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Cited by 54Impact of Technology on AdolescentsEating Disorders and BehaviorsDigital Media and Philosophy

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ALGORITHMS, ADDICTION, AND ADOLESCENT MENTAL HEALTH: An Interdisciplinary Study to Inform State-level Policy Action to Protect Youth from the Dangers of Social Media

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Costello, Nancy, Sutton, Rebecca, Jones, Madeline, Almassian, Mackenzie, Raffoul, Amanda, Ojumu, Oluwadunni, Salvia, Meg, Santoso, Monique, Kavanaugh, Jill R., Austin, S. Bryn·2023·American Journal of Law & Medicine
DOI 10.1017/amj.2023.25
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Abstract

A recent Wall Street Journal investigation revealed that TikTok floods child and adolescent users with videos of rapid weight loss methods, including tips on how to consume less than 300 calories a day and promoting a "corpse bride diet," showing emaciated girls with protruding bones. The investigation involved the creation of a dozen automated accounts registered as 13-year-olds and revealed that TikTok algorithms fed adolescents tens of thousands of weight-loss videos within just a few weeks of joining the platform. Emerging research indicates that these practices extend well beyond TikTok to other social media platforms that engage millions of U.S. youth on a daily basis.Social media algorithms that push extreme content to vulnerable youth are linked to an increase in mental health problems for adolescents, including poor body image, eating disorders, and suicidality. Policy measures must be taken to curb this harmful practice. The Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), a research program based at the Harvard T.H. Chan School of Public Health and Boston Children's Hospital, has assembled a diverse team of scholars, including experts in public health, neuroscience, health economics, and law with specialization in First Amendment law, to study the harmful effects of social media algorithms, identify the economic incentives that drive social media companies to use them, and develop strategies that can be pursued to regulate social media platforms' use of algorithms. For our study, we have examined a critical mass of public health and neuroscience research demonstrating mental health harms to youth. We have conducted a groundbreaking economic study showing nearly $11 billion in advertising revenue is generated annually by social media platforms through advertisements targeted at users 0 to 17 years old, thus incentivizing platforms to continue their harmful practices. We have also examined legal strategies to address the regulation of social media platforms by conducting reviews of federal and state legal precedent and consulting with stakeholders in business regulation, technology, and federal and state government.While nationally the issue is being scrutinized by Congress and the Federal Trade Commission, quicker and more effective legal strategies that would survive constitutional scrutiny may be implemented by states, such as the Age Appropriate Design Code Act recently adopted in California, which sets standards that online services likely to be accessed by children must follow. Another avenue for regulation may be through states mandating that social media platforms submit to algorithm risk audits conducted by independent third parties and publicly disclose the results. Furthermore, Section 230 of the federal Communications Decency Act, which has long shielded social media platforms from liability for wrongful acts, may be circumvented if it is proven that social media companies share advertising revenues with content providers posting illegal or harmful content.Our research team's public health and economic findings combined with our legal analysis and resulting recommendations, provide innovative and viable policy actions that state lawmakers and attorneys general can take to protect youth from the harms of dangerous social media algorithms.

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  • AI-driven social media algorithms are designed solely to capture attention for profit without prioritizing ethical concerns, personalizing content, and enhancing user engagement by continuously tailoring feeds to individual preferences.

    “AI-driven social media algorithms are designed solely to capture our attention for profit without prioritizing ethical concerns, personalizing content, and enhancing user engagement by continuously tailoring feeds to individual preferences.”

    From Social Media Algorithms and Teen Addiction: Neurophysiological Impact and Ethical Considerations (2025) · cites this paper as [18]

    The section on social media effects says algorithms populate individualized feeds with content that keeps users engaged, and that platforms monetize users’ time and attention. The Introduction says advertising profits give platforms little incentive to moderate harmful practices. These passages support the engagement-and-profit point, but not the absolute claim that algorithms are designed solely for that purpose or that ethical concerns are never prioritized; page numbers were not available in our copy. (LLM, conf=0.84)

