Original Research Report

The Journal of School Nursing

2023, Vol. 39(3) 248–261
Exploring Parents’ Intentions to Monitor ª The Author(s) 2020
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and Mediate Adolescent Social Media Use sagepub.com/journals-permissions

DOI: 10.1177/1059840520983286
journals.sagepub.com/home/jsn
and Implications for School Nurses

Kimberly D. Douglas, PhD, RN, CNE1 , Kandy K. Smith, DNS, RN1,

Mary W. Stewart, PhD, RN1, Jean Walker, PhD, RN1,
Leandro Mena, MD, MPH2,3,4,5, and Lei Zhang, PhD, MBA1

Abstract
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 ¼ 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

Background Social media is defined as “forms of electronic commu-

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 beha-
vior 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 Communi-
cations 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 simul-
taneous launch and increase use of the smartphone and
social media with the increase in depression and suicide
rates (Twenge, 2017b).
nication (such as website for social networking and micro-
blogging) through which users create online communities to
share information, ideas, personal messages, and other con-
tent (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
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
Douglas et al.
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 neg-
ative consequences of social media use including low self-
esteem, 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 stu-
dents in the United States have reported being bullied elec-
tronically 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 com-
pared 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 experi-
ment, 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 & Somer-
ville, 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 pedia-
tric 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.
249
Parental Monitoring
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 adoles-
cent 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 med-
iation. 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).
Study Framework
Parental Mediation
“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).
Theory of Planned Behavior (TPB)
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
250
Figure 1. Research conceptual framework (Ajzen, 1985; Nathanson, 1999; Valkenburg et al., 1999).
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, mon-
itor adolescent social media use; Ajzen & Fishbein, 1980).
Assuming parents have complete control over the behavior
of monitoring, parents were expected to carry out their inten-
tions 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 monitor-
ing and parental mediation theory, offered a useful frame-
work (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
The Journal of School Nursing 39(3)
explore parental monitoring and mediation practices of
social media use by their adolescents. The original research
questions included:
1. What do parents know about the risks of adolescent
social media use?
2. What are parents’ attitudes toward monitoring their
adolescent’s social media use?
3. What are the parents’ intentions to monitor their
adolescent’s social media use?
4. What mediation practices are parents using to subvert
the negative effects of social media?
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.
Method
Following expedited approval by the University of Missis-
sippi Medical Center’s institutional review board, the
research used an exploratory, quantitative design to describe
parental monitoring and mediation practices of adolescent’s
Douglas et al.
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, Face-
book 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). How-
ever, 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 adoles-
cent (11–17 years), such as mother, father, guardians, grand-
parents, or other family members. No participant identifiers
were collected, and no incentives were offered to
participants.
Data Collection
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 poten-
tial 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 con-
fidentiality, 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 dis-
played 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 volun-
tarily 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.
251
Instrument
Based on the TPB (Ajzen, 1985, 2006), parental mediation
theory, and previous work on parental mediation of chil-
dren’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 ques-
tions 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 ¼ strongly
agree to 5 ¼ strongly disagree). Parents’ perceived beha-
vioral 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 ¼
extremely hard to 7 ¼ extremely easy). Parents were then
asked to what extent they agreed with the following state-
ment, “I am confident I can monitor my preteen/teen’s social
media use.” Responses were on a 5-point Likert-type scale
(1 ¼ strongly agree to 5 ¼ strongly disagree). Finally, par-
ents 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 ¼ no control to 4 ¼
complete control). Parental intention to monitor their ado-
lescent’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 ¼
strongly disagree to 5 ¼ 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 indi-
cate 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
252 The Journal of School Nursing 39(3)

Table 1. Survey Items: Parental Monitoring and Mediation.

