Unjustified Critique of a CDC Report on Social Media Risks
Chris Ferguson's attack against the authors of a recent CDC report on risks associated with social media use by teens is neither justified nor fair.
The CDC recently published a report on the associations of frequent social media use with various risks among high school students per the results of the 2023 Youth Risk Behavior Survey.
Chris Ferguson, a psychology professor, has written a critique in which he accuses the CDC authors of incompetence as well as biased and outright unethical conduct.
The CDC Report
The full title of the CDC report, Frequent Social Media Use and Experiences with Bullying Victimization, Persistent Feelings of Sadness or Hopelessness, and Suicide Risk Among High School Students — Youth Risk Behavior Survey, United States, 2023, pretty much summarizes its content. The publication is part of the CDC Morbidity and Mortality Weekly Report series, which usually provides brief overviews of rudimentary facts that are relevant to public concerns and well-being.
The report defines frequent SM users to be those who reported using SM “at least several times a day” and finds that 77.0% of U.S. high school students fit the frequent SM users definition (81.8% among girls). The report also found that, adjusted for basic demographics (race and ethnicity, age, sex, and sexual identity), frequent SM users have elevated risks:
[…] higher prevalence of bullying victimization at school and electronically, persistent feelings of sadness or hopelessness, and some suicide risk among students (considering attempting suicide and having made a suicide plan), both overall and in stratified models.
The statistically insignificant risk elevations range a 21% increase for considering suicide to a 35% increase for persistent feelings of sadness or hopelessness to a 54% increase for being electronically bullied:
Risk elevations were largely similar for girls and sexual minorities; interestingly, frequent SM users among girls had highly elevated prevalence of being bullied in school (+54%) while boys did not (+17%).
Simply put, the CDC study appears to be a routine report of rudimentary results from a recent survey — the kind of a report that is common within the CDC MMWR series.
One limitation is that the report did not calculate risk elevations for students with more frequent use of SM, such the 37% of students who reported using SM every hour or more on average. My preliminary analysis indicates that risks in the 2023 YRBS data set are substantially higher for these ‘very frequent’ SM users compared to the ‘frequent’ users examined by the CDC report.
Accusation of Moral Panic
Ferguson is one of the most vocal and prominent opponents of concerns over harmful impacts of digital technologies and social media on adolescents.1
Ferguson starts his critique by accusing the CDC of spreading moral panic:
Ugh. I don’t want to make this Substack about social media effects all the time, particularly as that’s become an increasingly nasty and dumb debate. But people exaggerating weak evidence in support of a moral panic keeps coming.
This latest comes from the CDC which release a really crude study correlating social media time to mental health in youth.
Accusations of ‘moral panic’ (or ‘tech panic’) against those who express concerns over harms associated with SM use by adolescents have become routine even in psychology journals and scientific magazines, not to mention blogs and social media.2 What is unusual here is that the accusation is deployed against authors who merely report some risks associated with SM use rather than express their own concerns over SM harms.
Accusation of Incompetence
Ferguson then proceeds to ridicule the authors of the CDC report as incompetent:
I say crude because it’s the kind of simplistic study I wouldn’t let undergraduates do for a research project and I have to think that with 9 coauthors (why?), 5 of whom have Ph.Ds., they have to know better.
Studies in Morbidity and Mortality Weekly Report series certainly tend to be limited in scope, but that is not the same as being simplistic, which implies inappropriate simplification.
The derision deployed against the CDC authors (‘I wouldn’t let undergraduates do for a research project’) is highly unusual within the academia, especially when coming from a prominent psychology professor.
Ferguson justifies his ridicule as follows:
Basically, they used the Youth Risk Behavior Survey, which actually is a very good database, and simply correlated frequency of social media use to experiencing bullying as well as 3 mental health questions. They didn’t include potential theoretically relevant controls such as family abuse, which they did have in the same dataset.
The accusation that limiting controls to demographic variables amounts to incompetence is preposterous.
