JMIR PEDIATRICS AND PARENTING Ardesch et al

Original Paper

Problematic Social Media Use and Lifestyle Behaviors in

Adolescents: Cross-Sectional Questionnaire Study

Frank Hendrik Ardesch, MSc; Denise Dorothy van der Vegt, MSc; Jessica Christina Kiefte-de Jong, RD, PhD
Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, Leiden, Netherlands

Corresponding Author:
Frank Hendrik Ardesch, MSc
Department of Public Health and Primary Care
Health Campus The Hague, Leiden University Medical Center
Hippocratespad 21
Leiden, 2333 ZD
Netherlands
Phone: 31 641699387
Email: [email protected]

Abstract
Background: The use of social media by adolescents has increased considerably in the past decade. With this increase in
social media use in our daily lives, there has been a rapidly expanding awareness of the potential unhealthy lifestyle-related
health effects arising from excessive, maladaptive, or addictive social media use.
Objective: This study aims to assess the association between adolescents’ social media use and health-related behaviors.
Methods: We used a cross-sectional research approach and analyzed data from 96,919 adolescents at high schools throughout
the Netherlands. A structured 43-item questionnaire was used to gather data on sociodemographics, dietary and lifestyle
factors, and the degree of social media use based on the Compulsive Internet Use Scale. Logistic regression analyses were
performed to assess the association between problematic social media use (PSMU) and lifestyle behaviors while adjusting for
sociodemographic factors.
Results: Of the 96,919 included adolescents, 7.4% (n=7022) were identified as at risk for PSMU. Furthermore, logistic
regression results showed that adolescents who are at risk for PSMU were more likely to report alcohol consumption and
smoking while simultaneously having significantly lower levels of health-promoting behavior such as healthy eating habits
(eating fruits, vegetables, and breakfast regularly) and physical activity.
Conclusions: This study confirms that adolescents at risk of PSMU were more likely to exhibit an unhealthy lifestyle. Being
at risk for PSMU was a determinant of soft drug use, alcohol consumption, smoking, poor eating habits, and lower physical
activity independent of the additional adjusted covariates including demographic variables and remaining lifestyle variables.
Future research is needed to confirm this observation in an experimental setting.

JMIR Pediatr Parent 2023;6:e46966; doi: 10.2196/46966

Keywords: problematic social media use; lifestyle factors; adolescents; lifestyle behaviors; social media; addictive social
media use; high school; users; risk factor; sociodemographic factors; addiction; internet; internet use; social media use

associations between social media use and health outcomes

Introduction [2,3].
Nowadays, social media is an important part of the daily Adolescence is a developmental stage in which paren-
life of adolescents. In today’s society, social media has been tal influence decreases and the opinions of peers become
widely adopted, and adolescents have the highest rates of more important in determining behavior [4,5]. Therefore,
social media use of any age group [1]. As the time spent by adolescence has been proposed to be an important time
adolescents online has almost doubled in the past decade, the for the development of lasting health behaviors [6]. Follow-
widespread interest in how this might be affecting them led ing the behavior learning theory, individuals learn from
to the development of scientific evidence mapping potential one another via observation, imitation, and modeling [7].
Previous scientific evidence has shown that exposure to

