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Hot Topics in Social Media and Reproductive Health

Article in Journal of Pediatric and Adolescent Gynecology · June 2020

DOI: 10.1016/j.jpag.2020.06.016

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Hot topics in social media and reproductive health

Erin Kelleher, Megan A. Moreno, MD, MSEd, MPH

PII: S1083-3188(20)30253-9
DOI: https://doi.org/10.1016/j.jpag.2020.06.016
Reference: PEDADO 2507

To appear in: Journal of Pediatric and Adolescent Gynecology

Received Date: 16 February 2020

Revised Date: 17 June 2020
Accepted Date: 22 June 2020

Please cite this article as: Kelleher E, Moreno MA, Hot topics in social media and reproductive health,
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Adolescent Gynecology.
Hot topics in social media and reproductive health

Erin Kelleher1; Megan A Moreno, MD, MSEd, MPH2

Rosalin Franklin Medical School, Chicago, IL: 2University of Wisconsin Madison,

1

Department of Pediatrics, Madison, WI

Acknowledgment: No funding was associated with this article.

Corresponding author:

Megan A Moreno, MD, MSEd, MPH

2870 University Ave, Suite 200

Madison, WI 53705

mamoreno@pediatrics.wisc.edu

608-263-2846

Word count
Abstract: 124
Main text: 2480

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Narrative abstract

Today’s generation of adolescents and young adults have been labeled “digital natives”

given that they have had access to digital technology since birth. In this review, we

address two critical areas impacting adolescents’ reproductive health and social media.

First, we address the current state of the science across several ‘hot topic’ areas of social

media use, including body image and privacy concerns. Second, we shift to consider

social media as a potential health education tool in the area of reproductive health.

Throughout this review, we attend to gender differences for these topics, including

differences between males and females as well as differences between cis and trans

adolescents. Our goal is that this review provides a timely update for providers caring for

today’s digital natives.

Keywords:

Adolescent; social media; gender; transgender; privacy

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Introduction

Adolescents today are often referred to as “digital natives” given they are growing

up in an immersive technological society. The majority of adolescents and young adults

have a personal smartphone and engage with digital media; approximately 45% of

adolescents describe that they are online ‘almost constantly.’ 1 Several studies have

documented this populations’ frequent and near-ubiquitous media use as a population.2-4

Adolescent and young adults’ frequent and consistent media use has benefits and

risks. Benefits include opportunities for content creation and social support. 5 Risks

include negative health consequences, including concerns related to sleep, 6-8 as well as

relational risks such as sexting, bullying, unwanted predation and risky sexual partners.9-
12

In this review, we address two critical areas in current evidence around

reproductive health and social media. First, we address the current state of the science

across several ‘hot topic’ areas of social media use, including body image and privacy

concerns. Second, we describe social media as a potential health education tool in the

area of reproductive health. Throughout this review, we attend to gender differences for

these topics. We include evidence, where available, suggesting differences for cis-female

and cis-males, as well as available evidence about youth who identify as sexual and

gender minority (SGM) youth. Cisgender youth are youth for whom gender identity

aligns with their sex assigned at birth. SGM youth are youth who identify as lesbian, gay,

bisexual, transgender, gender non-conforming, queer, or questioning (LGBTQI).

Social Media Use

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 Given that social media are nearly ubiquitously used by adolescents and young adults,

it may not be surprising that among cisgender youth there are few gender differences in

the social media platforms used by this age group 13. Snapchat is the most frequently used

social media platform among females (42% vs. 29%) and YouTube for males (39% vs.

25%). However, there are differences in how males and females use social media14,15.

Adolescent females spend more time online 16 and are more likely to say they are near

constant online users compared to adolescent males (50 vs 39%) 13. Studies also suggest

that males are more likely to post about risky behavior on social media compared to

females17.

There are limited data regarding social media use among SGM youth 18. Similar to

cisgender youth, SGM youth use social media such as Facebook, Twitter and Tumblr, but

there are limited studies regarding whether specific sites are most popular for SGM

youth18,19. Considering how social media is used, qualitative and quantitative research

studies support that many SGM use social media to find strong, meaningful connections

and communities18,19. For many SGM youth struggling with their offline gender identity,

Facebook and YouTube serve as platforms to play and assert one’s gender identity 18. One

adolescent in a previous study noted that they were excited to share their identity publicly

by changing their name on Facebook. When people asked them about their profile

change, they used that moment as a teaching opportunity to describe their SGM

experiences. Popular SGM vloggers (video bloggers) use YouTube to educate their

audience, document their transition and build supportive communities.

Tumblr is a popular social media platform used by trans youth. While Facebook is

used for connecting to their peers geographically close to them, Tumblr may be used for

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reaching a wider audience without geographical barriers. In a previous study, SGM youth

described that they like Tumblr because of the way the platform looks and the ability to

connect with other trans youth18. Many SGM adolescents described that they enjoyed

actively using their Tumblr profile and felt as though they were contributing to the larger

online trans community.

