Nov 9, 2023 - Podcasts

How the U.S. Surgeon General hopes to make social media safer for kids

Young people were struggling before the pandemic. Today, their mental health challenges are acute—and social media is making it worse. U.S. Surgeon General Dr. Vivek Murthy has been sounding the alarm, and he tells Niala Boodhoo: "If we don't do something now, we are at risk of losing a generation of young people."

How does the Surgeon General plan to fix America's urgent youth crisis?

  • Plus, a reality check on efforts in Washington and beyond to make social media safer for kids.

Guests: U.S. Surgeon General Vivek Murthy; Axios tech and policy reporter Ashley Gold

Credits: 1 big thing is produced by Niala Boodhoo, Alexandra Botti, Fonda Mwangi and Alex Sugiura. Music is composed by Alex Sugiura. You can reach us at [email protected]. You can send questions, comments and story ideas as a text or voice memo to Niala at 202-918-4893.


NIALA BOODHOO: America's young people were struggling before the pandemic. Today? It's an emergency. And social media is making it worse.

U.S. SURGEON GENERAL DR. VIVEK MURTHY: "If we don't do something now, we are at risk of losing a generation of young people."

NIALA: America's youth crisis… and the Surgeon General's new plan to fix it.

I'm Niala Boodhoo, and from Axios, this is 1 big thing.

A few really difficult numbers to start us off this week: as of 2021, suicide is the second leading cause of death for kids ages 10-14, says the CDC. Rates of psychiatric emergency room visits for young people ages 6-24 went up more than 56 percent between 2011 and 2020—to 7.5 million visits. That's from a study in the Journal of the American Medical Association said this year. Surgeon General Dr. Vivek Murthy has been sounding the alarm on this for a while.

DR. MURTHY: If you have someone in your life you know who's struggling with their mental health, just raise your hand. Almost everyone in the room.

NIALA: Dr. Murthy is doing something new: talking to college kids around the country about their mental health.

DR. MURTHY: When I travel around the country and ask that same question to other audiences, the same thing happens. Almost every single hand goes up in the room. But part of the reason we're here today is not just to talk about how bad it is, but actually to talk about what we can do about it.

NIALA: That was at the University of Washington last week. I was there, too, and spoke to some students and recent graduates, including Deeya Sharma, who's headed to medical school. I asked her about the high suicide rate of young people—and whether that gets talked about on college campuses.

DEEYA SHARMA: I think it does but I don't know if people know where to look. I think there's a lot of noise at campus colleges. At big universities like ours where we have 40,000 students on campus at one point it's very easy for those voices that advocate for mental health awareness to get lost.

NIALA: Understanding why things have gotten so bad for our kids is complicated—and we know the effects of the pandemic made things worse fast. But one piece of the puzzle…is social media. 95 percent of young people ages 13-17 say they use a social media platform, according to Pew research from 2022. A third of that group say they use it almost constantly.

A Surgeon General's advisory this year cites studies saying that frequent social media use may be associated with actual changes to young developing brains, specifically in the amygdala and the prefrontal cortex. The big picture is that using social media could make kids more sensitive to social rewards and punishments…at an incredibly vulnerable time.

But there's been almost no action from tech companies or the U.S. government—later in the show we'll catch you up quick on the state of those effortse—but, in the meantime, Dr. Murthy wants to reach kids and parents directly. I spoke with him right after he talked to those students on his "We Are Made to Connect" College Tour, in Seattle.

NIALA: Dr. Vivek Murthy is the 21st Surgeon General of the United States. Welcome to One Big Thing. Thanks for being with us.

DR. MURTHY: Thanks so much, Niala. I'm excited for our conversation.

NIALA: So, I think many people still think of Surgeon General's warnings like around cigarettes when they hear your title,

DR. MURTHY: Uh huh-

NIALA: What led you to think this current crisis of mental health among young people is as acute a health problem as cigarettes was, or AIDS?

DR. MURTHY: Our office historically has focused on a number of subjects. And we, by the way, still have warning, certain warnings on cigarette packs. so folks should know that. What led me to focus on mental health and youth mental health in particular were a few things. One was conversations with young people around the country, which made it so clear to me that they were in crisis, and the second was looking at the data, which showed us that rates of depression, anxiety, and suicide were all going the wrong way.

