Disparities in Adolescent Screen Use by Sexual Orientation

Dr. Jason Nagata shares the compelling findings on sexual minority adolescents' screen habits and other insights from his new research study, "Associations between sexual orientation and early adolescent screen use: findings from the Adolescent Brain Cognitive Development (ABCD) Study," published in the June 2023 issue (Vol. 82) of Annals of Epidemiology.

Read the full article here:
https://www.sciencedirect.com/science/article/pii/S1047279723000534

To access the ABCD Data Repository from the NIMH, visit:
https://nda.nih.gov/abcd/

Episode Credits:

• Executive Producer: Sabrina Debas
• Technical Producer: Paula Burrows
• Annals of Epidemiology is published by Elsevier.
  
  
  

Transcript

Patrick Sullivan: 0:10

Hi, you're listening to EPITalk: Behind the Paper, a monthly podcast from the Annals of Epidemiology. I'm Patrick Sullivan, Editor-in-Chief of the journal, and in this series we take you behind the scenes of some of the latest publications featured in our journal. Today we're talking with Dr Jason Nagata about his article "Associations Between Sexual Orientation and Early Adolescent Screen Use: findings from the Adolescent Brain Cognitive Development (ABCD) study." You can find the full article online in the June 2023 issue of the journal at www. annalsofepidemiology. org. So Dr. Jason Nagata is an Associate Professor of Pediatrics in the Division of Adolescent and Young Adult Medicine at UCSF San Francisco, and Affiliated Faculty with the Institute for Global Health Sciences and the Center for Sexual and Gender Minority Health. He's also a co-founder of the International Association for Adolescent Health Young Professionals Network. Dr Nagata's research interests include digital technology, eating behaviors and disorders, food security, nutrition, alcohol use, cardiovascular disease, HIV and LGBTQ+ health. Dr Nagata, thank you so much for joining us today.

Jason Nagata: 1:32

Yeah, thanks so much, and thanks for featuring and doing this recording during Pride Month.

Patrick Sullivan: 1:38

So we're at least recording this during June, which is Pride Month, and I think it's a really great opportunity and I'm so excited to see your focus on not just LGBTQ+ health, but particularly in sort of younger people, and I wonder if you could just start out by describing some of the main findings from your paper.

Jason Nagata: 1:58

Our main findings were we looked at lesbian, gay and bisexual adolescents aged 10 to 14 years old and we found that, overall, LGBT youth had significantly more recreational screen time per day than their heterosexual peers. This ended up being about four more hours per day actually, which is quite a large amount if you think about it. We actually looked across all different modalities, so not just television viewing, which prior literature has really focused on, but really more contemporary modalities like social media, video chat, internet texting and video games, and essentially across all of these modalities, gay and lesbian youth had more recreational screen use throughout the day.

Patrick Sullivan: 2:41

Yeah, I mean that four hour figure just struck me, I mean as an effect size in the context of how many hours we have to spend in the day. It's really an incredible chunk of time. I mean, with respect to that difference, you sort of talk about the fact that sexual minority youth had a lot more screen time and the discussion you point out, because this is really a sort of observational study, it's a little hard to know what that represented and you sort of propose that maybe this is a defensive mechanism or maybe it's some kind of a resilience mechanism. So can you say a little bit more about how you thought about that association and what it might mean?

Jason Nagata: 3:19

Yeah, I think you're absolutely right. We do have the measure of the time difference, but we really don't know from this study, especially due to its observational nature sort of the content and the quality of that four hours that was being spent. So I think you're absolutely right. Some of the things that we thought about were that in general, we know that sexual minority youth maybe more likely to experience school-based bullying or exclusion from peer groups due to their sexual orientation, and they may actually be able to find some of that connection and support through online means. You can imagine that, particularly in a smaller community or a more rural community, sexual minority youth may be the only person in their class or cohort who is out and so it may be very isolating in terms of their in-person dynamics, but they may be able to find connection and support through virtual means and have access to more people.

Jason Nagata: 4:12

So I think there could definitely be beneficial and social support mechanisms that are part of this additional screen use. But we did actually specifically measure a problematic screen use measure. So there have been these validated questionnaires looking at problematic video game use, social media use and mobile phone use, and some of the questions in that measure assess qualities of problematic, say, social media use, such as using it too much, having conflicts related to use, having takeover more of your time and also even having difficulty with school work or other work due to that overuse of that modality. And we did also see across the board that sexual minority youth did report higher problematic use scores across social media and mobile phones and video games.

