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Using social media is a time-consuming activity of children and adolescents. Health authorities have warned that excessive use of social media can negatively affect adolescent social, physical, and psychological health. However, scientific findings regarding associations between time spent on social media and adolescent health-related quality of life (HRQoL) are not consistent. Adolescents typically use multiple social media platforms. Whether the use of multiple social media platforms impacts adolescent health is unclear.
The aim of this study was to examine the relationship between social media use, including the number of social media platforms used and time spent on social media, and adolescent HRQoL.
We analyzed the data of 3397 children (mean age 13.5, SD 0.4 years) from the Generation R Study, a population-based cohort study in the Netherlands. Children reported the number of social media platforms used and time spent on social media during weekdays and weekends separately. Children’s HRQoL was self-reported with the EuroQol 5-dimension questionnaire–youth version. Data on social media use and HRQoL were collected from 2015 to 2019. Multiple logistic and linear regressions were applied.
In this study, 72.6% (2466/3397) of the children used 3 or more social media platforms, and 37.7% (1234/3276) and 58.3% (1911/3277) of the children used social media at least 2 hours per day during weekdays and weekends, respectively. Children using more social media platforms (7 or more platforms) had a higher odds of reporting having some or a lot of problems on “having pain or discomfort” (OR 1.55, 95% CI 1.20 to 1.99) and “feeling worried, sad or unhappy” (OR 1.99, 95% CI 1.52 to 2.60) dimensions and reported lower self-rated health (β –3.81, 95% CI –5.54 to –2.09) compared with children who used 0 to 2 social media platforms. Both on weekdays and weekends, children spent more time on social media were more likely to report having some or a lot of problems on “doing usual activities,” “having pain or discomfort,” “feeling worried, sad or unhappy,” and report lower self-rated health (all
Our findings indicate that using more social media platforms and spending more time on social media were significantly related to lower HRQoL. We recommend future research to study the pathway between social media use and HRQoL among adolescents.
The number of adolescents who use social media daily has doubled in western countries, from 34% in 2010 to 70% in 2020 [
Findings on whether social media use improves or reduces children’s well-being are inconsistent [
However, studies have also shown that excessive social media use might decrease children’s well-being [
The aim of this study was to examine the relationship between the number of social media platforms used, time spent on social media, and HRQoL among children aged 13 years. We hypothesized that children who use multiple social media platforms and spend more time on social media would be likely to have lower HRQoL.
A cross-sectional study was designed using date from a cohort study—the Generation R Study. The Generation R Study is an ongoing prospective cohort study from fetal life onward in Rotterdam, The Netherlands. Detailed information on the Generation R Study has been published elsewhere [
Flowchart of participants.
The Medical Ethics Committee of the Erasmus University Medical Center approved the study (MEC 217.595/2002/202).
Children were asked to report which social media platforms they used. Nine widely used social media platforms (ie, Facebook, Instagram, Musical.ly, Pinterest, Skype, Snapchat, Twitter, WhatsApp, YouTube), “Other, namely:_,” and never used (ie, I do not use these platforms) were listed as the response options. To operationalize this variable, the number of different platforms used was counted. The variable was then divided into 0 to 2 platforms, 3 to 4 platforms, 5 to 6 platforms, and 7 or more platforms.
The time spent on social media was examined separately on weekdays and weekends since children spend more time on their phones or other devices at the weekends than on weekdays, as they are at school during the weekdays [
Children’s HRQoL was measured using EuroQol 5-dimension questionnaire–youth version (EQ-5D-Y) developed by the European Quality of Life Group [
Based on the literature, several variables were considered as the potential confounders in this study: child’s age, sex, ethnic background, family composition, net household income, and maternal educational level. Child ethnic background (Western, non-Western) was based on parental countries of birth obtained from questionnaire when the child was aged 6 years [
Descriptive analyses were applied to characterize the study population. Distribution of the reported problems in the 5 dimensions of HRQoL by the number of social media platforms used and the time spent on social media were assessed by chi-square tests and shown in
Missing data on covariates were imputed using multiple imputation methods, and 10 imputed data sets were generated. Pooled effect estimates (odds ratios [ORs] and β coefficients) and confidence intervals from these 10 imputed data sets were reported, and
Children with missing data on HRQoL (n=945) were compared with children without missing data (n=3397) using chi-square tests. Data were more often missing for children from mothers with a low educational level, a low household income, or a 1-parent family (all
To examine the robustness of our results, the relationship between the number of social media platforms used and HRQoL was examined using the continuous variable of the number of social media platforms used and shown in
Additionally, one variable-parental supervision was added as a confounder into the regression models and shown in
In total, 3397 children were included in this study. The mean age of the children was 13.5 (SD 0.4) years; 46.9% (1594/3397) were boys. More than two-thirds (2466/3397, 72.6%) of the children used 3 or more social media platforms. Of these, 37.7% (1234/3276) of the children used social media more than 2 hours on a weekday and 58.3% (1911/3277) did on a weekend day. From all 5 dimensions in HRQoL, children reported the most problems in “having pain or discomfort” (876/3385, 25.9%), followed by “feeling worried, sad, or unhappy” (557/3388, 16.4%). The average VAS score was 83.5 (SD 14.8;
General characteristics of the study population (n=3397).