Item Response Type

Have you ever done any of the following things Yes/no/N/A

Read a privacy policy for a website or social media site your preteen/teen was using?
Searched for your preteen/teen’s name online to see what information is available about them?
Helped your preteen/teen because you were concerned about something
posted to their profile or account?
Talked with your preteen/teen because you were concerned about something on their social media account?
Posted a comment on your preteen/teen’s social media about something on their social media profile or account?
Used parental controls on your preteen/teen’s mobile phone or computer?
Checked which websites your preteen/teen visited?
Taken away your preteen/teen’s cell phone or internet privileges as
punishment?
Limited the amount of time or times of day when your preteen/teen can go online?
Used monitoring tools to track your preteen/teen’s location with their mobile phone?
Looked at the phone call records or messages on your preteen/teen’s phone?
a
How often do you use social media (e.g., look at other profiles, make posts, send messages or pictures) with your Range: 1–5
preteen/teen together?
a
How often do you talk with your preteen/teen about . . . ? Range: 1–5
What is appropriate or inappropriate online behavior toward others
Talking with strangers online
What is appropriate or inappropriate for their age
That their use of technology is something you, the parent, want and need to know about
That everything sent over the internet can be shared
Sexting and/or stories of teen’s sexting (sending or receiving sexually explicit messages or images via social media or
mobile phone)
Cyberbullying
To what extent are you concerned, if at all, about the following issues? Range: 1–5.b
How your preteen/teen maintains their reputation online
How much information advertisers can learn about your preteen/teen’s online behavior
How your preteen/teen talk with people they do not know online
Your preteen/teen watching sexually explicit material (such as pornography)
Your preteen/teen participating in “sexting” (sending or receiving sexually explicit messages or images via social media
or mobile phone)
Legal trouble because of participating in sexting
How your preteen/teen’s online activity might affect their future academic or employment opportunities
Effects on health, such as effects on sleep
Number of people who are depressed (related to cyberbullying, sexting, or technology addiction)
Watching violent behavior
Private information getting into the wrong hands

Note. N/A ¼ not applicable.

a
Frequently, somewhat frequently, occasionally, rarely, and never. b Extremely worried, very worried, moderately worried, slightly worried, and not at all
worried.

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 media-
tion 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 ¼ frequently to 5 ¼ 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 mes-
sages or pictures) with your preteen/teen?” Responses were
on a 5-point Likert-type scale (1 ¼ frequently to 5 ¼ 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
Douglas et al. 253

Table 2. Parent Demographics.

Characteristics n % Characteristics n %

Parent role Parent education

Mother 710 84.9 Less than high school 6 0.7
Father 11 1.3 High school diploma 67 8.0
Stepmother 15 1.8 Some college 216 25.8
Stepfather 1 0.1 College graduate 435 52.0
Grandparent 8 1.0 Total 746
Other family member 1 0.1 Household
Legal guardian 3 0.4 One parent 134 16.0
Other 1 0.1 Two parent 483 57.8
Total 750 Blended 107 12.8
Parent age (years) Other 12 1.4
Less than 35 63 7.5 Total 736
35–39 174 20.8 Children younger than 11
40–44 179 21.4 None 432 51.7
45–49 163 19.5 One 187 22.4
50–54 115 13.8 Two 80 9.6
55þ 56 6.7 Three or more 40 4.8
Total 750 Total 739
Parent race/ethnicity Children between 11 and 17
White (non-Hispanic) 672 80.4 One 440 52.6
Black (non-Hispanic) 18 2.2 Two 223 26.7
Hispanic 30 3.6 Three or more 80 9.6
Other 27 3.2 Total 743
Total 747

were on a 5-point Likert-type scale (1 ¼ extremely worried
to 5 ¼ not at all worried).
Data Analysis
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 sam-
ple demographics. The w2 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 signifi-
cance threshold of p < 0.05 was used for this study.
Results
This nationwide sample (n ¼ 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%).
TPB Constructs
The TPB included variables of parents’ attitudes toward
monitoring, subjective norms, perceived behavioral control,
and intention to monitor. Most parents (92.0%) agreed par-
ents 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 moni-
toring 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.
Parental Monitoring
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
254 The Journal of School Nursing 39(3)

Table 3. Theory of Planned Behavior Descriptive Statistics.

