THE RISE OF DR. GOOGLE

How to Help Youth Develop Skills to Find Accurate Health Information Online

May 2023

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What is digital health literacy?
What does misinformation look like?
Beware of algorithms and echo chambers
Tips for family dialogue and action

Youth are increasingly accessing and sharing health information online, independent of the traditional channels of doctor-patient and parent-child communication. While there is a wealth of useful information to be found, children and teens are also encountering misinformation, negative health messages, and peer-created content that may not be relaying credible information.

How can families, schools, and communities encourage digital health literacy and help children use a critical lens to find trusted sources for health advice?  Children and Screens convened a panel of researchers, clinicians, and public health experts to discuss these issues and offer tips to youth to evaluate the health information they find online.

What is digital health literacy?

“Health literacy is the degree to which people can get, process, understand and communicate about health-related information to make informed health decisions. Given today's connected world, health literacy is also heavily tied to the online environment and electronic information sources. Digital health literacy is applying that idea of health literacy to digital information sources.”
- Jennifer Manganello, PhD, MPH - Professor of Health Policy, Management and Behavior, University at Albany, SUNY

What does misinformation look like?

“It takes a lot of forms, but there's a few simple rules:

  • Using correlation versus causation - implying two events that co-occur are related or causal in nature: for example, by claiming the rise in vaccination rates is causing the rise in autism diagnoses
  • Using emotional (especially fear) appeals with a very compelling picture that grabs our attention. “Destroying the lives of children one injection at a time.” It's memorable. It breaks through the clutter. It can also be a form of implicit misinformation that is harder to identify or tag.
  • “Just asking questions” is a common strategy - you're not exactly saying something is inaccurate. You're “just asking a question” that strongly undermines, or questions, best available evidence. This also goes along with impossible expectations - demanding a level of evidence that is not feasible to achieve.”

- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota

5 Quick Signs of Misinformation (FLICC)

  • Fake Experts
  • Logical Fallacies
  • Impossible Expectations
  • Cherry Picking
  • Conspiracy Theories

- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota
 (linked resource: https://skepticalscience.com/history-FLICC-5-techniques-science-denial.html)

Beware of Algorithms and Echo Chambers

“Seeing misinformation leads you to have misperceptions on that topic. This is especially true for young people and for video misinformation. So the fact that YouTube and TikTok are two of the most commonly used sources of social media for young people, and the fact that young people tend to be more likely to be drawn in by misinformation, is especially troubling. They're seeing the spaces where misinformation spreads and they're more likely to believe it.”

- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota

“Algorithms behind Tik Tokwill reshow you everything that you already liked. So if you find a teen who is hooked into content creators that may not be providing accurate information or pushing lifestyles that are not healthy, they're going to see that content more than a teen who has never really engaged with that.”

- Robin Stevens - Associate Professor of Communication, USC Annenberg

“What [teens] are often doing is following influencers, peers who look like them or who can speak their language, who might not be beholding to the same accuracy standards, who might be presenting information in order to gain attention, to gain notoriety, to gain money, rather than presenting the best available information. This can also lead people to fall into echo chambers and filter bubbles, places where they're seeing a lot of misinformation being repeated from a lot of different sources.”
- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota

Tips for Family Dialogue and Action

Stress accuracy and verify sources

“When we're on social media, we're there for social reasons, and accuracy might not be our top goal. [Remind children] that accuracy is important. Ask them to reiterate to you that, ‘Yeah, I think information should be accurate.’ Give them news literacy tips or invoke social norms - ‘In this house, we really want to only share accurate information. We really only want to see accurate information.’ All of those things can make people less likely to share misinformation and to respond to it. [...]
Teach young people to be looking outside of where they are for verification, but not necessarily just clicking the top source that they see, but looking at lots of different information, checking their bearings. If no prominent expert or news organization is reporting on it, it might not be true.”

- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota
Lean on dialogue, not controls
“When kids talk to us about their social media habits and experiences, we need to be curious and interested, not judgmental. We should talk less and smile more. The purpose of us having a conversation about social media experiences is for us to have another one in the future, because establishing an open dialogue about social media in an ongoing manner is far more important than any single situation. We need to make sure kids know that there will not be negative consequences from what they share.   I find as a parent of teens, it can be helpful for me to start the conversation with self-disclosure and talk about some of my own experiences on social media.  They feel much more comfortable talking about my mistakes, but that greases the wheels of dialogue and allows us to discuss important online dilemmas that affect them as well.”