Characteristic | Total | Missing | |||||
Child’s age (years), mean (SD) | 13.5 (0.4) | 112 (3.3) | |||||
Child’s sex, boy, n (%) | 1594 (46.9) | 0 | |||||
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Western | 2557 (76.0) | 33 (1.0) | ||||
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Non-western | 807 (24.0) | —a | ||||
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Low | 257 (8.2) | 268 (7.9) | ||||
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Middle | 860 (27.5) | — | ||||
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High | 2012 (64.3) | — | ||||
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<2000 | 411 (13.7) | 398 (11.7) | ||||
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2000-3600 | 791 (26.4) | — | ||||
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>3600 | 1797 (59.9) | — | ||||
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1-parent family | 542 (16.7) | 149 (4.4) | ||||
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2-parent family | 2706 (83.3) | — | ||||
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0-2 | 931 (27.4) | 0 | ||||
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3-4 | 1154 (34.0) | — | ||||
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5-6 | 763 (22.5) | — | ||||
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≥7 | 549 (16.2) | — | ||||
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<0.5 | 409 (12.5) | 121 (3.6) | |||
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0.5-2 | 1633 (49.8) | — | |||
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2-4 | 989 (30.2) | — | |||
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4-6 | 164 (5.0) | — | |||
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>6 | 81 (2.5) | — | |||
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<0.5 | 251 (7.7) | 120 (3.5) | |||
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0.5-2 | 1115 (34.0) | — | |||
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2-4 | 1408 (43.0) | — | |||
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4-6 | 321 (9.8) | — | |||
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>6 | 182 (5.6) | — | |||
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No problems | 3199 (94.4) | 7 (0.2) | |||
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Some or a lot of problems | 191 (5.6) | — | |||
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No problems | 3340 (98.5) | 6 (0.2) | |||
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Some or a lot of problems | 51 (1.5) | — | |||
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No problems | 3155 (93.1) | 8 (0.2) | |||
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Some or a lot of problems | 234 (6.9) | — | |||
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No problems | 2509 (74.1) | 12 (0.4) | |||
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Some or a lot of problems | 876 (25.9) | — | |||
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No problems | 2831 (83.6) | 9 (0.3) | |||
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Some or a lot of problems | 557 (16.4) | — | |||
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EQb VASc, mean (SD) | 83.5 (14.8) | 538 (15.8) |
aNot applicable.
bEQ: EuroQoL.
cVAS: visual analog scale.
Compared with children who used 0 to 2 platforms, those who used 5 to 6 platforms or 7 or more platforms were more likely to report having some or a lot of problems on “having pain or discomfort” dimension (5-6 platforms: OR 1.41, 95% CI 1.12 to 1.78; 7 or more platforms: OR 1.55, 95% CI 1.20 to 1.99). Compared with children who used 0 to 2 platforms, those who used more platforms were more likely to report having some or a lot of problems on “feeling worried, sad or unhappy” dimension (3-4 platforms: OR 1.42, 95% CI 1.09 to 1.85; 5-6 platforms: OR 1.61, 95% CI 1.25 to 2.08; 7 or more platforms: OR 1.99, 95% CI 1.52 to 2.60). Furthermore to using 7 or more social media platforms was related to lower VAS score (β –3.81, 95% CI –5.54 to –2.09;
The relationship between the number of social media platforms used and health-related quality of life among children aged 13 years.
HRQoLa | 0-2 platforms | 3-4 platforms | 5-6 platforms | 7≥ platforms |
Mobility, ORb (95% CI) | 1 (ref) | 1.04 (0.70 to 1.54) | 1.24 (0.81 to 1.89) | 0.94 (0.58 to 1.53) |
Looking after myself, OR (95% CI) | 1 (ref) | 0.55 (0.27 to 1.13) | 0.61 (0.27 to 1.38) | 0.75 (0.32 to 1.76) |
Ding usual activities, OR (95% CI) | 1 (ref) | 0.72 (0.51 to 1.02) | 0.70 (0.47 to 1.04) | 1.03 (0.69 to 1.53) |
Having pain or discomfort, OR (95% CI) | 1 (ref) | 1.23 (0.99 to 1.52) | 1.41 (1.12 to 1.78) | 1.55 (1.20 to 1.99) |
Feeling worried, sad or unhappy, OR (95% CI) | 1 (ref) | 1.42 (1.09 to 1.85) | 1.61 (1.25 to 2.08) | 1.99 (1.52 to 2.60) |
EQc VASd, 𝛽 (95% CI) | 1 (ref) | –0.35 (–1.74 to 1.03) | –0.91 (–2.45 to 0.63) | –3.81 (–5.54 to –2.09) |
aHRQoL: health-related quality of life.
bOR: odds ratio.
cEQ: EuroQoL.
dVAS: visual analog scale.