Strongly agree, Agree, Neutral, Disagree, Strongly disagree,

Constructs N n (%) n (%) n (%) n (%) n (%)

I intend to monitor a 827 332 (39.7) 310 (37.1) 88 (10.5) 40 (4.8) 57 (6.8)
Parents should monitor b 831 534 (63.9) 235 (28.1) 56 (6.7) 4 (0.5) 2 (0.2)
People important to me would 830 442 (52.9) 281 (33.6) 88 (10.5) 16 (1.9) 3 (0.4)
encourage me to monitor c
People important to me would 832 483 (57.8) 288 (34.4) 52 (6.2) 9 (1.1) 0
support me to monitor c
I am confident I can monitor d,e 829 237 (28.3) 342 (40.9) 125 (15.0) 109 (13.0) 16 (1.9)

Hard Somewhat hard Neither hard Somewhat easy Easy

nor easy
d
Monitoring my teen would be 833 117 (14.0) 230 (27.5) 96 (11.5) 164 (19.6) 226 (27.0)

No control Very little control Some control Complete control

How much control do have in 830 23 (2.8) 120 (14.4) 516 (61.7) 171 (20.5)
monitoring d
a
Intent. b Attitude. c Subjective norms. d Perceived behavioral control. e Item 18.

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 ado-
lescent’s mobile phone.
Parental Mediation
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 punish-
ment (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 adoles-
cent 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%—fre-
quently 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).
Parents’ Knowledge of Risks of Adolescent Social
Media Use
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 par-
ticipating in sexting” (26.8%—extremely worried or very
worried) and “how their teen maintains their reputation
online” (23.9%—extremely worried or very worried). Cron-
bach’s a for the 11 parental knowledge items was .94.
Comparing Groups
After our initial analysis of the data, the w2 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 pass-
word 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
Douglas et al. 255

Table 4. Parental Monitoring and Mediation Strategies Among Parents of Daughters and Sons.

Parents of n (%)

All, N ¼ 836 Males, n ¼ 301 Females, n ¼ 526 p Value

Do you know the password to your teen’s

Social media password
Yes 490 (64.3) 161 (59.6) 329 (66.9) .046*
No 272 (35.7) 109 (40.4) 163 (33.1)
Missing/N/A a 65
Mobile phone password
Yes 605 (80.1) 197 (73.8) 408 (83.6) .001**
No 150 (19.9) 70 (26.2) 80 (16.4)
Missing/N/A a 73
Checked your teen’s social media profile
Yes 678 (89.1) 227 (83.8) 451 (92.0) <.001**
No 83 (10.9) 44 (16.2) 39 (8.0)
Missing/N/A a 67
Have you ever done any of the following
Helped your teen set up privacy settings
Yes 553 (71.5) 174 (62.4) 379 (76.7) <.001***
No 220 (28.5) 105 (37.6) 115 (23.3)
Missing/N/A a 54
Talked with your teen because you were concerned about something posted
Yes 537 (73.2) 117 (68.1) 360 (75.9) .021*
No 197 (26.8) 83 (31.9) 114 (24.1)
Missing/N/A a 93
Posted a comment on your teen’s social media
Yes 421 (56.7) 128 (48.9) 293 (60.9) .002**
No 322 (43.3) 134 (51.1) 188 (39.1)
Missing/N/A a 84
Items 38–45 b w2 df
Appropriate online behavior 13.444 4 .009**
Talking with strangers online 19.188 4 .001**
What is appropriate to share online 12.468 4 .014*
Which online content is appropriate for age 10.880 4 .028*
Their technology use is something you need to know about 8.783 4 .067
Everything sent over the internet can be shared 2.323 4 .677
Sexting or stories of sexting 9.322 4 .054
Cyberbullying 9.206 4 .056
a
Missing includes nonresponses and responses of not applicable (N/A) and not included in percentages. b Responses were reverse coded for analysis: range (1
¼ never to 5 ¼ frequently).
*p < .05. **p < .01. ***p < .001.