- Paul Weigle, MD - Child and Adolescent Psychiatrist, Associate Medical Director of Ambulatory Services, Natchaug Hospital, Chair of the Media Committee, American Academy of Child and Adolescent Psychiatry

“It’s important to reach youth where they are at and in a way that resonates with them. Youth don't often use social media because they necessarily want to be taught about something. They're using social media for entertainment, they're using it for connection, and they're using it for a number of other reasons in their life. And it's important to think through how we can get our information across in a way that will help us resonate with youth and cut through some of that digital clutter that's also potentially there.”
- Jessica Willoughby, PhD - Associate Professor of Strategic Communication, Washington State University
“Have these conversations starting at a young age and all the way through as they get older. Try and make a game out of it. Try and teach them things in ways that they're going to find enjoyable because that's going to stick so much better than a lecture on “you should do this.”
- Emily Vraga, PhD - Associate Professor, Hubbard School of Journalism and Mass Communication, Don & Carole Larson Professorship in Health Communication, University of Minnesota 
Help children establish appropriate boundaries with peers
“Peer support is so valuable to adolescents. Young people will often take the role of acting as therapists (or even caregiver) to one another online, and this can be a sort of a positive way for young people to show caring and experiment with intimacy, including sharing secrets. However, oftentimes it becomes a negative, as peers expect one another to be available at all times and provide a degree of support that surpasses healthy boundaries. Peers are often capable of offering good advice to one another, but can serve as negative influences as well.  We should teach teens to be kind to peers online, but to know when to set healthy boundaries. For example, when a peer shows risky behavior online such as self harm or threats of suicidality, teenagers should feel empowered to come to their parents or a teacher rather than try to handle the situation themselves.”
- Paul Weigle, MD - Child and Adolescent Psychiatrist, Associate Medical Director of Ambulatory Services, Natchaug Hospital, Chair of the Media Committee, American Academy of Child and Adolescent Psychiatry 
“In thinking about how do we monitor, support and guide, it's also “How much do I want you hanging out with your friends or meeting new people or being in that social milieu?” It's not always just receiving content.  I look at social media and sexual health behavior, and we know it's a source of modeling and establishing norms. It teaches other teens, teens teach other teens, or older teens teach other teens, what are the normative behaviors. We know that social media is one of the most dominant forums where kids go to look for sexual health information.”
- Robin Stevens, PhD, MPH - Associate Professor of Communication, USC Annenberg
Identify resources before they need them
“If we're at a moment where we're really having a lot of affective feelings, where we're worried about something, we're concerned, and then we're going on and seeking information, it might make it so that we have more trouble deciphering the good sources from the bad or really understanding that content in the context of the things that we need to be thinking through.”

- Jessica Willoughby, PhD - Associate Professor of Strategic Communication, Washington State University

“A great place for parents and caregivers and providers to start to look on their own is Tik-tok and on Instagram, to see what content creators resonate. Realistically, young people aren't likely going to websites as much as we do. It's a great way to teach, to find people and say, “Hey, have you seen this?” Just start to introduce different credible sources that are “hip” and “cool.”

- Robin Stevens, PhD, MPH - Associate Professor of Communication, USC Annenberg 

“There are a number of national resources as well as resources at the state and local level, and helping youths really decipher which resources may be beneficial for them is something important that we can do. For example, for crisis type issues, youth really aren't going to call on the telephone anymore to talk to individuals. So finding the resources in a format that are going to reach youth where they're hoping to be heard and talked to is really useful.”

- Jessica Willoughby, PhD - Associate Professor of Strategic Communication, Washington State University

What to do when your child self-diagnoses using online information
“We should take their concerns seriously and do our best to assess them in a curious, nonjudgmental manner. We should find out where they learned about their diagnosis. What do their friends think? We should find out whether their teachers are observing symptoms at school. Do the symptoms of this diagnosis match up with our own experiences of our child? If we think that they may be incorrect, we want to provide reassurance but avoid being drawn into an argument. We want to listen for unmet needs that they might have that might get filled by this diagnosis. For instance, it might be something that they're reaching out to get our attention or to affiliate with a school or online peer group. If so, we can help them fill this need in a healthy fashion, such as by scheduling regular quality family time or supporting connection with peers via afterschool activities. If we think they may be correct or are suffering from another undiagnosed mental health condition, then consulting with your child’s pediatrician or a qualified mental health professional is vital.”

- Paul Weigle, MD - Child and Adolescent Psychiatrist, Associate Medical Director of Ambulatory Services, Natchaug Hospital, Chair of the Media Committee, American Academy of Child and Adolescent Psychiatry

Set Goals

Encourage your child to make a list of things they want to do or accomplish with their extra time. Maybe they want to
learn a new skill or spend more time practicing an old one, see friends, read a book, make something from scratch,
or help someone in need. Everyone in the family can make their own list, and then together you can work towards
completing them.

Go Screen-Free

If you haven’t already done so, agree upon spaces in home or specific times all screens will be put away. This might
include meal times, car rides, or specific family events like game nights or walks in the park. Some families take a
“digital Sabbath” once during a weekend. Phones and other personal screens are completely out of sight during these
times. Don’t forget to follow this rule yourself, too!