Patrick Sullivan: 4:59

Yeah, thanks for that additional information. I mean, I wonder if you could have whatever NIH grant you want and you wanted to answer this question about. Are these really defensive versus resilience or a mix of that? What kind of next steps might you take or how would you like to answer that question?

Jason Nagata: 5:18

Yeah, that's a really great question. I think right now the available data from this Adolescent Brain Development study cohort really is limited to the time measure, so we know how much time people are reporting, that they're spending on it, but we really don't know the content and the quality. However that's a great question that you asked the NIH actually is supporting in future years an app that will actually be passively scraping these kids' mobile phone use throughout the day for a three week period, and so actually during that time we will get a little bit more objective data and device-based measurement on specifically what types of apps people are using, and I think in my ideal scenario, if we actually could get the exact content you know what people are typing in searches and the exact type of interactions then we might be able to better answer exactly what the content and quality of the interactions that particularly sexual minority youth are engaging in on these online platforms.

Patrick Sullivan: 6:15

Yeah, that's great. I think one of the interesting things here is that you took the adolescent brain development's ABCD, this larger study, which really wasn't focused on sexual and gender minority youth, and just used a subset, and you still had enough sort of respondents in that to get some pretty significant findings. Was it challenging to sort of, or what was your process, to ask about access to these data and to propose this and to get access to this data set?

Jason Nagata: 6:44

Yeah, the ABCD study is a large study across 21 different sites.

Jason Nagata: 6:49

That's funded by the NIH, but the data availability is open to actually anyone with a data use agreement, and so you can apply through the National Institute of Mental Health Data Archive to get access.

Jason Nagata: 7:02

And I actually first learned about it because I was trying to study screen use and physical activity in adolescence as part of a career development award a K award as I started as a junior faculty and I was looking for different cohorts to analyze, and I came across the ABCD study cohort and was put into contact with the principal investigator in Northern California, where I'm from, and it just so happens that her name is Dr. Fiona Baker. That the PI for the Northern California site is also the co-chair of the digital technology working group, and so she really is the one who decides with, along with her committee, what digital technology and screen measures are assessed at each year, and so it ended up being a very nice collaboration, because she was local but also had the content expertise of this digital technology and social media use, and so we've been working a lot on analyzing the digital technology data from ABCD.

Patrick Sullivan: 7:58

That's great. I appreciate you sharing that because I think for a lot of folks, especially like students or people who are earlier in their careers, finding really rich data to do these kind of analyses with can feel like a challenge. But a lot of these federal big data collections you can get access to and I'm going to reach out to you after and make sure that we put a link in the show notes to if there's a website or a way to get more information about this particular dataset, because it sounds like people can actually come with ideas. So that'd be a real generous piece for you to share and for us to pass on in the show notes. So you talked some about the limitations of using the secondary data analysis and yet you found some really in epi terms, some pretty strong associations and some some pretty relatable associations in terms of these behaviors. So I wonder what implications you feel like. Is there anything policy wise yet, or is it mostly to inform future research or who needs to know about this?

Jason Nagata: 8:55

I mean I think that there are any kind of research these days on adolescent social media use is very policy revelant. Actually, just a few weeks ago, the US Surgeon General issued an advisory on youth social media and links to mental health. This actually just came a couple of years after the initial Surgeon General advisory on youth mental health more broadly in the context of the pandemic and actually our very first ABCD study, which showed that youth screen time doubled during the pandemic. So, at baseline of the ABCD study in 2016, at that time the cohort was nine to 10 years old. They had about, on average, four hours of recreational screen use per day and by May 2020, so, like the first few months of the pandemic that had doubled to almost eight hours per day. And that was recreational screen use. That didn't count. You know people were in zoom school or doing remote school work, and so actually that was the first article that was cited in the Surgeon General's report being, like you know, there's this huge increase in screen use. I mean understandably, of course, given the context, but still, as you were saying, if you think about kids spending eight hours of their recreational time every day on screens, which you know does make sense, but what you know what impacts that might have. You know both. There are certainly our benefits, but there are certainly our potential risks.