73.8% knew the password to phone (p ¼ .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 daugh-
ters, however, reported active mediation strategies com-
pared 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 ¼ .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 ¼ .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 <
256 The Journal of School Nursing 39(3)

Table 5. Parental Monitoring and Mediation Strategies Among Table 6. Active Mediation Among Parents of Younger and Older
Parents of Younger and Older Adolescents. Adolescents.
a
Parents, n (%) Active Mediation (Items 38–45) w2 df p Value

Younger Older Appropriate online behavior 17.643 4 .001

All, Adolescent, Adolescent, Talking with strangers online 29.488 4 <.001
N ¼ 830 n ¼ 441 n ¼ 389 p Value What is appropriate to share online 15.757 4 .003
Which online content is appropriate for age 30.318 4 <.001
Do you know the password to your teen’s: Their technology use is something you 30.182 4 <.001
social media need to know about
Yes 492 (64.3) 280 (73.5) 212(55.2) <.001*** Sexting or stories of sexting 22.164 4 <.001
No 273 (35.7) 101 (26.5) 172 (44.8)
Missing a 41 n ¼ 836. df ¼ degrees of freedom.
a
Email Responses were reverse coded for analysis: range (1 ¼ never to
Yes 553 (70.2) 312 (77.6) 241 (62.4) <.001*** 5 ¼ frequently).
No 235 (29.8) 90 (22.4) 145 (37.6)
Missing a 73
Mobile phone .001). More parents of younger adolescents (85.6%) checked
Yes 609 (80.4) 328 (86.8) 281 (74.1) <.001*** websites their teen had visited compared with parents of
No 148 (19.6) 50 (13.2) 98 (25.9) older adolescents (70.4%; p < .001), and 83.8% of parents
Missing a 39
of younger adolescents looked at their teen’s phone call
Have you ever done any of the following:
Searched for your teen online record or messages compared to 70.0% of parents of older
Yes 516 (63.0) 250 (57.9) 266 (68.7) .001** adolescents (p < .001; Table 5).
No 303 (37.0) 182 (42.1) 121 (31.3) Restrictive mediation practices showed greater differ-
Missing a 12 ences among age groups. More parents of younger adoles-
Checked websites your teen has visited cents used parental controls (73.4%) and web filtering
Yes 640 (78.4) 369 (85.6) 271 (70.4) <.001***
No 176 (21.6) 72 (14.4) 114 (29.6)
software (57.1%) compared with parents of older adoles-
Missing a 14 cents (45.7%, p < .001; 40.8%, p < .001, respectively). Par-
Looked at phone call records or messages on your teen’s phone ents of younger adolescents were more likely to report using
Yes 595 (77.0) 327 (83.8) 268 (70.0) <.001*** active mediation practices than parents of older adolescents.
No 178 (23.0) 63 (16.2) 115 (30.0) For example, more parents of younger adolescents (76.9%)
Missing a 57 helped their teens set up privacy settings for their social
Have you ever done any of the following:
Used parental controls
media compared with parents of older adolescents (66.1%;
Yes 490 (60.3) 314 (73.4) 176 (45.7) <.001*** p < .001). On the contrary, more parents of older adolescents
No 323 (39.7) 114 (26.6) 209 (54.3) (64.2%) posted a comment on their teen’s social media com-
Missing a 18 pared to only 48.9% of younger adolescents (p < .001).
Used web filtering software Parents of younger adolescents reported talking to their teen
Yes 397 (49.4) 242 (57.1) 155 (40.8) <.001*** more than parents of older adolescents about several risks
No 407 (50.6) 182 (42.9) 225 (59.2)
Missing a 27 related to adolescent social media use with the only excep-
Taken away your teen’s phone or internet as punishment tion being that of the topic of sexting. Parents of older ado-
Yes 643 (79.1) 354 (83.1) 289 (74.7) .003* lescents (76.8%) reported talking to their teen about sexting
No 170 (20.9) 72 (16.9) 98 (25.3) or stories of sexting statistically significantly more fre-
Missing a 17 quently compared to parents of younger adolescents
Limited the amount of time or times of day your teen can access (72.2%, p < .001; Table 6).
the internet
Yes 587 (71.9) 346 (81.0) 241 (62.0) <.001***
No 229 (28.1) 81 (19.0) 148 (38.0)
Missing a 14 Discussion
Helped your teen set up privacy settings In this study, we explored the parental monitoring and med-
