10.9% of males (2020). Cyberbullying has been linked to depression, anxiety, and suicide (Byrne et al., 2018; Hamm et al., 2015; Hutson et al., 2018). Equally concerning, high school students who engaged in consensual sexting reported higher rates of sexual activity compared to those who were not sexting (Frankel et al., 2018).
Social media provide avenues for adolescents to experiment, explore, and express their identities in a public forum. However, adolescents have a propensity for risky behavior and poor decision making. These tendencies toward risky behaviors are related to adolescent brain development (Feldstein Ewing et al., 2016). Specifically, an underdeveloped prefrontal cortex in the adolescent brain has been linked to impaired executive functioning and decision making in situations of high emotion or high reward, for example, sex, substance use, and obtaining “likes” or “follows” on social media (Hartley & Somerville, 2015; Schiebener et al., 2015).
Parental monitoring of adolescents is a known protective factor against risky behavior (Collier et al., 2016). Parents aim to protect adolescents from harmful cyber interactions, but in the digital age, parental monitoring has become more challenging due to the ubiquitous use of smartphone and social media apps. Increasing the number of parents who follow the AAP recommendations to place limits on the time children and adolescents spend online is set as a high priority public health issue according to the Healthy People 2030 objectives (U.S. Department of Health and Human Services, 2020). More research is needed to understand how parents manage adolescent social media use, and evidence-based interventions are needed to help parents mediate social media use. While this public health crisis is relevant to all health care providers, especially those working with pediatric populations, school nurses are uniquely positioned to help with this concern. School nurses can be a great resource for adolescents and parents to provide tools and education to implement strategies to help reduce the negative impacts of social media.
As it relates to various types of media, research indicates parental monitoring results in less aggression and fewer risky sexual behaviors (Collier et al., 2016; Khurana et al., 2015; Padilla-Walker et al., 2012). Defined as “a set of correlated parenting behaviors involving attention to and tracking of the child’s whereabouts, activities, and adaptations” (Dishion & McMahon, 1998, p. 61), parental monitoring includes efforts to know which social media sites (SMS) their adolescent visits, how often their adolescent uses social media, and with whom the adolescent interacts using social media. Parents may shadow their adolescent by “friending” or “following” their social media profile or search the adolescent’s activities online (e.g., searching the adolescent’s name on a search engine or check websites the adolescent visited by reviewing the browsing history). Although the terms monitoring and mediation are sometimes used interchangeably, in this study, parental monitoring was distinct from parental mediation. Specifically, in parental monitoring, the parent can track the adolescent’s activities without intervening between the child and the media (Dishion & McMahon, 1998). Parental mediation refers to actual strategies used to help reduce negative effects of the media (Livingstone & Helsper, 2008).
“Parental management of the relation between children and media” (Livingstone & Helsper, 2008, p. 581) served as one part of the theoretical framework and the definition of parental mediation in this research (Figure 1). Practices of parental mediation include three categories: active mediation, restrictive mediation, and co-use (Nathanson, 1999; Schofield Clark, 2011; Valkenburg et al., 1999). Active mediation refers to parent–child discussions about media content that can be instructive or critical in efforts to help the child critically think about what is viewed (Nikken & Jansz, 2014; Schofield Clark, 2011). Restrictive mediation refers to exerting control over the interaction with media by setting rules and restrictions to accessing media (Livingstone & Helsper, 2008; Nikken & Jansz, 2014; Schofield Clark, 2011). Finally, co-use (also called co-viewing) relates to the parent watching or interacting with the media together with the child (Livingstone & Helsper, 2008; Schofield Clark, 2011).
The TPB served as the second theory in the framework for this research (Ajzen, 1985; Ajzen & Fishbein, 1980; Figure 1). TPB assumes a person’s intent to perform a behavior is directly related to their attitude toward the behavior and the belief that people who are important to them will either support or not support the behavior, known as the subjective norm (Ajzen & Fishbein, 1980). In this study, attitude toward monitoring, the subjective norm, and perceived behavioral control of monitoring produced the formation of a behavioral intention to monitor. Typically, favorable attitudes, norms, and greater perceived control result in strong intentions to perform the behavior (in this case, monitor adolescent social media use; Ajzen & Fishbein, 1980). Assuming parents have complete control over the behavior of monitoring, parents were expected to carry out their intentions of monitoring.