Ferguson conflates the reporting of population risks (while using appropriate adjustments for demographics) with the explorations of potential causal pathways (while using various adjustments for ‘theoretically relevant controls’).
Ferguson’s flawed reasoning could be used to ridicule as ‘simplistic’ thousands of perfectly legitimate reports every year that are primarily concerned with risk associations rather than with causality.
Indeed the recent CDC report Adverse Childhood Experiences and Health Conditions also adjusts only for demographics when reporting risks associated with abuses within family.
Furthermore, as I will explain in the Appendix, the notion that the inclusion of ‘theoretically relevant controls’ (such as family abuse) will automatically provide more accurate approximation of causal effects is a severe misconception.
Accusation of Exaggeration
Ferguson also twice accuses the authors of exaggeration — once at the start (‘people exaggerating weak evidence in support of a moral panic’) and later toward the end (‘An exaggeration of effects that appear to be tiny, quite possibly statistical noise’).
This accusation is without any substantiation whatsoever — Ferguson provides no example of how the authors supposedly exaggerated their results.
Accusation of Statistical Misrepresentation
Ferguson also attacks the authors for failing to dismiss the elevated risks as ‘statistical noise’ and deem the risks to be ‘below clinical significance’ (as set by Ferguson):
The correlations they found were very tiny, mostly below the level that has a high potential to be statistical noise, and well below what I’ve recommended as a level that reaches clinical significance. At best, the results indicate tiny correlations between social media use and mental health, far smaller than would fit the kind of public apocalyptic narrative about the supposed dooms social media brings to kids.
The reference for the statistical noise assertion is a paper by Ferguson within which I found nothing that appears relevant to proving that the elevated risks (not correlations) such as the 54% cyber-bullying increase reported by CDC are likely mere statistical noise.
As to clinical significance, it’s unclear how Ferguson’s opinion about some universal cut-off level — a highly dubious notion to start with (as it presumes one can ignore what and how is actually being measured) — is of any relevance here.
Clinical significance concerns individual impacts — and these are not provided by the CDC report. What is clinical significance even supposed to mean in relation to dichotomous results such as, say, a 59% risk elevation of being bullied in school for frequent SM users among girls?
Accusation of Citation Bias
Ferguson alleges citation bias as follows:
[...] the authors claim early on that “Associations between frequent social media use and poor mental health outcomes among adolescents, including depression and suicide risk are being increasingly documented” and later claim “In alignment with existing research, findings in this report support associations between adolescent social media use and mental health…” But both these statements misrepresent the actual research literature, which has been inconsistent and, by and large, found only null to weak effects. No less a journal than The Lancet concluded this week that “However, attempts to conclusively link rising rates of mental illness or find any clear brain changes with the growing use of social and digital media during adolescence have proved difficult” and “…research on the effects of social media has so far produced mixed results.”
In reality, Ferguson provides zero evidence of any citation bias.
First, Ferguson leaves out and ignores the citations provided by the CDC authors.3
Failing to challenge these citations in any way, Ferguson instead provides two citations of his own that turn out to be entirely irrelevant.
The irrelevance of the first citation is clear already from the quotations: “However, attempts to conclusively link rising rates of mental illness or find any clear brain changes with the growing use of social and digital media during adolescence have proved difficult” and “…research on the effects of social media has so far produced mixed results.”
These excerpts from the editorial in The Lancet concern causation — not mere association!
The CDC authors, on the other hand, clearly refer to association — not causation.
Note that The Lancet editorial starts with the following admission about adolescent use of social media:
11% of adolescents report pathological use and addiction-like symptoms: they are unable to control their use, have withdrawal symptoms of anxiety and low mood when not able to use social media, neglect other activities, and report negative consequences on their usual daily life.
In context it is crystal clear that the editors are later concerned with the existence of a conclusive proof of causation, asserting it has not been found (despite the presence of associations between SM use and MH problems).
The second citation by Ferguson, a meta review of SM associations with aspects of well-being, is just as irrelevant as Ferguson’s first citation, since its authors explicitly exclude mental health outcomes such as symptoms of depression and suicidal conduct from their analysis (they instead focus on outcomes such as life satisfaction). In other words, Ferguson is conflating apples and oranges.