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  6. Isabel Lochman, Dexter schools sue social media giants, citing child mental health crisis, B M (Apr. 14, 2023), https://www.bridgemi.com/talent-education/dexter-schools-sue-social-media-giants-citing-child-mental-health-crisis [https://p erma.cc/Q7E4-TZWF]. 184 Id. 185 Complaint at 85, Seattle School District No. 1 v. META (Case 2:23-cv-00032). 186 RCW 7.48.120. 187 RCW 7.48.130. 188 Public nuisance, B, https://www.britannica.com/topic/nuisance [https://perma.cc/6Y8X-5XXV] (last accessed Apr. 19, 2023). 189 Gene Johnson, Schools sue social media companies for targeting children, K (Jan. 11, 2023, 4:46 AM), https://www.kare11. com/article/news/nation-world/schools-sue-social-media-companies/507-3fcdc58b-deaa-4f84-8594-57d1cda667b0 [https:// perma.cc/VM8E-WV4S]. 190 Tort Law: The Rules of Public Nuisance, L S, https://lawshelf.com/shortvideoscontentview/tort-law-the-rules-of- public-nuisance [https://perma.cc/EVD3-NJD9] (last accessed Mar. 1, 2023). 191 Nuisance, C L S, https://www.law.cornell.edu/wex/nuisance#:~:text=A%20public%20nuisance%20is% 20when,through%20a%20thing%20or%20activity https://perma.cc/XP73-38PB (last accessed Feb. 27, 2023). 192 Id. 193 Nuisance, JR R, https://law.jrank.org/pages/8871/Nuisance-Remedies.html [https://perma.cc/4LXR-C6P3] (last accessed Apr. 19, 2023). 194 Id. 195 Joe Toppe, Juul Labs will pay $1.2B for role in youth-vaping epidemic, F B. (Dec. 9, 2022, 1:39 PM), https:// www.foxbusiness.com/markets/juul-labs-pay-one-point-two-billion-role-youth-vaping-epidemic; https://www.kare11.com/ article/news/nation-world/schools-sue-social-media-companies/507-3fcdc58b-deaa-4f84-8594-57d1cda667b0 [https://perma.cc /B35S-TL92]. 196 Ty Roush, Juul To Pay $1.2 Billion To Settle Youth-Vaping Lawsuits, F (Dec. 9, 2022, 1:28 PM) https://www.forbes. com/sites/tylerroush/2022/12/09/juul-to-pay-12-billion-to-settle-youth-vaping-lawsuits/?sh=6d8cad09345c [https://perma. cc/W529-JUYR]. 197 Angelica LaVito, Lawmaker accuses Juul of illegally advertising vaping as a way to quit smoking, CNBC (Sept. 5, 2019, 3:23 PM), https://www.cnbc.com/2019/09/05/juul-accused-of-illegally-advertising-vaping-as-a-way-to-quit-smoking.html [https:// perma.cc/8ZGH-57PM]. 198 Roush, supra note 196. 199 Reuters, Juul agrees to pay $1.2bln in youth-vaping settlement-Bloomberg News, R (Dec. 9, 2022, 11:47 AM), https:// www.reuters.com/legal/juul-agrees-pay-12-bln-youth-vaping-settlement-bloomberg-news-2022-12-09/ [https://perma.cc/ WCQ2-Q9NM]. 200 Reuters, Juul to pay $462 million to California, New York, and other states over claims it marketed vapes to minors, NBC N (Apr. 12, 2023, 1:09 PM), https://www.nbcnews.com/health/health-news/juul-to-pay-462-million-claims-marketed- vapes-minors-rcna79375 [https://perma.cc/FY9Y-XK4X]. 201 See Ananya Bhattacharya, Minnesota is trying to prove Juul got teens addicted on vaping in a first-of-its-kind trial, Q (Mar. 24, 2023), https://qz.com/minnesota-jull-altria-trial-public-nuisance-vaping-1850260880; Juul's Trial in Minnesota End With a Settlement, CS N (Apr. 18, 2023), https://www.csnews.com/juuls-trial-minnesota-ends-settlement [https://perma. cc/8847-EKZQ]. 202
  7. Julian Shen-Berro, As Seattle schools sue social media companies, legal experts split on potential impact, C B (Jan. 17, 2023, 6:00 AM), https://www.chalkbeat.org/2023/1/17/23554378/seattle-schools-lawsuit-social-media-meta-instagram- tiktok-youtube-google-mental-health [https://perma.cc/3NUE-JTNG]. 203
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  9. Natasha Lomas, UK now expects compliance with children's privacy design code, T C (Sept. 1, 2021, 7:01 PM), https://techcrunch.com/2021/09/01/uk-now-expects-compliance-with-its-child-privacy-design-code/ [https://perma.cc/8R5 N-UKLV]. 217 Id.; Alex Hern, Social media giants increase global child safety after UK regulations induced, T G (Sept. 5, 2021, 10:14 AM), https://www.theguardian.com/media/2021/sep/05/social-media-giants-increase-global-child-safety-after-uk- regulations-introduced [https://perma.cc/7KVJ-FC84]; Google Announcement Shows Impact of Children's Code, 5R F. (Aug. 10, 2021), https://5rightsfoundation.com/in-action/google-announcement-shows-impact-of-childrens-code. html [https://perma.cc/XX28-UZPD]. 218 The California Age Appropriate Design Code Act §1798.99.30(a)(1)(A) (2022), https://leginfo.legislature.ca.gov/faces/ billTextClient.xhtml?bill_id=202120220AB2273 [https://perma.cc/2U4Y-W472]. 219 Id. at §1798.99.30(b)(2). 220 Id. at §1798.99.30(b)(4). 221 Id. at §1798.99.31(c). The Design Code appoints the California Attorney General's Office as the main enforcer of the state law. Similarly, the Attorney General may bring actions against businesses for unfair or deceptive practices, mirroring the claims the FTC can bring under Section 5 of the FTC Act. See Strasser et al., supra note 141. 