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online behavior is a significant source of influence on representative observational cross-sectional survey of eighth
adolescents’ health attitudes, intentions, and behaviors in and 10th grade adolescents in the Netherlands [20].
which adolescents are motivated to fit into group identities The Public Health Monitor Youth collected data through
and adopt the normative behaviors of their peers [4,8,9]. anonymous digital questionnaires in 596 high schools
throughout the Netherlands. To obtain a nationally repre-
Social media provides clear benefits, of which social
sentative sample of schools and pupils, the survey used a
interaction is the most important [10]. The interactive nature
random sampling design in a total of 25 municipal health
can provide opportunities to engage with peers on issues
care service regions. The size of samples varied per region.
and access support networks [4]. Other reasons for social
Schools were invited by letter to participate. Both parental
media use are the gathering of information and entertain-
consent and adolescents’ consent were obtained in advance of
ment purposes such as watching movies and listening to
the questionnaire. Participation in this study was voluntary.
music [1,11,12]. Despite these benefits, the negative impacts
Adolescents completed the questionnaire anonymously via
of social media use have become increasingly apparent, in
the internet during class.
particular, excessive, maladaptive, or addictive use of social
media, which is a condition also known by terms such as Participants
problematic social media use (PSMU) [13]. In general, PSMU
can be defined as “Use of social media that creates physio- A total of 596 schools were asked to participate. The school
logical, social, school, and/or work difficulties in a person’s response rate to the survey was 63.1% (n=376), and nonres-
life” [14]. There are notable unhealthy lifestyle behaviors ponse was mostly due to an overload of other surveys and
associated with PSMU among adolescents, such as physical fundamental objections. We derived the study sample from
inactivity, substance use, and poor dieting habits, and related Public Health Monitor Youth surveys conducted in 2015 [20].
to each other by confounding. Likewise, social media use The data consisted of a pooled sample of 96,919 adolescents
is positively associated with sedentary behavior [11,15]. For between the ages of 12 and 19 years who answered the
adults, there is strong evidence linking sedentary behavior questions on social media use and health behaviors.
to a higher risk of overweight and obesity, cardiovascular
disease, metabolic dysregulation, insufficient sleep, osteopo-
Ethical Considerations
rosis, and a reduction of psychosocial functioning [15,16]. Data collection procedures were approved (W19_148 #
Additionally, these negative health consequences are more 19.183) by the ethical committee of The National Insti-
likely to develop in adults who spent greater amounts of tute for Public Health and the Environment. Further details
time sedentary in their youth [15,17]. These consequences on the study design and methods are described elsewhere
highlight the importance of restricting sedentary time among [20]. Following Dutch law (Wet medisch wetenschappelijk
young people and adolescents [15]. onderzoek met mensen), ethical review and approval were not
required for the Public Health Monitor Youth as participants
International concern for the well-being and health of
were not subjected to any intervention or treatment. Addition-
adolescents has been growing after reports of increases in
ally, parents and children were informed by letters that by
unhealthy lifestyle behaviors [18]. The literature showed both
filling out the questionnaire, they consented to the anonymous
positive and negative associations between health behavior
use of data for research.
and social media whereby the overall conclusion states that
the time spent on social media replaces time spent other- Questionnaire
wise on health-related behaviors, such as physical activity
or sleeping [1,3,5,11,12]. These findings are consistent with A questionnaire with 43 multiple-choice questions was
the displacement hypothesis, which declares that interac- used to elicit information regarding each adolescent’s social
tions through online relationships would displace the time media use and lifestyle behavior (Multimedia Appendix 1).
allocated for offline activities, resulting in a disruption to The questionnaire was divided into five parts. In the first
one’s supposedly more valuable offline relationships [6,19]. part, adolescents were requested to respond to general and
However, most of the research on this topic has been demographic questions (eg, sex, age, type of education, and
conducted in Asian countries, and therefore, European results origin). The second part covered the perceived physical,
are of great interest as an addition to the current literature social, and mental health of the adolescents. The third part
[14]. Furthermore, most studies did not account for other provided questions about their lifestyle behaviors. Questions
lifestyle factors that can confound the observed associations. on lifestyle behaviors included substance use (eg, “What
Therefore, this study aimed to explore the health impacts types of substances have you ever used?”), alcohol consump-
related to a lifestyle of social media use among adolescents tion (eg, alcohol use per 4 wk and in a lifetime), smoking
living in the Netherlands. (eg, “Have you ever smoked?” and “How often do you
smoke”), eating habits (breakfast habits and the number
