China Medical Robot Industry Report,2020-2026Jul.2020METHODOLOGY Both primary and secondary research.
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The Office for Students(OfS)mental health analytics project:an evaluation iThe Office for Students(OfS)mental health analytics projectAn evaluationJim Keane,senior analytics consultant wellbeing,JiscContents1 Executive summary3Datafirst5 Engagement needed beyond data6 The predictive model10 Integrated service dashboard12 Student consent and consultation15 The power of the nudge17 Sustainability and wider rollout18 Appendix The Office for Students(OfS)mental health analytics project:an evaluation 1The OfS mental health and analytics project ran from July 2019 until July 2022 with the intentions:To deliver a step-change in mental health outcomes for students To develop and implement new and innovative collaborative proposals that will deliver changes in student mental health outcomes,with an emphasis on testing new interventions To provide an evidence base on what works that can be disseminated across the sector To develop strategic partnerships to address issues of connectivity and complexity in mental health supportThe intended outcomes of this approach were:1.Greater understanding of the factors associated with student crisis and poor mental health for students2.The ability to more accurately identify and intervene with students who are vulnerable and in crisis3.More accessible services and interventions for students in need of support4.An increase in the numbers of these students involved with mental health and wellbeing support servicesWe have focused on three outputs from the project:(i)the predictive model,(ii)the integrated service dashboard and(iii)the creation of a model of student consent for tailored messaging(eg nudges).The predictive model1 build and integrated dashboard were exclusive to the lead higher education partner(Northumbria University),whereas different models of student consent/nudge delivery were tested across all three partners(Northumbria University,Buckinghamshire New University and University of East London).We also consider the necessary works to deliver these.Given the variations between the three institutions activities this evaluation focuses on the activities of Northumbria University,as this was the most comprehensive case study of a whole university approach to mental health analytics.1 See types of analytics in education in the appendixExecutive summaryThe Office for Students(OfS)mental health analytics project:an evaluation 2Despite the COVID pandemic and a cyber-incident affecting Northumbria University,the project delivered unique insights into how analytics can be used to support student wellbeing,its limitations,and the practical challenges involved.Key points1.The project successfully proved that it is possible to predict a students wellbeing with significant accuracy to add operational value to student support models of intervention.2.Mental health analytics identifies additional students for support compared to educational analytics.3.Institutional data must be clean,accurate and available centrally.4.Mental health analytics does not remove the need for expert decision making within wellbeing teams,but it can improve the teams effectiveness and efficiency.5.Additional work will be required to move this from a project to a deliverable service.6.Improving access to data,and improving data quality,is a journey.The Office for Students(OfS)mental health analytics project:an evaluation 3The predictive model developed as part of the project contains over 800 variables that include static indicators alongside dynamic data fed from systems and facilities used by students.Northumbria Universitys project team chose indicators for the model and dashboard following a rapid evidence assessment(RAE),interviews with wellbeing staff,a case management review and audits to identify if the data was suitable for inclusion and whether it was held within the university.Induction categoryStudyCountrySample sizeStudent categoryMeasure of suicidal thoughts&behaviourThoughtsAttemptsPlansSuicidalityParental educationAssari 2018USA27961AllGaddis 2018USA60000AllMiller 2009USA791UGMiranda 2019Spain21051st yearaMortier 20188 countries139841st yearMortier 2017Belgium23371st yearTOTAL2(50%)2(67%)1(50%)1(100%)Accommodation statusDe Luca 2019USA26292UnclearEisenberg 2007USA2843AllEisenberg 2013USA14175AllFarabaugh 2012USA898AllKetchen Lipson 2015USA43210UGbKisch 2005USA15977UnclearMiranda 2019Spain21051st yearcMortier 20188 countries139841st yearMortier 2017Belgium23371st yearTOTAL2(22%)0(100%)0(100%)FinanceAssari 2018USA27961AllDavis 2020USA889AllEisenberg 2007USA2843AllEisenberg 2013USA14175AllFarabaugh 2012USA898AllMortier 2017Belgium23371st yearWilcox 2010|USA12531st yearTOTAL4(67%)1(33%)2(50%)Data firstThe Office for Students(OfS)mental health analytics project:an evaluation 4Induction categoryStudyCountrySample sizeStudent categoryMeasure of suicidal thoughts&behaviourThoughtsAttemptsPlansSuicidalityReligiosityAssari 2018USA27961AllEisenberg 2013USA2843AllEskin 201912 countries5572UnclearJohnson 2003USA5472AllMortier 20188 countries139841st yearTOTAL4(80%)2(100%)1(100%)a Association found in males but not females,b Associations related to campus variations between sites rather than students within the same campus,c Association found in females but not malesThe RAE required potential candidate indicators to have been previously validated by multiple studies and it involved an extensive literature review.Only indicators with an established evidence base were included.This helped accelerate the development of the model as the value of the indicators had already been verified at a population level,whereas many models are developed from data specific to their institution.Data mappingFollowing validation the project team undertook an extensive data mapping exercise to identify if(and where)the information was located in the universitys systems.This was an immense task and it would have been impossible if Northumbria University hadnt already carried out an extensive data and digital transformation over the previous decade.The lack of similarly high quality,available data proved challenging to the other partner universities in the project,and prevented them from developing a predictive model from the outset.“The sector could learn how to move to a data-informed mindset from Northumbria”22 A member of the project teamThe Office for Students(OfS)mental health analytics project:an evaluation 5Initially the Counselling and Mental Health Team(CMHT)was nervous about the use of this data and who would have access to it.However,the head of student mental health and wellbeing praised the work done by the projects academic lead Dr.James Newham who worked to allay their concerns and to show the value of having all the relevant data in one place.Projects often stumble and fall where key stakeholders(who are usually the end users of any technological innovation)have not been actively engaged.We were pleased to see this was not the case at Northumbria.The academic lead actively involved the CMHT in the project by regularly attending their team meetings and interviewing them as part of the data-mapping process.This allowed the team to have confidence in the project and it is an excellent example of stakeholder engagement.Engagement needed beyond dataThe Office for Students(OfS)mental health analytics project:an evaluation 6The model produced at Northumbria University predicts the future wellbeing of students based on data already held about them.This includes identifying those students who are at risk of experiencing low wellbeing.The university used these insights to send tailored nudges to students.Building this model required using the data sourced from the data mapping activities as predictor data.However,it still needed to be modelled against an outcome variable.The research team recognised that one of the most meaningful indicators of mental wellbeing was data from students themselves,gathered at a population level through a self-report questionnaire.The team decided to use the World Health Organizations Five Well-Being Index,or WHO-5 for short,to capture this data from students.The WHO-5 comprises five questions that together measure an individuals wellbeing in the previous two weeks.As the WHO-5 has clinical validity for assessing wellbeing,and can be completed quickly and independently,it was an ideal choice for the machine-learning approach to predict.The WHO-5 measures on a continuum,returning scores indicative of all levels of wellbeing including both low and high.It can also be used to identify changes in the level of wellbeing.Students at Northumbria University were asked to complete the questionnaire at multiple points during the year.This was an enrolment task initially,and subsequent responses were sought through email invitations.To train the model the project team combined the wellbeing level identified via students responses with the data already held in university systems.All students at the university were offered the chance to participate and more than 47,000 questionnaires were completed.Response rates were significantly lower through email invitation than via the centralised enrolment task,and those who responded to the email invitation were more likely to report lower levels of wellbeing and give data at different times of year.These observations highlight the challenges of training the model on a larger volume of data(enrolment data)and data in lower volumes across the year,which are more likely to be from the lower-level reporting students.The predictive modelThe Office for Students(OfS)mental health analytics project:an evaluation 7YearMonthData collectionResponders2020Aug-OctWHO5 1(enrolment)18,7932021MarWHO5 2(email)3663MayWHO5 3(email)3485Aug-OctWHO5 4(enrolment)183942022JanWHO5 5(email)for validation of predictive model2986Developing the modelA random forest technique was used to build the model.This approach uses a subset of the source data to build many multiple random decision trees,which are iterated multiple times until the model reaches a degree of accuracy in predicting the outcome for the training data.It is then tested on data it hasnt seen to assess its accuracy.Decision tree 1DataDecision tree 2Result 2AveragingPredictionResult 1Result nDecision tree nOne of the key advantages of this approach is that it allows the model to identify patterns in data free from any inherent bias that a human might have about the importance of individual elements.To put it another way,a random forest builds its model in a way that works to derive an answer free from any preconceptions of the value of certain data.The Office for Students(OfS)mental health analytics project:an evaluation 8The model at Northumbria was shown to predict low wellbeing for some students that educational analytics3 had predicted to have a high likelihood of continuation.This is not surprising,as the model for wellbeing prediction contains over 300 variables in addition to those in the educational analytics stack and predicts a different outcome.Development of the different modelsJust like a weather forecast,a predictive model will not always be correct.This was well understood at Northumbria and it shaped the way they used the output of the model:to send students a tailored nudge email or provide over the phone support,dependent on their predicted wellbeing.As part of the project the university generated predictions for all students and used them following a standard operating procedure:1.All students who consented to mental health analytics and completed a WHO-5 were initially contacted via nudges tailored to their self-reported WHO-5 score(eg high risk were directed towards counselling,medium risk towards guided online self-help).This gave insight into levels of poor wellbeing and likely response rate.2.As the project progressed the university moved on from nudging using the self-reported score and began to use the predicted one.Previous piloting of nudges from self-report scores had allowed the research team to work with the CMHT to establish thresholds for different types of nudges based on earlier response rates(see table below).This gave the potential to nudge more frequently and to a higher number of students as they were no longer reliant on self-report scores.3.Rates of referrals to respective services mentioned in nudges were monitored.YearMonthData collectionRespondersData nudges tailored toSent2020Aug-OctWHO5 1(enrolment)18,7932021MarWHO5 2(email)3663AprSelf-report2584MayWHO5 3(email)3485Summer vacationSepSelf-report2485Aug-OctWHO5 4(enrolment)18394NovSelf-report130212022JanWHO5 5(email)-for validation of predictive model29862 Mar Predictive1941530 MarPredictive18715May Predictive184973 Educational analytics is the term used at Northumbria for learning analytics as supplied by CivitasThe Office for Students(OfS)mental health analytics project:an evaluation 94.Subsequently,the university used the integrated service dashboard to examine a subset of students who had self-reported very low wellbeing on the WHO-5 on multiple occasions.5.Use of the dashboard was for:i.)Identifying any commonalities in risk factors among this subset.For example,those with a disability were less likely to self-refer following a nudgeii.)The head of CMHT,with an additional counsellor costed to the project,reviewed the list and decided where it was appropriate to contact the students directly given awareness of other potential risk factorsPutting the analytics project into action required a high level of expert involvement from the team.While it would be possible and desirable to automate some steps,they placed a high value on human decision making when deciding who to contact and how.“Data and processes are only as good as your humans”4Northumbria University recruited an additional practitioner into the Counselling and Mental Health Team.This person was dedicated to the project and assisted with validation and understanding of the model.As well as populating the indicators to the spreadsheet the practitioner helped to identify commonalities among students who were consistently calculated to have low wellbeing and thus to decide how specific groups could be targeted.The head of service was clear with us that the team would not have been able to accommodate the demands of the project without the additional team member.For mental health analytics to be delivered at scale there needs to be a combination of data centralisation and automation that will empower efficient expert decision making,as can be seen in practice in the pilot at Northumbria University.The digital transformation and the delivery of educational analytics were the essential foundations of the projects success.This did not happen without senior staff at Northumbria understanding the importance of having high-quality data centrally available and driving the necessary institutional change.4 A member of the project teamThe Office for Students(OfS)mental health analytics project:an evaluation 10Typically,data about students is distributed in multiple,siloed services across universities,which can prove a significant barrier to delivering integrated student support.Data may be present that together would form a wellbeing concern,but its distributed nature prevents staff from seeing a student holistically.The integrated service dashboard represents an excellent step in bringing together these disparate data items.Like the predictive model the dashboard used wellbeing indicators validated by a rapid evidence assessment.After the completion of the rapid evidence assessment the CMHT were consulted on the data items they would find of most use on a dashboard for clinical management.In addition some protected characteristic data was integrated into the dashboard even though it was identified as not suitable for predictive modelling,as it was meaningful for holistic case management at an individual level(eg disability records,cultural identity).Indicators included:Disability information Whether the student had active disabled students support recommendations(active DSSR)in place Personal extenuating circumstance(PEC)information,including if it had been rejected Change of circumstance(ChoC)information Whether they were a care leaver Whether English was their first languageIntegrated service dashboardThe Office for Students(OfS)mental health analytics project:an evaluation 11The dashboard allows staff to form a picture of student wellbeing by centralising previously siloed information,including RAG-rated individual indicators and the predicted continuation score from educational analytics.The dashboard was used to support the mental health analytics project rather than being generally available to support staff,but CMHT staff were able to use it to access information they would not normally have access to easily,if at all.This provided them with a better picture of each student and allowed student contact to be personalised.Building the dashboardA member of Northumbria staff then built the indicators identified by the rapid evidence assessment and CMHT into a dashboard within the universitys existing reporting infrastructure.Had the data not already been sourced and made centrally available for educational analytics and for the predictive model it would have been impossible to construct the dashboard.The Office for Students(OfS)mental health analytics project:an evaluation 12Much work has been done on whether a students consent is required5 to process their data for analytical purposes,and at Jisc we have produced a code of practice for learning analytics and a code of practice for wellbeing and mental health analytics.The approach for consent used at Northumbria University related explicitly to the project,hence they used a model of explicit and informed consent rather relying on a different lawful basis.Again,this was easier for Northumbria to achieve as they had already developed informed consent as part of their educational analytics deployment.This was an entirely appropriate approach for the research project but it could prove unhelpful in delivering mental health analytics in a business-as-usual setting as there may be legal,safeguarding or other circumstances where students are not permitted to opt out of such interventions.65 See:Mental health analytics:An innovative approach to understanding students wellbeing,Office for Students6 Code of practice for learning analytics(2023),JiscStudent consent and consultationThe Office for Students(OfS)mental health analytics project:an evaluation 13Contrasting lawful basesIt is worth contrasting the potential lawful bases that could be used for mental health analytics:BasisPotential benefitRisks/challengesInformed consent Used at NorthumbriaProcessing will be legalProvides an opportunity to inform students of activityExcludes some students who opt out from proactive monitoringLegitimate interest/contract Typically used for learning analytics on the grounds it is necessary to provide the best educational experienceDoes not require asking for consentAllows all students to be includedRemoves agency from the studentMay expose the institution to challenges that it is necessary for the purpose statedVital interest Used in emergency when the individual is incapable of giving consentDoes not require asking for consentAllows all students to be includedCan only be used where it is“essential for the life of the data subject or that of another natural person”7Cannot be used unless it is essentialPublic task Unlikely to be usedDoes not require asking for consentAllows all students to be includedIt is unlikely institutions have a legal requirement to provide a public taskWhat should be clear from the above is that legitimate interest or informed consent are the two practical bases that could be used for mental health analytics.The choice of which to use will vary depending on the individual circumstances of each institution.Northumbria consent statementA screenshot of the Mental Health Analytics Consent Statement is shown below.It mentions the Informed consent sheet,which expands on the projects purpose,impact and data protection.7 UK GDPR,Recital 46The Office for Students(OfS)mental health analytics project:an evaluation 14Northumbria asked all students the question above at their point of enrolment and allowed them to change their response at any time via the student portal.This aligns well with our guidance:“Individuals must be informed which data will be used for wellbeing and mental health purposes.This may be done through a privacy notice at the time of collection and/or through additional communications before data are used8.”However,the key issue here is not consent,but ensuring that students are informed that this activity will happen,which also provides an opportunity to explain that institutions have responsibilities beyond just teaching.9By raising this at enrolment Northumbria gave itself the opportunity to inform every student that the university was actively interested in their wellbeing and would take steps to support them.“Student representatives and key staff groups at institutions should be consulted about the objectives,design,development,roll-out and monitoring of analytics”10Consultation and the involvement of all stakeholders are both key to the success of any analytics project and we were pleased that students and their elected representatives including the president of the Students Union were on the project board at Northumbria,alongside staff representatives from the CMHT.Over 70%of students consentedThis is borne out by the level of response to the invitation to complete a WHO-5 questionnaire with more than 47,000 student responses during the project.8 Code of practice for wellbeing and mental health analytics(2020)9 Code of practice for wellbeing and mental health analytics(2020)10 Code of practice for learning analytics(2023)and code of practice for wellbeing and mental health analytics(2020)The Office for Students(OfS)mental health analytics project:an evaluation 15As we have already seen(in Development of the different models),Northumbria were well aware that predictive analytics will produce incorrect forecasts for some individuals and so they used it as a tool to help identify the most appropriate support to offer to students.Generic signpostingOne-to-one supportGuided self-helpWellbeing workshopsEveryoneHigh riskMedium riskLow riskAll students received information on the support available at Northumbria in nudges tailored to their predicted level of risk.Both the predicted level of wellbeing and the integrated service dashboard were used in determining which student to nudge,and how.As has been mentioned(in Development of the different models)this required a large amount of human activity to determine which students would receive which nudge and then contacting each group.Despite the manual effort required,Northumbria sent 74,717 individual nudges during the pilot.Open rates and click-through rates(to the highlighted support option)varied by level of student wellbeing,time of year and academic level.Open rates were considered higher than for typical university communications and those with lower wellbeing typically had higher response rates(see the table in the appendix).The power of the nudgeThe Office for Students(OfS)mental health analytics project:an evaluation 16While click-through rates represented small percentages of the total nudges sent,they translated to large increases in the CMHT caseload.For example,only 1%of 13,021 nudges sent in November 2021 led to CMHT service registration,but that 1%equated to a 50%increase in the services caseload.This is another example of the project team working successfully with key stakeholders,in this case to time the release of nudges to ensure CMHT services were not overwhelmed.We have provided examples of the text used in the nudges in the appendix.Effective nudgingSending nudges to students and them being effective are not the same thing,and many factors can affect their success.In our experience these include:ChannelCommonly nudges are sent to the university email address for students,which they may not be monitoring.Consideration should be given to the use of personal email or text messages.Clarity and brevityStudents are more likely to engage with a message if it is clear they need to.If sent by email the subject line should convey the messages importance and urgency.The opening paragraph of the message should tell them why they have been contacted and what they are required to do.The Office for Students(OfS)mental health analytics project:an evaluation 17Throughout this evaluation we have referred to the delivery of the early alert tool being limited to Northumbria University and to the challenges posed by diverse levels of digital maturity within the sector.This may lead those with a lower level of digital transformation to conclude that using analytics to support students is beyond their reach.While reliable analytics of any kind are fuelled by high-quality data,insights may be derived from simpler data sets institutions already have.Our interviewees were clear that a lack of readiness for fully-fledged analytics should not prevent institutions from taking action using the data they already have access to.“Start where you are its a journey and the sooner you do,you will help students now,not just in the future”11Those already invested in educational/learning analytics should be confident in using these tools to identify students to support.They will also find it easier to deploy wellbeing analytics than those who arent already effectively using other forms of analytics.As part of our interviews we were told that some indicators within the integrated service dashboard no longer functioned.This is no criticism of the project,and the dashboard was only ever designed to support that,but it is mentioned here to highlight that good data governance is not a job done once.It requires continuous effort and prioritisation to maintain the insights needed to drive a proactive and progressive institution.We also noted in the Development of the different models section that a high level of manual effort was required.Much of this would be mitigated if the analytics,dashboard and ability to nudge students were all contained within a single integrated application.This is an essential prerequisite to the wider adoption of wellbeing analytics within the sector.11 A member of the project teamSustainability and wider rolloutThe Office for Students(OfS)mental health analytics project:an evaluation 18AppendixWho we spoke toJames Newham,Northumbria University academic lead for the projectSam Fowler,Civitas data engineerEllen Smith,Northumbria University head of student mental health and wellbeingMara Larson-Richard CEO Adas List,formerly VP of international for CivitasTypes of analytics in educationTypeDescriptionDescriptiveWhat happened?DiagnosticWhy did it happen?PredictiveWhat will happen?PrescriptiveHow can we make it happen?Informed consent sheet Information sheet for Office for Students Mental wellbeing projectVersion 2 3-3-2021The purpose of this information sheet is to provide you with relevant information so that you can give your informed consent.Please read this document carefully and raise any issues that you do not understand with the investigator.What is the purpose of the project?Northumbria University processes a wide variety of data which is used to identify behavioural trends,which suggest whether a student is likely to continue studying the next academic year.This information includes data on access to online resources,assignment grades,etc.We want to see whether the same data could be used to identify emotional trends as well as behavioural trends,so that we can better highlight support services that are available to individual students that may be experiencing mental health difficulties.The Office for Students(OfS)mental health analytics project:an evaluation 19To test this theory,we would like to send information about online and in-person support to students we suspect may be experiencing difficulties.It is up to you to decide whether you would like to receive this additional support.We will only do so with your consent.By providing consent,you are allowing our Student Life and Wellbeing team to access data that is processed as part of our standard processing agreement with you(Please see our Student Privacy Notice).This includes information you provide the university,attendance data,IT usage,and academic record.To develop the system,we would also like to collect data on your mental wellbeing and correlate it with other data which we process as part of our standard data processing agreement with you.Your answers to this questionnaire help identify what data could be used to indicate when students are experiencing low mental wellbeing.This information will be processed solely for the purposes of the study and will not be used to make any decisions relating to you.Why have I been selected to take part and what are the exclusion criteria?We are asking every student at Northumbria University to take part and there are no exclusion criteria.What will I have to do?All you need to do is fill in a brief online questionnaire,along with your student ID number.This should take a maximum of a couple of minutes.What is the impact on me?1.If you have consented to receive additional support,by completing this questionnaire we will add your responses and you will continue to receive personalised support.2.If you have not consented to analytics,you will not be provided personalised support,but your answers to the mental wellbeing questionnaire still provides information that helps improves our system for all other students.You can change your opt-in preferences for this project at any time by updating your details via My Info in the Student PortalWill my participation involve any physical or psychological discomfort,or embarrassment?You will not experience any physical discomfort during this study.How will confidentiality be assured and who will have access to the information that I provide?Only the research team will have access to the data provided.To link your responses to data that is routinely collected,the research team will generate a unique code from your student ID number to prevent identifying you personally in the data analysis.Your personal name will not be used in any analysis.After data collection,all information will be stored on an encrypted file location that only the research team has access to.We will not provide you with feedback on your score to maintain anonymity.All data will be destroyed 3 years after the investigation has been completed.Data that has been identified as relevant will be provided to the Student Life and Wellbeing team in case they want to get in touch personally if they feel you may be experiencing difficulties.Will I receive any financial rewards/travel expenses for taking part?As this is an online survey,no financial rewards or travel expenses will be given.How can I withdraw from the project?To withdraw your information,please contact the researcher via email within 3 weeks of completing the questionnaire to ensure that data analysis has not started(james.newhamnorthumbria.ac.uk).The Office for Students(OfS)mental health analytics project:an evaluation 20Data Protection and ConfidentialityAny personally identifiable information and data gathered during this research is subject to and will be stored in line with EU General Data Protection Regulation(GDPR)and the UK Data Protection Act(2018).The legal basis for the studys personal data processing is that the research is being conducted in the public interest,and/or is necessary for scientific and historical research purposes.For more information on how research data is processed by Northumbria University,and your rights under the GDPR,please see our Research Participant Privacy NoticeYour data will be hosted securely by our software provider CIVITAS Learning International for analysis purposes,with results of analyses sent to Northumbria Universitys Student,Life and Wellbeing team.Civitas Learning International will not directly access your personal data but their system will provide information to inform the support offered by the Student,life and Wellbeing services.Personally identifiable information will be destroyed as soon as it is no longer needed.Consent forms with personal details will be destroyed within six months of the conclusion of the project.Any IP addresses collected via online survey systems will be deleted as soon as data collection is complete.If I require further information who should I contact and how?For further information,please contact the lead researcher via email(james.newhamnorthumbria.ac.uk).If you have any concerns or worries concerning this research or if you wish to register a complaint,please direct it to the Department of Psychology Ethics Chair at nick.neavenorthumbria.ac.uk.This study and its protocol have received full ethical approval from the Department of Psychology Ethics Committee.If you require confirmation of this please contact the Chair of this Committee(Nick Neave),stating the title of the research project and the name of the researcher.Table showing number of nudges sent to students in May 2022StatusPredicted scoreSentOpen%Click%Nudge templatePostgraduateBottom decile37655%3nd decile57155%2#rd to Top401847%1%3UndergraduateBottom and 2nd225240%1rd141539%0.9.veryone415848%0.8%3Undergraduate Final year4th-Top570749%0.6%3The Office for Students(OfS)mental health analytics project:an evaluation 21Text of nudge sent to students in lower deciles(nudge 1)Dear Student Firstname,With exams,assessments,and thinking of plans for the summer,this can be a particularly emotional time of year.Recognising the impact of this uncertainty or the stress of things not going as well as hoped,we wanted to make you aware of the Universitys Counselling Support.We offer a confidential,free,one-to-one service that will allow you to talk about whatever might be troubling you.By having a conversation you will be able to explore your personal thoughts,feelings,and experiences in a safe space.Many students use the service,often returning to continue sessions each academic year.You will not have to talk about anything you do not wish to discuss.If this appeals to you,you can access register here.If face to face appointments are not your thing,we also offer Silvercloud.Silvercloud allows you to work with online material to overcome problems and achieve personal goals.A practitioner will still check in with you via written communication on the SilverCloud Portal to review your progress and offer guidance and support.You can register for Silvercloud directly here.If you are not sure whether Silvercloud or counselling is best for you,our team can help you decide by registering here.Best wishes,Ellen SmithHead of Student Mental Health and WellbeingText of nudge sent to students in medium deciles(nudge 2)Dear Student Firstname,With exams,assessments,thinking of plans for the summer,and potentially life after university,this can be a particularly emotional time of year.Recognising the impact that this uncertainty can have and the stress of things not going as well as hoped,we wanted to make you aware of Silvercloud,one of the services available from Student Mental Health and Wellbeing.If face to face appointments are not your thing,Silvercloud allows you to work with online material to overcome problems and achieve personal goals.A practitioner will still check in with you via written communication on the SilverCloud Portal to review your progress and offer guidance and support.You can register for Silvercloud directly here.If you are not sure whether Silvercloud is best for you,our team can help you decide by registering here.Best wishes,Ellen SmithHead of Student Mental Health and WellbeingThe Office for Students(OfS)mental health analytics project:an evaluation 22Text of nudge sent to students in higher deciles(nudge 3)Dear Student Firstname,With exams,assessments,thinking of plans for the summer,and potentially life after university,this can be a particularly emotional time of year.Well done on making it to this point!If things havent gone as well as you hoped,and youre feeling stressed,here are some things to consider:Firstly,dont panic!Chances are there are options for you to consider.Is it as bad as you think?Talk to friends and family-its helpful to see other perspectives,things may not be as they seem to you.Speak to someone-whether thats your tutor or Ask4Help,make sure you gather information about any e.g.resit or appeal options and any steps you could take-there might be a deadline for these.Check out the Student Portal for“Help and Support”,you will be able to raise queries about your academic situation at the end of articles about your programme.https:/myportal.northumbria.ac.uk/Help-and-support/My-ProgrammeIf there have been any barriers to your performance,consider approaching your GP for medical evidence of any health/mental health issues if required.Check out Careers support if you think there will be an implication for future study or employment plans https:/www.northumbria.ac.uk/study-at-northumbria/planning-your-career/careers-and-employment/graduate-supportIf you need emotional support about your situation consider using the Counselling and Advice Helpline from qualified counsellors and advisors call Health Assured on 0800 028 3766 24 hours a day,7 days a week,365 days a yearAlternatively,Kooth is a free,online counselling and emotional wellbeing support service which you can access on your mobile,tablet or desktop.With Kooth you can chat online to qualified counsellors,read articles written by other students,get online support from the Kooth community,set personal goals and record how you feel.You can access Kooth at The full range of counselling and self-help services offered by Student Mental Health and Wellbeing can be found here.Best wishes,Ellen SmithHead of Student Mental Health and WellbeingThe Office for Students(OfS)mental health analytics project:an evaluation 23Jisc 4 Portwall Lane Bristol BS1 6NB 0203 697 5860 helpjisc.ac.uk jisc.ac.ukThe Office for Students(OfS)mental health analytics project:an evaluation June 2024