You know, in the decade prior to the pandemic, there was a 57 percent increase in the suicide rate among young people. And the pandemic certainly made mental health struggles worse for many young people. And I worry about this because, you know, we think about adolescence and childhood, not necessarily as an easy time, but hopefully as a time when kids are thriving and when they're looking forward to what comes next, when they're optimistic about the future, But so many young people are feeling the opposite. They're feeling depressed and anxious.

They're worried about the future. And we're seeing rates of emergency room visits for psychiatric illness. We're seeing rates of calls to suicide crisis centers, all go in the wrong direction when it comes to our kids.

So putting all of this together, it led me to believe that. If we don't do something now, if we don't marshall all of our resources to address the youth mental health crisis, we are at risk of losing a generation of young people. And I say this not just as Surgeon General, but as a dad of two small kids who I'm worried about as I think about the future that awaits them.

NIALA: So when we talk about the role of social media in this specifically, Is there only a certain kind of social media that causes harm, or are we really talking about kids growing up addicted to their phones and a constant instant connection, which may actually not be a connection?

DR. MURTHY: Social media is ultimately a tool. It's a, and whether or not it helps or harms has to do with how it's designed and how it's used. We found in the recent Surgeon General's advisory that I issued on youth mental health and social media that when adolescents spend three hours or more on social media, it doubles their risk of anxiety and depression symptoms.

This is concerning because the average amount of use among adolescents is actually three and a half hours a day. But it wasn't just that. Half of adolescents were saying that they felt using social media was making them feel worse about their body image. Uh, a third of adolescents were staying up till midnight or later on weeknights, uh, using their devices and much of that was social media use.

And that's, when you take away from the sleep of an adolescent, by the way, that increases their risk of poor mental health outcomes. So, I think that what has happened is that social media, while it may have been intended to help foster stronger healthy connections, has actually not done that for many of our kids, and in fact has shredded their self esteem, has often made them feel worse about their friendships, and has substituted what used to be in-person relationships for online relationships, which often unfortunately has meant that it substituted quality for quantity. And our kids, as a result, I think have become lonelier and more isolated.

And the place where I think we have failed as a society is that we have allowed this kind of technology to go largely unchecked, into the broader population, but particularly, uh, among kids.

More than 95 percent of kids are using social media. And we've done this without putting in any meaningful safety standards, any guard rails. You know, I, as a parent, I buy a car seat only if I know that it's adequate and it's met safety standards for my kid.

I know that the foods that I, that I feed them, that the toys that we buy for them, that these all had to go through some sort of checks to make sure that they were safe. Yet when you have kids spending so many hours of their day on social media, where are the safety standards?

It's why in the advisory I called for the establishment and the enforcement of real safety standards that help protect our kids from exposure to harmful content, that help prevent them from being manipulated by features that would seek to get them into excessive use of these platforms, or lead them into excessive use.

And that would also protect them from the bullying and harassment that too many kids are experiencing, including from strangers online.

NIALA: This is one area where there's bipartisan agreement when it comes to regulation on big tech for this, but do you see a likelihood of really strict regulation? Like, do you feel like that's a purview of the federal government, of Congress, that they should be doing this?

DR. MURTHY: This is one place where government is absolutely necessary. Nobody else can put in independent safety standards and enforce them. We've left it up to the companies to do on their own for the last nearly two decades. I am encouraged by the fact that there is a lot of bipartisan support for protecting our kids against the adverse effects of social media.

But I think we've got to move faster. You know, our kids only have one childhood. A year might not seem like a long time in the legislative cycle. It's a long time in the life of a child. And in addition to kids, we've got to think about parents. The entire burden of managing all of this, managing this rapidly evolving technology, has fallen on the shoulders of parents.

I've talked had heartbreaking conversations with so many parents who try their level best to manage and guide their kids to social media, but then later found out that they were being abused and exploited online and using platforms that their parents never knew about because the kids were able to hide the accounts and their parents didn't know that that was possible.

