CCPR: So this brings us back to the question: Does Internet addiction actually exist?
Dr. Moreno: I am still not sure if it exists. I love doing this work even with a huge dose of skepticism. Can you be addicted to the Internet as a whole, or is it a series of pieces of addiction? For example, is a video game addiction online different from Facebook addiction, and is that different from the compulsive checking of a smartphone?
CCPR: To change gears, talk to us a little bit about Facebook.
Dr. Moreno: The bulk of my work has been in the area of social media. I became interested in this during my adolescent medicine fellowship when I was seeing patients who were referred for something like stomach pains, and I would ask when they started and the patient would say: “It started the day that my best friend put this thing about me on Myspace [a precursor to Facebook] and now my whole life is ruined.”
CCPR: So you became interested in the power of what was basically a single website.
Dr. Moreno: Yes. I think that the power of the site to take things that teens maybe always knew and did, but make them so plainly visible, is fascinating. Younger teens will say, “I am trying to be like the popular kids at my school, but on Facebook they all post about drinking; does that mean that I should do that?”
CCPR: And you are particularly interested in its influence on health.
Dr. Moreno: Yes. How does health get displayed within social media by teens; what does it mean to them; how can we use it to interact with them? If you think about the things that influence adolescent health behavior, it is a complex picture with inherent and external or genetic and environmental influences, but two consistent influences are media and peers. Movies, television, and music have been shown to affect adolescents’ attitudes and behaviors, particularly about things like sexual behavior and substance use. And peers are also known to greatly influence adolescents’ behavior. Facebook has the sexiness of media but it is created by peers. It is a very tailored and potent source of influence.
CCPR: You published a paper on sexual expectations and Facebook. Please tell us about that.
Dr. Moreno: Once we started looking for it, we consistently found that many young women were displaying sexual references in their Facebook profiles. So we wondered how those references were interpreted by peers of the opposite sex. We showed young men examples of references and asked them how those references would influence their intentions towards these women if they met them.
CCPR: And what did you learn?
Dr. Moreno: We found that guys saw these types of references all the time, and that they heighten the males’ sexual expectations. So the guys would tell a story about being at a bar, for example, and meeting a girl—looking her up on Facebook, and if they saw these types of references, thinking, this looks like a girl I could probably score with tonight. These references strengthened the idea that the male could “hook up” with the female, but decreased the likelihood that he wanted to date her long term (Moreno MA et al, JPediatr Adolesc Gynecol 2011;24(2):85-89).
If people are using the Internet to the exclusion of making contacts in the offline world, they may fail to build an identity and establish a peer group, which may be to their detriment for the rest of their lives.
~ Megan Moreno, MD, MPH
CCPR: Is there some good that could come out of this behavior on Facebook?
Dr. Moreno: In the course of our research, we started seeing a lot of people talking about “having a bad day.” So we used clinically relevant criteria for depression and started counting references to these criteria on people’s profiles, and we consistently found about a quarter of profiles across the college population make one or more mention of a DSM-defined symptom of depression (Moreno MA et al, Depression Anxiety 2011;28(6):447-455; Moreno et al, Journal of Behavioral Health Services & Research, 2011;published online August 24 2011). So we asked ourselves: What can we do to get these kids some help? So now an area we have some optimism about is using these online disclosures to try to link these kids to clinical care.
CCPR: And how would you do that?
Dr. Moreno: We could, for example, work with a college counseling center to determine the three most common depression keywords on profiles that are linked to positive results on the PHQ-9. Then we create a Facebook advertisement with a link to the counseling center that pops up on their college students’ profiles if one of those keywords is present. [Facebook allows advertisers to create ads on the profiles of a very targeted population based on keywords and geography, among other criteria.]
CCPR: Very interesting. Thank you, Dr. Moreno.