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1Healthcare and Life Sciences World of Work 2024 Outlook 77%OF HEALTHCARE AND LIFE SCIENCES EMPLOYERS ARE STRUGGLING TO FIND THE SKILLED TALENT THEY NEEDGlobal InsightsOF HEALTHCARE AND LIFE SCIENCES ORGANIZATIONS ARE STRUGGLING TO ACHIEVE THEIR BUSINESS GOALS75 Million MORE HEALTHCARE WORKERS ARE NEEDED BY 2030Manpower|Experis|Talent Solutions2ContentsINTRODUCTIONCONCLUSIONA Prognosis of More AI AdoptionTREND ONEComing of AgeTREND TWOInoculating Against Supply Chain DisruptionTREND THREESecond OpinionsTREND FOURAn Rx for PxTREND FIVEGLP-1 Has Just BegunTREND SIXMedication RegulationTREND SEVEN3Transformation within the healthcare and life sciences sector continues to be driven by technological advancements and changing consumer behaviors.As we move further into 2024,these trends are shaping the industry in new and exciting ways.We will explore how global industry leaders will leverage accelerating innovation to create more patient-centric care and drive transformative advancements.For each trend,we will also examine the impact on the future of work.How will accelerating AI adoption impact the future of healthcare innovation and required workforce skills?How can the industry scale up to meet the growing healthcare demands of aging populations around the world?What is the impact of increasing global macroeconomic and supply chain complexity on the future of work in this industry?INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION4A Prognosis of More AI AdoptionThis shift towards AI-driven healthcare is expected to improve efficiency,accelerate drug development,reduce burnout,and potentially equalize access to care,especially in underserved areas.However,the integration of AI also demands a workforce that is adept at working alongside advanced technologies,necessitating ongoing education and adaptation.The Opportunity is Now:Today,only 38%of employers in the healthcare and life sciences sector globally say they are using conversational AI tools such as ChatGPT,which is well below the average current adoption rate(48%)for all industries.But the race is on with 22%of healthcare and life sciences employers planning to deploy these tools in the next 12 months and 14%saying they plan to do so in three years.1 Employers Identify Top Adoption Barriers:Healthcare and Life Sciences employers say high costs(34%),concerns about privacy or regulation(34%)and current employee skills gaps(31%)are the top challenges as they seek to accelerate AI adoption within their business.Employers in this sector were also more concerned about privacy,regulation and employee resistance to change(29%)than other industries.1 A“Wait and See”Diagnosis:When employers were asked to predict the impact of AI on key outcomes such as business performance,employee engagement and headcount,healthcare and life sciences respondents were the most pessimistic industry.However,most(51%)believe it will have a positive impact on overall headcount in the next two years.1HEALTHCARE AND LIFE SCIENCES EMPLOYERS ARE LESS OPTIMISTIC ABOUT AI THAN OTHER INDUSTRIES,BUT MOST(51%)STILL BELIEVE IT WILL CREATE JOBS IN THE NEXT TWO YEARS.1Workforce Implications:Relative AI pessimism within this sector offers an opportunity to differentiate,by more closely engaging employees in AI innovation.The right skilled talent can help overcome the privacy and regulatory risks,which are typically greater for businesses in this industry.A focus on managing strategic workforce planning fundamentals(e.g.,upskilling and reskilling,contingent workforce)can help organizations find the cost efficiencies needed to sustain investment in AI innovation.1.ManpowerGroup Employment Outlook Survey,Q3 2024INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION5Coming of AgeThe aging of the worlds population is exerting a profound impact on global healthcare systems.As life expectancy increases and birth rates decline,the proportion of older populations is rising rapidly.Healthcare services are facing mounting pressures,including increased demand for long-term care,higher healthcare expenditures,provider retirements,and a shifting disease burden.This trend will also constrain the workforce supply for the foreseeable future.The Golden Years:As life expectancy increases and birth rates decline,the proportion of older populations is rising rapidly,with those aged 60 and over expected to double from 12%to 22tween 2015 and 2050.In 2050,80%of 60 population will live in low-and middle-income countries.1 An Aging Workforce:By 2030,workforce aging will mean 150 million jobs will be now filled by workers over the age of 55.That figure is nearly equal to the entire working population of the US.In the Group of Seven(G7),experienced workers in these countries will comprise a quarter of the workforce by the end of the decade.Consequently,health and well-being to promote longevity will become increasingly important for employers.2 Growing Talent Needs:The global healthcare sector is facing a critical shortage of workers.By 2030,the World Health Organization(WHO)estimates the shortfall will grow to 10 million and disproportionately impact low and lower-middle income countries.3 Workforce Implications:Employers and policymakers around the world must innovate to educate,train,hire,and deploy more healthcare workers to meet the needs of aging populations.Workers in the healthcare and life sciences sector say they experience more daily stress than any other industry.At the same time,they are also the most likely to find meaning in their work.4 Employers must navigate this challenge to improve retention.A focus on diversity,equity,inclusion and belonging is not just the right thing to do in this sector,its a necessity to maximize talent pipelines amid persistent talent scarcity.1.World Health Organization 2.Bain&Company 3.World Health Organization 4.ManpowerGroup Workforce Survey,May 2024THE HEALTHCARE AND LIFE SCIENCES SECTOR MUST SCALE UP TO MEET THE NEEDS OF A RAPIDLY AGING GLOBAL POPULATION.1INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION6Inoculating Against Supply Chain DisruptionThe healthcare and life sciences industry is revamping its supply chains to be more resilient in the face of disruptions.This includes a shift toward localization bringing production of critical materials closer to manufacturing sites.Additionally,companies are embracing digitalization by using real-time data to track inventory and predict potential shortages.Sustainability is also a growing concern,with efforts being made to diversify supplier bases and mitigate climate risks.These trends aim to create a more agile and responsive supply chain that can navigate future challenges and ensure patients receive the vital treatments they need.Growing Momentum in the Americas:In 2022,reshoring and foreign direct manufacturing job announcements in the U.S.reached the highest rate ever recorded,with a total of 360,000 new jobs created,representing a 53%increase from 2021.In the medical industry alone,105 companies announced new facilities which will create more than 14,000 new jobs.1 Europe Takes Action:The European Commission recently formed a Critical Medicines Alliance to identify medicines vulnerable to global supply chain disruptions and identify opportunities to streamline regulation and consider incentives to boost local production of key drugs.2 Pharma-Focused:The overall Net Employment Outlook(NEO)the net of employers planning to hire vs.those planning headcount reductions improved slightly by 1%,totaling 27%for Q3 2024.However,strong global hiring demand in pharmaceuticals stood out with 50%vs.the previous year in Q3 2024.3 Workforce Implications:Growing supply chain complexity necessitates skilled professionals who can manage logistics,regulatory compliance,risk assessment,and vendor relationships.Demand for expertise in data analytics,digital technologies,and supply chain optimization has increased.Location strategy is an important consideration.New research from CBRE4 encourages employers to consider smaller medical innovation hubs and tools such as the Total Workforce Index to help.1.The Reshoring Initiative 2.European Commission 3.ManpowerGroup Employment Outlook Survey,Q3 2024 4.CBRERESHORING AND LOCALIZATION OF THE MEDICAL SUPPLY CHAIN WILL BE A KEY JOB CREATOR IN MANY COUNTRIES.2INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION7Second Opinions The current outlook for healthcare and life sciences offers a future of both unprecedented opportunity and uncertainty.Advancements in AI,genomics,and digital health technologies point toward a future of personalized medicine,preventive care,and more effective treatments.At the same time,a challenging global business environment increases the urgency for business transformation,human capital engagement,strategic acquisitions,and divestment.Continued Era of M.D.(Mergers&Divestments):Deal volumes for life sciences and healthcare dropped from 2022 highs,with life sciences transactions declining from 1,133 to 919,and healthcare deals falling from 1,001 to 857.However,these figures still indicate a robust level of dealmaking activity.Analysts expect strategic acquisitions and divestments to continue as major players seek to simultaneously scale and improve margins.1 Executives are Frustrated:While an overwhelming majority of healthcare leaders(90%)say AI transformation is a top priority for their organization,most(75%)say their organizations are not yet able to deliver on that priority because they have not sufficiently planned or allocated the necessary resources.2 Talent is Still Scarce:The healthcare and life science industry struggles with talent scarcity more than any other sector.Today,77%of employers in this industry say they are struggling to find the skilled talent they need.3 Workforce Implications:If todays current business uncertainty follows historical patterns,now is the time for employers to be bold and creative.Despite potential regulatory uncertainty,an aging population and rapid technological innovation offer long-term opportunities for this sector.Focusing on fundamentals such as strategic workforce planning,retention,upskilling,and reskilling offer the potential to pay future dividends.77%OF HEALTHCARE AND LIFE SCIENCES EMPLOYERS ARE STRUGGLING TO FIND THE SKILLED TALENT THEY NEED.31.KPMG 2.McKinsey 3.ManpowerGroup 2024 Global Talent Shortage SurveyINTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION8An Rx for PxThe evolution of patient experience(PX)is poised to significantly reshape the global workforce needs in healthcare and life sciences.As patients increasingly seek personalized,empathetic care,and seamless access to services,the demand for healthcare professionals who can deliver such experiences is surging.This focus on patient care is also occurring as many workers are burnt out and leaving the sector.A Triple Bottom Line:Most healthcare business leaders(60%)say improving patient experience is a top priority in 2024.At the same time,they also say increasing revenue(70%)and cost reduction are top priorities(55%).1 Growing Consumer Mistrust:As large investments to improve patient experience are increasing,so is consumers overall mistrust of medical technology.Most(55%)say technology will have a negative impact on healthcare due to increased costs,compromised privacy and unforeseen issues.This global mistrust has increased 8%since 2018.2 Improving Worker Experience to Impact PX:Employees in the global healthcare and life sciences sector report more stress than any other industry.More than half(52%)say they experience workplace stress on a daily basis.3Workforce Implications:Investments to better manage the stress of customer-facing frontline workers are simultaneously long-term investments to improve patient experience.Recruitment and retention of cybersecurity expertise is critical to avoid incidents which can impact customer trust and privacy.Increase the focus on soft skills across your organization to build a more patient-centric culture.Healthcare leaders must prioritize initiatives that promote empathy,transparency,and collaboration.1.Healthcare Financial Management Association 2.2024 Edelman Trust Barometer 3.ManpowerGroup Workforce Survey,May 2024MANAGING HEALTHCARE AND LIFE SCIENCES WORKER STRESS OFFERS AN OPPORTUNITY TO IMPROVE PATIENT EXPERIENCE.3INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION9GLP-1 Has Just BegunThe market for GLP-1 drugs,a class of medications primarily used for the treatment of Type 2 diabetes and obesity,is experiencing a remarkable surge.This growth is driven by the drugs efficacy in lowering blood sugar levels,reducing appetite,and aiding in weight management.As the prevalence of diabetes and obesity rises globally,the GLP-1 drug market is poised for continued expansion,with significant implications for patients,healthcare providers,and the pharmaceutical industry at large.A Recipe for Growth:Global use of GLP-1 drugs for diabetes and weight loss care has grown rapidly.Today,in the U.S.alone,1 in 8 Americans have used GLP-1 drugs.In the past year,Ozempic and Wegovy manufacturer Novo Nordisk has grown to become the most valuable company in Europe,surpassing global brands such as Louis Vuitton and ASML semiconductors.1 Just the Beginning:Despite the rapid growth,it is important to remember these drugs are still new.As researchers leverage AI to evaluate a growing volume of big data from patients,it could lead to the discovery of both,side effects and new uses for treatment(e.g.,prostate cancer).2 A Healthier Future of Work:Worldwide adult obesity has more than doubled since 1990 and adolescent obesity has quadrupled since 1990.In 2022,2.5 billion adults worldwide were overweight and 890 million were living with obesity.GLP-1 drugs add to a growing number of resources workers can access to improve their health and well-being.3 Workforce Implications:Competition for skilled talent will grow as the pharmaceutical industry works to introduce similar drugs and new treatments based on this new category of drugs.Production and distribution facility demand for workers will grow as manufacturing of these drugs continues to scale up.Demand for medical personnel specialized in weight loss care will grow to meet the needs of the growing numbers of patients seeking to use these drugs.1.Kaiser Family Foundation 2.Fast Company 3.World Health OrganizationMORE THAN 2.5 BILLION PEOPLE WORLDWIDE STRUGGLE WITH THEIR WEIGHT AND GLP-1 DRUGS OFFER NEW TOOLS TO HELP.3INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION10Medication RegulationThe healthcare and life sciences sector is facing a period of intensified regulatory scrutiny as it adapts to the rapid changes brought about by digitalization,automation,and new clinical trial models.While these advancements hold great promise,they also introduce a range of ethical and legal challenges,particularly concerning data privacy,consent,and health equity.The industrys response to the COVID-19 pandemic has shifted attitudes towards greater collaboration,but this comes with its own set of risks,including those related to mergers and acquisitions,product safety,as well as cost and availability.Industry Concern:When employers in the healthcare and life sciences sector were asked to rank their top AI adoption challenges,respondents around the world agreed costs and regulation were the top concerns.1 Potential Roadblocks in Europe:A growing matrix of industry regulation in Europe has the potential to slow medical device regulation.Industry leaders are very familiar with the recently enacted EU Medical Device Regulation(MDR)standards.However,devices which also use AI will also need to navigate the new EU AI Act,EU General Data Protection Regulation(GDPR)and additional local laws.2 Price Negotiation:The U.S.Inflation Reduction Act(IRA)has introduced significant changes to drug pricing,particularly within the Medicare program,which could have growing implications on revenue for the worlds largest pharmaceutical manufacturers.The full impact is not yet known,and the industry may need to adjust R&D and portfolio planning.3 Workforce Implications:Potential future R&D and compliance expenses uncertainty makes managing workforce costs increasingly important.Working with trusted partners can help offset total business risk.Future AI regulationparticularly when related to patient carewill require an increasingly skilled and agile workforce to keep up with the accelerating pace of change.1.Stanford University 2.ManpowerGroup Employment Outlook Survey,Q3 2024 3.Boston Consulting Group#1 HEALTHCARE AND LIFE SCIENCE BUSINESS LEADERS SAY COSTS AND REGULATIONS ARE THEIR TOP AI ADOPTION CONCERNS.3INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSION11Top Workforce Opportunities in Healthcare and Life SciencesLeverage Uncertainty for Opportunity:The current global business uncertainty provides opportunities for bold leaders to invest in their future human capital.Embrace AI:General industry skepticism of AI(higher than all other industries)offers an opportunity for skilled talent to find innovative solutions to leverage AI to create business differentiation.Focus on the Patient:Trusted sources such as the Edelman Trust Barometer point to growing patient skepticism of the healthcare industry.However,organizations which can earn their trust and deliver personalized care have the opportunity to gain competitive advantage.Chill Out:The workforce in this industry is the most stressed.Employers that find innovative solutions to manage it will gain a retention and talent advantage.Get Ready:The future of the healthcare and life sciences industry is bright.Organizations which can navigate the significant change management and talent scarcity challenges today will have the opportunity to deliver better experiences and outcomes for patients.INTRODUCTIONTREND ONETREND TWOTREND THREETREND FOURTREND FIVETREND SIXTREND SEVENCONCLUSIONAbout Us ManpowerGroup(NYSE:MAN),the leading global workforce solutions company,helps organizations transform in a fast-changing world of work by sourcing,assessing,developing,and managing the talent that enables them to win.We develop innovative solutions for hundreds of thousands of organizations every year,providing them with skilled talent while finding meaningful,sustainable employment for millions of people across a wide range of industries and skills.Our expert family of brands Manpower,Experis,and Talent Solutions creates substantially more value for candidates and clients across more than 70 countries and territories and has done so for more than 75 years.We are recognized consistently for our diversity as a best place to work for Women,Inclusion,Equality,and Disability,and in 2024 ManpowerGroup was named one of the Worlds Most Ethical Companies for the 15th time all confirming our position as the brand of choice for in-demand talent.Forward Looking Statements This report contains forward-looking statements,including statements regarding labor demand in the technology industry and use of emerging technologies.Actual events or results may differ materially from those contained in the forward-looking statements due to risks,uncertainties,and assumptions.These factors include those found in the Companys reports filed with the SEC,including the information under the heading“Risk Factors”in its Annual Report on Form 10-K for the year ended December 31,2023,which information is incorporated herein by reference.ManpowerGroup disclaims any obligation to update any forward-looking or other statements in this report,except as required by law.Career 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AI in Medical Research:Applications and ConsiderationsThe permanent and official location for the Health Information Management Working Group WorkingGroup is:https:/cloudsecurityalliance.org/research/working-groups/health-information-management 2024 Cloud Security Alliance All Rights Reserved.You may download,store,display on yourcomputer,view,print,and link to the Cloud Security Alliance at https:/cloudsecurityalliance.org subject tothe following:(a)the draft may be used solely for your personal,informational,noncommercial use;(b)the draft may not be modified or altered in any way;(c)the draft may not be redistributed;and(d)thetrademark,copyright or other notices may not be removed.You may quote portions of the draft aspermitted by the Fair Use provisions of the United States Copyright Act,provided that you attribute theportions to the Cloud Security Alliance.Copyright 2024,Cloud Security Alliance.All rights reserved.2AcknowledgmentsLead AuthorsJames AngleRebecca AckahContributorsMichael RozaReviewersSarah ShafqatTaresh MehraMeghana ParwateVaibhav MalikSharat GaneshAkshat VashishthaJoseph EmerickSrija Reddy AllamDr.Chantal SpleissRocking Wolf RanchMj SchwengerCo-ChairsJames AngleCSA Global StaffAlex KaluzaStephen LumpeStephen Smith Copyright 2024,Cloud Security Alliance.All rights reserved.3Table of ContentsAcknowledgments.3Table of Contents.4Abstract.5Introduction.5Drug Discovery Applications.7Diagnosis and Treatment Applications.8Cognitive Digital Twin.11Ethical and Legal Challenges.12Ethical Considerations.13Legal Considerations.15Cloud Computing.19Conclusion and Future Outlook.20References.21 Copyright 2024,Cloud Security Alliance.All rights reserved.4AbstractArtificial intelligence(AI)has revolutionized medical research by leveraging machine learning(ML),particularly deep learning(DL),to enhance various facets of healthcare.This paper explores the profoundimpact of AI across several domains within medical research.This study investigates AIs applications in drug discovery,encompassing de novo drug design,retrosynthesis,reaction prediction,and protein engineering.It also delves into AIs role in diagnosis,treatment,and personalized medicine,focusing on the concept of a Cognitive Digital Twin(CDT).Thisinnovative approach holds promise for predicting treatment outcomes,identifying health risks,andenabling proactive interventions.AIs ethical and legal challenges in medical research are also criticallyexamined.Our opinion is that recent advancements in AI,particularly in deep learning,have significantly bolsteredthese applications.Emerging methodologies in AI are poised to address complex challenges in drugdiscovery.Moreover,integrating open data sharing and collaborative model development is pivotal foradvancing AI-driven drug discovery.The paper also underscores the ethical and legal considerations1accompanying AIs rapid integration into medical research,urging prioritization of these critical issues.We conclude that AI continues to evolve with the potential to transform medical research by enhancingdeep learning capabilities and fostering interdisciplinary collaboration.AI promises to drive drugdiscovery,personalized medicine,and healthcare delivery breakthroughs.IntroductionThe advent of artificial intelligence(AI)has brought about a paradigm shift in numerous fields,withmedical research being one of the most significantly impacted areas.AI,particularly through theadvancements in machine learning(ML)and deep learning(DL),has introduced innovativemethodologies that are transforming the healthcare landscape.The ability of AI to process vast amounts2of data,recognize intricate patterns,and generate predictive models has opened new avenues for3research and development in medicine.AI is the application of computer science and data to solve4problems.ML is a type of AI that focuses on developing and using computer systems that can learn andadapt without following explicit instructions.DL is a type of ML based on artificial neural networks.55Minnick,C.,2024.Coding with AI For Dummies,John Wiley&Sons,Inc.,111 River Street,Hoboken,NJ4Gupta,R.,Srivastava,D.,Sahu,M.,Tiwari,S.,Ambasta,R.K.,&Kumar,P.(2021).Artificial intelligence to deep learning:Machineintelligence approach for drug discovery.Molecular Diversity,25(3),13151360.https:/doi.org/10.1007/s11030-021-10217-33Shafqat,S.,Kishwer,S.,Rasool,R.U.et al.Big data analytics enhanced healthcare systems:a review.J Supercomput 76,17541799(2020).https:/doi.org/10.1007/s11227-017-2222-42Sarah Shafqat,Zahid Anwar,Raihan Ur Rasool,Qaisar Javaid,et al.(2024).Rules Extraction,Diagnoses and Prognosis of Diabetesand its Comorbidities using Deep Learning Analytics with Semantics on Big Data.https:/doi.org/10.32388/67KZ7S.3.1Paul,D.,Sanap,G.,Shenoy,S.,Kalyane,D.,Kalia,K.,&Tekade,R.K.(2021).Artificial intelligence in drug discovery and development.Drug Discovery Today,26(1),8093.https:/doi.org/10.1016/j.drudis.2020.10.010 Copyright 2024,Cloud Security Alliance.All rights reserved.5.Figure 1:The general relationship between AI,ML,and DLIn recent years,integrating AI into medical research has led to remarkable progress in drug discovery,diagnostics,treatment planning,and personalized medicine.Drug discovery,traditionally atime-consuming and costly process,has been accelerated by AIs capability to analyze complexbiochemical data and predict potential drug candidates;this is accomplished using natural languageprocessing,advanced computing,and twinning.This includes:6de novo drug design(the generation of novel molecular entities with desired pharmacologicalproperties from scratch)advancementsretrosynthesis(where the main goal is to design efficient synthetic routes for a molecule ofinterest recursively)reaction prediction(an application for predicting chemical reactions and reaction pathways),andprotein engineering(the process of developing useful or valuable proteins through the design andproduction of unnatural polypeptides).7These AI-driven approaches have the potential to significantly reduce the time and cost associated withbringing new drugs to market.Moreover,AIs impact is not limited to drug discovery.In the realm of diagnostics,AI algorithms are being8employed to enhance the accuracy and efficiency of disease detection,often surpassing human8Shafqat,F.,Khan,M.N.A.,Shafqat,S.(2021).SmartHealth:IoT-Enabled Context-Aware 5G Ambient Cloud Platform.In:Marques,G.,Bhoi,A.K.,Albuquerque,V.H.C.d.,K.S.,H.(eds)IoT in Healthcare and Ambient Assisted Living.Studies in ComputationalIntelligence,vol 933.Springer,Singapore.https:/doi.org/10.1007/978-981-15-9897-5_37Jimnez-Luna,J.,Grisoni,F.,Weskamp,N.,&Schneider,G.(2021).Artificial intelligence in drug discovery:Recent advances andfuture perspectives.Expert Opinion on Drug Discovery,16(9),949959.https:/doi.org/10.1080/17460441.2021.19095676Mahajan,R.,2023.Quantum Care:A Deep Dive into AI for Health Delivery and Research,Advantage,Charleston S.C Copyright 2024,Cloud Security Alliance.All rights reserved.6performance in areas such as text or image analysis and genetic sequencing.Treatment and910personalized medicine have also benefited from AI by developing the Cognitive Digital Twin(CDT).Thissophisticated model simulates an individuals health status to predict treatment outcomes and identifypotential health risks.11However,despite these technological advancements,integrating AI into medical research presentssignificant ethical and legal challenges.Issues related to data privacy,algorithmic bias,and thetransparency of AI decision-making processes are critical concerns that need to be addressed to ensurethe responsible deployment of AI in healthcare.12This paper aims to provide a comprehensive review of the current state of AI in medical research,highlighting its applications,advancements,and the associated ethical and legal considerations.Byexamining these aspects,we seek to underscore AIs transformative potential in medical research whileadvocating for a balanced approach that prioritizes ethical standards and legal compliance.Drug Discovery ApplicationsAI has emerged as a powerful tool in drug discovery,transforming traditional approaches andrevolutionizing how we identify potential therapeutic compounds.This section explores the variousapplications of AI in drug discovery,highlighting its impact on predictive tasks,generative tasks,and theoverall drug discovery development process.The vast chemical space fosters the development of manydrug molecules.However,the need for advanced technologies limits the drug development process,making it a time-consuming and expensive task that AI can address.AI can rapidly identify hit and leadcompounds,validate drug targets more efficiently,and optimize the design of drug structures.13Despite its advantages,AI faces significant data challenges,such as the datas scale,growth,diversity,and uncertainty.The datasets available for drug development in pharmaceutical companies often includemillions of compounds,and traditional machine learning(ML)tools might need help to handle such vastamounts of data.Quantitative Structure-Activity Relationship(QSAR)-based computational models canquickly predict large numbers of compounds or simple physicochemical parameters.However,thesemodels fall short when predicting complex biological properties,such as efficacy and adverse effects ofcompounds.Additionally,QSAR-based models encounter issues like small training sets,experimental dataerrors,and lack of experimental validations.New AI methods,including deep learning(DL)and relevantmodeling studies,can enhance safety and efficacy evaluations of drug molecules using big data analysis.In 2012,a sponsored QSAR ML challenge explored DLs advantages in pharmaceutical drug discovery.DL131 Sarkar,C.,Das,B.,Rawat,V.S.,Wahlang,J.B.,Nongpiur,A.,Tiewsoh,I.,Lyngdoh,N.M.,Das,D.,Bidarolli,M.,&Sony,H.T.