Prior researchers have explored parental mediation of internet use, and two studies focused on parental mediation in children (aged 2–16 years; Nikken & Jansz, 2014; Sonck et al., 2013). Another study compared parental mediation in a sample of adolescents (aged 10–18 years) between Dutch and American parents (Krcmar & Cingel, 2016). Unique to this study, we expanded exploration to parental monitoring, mediation strategies, and parental knowledge of risks related to social media use. The TPB, concepts of parental monitoring and parental mediation theory, offered a useful framework (Figure 1) to explore and describe parental mediation strategies of their adolescent’s social media use; however, relationships between the concepts were not explored in this initial research. Therefore, the purpose of this study was to explore parental monitoring and mediation practices of social media use by their adolescents. The original research questions included:
With new understanding of parental monitoring and mediation, school nurses and others invested in adolescent health can develop interventions to support parents and their children as they navigate the benefits and risks of social media use.
Following expedited approval by the University of Mississippi Medical Center’s institutional review board, the research used an exploratory, quantitative design to describe parental monitoring and mediation practices of adolescent’s social media use. Parents of adolescents were recruited via paid targeted Facebook advertising to complete an online survey using Research Electronic Data Capture (Version 8.7.1, REDCap™, Vanderbilt University) hosted by an academic health sciences center in the southeastern United States. According to Smith and Anderson (2018), 68% of U.S. adults use Facebook, and 74% of those users visit the site daily. Therefore, Facebook was an excellent platform for the needed sample, reaching parents who use the internet and are more likely to mediate adolescent social media use.
Due to the exploratory nature of the study, a sample size estimation was not recommended (Jones et al., 2003). However, five published studies that explored parent mediation of children’s internet use obtained an average sample size of 670 (range: 357–1,004; Livingstone & Helsper, 2008; Padilla-Walker et al., 2016, 2018; Sonck et al., 2013; Symons et al., 2017) providing a target sample size of 700 for this study.
Participants included any person over the age of 18 who was fulfilling the responsibility of parenting for an adolescent (11–17 years), such as mother, father, guardians, grandparents, or other family members. No participant identifiers were collected, and no incentives were offered to participants.
The study was introduced to participants in one of three ways. First, a Facebook advertisement using three different images of adolescents and their smartphone targeted the population of interest via individual newsfeeds. The potential participant could voluntarily click the “Learn More” button. The Learn More button took the participant to the study landing page. The landing page contained information on the study purpose, efforts to maintain privacy and confidentiality, and risks and benefits of participating. Then, the potential participant responded to two screening questions, “Are you 18 years of age or older?” and “Are you fulfilling the responsibilities of a parent of an adolescent between the ages of 11 and 17 years?” If they answered “yes” to both questions, they were taken to the “parental monitoring of your preteen’s or teen’s social media use” survey. If they answered “no” to either of the questions, the software displayed a message thanking them for their interest and explaining that they were not eligible to participate in the study. Second, a study Facebook page was created to link to the Facebook ad. Here, the potential participant could voluntarily click the Learn More button that took the participant to the landing page as described above. Finally, the researcher utilized a snowball technique by sharing the Facebook ad through networks of friends and colleagues via Facebook. Any Facebook user who received the ad could share the Facebook ad or study Facebook page.
Based on the TPB (Ajzen, 1985, 2006), parental mediation theory, and previous work on parental mediation of children’s internet use (Nikken & Jansz, 2014; Sonck et al., 2013), the research team developed a 64-item survey. The survey contained 21 items addressing demographic questions of parents and their teens, parents’ computer skills, and frequency and types of parents’ and their adolescent’s social media use. Before implementation, two content experts reviewed the instrument for face validity.