An important difference among SGM youth compared to cis peers is that SGM

youth use a diverse range of social media sites beyond Facebook, YouTube and Tumblr

that have not been extensively studied in the current literature 18. Other sites used by SGM

adolescents include Fur Affinity (forum for animal fantasy writing), online comics, SGM

community subreddits just to name a few examples 18. SGM youth also enjoy sites that

don’t put their SGM identity at the forefront. One participant explained how although she

frequently posted on trans community Tumblr pages, she also described herself as a

“modern strange weird hippie girl who writes like a modern strange weird hippie girl and

modern strange hippie people like my style.” Research to date demonstrates the

complexity of SGM youth social media use and the need for larger studies to understand

the way SGM youth navigate different platforms.

Hot topics

Emotional Post Etiquette or Emotional Expression?

One growing area of research is in how young people express themselves and

their emotions on social media. A previous study examined the gender differences in how

young people perceived social norms around publicly expression emotions on different

social media platforms15. Both males and females perceived positive emotions as more

appropriate to post about compared to negative emotions on social media. Females were

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more likely than males to endorse expressing positive emotions on public social media

platforms such as Facebook, Twitter and Instagram. Females also found it more

appropriate to express positive and negative emotions on private platforms such as

Whatsapp. These findings suggest that females may find it more socially acceptable to

post about their emotions on social media, but these gender differences were not

consistent across all platforms.

Social media have been used by SGM youth to post about their emotions as well

as struggles with mental health. Some youth have endorsed that they prefer to talk about

their mental health online rather than in person 19. While there is support on social media

for SGM youth, there is also the presence of risky behavior. Some studies have

documented social media suicide notes in the SGM youth community 18. Posts are shared

publically on social media and reach a large audience via the spread of public hashtags.

Some SGM youth worry it may encourage vulnerable SGM youth to harm themselves.

One youth described a pattern of up to eight trans people in 3 months using a hashtag

associated with suicide18. Social media offers a safe space for many SGM youth to share

their experiences, but it may also expose youth to potentially harmful mental health

content.

Privacy and personal disclosures

Given the public nature of the internet, privacy is a key issue for young people

using social media. One study found that females were more concerned about their

privacy on social media compared to males 17. Males were more likely to self-disclose

personal information and their privacy concerns did not influence their individual

behavior, such as through “selfies.” Females expressed greater privacy concerns and this

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resulted in fewer individual selfie photos, as well as cropping and using filters on photos.

This finding supports previous literature that suggests individuals with privacy concerns

moderate their content through cropping, hiding or other forms of editing 20. Posting a

group selfie was perceived differently, with no gender differences in privacy concern for

these types of group posts17. Further, previous literature suggests group selfies support

peer mentorship which is important to adolescents 21.

Body Image

Body image is a growing area in which studies suggest potential for harm from

social media use among adolescents. Previous studies have found that among males and

females, a higher level of Facebook involvement was associated with higher levels of

objectified body consciousness, leading to higher rates of reporting body shame 22.

Objectified body consciousness is a preoccupation with one’s body appearance compared

to others23,24. High levels of Facebook involvement have been associated with body

surveillance which places a greater emphasis on self-worth by their physical

appearance22. Females report experiencing a greater magnitude of body objectification

and shame with increased rates of Facebook use compared to males22.

For males and females, appearance and weight have been proposed as moderators

between excessive time on social media and restrained eating. It is common for young

people to make unrealistic comparisons of themselves to celebrities or other individuals

online with “ideal” bodies25,26. These unrealistic expectations may have negative health

consequences such as contributing to risk for eating disorders 25. Among females,

appearance and weight were mediating variables for the relationship between excessive

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time on social media and emotional eating. Emotional eating is more common in females

and is a maladaptive coping mechanism for unpleasant emotions 25,27.

Less is known about these relationships in SGM youth. Some SGM youth

describe feeling safer expressing their gender identity online compared to offline. One

study found that participants were rarely victimized online and most of their victimization

occurred offline19.

Social media and reproductive health education

Previous work supports that cisgender and SGM youth are open to interacting

with healthcare professionals through social media. Many adolescents use social media

and the internet to learn about reproductive health, but have concerns about the accuracy

of information found online28,29. In one study, a majority of adolescents were amenable to

learning about reproductive health on social media via valid sources 28-32. Previous

studies have utilized Facebook to teach topics in reproductive health such as sexually

transmitted infections (STIs), pregnancy in adolescence and safe sex 30,31. Adolescents and

young adults may feel more comfortable sharing and learning about reproductive health

through Facebook because they feel it is a safe space to ask questions and interact with

other teens and health services30,31. Adolescents and young adults might also feel that

social media is an appropriate educational platform because a majority are regular social

media users32, and are familiar with using the platforms29.