(2023).Artificial Intelligence and Machine Learning Technology Driven Modern Drug Discovery and Development.International Journal ofMolecular Sciences,24(3),2026.https:/doi.org/10.3390/ijms2403202612Naik,N.,Hameed,B.M.Z.,Shetty,D.K.,Swain,D.,Shah,M.,Paul,R.,Aggarwal,K.,Ibrahim,S.,Patil,V.,Smriti,K.,Shetty,S.,Rai,B.P.,Chlosta,P.,&Somani,B.K.(2022).Legal and Ethical Consideration in Artificial Intelligence in Healthcare:Who TakesResponsibility?.Frontiers in surgery,9,862322.https:/doi.org/10.3389/fsurg.2022.86232211Valle A.(2024).Envisioning the Future of Personalized Medicine:Role and Realities of Digital Twins.Journal of medical Internetresearch,26,e50204.https:/doi.org/10.2196/5020410Alowais,S.A.,Alghamdi S.S.,Alsuhebany N.,Alqahtani,T.,Alshaya,A.I.,Almohareb S.N.,Aldairem A.,Alrashed1 M.,Bin Saleh K.,Badreldin,H.A.,Al Yami,M.S.,Al Harbi,S.,and Albekairy,A.M.,2023.Revolutionizing healthcare:the role of artificial intelligence inclinical practice,BMC Medical Education,https:/doi.org/10.1186/s12909-023-04698-z9Shafqat,S.,Anwar,Z.,Javaid,Q.,&Ahmad,H.F.(2024).NER Sequence Embedding of Unified Medical Corpora to IncorporateSemantic Intelligence in Big Data Healthcare Diagnostics.https:/doi.org/10.32388/HPAUYJ.2 Copyright 2024,Cloud Security Alliance.All rights reserved.7models outperformed traditional ML approaches for drug candidates.Furthermore,AIs generative14capabilities are equally remarkable,showing the potential for drug discovery.De Novo drug design refers to the creation of entirely new molecules guided by desired properties orfunctions.Unlike traditional drug discovery,which relies on modifying existing compounds,the De Novoapproaches bypass this constraint.AI algorithms play a crucial role in De Novo drug design by exploringvast chemical space and predicting novel molecular structures to address specific medical issues.Thesemethods leverage deep learning,reinforcement learning,and generative models.By generating newmolecules,the De Novo approaches offer exciting possibilities for discovering innovative drugs withimproved safety and efficacy profiles.15Using Retrosynthesis and Reaction Prediction,chemists often face the challenge of designing efficientsynthesis routes for complex molecules.AI assists in this process through retrosynthesis and reactionprediction.AI algorithms break down a target molecule into simpler building blocks,suggesting feasiblesynthetic pathwaysthese synthetic pathways aid chemists in planning efficient routes for large-scalesynthesis.16Using Protein Design,AI extends its reach beyond small molecules to protein engineering.Proteins areessential for biological functions,and designing novel proteins with specific properties is critical fortherapeutics.AI algorithms analyze protein structures,predict stability,and optimize binding sites.Similarto De Novo drug design,AI generates novel protein sequences and can tailor these sequences for specificfunctions,such as binding to disease targets or catalyzing reactions.17These advancements hold immense potential by accelerating drug discovery by suggesting novelcompounds,improving drug safety and efficacy profiles,enabling personalized medicine throughcustomized protein therapeutics,and addressing unmet medical needs by creating innovative molecules.Diagnosis and Treatment ApplicationsMedical diagnostics is the process of evaluating medical conditions or diseases by analyzing symptoms,18medical history,and test results.Medical diagnostics aims to determine the cause of a medical problemand make an accurate diagnosis to provide effective treatment.On a global scale,effective diagnosis is still a challenge.The complexity of disease mechanisms andunderlying symptoms has hampered the development of diagnostic tools and treatments.Diagnosisidentifies the disease or conditions that explain a persons symptoms and signs.Diagnostic information isgathered from the patients history and physical examination.It is frequently difficult since many18Shafqat,S.,Abbasi,A.,Khan,M.N.A.,Qureshi,M.A.,Amjad,T.,&Ahmad,H.F.(2018).Context Aware SmartHealth CloudPlatform for Medical Diagnostics.Context,9(7).https:/doi.org/10.14569/IJACSA.2018.09074117Gupta,R.,Srivastava,D.,Sahu,M.,Tiwari,S.,Ambasta,R.K.,&Kumar,P.(2021).Artificial intelligence to deep learning:Machineintelligence approach for drug discovery.Molecular Diversity,25(3),13151360.https:/doi.org/10.1007/s11030-021-10217-316Jimnez-Luna,J.,Grisoni,F.,Weskamp,N.,&Schneider,G.(2021).Artificial intelligence in drug discovery:Recent advances andfuture perspectives.Expert Opinion on Drug Discovery,16(9),949959.https:/doi.org/10.1080/17460441.2021.190956715Jimnez-Luna,J.,Grisoni,F.,Weskamp,N.,&Schneider,G.(2021).Artificial intelligence in drug discovery:Recent advances andfuture perspectives.Expert Opinion on Drug Discovery,16(9),949959.https:/doi.org/10.1080/17460441.2021.190956714Paul,D.,Sanap,G.,Shenoy,S.,Kalyane,D.,Kalia,K.,&Tekade,R.K.(2021).Artificial intelligence in drug discovery anddevelopment.Drug Discovery Today,26(1),8093.https:/doi.org/10.1016/j.drudis.2020.10.010 Copyright 2024,Cloud Security Alliance.All rights reserved.8indications and symptoms are ambiguous.AI can enhance a providers ability to diagnose and treat.AIprimarily focuses on developing algorithms and techniques to determine whether a systems behavior iscorrect in disease diagnosis.19With the rapid advancement of AI,its influence on clinical diagnosis and treatment is increasing.MLintense learning,a subset of ML,allows it to work with larger and unstructured data sets to understandcomplex relationships and present more intricate insightsthat are used to assist in diagnosis and2021treatment.A study analyzing a large collection of mammograms with an AI system showed promising results in breastcancer diagnosis.The AI system reduced false positives by 5.7%and false negatives by 9.4%,potentiallyleading to more accurate diagnoses and improved patient outcomes.In a South Korean study(Changes incancer detection and false-positive recall in mammography using Artificial Intelligence:a retrospective,Multireader Study)where authors compared AI versus radiologist diagnosis of breast cancer,the findingwas that the AI-utilized diagnosis was more likely to accurately diagnose breast cancer with masscompared to radiologists,90%vs.78%,respectively.In these studies,it is clear AI tools can improveaccuracy,reduce costs,and save time compared to traditional diagnostic methods.22The ability to process large volumes of data sets has aided in advancing personalized medical care.Deeplearning algorithms can analyze a patients genetic makeup,medical history,family history,and lifestyle tooptimize treatments for each patient.This marks the move to precise,patient-centric treatment.Currently,many AI-powered applications are used to diagnose and treat diseases.AI in mammography/oncology:Breast cancer diagnosis and staging are areas in which AIapplications appear to provide better results than human readings.In a study using a training setof 129 slides(49 with metastases to lymph nodes and 80 without),when compared with 11pathologies,the algorithm achieved better diagnostic performance.23AI in cardiology:Using AI results in faster interpretation and diagnosis in many areas of cardiology.Electrocardiogram readings are automatically interpreted,and echocardiography with 3D modecardiac imaging automatically provides measurements of cardiac function.AI in radiology:AI has gained popularity in the field of radiology,due in part to the remarkableprogress in image-recognition tasks,which in recent years has seen growth in the amount ofsufficient digital data accumulation and availability,as well as significant computational power.2424Kumar,R.,Sharma,A.,Sharma,P.,Thaman,R.,2022.Role of Artificial Intelligence in Diagnosis and Treatment of Various MedicalDiseases in Patients,AMEI s Current Trends in Diagnosis&Treatment,DOI:10.5005/jp-journals-10055-013123Bejnordi BE,Veta M,van Diest PJ,et al.,2017.Diagnostic assessment of deep learning algorithms for detection of lymph nodemetastasis in women with breast cancer,Journal of the American Medical Association 2017;318(22):21992210.DOI:10.1001/jama.2017.14585.22Alowais,S.A.,et al.,72023.Revolutionizing healthcare:the role of artificial intelligence in clinical practice,BMC Medical Education,https:/doi.org/10.1186/s12909-023-04698-z21Shafqat,S.,Fayyaz,M.,Khattak,H.A.et al.Leveraging Deep Learning for Designing Healthcare Analytics Heuristic for Diagnostics.Neural Process Lett 55,5379(2023).https:/doi.org/10.1007/s11063-021-10425-w20LeCun,Y.,Bengio,Y.and Hinton,G.,2015.Deep Learning.Nature,521(7553),pp.436-444.19Alowais,S.A.,Alghamdi S.S.,Alsuhebany N.,Alqahtani,T.,Alshaya,A.I.,Almohareb S.N.,Aldairem A.,Alrashed1 M.,Bin Saleh K.,Badreldin,H.A.,Al Yami,M.S.,Al Harbi,S.,and Albekairy,A.M.,2023.Revolutionizing healthcare:the role of artificial intelligence inclinical practice,BMC Medical Education,https:/doi.org/10.1186/s12909-023-04698-z Copyright 2024,Cloud Security Alliance.All rights reserved.9These are a few examples of how AI can be used to diagnose and treat diseases.The list of uses iscontinuously growing as AI capabilities grow.Personalized medicine is an area that has seen tremendous growth in recent years.Most medicaltreatments are designed for the average patient in a one-size-fits-all approach,which may besuccessful for some patients but not for others.The ability to process large volumes of data opens the25door to personalized medicine.Personalized medicine is the treatment of patients using treatment planstailored to each patient instead of the one-size-fits-all approach used today.The terms personalized andprecision medicine are often used interchangeably.In this article,we use the term personalized medicinebecause it refers to treatments and preventions that are developed uniquely for each individual.Additionally,AI can help doctors make individual predictions about disease risk that can help somebodychoose a prevention plan that is right for them.AI-driven personalized medicine,because it is based on each patients unique genetic makeup,medicalhistory,and lifestyle,is beginning to overcome the limitations of traditional medicine.Increasingly,it isallowing healthcare providers to:Shift the emphasis in medicine from reaction to preventionPredict disease susceptibilityImprove disease detectionPreempt disease progressionCustomize disease-prevention strategiesPrescribe more effective drugsAvoid prescribing drugs with predictable side effectsReduce the time,cost,and failure rate of pharmaceutical clinical trialsEliminate trial-and-error inefficiencies that inflate healthcare costs and undermine patient care26Better disease detection accuracy is the gateway to timely interventions and more successful treatmentoutcomes.AI allows healthcare to identify the subtlest patterns in patient data,bringing personalizedmedicine closer to reality.Additionally,assessments become more objective and accurate.AI algorithmsdont perform as humans do;they are consistent and highly accurate,which can reduce misdiagnoses andfalse positives.AI and personalized medicine have come together to pave the way for advancements inthe diagnosis and treatment of many different diseases,and cancer is a significant one at that.27Another area that shows great promise is in treating patients with multiple chronic diseases.Healthcare isprimarily designed to provide care on a disease-by-disease basis.Individuals with multiple diseases haveto see various specialists,which provides an opportunity for confusion.The most common exampleinvolves the use of various medications;the use of one may contraindicate the use of another.In short,allof this can result from fragmented care.The management of multiple chronic conditions has both majorhealth and cost implications.Care coordination is often the missing link.If care is coordinated,medical and social service providersbring their expertise to bear on everyones health problems in the most effective and coordinated manner,27Laliotis,G.,2023.AI in Personalized Medicine:Precision Healthcare Today,Retrieved fromhttps:/docus.ai/blog/ai-in-personalized-medicine26The Jackson Laboratory,2024.What is personalized medicine,Retrieved from What is personalized medicine?25Precision Medicine|FDA Copyright 2024,Cloud Security Alliance.All rights reserved.10as simulated here as an agent-based SmartHealth cloud system.Drug interaction can be identified and28managed to enhance the patient outcome.29Cognitive Digital TwinThe move to personalized healthcare,as simulated in an agents-based system in SmartHealth Internet ofThings(IoT)-cloud network,drives the development of cognitive digital twins(CDTs).A CDT is a digitalrepresentation of a physical system augmented by AI.CDTs are valuable because they can span the entiresystem lifecycle;they are twinning.The digital twin concept has been introduced previously.The conceptwas introduced in 2003 in a paper by Dr.Michael Grieves,(http:/dx.doi.org/10.1504/IJPD.2005.006669)who discussed creating a digital replica or agents of a physical system or entity in product management.Digital twins are used in designing,manufacturing,and operating systems.By understanding what a CDT is and how it works,it is not much of a leap to see the potential CDTs havein healthcare.The most ambitious application of CDTs aims to achieve a complete digital representation30of the physical patient to improve disease prevention,diagnosis,and treatment.Despite this long-termperspective,currently available applications mainly concern the simulation of single anatomical structures,physiological processes,or metabolic interactions.31Figure 2:Graphical representation of the development of a digital twin of a physical entity from datacollection and integration to performing predictions and establishing appropriate interventions31Cellina,M.;C,M.;Al,M.;Irmici,G.;Ibba,S.;Caloro,E.;Fazzini,D.;Oliva,G.;Papa,S.Digital Twins:The New Frontier forPersonalized Medicine?Appl.Sci.2023,13,7940.https:/doi.org/10.3390/app1313794030Mahajan,R.,2023.Quantum Care:A Deep Dive into AI for Health Delivery and Research,Advantage,Charleston S.C29Philippatos,G.,2018.Artificial Intelligence and Multiple Chronic Diseases,Retrieved fromhttps:/ Simulation Representing a Hybrid Architecture Over CloudIntegrated with IoT.In:Arai,K.,Kapoor,S.,Bhatia,R.(eds)Advances in Information and Communication Networks.FICC 2018.Advances in Intelligent Systems and Computing,vol 887.Springer,Cham.https:/doi.org/10.1007/978-3-030-03405-4_31 Copyright 2024,Cloud Security Alliance.All rights reserved.11CDTs require vast amounts of data to represent their physical counterparts accurately.Data can begathered using different methods and integrated into one model to simulate pathways,organs,ororganisms.However,collecting all that data may be incredibly challenging in healthcare compared to theoriginal digital twin applications.While a lot of environmental data can be continuously captured usingbody-worn sensors like a personal fitness device(e.g.,Fitbit)or smartwatch,more complicated andintrusive methods may be necessary to gain-omics or imaging information.32Multiple projects have created a digital twin for the human brain to understand it better or for cognitivedisease research and treatment.Both Siemens and Phillips have working versions of virtual hearts using AIand CDT technology that allow cardiologists to evaluate several functions that are relevant to thediagnosis and treatment of cardiovascular disease.33Apart from organ-specific digital twins like hearts,vast amounts of data generated in-omics researchmay also be used to create full-body digital twins.For example,in cancer research,single-cell digital twinsbased on metabolomics(the study of metabolites,the chemical substances produced as a result ofmetabolism)and fluxomics(an innovative-omics research field that measures the rates of all34intracellular fluxes in the central metabolism of biological systems).The analysis of production and35consumption of metabolites have been proposed as a tool to better discriminate between cancerphenotypes.Digital twins,once available,with their ability to integrate real-time data and advanced36analytics,hold great potential for predictive analytics and preventive interventions in healthcare.Digitaltwin technology may be used to predict treatment outcomes and simulate various events.By leveragingpatient data,machine learning algorithms,and predictive modeling,digital twins can identify potentialhealth risks,predict disease progression,and enable proactive interventions.37CDTs can capture an individuals health data,including genetic information,medical history,and lifestylefactors.Medical personnel can use this data to create personalized treatment plans.In the future,38patients can access their information online,schedule appointments,and enter symptoms.Combinedwith the CDT information,the system can perform personalized screening.This prepares the provider forthe visit and allows them to focus on the issues presented.Ethical and Legal ChallengesAs we navigate the complex landscape of AIs integration into healthcare,we discover this journey is notwithout ethical and legal hurdles.“Ethics is understanding and applying the moral principles of right andwrong that govern a persons behavior or actions.”Because most of what we do with AI is3939Schmarzo,B.,2023.AI&Data Literacy:Empowering Citizens of Data Science,P.139 Packt Publishing Ltd.Birmingham,U.K.38Cellina,M.;C,M.;Al,M.;Irmici,G.;Ibba,S.;Caloro,E.;Fazzini,D.;Oliva,G.;Papa,S.Digital Twins:The New Frontier forPersonalized Medicine?Appl.Sci.2023,13,7940.https:/doi.org/10.3390/app1313794037Valle A(2023)Digital twin for healthcare systems,Front.Digit.Health 5:1253050.doi:10.3389/fdgth.2023.125305036Meijer,C.;Uh,H.-W.;el Bouhaddani,S.Digital Twins in Healthcare:Methodological Challenges and Opportunities.J.Pers.Med.2023,13,1522.https:/doi.org/10.3390/jpm1310152235Emwas Abdul-Hamid,Szczepski Kacper,Al-Younis Inas,Lachowicz Joanna Izabela,Jaremko Mariusz,2022.New MetabolomicsApproaches to Monitor Metabolic Pathways,Frontiers in Pharmacology V13,DOI=10.3389/fphar.2022.80578234Bain,J.,and Newgard,C.,metabolomics.Encyclopedia Britannica,27 Apr.2024,https:/ Care:A Deep Dive into AI for Health Delivery and Research,Advantage,Charleston S.C32Meijer,C.;Uh,H.-W.;el Bouhaddani,S.Digital Twins in Healthcare:Methodological Challenges and Opportunities.J.Pers.Med.2023,13,1522.https:/doi.org/10.3390/jpm13101522 Copyright 2024,Cloud Security Alliance.All rights reserved.12mathematics-based,we sometimes forget the bigger mission of AI,which is to deliver meaningful,relevant,responsible,and ethical outcomes.Ethics is the foundation of all AI models design,development,and deployment.Ethical ChallengesLegal ChallengesBiasesSafety and EffectivenessData PrivacyLiabilityInformed ConsentData Protection and PrivacySafetyCybersecurityIntellectual PropertyEthical ConsiderationsBuilding AI systems involves data acquisition and management and focuses on collecting data,particularlyon individuals.Protecting individuals requires systems that are free from bias.However,data is not the40only source of bias in ML systems.Algorithms and the way data is processed can introduce bias to thedata.Despite our best efforts,data processing may even emphasize the bias and let it spread beyondalgorithms and toward other parts of ML-based systems,such as user interfaces or decision-makingcomponents.41Data influences the output observations,interpretations,and recommendations,so selecting anappropriate AI training data source is critical.If training data is biased due to the underrepresentation ofcertain groups,the resulting algorithm can inherit those biases.These biases can then be reflected andpotentially amplified in the algorithms outputs.The same is true for human biases(intentional and not)operating in the environment from which the data was collected.42Biases can result from biased training data,leading to diagnosis,treatment,and outcome disparities.What is bias,and why do we want to manage it?Individual bias is a preconceived tendency,inclination,feeling,or opinion.Statistically,bias is a systematic distortion of a statistic because of a samplingprocedure.For example,sampling only in one ethnic group as opposed to all groups.It results in a degreeto which the result deviates from the truth.There are two reasons for AI bias:1.Cognitive bias:Cognitive bias can get into ML algorithms by designers unknowingly introducingthem into the algorithm or using a training data set that includes biases.This describes the42Matheny,M.,S.Thadaney Israni,M.Ahmed,and D.Whicher,Editors.2019.Artificial Intelligence in Health Care:The Hope,theHype,the Promise,the Peril.NAM Special Publication.Washington,DC:National Academy of Medicine.41Staron,M.,2024.Machine Learning Infrastructure and Best Practices for Software Engineers Packt Publishing,Birmingham,UK40Shafqat,S.,Anwar,Z.,Javaid,Q.,&Ahmad,H.F.(2023,March).A unified deep learning diagnostic architecture for big datahealthcare analytics.In 2023 IEEE 15th International Symposium on Autonomous Decentralized System(ISADS)(pp.1-8).IEEE.Copyright 2024,Cloud Security Alliance.All rights reserved.13tendency of peoples feelings and experiences to affect their judgment.When it comes to AIdecisions,a prominent cognitive bias is the availability heuristic,which states that human beingstend to rely on information that supports their current beliefs.432.Incomplete data:When data is incomplete,it may not be representative and include bias.44How do we remove unwanted bias from AI algorithms?It is essential to understand that removingunwanted bias does not guarantee fairness.There are,however,some steps you can take to reduce bias:1.Ensure the algorithm and data being assessed are known.2.Test all data for bias.3.Look for how you can improve the process as you identify biases.4.Maintain a diverse AI team to help you mitigate unwanted AI biases.45The concern for patient data privacy is at the forefront of the discussion.Healthcare AI requires vastamounts of data.Most of the data includes protected health information(PHI).This data is collected andanalyzed to train AI models.The confidentiality and security of this data must be maintained.Thepotential harm of a data breach and the resulting exposure of this data raises significant concerns.Ifpatients and clinicians do not trust AI,their successful use in clinical practice will fail.It is criticallyimportant to inform patients about the adequate processing of their data and have an open dialogue topromote trust.The following two examples are where Google collected patient data.Google and theUniversity of Chicago Medical Center collaborated to develop software to anticipate patients futurehealthcare needs.The University delivered several years of anonymized patient medical records toGoogle to“train”the softwares algorithms.Google also engaged with one of the largest healthcare46systems in the U.S.on a project to collect and crunch the detailed PHI of millions of people across 21states.These examples highlight the potential to violate privacy rights when developing AI solutions.47They did not account for privacy issues with anonymized data such as linkage.There have been severalinstances where anonymized databases have been linked to databases containing personal informationresulting in the identification of the individuals in the anonymized database.Informed consent is an exciting and challenging topic regarding AI in healthcare.Informed consent to useHealth AI applications,such as imaging,diagnostics,and surgery,will transform the provider-patientrelationship.How will the use of AI assistance work with the principles of informed consent?This questionhas received little attention in the ethical debate,even though informed consent will be one of the mostimmediate challenges in using AI in a clinical environment.There is a need to examine the circumstances(if at all)in which the principles of informed consent should be deployed in the clinical AI space.Doclinicians have a responsibility to educate the patient about the use of AI,including the forms of ML usedby the system,what data inputs,and the possibility of biases or other shortcomings in the data?Does the47Copeland R.,2019.Googles Project Nightingale gathers personal health data on millionsof Americans,Retrieved fromhttps:/ v.Google.No.1:19-cv-04311;2019.45Cloud Security Alliance,2021 Artificial Intelligence in Healthcare,Retrieved fromhttps:/cloudsecurityalliance.org/artifacts/artificial-intelligence-in-healthcare44Dilmegani,C.(2021,October 8).Bias in AI:What it is,Types&Examples of Bias&Tools to fix it.AI Multiple.https:/ 19).Human Cognitive Bias And Its Role In AI.Mindbreeze InSpire.https:/ Copyright 2024,Cloud Security Alliance.All rights reserved.14clinician need to notify the patient that AI is being used?These questions are challenging to answer;however,they must be answered before the healthcare profession adapts to the wide-scale use of AI.Safety is a challenge for AI in healthcare.A well-publicized example,IBM Watson for Oncology,hasrecently come under criticism by reportedly giving“unsafe and incorrect”recommendations for cancertreatments.The problem seems to be in the training of Watson for Oncology.Instead of using real patientdata,the software was only trained with a few“synthetic”cancer cases,meaning they were devised bydoctors at the Memorial Sloan Kettering(MSK)Cancer Center.This real-life example shows that it is ofuttermost importance that AI use is safe and effective.To realize the potential of AI,stakeholders,particularly AI developers,need to ensure two key things:the reliability and validity of the data sets,andtransparency.While Watson had issues with synthetic data,accurate synthetic data can be used to48increase diversity in data sets and to increase the robustness and adaptability of AI models.Syntheticdata can be created from using accurate forward models(that is,models that simulate outcomes givenspecific inputs),physical simulations or AI-driven generative models.49First,the used data sets need to be reliable and valid.The better the training data,the better AI willperform.In addition,algorithms often need refinement to generate accurate results.Second,safety andpatient confidence must be ensured through transparency.AI developers should be completelytransparent about the data used and any software shortcomings.Transparency creates trust amongclinicians and patients,which is the key to the successful implementation of AI in clinical practice.50Currently,most healthcare AI systems are perceived as a“black box”;something goes in,and somethingcomes out,with no understanding of what happens inside.This can lead to distrust in AI algorithms andtheir accuracy and reliability in an area where a decision could mean the life or death of the patient.As aresult of this distrust,the term Explainable Artificial Intelligence(XAI)has been gaining momentum as apossible solution.XAI attempts to move from a“black box”to a transparent“glass box.”In a glass boxmodel(such as a decision tree or linear regression model),all parameters are known,and we know exactlyhow the model comes to its conclusion,giving full transparency.Moving to XAI will provide transparency51and build confidence in clinical AI.Legal ConsiderationsIt is of utmost importance that AIs are safe and effective systems.To promote this goal,the U.S.government published a blueprint for an AI Bill of Rights,including a section on the safe and effective useof AI,and the National Institute of Standards and Technology(NIST)AI Safety Institute(AISI)releasedtheir strategic goals.The following is from the proposed AI Bill of Rights:“You should be protected from unsafe or ineffective systems.Automated systems should be developedwith consultation from diverse communities,stakeholders,and domain experts to identify the systemsconcerns,risks,and potential impacts.Systems should undergo pre-deployment testing,risk51Hulsen,T.Explainable Artificial Intelligence(XAI):Concepts and Challenges in Healthcare.AI 2023,4,652666.https:/doi.org/10.3390/ai403003450Gerke,S.,Minssen,T.,&Cohen,G.(2020).Ethical and Legal Challenges of Artificial Intelligence-Driven Health Care.In A.Bohr,&K.Memarzadeh(Eds.),Artificial Intelligence in Healthcare(1 ed.,pp.295-336).Elsevier49Chen,R.J.,Lu,M.Y.,Chen,T.Y.et al.Synthetic data in machine learning for medicine and healthcare.Nat Biomed Eng 5,493497(2021).https:/doi.org/10.1038/s41551-021-00751-848Ross,C.,&Swetlitz,I.