Accusation of Unethical Conduct
Ferguson does not stop at ridiculing the authors as incompetent and biased — he also accuses them of outright unethical conduct:
This behavior…misrepresenting prior research as more conclusive than it actually is…is called citation bias and often serves as a risk marker of researcher expectancy effects and false-positive results. I’d argue such behavior borders on the (minor league to be sure) unethical and certainly is irresponsible for an organization such as the CDC.
Accusations of citation bias tend to be subjective and controversial, at times arguably revealing more about the biases of the accusers rather than the accused. For these reasons it is inadvisable — and rare — for the accusers to equate supposed citation bias with unethical conduct, which is a very grave accusation.
Indeed any accusations of unethical conduct are highly extraordinary within academic and scientific communities, especially when directed against staff members of CDC for writing a routine CDC report.4
The fact that Ferguson fails to substantiate any of his criticisms makes this accusation all the more remarkable.
Accusation of Biased Results
Ferguson seems to imply that supposed research bias somehow affected the very results when he condemns the authors as guilty of “researcher expectancy effects”5 — an accusation that implies not only mere bias, but also biased results. Such an insinuation might make some sense with respect to, say, experimental studies, but it is unclear how to make any sense of it in respect to a routine report of risk associations.
Indeed this is an accusation without any substantiation whatsoever — Ferguson provides no example of any ‘researcher expectancy effects’ nor does he explain what this is supposed to mean in this particular context.
Attack on the Integrity of CDC
Ferguson concludes as follows:
[...] Ultimately, my confidence in the CDC as a reliable reporter of information has dropped after seeing this report. Perhaps, as a government agency, they must sing to a particular tune that has become politically convenient. Unfortunately, this kind of weak effort can only reduce public trust in an organization like the CDC on issues that really matter.
In essence, Ferguson is damning CDC simply because it informed the public about some risk elevations associated with social media use, and in response he is willing to help undermine the reputation of CDC not only on the topic of social media, but in all areas of its endeavor.
Discussion
A close reading indicates that Ferguson is outright demanding that researchers must not report social media associations with harm adjusted for or stratified by demographics — a demand that seems a step toward scientific censorship.6
Note also that Ferguson is essentially condemning the authors for failing to propagate Ferguson’s own views rather than criticizing their own interpretations.
Ferguson’s ridicule of the authors and his attack on their integrity could lead to self-censorship by researchers if Ferguson’s example is followed by other opponents of concerns over SM harms and becomes a common tactic.
Finally, note that the time and effort necessary to respond to Ferguson’s attack on the CDC report has been no doubt far greater that the time and effort Ferguson had to expend. This illustrates an unfortunate asymmetry principle: spurious accusations buttressed by defective arguments often take fraction of the time and effort necessary to counter them.
Conclusion
Ferguson’s criticism of the CDC report on social media risks is without merit. The accusations of bias and unethical conduct against the CDC authors are in particular highly spurious and unfair.
Appendix
CDC Report Limitations
Given the brevity of the Morbidity and Mortality Weekly Report series, the CDC report on SM risks is unsurprisingly short but that is not the same as simplistic, which implies inappropriate simplification.
Indeed Ferguson is implying that reporting risks adjusted only for demographics is inappropriate: the authors should have included all ‘potential theoretically relevant controls’ (or at least those favored by Ferguson).
Note that the CDC report on SM risks is limited to associations — it does not address causation whatsoever. Indeed, the report states clearly: “causality and directionality of associations between frequent social media use and health behaviors and experiences cannot be established [based only on the 2023 YRBS data set].”
Ferguson seems to be of the opinion that elevated MH risks associated with SM use must not be reported to the public unless the report also includes regressions typically used to investigate potential causal pathways — a complex matter far beyond the intended scope of the brief CDC report.
Kitchen Sink Regression
Presuming that the inclusion of ‘potential theoretically relevant controls’ will automatically provide a better estimate of causal effects — as Ferguson seems to assume — is a severe misconception.
