Social media use is a pervasive aspect of our culture and one of the primary tools we rely on for social connection. Platforms like Facebook, TikTok and Instagram shape the way we nurture friendships, explore interests, gather news and promote events that bring us together.

But a growing body of research calls into question whether social media's harmful effects on young people outweigh the benefits it provides for self-expression, creativity and fostering relationships.

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U.S. Surgeon General Dr. Vivek Murthy issued an advisory Tuesday building on a recent wave of new guidance and recommendations for social media use among children and teenagers. He urged serious consideration of how policymakers, technology companies, parents, researchers and kids can examine the impacts of social media and adjust to make these platforms more supportive of mental health.

"Children are exposed to harmful content on social media, ranging from violent and sexual content, to bullying and harassment," Murthy said. "And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends. We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address."

A 25-page report from Murthy dives into some alarming statistics about the level of dependency young people have on social media and the problems it introduces.

Brain development a major concern for heavy social media users

About 95% of youth ages 13-17 use some form of social media, including more than one-third who say they are on these platforms "almost constantly," the Pew Research Center reported last year.

In the U.S., most social media sites have minimum age requirements of 13, but nearly 40% of children ages 8-12 report that they also use social media. The most common social media platforms used by teenagers are YouTube, TikTok, Instagram and Snapchat. Older groups are more often users of sites like Facebook, Reddit and Twitter.

Murthy said there is simply not enough evidence yet to determine whether social media is safe to be used by children and teens, but existing research suggests there are clear risks and negative consequences that stem from heavy reliance these platforms.

The surgeon general's report emphasizes that brain development, especially between ages 10-19, is a crucial factor in assessing the risks of social media. These years are typically formative and emotionally turbulent for young people — and they tend to be the stages of development when problems such as depression emerge.

Research suggests frequent social media use may be linked to changes in the developing brain related to emotional learning and behavior, impulse control and moderating social conduct. Among girls ages 11-13 and boys age 14-15, social media use is specifically associated with decreased life satisfaction, according to large U.K. study involving more than 84,000 participants from 10 to 80 years old.

In the U.S., one long-term study found that youth ages 12-15 who spent more three hours daily on social media were twice as likely to develop depression and anxiety. These results came after adjusting for the mental health histories of the study participants. The teens who spent more time on social media showed higher levels of internalizing and externalizing problems, leading to personal turmoil and behaviors that negatively affect others.

A significant factor in these outcomes is not necessarily the general use of these platforms, but rather the types of content that young people see on them. That includes videos, photos, comments and links to outside sources.

Nearly two-thirds of adolescents say they are "often" or "sometimes" exposed to hate-based content on social media, including about one-third of girls of color, who say they see racist language at least monthly, Murthy's report noted. 

Nearly half of adolescents ages 13-17 report that social media has a negative effect on their body image, compared to 40% who say it has no strong effect and 14% who say it makes them feel better about their bodies, according to the Digital Wellness Lab at Boston Children's Hospital. Multiple studies found that social comparison on social media platforms is likely a contributing factor to the development of eating disorders.

And in a review of 36 studies, the relationship between cyberbullying on social media and depression was found to be strongest among adolescent girls and LGBTQ+ youth.

Perhaps most telling, nearly 75% of teens surveyed by Pew believe social media sites are doing only a fair or poor job of addressing online harassment and cyberbullying.

What can be done to manage social media's risks for youth?

The surgeon general's report comes on the heels of new guidelines issued by the American Psychological Association, which advises that young people should be trained in social media literacy before they create accounts. This could lead to more "balanced, safe and meaningful experiences" on these platforms, the APA said in sharing 10 recommendations for parents, educators and tech companies.

Much of Murthy's report focused on how stakeholders can make concerted efforts to address the harms that social media causes among young people. It warned that kids and adolescents don't have the luxury of waiting years before these problems are better understood and new approaches are taken.

Nearly 70% of parents believe parenting is now more difficult than it was 20 years ago, according to research cited in the report. They cite technology and social media as the top two reasons. Although most parents recognize it is their responsibility to manage the risks of social media for their children, about 80% believe tech companies share in that responsibility.

State governments have become more active in considering ways to contain the negative influences that social media has among youth. Utah recently became the first state to require parental consent for minors to sign up for social media sites and banned children from using these platforms during school hours and overnight. That law, expected to take effect next March, likely will be challenged in court by the tech companies it affects. 

Lawmakers in Ohio, Connecticut, Pennsylvania and other states also have explored legislation regulating social media, while federal lawmakers have proposed the Clean Slate for Kids Act to require tech companies to delete data collected on children under 13 years old.

Some of these legislative efforts have been politically controversial because they are viewed as threats to the First Amendment. Verification requirements also may exclude certain disadvantaged adults from using social media platforms if they don't have the necessary identification, and critics question whether the privacy of the data that's collected during sign-ups will be protected. 

Murthy's report referenced the history of regulatory safeguards that have been created for industries like toys, medications and transportation to protect the public. With social media, there are additional challenges to consider due to its deep integration into youth culture and its presence on personal electronics used for other, important purposes like education and communicating with parents.

To point the way forward for social media, Murthy said a multifaceted strategy is needed to elevate the positives that young people get from sites like TikTok, Instagram and Snapchat while working directly to identify and mitigate negative aspects.

One key recommendation in the report is to increase data sharing between tech companies and independent health researchers. This would produce detailed, timely findings for the public to review how social media platforms are impacting young people, Murthy said. The research could serve as the basis for changes in social media design features, making them more age-appropriate to limit exposure to harmful content and reduce the amount of time kids spend on platforms.

Parents and caregivers are encouraged to establish tech-free zones in their homes that better foster in-person relationships and teach kids about responsible online behavior.

For young people who are now aware of the pros and cons of social media, Murthy recommended they intentionally limit time on platforms, block unwanted content, be careful about sharing personal information and reach out to adults for help when they see harassment or abuse.

Murthy has directed more energy toward addressing the nation's mental health in recent months, including an April report on the epidemic of loneliness and social isolation affecting half of Americans.

His report on social media use among children received backing from the leaders of the American Academy of Family Physicians, the American Academy of Pediatrics, the American Medical Association and the American Public Health Association.

"Today's children and teens do not know a world without digital technology, but the digital world wasn't built with children's healthy mental development in mind," said Sandy Chung, president of the American Academy of Pediatrics. "We need an approach to help children both on and offline that meets each child where they are while also working to make the digital spaces they inhabit safer and healthier."