Yes 555 (71.5) 300 (76.9) 255 (66.1) .001**
iation practices of their adolescent’s social media use.
No 221 (28.5) 90 (23.1) 131 (33.9)
Missing a 54 According to the literature, most parents utilize some form
Posted a comment on your teen’s social media of monitoring practices to subvert the negative effects of
Yes 423 (56.7) 179 (48.9) 244 (64.2) <.001*** media (Padilla-Walker et al., 2018). Our findings were sim-
No 323 (43.3) 187 (51.1) 136 (35.8) ilar with most parents reporting monitoring their adoles-
Missing a 84 cent’s social media, such as knowing the password to their
Note. N/A ¼ not applicable. adolescent’s social media and using monitoring tools to
a
Missing includes nonresponses and responses of “N/A.” track their adolescent’s location; however, one third of par-
*p < .05. **p < .01. ***p < .001. ents reported not doing these things.
Douglas et al.
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 adoles-
cent’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 inter-
nationally (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 chal-
lenging for parents and is somewhat dependent on the ado-
lescent 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 cyber-
bullying 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 dis-
closed to parents. As the landscape of monitoring adoles-
cent’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 neg-
ative 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 informa-
tion 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 filter-
ing 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
257
media (Krcmar & Cingel, 2016; Padilla-Walker & Coyne,
2011; Padilla-Walker et al., 2012; Sonck et al., 2013). Nev-
ertheless, slightly fewer parents discussed risks such as sext-
ing 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 con-
versations can be difficult for some parents. School nurses
can help facilitate these conversations by providing educa-
tion for parents on effective communication on difficult
topics.
When comparing groups, more parents of daughters
reported knowing the passwords of the various communica-
tion 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 ado-
lescents. 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 prac-
tices 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 ado-
lescents (Families Managing Media, 2020).
Consistent with prior research regarding parental media-
tion of adolescent’s internet use, these results showed par-
ents 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 adoles-
cent social media use as an important topic specifically for
school nurses as they interact with preadolescents and
adolescents.
258
Implications for School Nurses
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 med-
iating 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
Limitations of this study included the sample demographics
and limited generalizability. Most participants were White
mothers with high levels of education. Therefore, the find-
ings 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 par-
enting 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 homoge-
nous 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 devel-
oped to measure parental mediation constructs to the
The Journal of School Nursing 39(3)
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 adoles-
cent social media use is needed.
Conclusion
This study highlighted areas of concern and need for educa-
tion 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 sev-
eral risks and believe they should be monitoring their ado-
lescent’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 learn-
ing, 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 psychometri-
cally sound instruments to measure parental monitoring and
mediation of adolescent social media use. Finally, more
research is needed to explore the development of interven-
tions for school nurses to use for the education of parents and
measure student health and education outcomes (Best et al.,
2018).
Acknowledgment
We would like to thank Dr Kathleen Rhodes, PhD, RN, FNP-C,
assistant professor of Nursing and Nurse Practitioner in a school-