TPB. Parents’ attitude toward monitoring their adolescent’s social media use was measured by one item. The parent was asked to rate their agreement to the statement, “Parents should monitor their preteen/teen’s social media use.” Two items were used to measure parents’ subjective norms of monitoring. Parents were asked to what extent they agreed to the following statements: “People who are important to me would encourage me to monitor my preteen/teen’s social media use” and “People who are important to me would support me to monitor my preteen/teen’s social media use.” Responses were on a 5-point Likert-type scale (1 = strongly agree to 5 = strongly disagree). Parents’ perceived behavioral control of monitoring their adolescent’s social media use was measured using three items. Parents were asked to rate the statement “Monitoring my preteen/teen’s social media use is/would be” using a 7-point rating scale (1 = extremely hard to 7 = extremely easy). Parents were then asked to what extent they agreed with the following statement, “I am confident I can monitor my preteen/teen’s social media use.” Responses were on a 5-point Likert-type scale (1 = strongly agree to 5 = strongly disagree). Finally, parents were asked how much control they think they have in monitoring their adolescent’s social media use. Responses were on a 4-point Likert-type scale (1 = no control to 4 = complete control). Parental intention to monitor their adolescent’s social media use was measured by one item, “I intend to monitor my preteen/teen’s social media use in the future.” Responses were on a 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree).
Parental monitoring. Parental monitoring was measured by eight items. First, parents were asked if the parent knows their adolescent’s passwords for social media accounts, email, or mobile phone. Next, the parent was asked to indicate yes, no, or “n/a” to five statements about actions they may have taken to monitor their adolescent’s social media use, such as “searched for your preteen/teen’s name online to see what information is available about them” and “used monitoring tools to track your preteen/teen’s location with their mobile phone” (Table 1).
Parental mediation. Parental mediation was measured by 17 items to measure restrictive, active, and co-use strategies and is listed in Table 1. Restrictive mediation was measured by four items. Parents were asked to indicate yes, no, or n/a if they have ever done actions related to restrictive mediation such as “used parental controls on your preteen/teen’s mobile phone or computer.” Active mediation was measured by 12 items. First, parents were asked to indicate yes, no, or n/a to four statements related to active mediation such as “read a privacy policy for a website or SMS your preteen/teen was using.” Next, the parent was asked how often they talked with the teen about eight statements related to risky social media behavior, for example, “sexting and/or stories of teen’s sexting.” Responses used a 5-point Likert-type scale (1 = frequently to 5 = never). Co-use was measured by one item asking the parent “how often do you use social media (e.g., look at other profiles, make posts, send messages or pictures) with your preteen/teen?” Responses were on a 5-point Likert-type scale (1 = frequently to 5 = never; Table 1).
Parental knowledge of risks of adolescent social media. Parental knowledge of risks related to social media use was measured by 11 items. Parents were asked, “To what extent are you concerned, if at all, about the following issues” followed by 11 statements such as “How your preteen/teen maintains their reputation online” and “How your preteen/teen talk with people they do not know online” (Table 1). Responses were on a 5-point Likert-type scale (1 = extremely worried to 5 = not at all worried).
Data analysis was conducted using IBM SPSS Version 24 (IBM Corp., 2016) after data were imported from RED-Cap™. Descriptive statistics were used to describe the sample demographics. The χ2 test was used to investigate whether parents’ responses differed by groups of parents. Responses from parents of sons compared to parents of daughters and parents of younger compared to parents of older adolescents were analyzed. Seventeen items included a response of N/A, which ranged from 1.3% to 9.4% of the responses for those items. In instances where N/A was an option, the response was recategorized as “missing” for analysis purposes. Less than 10% of responses were missing for each variable. All tests were two-sided, and a significance threshold of p < 0.05 was used for this study.
This nationwide sample (n = 836; Table 2) was primarily mothers (84.9%), White (80.4%), and college educated (25.8% some college; 52.0% college graduate). Survey responses included participants reporting from every state in the United States except Hawaii and the District of Columbia. Locations were aggregated according to the U.S. Census Bureau regions (Northeast: 14.4%, South: 31.3%, Midwest: 29.5%, West: 13.3%, and Pacific: 0.1%). Parent-reported adolescent demographics showed a majority of the adolescents were female (62.9%) and White (81.6%).