(2017).IBM to Congress:Watson will transform health care,so keep your hands off our supercomputer.STAT.Retrieved from https:/ Copyright 2024,Cloud Security Alliance.All rights reserved.15identification and mitigation,and ongoing monitoring that demonstrates they are safe and effectivebased on their intended use,mitigation of unsafe outcomes beyond the intended use,and adherence todomain-specific standards.Outcomes of these protective measures should include the possibility of notdeploying or removing a system from use.Automated systems should not be designed with an intent orreasonably foreseeable possibility of endangering your safety or the safety of your community.Theyshould be designed to protect you from harm from unintended,yet foreseeable proactively,uses orimpacts of automated systems.You should be protected from inappropriate or irrelevant data use in thedesign,development,and deployment of automated systems and the compounded harm of its reuse.Independent evaluation and reporting that confirms that the system is safe and effective,includingreporting of steps taken to mitigate potential harms,should be performed and the results made publicwhenever possible.”52The strategic vision released by NIST outlines the steps that the AISI plans to take to advance the scienceof AI safety and facilitate safe and responsible AI innovation.To do this,it empowers its team to undertakenew projects in pursuit of much-needed outcomes for AI safety,including creating testing benchmarks foradvanced models and developing guidelines for evaluating systemic risks.The three strategic goals are:1.Advancing the science of AI safety2.Articulating,demonstrating,and disseminating the practices of AI safety3.Supporting institutions,communities,and coordination around AI safetyFigure 3:AISI Strategic goals working together toward safe AIMitigating the safety risks of a transformative technology is necessary to harness its benefits.53The future of tort doctrine on healthcare AI is highly uncertain.There is a limited body of case law aroundharm from using software in healthcare,and even fewer cases are explicitly related to AI.The courts donot clearly distinguish cases between healthcare software and healthcare AI when questions pertaining toliability matters for patients,physicians,policymakers,and the deployment of AI in healthcare.5454Mello,M.M.and Guha,N.,2024.Understanding Liability Risk from Healthcare AI,Stanford University Human-Centered ArtificialIntelligence.Retrieved from https:/hai.stanford.edu/sites/default/files/2024-02/Liability-Risk-Healthcare-AI.pdf53NIST,2024.The United States Artificial Intelligence Safety Institute:Vision,Mission,and Strategic Goals,Retrieved fromhttps:/www.nist.gov/system/files/documents/2024/05/21/AISI-vision-21May2024.pdf52The White House,2022.Blueprint for an AI Bill of Rights,Retrieved from Blueprint for an AI Bill of Rights|OSTP|The White House Copyright 2024,Cloud Security Alliance.All rights reserved.16The Food and Drug Administration(FDA)oversees the safety and efficacy of medical devices.The FDAhas not effectively addressed the safety issues of AI systems in its clearance processes.If the FDA cannotreasonably reduce the risk of injury for AI-enabled medical devices,injured patients could rely on ex-postrecovery options,as in product liability cases.However,the Medical Device Amendments(MDA)of 1976introduced an express preemption clause that the U.S.Supreme Court has interpreted to nearly forecloseliability claims,based almost entirely on the comprehensiveness of FDA clearance review processes.One possible way for a plaintiff to successfully survive preemption is AI technology.The courts shouldevaluate whether the technology that allegedly caused the injury has changed materially from thetechnology reviewed in the premarket approval(PMA)and whether the manufacturer promptly submitteda required PMA supplement.If the AI is dynamic,as more accurate diagnoses and images are fed into thesystem,the AI algorithm should become more precise through self-learning.The question of materialchange will have a crucial impact on FDA medical device preemption.In this case,the court couldpresume that the technology is different from its approved form.55So,how can healthcare organizations protect themselves from liability claims?First,it is also essential torecognize that AI developers are jockeying to secure health system contracts and to access patient data.This buyers market allows healthcare organizations to bargain for terms that minimize liability risk.Second,Indemnification clauses are another important tool for informing liability.Healthcareorganizations can use indemnification clauses to establish who pays.Healthcare organizations can requiredevelopers to pay for errors in the models output while providers pay for mistakes from poor deploymentor misuse of the AI technology.Contracts between healthcare organizations and AI developers could alsospecify minimum insurance requirements and the healthcare organizations responsibilities to monitorsystems post-deployment.AI applications have tremendous potential to improve the quality of care and boost patient outcomes.However,the potential for injuries means that healthcare organizations and patients must carefully weighthe risks against the benefits.Managing liability will be crucial to harnessing the potential of healthcare AIinnovations.56Data protection and privacy are critical in AI-enabled healthcare systems.AI use in healthcare is increasingsubstantially,and these systems leverage algorithms to analyze large data sets containing patient data.While the benefits of AI in healthcare can be immense,it also raises concerns about the privacy andprotection of personal health information.AI in healthcare systems relies on collecting and storingsensitive personal health data.The extensive use of personal data for AI analysis introduces risks toindividuals privacy.Unauthorized access,data breaches,and inappropriate handling of personal healthinformation can lead to consequences such as identity theft,discrimination,or compromised patientconfidentiality.Data protection is crucial to safeguarding personal health informations privacy,confidentiality,andsecurity.The following are some key aspects of data protection:Minimize the amount of data you collect.Only collect the required data for the stated purpose.Encrypt data to protect data at rest and in transit.56Mello,M.M.and Guha,N.,2024.Understanding Liability Risk from Healthcare AI,Stanford University Human-Centered ArtificialIntelligence.Retrieved from https:/hai.stanford.edu/sites/default/files/2024-02/Liability-Risk-Healthcare-AI.pdf55Tschider,C.A.,2021.Medical Device Artificial Intelligence:The New Tort Frontier,46 BYU L.Rev.1551.Retrieved from:https:/digitalcommons.law.byu.edu/lawreview/vol46/iss6/7 Copyright 2024,Cloud Security Alliance.All rights reserved.17Implement role-based access control to restrict data access.Anonymize or de-identify personal health information before using it for AI analysis or sharing.Establish data-sharing agreements when sharing data with external entities.Define retention periods for data and regularly review and securely dispose of data that is nolonger required.Implement robust security measures for infrastructure and network support.57While these steps will help ensure data protection,additional steps are needed to ensure privacy.Whendesigning AI systems,programmers should include privacy engineers in the process to identify privacyrequirements and implement Privacy by Design(PbD),building in privacy.One method of protecting privacy is to use differential privacy,which is a mathematical approach thatattempts to add randomness or noise to sensitive data to conceal the contributions of each participant.58“The Fundamental Law of Information Recovery states that overly accurate answers to too manyquestions will spectacularly destroy privacy.The goal of algorithmic research on differential privacy is topostpone this inevitability as long as possible.”59Security presents AI with a new set of challenges,compounded by the fact that most algorithms requireaccess to massive data sets.Security is a necessary component of AI to ensure that results received froman analysis reflect reality.Otherwise,decisions made based on the study will be flawed.When the effectsare large enough,patient health can be adversely affected,and faith can be lost in the reliability of AIresults.60The essential goal of AI security is to obtain more consistent,reliable,trustworthy,and unbiased resultsfrom AI.Security focuses on creating an environment where the data,algorithm,responses,and analysiscombine to allow AI to produce reliable and useful results.Security is complicated by the sharedresponsibility model in cloud security and the different elements requiring security,which include data,information,application,and user security.Data security:At the data level,cybersecuritys role is to keep the data safe.The focus is onmaintaining confidentiality,integrity,and availability of data.Information security:Data is transformed into information that Health Delivery Organizations(HDOs)use.At the information level,cybersecurity ensures that information is being accessedand handled correctly and securely.61Application security:At the application level,the role of cybersecurity is to ensure that theapplication cannot be compromised.User security:Proper identity and access management at the user level is essential to preventuser compromise.61Oak R.,2023.10 Machine Learning Blueprints You Should Know for Cybersecurity,Packt Publishing,Birmingham,UK.60Mueller J.,P.,2022.Machine Learning Security Principles,Packt Publishing,Birmingham,UK.59Dwork,C.and Roth,A.,2014.The Algorithmic Foundations of Differential Privacy,Theoretical Computer Science Vol.9,Nos.34p.211407.DOI:10.1561/040000004258Yadav N,Pandey S,Gupta A,Dudani P,Gupta S,Rangarajan K.Data Privacy in Healthcare:In the Era of Artificial Intelligence.Indian Dermatol Online J.2023 Oct 27;14(6):788-792.doi:10.4103/idoj.idoj_543_23.57Frank,E.,&Olaoye,G.,2024.Privacy and data protection in AI-enabled healthcare systems,Retrieved fromhttps:/ Copyright 2024,Cloud Security Alliance.All rights reserved.18Understanding the shared responsibility model is essential since AI includes a cloud element.The rapid advance of AI technologies capable of generating realistic audio,imagery,and text has raisedquestions about copyright protections and how they apply to content created or used with AI.GenerativeAI raises copyright issues stemming from using existing works to train the AI and the output from the workgenerated by using the copyrighted training material.When AI systems are trained using digital copies of text and images from the internet,the U.S.Patent andTrademark Office notes that the process will almost by definition involve the reproduction of entire worksor substantial portions thereof.According to the Congressional Research Service(CRS),creating copieswithout express or implied permission from the various copyright holders may infringe the copyrightholders exclusive right to make reproductions of their work.62Since medical AI uses large amounts of patient data to train the model,the question is,who owns thedata?The model should have a copyright,so how does that fit into copyright law when patient data isused?Do you have to get the patients permission to use their data?Even if it is anonymized,it is still theirdata.As you can see,AI brings up a lot of legal questions that,at some point,will need to be answered.Cloud ComputingAI in healthcare would not be as effective without cloud computing.While it is possible for a singleorganization to accumulate a large data set to build and train an AI model without cloud computing,propagating the widespread use of the model requires the power of the cloud.AI and cloud computingmake the perfect match for data-driven innovation like drug discovery and cognitive digital twins.Cloudcomputings scalability and ability to access large volumes of data provide an ideal environment for AI.As with any cloud implementation,addressing privacy and security concerns is essential.To accomplishthis,HDOs must consider the shared responsibility model used in cloud computing.While cloud serviceproviders secure the infrastructure and physical aspects of the cloud,HDOs are responsible for securingtheir data,ensuring access controls,and safeguarding against potential risks like corrupted datasets usedin healthcare AI models.A corrupt data set that feeds a healthcare AI model can end up causingsignificant harm.This underscores the critical need for HDOs to implement stringent security measuresand maintain data integrity that aligns with their responsibilities and critical safety compliance mandates.62Revell E.,2023.AI complicates copyright law,Retrieved from AI complicates copyright law|Fox Business Copyright 2024,Cloud Security Alliance.All rights reserved.19Conclusion and Future OutlookThe convergence of medical advancements and breakthroughs in artificial intelligence has ushered in anew era of immense potential for healthcare delivery and research.Medicine stands at the precipice of aparadigm shift,where it will transition from a reactive approach you get sick,get diagnosed,get treated to a proactive one,predicting and preventing disease before it takes hold.63This future hinges on developing cognitive digital twins,virtual representations that can learn anindividuals unique biology and predict potential health issues.Cognitive digital twins can be empoweredto identify personalized treatment plans by leveraging AI in drug discovery and diagnosis.This newfoundunderstanding will revolutionize diagnostics and accelerate drug discovery,paving the way for highlytargeted and personalized therapies.As medicine continues to harness AIs power,it can expect a transformative impact on patient care,withimproved accuracy in diagnosis,the development of personalized treatment plans,and a healthcaresystem that is both more efficient and effective.However,it is crucial to acknowledge that this journey willnecessitate collaboration between medical professionals,AI developers,policymakers,and patients.Asmedicine forges ahead with AI in healthcare,navigating the ethical and legal landscape will be crucial.Thisincludes ensuring data privacy,mitigating algorithm bias,and fostering trust between patients andtechnology.Secure and scalable cloud infrastructure will also be instrumental in realizing the full potentialof AI in healthcare,as large-scale data analysis and complex computations are essential for theseadvancements.In conclusion,embracing this transformative technology and addressing the associated challenges canusher in a new era of personalized,proactive,and preventive medicine,ultimately leading to a healthierand more empowered populace.The future of AI in healthcare is bright.63Mahajan,R.,2023.Quantum Care:A Deep Dive into AI for Health Delivery and Research,Advantage,Charleston S.C.Copyright 2024,Cloud Security Alliance.All rights reserved.20ReferencesAlowais,S.A.,Alghamdi S.S.,Alsuhebany N.,Alqahtani,T.,Alshaya,A.I.,Almohareb S.N.,Aldairem A.,Alrashed1 M.,Bin Saleh K.,Badreldin,H.A.,Al 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Publishing,Birmingham,UK.Naik,N.,Hameed,B.M.Z.,Shetty,D.K.,Swain,D.,Shah,M.,Paul,R.,Aggarwal,K.,Ibrahim,S.,Patil,V.,Smriti,K.,Shetty,S.,Rai,B.P.,Chlosta,P.,&Somani,B.K.(2022).Legal and Ethical Consideration inArtificial Intelligence in Healthcare:Who Takes Responsibility?Frontiers in surgery,9,862322.https:/doi.org/10.3389/fsurg.2022.862322NIST,2024.The United States Artificial Intelligence Safety Institute:Vision,Mission,and Strategic Goals,Retrieved from https:/www.nist.gov/system/files/documents/2024/05/21/AISI-vision-21May2024.pdfOak R.,2023.10 Machine Learning Blueprints You Should Know for Cybersecurity,Packt Publishing,Birmingham,UK.Paul,D.,Sanap,G.,Shenoy,S.,Kalyane,D.,Kalia,K.,&Tekade,R.K.(2021).Artificial intelligence in drugdiscovery and development.Drug Discovery Today,26(1),8093.https:/doi.org/10.1016/j.drudis.2020.10.Philippatos,G.,2018.Artificial Intelligence and Multiple Chronic Diseases,Retrieved fromhttps:/ 2024,Cloud Security Alliance.All rights reserved.22Revell E.,2023.AI complicates copyright law,Retrieved fromhttps:/ to Congress:Watson will transform health care,so keep your hands offour supercomputer.STAT.Retrieved fromhttps:/ Intelligence and Machine Learning Technology Driven Modern DrugDiscovery and Development.International Journal of Molecular Sciences,24(3),2026.https:/doi.org/10.3390/ijms24032026Schmarzo,B.,2023.AI&Data Literacy:Empowering Citizens of Data Science,Packt Publishing Ltd.Birmingham,U.K.Staron,M.,2024.Machine Learning Infrastructure and Best Practices for Software Engineers PacktPublishing,Birmingham,U.K.The Jackson Laboratory,2024.What is personalized medicine,Retrieved fromhttps:/www.jax.org/personalized-medicine/precision-medicine-and-you/what-is-precision-medicine#The White House,2022.Blueprint for an AI Bill of Rights,Retrieved fromhttps:/www.whitehouse.gov/ostp/ai-bill-of-rights/Tschider,C.A.,2021.Medical Device Artificial Intelligence:The New Tort Frontier,46 BYU L.Rev.1551.Retrieved 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2024Unpacking Grind Culture in American Teens:Pressure,Burnout,and the Role of Social MediaCOMMON SENSE IS GRATEFUL FOR THE GENEROUS SUPPORT AND UNDERWRITING THAT FUNDED THIS RESEARCH REPORTJennifer Caldwell and John H.N.FisherPivotal VenturesSusan Crown Exchange2024Unpacking Grind Culture in American Teens:Pressure,Burnout,and the Role of Social MediaSuggested citation:Weinstein,E.,Konrath,S.,Lara,E.A.,Tench,B.,James,C.,Mann,S.,&Lenhart,A.(2024).Unpacking grind culture in American teens:Pressure,burnout,and the role of social media.San Francisco,CA:Common Sense Media,Center for Digital Thriving,and Indiana University.CreditsAuthorsEmily Weinstein,EdD,Executive Director,Center for Digital ThrivingSara Konrath,PhD,Associate Professor,Lilly Family School of PhilanthropyEduardo Lara,BA,Research Specialist,Center for Digital ThrivingBeck Tench,PhD,Researcher and Designer,Center for Digital ThrivingCarrie James,PhD,Managing Director,Center for Digital Thriving Supreet Mann,PhD,Director of Research,Common Sense MediaAmanda Lenhart,MA,Head of Research,Common Sense MediaAcknowledgmentsThe report authors and project team would like to express their gratitude to all of the young people who shared their perspectives and insights for this report.We would also like to thank Sara Konrath(Indiana University)for leading data analysis and Yuning Liu(Harvard University)for her support on the early analyses for this report.Additionally,we thank Destinee Ramos(Harvard University)for her feedback on the survey and support in facilitating co-interpretation,and Beck Tench for the gorgeous graphics.We are so grateful to Jacqueline Nesi and Jennifer Wallace for their substantive reviews and thoughtful suggestions as we worked to capture the complexity in the data and make the findings accessible and useful.We would also like to thank the people behind the scenes who make these reports possible:Chris Arth,Christopher Dare,Emely Garcia,Jennifer Robb,and Alice Seiler for the copy edit and design;Christian Medina Beltz,Margaret Corona,Natalia Garcia,Susan Guibert,Adriene Davis Kalugyer,Mackenzie Kreitler,and Marisa Naughton for their marketing and communication work;Laura Ordoez for her work creating materials for parents and caregivers based on this report;and the internal review team at Common Sense Media,who brought their expertise and insight to the report draft.Thanks,too,to our colleagues at SSRS,Kristen Conrad and Jania Marshall,who helped us realize our survey design vision.Table of ContentsKey Findings.1Summary of Methods .8Introduction.9The Current Study .11Unpacking Grind Culture:Pressures and Burnout.12Different Types of Pressure.14Game Plan.14Achievement .15Appearance .15Social Life and Friendship.16Activism .16What Contributes?.19A Closer Look at Social Media .21A Closer Look at Gaming .28Burnout .30Self-Care Practices.33Spotlight:LGBTQ Teens .40Conclusion.42What Helps?Advice from Teens.43Methodology .45References.47Appendix.50vI UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 11.A majority of American teens feel at least one of six types of pressure.A majority(81%)of American teens report experiencing pressure that makes them feel bad in at least one of six domains,and more than half(52%)say they personally expe-rience this negative pressure in three or more domains.At the same time,19%report no feelings of pressure in any domain we examined.Im scared because what if I dont meet the stan-dards that everyones hoping?You want to seem like the most impressive person,the person that does all this,the person thats the president of all these clubs.And its like you cant do all these clubs,you dont have enough time,you have to study.And its just overwhelming because you feel like youre not doing enough.Black teen girl,11th gradePressures vary by teen,and those that weigh heavily on some are not relevant at all to others.Below are the six types of pressure we asked about1 and the percentage of teens who say the pressure negatively affects them personally somewhat or very much:Game Plan:56%of American teens feel pressure to have their future life figured out(e.g.,college,career,relationships).Achievement:53%of teens feel pressure to be excep-tional and impressive through their achievements(e.g.,honors classes,good grades,jobs).Appearance:51%of teens feel pressure to look their best or present themselves in a certain way(e.g.,follow trends,have a certain body type).Social Life:44el pressure related to having an active and visible social life(e.g.,hanging out with friends,going to social events/parties).Friendship:41el pressure to stay available and be supportive to friends(e.g.,respond to texts/social media from friends right away,be there when needed).Activism:32el pressure to do good for their com-munity or the world,or to be informed about different issues(e.g.,helping community members,supporting or giving money to causes,keeping up with the news).One of my grinds,for me,is the constant need to be the best or just constantly be able to perform and excel at everything I do because of the sense that if youre not constantly performing at an amazing rate,youre not doing enough.Youre not enough.Just a constant need to be perfect or else its just you dont feel like you belong or youre not enough.LGBTQ Latinx teen,10th gradeIdentities matter:Girls and nonbinary teens(compared to boys)and LGBTQ teens(compared to cisgender and non-LGBTQ teens)report greater feelings of pressure in every domain.These differences by gender and sexual orientation are all statistically significant.Teens from families of higher socioeconomic status(in terms of income and parental education)report more pressure specifically related to having a Game Plan,to Achievement,and to their Appearance.Higher parental education was also associated with more Social Life pressure.Key Findings1 For the full question wording for this and all data in this report,please see the survey questionnaire,available at https:/monsensemedia.org/sites/default/files/research/report/teen-grind-pressures-study-2023-questionnaire.pdf.2 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Pressures Experienced by U.S.TeensSOMEWHATVERY56QDA2S%Game PlanAchievementAppearanceSocial LifeFriendshipActivismNote:This chart illustrates the six types of pressure experienced by American teens.Game Plan pressure(56%),Achievement pressure(53%),and Appearance pressure(51%)affect over half of teens surveyed.Social Life pressure(44%),Friendship pressure(41%),and Activism pressure(32%)impact fewer than half of teens.The percentages listed on the right represent teens who report that each pressure affects them somewhat(orange)or very much(red).The percentages listed on the left(in gray)represent teens who report that each pressure affects them not at all or a little.Intensity of Pressures Experienced by U.S.Teens,by GenderNOT AT ALLA LITTLESOMEWHATVERYCisgender boyCisgender girlNonbinaryNOT AT ALLA LITTLESOMEWHATVERYNOT AT ALLA LITTLESOMEWHATVERYNOT AT ALLA LITTLESOMEWHATVERYNOT AT ALLA LITTLESOMEWHATVERYNOT AT ALLA LITTLESOMEWHATVERYGame PlanAchievementAppearanceSocial LifeFriendshipActivismNote:Nonbinary teens report higher levels of pressure across all domains,and cisgender girls generally report more pressure than cisgender boys.This graphic is based on the question How much does this pressure affect you personally?Each figure represents a point on a four-point scale,where 1=Not at all and 4=Very.The differences shown here are all statistically significant.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 32.More than one-quarter of American teens struggle with burnout.Burnout involves feelings of emotional exhaustion,cynicism,and a lack of confidence that your effort will make a differ-ence(Maslach&Leiter,2016;Npoles,2022).Most American teens(73%)say they are not feeling burned out,but more than one in four teens(27%)say that they are actively strug-gling with burnout.We found that pressures and feelings of burnout coexist in teens.Teens who report feeling more types of pressure and a greater intensity of pressure are more likely to also report feeling burned out.American Teens Feelings of Burnout1I have no symptoms of burnout.73%Not Burned OutScored 1 or 227%Burned OutScored 3,4,or 52I dont always have as much energy as I once did,but I dont feel burned out.3I am definitely burning out.4 or 5The symptoms of burnout wont go away;I often wonder if I can go on.Note:This chart shows the extent of burnout among American teens.More than one in four teens(27%)are actively struggling with burnout(responses 35),while 73%are not feeling burned out(responses 12).What creates burnout in my life would be things that put pressure on me,I suppose.Latino teen boy,12th gradeI think of burnout like an overused machine in a fac-tory Youre just doing the same thing over and over,and you dont feel like you really have a purpose.Black teen girl,11th grade4 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.4.Social media has a dual influence:It may amplify pressures,but can also reduce them.A majority of teens say that social media at least sometimes amplifies(worsens)every pressure they feel.Fully three-quarters of teens who feel Appearance pres-sure say social media makes it worse at least sometimes,and a similar proportion who experience Social Life and Activism pressures say that social media makes them worse.Two-thirds say the same about Game Plan,Achievement,and Friendship pressures.At the same time,meaningful proportions of teens(39%to 52%)say that social media at least sometimes decreases each pressure.Thus,teens reports reveal a complex interplay between social media and pressureone that is negative-leaning,but not without instances of positive influence.Social media is the most likely to worsen Appearance,Social Life,and Activism pressures.For Achievement,Game Plan,and Friendship pressures,other contributors are more salient(e.g.,teens themselves,parents and family members,adults from school).With respect to particular apps,teens say Appearance pressure is most often worsened by Instagram,TikTok,and Snapchat,and less often worsened by messaging apps and social gaming.Were always seeing someones face on social media,youre always comparing yourself to someones face.Someones always going to create a new trend.Youre gonna want to follow that trend.You dont feel perfect in that trend.Now youre leading yourself into self-doubt and all these like insecurities and whatnot.So the pressure is there and very strong,especially with beauty standards and the way that we change beauty standards and the fact that the beauty standard isnt realistic and they dont look like real people.LGBTQ Black teen,10th grade3.The pressure that teens feel comes from a variety of sources,including adults in teens lives,social media,and even themselves.Teens say that pressure comes from a variety of sources,most notably from the adults in their lives,like parents or family members,and the adults at school,like teachers,guidance counselors,and coaches,especially for Game Plan pressure.Teens also mention the pressures they put on themselves,especially Achievement pressure,though social media also plays a role,especially for Appearance pressure.ParentsI dont think they most of the time mean to kind of add pressure.But a relationship that one has with their parents might increase or decrease one of these pressures.LGBTQ Latina teen girl,11th gradeI feel this pressure from sports coaches a lot because its like anytime youre not perfect,youre scared.Like,Is this person going to take my spot?Is the coach gonna bench me?Am I not good anymore?What hap-pened?Why do I suck?Black teen girl,11th gradeIn my experience,social media makes me feel a lot more pressure about Achievement and Game Plan and Friends.Its,like,all of them,because I compare myself to other peoples achievements.And I can see on Instagram,for example,other people posting with their friends,and it might make me realize,like,I dont really hang out with my friends as much as some other people do.And in those ways social media increases all my pressures because its what I can use to compare myself to others.LGBTQ White teen girl,12th grade 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 5The Impact of Social Media on Appearance Pressure8 out of 10 teens social media at least sometimes increases Appearance pressure.4 out of 10 teens social media at least sometimes decreases Appearance pressure.This figure shows that approximately 8 in 10(79%)teens who feel Appearance pressure say social media at least sometimes increases it,and almost 5 in 10(48%)say it only increases pressure.Approximately 4 in 10(38%)say social media at least sometimes decreases appearance pressure,and about 1 in 10(13%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Appearance pressure.The Impact of Social Media on Achievement Pressure7 out of 10 teens social media at least sometimes increases Achievement pressure.5 out of 10 teens social media at least sometimes decreases Achievement pressure.This figure shows that nearly 7 in 10(67%)teens who feel Achievement pressure say social media at least sometimes increases it,and 3 in 10 say it only increases pressure(30%).Less than half(45%)say social media at least sometimes decreases Achievement pressure,and less than 1 in 10(8%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influ-ence on Achievement pressure.The Impact of Social Media on Game Plan Pressure7 out of 10 teens social media at least sometimes increases Game Plan pressure.5 out of 10 teens social media at least sometimes decreases Game Plan pressure.This figure shows that nearly 7 in 10(68%)teens who feel Game Plan pressure say social media at least sometimes increases it,and over 3 in 10 say it only increases pressure(32%).Approximately 4 in 10(44%)say social media at least sometimes decreases Game Plan pressure,and nearly 1 in 10(8%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Game Plan pressure.The Impact of Social Media on Social Life Pressure8 out of 10 teens social media at least sometimes increases Social Life pressure.5 out of 10 teens social media at least sometimes decreases Social Life pressure.This figure shows that nearly 8 in 10(75%)teens who feel Social Life pressure say social media at least sometimes increases it,and 4 in 10 say it only increases pressure(40%).Over 4 in 10(42%)say social media at least sometimes decreases Social Life pressure,and less than 1 in 10(7%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Social Life pressure.The Impact of Social Media on Friendship Pressure7 out of 10 teens social media at least sometimes increases Friendship pressure.5 out of 10 teens social media at least sometimes decreases Friendship pressure.This figure shows that nearly 7 in 10(69%)teens who feel Friendship pressure say social media at least sometimes increases it,and 3 in 10 say it only increases pressure(30%).Approximately 5 in 10(50%)say social media at least some-times decreases Friendship pressure,and about 1 in 10(11%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influ-ence on Friendship pressure.The Impact of Social Media on Activism Pressure7 out of 10 teens social media at least sometimes increases Activism pressure.5 out of 10 teens social media at least sometimes decreases Activism pressure.This figure shows that over 7 in 10(73%)teens who feel Activism pressure say social media at least sometimes increases it,and over 3 in 10 say it only increases pressure(33%).Over 5 in 10(51%)say social media at least sometimes decreases Activism pressure,and over 1 in 10(11%)say it only decreases pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Activism pressure,and one that is more balanced than for other pressures.6 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.You get to escape when youre gaming.Why would you think about appearance,my achievements?Why would I need to focus on the future,my social skills,my social pressures,the friendships?Gaming is intend-ed to focus you on the game,and not whats going on around you.White teen boy,10th gradeI choose my player.She makes me so happy playing her because shes,like,amazing.I get lost into the game because Im building stuff,Im fighting monsters and stuff.And I forget about everything else thats going on.Black teen girl,11th grade5.Gaming can be a pressure release valve for teens.Almost 80%of teens report gaming with others.Social gaming is different from other social media because it is more often a pressure release valve or at least a meaningful temporary distraction from pressures they feel:While teens most commonly answer that gaming has no effect on the pressures they feel,about one in four say that gaming actu-ally reduces each pressure.Relative to the other social media platforms,gaming was the platform that teens most often said alleviates their pressures.The Impact of Gaming on PressuresSocial LifeAchievementGame PlanMakes it worseNo effectA mix of bothMakes it betterAppearanceFriendshipActivismNote:This graphic illustrates the multifaceted impact of gaming on various pressures.More teens say that gaming only alleviates their pressures than only exacerbates them,though many teens who play social games say this has no effect on the pressure that they feel(gray),and some say the influence is mixed(as represented by overlapping green and red boxes).2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 7Frequency of Self-Care Activities by U.S.TeensIn the last week,teens Never13 Days4 DaysGot 7 or more hours of sleep per night96U%Got at least 1 hour of exercise/physical activity13G%Did something just for fun or relaxation5U%Spent time outside or in nature16T0%Helped friends or classmates9g$%Had a deep/meaningful conversation with a friend19Y%Did something creative(not for school)23a%WHAT HELPS?By studying the teens who report few to no negative pressures,we can identify practices that may help with pressure and burnout,including:Getting sleep Spending time outdoors or in nature Having more open schedules(free time,less restrictive scheduling,and using the internet less frequently)WHAT CAN ADULTS DO TO HELP?Teens in our advisory sessions shared other ways that adults can help:Adults can help teens make decisions that prevent overload.Adults can recognize teens efforts vs.just the outcome.Adults can share in teens joys.Adults can empathize,rather than minimize,when teens share about their stress/pressures.Adults can be curious about teens social media experiencesand not assume its all bad.6.Self-care practices may mitigate teen burnout,and they are weekly(but not daily)aspects of most teens lives.For adolescents,self-care activities,like getting sufficient sleep,physical activity,and meaningful social connection,are often considered cornerstones of well-being.We found that American teens who engage in more self-care practices report fewer pressures and lower burnout.A majority of teens engage in key self-care practices weekly,but not daily.Just over half(51%)of teens reported engaging in all seven self-care practices we examined at least once during the past week.However,of these practices,most teens do not spend daily time in nature,do fun or relaxing things,have deep or meaning-ful conversations with friends,engage in creative activities outside of schoolwork,help others,or get at least an hour of exercise.Only one in 50 teens(2%)engaged in all of the self-care practices on four or more days,and one in seven teens(14%)did not engage in any self-care practice on four or more days in the past week.Many teens arent getting enough sleep or exercise.Nearly half of teens(45%)got less than seven hours of sleep on multiple nights during the past weekless than the 8 to 10 hours per night recommended for teenswhile 55%of teens got seven or more hours of sleep on at least four of the last seven nights.With respect to exercise,60ll short of the daily one-hour recom-mendation,and about one in eight did not meet this guideline on any days over the past week.Teens face barriers to self-care.Teens who co-inter-preted the survey findings alongside us described barriers to self-care,including feeling unable to put away their devices,like phones or gaming consoles,but alsonotablyconstraints on their time,as well as beliefs that self-care just isnt productive.8 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.This is a nationally representative survey of 1,545 teens age 13 to 17 in the United States.The survey was conducted by SSRS using their SSRS Opinion Panel,and also includes survey participants from nonprobability opt-in web panels to oversample for Black teens and LGBTQ teens.Survey data was collected from October to November 2023,and co-interpretation focus groups took place from February to April 2024.The survey was fielded online,in English or Spanish.Data and analyses are weighted.We examined whether results depended upon gender,age,race/ethnicity,loca-tion,family/household income,parent education,and LGBTQ identity.The margin of error in this survey is 3.0 percentage points.The margin of error is calculated using a 95%con-fidence interval.For surveys that use a 95%confidence interval,which is an industry standard,one would expect that the results would contain the population value 95%of the time.The calculated margin of error for this study also accounts for the most conservative sample propor-tion estimate:50%.This means that the margin of error calculation assumes 50%of the sample will answer a question