based clinic for her expertise and contribution to this article.
Author Contributions
K.D.D., K.K.S., M.W.S., J.W., L.M., and L.Z. contributed to con-
ception or design; contributed to acquisition, analysis, or interpre-
tation; 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.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Douglas et al.
Funding
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.
ORCID iD
Kimberly D. Douglas, PhD, RN, CNE https://orcid.org/0000-
0003-1804-3239
References
ABC News. (2017). Teen girls open up about the ‘constant pres-
sure’ of social media. https://abcnews.go.com/Nightline/video/
teen-girls-open-constant-pressure-social-media-50879297
Ajzen, I. (1985). From intentions to actions: A theory of planned
behavior. In J. Kuhl & J. Beckmann (Eds.), Action control (pp.
11–39). Springer-Verlag.
Ajzen, I. (2006). Constructing a theory of planned behavior ques-
tionnaire. http://people.umass.edu/aizen/pdf/tpb.measurement.
pdf
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and
predicting social behavior. Prentice-Hall.
Allison, V. L., Nativio, D. G., Mitchell, A. M., Ren, D., & Yuhasz,
J. (2014). Identifying symptoms of depression and anxiety in
students in the school setting. Journal of School Nursing, 30,
165–172. https://doi.org/10.117/1059840513500076
American Academy of Pediatrics Council on Communications and
Media. (2016a). Media and young minds. Pediatrics, 138(5),
e20162591. https://doi.org/10.1542/peds.2016-2591
American Academy of Pediatrics Council on Communications and
Media. (2016b). Media use in school-aged children and adoles-
cents. Pediatrics, 138(5), e20162592. https://doi.org/10.2196/
ijmr.5668
Apple, I. (2018, June 4). News release: iOS 12 introduces new
features to reduce interruptions and manage screen time.
https://www.apple.com/newsroom/2018/06/ios-12-introduces-
new-features-to-reduce-interruptions-and-manage-screen-time/
Best, N. C., Oppewal, S., & Travers, D. (2018). Exploring school
nurse interventions and health and education outcomes: An
integrative review. Journal of School Nursing, 34, 14–27.
https://doi.org/10.1177/1059840517745359
Byrne, E., Vessey, J. A., & Pfeifer, L. (2018). Cyberbullying and
social media: Information and interventions for school nurses
working with victims, students, and families. Journal of School
Nursing, 34, 38–50. https://doi.org/10.1177/1059840517740191
Centers for Disease Control and Prevention. (2020). 2019 Youth
risk behavior surveillance system. https://www.cdc.gov/
healthyyouth/data/yrbs/results.htm
CNN. (2015). CNN special report: Being 13: Inside the secret
world of teens. https://www.cnn.com/specials/us/being13
Collier, K. M., Coyne, S. M., Rasmussen, E. E., Hawkins, A. J.,
Padilla-Walker, L. M., Erickson, S. E., & Memmott-Elison, M.
K. (2016). Does parental mediation of media influence child
outcomes? A meta-analysis on media time, aggression,
259
substance use, and sexual behavior. Developmental Psychology,
52, 798–812. https://doi.org/10.1037/dev0000108
Common Sense. (2020). About us. https://www.commonsenseme
dia.org/
Dishion, T. J., & McMahon, R. J. (1998). Parental monitoring and
the prevention of child and adolescent problem behavior: A
conceptual and empirical formulation. Clinical Child and Fam-
ily Psychology Review, 1(1), 61–75.
Families Managing Media. (2020). Screen strong. https://screen
strong.com/
Feldstein Ewing, S. W., Ryman, S. G., Gillman, A. S., Weiland, B. J.,
Thayer, R. E., & Bryan, A. D. (2016). Developmental cognitive
neuroscience of adolescent sexual risk and alcohol use. AIDS Beha-
vior, 20, S97–S108. https://doi.org/10.1007/s10461-015-1155-2
Frankel, A. S., Bass, S. B., Patterson, F., Dai, T., & Brown, D.
(2018). Sexting, risk behavior, and mental health in adolescents:
An examination of 2015 Pennsylvania Youth Risk Behavior
Survey data. Journal of School Health, 88(3), 190–198.
https://doi.org/10.1111/josh.12596
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures:
Guidelines for health supervision of infants, children, and ado-
lescents (4th ed.). American Academy of Pediatrics.
Hamm, M. P., Newton, A. S., Chisolm, A., Shulhan, J., Milne, A.,