of days eating fruits or vegetables), and physical activity
Methods (number of days per week of physical activity for at least
1 h). In the fourth part, the adolescents were asked about their
Data Source school life experiences (eg, functioning at school or bully-
ing). The last part addressed questions related to adolescents’
The data used for the study were collected from the Pub-
social media use, gaming resilience, and sexuality. Questions
lic Health Monitor Youth 2015, which is a nationally
related to social media referred to the use of messaging via
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smartphone, tablet, or PC (eg, WhatsApp or Snapchat); social and eating breakfast (5 or more times a week: yes/no), fruits
network sites (eg, Facebook or Twitter); and forum sites. The (5 or more times a week: yes/no), or vegetables (5 or more
frequency of social media use (“How often are you active times a week: yes/no). For soft drugs, hard drugs, and alcohol,
on social media?”) was measured by a Likert-like scale with the “recently used” category indicates that someone used
6 response possibilities: never, <1 day per week, 1 day per drugs or alcohol in the last 4 weeks.
week, 2-3 days per week, 4-5 days per week, or (almost)
every day. Statistical Analysis
The P value for trend was calculated by using a linear
Problematic Social Media Use regression model. Results of the multiple logistic regres-
To measure the consequences of PSMU, the abbreviated sion models to analyze the association between PSMU and
version of the Compulsive Internet Use Scale from the Dutch individual lifestyle factors were presented in an unadjus-
research institute IVO was used [21]. The outcome variable, ted model (model 1); a model adjusted for sex, age, and
at risk for PSMU, was based on the following 7 items of the educational level (model 2); and a model between the risk
Compulsive Internet Use Scale: “How often do you find it of PSMU and lifestyle behaviors, corrected for sex, age,
difficult to quit social media?” “How often say others that educational level, family composition, mutual adjustment for
you should spend less time on social media?” “How often substance use (soft and hard drugs), alcohol consumption,
would you rather use social media than spend time with smoking, physical activity, and eating habits (fruit, vegeta-
others in real life?” “How often do you feel restless, stressed ble, and breakfast intake; model 3). The associations were
or annoyed when you can’t use social media?” “How often reported as odds ratios (ORs) with 95% CIs. P values
do you neglect your homework to use social media?” “How <.05 were considered to be statistically significant. Missing
often are you using social media because you feel bad?” values were imputed by using the Markov chain Monte Carlo
and “How often do you lack sleep through social media?” A method. After the imputation procedure, the effect estimates
Likert-like scale was used with 5 possible responses: never were pooled. The pooled estimates were used to perform the
(0), seldom (1), sometimes (2), often (3), and very often (4). analyses in this study. All analyses were performed by using
The mean values of the sum of the Likert scale responses the statistical software SPSS version 26 (IBM Corp).
were calculated, and a mean score of 0 to 2 was labeled as no
or low risk of PSMU, and a total of 2 to 4 was labeled as at
risk of PSMU. These cutoffs were based on the approach of
Results
Van Rooij et al [22] who found groups demarcating potential
addiction and high-risk use for high engagement based on Study Population Characteristics
latent class analysis in the general population. Table 1 presents the characteristics of the study sample over
two groups based on the risk for PSMU. The study sample
Covariate Assessment consisted of adolescents who answered questions on social
Covariates of interest were derived from the existing media use and health behaviors (N=96,919) in which 89,710
literature. All covariates were measured by the original (92.6%) of the adolescents were not at risk or were at low risk
questionnaire. The following covariates were considered for PSMU, while 7209 (7.4%) were at risk for PSMU. The
important because of their relationship with PSMU: sex at-risk PSMU group consisted of a higher number of female
(male/female); age (continuous); family composition (two adolescents 4749 (65.9%). Both groups had approximately
parents, stepfamily, co-parenting, single-parent household, or equal mean ages (14.29, SD 1.25 years vs 14.48, SD 1.22
living with others or on its own); educational level (pre- years), ranging from 12 to 19 years. Preuniversity educa-
vocational secondary education, senior general secondary tion was more common among low-risk users (n=19,151,
education, or preuniversity education); soft drugs (never, 21.4%) than in the at-risk PSMU group (n=856, 11.9%), and
ever, or recently used marijuana or hash); hard drugs (never, the majority of both groups attended prevocational school
ever used, or recently using ecstasy, cocaine, psyche- or senior general secondary education. Lifestyle behaviors
delic mushrooms, amphetamine, lysergic acid diethylamide, such as substance use, alcohol consumption, and smoking
gamma hydroxybutyrate, heroin, or laughing gas); alcohol were more commonly observed among the at-risk PSMU
consumption (never, ever, or recently used alcohol); smoking group. No-risk or low-risk users skipped breakfast, fruit, and
(never smoked, ever smoked, or daily smoker); physical vegetable intake less often compared to the at-risk PSMU
activity (weekly physical activity at a club or gym: yes/no); group.