In health education research, Facebook was the most common platform utilized

for previous studies31,33,34. Facebook has been shown to be a feasible platform for

participant recruitment and toeducate adolescents about sexual and reproductive

health31,33,34. Participant recruitment through Facebook is a cost effective method to reach

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geographically, ethnically and racially diverse populations 28,33,34. A majority of

adolescents were interactive in the interventions and enjoyed learning about reproductive

health through Facebook30,31. In one study, HIV positive teens wanted to stay in the

Facebook support group after the study ended and said they would share the group with

other teens with HIV31. Participants reported they enjoyed engaging and sharing

experiences and also felt supported by their peers with HIV 31. They described that the

online group also reminded them to take their care of themselves such as taking their HIV

medications on time31.

For SGM youth, the internet may play a critical role for learning about sexual

education. As only five states in the US have guidance or laws in place to allow SGM-

inclusive sexual education in schools, the internet can become a sole source of education

for these adolescents35. Previous studies have illustrated that SGM youth use the internet

to seek information about what gender identity labels mean as well as to seek local

resources36. Youth have also used the internet to learn about critical processes, such as

coming out or gender transition18,37.

Social media in health interventions: Feedback from young people

Adolescents in previous studies have expressed that they liked Facebook because

it was easy to use and could be accessed anytime 28,30,32. Adolescents enjoyed interacting

with their peers and commonly felt that social media was a safe space to ask personal or

“embarrassing” questions and share experiences 30,31. Adolescents felt supported by their

peers30,31 and felt it was easier to discuss sensitive topics such as sex and sexuality

online30. Participants liked meeting new people and many developed bonds with their

peers and their healthcare facilitator30,31. In some instances, the online relationships with

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the facilitator carried over into offline relationships in the clinic 30. Thus, online

relationships strengthened offline interactions 30.

Adolescents expressed preferences for content that was educational and attention

grabbing28,29,32. One study created a Facebook profile for sexual health education,

participants liked that the profile had attention grabbing videos and utilized up-to-date

messaging29. Adolescents agreed that risk factors, transmission, prevention, signs and

symptoms, testing a treatment of STIs was important content on the Facebook page. They

also thought that learning through both real-life stories and statistical information were

valuable.

Adolescents expressed concerns about maintaining their privacy regarding

sexual/reproductive resources28-31. Some adolescents felt that their privacy and personal

information would not be protected with a Facebook intervention 28,29. Another expressed

concern was that STI information was considered “too heavy” for social media 28. Further,

some felt that social media should be used for socializing, and educational posts did not

belong on social media28.

Future directions for reproductive health educational interventions and approaches

Previous work supports adolescent and young adults’ preferences for social media

to have “trendy” topics, “catchy” captions, humorous videos and attention grabbing yet

reliable content28,29,32. Posts should vary in content and format to incorporate videos,

images and up-to-date messaging28,32. Adolescents wanted factual information about

substance use, HIV/AIDS knowledge and facts, and safe sex behaviors 32. Suggestions for

the frequency of posts ranged from a few times a day to a few times a week 32. While

many previous studies have focused on Facebook, given it has existed for longer than

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some newer platforms, it is important to note that social media are constantly evolving

and changing. In one study, adolescents also suggested utilizing other platforms such as

Twitter, Snapchat and Instagram29.

Previous work focused on the SGM community has argued that technology

should be used to create a safe and anonymous place for SGM youth to learn about

critical topics, including STIs38. One study found that allowing SGM youth to interact

together was perceived as beneficial for both information acquisition as well as social

support39. Another online sexual health intervention had positive results for knowledge

acquisition, suggesting the online health education intervention was feasible, acceptable

and effective40.

SGM youth have also suggested that clinicians use social media to interact and

learn about the experiences and needs of the SGM youth 19. Like cisgender youth, some

SGM youth feel more comfortable using online resources rather than talking in person.

Healthcare providers should be aware of the potential harmful mental health content that

SGM youth see online. It is important for healthcare providers to discuss patients’ social

media use and what benefits or risks they experience. Another youth suggestion was for

healthcare professionals to use social media to educate and resolve conflicts with parents

of SGM youth. Examples include educational social media messages about gender

reassignment surgeries or hormones.

Conclusions

Research indicates that cis male and female adolescents use similar social media

platforms, but utilize them in different ways. Females spend more time on social media,

share their emotions, have more privacy concerns and are less likely to engage in risky

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behaviors compared to males. Females are also more negatively impacted by self-

comparison and criticism through social media. SGM youth use social media to connect

with other SGM youth, express their identities and share their experiences in a safe space.

Social media is constantly evolving which causes new trends and creation of new

platforms. However, it is important to understand the gender differences across platforms

to properly monitor and gain insights into adolescents regarding self-esteem, mental

health and substance use.

Adolescents have a positive attitude towards reproductive health resources

through social media, but are concerned about maintaining their anonymity 28,29,32. Social

media such as Twitter and Reddit offer higher levels of profile anonymity which could

decrease the risk of self-disclosure. There are limited data regarding whether Facebook

reproductive interventions and education decreases risky sexual behavior. Future research

should measure the success and outcomes of social media reproductive health programs.

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Conflicts of interests

The authors have no conflicts of interest to declare.

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