Sundar, P., Ennis, H., Scott, S. D., & Hartling, L. (2015). Pre-
valence and effect of cyberbullying on children and young peo-
ple: A scoping review of social media studies. JAMA Pediatrics,
169, 770–777. https://doi.org/10.1001/jamapediatrics.2015.0944
Hartley, C. A., & Somerville, L. H. (2015). The neuroscience of
adolescent decision-making. Current Opinion Behavior Sci-
ence, 5, 108–115. https://doi.org/10.1016/j.cobeha.2015.09.004
Hutson, E., Kelly, S., & Militello, L. K. (2018). Systematic review
of cyberbullying interventions for youth and parents with impli-
cations for evidence-based practice. Worldviews on Evidence-
Based Nursing, 15(1), 72–79. https://doi.org/10.1111/wvn.
12257
IBM Corp. (2016). IBM SPSS statistics for windows (Version 24.0)
[Computer software]. https://www.ibm.com/support/knowl
edgecenter/SSLVMB_24.0.0/spss/product_landing.html
Jones, S. R., Carley, S., & Harrison, M. (2003). An introduction to
power and sample size estimation. Emergency Medicine Jour-
nal, 20, 453–458. https://doi.org/10.1136/emj.20.5.453
Kelly, Y., Zilanawala, A., Booker, C., & Sacker, A. (2018). Social
media use and adolescent mental health: Findings from the UK
Millennium Cohort Study. EClinicalMedicine, 6, 59–68. https://
doi.org/10.1016/j.eclinm.2018.12.005
Kerr, M., Stattin, H., & Burk, W. J. (2010). A reinterpretation of
parental monitoring in longitudinal perspective. Journal of
Research on Adolescence, 20(1), 39–64. https://doi.org/10.
111/j.1532-7995.2009.00623.x
Khurana, A., Bleakley, A., Jordan, A. B., & Romer, D. (2015). The
protective effects of parental monitoring and internet restriction
on adolescent’s risk of online harassment. Journal of Youth
Adolescence, 44, 1039–1047. https://doi.org/10.1007/s10964-
014-0242-4
260
Krcmar, M., & Cingel, D. P. (2016). Examining two theoretical
models predicting American and Dutch parents’ mediation of
adolescent social media use. Journal of Family Communication,
16(3), 247–262. https://doi.org/10.1080/15267431.2016.1181632
Liau, A. K., Khoo, A., & Ang, P. H. (2008). Parental awareness and
monitoring of adolescent internet use. Current Psychology, 27,
217–233. https://doi.org/10.1007/s12144-008-9038-6
Livingstone, S., & Helsper, E. J. (2008). Parental mediation of chil-
dren’s internet use. Journal of Broadcasting & Electronic Media,
52, 581–599. https://doi.org/10.1080/108838150802437396
Merriam-Webster (Ed.). (n.d.). Social media: erriam-Webster dic-
tionary.com. https://www.merriam-webster.com/dictionary/
social%20media
Miron, O., Yu, K. H., Wilf-Miron, R., & Kohanne, I. S. (2019).
Suicide rates among adolescents and young adults in the United
States, 2000-2017. Journal of American Medical Association,
321, 2362–2364. https://doi.org/10.1001/jama.2019.5054
Nagata, J. M., Magid, H. S. A., & Gabriel, K. P. (2020). Screen time for
children and adolescents during the coronavirus disease 19 pandemic.
Obesity, 28, 1582–1583. https://doi.org/doi.org/10.1002/oby.22917
Nathanson, A. I. (1999). Identifying and explaining the relationship
between parental mediation and children’s aggression. Commu-
nication Research, 26(6), 124–143. https://doi.org/10.1177/
009365099026002002
Nikken, P., & Jansz, J. (2014). Developing scales to measure par-
ental mediation of young children’s internet use. Learning,
Media and Technology, 39(2), 250–266. https://doi.org/10.
1080/17439884.2013.782038
Odgers, C. L., & Jensen, M. R. (2020). Annual research review:
Adolescent mental health in the digital age: facts, fears, and
future directions. Journal of Child Psychology and Psychiatry,
61(3), 336–348. https://doi.org/10.1111/jcpp.13190
Padilla-Walker, L. M., & Coyne, S. M. (2011). Turn that thing off!
Parent and adolescent predictors of proactive media monitoring.
Journal of Adolescence, 34, 705–715. https://doi.org/10.1016/j.
adolescence.2010.09.002
Padilla-Walker, L. M., Coyne, S. M., & Collier, K. M. (2016).
Longitudinal relations between parental media monitoring and
adolescent aggression, prosocial behavior, and externalizing
problems. Journal of Adolescence, 46, 86–97. https://doi.org/
10.1016/j.adolescence.2015.11.002