Table 1. Baseline characteristics of included adolescents (N=96,919).

No or low-risk problematic social media use At-risk problematic social media use P value
Total, n (%) 89,710 (92.6) 7209 (7.4) N/Aa
Sex (female), n (%) 43,292 (48.3) 4749 (65.9) <.001
Age (years), mean (SD) 14.29 (1.25) 14.48 (1.22) <.001
Family composition, n (%) <.001
Two parents 68,537 (76.4) 4877 (67.7)

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No or low-risk problematic social media use At-risk problematic social media use P value
Stepfamily 5801 (6.5) 647 (9.0)
Co-parents 5838 (6.5) 518 (7.2)
Single parent 8573 (9.6) 956 (13.3)
With others or on its own 961 (1.0) 211 (2.9)
Educational level, n (%) <.001
Prevocational secondary education 45,760 (51) 4622 (64.1)
Senior general secondary education 24,799 (27.6) 1731 (24.0)
Preuniversity education 19,151 (21.4) 856 (11.9)
Substance use, n (%)
Soft drugs <.001

Never used 81,190 (90.5) 5601 (77.7)

Recently used 4248 (4.7) 917 (12.7)
Ever used 4272 (4.8) 693 (9.6)
Hard drugs <.001

Never used 88,193 (98.3) 6819 (94.6)

Recently used 546 (0.6) 149 (2.1)
Ever used 972 (1.1) 241 (3.3)
Alcohol use, n (%) <.001
Never used 59,433 (66.3) 3096 (42.9)
Recently used 23,510 (26.2) 3398 (47.1)
Ever used 6767 (7.5) 715 (10.0)
Smoking, n (%) <.001
Never smoked 77,081 (85.9) 4778 (66.3)
Ever smoked 8749 (9.8) 1563 (21.7)
Daily smoker 3881 (4.3) 868 (12.0)
Physical activity, n (%) <.001
Weekly, yes 69,794 (78.1) 4968 (68.9)
Eating habits, n (%)
Breakfast ≥5 d/wk, yes 76,194 (84.9) 4625 (64.2) <.001
Fruit ≥5 d/wk, yes 45,160 (50.3) 2661 (36.9) <.001
Vegetables ≥5 d/wk, yes 72,187 (80.5) 4937 (68.5) <.001
aN/A: not applicable.

PSMU and Lifestyle Behaviors 3.50-3.73), and negatively associated with physical activity
(OR 0.63, 95% CI 0.62-0.65) and fruit (OR 0.58, 95% CI
The association between being at risk for PSMU and various 0.57-0.59), vegetable (OR 0.53, 95% CI 0.52-0.54), and
lifestyle variables is shown in Table 2. Model 1 demonstrates breakfast intake (OR 0.32, 95% CI 0.31-0.33). After adjusting
that, without any adjustments, being at risk for PSMU was for sex, age, and educational level (model 2), the model
positively associated with soft drugs (recently used: OR 3.12, showed similar significant results. Furthermore, model 3
95% CI 2.90-2.35; ever used: OR 3.12, 95% CI 2.90-2.35) revealed that after adjusting for sex, age, educational level,
and hard drugs (recently used: OR 3.53, 95% CI 2.88-4.33; household composition, and the remaining lifestyle behaviors,
ever used: OR 3.20, 95% CI 2.67-3.84), alcohol consump- only the association with hard drugs became nonsignificant
tion (recently used: OR 2.77, 95% CI 2.71-2.83; ever used: (recently used: OR 1.12, 95% CI 0.90-1.39; ever used: OR
OR 2.03, 95% CI 1.96-2.10), and smoking (recently used: 1.09, 95% CI 0.87-1.37) when compared to the other models.
OR 2.88, 95% CI 2.71-3.07; ever used: OR 3.61, 95% CI

Table 2. Logistic regression results showing the association between the risk of problematic social media use and lifestyle behaviors among the
adolescents.
Outcome variable Model 1a, ORb (95% CI) Model 2c, OR (95% CI) Model 3d, OR (95% CI)
Soft drugs
Never used 1.00 (reference) 1.00 (reference) 1.00 (reference)