a certain way.Nineteen teens age 13 to 17 participated in focus group sessions to co-interpret and contextualize findings from this survey.These teens were not part of the initial survey sample.The quotations included throughout this report are from these focus groups.For additional details,please see the Methodology section of this report.Summary of Methods 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 9If we wanted to reverse trends in adolescent mental healthto see youth thriving,rather than strugglingwhere would we start?Many people point first to social media.In the current study,we examine American teens experiences of different pressures that may contribute to grind culture and burnout.We begin with the aim of understanding teens experiences in general,and then home in on the ways in which social media and gaming are relevant.This flips a typical approach in research about youth and social media:Instead of asking about positive and negative experi-ences as they arise for teens on social media,we first examine the pressures that teens feel,and then ask about how those pressures intersect with social media and other factors.Our overarching goal is to make visible teens perspectives and situate the diverse roles of technology in their well-being.Ultimately we hope to contribute new insights,nuance where it is warranted,and support for a solutions-oriented frame to current public discourse.In the current U.S.context,teens heading to school are as likely to pocket their smartphones as they are to reach for their house keys,backpacks,or water bottles.It is easier for teens to edit Instagram Reels and set up Discord servers than it is to set up bank accounts.Most(88%to 95%)have personal smartphones,and social media and gaming are staples(Common Sense,2022;Pew Research,2023).These technologies have scaled quickly,ahead of a full under-standing of their impacts for youth well-being.National data on the mental health of Generation Z has been ringing alarm bells:There have been notable increases in persistent sadness and hopelessness,loneliness,and suicidal thoughts and behaviors over the the last decade(CDC,2022;CDC YRBS,2024;Office of the Surgeon General,2023).Nearly 3 in 10 young people age 14 to 22 report moderate to severe depres-sive symptoms,and this number is even higher among LGBTQ youth,nearly half of whom(49%)report such symp-toms(Common Sense&Hopelab,2024).For youth of color,national survey data also highlights preva-lent and elevated mental health struggles:More than one in two Black,Latino,Native American,and multiracial youth and young adults have experienced moderate to severe depres-sive symptoms,as well as 48%of Asian American and Pacific Islander(AAPI)youth and young adults(The AAKOMA Project,2022).Social media apps loom large in the conversation about youth mental health,even as scholars continue to debate what con-clusions are warranted from available data(e.g.,Haidt,2024;Odgers,2024).Researchers generally agree that the data also shows that youth are having different experiences,and that the impacts are not solely or universally negative(Moreno et al.,2022;Coyne et al.,2022).At the same time,social media and smartphones are widely considered as key contributors to adolescent mental health trends(APA,2024;Murthy,2024).Importantly,research also suggests that both the benefits and harms of social media may be magnified for youth of color and for LGBTQ youth(Common Sense Media,2024).Social media aside,we know that adolescence is a develop-mental period of heightened stress reactivity.In a neurological and physiological sense,adolescents are particularly reactive to stress(Romeo et al.,2017).This is an important reason to pay attention to teens experiences:When stress is intense or prolonged,or adolescents do not have sufficient coping resources and support,it can lead to experiences of anxiety and depression as well as other negative health outcomes(AACAP,2019).We can think about pressure as the external demands on a teen,and stress as their response to that pressure.Stress and pressure can go hand in hand in ways that manifest differently for different young people.For example,in her book Under Pressure,Dr.Lisa Damour describes the ways in which aca-demic,social life,and appearance pressures contribute to elevated stress and anxiety among girls.When young people are under pressure,their personalities and sensitivities shape how they respond(e.g.,see Charbonneau,Mezulis,&Hyde,2009;McLaughlin et al.,2010).While one young person may be more sensitive or emo-tionally reactive to pressure than another,the reality is that young people also have vastly different pressures put upon them.Identities,circumstances,and broader systemic forces are all relevant.The broader context that surrounds themfriends,family,school,and social mediacan increase or decrease pressure,too.Introduction10 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Parsing American teens reports of the different pressures they face helps us take stock of their current experiences.It also invites us to interrogate how social media relates to the different pressures that teens feel.The pressures are not inherently tied to technology,but they intersect with teens digital experiences in a variety of ways.We investigate how teens see these pressures as influenced by different people in their lives(adults,friends,peers)and by digital environments,including social media and gaming.We also explore connections to teens self-care practices and to their reports of burnout.While burnout is most often researched in the context of adult populations and in relation to professional work(Bakker&Sanz-Vergel,2020),it is a well-established concept linked to stress,pressure,and mental health.Burnout is characterized by emotional exhaustion,cynicism,and low feelings of accomplishment or efficacy(Maslach&Leiter,2016;Npoles,2022),and is more likely in contexts where demands and pressures overwhelm resources and supports to deal with them.Feeling burned out is a sign-post that pressure is overwhelming.In broader research on adolescent mental health,there is considerable attention to experiences like depressive symp-toms,feelings of hopelessness,loneliness,and anxiety;burnout is less often examined(Walburg,2014).But teens descriptions of the aforementioned pressures piqued our interest in burnout,as they repeatedly described pressure to do the most and spread myself thin and drew connections to a grind culture that seems to celebrate and even fetishize constant activity at all costs.We therefore explore teens overall reports of burnout and associations between pres-sures and burnout.This report purposefully centers teens perspectives.We examine pressures that teens in our prior research told us they face,as well as how these pressures relate to burnout and to a collection of self-care practices.We grapple with the roles that social technologies play in these pressures,but also the roles played by people in their lives(parents and family members,teachers,friends,peers).The findings are a data-driven call for adults to approach the roles that social media and gaming play in young peoples lives with curiosity.That is,to consider teens social media experi-ences in the context of pressures and stresses that are relevant for different youth,and to ask questions about the sources of those pressures and the ways tech isand isntcontributing to them.One thing we know is that perception matters when it comes to pressure and mental health.In this report,we focus on the perspectives of American teens.We examine a collection of pressures,as well as the ways in which teens see social media and gaming as relevant to the pressure they feel.These pres-sures include:Game Plan:pressure to have your future path all figured out Overwhelming pressure from school and your future career;needing to have everything figured out.Achievement:pressure to achieve the most;to be impressive Pressure to be the best in all aspects of life.Appearance:pressure to look your best;to present your-self in a certain way Look my best at all times(outfits,makeup,body).Social Life:pressure to have an active social life(in person)Be social/partying/hanging out with friends all the time.Friendship:pressure to be available and/or show support for friends Pressure to keep communicating.Activism:pressure to be informed;to do good for your community or the world Consistently stay informed and outspoken.These pressures reflect established themes across existing literature on adolescence,including those related to the real risks for teen well-being associated with extreme pressure to excel(Robert Wood Johnson Foundation,2018).Yet the set of pressures included here are featured specifically because they emerged in prior qualitative research with teens about digital well-being(Weinstein,Davis,&James,2024;Weinstein,Tench,&James,2022;Weinstein&James,2022).That said,it is essential to acknowledge that there are heavy burdens on some teens that are beyond the focus of this study.This is not to minimize the weight of pressures related to finances and family circumstances,for example,nor to over-look the tolls of poverty,trauma,or discrimination as critical risk factors related to mental health(Robert Wood Johnson Foundation,2018).2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 11The Current StudyWe also asked teens about the frequency of their self-care practices in the past week.We selected practices that previ-ous research with adults suggests are restorative for stress and burnout:physical health practices like getting enough sleep(Chin,Guo,Hung,Yang,&Shiao,2015)and exercise(Naczenski et al.,2017)especially outdoors(Kondo,Jacoby,&South,2018;Thompson Coon et al.,2011);social practices like having meaningful conversations(Kim,Jee,Lee,An,&Lee,2018;Delroisse,Rim,&Stinglhamber,2023)and helping others(Wekenborg et al.,2022);and psychological flow practices like creative and fun/relaxing activities(e.g.,see Tjasink,Keiller,Stephens,&Carr,2023;Li,Lai,Friedrich,Liu,&Popkin,2023).Its important to note,though,that pressures and burnout risks go beyond what a teen does individually,which is why we also explore teens perceptions of the people and contexts around them that contribute to increasing or decreasing negative pressure.This report helps to unpack some of the pressures that teens feel and strives to help us be more attentive to the particular roles of social technologies in making those pressures better or worse(or having no impact at all).Throughout the report,we integrate perspectives of teens who co-interpreted the survey data.Our hope is to illuminate some of the texture around teens felt pressures,and to provide insights that support timely,grounded conversations about social media and youth mental health.This report describes findings from a nationally representa-tive survey,conducted online from October to November of 2023,with 1,545 adolescents(age 13 to 17)in the United States.The purpose of the study was to explore various pres-sures,teens views on what contributes to those pressures(including different people in their lives and on social media),self-care practices,and feelings of burnout.The survey data was co-interpreted with teens through 12 in-depth youth advisory group sessions.The study oversampled for and designed analytic approaches to ensure that the experiences of Black teens and LGBTQ teens were represented.The focus of this study was grounded in young peoples voices and their descriptions of grind culture and a variety of pres-sures related to it.We asked teens whether they use social media and which platforms they use the most(e.g.,YouTube,TikTok,Instagram,Snapchat,messaging apps,X/Twitter,gaming,BeReal,Reddit,and more).12 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Unpacking Grind Culture:Pressures and BurnoutAmerican youth experience a variety of pressures in their everyday lives,and these pressures can influence their mental health and even their day-to-day functioning.But their experiences of pressure differ in meaningful ways.While a majority(81%)of American teens struggle with feeling bad related to at least one of six pressure points we examined,nearly one in five(19%)feel none of these pres-sures.Forty-one percent of teens report feeling the pressure very much(i.e.,the highest level of pressure provided in the response options)in one or more areas.Below are the six pressures we asked about2 and the percent-age of teens who say the pressure affects them personally somewhat or very much:Game Plan:56%of American teens feel pressure to have their future life figured out(e.g.,college,career,relationships).Achievement:53%of teens feel pressure to be excep-tional and impressive through their achievements(e.g.,honors classes,good grades,jobs).Appearance:51%of teens feel pressure to look their best or present themselves in a certain way(e.g.,follow trends,have a certain body type).Social Life:44el pressure related to having an active and visible social life(e.g.,hanging out with friends,going to social events/parties).Friendship:41el pressure to stay available and be supportive to friends(e.g.,respond to texts/social media from friends right away,be there when they need them).Activism:32el pressure to do good for their com-munity or the world,or to be informed about different issues(e.g.,helping community members,supporting or giving money to causes,keeping up with the news).2 For the full question wording for this and all data in this report,please see the survey questionnaire,available at https:/monsensemedia.org/sites/default/files/research/report/teen-grind-pressures-study-2023-questionnaire.pdf.Number of Pressures Experienced Among U.S.Teens19%Report no pressures at a level of“somewhat”or “very.”29%Report 1 or 2 pressures at a“somewhat”or“very”level.39%Report 35 pressures at a“somewhat”or“very”level.13el all 6 pressures at a“somewhat”or“very”level.Note:The figure highlights that while most teens experience some degree of pressure,a significant portion(41%)feel intense pressure in at least one area.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 13Intensity of Pressures Experienced by U.S.Teens NOT AT ALLA LITTLESOMEWHATVERY%of teens who feel pressureaffects them at least“somewhat”56QDA2S%Game PlanAchievementAppearanceSocial LifeFriendshipActivismNote:This figure shows that Game Plan,Achievement,and Appearance pressures affect more than half of teens.Social Life and Friendship pressures notably impact teens,but to a lesser extent.Activism pressure is the least frequently reported,but it still affects nearly one-third of teens.Pressure that may feel motivating can quickly become nega-tively hued.And the reverse is true as well.Research on stress and child development recognizes positive stress as a normal and essential part of healthy development(Center on the Developing Child,n.d.).A crucial question we consid-ered in collecting,analyzing,and co-interpreting the data was whether and when teens feel constructive versus over-whelming pressure.Pressure is a complex dynamic.It can be overwhelming,but pressure isnt inherently problematic or concerning.This was a careful line we had to walk throughout the survey develop-ment and co-interpretation sessions.For example,we used language in our survey to focus on pressures that make teens feel bad to connote pressures with negative valence.Still,time and again we were reminded that teens have a nuanced relationship with pressure.At times,teens who co-interpreted the survey data acknowledged that it can be motivating.It can get bad at some point,but I also think that pressure can be the initiative for you to do something else.For example,when I have pressure,like when one of my friends is getting a 96 percent,and Im getting a 94,I can be like,I can do 97!I can be better than you.And I just start doing that and just start going by the pressure.Latina teen girl,10th grade14 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Three pressures were each reported by over half of surveyed teens:Game Plan,Achievement,and Appearance.Three other pressuresSocial Life,Friendship,and Activism pres-sureseach affected less than half of surveyed teens,with Activism impacting about one-third.Game Plan pressure(pressure to have a clear future path for ones life)was the most common pressure reported,by 56%of American teens.This was followed by Achievement pressure(the pressure to excel in current pursuits or to be the most impressive),reported by 53%.Appearance pressure(looking ones best or having a certain body type)was also relevant for about half of the teens surveyed(51%).About three-quarters of teens(74%)felt pressure in at least one of these three areas,55%in at least two,and 30%said they feel all three:Achievement,Game Plan,and Appearance pressure.Smaller proportions of teens reported feeling pressures related to having an active Social Life(44%),Friendships(being available and supporting friends;41%),and Activism(being informed about different issues;32%).In general,teens who felt more of one pressure also tended to feel more of other pressures.What follows is an overview of each pressure.Game Plan More than half of teens surveyed(56%)report that feeling pressure to have a future path all figured out is very or somewhat pronounced for them(21%and 34%,respec-tively).For another one in four teens(28%),this Game Plan pressure is felt only a little,and 17%say they do not feel this pressure at all.Teens who examined the survey findings alongside us noted that:From a small,small age,you are always asked,Oh,what do you want to do when youre older?Its almost pressurized to succeed and try and find your place and what you want to do in the world.White teen boy,10th gradeIts definitely starting to get to me now that I have like two or three months of my junior year left.Everyone wants to know,Hey,what are you going to major in?Where do you see yourself in a few years or after col-lege?What college do you want to go to?Latina teen girl,11th gradeDifferent Types of PressuresHow Much Does Each Pressure Personally Affect American Teens?PressureNot at allA littleSomewhatVeryTotal who feel the pressure negatively affects them at least somewhatGame Plan17(4!Vhievement1623 S%Appearance20)2Q%Social Life2702D%Friendship2631Ativism362&%72%Note:Numbers may not sum exactly due to rounding.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 15In some cases,the cost is rest or downtime:Every time I do waste time,I feel so guilty about it.When I waste time,then I feel so bad about it that Ill study for the whole week straight,not play any games,not watch any YouTube videos,not watch any Netflix videos for the whole week.Just study,study,study.Grind,grind,grind.Its an exhausting cycle.Black teen girl,11th gradeAnd in some cases,the cost is relationships:I feel like its very difficult to get out of this feedback loop,almost,and just constantly comparing yourself with others.And sometimes its really annoying,and I feel like it does disrupt the relationship that I have with some people.So I dont know.I guess achieve-ment would be one of the prices.Latino teen boy,12th grade Achievement pressure and Game Plan pressure are related.Indeed,72%of those who reported feeling Game Plan pres-sure also reported Achievement pressure.Achievement pressure is by no means universal.As the survey data signals,16%said they feel no Achievement pres-sure(not at all)and another 32el only a little.AppearanceMore than half of teens surveyed(51%)report that pressure to look their best or present themselves in a certain way is very or somewhat pronounced for them(19%and 32%,respec-tively).For another 29%this Appearance pressure is felt only a little,while 20%say they do not feel this pressure at all.Teens report that social media is the top contributor to increasing Appearance pressure(Please see figure on page 20).And though Appearance pressure was more frequently and strongly reported on the survey by girls,the pressure was reported by girls(57%),boys(42%),and nonbinary youth(69%).During co-interpretation,teens reiterated that Appearance pressure is not just a girl thing and described how it can come up for boys,for example,related to working out or having a particular body type.Achievement More than half of teens surveyed(53%)report that feeling pressure around Achievement is very or somewhat pro-nounced for them(20%and 33%,respectively).For another 32%this pressure is felt only a little,while 16%say they do not feel this pressure at all.For some teens,this pressure is a constant:Youre always pushed to achieve your highest goal,highest capability,and work towards what you want to achieve and what people think your highest poten-tial is.White teen boy,10th gradeThe achievement pressure is something I think about constantly as I am a first-generation immigrant The achievement thing is something I hold in my head a lot because I do want to impress my parents,make them proud.And at the same time it can get overwhelming,it can like mess with my brain sometimes.LGBTQ Black teen,10th gradeAs we examined the survey findings alongside teens,they raised several further considerations about Achievement pressure.In addition to connections to social media and comparison(which are described on page 24),they noted:Achievement can come at high costs for teens.In some cases,the cost is a balanced life and emotional well-being:I know I always feel pressure to not waste time,where it makes me not do the things that I like doing for myself,and it makes me spend time with my friends less,and all the sorts of things that you know make a balanced life.Even during exam seasons,Ill stop going to my sport because I have to spend so much time on school,and I dont think thats very good for my overall emotional mental health.LGBTQ White teen girl,12th grade16 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Friendship pressure is connected to teens individual rela-tionships,and to the ways they experience pressure related to investing in those friendships.About two in five(41%)report this pressure as very or somewhat pronounced for them(10%and 31%,respectively).For another 33%this pressure is felt only a little,while 26%say they do not feel this pressure at all.For some teens,aspects of friendship pressure include responding to text messages,commenting on friends social media posts,and generally being available to friends.However,the pressure also comes up related to conflicts with friends and group dynamics(e.g.,choosing sides in social conflicts).ActivismAbout one in three teens(32%)report feeling Activism pres-sure or the pressure to do good for their community or the world or to be informed about different issues,with 7%reporting the pressure as very and 26%as somewhat pronounced for them.3 For another one in three teens(32%),this pressure is felt only a little,while the remaining third(36%)say they do not feel this pressure at all.Though this pressure is not felt by most American teens in our study,we heard from teens who co-interpreted the survey findings alongside us that it can be quite overwhelming.I take activism very seriously,and I try to keep myself up with things,trying to consume all the knowledge and stuff like that.Sometimes it does become over-whelming,especially since some of the issues I think and talk about are things that are very gruesome and things that you know teens shouldnt necessarily be,like,fixating and focusing on.So I feel like sometimes that grinds me a little bit because I feel like I need to know everything and so I guess that would be one of my grinds.LGBTQ Black teen,10th gradeTeens in co-interpretation groups also recalled different moments when they started to notice pressure to look a certain way:I did not think about appearance until I became a teen.Seeing other teens getting ready for quinceaeras,I thought Am I supposed to like poofy dresses?!Latina teen girl,10th grade Social Life and Friendship pressuresForty-four percent of teens report feeling pressure to have an active social life(in person)after school and on weekends(Social Life pressure),and 41%reported pressure specifically related to being available or showing support for friends(Friendship pressure).I sometimes feel guilty,because I have to put myself over other things first.So I think in the back of my mind I feel that pressure,like maybe Im not being good enough as a friend.LGBTQ biracial teen girl,10th gradeSocial Life pressure includes having friends to hang out with or study with,or being invited to and attending social events,parties,and even group chats or virtual spaces where peers congregate.More than two in five(44%)report this pressure as very or somewhat pronounced for them(12%and 32%,respectively).For another 30%this pressure is felt only a little,while 27%say they do not feel this pressure at all.For those who experience a feeling of pressure to maintain an active social life,financial pressures can be relevant and intertwined:Theres definitely pressure to like,always go out and like,when youre going out,you like spend money to eat or to do an activity.LGBTQ Asian teen girl,12th grade3 Numbers may not sum exactly due to rounding.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 17A familys income or a parents education level is also related to teens experiences with the different pressures examined in this report.Teens with higher family income or with parents who have higher educational attainment report more pressure specifically related to having a Game Plan,Achievement,and Appearance.Family income or parent education were unre-lated to Friendship and Activism pressures.Higher parental education was also associated with more Social Life pressure.Teens who co-interpreted the survey data with us shared reactions to this finding based on personal experience and observations of their peers,giving voice to what Wallace(2024)has referred to as the encore effectthat is,a kind of pressure to replicate parents success:My parents went to college,both of them,and they always tell me how they went to college,so college is supposed to be two times easier for me since they already went to college.And that just gives me a little bit more pressure.Latina teen girl,10th gradeI have a lot of people in my school that their parents are doctors,lawyers,and all this other big-time stuff,and they just feel so pressured to fit into the fam-ily aesthetic that they start crumbling.Its because theyre afraid of disappointment from their family.Black teen girl,11th gradeFor the six pressures examined in this survey,there were no consistent patterns by race/ethnicity.I just feel like Im not doing enough toward my commu-nity to help them be better and be more informed and,like,just create a better environment for the upcoming generation.I feel like I dont know where to start,and its like youre not doing anything to help your commu-nity,and I feel like a failure because of that.Black teen girl,11th grade Which teens are reporting more pressure?A few notable patterns emerged across different types of pressures.Girls and nonbinary teens report greater feelings of pressure in every domain,compared to teen boys.Specifically,compared to boys,teen girls are:87%more likely to experience Appearance pressure 53%more likely to experience Friendship pressure 42%more likely to experience Social Life pressure 39%more likely to experience Game Plan pressure 32%more likely to experience Achievement pressure 25%more likely to experience Activism pressureSimilarly,LGBTQ teens report greater feelings of pressure in every domain,compared to cisgender and non-LGBTQ teens.(See Spotlight:LGBTQ Teens,beginning on page 40,for more detail.)18 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.I think my school is a generally competitive school.So theres a lot of toxicity related to that.Im a senior right now,a lot of people like sort of brag about their college acceptances So that sort of adds onto the Game Plan pressure and sort of ties to Achievement pressure.LGBTQ Asian teen girl,12th gradeEven though they dont mean to,I feel like my parents really add to the pressure.LBGTQ Latina teen girl,11th gradeOur classmates can make certain comments that may passively stick with you in terms of maybe your appearance or a certain insecurity you may have.LGBTQ Asian teen girl,12th gradeOn social media,you see a lot of people my age being so successful in life,and I cant help but think,like,Wow!Theyre my age,and theyre already starting their career,and theyre already making tons of money every day.And its like you start to compare yourself so you start to feel,like,kind of left behind.LGBTQ Latina teen girl,11th gradeI feel this pressure from sports coaches a lot its like anytime youre not perfect,youre scared.Like,Is this person going to take my spot?Is my coach gonna bench me?Am I not good anymore?What happened?Why do I suck?And it just circles your mind.Black teen girl,11th gradeWith other peers or classmates were all learning the same thing,but for some reason this persons,like,an all-star,like,they do everything easily.Theyre breezing through every class.They never had to study.And its like,now you feel pressure because youre like,Wait,am I like doing something wrong?Like,How come I cant understand,am I not smart enough?And so it just really pressures you to work harder,do this more,and now youre studying at 12 a.m.,not getting enough sleep.You still get the grades you get because,I mean,youre not getting sleep.This is like a downward spiral and its just,I dont know,this is really hard.Black teen girl,11th grade 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 19Feelings of pressure come from a variety of sources,including adults in teens lives,social media,and even themselves.We asked teens what contributes to the pressure they feel.We were specifically interested in the contexts and sources of these pressures:Do they see the pressure as coming from themselves,from the people and content they follow on social media,from their closest friends,from their parents/family members,from the teachers or other adults at school,or from people in their community(e.g.,neighborhood,church)?We focused the analyses for pressure contributors on those teens who actually reported feeling the pressure(excluding those who said they do not feel the pressure at all).Pressure on teens comes from a variety of sourcesTeens feedback points to a constellation of sources,rather than one single driver of pressure.For example,teens most often say that teachers,guidance counselors,coaches,and other adults at school(48%)and they themselves(44%)increase their Game Plan pressure,but 39%also say pressures come from other family members.These same sources were also seen as the top contributors to Achievement pressure,but showing a different pattern of influence.That is,teens say that they themselves(48%)and adults at school(38%)put the most pressure on themselves.They also feel pressure from parents/family members(34%).The top sources of Appearance pressure look a little different.Here,teens most often point to three top contributors:social media(48%),other peers or classmates(46%),and themselves(46%).(We discuss social media in more depth in the next section.See page 21).In addition,teens tell us that some sources have dual influ-ences,both increasing and decreasing pressures.This is important to note because it suggests that most teens are reporting increased pressures from these sources at least sometimes.For example,40%of teens say that they them-selves sometimes increase and sometimes decrease their feelings of Game Plan pressure.Teens also report mixed influences on Game Plan pressure from other peers or class-mates(40%)and their closest friends(38%).For Achievement pressures,teens similarly report that people and contexts have a complex role in terms of some-times increasing or decreasing it.For example,40%see a dual role from other peers or classmates,with similar propor-tions seeing this complexity from themselves(37%),people and content on social media(37%),parents or family members(37%),and school adults(38%).Finally,for Appearance pressures,teens say that they them-selves(38%),their closest friends(38%),other peers or classmates(37%),people in their community(36%),and parents or family members(35%)both decrease and increase their pressure to look their best.