So the bottom line is parents are doing their level best, but someone's got to have their back. And this is where policy makers need to not only step in, but step in quickly because kids can't wait.

NIALA: We actually got a lot of listeners who sent in questions to ask you, and I'm hoping I can just play one for you here, and have you respond to this.

DYLAN: Hello, this is Dylan from Portland. I'm a father of a three year old. Two questions.

First, what is the ideal age, if any, that any kid should get social media and then what should it look like once they get it in terms of restrictions, which app, any place to get started as parents. And secondly, from a teaching perspective, students are so addicted to it, especially by high school. What can we do as schools and as teachers?

And a lot of people want to just take away phones completely, network. That works, sometimes it doesn't, any help would be greatly appreciated.

DR. MURTHY: Well, I'm so glad Dylan asked this question and I think about this as a dad as well.

I've got kids who are five and seven, they're growing up fast, and I know they're, they're- I already know that their peers are talking about social media. Because my daughter came home, actually, when she was in her last year of preschool, and she asked my wife and I about posting a picture on social media. And we were shocked because we've never talked to her about it, but her friends are talking about it in preschool-

NIALA: Did she know the platform? Cause I'm also wondering-

DR. MURTHY: She did. She mentioned a specific platform and asked if we could post it on that.

None of this is easy, but let me tell you what I'm planning to do with my wife for our kids. My wife and I are planning to wait until after middle school to allow our kids to use social media. We will reassess when they're in high school based on three things. One, whether or not there are actually safety standards in place by them that are being enforced.

Two, based on what the scientific data shows us about the impacts of the platforms on the mental health and well being of kids. And third, based on their own maturity, and their readiness to use it. For kids who are already on social media though, for parents out there who might say, hey, actually my kid's already in middle school and is on social, what do I do?

I recognize this is not easy to manage, but I would say that it's critical to protect certain specific times in your child's day and to make those tech free zones. Those are specifically before your child goes to bed, I would say ideally an hour before your child goes to bed, and throughout the night should be time where they do not have access to their phone.

It steals their sleep, ruins the quality of their sleep, and can contribute again to mental health challenges. The second area I would protect is their time when they're in person and interacting with friends and with family members. That could be, you know, playdates if your kids are younger. It could be time when they're like, you know, playing sports with their friends.

It could be time around the dinner table or when they're over at a friend's house for dinner. The third area to protect is our kids time for learning. And this gets into the second part of Dylan's question around school. You know, we all think we can multitask, but the science is very clear we can't. And when we get distracted, it takes us many minutes to regain our focus.

Imagine being a child in the classroom, trying to listen to what the teacher is saying, but then constantly being distracted by your phone lighting up with alerts or texting in between. That's not a recipe for learning.

There are more and more schools that are making efforts to make classroom time phone free time. And I actually think that that's a good idea. I don't think it's always easy to do, and there are important questions schools will have to figure out, like, number one, how to bring parents and kids into that discussion process before such a system is established.

Two, how to think about enforcement, so that you're not burdening teachers with more and more responsibilities. I will say one last thing. None of this is simple. Thank Especially if you're a parent whose child is saying, "Hey, everyone else is on social media.

Why am I the only one who's not allowed to be on it?" So here, what I think is really important is for parents to actually partner with each other. To recognize that, hey, none of us as parents can do this work alone. But if there are a few of us parents who make this decision together, to delay use for our kids or to have tech-free zones in our children's days.

It makes it easier for us as parents, but also for our kids, because they know that, hey, I'm not the only one being singled out here. There are other kids in my class, in my school, who may be going through a similar experience.

NIALA: More coming up with Dr. Vivek Murthy, Surgeon General. Stay with us.

Welcome back to 1 big thing, from Axios. I'm Niala Boodhoo.

Dr. Vivek Murthy has made the mental health of young people a main cause for his office. That's what's behind the Surgeon General's "We Are Made to Connect" College Tour. At each stop, he is speaking to students and issuing them a five-day challenge.

DR. MURTHY: I think it's so important for us that we focus our energy on rebuilding social connection, which is one of the most powerful ways we can help reduce the risk of mental illness down the line.