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Outcome variable Model 1a, ORb (95% CI) Model 2c, OR (95% CI) Model 3d, OR (95% CI)
Recently used 3.12 (2.90-3.37)e 3.32 (3.06-3.60)e 1.43 (1.29-1.59)e
Ever used 2.35 (2.16-2.56)e 2.32 (2.12-2.54)e 1.19 (1.07-1.32)e
Hard drugs
Never used 1.00 (reference) 1.00 (reference) 1.00 (reference)
Recently used 3.53 (2.88-4.33)e 3.30 (2.66-4.09)e 1.12 (0.90-1.39)
Ever used 3.20 (2.67-3.84)e 2.72 (2.24-3.29)e 1.09 (0.87-1.37)
Alcohol use
Never used 1.00 (reference) 1.00 (reference) 1.00 (reference)
Recently used 2.77 (2.71-2.83)e 3.11 (3.03-3.18)e 2.26 (2.10-2.43)e
Ever used 2.03 (1.96-2.10)e 2.20 (2.12-2.28)e 1.80 (1.64-1.98)e
Smoking
Never used 1.00 (reference) 1.00 (reference) 1.00 (reference)
Ever used 2.88 (2.71-3.07)e 2.73 (2.66-2.80)e 1.51 (1.47-1.56)e
Daily use 3.61 (3.50-3.73)e 3.37 (2.25-3.49)e 1.32 (1.26-1.38)e
Weekly physical activity
No 1.00 (reference) 1.00 (reference) 1.00 (reference)
Yes 0.63 (0.62-0.65)e 0.74 (0.72-0.75)e 0.84 (0.82-0.86)e
Fruit intake
<5 d/wk 1.00 (reference) 1.00 (reference) 1.00 (reference)
≥5 d/wk 0.58 (0.57-0.59)e 0.59 (0.58-0.60)e 0.73 (0.72-0.75)e
Vegetable intake
<5 d/wk 1.00 (reference) 1.00 (reference) 1.00 (reference)
≥5 d/wk 0.53 (0.52-0.54)e 0.55 (0.54-0.56)e 0.67 (0.65-0.69)e
Eating breakfast
<5 d/wk 1.00 (reference) 1.00 (reference) 1.00 (reference)
≥5 d/wk 0.32 (0.31-0.33)e 0.38 (0.37-0.39)e 0.52 (0.50-0.53)e
aModel 1: unadjusted.
bOR: odds ratio.
cModel 2: adjusted for sex, age, and educational level.
dModel 3: adjusted for sex; age; educational level; household composition; soft drugs; hard drugs; alcohol; smoking; physical activity; and fruit,
vegetable, and breakfast intake.
eP<.001

