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Q & A with Scott Frank, MD

Scott Frank discusses how texting and social media affect adolescent behaviors, and how social networks could promote healthy communities and neighborhoods.

Q & A with Scott Frank, MD

Scott Frank, MD

Scott Frank, MD, is the founding Director of the Master of Public Health Program at CWRU School of Medicine and is currently Director of Public Health Initiatives in the Department of Population and Quantitative Health Sciences. He is the Principal Investigator of the Health Data Matters online resource. He maintains a clinical family practice and has annually been named among the “Best Doctors in America” since 2002. Dr. Frank is involved in research and teaching domains such as social justice, public health services and systems, public health information technology, adolescent health, tobacco control, substance abuse prevention, public health and medicine, assessment of stress, and the role of spirituality and religion in health.


Q: Let’s discuss your study that focused on texting and social media use in adolescents, and your research results.
A: We did a study looking at how adolescents were using Facebook, and it was really the first study of its kind that looked at the health risk behaviors of teens who were using Facebook more often. We looked at two concepts. One, social networking, and the other texting. When teens were using those technologies to an extreme, we referred to that behavior as hyper-texting and hyper-networking. That set of teens had many more health risks. We suggested that social networking and texting information technology really represented a new adolescent health risk. Those teens were more likely to drink alcohol, smoke tobacco, binge drink, have unsafe sex, be depressed and engage in self-harm. All of those things were concerning to us.


Q: And how did you define “hyper-texting?” Was that a certain amount of texts being sent?
A: At the time, we defined it as 120 or more texts a day, on a school day. We found that about 21 percent fell into that group. When we did the same study three years later, it was at about 30 percent, and if we were to do it today, it may even be higher than that. So, the extent of texting, the manner in which we use text messages for usual communication, has certainly changed. We defined hyper-networking, as three or more hours on a school day spent on social networks. And at the time, about 22 percent of adolescents were hyper-networking.


Q: So, you said you found that when adolescents were hyper-texting and hyper-networking, it did often lead them to become more depressed?
A: There was a greater extent of sadness expressed by the teens, a higher level of suicidal thought was expressed, and more kids were likely to be involved in self-harm types of behaviors like cutting.


Q: Is there something you would recommend parents, family members or friends could do if they notice a teen is experiencing depression and they’re on their phone often?
A: One of the things that has been pretty robustly demonstrated is that real life social networks are highly useful in avoiding stress, avoiding depression and coping with life when put in contrast with the virtual social networks. That means that encouraging kids to get physically involved with each other through after school activities, clubs, sports, getting out of the house really all have a positive connotation. Putting limits on the amount of screen time kids have is a good strategy as well.


Q: And you mentioned you conducted a follow up study to this research? Tell me a bit about that.
A: We did a follow up study to look at some of the reasons why it was that kids were more likely to be engaged in these behaviors. We found that about:

  • 80% were texting or posting things they didn’t want their parents to see
  • 56% were using social networking to find places where they could meet with friends without adult supervision
  • 40% used social networking to find a place where they could meet and drink alcohol
  • 25% used social networking to find a place where they could hook up or have sex

So you can see the more that kids are using these social networks, the more likely they may use them in ways that aren’t in their best health interests.


Q: Do you have any plans to do future studies in this research area?
A: We’re involved with ongoing surveillance of adolescent behaviors, and this is becoming increasingly important. One of the areas that’s really lagging behind in research is the whole Twitter phenomenon. Twitter can be a very toxic platform, as we’ve seen in politics. It can also be a good way to reach people. We did include Twitter in our follow up study, but it really hadn’t evolved to the place that it is now. I’d love to do some follow up. Also we’re not using these platforms both to push out health promotion messages, and to do research on attitudes within communities. By looking at how people are using Facebook and Twitter, we can actually measure things like area level racism – how much racism is in a geographical area, based on how people are tweeting, searching Google and using Facebook. These Twitter and social metrics that can be used to really look at everything from happiness, to racism, to food poisoning really represent an opportunity for us in public health to find ways to take maximum advantage of health information technology.


Q: Very interesting. Is there anything else you’d like to add to the topic?
A: I will mention a program that we run called Health Data Matters, which is an open platform, open access website that places health outcomes, socioeconomic information all into one space. We use a hyperlocal approach, so you really can look at what’s happening in neighborhoods as it relates to health outcomes, and what patterns we see across the city and the county. This has led us to become very involved with health information technology innovation and public health innovation to develop apps, software and technology tools that help promote health and use these social networks in the most positive way possible.

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