The TPB included variables of parents’ attitudes toward monitoring, subjective norms, perceived behavioral control, and intention to monitor. Most parents (92.0%) agreed parents should monitor their adolescent’s social media use, a finding that was consistent with perceived subjective norms that would encourage (86.5%) and support (92.2%) them to monitor their teen’s social media (Table 3). However, only 69.0% agreed or strongly agreed that they were confident to monitor their teen. Just under half (46.6%) reported monitoring their teen would be “easy,” while 41.5% reported it would be “hard.” When asked about their intent to monitor, most parents agreed (76.8%) they had intentions to monitor their adolescent’s social media use. Cronbach’s as for the two subjective norm items and three perceived behavioral control items were .85 and .76, respectively.
Most parents in this study reported knowing the password to their adolescent’s mobile phone (73.3%) and email (66.5%), but fewer parents knew the password for their adolescent’s SMS (59.3%). Parents reported having posted a comment on their adolescent’s social media profile (51.0%), checked websites their adolescent has visited (77.0%), checked their adolescent’s social media profile (81.9%), and searched for their teen’s name online (62.1%). Finally, more than half (52.9%) had tracked their adolescent’s location on their adolescent’s mobile phone.
Parents reported using some restrictive mediation practices. Almost 60% of parents reported using parental controls (58.9%) on their adolescent’s phone or computer, but only 47.7% reported using web filtering software. Most often used restrictive mediation practices included taking away their adolescent’s cell phone or internet privileges as punishment (77.4%) and limiting the amount of time or times of day their adolescent could go online (70.6%). Parents also used active mediation. Just over half of the parents (52.8%) reported reading a privacy policy for a website or SMS their adolescent was using. More than two thirds (66.9%) reported helping their adolescent set up privacy settings for an SMS, and 65% talked with their adolescent because the parent was concerned about something posted on their adolescent’s social media account.
Parents in this study also reported a high frequency of talking with their adolescents about risks related to adolescent social media. Parents talked to their adolescent most often about “everything sent over the internet can be shared” (81.1%—frequently or somewhat frequently), followed by “what is appropriate to share online” (77.5%—frequently or somewhat frequently) and “talking with strangers online” (76.5%—frequently or somewhat frequently). Although still common, the topics parents discussed the least with their adolescent were “sexting or stories of sexting” (71.0%—frequently or somewhat frequently), “which online content is appropriate for their age” (69.6%—frequently or somewhat frequently), and “cyberbullying” (69.8%—frequently or somewhat frequently). Cronbach’s a for the eight active mediation Likert-type scale items was .93. Co-use was used the least among parents in this study (36.4%— frequently or somewhat frequently).
The highest concern of parents in this study expressed was “private information getting into the wrong hands” (50.9%—extremely worried or very worried). Parents also reported concern regarding “depression” (47.3%—extremely worried or very worried) and the “effects on health” (44.5%—extremely worried or very worried). Parents were less concerned about “legal trouble because of their teen participating in sexting” (26.8%—extremely worried or very worried) and “how their teen maintains their reputation online” (23.9%—extremely worried or very worried). Cronbach’s a for the 11 parental knowledge items was .94.
After our initial analysis of the data, the χ2 test was used to investigate for any differences among groups of parents. Responses from parents of sons were compared with parents of daughters and parents of younger adolescents (11–14 years) with parents of older adolescents (15–17 years). Few differences appeared in parental monitoring practices with parents of sons compared with daughters. Knowing the password to their teen’s social media and phone differed by gender of the child. Of parents with daughters, 66.9% knew the password to social media accounts, and 83.6% knew the password to the phone. Significantly different, 59.6% of parents of sons knew the password to social media, and 73.8% knew the password to phone (p = .046; p < .001, respectively). More parents of daughters (92.0%) reported checking their teen’s social media profile compared with parents of sons (83.8%; p < .001; Table 4).
No differences existed between the gender of the child and restrictive mediation practices. More parents of daughters, however, reported active mediation strategies compared with parents of sons. For instance, 76.7% of parents of daughters helped their teen set up privacy settings on their social media compared with 62.4% of parents of sons (p < .001). Finally, slightly more parents of daughters (39.9%) reported using co-use mediation practices compared with 31.6% of parents of sons (p = .045). No differences were noted among parents of sons compared with parents of daughters and concern regarding risks of adolescent social media use. The only exception was more parents of sons were concerned about their teen watching sexually explicit material compared to parents of daughters (p = .003).