prevalence between 8.1% and 50.9% [23]. Nevertheless,

Discussion the direct comparison of these studies is complicated due
to the different diagnostic criteria and methodologies used
This study showed that adolescents who are at risk of PSMU
(eg, the lack of a consensual definition of PSMU) [23,27].
were more likely to exhibit an unhealthy lifestyle. Being at
This study found an independent association of social media
risk for PSMU was positively associated with substance use,
with alcohol consumption and less physical activity, which
alcohol consumption, and smoking, and negatively associ-
is comparable with the previous Dutch study by Busch et
ated with physical activity and eating breakfast, vegetables,
al [28]. They investigated the relationship between screen
and fruits regularly, independent of the additional adjusted
time (including excessive internet, TV, and video gaming)
covariates including demographic variables and remaining
and several health-related behaviors (eg, soft drugs, alcohol
lifestyle variables.
use, smoking, unsafe sex, skipping school, bullying, poor
In this survey, the prevalence of PSMU was 7.4%, which nutritional behavior, and physical activity) in adolescents.
is mostly in line with previously conducted studies [23-25]. The results demonstrated that screen time was independ-
The international variations of PSMU prevalence rates are ently associated with alcohol consumption, bullying, and less
reported on in a recent study by Cheng et al [26]. In physical activity. However, this study did not account for the
Europe and the United States, prevalence rates ranged from mutual relation between health behaviors and only adjusted
7.9% to 25.2% among adolescents, and prevalence rates in the analyses for demographic characteristics.
the Middle East and Africa ranged from 17.3% to 23.6%
Screen-based sedentary behaviors have been recognized
[23]. Moreover, the highest variation in prevalence among
as a significant contributor to negative health indicators in
adolescents was observed in Asian studies, with a reported
various aspects of adolescents [16,29]. Physical consequences
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consisted of being overweight and having risk factors analyzed both common risk and protective factors for risk
for cardiovascular diseases (eg, obesity, hypertension, and behaviors [42,43].
high-density lipoprotein dysfunction) due to a lack of physical
This study was strengthened by the fact that this study
activity and passive food consumption [16,30,31]. Adolescent
was conducted with nearly 100,000 adolescents in the
screen time and skipping breakfast regularly are associated
Netherlands, using one of the largest surveys ever conduc-
with a higher calorie intake [32]. Eating in front of a
ted in terms of the number of samples of epidemiological
screen and not having a regular breakfast routine can lead
research into PSMU among adolescents [44]. Besides the
to excessive snacking and poor food choices [33]. This results
large sample size, the participating schools were randomly
in a higher calorie intake, which can contribute to weight
selected nationwide. This random selection supports the
gain and other health problems. Furthermore, sleep quality
assumption that this sample is representative of the entire
is affected by exposure to bright and blue lights emitted by
Dutch population. Analyses were also strengthened by not
digital devices that may suppress melatonin production and
only adjusting for potential confounding factors (sex, age, and
cause circadian disruption [16,34]. Another mechanism that
socioeconomic status) but also mutually adjusting for other
affects sleep is chronic sympathetic arousal. Psychophysio-
lifestyle factors as unhealthy behaviors cluster together [45].
logical arousal may increase due to playing video games,
A limitation of this study was that the data was collected
which leads to sympathetic dysregulation [16,34]. As a
as a cross-sectional study. For this reason, it is not possible
result, pre-bedtime relaxation may be impeded, which leads
to determine whether significant associations between PSMU
to delayed and shortened sleep [16,35]. At the same time,
and the presumed outcomes such as an unhealthy lifestyle
chronic sympathetic arousal is also associated with metabolic
are causal or whether adolescents with an unhealthy lifestyle
dysregulation, including lower levels of cortisol and insulin
are more likely to engage in PSMU; additional longitudinal
resistance [16]. Lastly, a study by French et al [36] observed
data assessments with multiple measures of social media
that outdoor activity stimulates the release of dopamine from
addiction are needed. Additionally, social desirability may
the retina. This release of dopamine suppresses the develop-
have influenced the results, as the data was collected using
ment of myopia. Hence, adolescents who spend more time
a self-reported questionnaire. However, since the question-
inside are more likely to become myopic.
naire was anonymous and not linked to adolescents’ health
Neurophysiological issues can accompany PSMU. One of records, bias due to social desirability was more likely to be
these issues is a low level of support, resulting in decreased diminished. Another shortcoming is the missing data about
social coping, for example, less social support and attachment mental health. The psychiatric profile of the adolescents was
with family and peers [16,37,38]. This decrease in social not assessed in this study and could be an important factor
coping comes at the expense of face-to-face contact, which according to recent research [46]. Therefore, it is possible
in turn is strongly associated with positive well-being and that mental health problems such as depression have gone
life satisfaction [16,38]. All of these components together unnoticed and may have biased the outcome results, assuming