This leads to so-called Kitchen Sink Regression that immediately exposes any analysis to the dangers of inappropriate controls such as endogenous selection bias.
For example, sleep could no doubt be a confounder: sleeping problems could lead to both higher SM use and poorer MH. And yet sleeping problems could also be the result of SM addiction as well as poor MH.
Family abuse, the factor mentioned by Ferguson, could itself be influenced by excessive SM use — in either direction, be it due to increased family conflicts over time spent on SM or be it due to lesser contact with parents due to time spent on SM.
Family abuse could also be an inappropriate reaction to MH problems of a student — or its prevalence could be exaggerated in reports from students with MH problems.
It is impossible to tell how the various causal influences combine without much deeper analysis and data.
In general, ‘kitchen sink’ regressions (adding many potentially relevant controls) can severely attenuate associations with risks regardless of the underlying causation mechanism. That may please Ferguson, but it is inappropriate in reports concerned with risk associations within populations rather than with explorations of potential causative pathways.
See, for example:
The new moral panic: Social media
Is Social Media Destroying the World?!!! | Chris Ferguson | TEDxStetsonU
Dr Chris Ferguson: Demented Politicians, Social Media & The Rise of Critical Theory
Screens aren't causing a mental health crisis
Hold on. Does social media use really affect kids?
No, smartphones alone aren't making us unhappy
Note that Ferguson’s dismissals of SM concerns extend to those of the Surgeon General, as seen in this excerpt:
In the view of his critics, Surgeon General Vivek Murthy is feeding into anti-social media hysteria. “There's really no good evidence to support the claims that the surgeon general is making,” says Chris Ferguson, a psychology professor at Florida’s Stetson University who studies the effects of technology on children. Social media, he says, is being used as a scapegoat for the real issues affecting children—like absent fathers and domestic violence. Instead, he says the surgeon general is inciting “moral panic.”
See Some child psychologists say the U.S. surgeon general’s call for social media warning labels is misguided ‘moral panic’ for details.
For some examples of "moral panic" or "tech panic" accusations, see:
The Sisyphean cycle of technology panics
The Role of Moral Panics in Media Transformation
Too much, too young? Social media, moral panics and young people’s mental health
Don’t fall for the moral panic over children’s screen time
Enough with the moral panic over smartphones. The kids are all right.
Three problems with the debate around screen time. The cycle of moral panic around screen time and technology use feels endless.
A Moral Panic Is Brewing About Instagram and Video Games. Don't Fall for It.
The citations provided by the CDC authors are A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents) and Does social media use confer suicide risk? A systematic review of the evidence.
The institutional associations of the CDC report authors include the Oak Ridge Institute for Science and Education:
1Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia; 2 Division of Violence Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia; 3 Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia; 4 Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
This is first mention by Ferguson in this assertion:
This behavior…misrepresenting prior research as more conclusive than it actually is…is called citation bias and often serves as a risk marker of researcher expectancy effects and false-positive results.
It is again mentioned later:
So we have:
[…]
3) Researcher expectancy effects as indicated by failure to accurately portray prior research on social media and mental health.
There is a difference between demanding that authors add another level of risk adjustment analysis and demanding that any risk adjustment must include certain controls decreed by Ferguson. It is the latter that seems to be the intent of the critique by Ferguson.
Maybe because it actually IS (at least largely) a moral panic, even if there MAY be a KERNEL of truth in there somewhere. And that moral panic, along with pendulum theory, will inevitably and predictably go too far if allowed to fester and proceed unfettered and unchecked, just like every other moral panic in history.
Just look at Australia, for example. And that's NOT the end of it, as they will NOT stop there, nor will it be confined to Australia either. This is merely one of the first of many, many dominoes to fall.
Why is this man so hell bent on denying an association between social media and mental health? Does he have a conflict of interest somewhere in his funding that you’ve found? I find these academic debates really interesting and informative but also very distracting. Anyone who works directly with youth sees the change, sees the correlation and in some cases the causation.