After adjusting for all variates, higher social media use both on weekdays and weekends were related to more problems reported in each dimension and lower VAS score (
With regard to the VAS score, higher social media use was related to lower VAS score. Children who used social media more than 6 hours per day had the lowest VAS scores compared with children who used less than 30 minutes per day (β –7.70, 95% CI –11.82 to –3.59). The results of the relationship between the time spent on social media and HRQoL during weekends were comparable to the results of weekdays, although effect estimates (ORs and β) were smaller.
The results showed that using more social media platforms was related to reported problems on the “having pain or discomfort” (OR 1.10, 95% CI 1.04 to 1.17) and “feeling worried, sad or unhappy” (OR 1.11, 95% CI 1.03 to 1.18) dimensions and lower VAS score (β –0.42, 95% CI –0.81 to –0.03) when regarding the number of social media platforms used as the continuous variable (
This study investigated the relationship between the number of social media platforms used, time spent on social media, and HRQoL in children aged 13 years. The findings show that 72.6% of the children aged 13 years used 3 or more social media platforms. Around 40% of the children used social media at least 2 hours per day during weekdays (37.7%) and over half of the children on weekends (58.3%). Our findings also show that using more social media platforms and spending more time on social media were related to lower HRQoL.
A higher number of social media platforms used was related to lower HRQoL, which is in line with our hypothesis. Children who used more social media platforms had a higher odds of reporting having some or a lot of problems on the 5 HRQoL dimensions and reported lower self-rated health than their counterparts. An increased number of social media platforms used may elevate the stress of meeting the expectations to check for updates and respond on time on several social media platforms [
However, it is important to note that decreasing the number of social media platforms used for children may be challenging in today’s world. Children may be reluctant to give up any platform because they use different platforms for different reasons [
Our findings suggest that more social media use (on both weekdays and weekends) was related to a lower HRQoL, which is in line with the hypothesis. Children who spent more time on social media were more likely to report having some or a lot of problems on the 5 HRQoL dimensions, and report lower self-rated health than those who spent less time on social media. These findings are in line with previous studies demonstrating that social media use among children aged 13 years and older was inversely associated with HRQoL outcomes such as physical health status and psychological well-being [
Previous studies have shown that children who spend more time on social media might have a greater chance of being the victim of cyberbullying or direct attacks from others on their sense of well-being [
In this study, social media use was assessed with the number of social media platforms used and time spent on social media. Further, this study was conducted among children aged 13 years, a sensitive developmental period during which little is known about social media use and its impact on HRQoL. However, the following methodological considerations need to be taken into account. First, for our cross-sectional analyses data from children aged 13 years were used. During this measurement, data on time spent on social media and the type of social media used were collected. The next measurement was performed on child aged 18 years. We recommended follow-up studies to explore the longitudinal associations between social media use and HRQoL. Second, social media use was captured via self-reported questionnaire, which may lead to overestimating or underestimating the time spent on social media. More accurate measuring method such as passive sensing (eg, apps installed on the devices that track real-time use [
This study captured the number of social media platforms used and time spent on social media among children aged 13 years. Children using more social media platforms and spending more time on social media were more likely to report a lower HRQoL, including reporting having some or a lot of problems on the 5 HRQoL dimensions and lower self-rated health. Better understanding of how social media platforms contribute to children’s health and well-being may contribute to more support in adolescent social media use.
Distribution of the reported problems in the 5 dimensions of HRQoL and the VAS score by the number of social media platforms used and the time spent on social media among children aged 13 years.
The relationship between the time spent on social media and health-related quality of life among children aged 13 years.
Sensitivity analyses: the relationship between the number of social media platforms used and health-related quality of life.
Sensitivity analyses: the relationship between the number of social media platforms used and health-related quality of life.
Sensitivity analyses: the relationship between the time spent on social media and health-related quality of life.
EuroQol 5-dimension questionnaire–youth version
health-related quality of life
odds ratios
visual analog scale
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, Municipal Health Service Rotterdam area, Rotterdam Homecare Foundation, and Stichting Trombosedienst and Artsenlaboratorium Rijnmond. The authors wish to thank the study participants for their contribution to the study and current and past investigators and staff. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
YY, JYH, AvG, and HR conceptualized and designed the study. YY performed the statistical analyses and drafted the manuscript. AvG and HR supervised the data analyses. JYH and AvG contributed to methodology considerations. JYH, AvG, and HR reviewed the manuscript for intellectual content.
None declared.