Padilla-Walker, L. M., Coyne, S. M., Fraser, A. M., Dyer, W. J., &
Yorgason, J. B. (2012). Parents and adolescents growing up in
the digital age: Latent growth curve analysis of proactive media
monitoring. Journal of Adolescence, 35, 1153–1165. https://doi.
org/10.106/j.adolescence.2012.03.005
Padilla-Walker, L. M., Coyne, S. M., Kroff, S. L., & Memmott-Elison,
M. K. (2018). The protective role of parental media monitoring
style from early to late adolescence. Journal of Youth Adolescence,
47, 445–459. https://doi.org/10.1007/s10964-017-0722-4
Pechmann, C., & Catlin, J. R. (2020). Facilitating adolescent well-
being: A review of the challenges and opportunities and the
beneficial roles of parents, schools, neighborhoods, and policy-
makers. Journal of Consumer Psychology, 30(1), 149–177.
https://doi.org/10.1002/jcpy.1136
The Journal of School Nursing 39(3)
Rideout, V., & Robb, M. B. (2019). The common sense census:
Media use by tweens and teens, 2019. https://www.commonsen
semedia.org/research/the-common-sense-census-media-use-
by-tweens-and-teens-2019#:*:text¼The%20Common%20
Sense%20Census%3A%20Media%20Use%20by%20Tweens
%20and%20Teens%2C%202019,-Kids’%20media%20 prefer
ences&text¼This%20large%2Dscale%20study%20explores,and
%20what%20they%20enjoy%20most
Romo, D. L., Garnett, C., Younger, A. P., Stockwell, M. S., Soren,
K., Catallozzi, M., & Neu, N. (2017). Social media use and its
association with sexual risk and parental monitoring among a
primarily Hispanic adolescent population. Journal of Pediatric
Adolescent Gynecology, 30(4), 466–473. https://doi.org/10.
1016/j.jpag.2017.02.004
Schiebener, J., Garcia-Arias, M., Garcia-Villamisar, D., Cabanyes-
Truffino, J., & Brand, M. (2015). Developmental changes in
decision making under risk: The role of executive functions and
reasoning abilities in 8- to 19-year-old decision makers. Child
Neuropsychology, 21(6), 759–778. https://doi.org/10.1080/
09297049.2014.934216
Schofield Clark, L. (2011). Parental mediation theory for the digital
age. Communication Theory, 21, 323–343. https://doi.org/10.
1111/j.1468-2885.2011.01391.x
Smith, A., & Anderson, M. (2018). Social media use in 2018. http://
www.pewinternet.org/2018/03/01/social-media-use-in-2018/
Sonck, N., Nikken, P., & de Haan, J. (2013). Determinants of
internet mediation. Journal of Children and Media, 7(1),
96–113. https://doi.org/10.1080/17482798.2012.739806
Symons, K., Ponnet, K., Emmery, K., Walrave, M., & Heirman, W.
(2017). Parental knowledge of adolescent’s online content and
contact risks. Journal of Youth Adolescence, 46, 401–416.
https://doi.org/10.1007/s10964-016-0599-7
Twenge, J. M. (2017a, September). Have smartphones destroyed a
generation? The Atlantic. https://www.theatlantic.com/maga
zine/archive/2017/09/has-the-smartphone-destroyed-a-genera
tion/534198/
Twenge, J. M. (2017b). iGen: Why today’s super-connected kids
are growing up less rebellious, more tolerant, less happy-and
completely unprepared for adulthood. Atria Books.
U.S. Department of Health and Human Services. (2010). Healthy
people 2020. https://www.healthypeople.gov/2020/About-
Healthy-People/How-To-Use-HealthyPeople.gov
U.S. Department of Health and Human Services. (2020). Healthy
people 2030. https://health.gov/healthypeople
Valkenburg, P. M., Krcmar, M., Peeters, A. L., & Marseille, N.
M. (1999). Developing a scale to assess three styles of tele-
vision mediation: Instructive mediation, restrictive media-
tion, and social coviewing. Journal of Broadcasting &
Electronic Media, 43(1), 52–67. https://doi.org/10.1080/
08838159909364474
Woods, H. C., & Scott, H. (2016). #Sleepyteens: Social media use
in adolescence is associated with poor sleep quality, anxiety,
depression and low self-esteem. Journal of Adolescence, 51,
41–49. https://doi.org/10.1016/j.adolescence.2016.05.008
Douglas et al.
Author Biographies
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.
261
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 Depart-
ment of Population Health Science, a professor of Medicine in Divi-
sion 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.
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