The 5-for-5 challenge that we're posing, uh, it's designed to give them the experience of social connection and ideally to build a habit. And the challenge itself is very simple. We asked them over the course of the next five days to take five actions that connect them to someone else. And those could be either expressing gratitude, extending support, or asking for help.

NIALA: How do you, how much do you worry about your ability to get your message across on health and on this, when everything that the government does is often seen as partisan.

DR. MURTHY: I'll tell you this, Niala, there's no substitute to showing up in people's communities and speaking directly to them. That's how we rebuild trust. It's by showing up where people are. It's by hearing their questions and their concerns. It's by speaking to them about what we feel and what our ideas are, what our concerns are.

It's what I learned when I was in medical school. It's how I've approached being a doctor. To have an honest and open conversation with the patient and to build trust through transparency.

NIALA: So, we've seen data about specific risks to young women on social media and we had a mom ask this question.

LISTENER: As a mom of a young girl, I worry about the impact of social media on their body of steam and their body image and I'd love to hear Dr. Murthy's thoughts about how we can... protects them from the awful images that they see on social media related to women's bodies, but then also how we can help them think more critically about what they're seeing on social media in this regard.

DR. MURTHY: I wish I could tell parents, oh, you can just flip a couple of switches and your social media feed for your child will be free, of those kind of influences. We're not there yet, and we need to get there fast.

But until we do, a couple things I'd recommend. Number one, so make sure that you're actually talking to your kids about how social media is making them feel, particularly about body image. You might be surprised that they may not be talking to anyone about that, even to their friends, even though many of their friends may feel similarly.

The second thing that I would do also, is I would seriously consider, either delaying the use of social media for your children or creating tech-free zones for your kids.

The third thing I would do is to make sure we fill their lives with positive influences. We need to reaffirm our kids, help them feel like they are enough, and so how do we do that? Well, we surround them with people who appreciate them, right?

We help them extend appreciation to their friends as well. But I think right now in the absence of safety standards that are really enforced I do not feel like I can confidently say that social media is a safe place for kids, and that's why, I would, would do everything I could as a parent, to avoid my kids being on it, being exposed to harmful content, being exposed to the terrible culture of comparison that exists online. But it's again why I think as parents, we need to support each other because it's not easy, but together, I think we have a much better chance of keeping our kids safe.

NIALA: Dr. Vivek Murthy is the 21st Surgeon General of the United States. Thank you for taking the time to speak with

DR. MURTHY: Thanks so much, Niala.

NIALA: So just how close are we to seeing the kind of safeguards Dr. Murthy—and so many others—are calling for? Axios tech and policy reporter Ashley Gold has a reality check.

ASHLEY GOLD: The United States has been working toward a federal privacy bill, and that does not seem to be passing anytime soon. What does have some momentum are some pieces of legislation on Capitol Hill that are bipartisan. And that would specifically govern how social media companies like Meta, YouTube, TikTok, and X would treat children on their platforms.

That could be age restrictions. That could be new forms of accountability. That could be more transparency for both users and parents. A bill called the Kids Online Safety Act from Senators Marsha Blackburn and Richard Blumenthal has had a lot of momentum, it was possibly going to be folded into an end of year spending bill last year, and it did not.

Those two are still very much pushing for that bill. And Leader Schumer, as we've reported at Axios, is interested in some sort of package around kids online safety. However...we all know how hard it is to actually get bills over the finish line, especially when the government as it stands is prone to shutting down.

There have been a lot of lawsuits against tech companies, school districts have brought lawsuits against tech companies saying that social media has hurt kids. So have individual groups of parents and state attorneys general. So where we may end up seeing some real action sooner is the courts.

NIALA: That's all for this week's edition of 1 big thing. You can always send feedback by texting me at 202 918 4893, or emailing [email protected].

The 1 big thing team includes Supervising Producer Alexandra Botti and Sound Engineer Alex Suigura, who also composed our theme music. Aja Whitaker-Moore is Axios' Executive Editor, and Sara Keuhalani Goo is Axios' Editor in Chief. Special thanks to Fonda Mwangi for her help this week.

I'm Niala Boodhoo. Thanks for listening, stay safe, and we'll be back with you next Thursday.

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