increase the risk for depression, isolation, and loneliness, and that adolescents with mental issues are less likely to make
may further maintain addictive behavior [16,37]. Likewise, healthy lifestyle choices. Furthermore, the questionnaire has
neuroanatomical changes may occur, including decreased not been validated. Therefore, differential misclassification
impulse control and dysfunctional decision-making and could influence the results. Lastly, it can be asserted that,
emotional processing, and can involve craving behavior and over the past 8 years, social media has undergone transfor-
maintain addictive behavior [16]. Furthermore, it is known mations that make contextual alignment between 2015 and
from recent studies that several health-related behaviors have 2023 somewhat challenging. Nevertheless, we intentionally
a clustered profile. These behaviors influence each other opted to use pre–COVID-19 pandemic data due to its reduced
instead of acting independently on one’s health [39]. This bias. Subsequent research endeavors should aim to replicate
clustered profile is accompanied by a synergetic effect, which our findings using the same methodology to validate our
means that certain behaviors increase the likelihood of being outcomes.
involved in other risk behaviors [40]. Consequently, due
Concerns about PSMU have increased since the preva-
to this covariance, the risk of disease is higher with clus-
lence increased due to the COVID-19 pandemic [47-49].
tered behaviors compared to nonclustered behaviors. This
Given its impact on health, it is important to develop
increase can be explained by the “Gateway” hypothesis
interventions to reduce PSMU. Both pharmacotherapeutic
that, on top of the health risks that come with certain risk
and psychological interventions have been studied to reduce
behaviors, someone’s mindset and decision-making abilities
PSMU [50]. Pharmacotherapeutic interventions have mainly
are affected by partaking in other risk-taking behaviors
paid attention to dopamine regulators and selective seroto-
[39,41,42]. Empirical support for this theory has been found.
nin reuptake inhibitors since these medications have proven
For example, alcohol users are more likely to take part in
effective for other psychological conditions such as attention-
smoking than nonalcohol drinkers [39,41]. Another explan-
deficit/hyperactivity disorder, substance use disorder, and
atory hypothesis for the co-occurrence of risk behaviors
obsessive-compulsive disorder [51,52]. A recent meta-analy-
during adolescence is the “Problem Behavior Theory,” which
sis by Kim and Noh [53] showed that cognitive behavioral
suggests that partaking in “problem behavior” in early
therapy, family-based interventions, and counseling programs
adolescence is enacted as a means of demonstrating maturity
can reduce the severity of PSMU [53]. However, evidence on
and independence and repudiating conventionality [42]. This
which intervention is most effective in reducing the severity
theory has been empirically supported by a few studies that
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of PSMU and its subsequent impact on health and health the COVID-19 pandemic, with adolescents being more likely
behavior is limited. Given the nearly universal accessibility to develop PSMU. While social media use is not inherently
of social media, public health authorities have the opportunity negative, offering several benefits such as social connection
to disseminate messages to adolescents in an innovative way and interaction, excessive and uncontrolled social media use
using social media to promote healthy decision-making and can be accompanied by negative health-related behaviors.
thereby a healthy lifestyle. Nowadays, there is considerable This study confirmed that adolescents who are at risk of
interest in digital interventions for behavior change that seem PSMU were more likely to exhibit an unhealthy lifestyle.
cost-effective [54]. Despite the wide use of some health apps Being at risk for PSMU was an independent risk factor for
or devices, only a few health apps contain evidence-based substance use, alcohol consumption, smoking, poor eating
behavioral change strategies or theoretical frameworks, or habits, and physical activity independent of the additional
are based on clinical guidelines, and most of them ignore adjusted covariates including demographic variables and
the totality of health behaviors including PSMU [55,56]. remaining lifestyle variables. To develop effective social
Therefore, the validation of the effectiveness of these digital media interventions, public health must prioritize studying the
interventions requires future research to address both the clustering of multiple health-related behaviors.
challenge of PSMU as well as other health behaviors.
Social media use is currently one of the most popular
activities in today’s world, which has further increased after

Acknowledgments
We would like to acknowledge the Municipal Health Service–Medical Emergency Services Organization in the Region for
providing the data used in this research.
Conflicts of Interest
None declared.
Multimedia Appendix 1
Basisvragenlijst Gezondheidsmonitor Jeugd 2015.
[DOCX File (Microsoft Word File), 60 KB-Multimedia Appendix 1]
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Abbreviations
OR: odds ratio
PSMU: problematic social media use

Edited by Sherif Badawy; peer-reviewed by Danielle Lambert, Narges Esfandiari; submitted 03.03.2023; final revised
version received 27.10.2023; accepted 01.11.2023; published 28.12.2023

Please cite as:

Ardesch FH, van der Vegt DD, Kiefte-de Jong JC
Problematic Social Media Use and Lifestyle Behaviors in Adolescents: Cross-Sectional Questionnaire Study
JMIR Pediatr Parent 2023;6:e46966
URL: https://pediatrics.jmir.org/2023/1/e46966
doi: 10.2196/46966

© Frank Hendrik Ardesch, Denise Dorothy van der Vegt, Jessica Christina Kiefte-de Jong. Originally published in JMIR
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