(For a more detailed visual-ization of what contributes to teens pressure,please see Figure 6 in the Appendix.)Who helps reduce feelings of pressure?Importantly,the data also provides some insight into where pressure relief can come from for teens.Their closest friends and parents/family members are most relevant as sources of decreasing felt pressure.For teens who are feeling Game Plan pressure,their closest friends decrease the pressure for 26%of teens,and parents/family members for 18%.For Achievement pressure,30%say their close friends decrease their feelings of pressure,and 20%say their parents/family members do.For Appearance pressure,31%say parents/family members reduce this pressure,and 29%say closest friends do.What Contributes to Pressure?20 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.What Increases the Pressures That Teens Face?Game Plan Top Sources:School Adults(48%)Myself(44%)Parents/family(39%)Achievement Top Sources:Myself(48%)School adults(38%)Parents/family(34%)Appearance Top Sources:Social Media(48%)Myself(46%)Peers/Classmates(46%)Social Life Top Sources:Social Media(40%)Myself(39%)Peers/Classmates(38%)Friendship Top Sources:Myself(35%)Peers/Classmates(32%)Social Media(30%)Activism Top Sources:Social Media(33%)School Adults(31%)Myself(27%)School AdultsMyselfParents/FamilySocial MediaClassmatesCommunityClosest FriendsNote:This figure shows that the pressures teens face are influenced by multiple sources.Most pressures have multiple top contributors that are effectively tied for the top spot.That is,differences between the top few contributors to the pressure are likely to be statistically similar to one another if they are within 3%to 4%of each other.The figure can be explored by tracing an influence(e.g.,myself,social media)to the corresponding pressures(e.g.,Game Plan,Achievement),or by examining the ranking of each influence on a given pressure.The thicker the line,the greater the influence,and influences are traced in order of prevalence(though again,note that not all ordering differences are statistically significant).The information is also presented numerically(see Table 1 in the Appendix).2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 21We asked teens about the social media platforms they use and how frequently they use them,from do not currently use to almost constantly.In this sample,teens most widely used:With respect to frequency of use,about one in five teens reported using the following apps almost constantly:A Closer Look at Social MediaFrequency of Social Media Platform UseYouTube Messaging AppsTikTokGaming with othersInstagramSnapchatFacebookTwitter/XDiscordRedditTwitchBeRealDaily UseAlmost constantlyMultiple times per dayAbout once per dayWeekly UseAbout 35 times per weekOnce or twice a weekLess than once a weekDo NOT currently useNote:This figure shows the frequency of social media platform use for American teens(as of October/November 2023),ranging from almost constantly(darkest green,at top)to do not currently use(gray,at bottom).The intensity of color reflects the usage frequency,highlighting which platforms are most and least used by teens.YouTube(97%)Messaging apps(83%)TikTok(82%)Gaming with others(80%)Instagram(78%)Snapchat(74%)TikTok(22%)Messaging apps(20%)YouTube(20%)Snapchat(17%)22 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.The Impact of Social Media on Appearance Pressure8 out of 10 teens social media at least sometimes increases Appearance pressure.4 out of 10 teens social media at least sometimes decreases Appearance pressure.This figure shows that approximately 8 in 10(79%)teens say social media at least sometimes increases Appearance pres-sure,and almost 5 in 10(48%)say it only increases this pressure.Approximately 4 in 10(38%)say social media at least sometimes decreases Appearance pressure,and about 1 in 10(13%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Appearance pressure.When we examined these survey findings with teens,we askedbefore showing them the findingswhich of the six pressures they expected would be most influenced by social media.One teens poignant,immediate reply was:Its definitely Appearance.And if its not Appearance,this is rigged!LGBTQ Black teen,10th grade.With respect to particular apps,teens most often named TikTok,Instagram,and Snapchat as specific contributors to increasing Appearance pressure(i.e.,makes me feel worse).Social media has a dual influence:It acts as an amplifier of pressures,but can reduce them,too.A majority of teens say that people and content on social media at least sometimes worsen every pressure they feel.Over three-quarters of teens who feel Appearance pressure point to social media as at least sometimes worsening it(79%),and a similar proportion for Social Life(75%)and Activism pressures(73%).Two-thirds say the same about Game Plan(68%),Achievement(67%),and Friendship pres-sures(69%).Yet at the same time,meaningful proportions of teens say that social media at least sometimes decreases each pressure(38%to 51%,depending on the pressure in question).Thus,teens reports reveal a complex interplay between social media and pressureone that is negative-leaning,but not without instances of positive influence.Social media influences on Appearance pressureMore than three-quarters of teens who report Appearance pressure say that social media at least sometimes increases(worsens)this pressure(79%,of which 48%say social media only increases Appearance pressure,and 31%say the influ-ence is mixed).A smaller number say that social media at least sometimes decreases the pressure(38%,including the 31%who say the influence is mixed and the 7%who say social media only decreases Appearance pressure).Just 13%say social media has no influence on their experiences of Appearance pressure.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 23The Impact of Social Media Platforms on Appearance PressureYouTubeMessaging AppsTikTokGaming w/OthersInstagramSnapchatFacebookMakes it worseNo effectA mix of bothMakes it betterNote:The figure above demonstrates how different apps(e.g.,Instagram,TikTok)affect teens Appearance pressure,among teens who use each app.Apps are ordered by their negative impact(e.g.,Instagram has the most negative influence on Appearance pressure;Gaming with others has the least).Within each app,the boxes in green(decreases pressure),red(increases pressure),and overlapping colors(a mix of both)show the nuances in teens portrayals,while the gray figures identify teens who said the app has no effect on their feelings of Appearance pressure.Table 2 in the Appendix presents this information numerically.*Not shown:Twitter,Reddit,Discord,BeReal,and Twitch were included on the survey but are not reported in this table,which summarizes data only for the most commonly used apps.24 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Social media influences on Achievement and Game Plan pressures Two-thirds of teens who report Achievement pressure say that social media at least sometimes worsens this pressure(67%,of which 30%said social media only increases Achievement pressure,whereas 37%said the influence is mixed).A smaller number(45%)say that social media at least sometimes decreases Achievement pressure,including the 37%who say the influence is mixed and the 8%who say social media only decreases Achievement pressure.One-quarter(25%)say social media has no effect on their feelings of Achievement pressure.The Impact of Social Media on Achievement Pressure7 out of 10 teens social media at least sometimes increases Achievement pressure.5 out of 10 teens social media at least sometimes decreases Achievement pressure.This figure shows that nearly 7 in 10(67%)teens who feel Achievement pressure say social media at least sometimes increases it,and 3 in 10 say it only increases this pressure(30%).Less than half(45%)say social media at least some-times decreases Achievement pressure,and less than 1 in 10(8%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Achievement pressure.We observed similar findings related to Game Plan pressure:Of those who experience this pressure,32%say social media only increases it,and 36%say the influence is mixed.On the flip side,44%say it at least sometimes decreases the pres-sure(including the 36%who say the influence is mixed and the 8%who say it only decreases Game Plan pressure).One-quarter(25%)say social media has no effect on their feelings of Game Plan pressure.In the co-interpretation focus groups,teens referenced Appearance-amplifying elements of Instagram,including filtered and curated content from peers,influencers,and celebrities.I put Instagram as it increases the pressure,because its so easy,like the others have mentioned,just to scroll and see constant filters and beautiful people.And you dont really take into account,you know,if they edit their photo.They have professional makeup artists or hairstylists,whatever the case may be.LGBTQ Asian teen girl,12th gradeTeens also raised considerations about the ways TikTok influencers contribute to Appearance pressure,for example,as related to beauty products and routines.This occurs par-ticularly often for younger girls,like one teens 11-year-old cousin who feels like shes not pretty if she doesnt use this expensive moisturizer and that expensive face wash(Black teen girl,11th grade),and also for teen boys related to gym culture and the ideal body type.With respect to gym content,one teen noted,A lot of my guy friends are affected by gym content and feel the pressure to,like,work out every single day,or,like,have the ideal body type(LBGTQ Asian teen girl,12th grade).A teen boy shared,As someone that goes to the gym and watches a lot of gym content,there are so many,like,influencers online that have just the perfect bodies.Latino teen boy,12th gradeFilters can be particularly relevant on Snapchat,as described by the teen who shared,In middle school,everyone around me would use the Snapchat filters that would make you look better.I got so used to seeing myself a certain way that when I turned it off,I would get insecure.So once I deleted that app and I stopped using the filters,I felt better about myself.LGBTQ biracial teen girl,10th grade.2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 25But as a reminder that teens experiences of different plat-forms vary in meaningful ways,it is worth noting that others directly pointed to Reddit as having the opposite effect for them:On Reddit pages about SATs and AP classes,I think theyre very inflated with the,like,the level of expec-tations of greatness that they have on there,and I feel like that makes a lot of people feel bad about them-selves,even when you can look at it and then look at statistics and know that only the people with the high-est numbers are the ones posting on there.And I think that the communities there are really negative and can make people feel bad about themselves.LGBTQ White teen girl,12th gradeSocial media influences on Social Life and Friendship pressuresThree-quarters of teens who report Social Life pressure say that social media at least sometimes worsens this pressure(75%,of which 40%say social media only increases Social Life pressure,and 35%say the influence is mixed).For this pres-sure,42%say that social media at least sometimes decreases pressure(including the 35%who say the influence is mixed and the 7%who say social media only decreases their Social Life pressure).Another 18%say it has no effect.The Impact of Social Media on Social Life Pressure8 out of 10 teens social media at least sometimes increases Social Life pressure.5 out of 10 teens social media at least sometimes decreases Social Life pressure.This figure shows that nearly 8 in 10(75%)teens who feel Social Life pressure say social media at least sometimes increases it,and 4 in 10 say it only increases this pressure(40%).Over 4 in 10(42%)say social media at least sometimes decreases Social Life pressure,and less than 1 in 10(7%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influ-ence on Social Life pressure.The Impact of Social Media on Game Plan Pressure7 out of 10 teens social media at least sometimes increases Game Plan pressure.5 out of 10 teens social media at least sometimes decreases Game Plan pressure.This figure shows that nearly 7 in 10(68%)teens who feel Game Plan pressure say social media at least sometimes increases it,and over 3 in 10 say it only increases this pres-sure(32%).Approximately 4 in 10(44%)say social media at least sometimes decreases Game Plan pressure,and nearly 1 in 10(8%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Game Plan pressure.In our co-interpretation groups with teens,we heard about how social media can spark social comparisons that are spe-cifically linked to others achievements and success:Social mediabased off my feedwho Im seeing is all of these really successful peoplelike people my age and all of their achievements.So then I just feel like I end up comparing myself even more and with personal friends or classmates.LGBTQ biracial teen girl,10th gradePersonal records at the gym,college acceptances,and other personal achievements are other forms of social media sharing that teens described as having potential to exacer-bate pressure.On the other hand,they shared that particular uses of social media can help directly reduce these:I dont use Reddit often,but the only times that I do is for advice with school,or my career.It was the only so-cial media platform that I said decreases my pressure,because I feel like with that platform you could find guidance or with tips I feel like are really important for teenagers.LGBTQ biracial teen girl,10th grade 26 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.On the other hand,social media can also ease Social Life pressure.For example,teens shared that it provides a con-tinued opportunity to connect with peers,which can reduce the pressure put on in-person interactions.However,the opportunity for ongoing connection can be a burden.Being constantly connected through their smart-phones can amplify the pressure that teens feel to reply to friends and maintain regular contact.Replying to my friends texts,answering calls,and just having all these expectations in a friendship met sometimes I feel that if I dont talk to a friend that much,then that could affect,like,my social life,and it could all like crumble down.Even though I know it wont,theres still that little pressure in the back of my head that it could.LGBTQ Asian teen girl,12th gradeGroup chats with a large volume of participation are also relevant here:While they can support friendship and close-ness in meaningful ways for the teens who are included,knowing about group chats that some peers are in(and others are being excluded from)can also worsen the Friendship and Social Life pressures that teens feel.Social media influences on Activism pressure Nearly three-quarters of teens who feel Activism pressure say that social media at least sometimes increases this pres-sure(73%,of which 33%say social media only increases Activism pressure;40%say the influence is mixed).For this pressure,more than half(51%)say that social media at least sometimes decreases the pressure(including the 40%who say the influence is mixed,and another 11%who say it only decreases the pressure.Another 16%say it has no effect.Just over two-thirds who experience Friendship pressure say that social media at least sometimes worsens it(69%,of which 30%say it only increases the pressure;another 39%say the influence is mixed).Fully half of teens say social media at least sometimes decreases Friendship pressure for them(including the 39%who say the influence is mixed and another 11%who say social media only decreases this pressure).Another 21%say it has no effect.The Impact of Social Media on Friendship Pressure7 out of 10 teens social media at least sometimes increases Friendship pressure.5 out of 10 teens social media at least sometimes decreases Friendship pressure.This figure shows that nearly 7 in 10(69%)teens who feel Friendship pressure say social media at least sometimes increases it,and 3 in 10 say it only increases this pressure(30%).Approximately 5 in 10(50%)say social media at least sometimes decreases Friendship pressure,and about 1 in 10(11%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Friendship pressure.In our co-interpretation groups with teens,we heard about a variety of ways in which social media can convey a sense of what social life should be,and in ways that contribute to compari-sons that can make teens feel worse.I can see on Instagram,for example,other people post-ing with their friends.And it might make me realize,like I dont really hang out with my friends as much as some other people do.And in those ways,social media increases all my pressures because its what I can use to compare myself to others.LGBTQ White teen girl,12th grade It can also feel like:everybodys at a party or something during the week-end because social media is always,like,full of stuff that theyre doing,and Im just here.Latina teen girl,10th grade 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 27Content and context matterThe data from this study suggests that social media can play different roles in the pressures that teens feelin some cases,amplifying pressure,in other cases,decreasing it,and some-times a mix of both.The overall portrayal is negative-leaning,with social media more often worsening pressures rather than helping to decrease them,though the data does showcase nuance and varied experiences.Teen co-interpreters offered insights about the importance of content and context,too.They emphasized that the type of content Im consuming matters on social media(LGBTQ White teen girl,12th grade),and acknowledged that algorithms shape the content and therefore how pressures are impacted:I personally think that it depends on how the algo-rithm is suggesting stuff to you Its depending on what youre looking at and what youre doing on that platform sometimes.Sometimes it gives youit allows you to ease the pressure because of how the algorithm is working and how your mind is processing those things.So I think its just kind of one of those things where it can be anything.White teen boy,10th gradeAnd they pointed to particular positives related to interest-driven engagement and learning.For example,If Im on Twitter,where for me is where Im in a lot of fandom spaces that I like,I really enjoy that time be-cause Im looking at really cool art or reading peoples opinions.And because thats like important to me and to whatever,you know,media Im enjoying,that feels a lot more valuable to me,and like,I always notice Im happier whenit sounds really weirdbut when Im able to spend more time in those spaces.LGBTQ White teen girl,12th grade The Impact of Social Media on Activism Pressure7 out of 10 teens social media at least sometimes increases Activism pressure.5 out of 10 teens social media at least sometimes decreases Activism pressure.This figure shows that over 7 in 10(73%)teens who feel Activism pressure say social media at least sometimes increases it,and over 3 in 10 say it only increases this pres-sure(33%).Over 5 in 10(51%)say social media at least sometimes decreases Activism pressure,and over 1 in 10(11%)say it only decreases this pressure.Thus,the figure reflects a mixed but negative-leaning portrayal of social medias influence on Activism pressure,and one that is more balanced than for other pressures.From teens who examined the survey findings with us,we heard that Activism pressure has both obvious and more subtle dimensions online.Teens described how seeing other people and influencers post about activism motivates people to do the same.They also said that seeing a steady flood of activist-oriented content can also make teens feel very,like,desensitized(LGBTQ Asian teen girl,12th grade).And they described feeling pressure to be informed and speak out:You are called out a lot more on social media espe-cially in our current state,you know,to speak on sub-jects,to go out of your way to say what you need to.I see a lot of my friends say stuff.I personally say stuff about whatever I feel like I need to do because I have my voice for a reason.So the pressure to be informed,and the pressure to know everything,and the pres-sure to,you know,grasp things have lasted for over a hundred years,grasp a lot of issues and to speak on them eloquently,and to be able to put them in a way that other teens can understandthat pressure is like very high.LGBTQ Black teen,10th grade28 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Gaming can be a release valve for the pressure and stress that teens feel.Eighty percent of teens report gaming with others,and social gaming is different from other social mediait generally reduces feelings of pressure,and rarely worsens them.Almost 80%of teens report that they engage in digital games with others.For these teens who are social gamersthat is,those who play online games(e.g.,Minecraft,Fortnite)that involve interacting with other playersteens most com-monly answer that it has no effect on the pressures they feel,and roughly one in four say that gaming only helps to decrease each pressure.Relative to the other social media platforms,social gaming stands out as being the most positive and least pressure-amplifying.Depending on the pressure,between 23%and 28%say gaming only decreases the pressure,4%to 10%say gaming only increases the pressure,14%to 26%say the influ-ence is mixed,and 41%to 55%say it has no effect.This generally echoes existing research on the benefits of playing video games(Granic et al.,2014),including how teens say gaming helps more often than hurts in areas like supporting teens friendships,mental health,and problem-solving skills(though not with sleep and school performance)(Gottfried&Sidoti,2024).This differentiation of gaming from social media reflected in the survey findings was also bolstered by comments from teen co-interpreters who explained:Gaming for about an hour versus social media for an hoursometimes social media can leave me feeling very overstimulated.Theres so much content and material Im absorbing in,like,a small time frame.So yeah,I think gaming,compared to social media,is more relaxing,and it doesnt,like,hurt my brain as much because I can just take the time to chill and relax.Whereas with social media,although I would go on it to relax,it leaves me feeling different ways.LGBTQ biracial teen girl,10th gradeYou get to escape when youre gaming.Why would you think about appearance,my achievements?Why would I need to focus on the future,my social skills,my social pressures,the friendships?Gaming is intended to focus you on the game and not whats going on around you,almost.White teen boy,10th gradeTeens also acknowledge that gaming can be stressful if inter-actions become tense.They also point out that it can be an escape while playing,but may distract from tackling priorities,which then later increases stress.Afterward,gaming might reduce your amount of free time,which in turn can then increase your pressure.LGBTQ biracial teen girl,10th gradeA Closer Look at Gaming 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 29The Impact of Gaming on PressuresSocial LifeAchievementGame PlanMakes it worseNo effectA mix of bothMakes it betterAppearanceFriendshipActivismNote:This graphic illustrates the multifaceted impact of gaming on various pressures.More teens say that gaming only alleviates their pressures than only exacerbates them,though many teens who play social games say this has no effect on the pressure that they feel(gray),and some say the influence is mixed(as represented by overlapping green and red boxes).30 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Burnoutand 48%of teens endorsed the statement Occasionally I am under stress,and I dont always have as much energy as I once did,but I dont feel burned out.Among those who said they were experiencing burnout,19%said,I am definitely burning out,and 5%endorsed the state-ment,The symptoms of burnout that I am experiencing wont go away.I think about this a lot.Another 3%agreed with I feel completely burned out and often wonder if I can go on.I am at the point where I may need some changes or need to seek some sort of help.My older brother who was,I think,just leaving middle school,was going into high school and was talking about how he couldnt find a reason to go to school anymore cause he was just so tired all the time.He just kept working and working and working,and he was just burnt out.He was just he was just donejust tired of it,constantly.I remember my older brother described it in a way where he said,I feel like a train whos burnt off every ounce of fuel thats left,but still hasnt reached the station.LGBTQ Latinx teen,10th gradeI define burnout as getting overwhelmed and not being able to do everything you need to do.It is a collec-tion of everything you have to do in your life,not just school,work,social.Latino teen boy,12th grade Teens who report a greater number of pressures are more likely to also report feeling burned out,as are those who reported feeling any given pressure more intensely.For each additional pressure that a teen reports,there is a 2.2 times increase in their likelihood of reporting burnout.Notably,among teens who report experiencing none of the pressures,only 5%(1 in 20)reported experiencing burnout,whereas 43%(nearly 9 in 20 teens)reported burnout if they had also reported four or more pressures.One interesting exception is the Activism-related pressure,which was associated with slightly lower,rather than higher,burnout.More than one-quarter of American teens struggle with burnout.Burnout can occur when teens face persistent,over-whelming pressure without adequate social support systems or effective self-care practices.As one teen put it:What creates burnout in my life would be things that put pressure on me,I suppose.Latino teen boy,12th gradeBurnout is typically defined in research using three criteria:emotional exhaustion,cynicism or depersonalization,and low sense of personal accomplishment or self-efficacy(Maslach,Shaufeli,&Leiter,2001;Walburg,2014).In their own words,teens described burnout in ways that closely align with these criteria.They described it as losing motivation,when you stop caring about doing assignments LGBTQ Latina teen girl,11th grade,and when you lose interest in things,eat less,sleep more,generally numb LGBTQ Asian teen girl,12th grade.I think of burnout like an overused machine in a fac-tory Youre just doing the same thing over and over,and you dont feel like you really have a purpose.Black teen girl,11th grade Mistrust of others and paranoid competitiveness were also relevant in some teens descriptions:When people start getting burned out,they start where theyre working and they work themselves into exhaustion,but they still want to be able to beat the other person.They still want to get the highest grades,and it turns into an almost paranoid sort of need to be better You just kinda become paranoid.LGBTQ Latinx teen,10th gradeIn our survey,more than one in four American teens(27%)said they were experiencing burnout.Among those who reported that they were not burned out,25%endorsed the statement I enjoy my life.I have no symptoms of burnout,2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 31American Teens Feelings of Burnout1I have no symptoms of burnout.73%Not Burned OutScored 1 or 227%Burned OutScored 3,4,or 52I dont always have as much energy as I once did,but I dont feel burned out.3I am definitely burning out.4 or 5The symptoms of burnout wont go away;I often wonder if I can go on.Note:This chart shows the extent of burnout among American teens.More than one in four teens(27%)are actively struggling with burnout(responses 35),while 73%are not feeling burned out(responses 12).Percentage of Teens Who Feel Burned Out,by Number of Reported PressuresNo PressuresOne PressureTwo PressuresThree PressuresFour PressuresFive PressuresSix Pressures5%Burned Out14%Burned Out20%Burned Out31%Burned Out44%Burned Out42%Burned Out42%Burned OutNote:This figure shows the percentage of teens who feel burned out,organized by the number of negative pressures reported.For example,among those teens who report no pressures that make them feel bad,5el burned out;among those who report all six negative pressures,42el burned out.This chart highlights the compounding effect of multiple pressures and indicates a clear relationship between teens reports of pressure(s)and of burnout.32 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Certain demographic groups of teens reported higher levels of burnout:nonbinary teens(compared to teen girls and teen boys),older teens(compared to younger teens),and LGBTQ teens(compared to cisgender straight teens).Youth who co-interpreted the survey data with us surfaced several methodological considerations related to how we asked about and measured burnout in our survey:1.The survey data may underreport teen burnout because of stigma associated with the term burnout itself(A lot of people might stigmatize burnout mental health issues in generalLGBTQ White teen girl,12th grade),as well as because the term could be interpreted by some teens as a true point of crisis(Thats a very strong word that I take seriously Were stressed,you know.Were tired.But I feel like we still have energy to keep going at the same point.LGBTQ White teen girl,12th grade).2.Burnout may be seen as more fluid by teens than it is by adults(e.g.,burnout comes in waves,depending on what you have going onLGBTQ biracial teen girl,10th grade).Some days,I do feel burned out,and then other days,I dont.Instead of just like,I am burning out.If that makes sense.LGBTQ biracial teen girl,10th grade 3.We used a validated and widely used Likert scale item for measuring burnout,but teens noted that the scale could have had more granularity to give them the opportunity to indicate nuance.With the one through five scale,its a bit of an extreme jump to go from Im expe-riencing symptoms to Im wondering if I can go on.LGBTQ White teen girl,12th grade 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 33Self-Care PracticesOn average,teens report that they engage in two self-care practices on four or more days in the past week.Only one in 50 teens(2%)engage in every practice on four or more days,and one in seven teens(14%)did not engage in any self-care practice on four or more days in the past week.For teens who engaged in any protective practice four or more days over the past week,55%slept more than seven hours per night,40%did something for fun or relaxation,40%got at least an hour of exercise/physical activity,30%spent time outside or in nature,24%gave help to friends or classmates,22%had deep/meaningful conversations with friends,and 16%did something creative that was not for school.Teens who exam-ined the survey findings alongside us speculated that the self-care practices that teens reported in our survey may have been clustered over weekend days versus on weekdays.For a closer look at teens engagement in these self-care practices,please see the table on the following page.Teens who engage in more self-care practices report lower burnout.Most teens actively engage in a variety of self-care practices,but many still fall short of recommended guidelines for sleep and exercise.Self-care practices can help regulate healthy routines and buffer negative impacts of pressure and stress.For adoles-cents,self-care activities like getting sufficient sleep,physical activity,and meaningful social connection are cornerstones of adolescent well-being and key buffers for mental health(Kiss et al.,2022).We asked American teens about when(and how frequently)they engage in a variety of self-care practices.We asked about a variety of practices that research suggests may have protective factors against stress and burnout.These include physical health practices(seven hours or more of sleep,exercising an hour or more,spending time in nature),social practices(helping out a friend,having a deep or meaningful conversation with a friend),and psychological flow-related practices(doing something fun or relaxing,engaging in a creative activity).34 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Frequency of Self-Care Practices Among U.S.Teens4 or more days in the past week13 days in the past weekNever in the past weekPhysical Self-Care PracticesSleep(7h )Exercise(1h )Time Outsideor in NatureSocial Self-Care PracticesDeep/Meaningful ConversationHelped a Friendor ClassmatePsychological Flow Self-Care PracticesDid SomethingCreativeDid SomethingFun/RelaxingNote:This figure shows the frequency of self-care practices for American teens(as of October and November 2023)across three areas of self-care:physical,social,and psychological flow.Responses range from 4 or more days in the past week(darkest colors,at top)to 13 days in the past week(lighter colors,in the middle)and Never in the past week(gray,at bottom).The data reveals that teens are more likely to engage in self-care practices weekly instead of daily.Frequency of Self-Care Activities by U.S.TeensIn the last week,teens Never13 Days4 DaysGot 7 or more hours of sleep per night96U%Got at least 1 hour of exercise/physical activity13G%Did something just for fun or relaxation5U%Spent time outside or in nature16T0%Helped friends or classmates9g$%Had a deep/meaningful conversation with a friend19Y%Did something creative(not for school)23a 24 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 35Most teens are engaging in creative activities weekly,but not daily.Six in 10 teens(61%)did something creative that was not for school on one to three days in the past week,and one in six(16%)did so on four or more days.Nearly one in four teens(23%)did not engage in a creative activity in the past week.Most teens are doing things for fun and relaxation weekly,but not daily.Over half of teens(55%)did something for fun or relaxation on one to three days in the past week,and two in five(40%)did this on four or more days.Only about 5%did not do anything for fun or relaxation on any days.Routine practices for self-care are less common for some groups of teens.LGBTQ teens report less engagement in the physical self-care activities(sleep,exercise,and spending time outside or in nature).However,they report similar engagement in social(helping a friend,having a meaningful conversation)and psychological flow(fun/relaxation,cre-ativity)self-care activities as their straight and cisgender peers.(See Spotlight:LGBTQ Teens,beginning on page 40,for more detail.)Similarly,teen girls report less engagement in physical self-care activities compared to teen boys,such that they are 42%less likely to get more than one hour of exercise weekly,29%less likely to get at least one night of more than seven hours of sleep weekly,and 26%less likely to spend time in nature or outside at least once weekly.However,teen girls are 45%more likely to have deep and meaningful conversations with friends weekly and 53%more likely to engage in creative activities at least once weekly.Self-care and burnoutMore self-care is associated with lower burnout.On average,for each additional self-care practice that teens reported at least weekly,there is a 23crease in their likelihood of being burned out.Both higher intensity(days per week)and number of practices seem to matter.About one-third(34%)of teens who engage in a low(zero or one)number of self-care practices at least four times weekly report being burned out.Of the teens with mod-erate self-care engagement(two to five practices at least four times weekly),23%report being burned out.And only 6%of teens with high self-care engagement(six to seven practices,at least four times weekly)report being burned out.Notably,among the teens who engage in all self-care practices at least four days a week,none report being burned out.Of the teens who engage in no regular(four or more days)self-care prac-tices,41%report experiencing burnout.Sleep experiences vary,but many teens arent getting enough.The American Academy of Sleep Medicine recom-mends that teens(age 12 to 18)should regularly sleep 8 to 10 hours per night(Paruthi et al.,2016).In the current sample,55%of teens got seven or more hours of sleep at least four of the last seven nights,leaving almost half(45%)who did not.Over one in three teens(36%)got seven or more hours of sleep on one to three days,and nearly 1 in 10 teens(9%)did not get seven or more hours of sleep on any night in the past week.Most teens are not getting enough daily physical exercise.The American Academy of Pediatrics recommends that teens get a minimum of one hour of exercise each day.In this survey,40%of teens got the recommended amount of exercise at least four days in the past week;the majority(60%)did not.Less than half(47%)of teens got the one-hour recommenda-tion on one to three days,and about one in eight(13%)did not meet the one-hour recommendation on any days.Most teens spend time outside in nature weekly,but not daily.Of the teens we surveyed,84%spent at least some time outside in the prior week;30%spent some time outside on four or more days of the prior week and 54%spent time outside on one to three days.Further,16%say that they spent no time outside or in nature on any day in the last week.Teens who co-interpreted the survey findings with us suggested that access to nature and/or safe outdoor spaces might be a barrier for some youth.About one in five teens had no deep or meaningful conver-sations with friends in the last week.A majority of teens(59%)report that they had deep and meaningful conversa-tions with friends one to three times in the past week.Twenty-two percent had meaningful conversations on four or more days in the past week,and 19%reported that they had not had a deep or meaningful conversations with a friend in the past week).Some teens who examined these survey findings noted that it can be difficult for teens to find rela-tionships where they can share authentically and without judgment.Other teens said that while they spent valued time socializing,they wouldnt have said that they had deep and meaningful conversations because they interpreted those as more in depth and talking about my feelings versus casual,fun socializing.Most teens are helping their peers weekly,but not daily.As expected from recent research(Konrath et al.,2023),teens today are prosocial,with two-thirds of the teens we surveyed(67%)providing help to friends or classmates one to three days in the past week,and almost one-quarter(24%)helping a friend on four or more days.About 1 in 10 teens(9%)did not help a friend or classmate on any days.36 UNPACKING GRIND CULTURE IN AMERICAN TEENS:PRESSURE,BURNOUT,AND THE ROLE OF SOCIAL MEDIA 2024 COMMON SENSE MEDIA,THE PRESIDENT AND FELLOWS OF HARVARD COLLEGE,AND THE TRUSTEES OF INDIANA UNIVERSITY.ALL RIGHTS RESERVED.Looking specifically at those teens who report no pressures that make them feel bad,several practices and patterns emerge.They tend to get more sleep:They are 227%m
