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Digital media use has increased rapidly during the past two decades, and media use is now a major issue in adolescent development. Online connections and communities can help foster healthy identity development and provide needed peer support, particularly for adolescents from historically marginalized communities. Online harassment, or cyberbullying, is a common phenomenon. Media use can interfere with sleep hygiene and quality, and screen-based sedentary behaviors have been associated with decreased physical activity, decreased aerobic fitness, and increased adiposity among adolescents. The literature on media use and adolescent mental health still is evolving. Some research suggests a U-shaped association between these two factors, with high and low levels of internet use associated with depression. Social media use may amplify peer pressure to engage in sexual behavior, provide exposure to a greater network of individuals with sexual experience, and increase the risk of sexual behaviors. Counseling adolescent patients about safe and healthy media use is essential. Conversations with patients and their families about media use should begin before adolescence and continue through adolescence in the context of routine preventive care. The American Academy of Pediatrics (AAP) recommends creation and implementation of a Family Media Use Plan.

Case 4. BK is a 14-year-old adolescent girl (pronouns: she/her) who comes to your office with her mother for a routine visit. In response to your inquiry about school performance, her mother says that her grades have fallen a bit this year. She adds that BK always appears tired and stays up late using her cell phone. When asked about her media use, BK says she has a new girlfriend who lives in another state. They met on an app for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth and have been together for 3 months but have never met in person. She states that this app has provided her with a network of individuals who have “been through the same thing.” She stays up late using Snapchat and watching YouTube. She now spends approximately 8 hours per day on screen time.

Digital media use has increased rapidly during the past two decades, and media use is now a major issue in adolescent development.155 Most adolescents are digital natives, meaning that they do not remember a time before the internet.156 Many have used mobile devices since early childhood, and approximately 1 in 5 children younger than 12 years has their own smartphone.157

Access to the internet via mobile devices is ubiquitous, with 95% of US adolescents ages 13 to 17 years reporting access to a smartphone in 2018.158 These findings are consistent across sexes, races, ethnicities, and socioeconomic backgrounds. Approximately 88% of US adolescents reported having access to a desktop or laptop computer in the home, with access varying by income level.

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