Jason Nagata: 10:10

And I just think that you know, given the Surgeon General advisory that just came out a few weeks ago, and there's actually tons of legislation right now at the federal and state level about social media and adolescents right now, about, you know, age limits. You know currently the age limit is 13. You technically need to be 13 years old to have an account, but there's no robust age verification so anyone can actually lie about their age and get an account. One other finding from the ABCD study was that at baseline, you know, these nine to 10 year olds, about 20% had a social media account, although none of them technically should have been able to. So that was also a finding that all 20% of this national sample had lied about their age to. You know, get an account, which just reiterates that. You know the age verification process is not really robust. So I think that there are lots of implications for any of these ABCD studies just because there's so much ongoing legislation about social media in teens and particularly the early adolescents.

Patrick Sullivan: 11:11

Yeah, thanks for that. I also feel like, from a perspective of a person who writes grants also, that this seems like a real opportunity, you know, for sort of mHealth or digital health based interventions. You know, we say we want to meet people where they are with public health services and, if anything, this just suggests that, although there are particular challenges experienced by these LGBT or, in your study, sexual minority youth participants, there also is this highly prevalent device access and a lot of time and a lot of opportunity if the interventions can be developed that then are effective in being delivered through that format. So I mean, I think there's risk and there's also opportunity. It seems like, yes, absolutely All right.

Patrick Sullivan: 11:57

So we're going to pivot just a little bit, because part of the subtitle of the podcast is behind the paper and so I always think it's interesting just to talk to people a little bit about the process. I think, especially for students, for people who are earlier in their careers, a lot of times they want to ask questions about like how do you come up with ideas and how do you get that done and how do you get your colleagues on board, and just like the process of producing this kind of research. So I wonder if you could just talk a little bit about, like, what was your most exciting part of conducting this particular research. Like there's always some data cleaning and some IRB approvals or some you know, but where was the excitement for you and discovery in your process?

Jason Nagata: 12:39

Yeah, thanks for covering these topics about behind the paper. I actually think that my favorite part about this involves students. So the second and third author of this paper, or respectively, a medical student at UCSF and a master's of public health student at UC Berkeley, and over the summer we host a number of summer students who do full-time research. It just ends up being like how most of the academic calendars work, for, like the med students, they usually have the summers off to do research, similar for the masters and public health students, and so we were actually.

Jason Nagata: 13:12

The main objective of my K award is not necessarily looking at sexual minority health. It was more broadly looking at downstream effects of social media and screen use and physical activity. But as a gay man myself and somebody who has interest in LGBT or sexual minority research, this sort of came up as a side project because I had a couple of students who are interested in the topic and LGBT health more broadly and we had already analyzed all the screen data for other prospective analyses, and so it just so happened that we were like, oh, we should look to see if there's any associations with sexual orientation and screen use, and so this actually was like a summer research project from last summer that kind of came about from a collaboration with two really spectacular students.

Patrick Sullivan: 13:59

That's great, and thank you both for making those opportunities available to earlier career colleagues and I think for me it's some of the most joyful work that I do is working with earlier career people who are in that process of like devouring the methods, the substance and producing these things and for identifying yourself as a gay man, as I am, and we also bring our own lived experiences to this work and sharing that, I think, is also generous. There's a time in my career where I'm probably much, much older, but the time when I was much more reserved about my personal life and so questions didn't get asked. So I think it's a feature of our identities and our willingness to share them that it opens up areas of inquiry that just didn't happen before. So thank you for both of those counts and thanks for recognizing your earlier career colleagues and their contributions to the paper.

Patrick Sullivan: 14:56

And I'm just asked one more question about your own path. So, in terms of your training, your development, how did you get involved in this particular area of research and adolescent health, young adult health, lgbtq health, and was that sort of a place you were aiming towards? Or for a lot of us, it's a place that we find ourselves, where we land because of the world and stuff. So what was your journey to have this particular focus in your research?

Jason Nagata: 15:23

Yeah, I think it was a little bit of a mix of many of luck and interest. Adolescent health and medicine. I really like it because it has this intersection of physical health issues and mental health and there's just so much excitement during adolescence, there's so much growth and development and people are becoming, or transitioning towards becoming, adults, and I guess I would say that my first influence was really my parents. My mom was a pediatric nurse and my father was a mental health social worker, so in some ways I basically am doing the intersection of their two careers. So I don't know, maybe I was destined for it.