Several differences were seen among parents of younger adolescents (11–14 years) compared with parents of older adolescents (15–17 years). Knowing the password to social media accounts, email, and phone differed by age categories with 73.5% of parents of younger adolescents knowing the password to their adolescent’s social media compared with 55.2% of parents of older adolescents (p < .001), 77.6% of parents of younger adolescents knowing the password to their adolescent’s email compared with 62.4% of parents of older adolescents (p < .001), and 86.8% of parents of younger adolescents knowing the password to their phone compared with 74.1% of parents of older adolescents (p < .001). More parents of younger adolescents (85.6%) checked websites their teen had visited compared with parents of older adolescents (70.4%; p < .001), and 83.8% of parents of younger adolescents looked at their teen’s phone call record or messages compared to 70.0% of parents of older adolescents (p < .001; Table 5).
Restrictive mediation practices showed greater differences among age groups. More parents of younger adolescents used parental controls (73.4%) and web filtering software (57.1%) compared with parents of older adolescents (45.7%, p < .001; 40.8%, p < .001, respectively). Parents of younger adolescents were more likely to report using active mediation practices than parents of older adolescents. For example, more parents of younger adolescents (76.9%) helped their teens set up privacy settings for their social media compared with parents of older adolescents (66.1%; p < .001). On the contrary, more parents of older adolescents (64.2%) posted a comment on their teen’s social media compared to only 48.9% of younger adolescents (p < .001). Parents of younger adolescents reported talking to their teen more than parents of older adolescents about several risks related to adolescent social media use with the only exception being that of the topic of sexting. Parents of older adolescents (76.8%) reported talking to their teen about sexting or stories of sexting statistically significantly more frequently compared to parents of younger adolescents (72.2%, p < .001; Table 6).
In this study, we explored the parental monitoring and mediation practices of their adolescent’s social media use. According to the literature, most parents utilize some form of monitoring practices to subvert the negative effects of media (Padilla-Walker et al., 2018). Our findings were similar with most parents reporting monitoring their adolescent’s social media, such as knowing the password to their adolescent’s social media and using monitoring tools to track their adolescent’s location; however, one third of parents reported not doing these things.
Utilizing the TPB as a framework for exploring parental monitoring of adolescent social media use provided insight into parents’ intentions to monitor. Most parents agreed or strongly agreed that parents should monitor their adolescent’s social media use and reported positive responses to subject norms; however, parents reported less confidence in their perceived control of monitoring. These results were similar to other studies both in the United States and internationally (Krcmar & Cingel, 2016; Sonck et al., 2013). According to the TPB, perceived behavioral control is instrumental in predicting intention to perform a behavior when behavior is under volitional control and may explain the reduced reports of intention to monitor compared to attitudes toward monitoring (Ajzen, 1985).
Parental monitoring during the adolescent years is challenging for parents and is somewhat dependent on the adolescent to willingly disclose their activities to the parent (Kerr et al., 2010). School nurses may be the first to witness such things as cyberbullying or the consequences of cyberbullying and are in a position to assist parents in addressing the negative effects (Byrne et al., 2018). Parents can monitor their adolescent’s activity online by being their “friend” on social media to monitor what is posted on their adolescent’s social media (Romo et al., 2017). Nevertheless, adolescents are resourceful, long for privacy, and have found ways to sabotage some monitoring efforts such as blocking their parents from their SMS and creating fake profiles not disclosed to parents. As the landscape of monitoring adolescent’s activities changes, parents benefit from understanding how to monitor their adolescent social media use in other ways. Likewise, school nurses need to understand the negative effects of social media to screen students who may come to them to receive care (Byrne et al., 2018). Common Sense Media®, a nonprofit organization providing information and advice to parents and educators about various media types, is an easily accessible website for parents, nurses, and teachers to learn the latest research on social media use (Common Sense, 2020).