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2024Getting Help Online:How Young People Find,Evaluate,and Use Mental Health Apps,Online Therapy,and Behavioral Health InformationCOMMON SENSE IS GRATEFUL FOR THE GENEROUS SUPPORT AND UNDERWRITING THAT FUNDED THIS RESEARCH REPORTJennifer CaldwellJohn H.N.Fisher2024Getting Help Online:How Young People Find,Evaluate,and Use Mental Health Apps,Online Therapy,and Behavioral Health InformationThe report authors and project team would like to express their gratitude to all the young people who shared their time,expertise,and lived experiences to help shape the design of the study,who gave their time to take the survey,and who contributed to the interpretation and presentation of the findings.We would also like to thank Susannah Fox and Vicky Rideout,who designed the two previous studies and authored the reports.You can read the previous reports here:Digital Health Practices,Social Media Use,and Mental Well-Being Among Teens and Young Adults in the U.S.by Victoria Rideout and Susannah Fox(2018)Coping with COVID-19:How Young People Use Digital Media to Manage Their Mental Health by Victoria Rideout,Susannah Fox,Alanna Peebles,and Michael Robb(2021)CreditsAcknowledgments:This project represents the work of many people from Hopelab,Common Sense Media,and NORC at the University of Chicago.Below,we detail each part of the project and the contributors.Mike Parent,Amy Green,and Emma Bruehlman-Senecal,with support from Amanda Lenhart and feedback from a number of teen and young adult advisorsNORC at the University of ChicagoNORC at the University of Chicago,Mike Parent,Jayla Stokesberry,Amy Green,and Emma Bruehlman-Senecal,with support from Amanda Lenhart,Mary Madden,Angela Calvin,Alexa Hasse,and many teens and young adultsAngela Calvin,Alexa Hasse,and Mary Madden,with support from Amanda Lenhart and the Hopelab teamChristopher Dare and Jennifer RobbChris Arth and Emely GarciaMarisa Naughton,Natalia Garcia,Christian Medina Beltz,Juan Martinez,Robin Raskob,and Phuong PhamSurvey development and design:Data collection:Data analysis and interpretation:Report writing:Copy editors:Designers:Communications:Table of ContentsIntroduction .1Key Findings .4Part 1:How Young People Find and Evaluate Behavioral Health Information Online.10Part 2:Online Therapy and Behavioral Health Apps .18Conclusion.24Methodology.261 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Adolescents and young adults are facing elevated rates of mental health issuesand theyre also struggling with access to the mental health care they urgently need.Many young people who struggle with their mental health are attending schools or living in communities where mental health profes-sionals are limited,absent,or not accepting new patients.And when young people express the need for professional help,they often encounter obstacles to seeing a therapist,such as prolonged wait times,limited local access to mental health providers,or financial barriers.Young people also face challenges finding therapists who are culturally responsive to their individual backgrounds.In light of these barriers,young people turn to social media and digital mental health apps to attempt to fulfill their needs.Awareness of these systemic barriers is growing,prompting efforts to increase the accessibility of mental health support for young people.When in-person therapy sessions became impractical during the COVID-19 pandemic,policy changes and modifications to licensing regulations enabled telehealth services for patients to expand beyond traditional clinical settings.The policy shift broadened the therapy landscape,increasing online-based alternatives to traditional in-person therapy.1The rise in options for online therapy shifted schools approaches to addressing the growing number of young people in need of behavioral health services(i.e.,services for mental health,substance use,and wellness).Educational insti-tutions in the United States began exploring these alternatives to expand mental health services to K12 and higher educa-tion students by connecting and sometimes contracting with direct-to-consumer private companies,nonprofit organiza-tions,or state-run programs that offer online therapy.Schools hoped that offering these services to students would help compensate for the shortage of social workers and school psychologists,2 and enable more young people to access at least short-term mental health care.However,while online therapy platforms can offer increased convenience,accessibility,and affordability when compared with traditional in-person treatment,important concerns remain related to patient data privacy,limited insurance cov-erage,and quality of care.3 At the same time,young people are proactively taking charge of their own mental health by seeking information online via social media and mental health apps.Youth often turn to video-based platforms like YouTube and TikTok,using them as search engines instead of Google.4 These platforms can be accessed immediately,24/7,and offer quick,sometimes enter-taining,and easily digestible information in short video format.Social media platforms also offer access to communi-ties and content creators who have similar,relatable mental health experiences and who can share their lived experiences and hard-won personal expertise.Introduction1 Clark,K.,Fazlullah,A.,Garner,D.,Golnabi,S.,Hill,H.,Kalmus,M.,McQuiggan,M.,&Salmirs,E.(2022).Closing the digital divide benefits everyone,not just the disconnected:An analysis of how universal connectivity benefits education,health care,government services,and employment.Common Sense.https:/monsensemedia.org/research/closing-the-digital-divide-benefits-everyone-not-just-the-unconnected 2 Sohn,E.(2024).Theres a strong push for more school psychologists.Monitor on Psychology,55(1),72.https:/www.apa.org/monitor/2024/01/trends-more-school-psychologists-needed3 Garofalo,L.(2024).Doing the work:Therapeutic labor,teletherapy,and the platformization of mental health care.Data&Society Research Institute.http:/dx.doi.org/10.2139/ssrn.47790054 Lim,M.S.,Molenaar,A.,Brennan,L.,Reid,M.,&McCaffrey,T.(2022).Young adults use of different social media platforms for health information:Insights from web-based conversations.Journal of Medical Internet Research,24(1),Article e23656.https:/doi.org/10.2196/23656GETTING HELP ONLINE 2 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Youth also passively come across mental health information delivered by algorithms in their social media feed,regardless of whether they are looking for it,which can significantly impact their understanding of,decisions about,and behaviors around mental health.5,6 Although mental health information is easy to access on social media,it might not be beneficial or accurate,or could lead to harm.7 Many researchers and mental health professionals question the reliability of online information,especially with the prevalence of health misinformation on social media during the pandemic.8Young people are also embracing mental health apps as valued tools for managing their mental well-being.Mental health apps provide tools and activities aimed at tracking,managing,and improving mental health through such features as guided meditation,mood tracking,educational content,and commu-nity support.These apps are useful companions for managing mental well-being,but there is a lack of readily available infor-mation for young people about which apps are most helpful,evidence-based,inclusive,most applicable to their circum-stances,and have adequate privacy protections(e.g.,not sharing their health information with third parties).9The current study focuses on some of the most important users of these platforms and programs:teens and young adults.Considering the present array of mental health resources available to young people and concerns about increasing mental distress in this group,its crucial to examine the frequency with which they use digital technology for infor-mation and support.This usage can include how young people manage their mental health,how they understand their expe-riences with these resources,and how they judge the trustworthiness of mental health information.Hopelab and Common Sense are determined to learn more.In a survey conducted in October and November of 2023,we asked young people about their use and the helpfulness of these platforms and programs.Recognizing the strengths and limitations of these mental health apps and services will be the first step in determining what is working and what needs to change to improve mental health care for all young people.Summary of methodology This is a nationally representative survey of 1,274 teens and young adults age 14 to 22 in the United States.The survey was conducted by NORC at the University of Chicago,using their probability-based panel,as well as online opt-in panels to oversample for those who are LGBTQ ,Black,and Latino.Data was collected from October to November 2023.The survey was fielded online,in English or Spanish.The survey included several open-ended questions for respondents to share personal experiences.Data was analyzed by gender,age,race/ethnicity,and LGBTQ identity.A screener was included in the survey to identify levels of depressive symptoms(PHQ-8).Changes over time and differences between subgroups were tested for statistical significance at the level of p .05.In this report,the term teens refers to people age 14 to 17,the term young adults refers to those age 18 to 22,and the terms youth and young people refer to our entire sample of 14-to 22-year-olds.The findings around app use and online information cover a range of behavioral health conditions including mental heath,substance use,and wellness.Across the report,we use the terms mental health and behavioral health interchangeably to refer to this data.5 Hornik,R.,Parvanta,S.,Mello,S.,Freres,D.,Kelly,B.,&Schwartz,J.S.(2013).Effects of scanning(routine health information exposure)on cancer screening and prevention behaviors in the general population.Journal of Health Communication,18(12),14221435.https:/doi.org/10.1080/10810730.2013.7983816 Katella,K.(2024,January 8).How social media affects your teens mental health:A parents guide.Yale Medicine.https:/www.yalemedicine.org/news/social-media-teen-mental-health-a-parents-guide7 Verma,G.,Bhardwaj,A.,Aledavood,T.,De Choudhury,M.,&Kumar,S.(2022).Examining the impact of sharing COVID-19 misinformation online on mental health.Scientific Reports,12,Article 8045.https:/doi.org/10.1038/s41598-022-11488-y8 Suarez-Lledo,V.,&Alvarez-Galvez,J.(2021).Prevalence of health misinformation on social media:Systematic review.Journal of Medical Internet Research,23(1),Article e17187.https:/doi.org/10.2196/171879 Litke,S.G.,Resnikoff,A.,Anil,A.,Montgomery,M.,Matta,R.,Huh-Yoo,J.,&Daly,B.P.(2023).Mobile technologies for supporting mental health in youths:Scoping review of effectiveness,limitations,and inclusivity.JMIR Mental Health,10,Article e46949.https:/doi.org/10.2196/46949GETTING HELP ONLINE 4 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.1.While social media and the web are important sources of mental health information,most young people report that they take extra steps to verify what they find.Almost two-thirds(65%)of young people age 14 to 22 have ever searched online for any behavioral health topics(i.e.,mental health,substance use,and wellness).Among those young people who have ever searched online for information related to their mental health,the most common sources are websites focused on health or mental health(such as Healthline,WebMD,Psychology Today,the Centers for Disease Control and Prevention,and the National Alliance on Mental Illness),with 53%saying they have looked for behav-ioral health information from this type of source.However,social media sites are also an important source of information for many young people:38%have searched YouTube for information related to behavioral health.34%have searched TikTok.23%have searched Instagram.16%have searched Reddit.8%have searched Twitter/X.6%have searched for mental health information using ChatGPT or other generative artificial intelligence (AI)tools.Key FindingsMost young people do not take the information they find at face value,and they engage in a variety of practices to check and verify information they see online.Among those who have ever searched online for behavioral health-related information:89%sometimes,often,or always10 consider the trustwor-thiness of the source.88%sometimes,often,or always take information with a grain of salt.83%sometimes,often,or always compare information across multiple sources.69%sometimes,often,or always run information by friends and family.Both Black and Latino young people were more likely to say social media was somewhat or very important as a place to find information or resources about mental health or well-being than their White peers(64%and 59%vs.44%).In our qualitative interviews and focus groups conducted for this study,both Black and Latino youth reflected on the value of being able to turn to social media for mental health support when they face stigma within their families or communities.10 Response choices were never,hardly ever,sometimes,often,and always.5 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.3.More than half of young people have used an app to support their mental health or well-being.For Latino and Black young people,limitations related to in-person therapysuch as accessibility,affordability,and cultural stigmamay contribute to higher rates of app usage.A majority of young people(54%)say they have used a mental health or other type of app to help support their well-being.Having ever used an app to support mental health is more common for women and girls(62%)than for men and boys(44%),and usage is more common in young adults(60%)than teens(46%).In addition,app use varied by race and ethnicity;Latino young people(64%)were more likely to use behavioral health apps than Black young people(58%),and both Latino and Black young people were both more likely to use apps than White young people(47%).In our qualitative interviews and focus groups,Latino and Black youth attributed this higher use of behavioral health apps to their affordability and acces-sibility relative to therapy,and the difficulties of finding a therapist with a similar racial/ethnic identity,in addition to cultural stigma associated with seeking therapy.Although apps are often touted as an alternative to in-person or virtual care provided by a therapist,questions remain about the helpfulness of different apps.Among respondents who have ever used an app for their mental health and well-being,47%found the app to be very helpful or somewhat helpful,while 37%found the app a little helpful or not at all helpful.An additional 16%said they did not remember if the apps they used were helpful.2.Online therapy has increased access to mental health support and is generally seen as helpful by those who seek it.Just over one-quarter of 14-to 22-year-olds have ever attended online therapy to support their mental health and well-being,with 15cessing it within the past year,and 12fore that.Contrary to patterns for in-person mental health care for young people,Latino young people were more likely to report accessing online therapy than their White and Black peers(34%vs.23%and 27%).And online therapy has been more widely embraced by LGBTQ young people,who are about twice as likely as their non-LGBTQ peers to report ever having attended online therapy(44%vs.23%).Among those who have ever attended online therapy,about 6 in 10 found the experience very helpful(31%)or somewhat helpful(31%),while nearly one in three were helped only a little(27%)or not at all(5%).In addition,6%could not remem-ber how helpful their last online therapy experience was.When asked why they had not tried online therapy,most pointed to a lack of need(52%)or desire(23%)for a therapist,or a preference for in-person therapy(20%).It is important to note that online therapy rates may also be impacted by factors not captured in the survey,such as access to technology and privacy or space for an appointment.GETTING HELP ONLINE 6 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.5.LGBTQ youth and young people with depressive symptoms are more likely to have searched online for behavioral health information,to have used online therapy,and to have used apps to support their mental health or well-being.LGBTQ young people are more likely to have ever sought information online about behavioral health-related topics than those who are not LGBTQ (91%vs.61%).About half of LGBTQ young people have ever searched online for information about eating disorders(52%),drug or alcohol abuse(51%),depression(49%),ADHD(49%),and anxiety(48%)each of these rates are more than twice the percent of non-LGBTQ young people who have ever searched for information on these topics.Those who are LGBTQ are also about twice as likely as their non-LGBTQ peers to report ever having attended online therapy(44%vs.23%).And compared to non-LGBTQ young people,LGBTQ young people are also more likely to use all types of mobile behavioral health apps,with the exception of apps to support better sleep.Additionally,depressive symptomsand their degree correlate with significant differences in certain activities like looking up behavioral health information,attending online therapy,and using apps related to mental health.As young peoples reported severity of depressive symptoms increases,so does the likelihood that they will go online to look up health information on the majority of topics related to behavioral health.Young people with moderate to severe depressive symptoms are more likely than those with mild depressive symptoms and those with no symptoms to look up health information online on most mental and behavioral health topics,like depression,substance abuse,or eating disorders.4.More than half of young people who have sought online therapy in the past year did so through a private practice or medical setting;3 in 10 young people have used an online teletherapy platform through a telehealth company.Among young people who have attended online therapy in the past year,they most often received this therapy through an individual private practice or medical setting(59%),while 31%of this group received online therapy through a telehealth company,such as BetterHelp,Talkspace,or Brightline.Another 14%of online therapy users from the last year used an online peer support service,where they can connect with other peers experiencing similar mental health issues for mental health support,and 7%said they used a chatbot,such as Woebot,for online therapy.In an open-ended question about sources of online therapy,users of teletherapy plat-forms cited direct-to-consumer platforms,university-focused providers,and smaller regional and local online mental health providers,as well as sites for intensive outpatient intervention and ADHD management.7 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.LGBTQ youth are far more likely to search for a variety of behavioral health-related info online%of young people age 1422,by LGBTQ who selected the following behavioral health topics20 !%Stress44%Trauma44%Smoking or vaping44#G%Autism spectrum disordersADHD49ting disorders21R%LGBTQ Non-LGBTQ Depression49#%Drug or alcohol abuse51 %Any of these behavioral health topics91a%Happiness or well-being 44 %Sleep43!%Any other behavioral health topic5%2%Anxiety48!%Note:Differences between LGBTQ and non-LGBTQ youth are statistically significant at the level of p .05.Q:Have you ever gone online,whether through a website,a search engine,an app,or any other means,to look for information on any of the following health topics?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.In a similar vein,the likelihood that a young person has attended online therapy tracks with the severity of a persons symptoms.Young people with moderate to severe depressive symptoms are more likely than those without such symptoms to have used online therapy in the last year(25%vs.8%)or before(22%vs.5%).In addition,the use of almost all types of mobile behavioral health apps tracks with the severity of an individuals depres-sive symptoms,as young people with more severe symptoms are more likely to report using all types of behavioral health apps.Similar shares of youth with moderate to severe,as well as mild,depressive symptoms have used apps related to depression and anxiety:about 4 in 10 with moderate to severe symptoms(38%for depression and 36%for anxiety);around 2 in 10 with mild symptoms(22%and 24%,respectively);and less than 1 in 10 with no symptoms(6%and 9%).Besides apps related to depression and anxiety,young people with moderate to severe depressive symptoms are more likely than those with mild symptoms and no symptoms to use a variety of apps related to other aspects of mental health and well-being.GETTING HELP ONLINE 8 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Young people with depressive symptoms are more likely to use all types of mobile behavioral health apps%of young people age 1422,by depressive symptoms who have ever used a mobile app related to the followingDrug or alcohol abuse17%9%18%6pressionAny other health-related topic31%9%96$%Anxiety Moderate to Severe Mild None498%Sleep7%Mood tracker23C2%Happiness or well-being42%Meditation/mindfulness453HD26%5%Quitting smoking or vaping21%29)%Stress reductionNote:Differences among those with no,mild,and moderate to severe depressive symptoms are statistically significant for all items at the level of p .05,with the exception of quitting smoking or vaping between those with mild and moderate to severe symptoms.Q:Have you ever used a mobile app related to any of the following?Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 10 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.A little over two-thirds of young people have searched online for information about at least one topic related to behavioral health,whether through a website,search engine,app,or any other means.Many young people search online to learn more about topics related to their mental health and well-being.The majority of teens and young adults have wide-ranging access to informa-tion on various health topics and conditions through websites,Part 1:How Young People Find and Evaluate Behavioral Health Information Online Online behavioral health information searches,by year,and by age,gender,LGBTQ ,and race/ethnicity in 2023Among ages 14 to 22,percent who have ever searched online aboutData CollectionAgeGenderRace/EthnicityLGBTQ 20182020202314 to 17 18 to 22Men/boysWomen/girlsWhiteBlackLatinoLGBTQ Non-LGBTQ Depression398701307$&I3rug or alcohol abuse249589964&$Q0ating disorders19869009705521%bStress449488964#&D1nxiety4225998895181DHDNANA247865#$I9utism spectrum disordersNANA2498719870%bTraumaNANA236675#D9%bSleepNANA249966$C1%bSmoking or vaping*NA24%20969743%bHappiness or well-beingNANA248995 D0ny other mental health issue6%2%2%2%2%1%2%5ny of these behav-ioral health topicsNANA65%*54380276911%bNote:Items with different superscripts differ significantly across rows within each category(p .05).*In 2018,this item was worded as smoking and did not include vaping.*The 2023 report included different health topics compared with the 2018 and 2020 reports.In 2018 and 2020,both behavioral and physical health searches were included.Therefore,the percentage forAny of these behavioral health topics in 2023 cannot be comparable to 2018 and 2020 data.Q:Have you ever gone online,whether through a website,a search engine,an app,or any other means,to look for information on any of the following health topics?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted in 2018(n=1,334),2020(n=1,492),and 2023(n=1,274)with young people age 1422 nationwide.search engines,and apps.Young people are especially drawn to searching online and on social media to learn more about behavioral health(i.e.,mental health,substance use,and wellness).11 Most young people have searched online for information about at least one of the behavioral health-related topics asked about in the survey,whether through a website,a search engine,an app,or any other means.Just under two-thirds(65%)report having ever looked for behavioral 11 Skinner,H.,Biscope,S.,Poland,B.,&Goldberg,E.(2003).How adolescents use technology for health information:Implications for health professionals from focus group studies.Journal of Medical Internet Research,5(4),e32.https:/doi.org/10.2196/jmir.5.4.e3211 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.health-related information online,while 35%say they have never searched online for any of the behavioral health topics included in the survey.Depression was the behavioral health topic most commonly researched online(27%of 14-to 22-year-olds surveyed),followed by eating disorders(26%),smoking or vaping(25%),anxiety(25%),and drug or alcohol abuse(25%).Young adults(age 18 to 22)are more likely than teens(age 14 to 17)to report ever looking up any of the topics related to their behavioral health online,either through a website,search engine,app,or any other means(73%vs.54%,respectively).The largest difference across age groups is related to searching for information online about smoking or vaping.Young adults are nearly twice as likely as teens to say they have ever gotten information online about smoking or vaping(32%vs.16%).Women and girls are more likely than men and boys to search for behavioral health-related information online.LGBTQ young people are twice as likely as non-LGBTQ young people to have ever looked up behavioral health information online.LGBTQ young people are more likely to have ever sought information online about one or more of the behavioral health-related topics than those who are not LGBTQ (91%vs.61%).About half of LGBTQ young people have ever searched online for information about eating disorders(52%),drug or alcohol abuse(51%),depression(49%),ADHD(49%),and anxiety(48%)and each of these rates are more than twice the percentage of non-LGBTQ young people who have ever searched for information on these topics.Black,White,and Latino young people look for behavioral health information online on each topic at similar rates,with a few exceptions.White young people are more likely than Black young people to look for information on eating disorders(27%vs.20%).White young people are more likely to report they have ever searched online for information about anxiety(29%)when compared to both Latino(21%)and Black young people(15%),and Latino young people are significantly more likely than Black young people(21%vs.15%)to search for anxiety.Black youth are less likely than White or Latino youth to search for health information on smoking or vaping(19%vs.26%and 27%,respectively).LGBTQ youth are far more likely to search for a variety of behavioral health-related info online%of young people age 1422,by LGBTQ who selected the following behavioral health topics20 !%Stress44%Trauma44%Smoking or vaping44#G%Autism spectrum disordersADHD49ting disorders21R%LGBTQ Non-LGBTQ Depression49#%Drug or alcohol abuse51 %Any of these behavioral health topics91a%Happiness or well-being 44 %Sleep43!%Any other behavioral health topic5%2%Anxiety48!%Note:Differences between LGBTQ and non-LGBTQ youth are statistically significant at the level of p .05.Q:Have you ever gone online,whether through a website,a search engine,an app,or any other means,to look for information on any of the following health topics?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 12 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.In 2023,young people were less likely to search for health information on depression,anxiety,and stress,compared with 2018 and 2020.There is a notable decline in the percentage of young people who have ever looked online for information on depression(39%in 2018 and 38%in 2020 vs.27%in 2023),anxiety(42%in both 2018 and 2020 vs.25%in 2023),and stress(44%in 2018 and 39%in 2020 vs.24%in 2023).This finding could be partially attributed to young peoples exposure to online behavioral health information,particularly against the back-drop of the COVID-19 pandemic.One study12 that focused on how young adults(age 18 to 25)used digital tools to support their mental health during the pandemic lockdown found that serendipitous finds played an important role in determining which resources participants used.Exposure to behavioral health content is particularly relevant when considering how recommendation algorithms shape the information young people see online.13 Adolescents search less often for mental health information,possibly because algorithms bring the information,to them,such as the ForYou page on TikTok.12 Pretorius,C.,&Coyle,D.(2021).Young peoples use of digital tools to support their mental health during COVID-19 restrictions.Frontiers in Digital Health,3,763876.https:/doi.org/10.3389/fdgth.2021.763876 13 Katella,K.(2024,January 8).How social media affects your teens mental health:A parents guide.Yale Medicine.https:/www.yalemedicine.org/news/social-media-teen-mental-health-a-parents-guideSearches for health information on depression,anxiety,and stress have decreased significantly%of young people age 1422,by year of data collection who selected the following health topics44 23 2020 2018Depression27%*389%Anxiety25%*42%Stress39$%*42%Note:*Differences between 2023,versus 2020 and 2018,are statistically significant at the level of p .05.Q:Have you ever gone online,whether through a website,a search engine,an app,or any other means,to look for information on any of the following health topics?