Spice Up Mealtime Convo

Make family dinnertime more interesting with conversation starters and leave your screens off the table. Ask
questions like, if you could travel back in time, when would it be? If you would travel anywhere in the world,
where would it be? Ask each family member to name one thing that they are curious about. Have each child
share what he or she would like to be when they grow up. Look online for some interesting statistics from 2022 and
ask your family questions like, What country in the world consumes the most candy per capita per year? Who
was the most influential thinker who ever lived? Bring up an issue and try arguing for or against. You may
be surprised how much your family has to say!

Embrace Boredom

It’s okay to be bored! Resist the urge to hand over a screen and let your child sit in their boredom. It might be
uncomfortable at first, but it has many benefits for developing (and overworked) brains, including self-awareness,
creativity, and rest.

Create And Explore Together

Breaks are the perfect time to work together on a family project. Wax nostalgic sharing old family stories your kids
might not know, looking back at and organizing or digitizing old photos, and/ or exploring your ancestors’ journeys
by creating a family genealogy. Creating new spaces in your home or working on a family art project to hang in the
kitchen are also great ways to spend time together and give everyone a sense of purpose and accomplishment.

Find Balance

When school is out, it can be tempting to go into full relaxation mode. Encourage your children to use this time for
personal growth, or learning things they may not have time for during a usual school week. This time can be balanced
with time for general entertainment or rest, and you may even set different screen time allowances for each. Whether
just having fun, learning something new, or connecting with friends and family – on screens or off screens – it’s
important to help your children find balance in their time spent doing different activities.

Get Engaged

Try to take your own break from work and other responsibilities to engage in screen-free fun with your child.
Brainstorm media free things you can do, like a trip to the zoo, a walk around the neighborhood, a scavenger hunt
(indoors or outdoors, depending on weather), or building a fort! The options are endless and can take anywhere from
5 minutes to a whole day - so get creative and encourage your children to do the same.

Take Breaks

If your children are getting screen time, make sure they take a 10-15 minute break every hour or so. This break can
be anything that doesn’t involve technology, but the more active or social the break, the better. This will help
“reset” their brain and prevent tech overload.

Take Time For Others

Make time for acts of service. Serve food at a local soup kitchen or help at a community garden, or donate clothing,
food, or toys. Research options in your community, encourage your teens to help with the search, and give back as a
family

Share The Love

Encourage everyone in your household to share the love with someone each and every day! Give a hug (to someone in
your house!), write a personal holiday card, create a homemade holiday gift, enjoy each person’s favorite meal just
because it’s their favorite, send a holiday music video to grandma and grandpa – the possibilities are endless!

Stick To Routine

It’s okay to make some exceptions during holiday breaks, especially if extracurricular activities are on hold, but
try to stick to your usual routines and rules around screen time, including no screen time before bed! If you’re
going to allow additional screen time during breaks, try to incorporate it earlier in the day.

Stay Connected

Adolescence is marked by the increasing importance of friendships, but holidays with family can make in-person peer
socializing difficult. Encourage face-to-face gatherings, but also allow space for your teen to actively connect
with their friends online, whether that’s through video chatting, texting, gaming, or active communication on social
media. Establish ground rules early to make sure this time is limited and balanced with time for family and other
activities.

Motivational Interview Activity

Motivational interviews are conversations that can help children understand their own motivations for change. Having
these conversations can help children find their own reasons for reducing screen time and engaging in other
activities. Here are guidelines from "Motivational Interviewing: A Primer for Child Welfare Professionals.”

  • When talking to kids about screen time, practice your OARS skills!
    • Open ended questions
    • Affirm a child’s experience
    • Reflect out-loud on what a child says
    • Summarize their reflections
  • Productive conversations can follow 4 phases. Importantly, they don’t have to happen in this order. Do what
    works best for you and your kids.
    • Engaging: Understand why a child is using screens.
      • Ask why a child is using screens. Maybe they miss their friends? Maybe they can’t think of
        anything else to do?
    • Focusing: Focus on a specific goal!
      • Keep things focused on reducing screen time.
    • Evoking: What are the child’s motivations to achieve that goal?
      • Does your child want a cleaner room, and why? Do they want to learn a new hobby? If they’re
        feeling isolated during a break, are there activities that would help?
    • Planning: Develop a plan to achieve that goal.
      • You can plan to organize their room for 1 hour a day. Or you can schedule time to practice
        something they’re interested in. The plan may also include identifying what help they need (a
        ride to the grocery store) to accomplish their goal.
Thanks to our experts!

We would like to acknowledge the contributions of the following experts through our Ask the Experts webinars, Guidelines for Parents, and Tips for Parents columns.

Jessica Hartshorn, Parents

Kathy Hirsh-Pasek,PhD, Temple University, Brookings Institution

Laura Markham, PhD, Aha! Parenting

Juliana Miner, MPH, George Mason University

Martin Paulus, MD, Laureate Institute for Brain Research

Arlene Pellicane, MA, author

Larry Rosen, PhD, California State University, Dominguez Hills

Yalda Uhls, PhD, University of California, Los Angeles

To learn more, view the entire webinar, “The Rise of “Dr. Google”” Youth and Online Health Information our YouTube channel.