Results from this study showed most parents reported using restrictive mediation such as using parental controls on their adolescent’s phone or computer and limiting the amount of time their adolescent can go online. Nevertheless, just under half of the parents reported using web filtering software. These results are similar to those of Livingstone and Helsper (2008) who found parents restricted their child or adolescent from using the internet, but only a few used web filtering software. Web filtering software can help track and monitor adolescent social media use. School nurses could develop educational material to help parents who have fewer technical skills to understand the options in web filtering software and tools already built in some smartphones such as “Screen Time” on the Apple iPhone (Apple, 2018).
This study’s findings were consistent with other studies regarding active mediation as the most common mediation strategy used by parents to counteract the negative effects of media (Krcmar & Cingel, 2016; Padilla-Walker & Coyne, 2011; Padilla-Walker et al., 2012; Sonck et al., 2013). Nevertheless, slightly fewer parents discussed risks such as sexting and cyberbullying. Prevalence of sexting and cyberbullying ranges 23%–30% among adolescents (Byrne et al., 2018; Frankel et al., 2018; Hamm et al., 2015; Romo et al., 2017). Parents talking to their adolescents about these risky behaviors can reduce the risk of them engaging in these activities (Pechmann & Catlin, 2020), but starting these conversations can be difficult for some parents. School nurses can help facilitate these conversations by providing education for parents on effective communication on difficult topics.
When comparing groups, more parents of daughters reported knowing the passwords of the various communication devices (phone, email, and social media) and checked their adolescent’s profile compared to parents of sons. These results are similar to those of Khurana et al. (2015) who found girls reported increased rates of parental monitoring compared to boys. Yet Kelly et al (2018) found girls were more at risk for spending more time on social media, to experience cyberbullying, have low self-esteem, and to report depressive symptoms. On the contrary, Liau et al. (2008) found parents reported greater levels of parental monitoring in the activities of supervision and tracking of boys compared to girls.
More parents of younger adolescents reported monitoring and mediation practices compared with parents of older adolescents. These results are consistent with other studies (Livingstone & Helsper, 2008; Nikken & Jansz, 2014; Padilla-Walker & Coyne, 2011; Sonck et al., 2013) that found parents utilize more monitoring and mediation practices of children’s internet use when their child is younger and then adjust their monitoring efforts as the child ages. Parents rely less on monitoring practices with adolescents to allow them greater autonomy. Providing resources to parents before middle school can help parents set standards and healthy social media use behaviors for preadolescents and guide parents who may want to limit their child’s access or delay their participation in social media. Another source for nurses and parents is Families Managing Media®, which provides information, resources, and tools for parents related to delaying and limiting screen time for children and adolescents (Families Managing Media, 2020).
Consistent with prior research regarding parental mediation of adolescent’s internet use, these results showed parents are very concerned about many of the known risks of adolescent social media use. In this study, parents’ greatest concerns were private information getting into the wrong hands followed by depression and effects on health such as sleep. These findings reveal that the greatest concerns of parents were related to health issues, supporting adolescent social media use as an important topic specifically for school nurses as they interact with preadolescents and adolescents.
Study results indicated that while parents desire and intend to monitor social media use, there remains an inability by many to implement the monitoring and mediation that is perceived to be necessary to mitigate social media use and misuse. This educational deficit presents an opportunity for the school nurse to discuss options for monitoring and mediating social media. First, by screening adolescents for depression, anxiety, and problematic social media use, school nurses can help identify at-risk adolescents (Allison et al., 2014). Nevertheless, few tools have been developed specifically for school nurses. For example, the AAP’s Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (Hagan et al., 2017) gives directions for health care providers for screening media and anticipatory guidance, but it lacks information on specific concerns related to problematic social media use. Second, school nurses can advocate for and equip parents with resources and training to understand the benefits and risks of social media and the use of monitoring tools such as web filtering software. Efforts to increase media literacy can have a positive impact on the confidence parents need to monitor and mediate their adolescent’s social media use. Likewise, school nurses can help parents start conversations about sensitive topics such as sexting. Finally, school nurses can help parents set standards or even delay social media use, if parents so choose, in order to promote the healthy use of social media and improve the health of adolescents in their schools. Introducing this education for parents when children are in elementary school may also help reduce the negative effects associated with adolescent social media use.