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted in 2018(n=1,334),2020(n=1,492),and 2023(n=1,274)with young people age 1422 nationwide.13 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.At least one in three young people report turning to YouTube and TikTok as a source for mental health information;6%use ChatGPT or other generative AI tools for mental health information.Among young people who have ever searched for information related to their mental health online,websites focused on health or mental health(such as Healthline,WebMD,Psychology Today,the Centers for Disease Control and Prevention,and the National Alliance on Mental Illness)are the most common sources,with 53%saying they have looked for mental health information from this type of source.However,at least one in three have looked for mental health information on social media sites,such as YouTube(38%)and TikTok(34%).Smaller shares say they have searched for mental health information on social platforms,like Instagram(23%),Reddit(16%),or Twitter/X(8%).An additional 7%have looked for mental health information from another app or website,and 6%have searched using ChatGPT or other gen-erative AI tools.Some differences in source types also emerge across age groups among young people who have ever looked up health information online.Young adults are more likely than teens to look up mental health information from health-focused web-sites(58%vs.45%)and from Reddit(20%vs.9%).Looking at differences between gender groups among young people who have ever searched for mental health-related information online,men and boys are more likely to report YouTube as a source when compared with women and girls(46%vs.31%).By comparison,women and girls are more apt to search online for mental health information on TikTok(44%vs.22%)and Instagram(27%vs.16%)when compared with men and boys.About 4 in 10 young people with moderate to severe depressive symptoms report looking up behavioral health-related information online.Among young people,as their reported severity of depressive symptoms increases,so does the likelihood of going online to look up behavioral health-related topics.Youth with moderate to severe depressive symptoms are more likely than those with mild depressive symptoms and young people with no symptoms to look up health information online about depres-sion(47%vs.30%vs.15%),anxiety(46%vs.32%vs.11%),sleep(41%vs.34%vs.11%),and happiness or well-being(41%vs.31%vs.12%).Compared with young people who have no depressive symptoms,those with moderate to severe symp-toms are more than three times as likely to look up information online about stress(40%vs.12%).GETTING HELP ONLINE 14 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.The likelihood that a young person has searched for certain behavioral health topics often tracks with the severity of their symptoms%of young people age 1422,by depression status who selected the following behavioral health topics39%14%Moderate to Severe Mild NoneDepression470%Anxiety462%Any of these behavioral health topicsTraumaStressHappiness or well-beingSleepAny other mental health issueDrug or alcohol abuse36Dting disorders42B(B1B3A4A12G(%4%3HDAutism spectrum disordersSmoking or vapingNote:Differences among those with no,mild,and moderate to severe depressive symptoms are statistically significant for all items at the level of p .05,with the exception of drug or alcohol abuse,stress,and any other mental health issue between those with mild and moderate to severe symptoms.Q:Have you ever gone online,whether through a website,a search engine,an app,or any other means,to look for information on any of the following health topics?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.Young people say they check multiple sources and tend to trust mental health information when it comes from an expert or professional source.Before asking closed-ended questions about specific ways that young people might vet online mental health information,we asked young people to describe how they decide to trust mental health information found online.This open-ended question about specific vetting techniques allowed young people to describe their experiences without being shaped by the response items in our survey.Determining whether the information came from a mental health professional and checking multiple sources for sup-porting information were the most frequently mentioned ways of deciding whether to trust online behavioral health information.Many young people expressed that they were more likely to trust the information if it was from an expert or professional.For example,one respondent said,It was medication informa-tion resources sent by a psychiatrist.I trusted the professional.(White,young adult man)In addition,some respondents mentioned that they follow trusted mental health professionals on social media:I follow multiple psychologists and counselors on Instagram,as well as support groups for things like harm reduction and eating dis-orders,so I see their posts often.(White,young adult,no gender given)Consulting multiple sources was another way young people decided whether to trust the information they found online.For instance,many young people said they come across infor-mation on social media by content creators and seek out more information through other sources:Ive seen a lot of stuff recently about people getting diagnosed with ADHD in adult-hood.Ive seen it from a lot of content creators who share tips and tricks on how to hack your ADHD to get things done.It definitely led me to doing more research online.(White,young adult woman)Some used a combination of getting information from trusted professionals while also using search engines to check multiple sources:I saw a TikTok about autism from a certified profes-sional and looked into their advice on Google afterwards.I trusted them because of their qualifications.(White,nonbi-nary young adult)15 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Among those who have ever searched for mental health infor-mation online,young adults are more likely than teens to say they sometimes or more often take mental health information with a grain of salt(89%vs.85%)and compare information across multiple sources for consistency(88%vs.73%).Young people of all ages are equally likely to report considering the trustworthiness of the source or asking friends and family about information.One difference emerges on vetting information across racial and ethnic groups:Latino young people are more likely than White young people to say they sometimes or more often ask friends and family about the mental health information and advice they find online(75%vs.66%).Most young people vet the mental health information they find online.More than 8 in 10 young people evaluate the trustworthiness of a source.In an age of proliferating misinformation and disinformation,being able to discern trustworthy information online is a chal-lenge and an important skill.Young people engage in a variety of practices to check and verify information they see online.Among those who have ever searched for behavioral health-related information online,more than 8 in 10 young people sometimes or more often14 consider the trustworthiness of the source(89%),compare information across multiple sources(83%),and take information with a grain of salt(88%).Running information by friends and family is less common,with 69%saying they sometimes or more often do this,and 31%saying they hardly ever or never do.14 Response choices were never,hardly ever,sometimes,often,and always.Where young people search for mental health information or advice,by age,gender,race/ethnicity,and LGBTQ identityAmong age 1422,percent of those who have looked online for mental health information or advice onTotalAgeGenderRace/EthnicityLGBTQ 14 to 1718 to 22Men/boysWomen/girlsWhiteBlackLatinoLGBTQ Non-LGBTQ Health websites53E88891170%bReddit16%9063293%bTwitter/X8%6%9%6%8%7%9%bYouTube38D56126047%Instagram23 $722#20%bTikTok34444244402hatGPT6%5%6%7%5%40%6%Another app or website7%7%7%8%7%Note:Items with different superscripts differ significantly across rows within each category(p .05).Results among the race/ethnicity and LGBTQ data should be interpreted with caution due to the small sample sizes.Q:Where have you looked online for mental health information or advice?Select all that apply.Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 16 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Most young people sometimes or more often evaluate mental health information online%of young people age 1422 who have ever searched for mental health information online and selected the following statements Compare information across multiple sources83%Take the information that you find with a grain of salt88%Sometimes to Always Never to Hardly EverConsider the trustworthiness of the source89%Ask friends and family about the information you find691%Q:When looking for mental health information or advice online,how often do you?Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 18 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Part 2:Online Therapy and Behavioral Health AppsMore than one-quarter(26%)of 14-to 22-year-old respon-dents to this survey reported having ever attended online therapy to support their mental health and well-being,with 15%attending within the past year and 12%attending before that.19While there are no significant differences by age or gender in online therapy use,those who are LGBTQ are about twice as likely as their non-LGBTQ peers to report ever having attended online therapy(44%vs.23%).Latino young people were more likely to report ever accessing online therapy than their White and Black peers(34%vs.23%and 27%).Similar rates of Latino(13%)and White young people(15%)say they have used online therapy in the past year.However,Latino young people are more likely to have seen a therapist online more than a year ago(21%)as com-pared to White youth(9%).When asked about this finding in interviews and focus groups,Latino young people noted that online therapy can be more affordable,more accessible,more discreet,and have better cultural representation than in-person therapy options.Young people with mild to severe depressive symptoms are more likely than those without any symptoms to have used teletherapy in the last year or before.More than a quarter of young people have ever attended online therapy.With the lack of adequate mental health services in the United States and a scarcity of available therapists who focus on ado-lescents,it can be challenging for teens and young adults to access mental health care.We also know that in general,Black and Latino youth are less likely to access traditional in-person mental health services than White youth;recent federal data indicates lower levels of treatment of major depressive epi-sodes among Black(36%)and Latino(36%)young people when compared with their White peers(46%).15 Cities,states,and school districts as well as families are beginning to turn to online therapy offerings to stand in and help close the gap in places where there is high demand and low availability of in-person sources.16In November 2023,New York City rolled out a three-year,$26 million project17 with a direct-to-consumer online therapy platform,offering 400,000 adolescents in New York City access to unlimited texting and a 30-minute virtual telether-apy session with a therapist once a month.In addition,a number of the countrys largest school districts,18 including those in Los Angeles,Miami,Las Vegas,and Washington,D.C.,are offering online therapy sessions through schools.But how many young people have actually taken advantage of online therapy?Do young people want to use it?What bar-riers do they face?And all things considered,do they find it effective for alleviating or managing their mental distress?15 Center for Behavioral Health Statistics and Quality.(2021).Racial/ethnic differences in mental health service use among adults and adolescents(20152019)(Publication No.PEP21-07-01-002).U.S.Department of Health and Human Services,Substance Abuse and Mental Health Services Administration.https:/www.samhsa.gov/data/report/racialethnic-differences-mental-health-service-use 16 Clark,K.,Fazlullah,A.,Garner,D.,Golnabi,S.,Hill,H.,Kalmus,M.,McQuiggan,M.,&Salmirs,E.(2022).Closing the digital divide benefits everyone,not just the disconnected:An analysis of how universal connectivity benefits education,health care,government services,and employment.Common Sense.https:/monsensemedia.org/research/closing-the-digital-divide-benefits-everyone-not-just-the-unconnected17 Barry,E.,&Caron,C.(2023,December 15).New York City is offering free online therapy to teens:Will it work?New York Times.https:/ Gecker,J.(2023,December 3).Lacking counselors,US schools turn to the booming business of online therapy.Associated Press.https:/ Numbers may not sum exactly due to rounding.19 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Lack of need or desire for a therapist,and a preference for in-person therapy,are the top reasons why young people do not use online therapy services.Among teens and young adults age 14 to 22 who reported never attending online therapy,when asked why they had not,about half(52%)of young people indicate that they do not need support with their mental health or well-being,23%report that they do not want to speak to a therapist,and 20%say they would prefer to speak with a therapist in person rather than online.Other young people report cost and access as reasons why they dont use online therapy,saying that it is too expensive(8%),that they are uninsured or underinsured(5%),or that they dont know how to find an online therapy practice(6%).Others report concerns that a therapist would not be able to help them(9%)or report previous bad experiences with therapy,whether online(1%)or in person(3%).And some young people report stigma around mental health as a barrier to use(6%)and difficulty asking or convincing parents to allow them to seek therapy(6%).In particular,in focus groups and interviews,LGBTQ young people expressed concerns around identity-related stigma,privacy,therapist expertise,and sensitivity when dealing with issues related to LGBTQ identity.It is important to note that online therapy uptake may also be shaped by factors not captured in the survey,such as access to technology and privacy or space for an appointment.The likelihood that a young person has attended online therapy in the 12 months prior to the survey tracks with the severity of a persons symptoms.Those with moderate to severe depressive symptoms(25%)are more likely than those with mild symptoms(18%)to have attended online therapy in the past 12 months.Furthermore,young people with mild symptoms are more likely than those with no symptoms(8%)to have attended online therapy in this time span.In addition,young people with moderate to severe depressive symptoms(22%)and mild symptoms(14%)are more likely than those with no symptoms(5%)to have attended online therapy prior to this time period.LGBTQ and Latino youth turn to online therapy in greater numbers%of youth age 1422,who have used online therapy 1822171711%LGBTQ 24 %*Non-LGBTQ 13%Yes,I have within the past 12 months Yes,but not in the past 12 monthsLatino13!%*Black14%White15%9%Girls/Women17%Boys/Men11%9%Overall12%Note:*Differences between Latino youth,versus White and Black youth,as well as between LGBTQ and non-LGBTQ youth,are statistically significant at the level of p .05 for ever using online therapy.Q:Have you ever attended online therapythat is,connected with a therapist remotely by computer or phoneto support your mental health and well-being?Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 20 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.More than half of those who seek online therapy do so through a private practice or medical setting,while about one-third rely on telehealth companies.Among young people who have attended online therapy in the past year,they most often received this therapy through an individual private practice or medical setting(59%),while 31%of this group received online therapy through a telehealth company,such as BetterHelp,Talkspace,or Brightline.Another 14%of online therapy users used an online peer support service for mental health support in the last year,and 7%said they used a chatbot,such as Woebot,for online therapy.In an open-ended question,users of teletherapy plat-forms cited direct-to-consumer platforms,university-focused providers,smaller regional and local online mental health providers,as well as sites for intensive outpatient intervention and ADHD management,as sources of care.Among those who have been in online therapy,teens age 14 to 17 are more likely than young adults age 18 to 22 to have their online therapy conducted through an individual practice or medical setting(76%vs.51%,respectively).Online therapy is generally seen as helpful by those who seek it.Among young people age 14 to 22 who have ever attended online therapy,about 6 in 10 found the experience very helpful(31%)or somewhat helpful(31%),while nearly one in three were helped only a little(27%)or not at all(5%).In addition,6%could not remember how helpful their last online therapy experience was.Three in ten have used a behavioral health app to support their well-being.Some young people are turning to apps to support their well-being,with over half(54%)indicating they have ever used at least one app to help with their mental health or well-being.The most common kinds of apps downloaded include those for sleep(31%),meditation/mindfulness(29%),happiness(25%),stress reduction(22%),and mood tracking(20%).In open-ended questions,survey participants offered other examples of apps used to support their mental health,including medita-tion apps,major social media platforms,direct-to-consumer therapy platforms,habit trackers,and sobriety apps,as well as default general health apps that come pre-installed on a phone,calming games,affirmations,virtual plant and pet care apps,white noise apps to help with sleep,journaling or diary apps(including voice memos),and menstrual period trackers.Barriers to teletherapy include preference for in-person therapy,access challenges,and stigma%of young people age 1422 who responded yes to the following statements Dont need support52%Dont want to speak with a therapist23%Prefer in-person20%Waitlist too long1%Previous negative experience(online)1nt find therapist with similar identity and lived experience2%Previous negative experience(in person)3%Other3%Uninsured/no coverage5ar or stigma6%Dont know how to find online therapist6%Parents dont want me in therapy6%Dont believe therapist can help9%Too expensive8%Note:Q:Why havent you attended online therapythat is,connected with a therapist remotely by computer or phone?Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.21 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Youth use apps primarily to support sleep,stress reduction,and mindfulness%of youth age 1422,who have used mobile apps related to the following11%Any other health-related topic 5%Meditation/mindfulness15%Mood tracker10%Yes,I have within the past 12 months Yes,but not in the past 12 months17%Sleep13%Stress reduction 14%9%Happiness or well-being12%Quitting smoking or vaping5%5%Drug or alcohol abuse4%3HD6%7%Anxiety11%8pression8%Source:Q:Have you ever used a mobile app related to any of the following?NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.Latino young people,young adults,and women and girls are more likely to indicate they have ever used almost all apps surveyed related to mental health and well-being,compared to their peers.App use varies by race and ethnicity,with Latino young people(64%)more likely to use behavioral health apps than Black young people(58%),who are both more likely to use such apps than White young people(47%).Latino young people are more likely to report ever using apps related to mood tracking(31%)than Black(22%)or White(14%)youth.Similarly,Latino young people are more likely than their Black or White peers to report using apps to help with sleep(38%vs.32%and 27%.)Black and Latino young people are more likely than White youth to indicate ever using apps related to anxiety(28%and 26%vs.15%),depression(27%and 25%vs.13%),ADHD(17%and 20%vs.10%),stress reduction(26%and 30%vs.18%),quitting smoking or vaping(17%and 17%vs.5%),and alcohol and drug abuse(12%and 10%vs.4%).In our qualitative interviews and focus groups,Latino and Black young people attributed this higher use of behavioral health apps to their affordability and accessibility relative to therapy,and the difficulties of finding a therapist with a similar racial/ethnic identity,in addition to cultural stigma associated with seeking therapy.Young adults age 18 to 22 report ever using apps for depres-sion,anxiety,ADHD,and happiness and well-being more often than 14-to 17-year-olds.In addition,compared to men and boys,women and girls are more likely to ever use apps related to anxiety(25%vs.12%),mindfulness(35%vs.22%),stress reduction(27%vs.15%),mood tracking(24%vs.13%),and happiness(30%vs.17%).Young people with depressive symptoms are more likely to use all types of apps for behavioral health.Among young people with depressive symptoms,the use of all types of mobile behavioral health apps tracks with the severity of an individuals symptoms,as youth with more severe symptoms are more likely to report using all types of behavioral health apps.Similar shares of youth with moder-ate to severe,or mild,depressive symptoms have used apps related to depression and anxiety:about 4 in 10 of those with moderate to severe symptoms(38%for depression and 36%for anxiety);around 2 in 10 with mild symptoms(22%and 24%,respectively);and less than 1 in 10 with no symptoms(6%and 9%).GETTING HELP ONLINE 22 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.know how to find ones that would be helpful to them(5%),had a lack of trust in apps(9%),or were unable to find apps that were specific to their identity or lived experience(6%).Concerns about the expense of apps and fear or stigma around using these apps were also cited by small numbers of young people who had not used behavioral health apps.Teens are more likely to cite lack of need for apps as a reason for non-use than young adults(70%vs.57%),while young adults are more likely than teens to point to a lack of desire to use an app(20%vs.11%of teens)and because they dont believe an app would help them(24%vs.10%of teens).Though many young people use behavioral health apps to manage mental health,they give mixed reviews on the helpfulness of these apps.While apps are held up as an alternative to in-person or online care provided by a therapist,questions remain about the effi-cacy of different apps.Of the teens and young adults who have ever used an app for their mental health and well-being,47%found the app to be very helpful(16%)or somewhat helpful(31%),while 37%found the app a little helpful(28%)or not at all helpful(9%).Sixteen percent were not able to remember accurately if the app was helpful.Besides apps related to anxiety and depression,young people with moderate to severe depressive symptoms are more likely than young people with mild symptoms and no symptoms to use a host of apps related to other aspects of mental health and well-being.Those with mild symptoms are also more likely to use these apps than young people with no symptoms.App types encompass those related to meditation(45%for those with moderate to severe symptoms,33%for those with mild symptoms,and 18%for those with no symptoms),sleep(49%,38%,and 18%,respectively),stress reduction(39%,29%,and 10%),happiness or well-being(42%,32%,and 14%),and mood tracking(43%,23%,and 7%).Lack of need for an app and concerns that it would not help are the top reasons why young people do not use apps to support their mental health or well-being.Among those who have never used an app to support their mental health or well-being,more than half(63%)say they do not need support with their mental health or well-being.Others do not believe that using an app would help(17%)or do not want to use an app to support their mental health or well-being(16%).Other young people reported knowledge barriers,that they didnt know these apps existed(10%),didnt Percent of young people who have used certain mobile apps related to mental health,by age,gender,race/ethnicity,and LGBTQ in 2023Among ages 14 to 22,percent of those who have ever used a mobile app related to any of the followingTotalAgeGenderRace/ethnicityLGBTQ 14 to 1718 to 22Men/boysWomen/girlsWhiteBlackLatinoLGBTQ Non-LGBTQ Sleep31$66572860%Meditation/mindfulness29$22546568%bHappiness or well-being2507011073%bStress reduction2255786050nxiety1932558618%bMood tracker2043442148epression1814937587DHD135172092%bQuitting smoking or vaping10%72%5774rug or alcohol abuse7%4%7%4200ny other health-related topic17002548265%bNote:Items with different superscripts differ significantly across rows within each category(p .05).Q:Have you ever used a mobile app related to any of the following?Source:NORC survey for Hopelab and Common Sense conducted Oct.4Nov.14,2023,with 1,274 young people age 1422 nationwide.GETTING HELP ONLINE 24 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.ConclusionLatino young people are more likely to have attended online therapy and to seek therapy through a telehealth company than their White peers,and Black,Latino,and LGBTQ young people are more likely to use behavioral health apps.In focus groups,Black and Latino young people pointed to the poten-tial of these technologies to help communities overcome barriers of cultural stigma,provide low-cost access,and facili-tate connections with providers who share their ethnic and racial identities.Yet,in the survey,youth indicated mixed satisfaction with online therapy and apps.Within qualitative interviews and focus groups,LGBTQ young people in particular expressed concerns around attend-ing online therapy related to stigma,privacy,and therapist expertise and sensitivity around dealing with LGBTQ iden-tity-related issues.Based on these patterns,telehealth and behavioral health apps need to do more to address LGBTQ young peoples concerns related to privacy,stigma,and iden-tity-related competencies.These findings also point to a broader need for targeted research into the qualities of online therapy and apps that make them more or less supportive,to facilitate the development of more effective online behavioral health services.Overall,this study suggests that online therapy and behav-ioral health apps have begun to reduce barriers to access for Black and Latino young people,and fill some needs for LGBTQ youth,but work remains to fully realize their poten-tial to be both culturally appropriate and youth-centered.With the increase in concern over youth mental health in the past decade,and in the absence of a parallel increase in care providers over the same time,many young people struggle to find in-person care,support,and actionable information for their behavioral health challenges.To address this gap,provid-ers have developed new paths for care to expand capacity and begin to address the growing need for accessible support and information.This report shares new data that puts into perspective how these newer options for careincluding behavioral health apps,online therapy,and information on mental health shared through a variety of platformsare being used and what users think about their effectiveness.One long-standing challenge of in-person youth mental health services has been that Black and Latino young people have lower rates of access and use of care when compared with White young people.20 We see that users who are historically underserved by in-person care often take greater advantage of online offeringspotentially in part because such avenues can provide more tailored,affordable,culturally appropriate care,and also offer discreet access that works around community stigma about mental health.The data also shows that young people who report symptoms of depressionincluding those who generally report substan-tially higher rates of these symptoms,like LGBTQ young peopleare also taking greater advantage of these online opportunities for therapy,interventions,and information.However,despite the sizable share of certain groups of young people who are turning to online therapy and behavioral health apps for support,the findings call attention to room for improvement in the accessibility and helpfulness of these digital platforms.While 31%of those who used an app to support their mental health said they were somewhat helpful in the current survey,just 16%of app users felt they were very helpful.The picture was more mixed to positive for online therapy,with 31%of those who attended saying it was somewhat helpful,and another 31%reporting that it was very helpful.20 Lu,W.,Todhunter-Reid,A.,Mitsdarffer,M.L.,Muoz-Laboy,M.,Yoon,A.S.,&Xu,L.(2021).Barriers and facilitators for mental health service use among racial/ethnic minority adolescents:A systematic review of literature.Frontiers in Public Health,9.https:/doi.org/10.3389/fpubh.2021.64160525 GETTING HELP ONLINE COMMON SENSE MEDIA.ALL RIGHTS RESERVED.Study LimitationsAs with any study,various limitations should be kept in mind as stakeholders seek to translate the findings into recommen-dations.Crucially,this report does not seek to establish causality in its analysis and does not offer claims about the extent to which the use of behavioral health information,online therapy,and mental health apps drives positive or nega-tive outcomes in youth mental health and well-being.Instead,this study contributes to a growing body of research illustrat-ing the varied contexts in which young people make use of the digital tools at their disposal to find information and seek out professional and peer-based support across websites,social media platforms,and apps.Additionally,while the study reports differences by demo-graphic groups such as age,gender,race/ethnicity,and LGBTQ identity,such findings should not be interpreted as applicable to all young people in such groups.Young peopleand subgroups of themare not a monolith.The impact that online behavioral health resources have on specific young people depends on their developmental level,individual dis-positions,and contextual aspects(e.g.,school,peer groups,family,socioeconomic status,etc.).21,22Furthermore,while oversampling techniques allowed for deeper analysis of youth who are LGBTQ ,youth of color,and those who report depressive symptoms,certain smaller sub-groups(such as nonbinary youth)were still too small to be meaningfully included in the analysis.It is essential to continue investment in studies such as these that present high-quality,nationally representative data paired with qualitative responses that reflect the lived experiences and views of teens and young adults as we seek to understand the complex interplay between young peoples use of technology and their well-being.21 Valkenburg,P.M.,&Peter,J.(2013).The differential susceptibility to media effects model.Journal of Communication,63(2),221243.https:/doi.org/10.1002/9781119011071.iemp0122 22 Beyens,I.,Pouwels,J.L.,van Driel,I.I.,Keijsers,L.,&Valkenburg,P.M.(2020).The effect of social media on well-being differs from adolescent to adolescent.Scientific Reports,10(1),Article 10763.https:/doi.org/10.1038/s41598-020-67727-7GETTING HELP ONLINE 26 COMMON SENSE MEDIA.ALL RIGHTS RESERVED.MethodologyFor a detailed description of the Methodology for this report,please refer to the Methods section in our previous report based on this same data collection,A Double-Edged Sword:How Diverse Communities of Young People Think About the Multifaceted Relationship Between Social Media and Mental Health.The report is available at:monsense.org/youth-perspectives-social-media-mental-health 2024 Common Sense Media.All rights reserved.Common Sense,associated names,associated trademarks,and logos are trademarks of Common Sense Media,a 501(c)(3)nonprofit organization(FEIN:41-2024986).commonsense.orgHopelab Hopelab is a transformative social innovation lab and impact investor working to support the mental well-being of adolescents age 10 to 25,especially Black,Indigenous,and people of color(BIPOC)and LGBTQ young people.Through philanthropic funding,collaborations,and intergenerational partnerships,Hopelab works at the intersection of tech and mental health alongside entrepreneurs,funders,researchers,and young change-makers to create systems of change and build a thriving future for underserved young people.For more information,visit hopelab.org.Common Sense Media Common Sense is the nations leading nonprofit organization dedicated to improving the lives of all kids and families by providing the trustworthy information,education,and independent voice they need to thrive in the 21st century.Our independent research is designed to provide parents and caregivers,educators,health organizations,and policymakers with reliable,independent data on childrens use of media and technology and the impact it has on their physical,emotional,social,and intellectual development.For more information,visit commonsensemedia.org/research.NORC at the University of Chicago NORC at the University of Chicago is an independent research institution that delivers reliable data and rigorous analysis to guide critical programmatic,business,and policy decisions.Since 1941,NORC has conducted groundbreaking studies,created and applied innovative methods and tools,and advanced principles of scientific integrity and collaboration.Today,government,corporate,and nonprofit clients around the world partner with NORC to transform increasingly complex information into useful knowledge.NORC conducts research in five main areas:Economics,Markets,and the Workforce;Education,Training,and Learning;Global Development;Health and Well-Being;and Society,Media,and Public Affairs.For more information,visit norc.org.
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