Jason Nagata: 16:01

But as I went through college and medical school, I actually was very interested in nutrition issues and I think that pediatrics is a time when nutrition is really important, and so I initially became interested in pediatrics because I was looking at sort of behavioral nutrition research.

Jason Nagata: 16:19

I liked the pediatric population and then when I was a third year medical student that's when you start your clinical training I was actually just placed in the teen clinic, so mostly dealing with primary care for teenagers and also specialty care related to eating disorders and other mental health issues and teens, and I just loved it because I think you could really interact and talk and engage with the teenagers themselves, but they were still in need of guidance, and so I just really enjoyed that patient population and then I think from there, noted that you know, adolescent medicine is actually a relatively new specialty in pediatrics, only within the last 30 or so years. There's just so much, I think, research gaps in the field that it seemed like it was a good fit because it was a relatively new field. There's a lot of research that still needs to be done and I just enjoy working with a population clinically.

Patrick Sullivan: 17:12

Yeah, thanks, and I think there's also you'd know better than I would, but I think there's also a higher prevalence of eating disorders in sexual gender, minority youth. Is that right?

Jason Nagata: 17:23

Yes, absolutely. I should have also mentioned that I guess I sort of have two lines of work. One is this sort of population-based epi research, looking at the ABCD study and other cohorts focused on adolescents. But my clinical research is almost exclusively now focused on eating disorders and particularly in sexual and gender minority youth and actually boys and men.

Patrick Sullivan: 17:45

Great. Well, I'm going to give you the final word here, and just I've sort of mentioned a couple times that the later I get in my career, the more I'm focused on earlier career people and young researchers and aspiring students. So do you have any advice for young researchers or students who may have an interest in this topical area and who want to pursue research and who are not sure how to get on that path? What advice would you give?

Jason Nagata: 18:10

Yeah, I think that my best advice is to choose a topic that you're passionate about and then really persevere. I was going to mention that one of the biggest challenges, I think, for this research was getting that initial NIH funding, and so, for the K award that I had mentioned, that I applied for in order to allow me to conduct these analyses of the ABCD study and other adolescent cohorts, I think I had to apply for it three times before it was finally funded, but now that it is funded, it's just been really amazing. I think I chose the sort of topic that I really wanted to delve into and I really appreciated being able to have a lot of protected time now to run these analyses in the ABCD study, and I think that because I continued to try, despite critical reviews, I'm really happy that I didn't change topics, but I still, like you know, worked on revising until it was in a fundable range.

Patrick Sullivan: 19:07

Yeah, and that is an important message for those folks who are in that sort of PhD to K transition. I think that is much more than norm of the experience is multiple cycles of review and update, and I know it can feel discouraging, but it's also like that gives you that really great runway in which, to you know, get your own program of research started and focus on what you want to. So congratulations on that. So do you have any other last thoughts that you'd like to share with our listeners, or anything else that I haven't asked you about your research that you think is important to share?

Jason Nagata: 19:43

No, I think that this has been a really wonderful conversation and thanks so much for featuring our work, and I do hope that we'll be able to look at other insights related to sexual minority disparities in the ABCD study and other cohorts and adolescents, because I do think that there's a lot of topics that really haven't been explored at all in the research field in terms of sexual minority disparities. I think there's been relatively more on sexual health and maybe mental health and substance use, but I think there are so many other areas of physical health that are collected in ABCD and other cohorts that really need to be explored and identified more in the scientific literature.

Patrick Sullivan: 20:23

Thanks, and I'll leave a little Easter egg for people who've listened all the way through, which is that we're going to be launching a special issue of Annals on Health and Equities, and one of the explicit calls will be around sexual and gender minority, as well as race, ethnicity, economic inequities. So you might line up and have a great next paper, as the Health Equity Issue Calls for Manuscripts. So that brings us to the end of the episode. Thanks again, Dr. Nagata, for joining us today. It was such a pleasure to have you on the podcast and thanks again for the work that you do in making time to tell us about it.

Jason Nagata: 20:58

Thanks so much for having me.

Patrick Sullivan: 21:05

I'm your host, Patrick Sullivan. Thanks for tuning in to this episode and see you next time on EPI Talk behind the paper. EPI Talk is brought to you by Annals of Epidemiology, the official journal of the American College of Epidemiology. For a transcript of this podcast or to read the article featured on this episode and more from the journal, you can visit us online at www. annalsofepidemiology. org.