Limitations of this study included the sample demographics and limited generalizability. Most participants were White mothers with high levels of education. Therefore, the findings have limited generalizability to highly educated White females. For example, less than 15% of our sample was male. The way Facebook chooses who views the Facebook ad may also play a role in those who engaged in the study. Females may post, like, or share information related to parenting more often than males and may inevitably have been shown the ad related to parenting more often. Also, the use of snowball sampling may have contributed to the homogenous sample as the demographics of this sample were similar to those of the primary researcher. Using only one SMS, Facebook, does not account for parents or guardians who either do not use social media or may use a different SMS, such as Instagram or Twitter. While social media may encourage participation, one cannot confirm the identity of the one completing an anonymous survey.
Finally, the novel instrument requires interpreting the results with caution. Although instruments have been developed to measure parental mediation constructs to the researcher’s knowledge, no validated instrument exists to measure parental monitoring and mediation of adolescent social media use. The development of psychometrically sound instruments to measure parental mediation of adolescent social media use is needed.
This study highlighted areas of concern and need for education of parents regarding the risks and benefits of adolescent social media use and the resources available to parents to monitor their adolescent. Parents are concerned about several risks and believe they should be monitoring their adolescent’s social media use; however, they lack confidence in their ability to do this effectively. Resources are available to parents, but most parents are left searching for these resources on their own. Some parents lack the knowledge and/or technical skills to utilize the tools available to them. Efforts to increase the number of parents following AAP recommendations to place limits on the time their child spends using media is a high-priority public health issue (U.S. Department of Health and Human Services, 2020). With the onset of COVID-19 and the switch to online learning, adolescents are now spending even more time on screens (Nagata et al., 2020). School nurses cannot address this alone, but they can be a great resource for parents for tools and education to implement strategies to help monitor and mediate their adolescent’s social media use. Parents, schools, and health care providers need to be aware and involved in the activities of adolescents to maintain a pulse of what occurs on SMS and its effect on their health. Future research should include the development of psychometrically sound instruments to measure parental monitoring and mediation of adolescent social media use. Finally, more research is needed to explore the development of interventions for school nurses to use for the education of parents and measure student health and education outcomes (Best et al., 2018).
We would like to thank Dr Kathleen Rhodes, PhD, RN, FNP-C, assistant professor of Nursing and Nurse Practitioner in a schoolbased clinic for her expertise and contribution to this article.
K.D.D., K.K.S., M.W.S., J.W., L.M., and L.Z. contributed to conception or design; contributed to acquisition, analysis, or interpretation; critically revised the article; gave final approval; and agreed to be accountable for all aspects of work ensuring integrity and accuracy. K.D.D. drafted the article.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was made possible by the Mississippi Nurses Foundation’s PhD Nursing Research Grant.
Kimberly D. Douglas, PhD, RN, CNE https://orcid.org/0000-0003-1804-3239
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Kimberly D. Douglas, PhD, RN, CNE, is an assistant professor in School of Nursing at the University of Mississippi Medical Center.
Kandy K. Smith, DNS, RN, is a professor in School of Nursing at the University of Mississippi Medical Center.
Mary W. Stewart, PhD, RN, is a professor in School of Nursing at the University of Mississippi Medical Center.
Jean Walker, PhD, RN, is a professor in School of Nursing at the University of Mississippi Medical Center.
Leandro Mena, MD, MPH, is a professor and chair of the Department of Population Health Science, a professor of Medicine in Division of Infectious Diseases, and School of Population Health/School of Medicine at the University of Mississippi Medical Center.
Lei Zhang, PhD, MBA, is a professor in School of Nursing at the University of Mississippi Medical Center.
1 School of Nursing, The University of Mississippi Medical Center, Jackson, MS, USA
2 Department of Population Health Science, The University of Mississippi Medical Center, Jackson, MS, USA
3 Division of Infectious Diseases, Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
4 School of Population Health, The University of Mississippi Medical Center, Jackson, MS, USA
5 School of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
Corresponding Author:Kimberly D. Douglas, PhD, RN, CNE, School of Nursing, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, USA.Email: kddouglas@umc.edu