222 Ca. AB 2273 §1798.99.30(b)(2). 223 Balbuzanova, supra note 110; Johnson, supra note 119. 224 What is the Age-Appropriate Design Code -and How is it Changing the Internet?, P Z (July 27, 2022), https:// parentzone.org.uk/article/what-is-the-age-appropriate-design-code [https://perma.cc/7W82-3U5U]. 225 Paul Harper & Catherine Micallef, How Old Do You Have to be to Have Facebook and Instagram Account? Social Media Age Restrictions Explained, T U.S. S (June 8, 2022, 12:33 PM), https://www.the-sun.com/tech/289567/age-restrictions- facebook-snapchat-twitter-instagram/ [perma.cc/PY3Z-LE4M]. 226 Id. 227 Ariel Fox Johnson, 13 Going on 30: An Exploration of Expanding COPPA's Privacy Protections to Everyone, 44 S H L. J. 419, 448-49 (2020). Congress is currently considering legislation that would amend COPPA to strengthen protections related to the online collection, use, and disclosure of personal information of minors under age 17. Co-authored by U.S. Senators Edward Markey (D-MA) and Cassidy (D-LA), COPPA 2.0 would: (1) expand protections to teens age 13-16 by requiring their opt-in consent before data collection; (2) ban targeted advertising to all covered minors; (3) close a loophole in COPPA that allows sites and apps to turn a blind eye to young people using their services and evade compliance; (4) create an "eraser button" for parents and kids requiring companies to delete personal information of minors;
  10. Lauren Feiner, Kids Online Safety Act may harm minors, civil society groups warn lawmakers, CNBC N (Nov. 28, 2022, 12:01 AM), https://www.cnbc.com/2023/05/02/updated-kids-online-safety-act-aims-to-fix-unintended-consequences.html [https:// perma.cc/AZP4-XQJF]. 238 The earlier version of the bill did not include these safeguards. 239 The ACLU, which was opposed to the earlier version of the bill, expressed its continued opposition to KOSA 2.0, stating that "[KOSA] would ironically expose the very children it seeks to protect to increased harm and increased surveillance." Lauren Feiner, Lawmakers update Kids Online Safety Act to address potential harms, but fail to appease some activists, industry groups, CNBC N (May 2, 2023, 1:12 PM), https://www.cnbc.com/2023/05/02/updated-kids-online-safety-act-aims-to-fix- unintended-consequences.html [https://perma.cc/LDY7-MSPV]. (quoting ACLU Senior Policy Counsel Cody Venzke)). Additionally, NetChoice, a lobbying group for multinational technology companies including Google, Meta, TikTok and 259
  11. Edward O. Wilson, Debate at the Harvard Museum of Natural History, Cambridge, Mass., (Sept. 9, 2009) https:// www.oxfordreference.com/display/10.1093/acref/9780191826719.001.0001/q-oro-ed4-00016553;jsessionid=0CDC082C53C0 19ACD4F203281506A378 [https://perma.cc/55PX-LCAV]. 260 O   S G (OSG). P Y M H: T U.S. S G' A 9 (2021). 261 · DOI
  12. actually receive a housing ad."# In total, the complaint alleged that Meta "used these three aspects of its advertising system to target and deliver housing-related ads to some Facebook users while excluding other users based on FHA-protected characteristics." Id. 273 Id. 274 Id. 275 Id. 276 Id. at 7. 277 Id. 278 Interview with Jacob Appel, Chief Strategist, Oneill Risk Consulting & Algorithm Auditing (June 1, 2022) (on file with Strategic Training Initiative for the Prevention of Eating Disorders legal team) [hereinafter Interview with Jacob Appel]. 279 Id. 280 Id. 281 Id. 282 Id. 283 Id. 284 Id. 285 Id. 286 Emma Roth, Meta's new ad system addresses allegations that it enabled housing discrimination, Tʜᴇ Vᴇʀɢᴇ (Jan. 9, 2023, 6:03PM), https://www.theverge.com/2023/1/9/23547191/meta-equitable-ads-system-settlement [https://perma.cc/Z4G7- JP89]. 287 The United States Attorney's Office for the Southern District of New York, United States Attorney Implements Groundbreaking Settlement With Meta Platforms, Inc., Formerly Known As Facebook, To Address Discrimination In The Delivery Of Housing Ads, Dᴇᴘ'ᴛ ᴏғ Jᴜsᴛ. (Jan. 9, 2023), https://www.justice.gov/usao-sdny/pr/united-states-attorney- implements-groundbreaking-settlement-meta-platforms-inc-formerly [https://perma.cc/LJR8-UGZE] [hereinafter Jan. US Attorney's Office]. 288 Settlement Agreement at 6, United States v. Meta Platforms, Inc., No. 1:22-cv-05187 (S.D.N.Y. June 21, 2022). 289 Interview with Jacob Appel, supra note 247. 290 Id. 291 Settlement Agreement at 9, United States v. Meta Platforms, Inc., No. 1:22-cv-05187 (S.D.N.Y. June 21, 2022). 292 Jan. US Attorney's Office, supra note 255. 293 Id. 295 See Suku Sukunesan, Examining the Pro-Eating Disorders Community on Twitter Via the Hashtag #proana: Statistical Modeling Approach, 8 JMIR Mᴇɴᴛᴀʟ Hᴇᴀʟᴛʜ 1, 2 (2021). 296
  13. See, e.g., Jennifer A. Harriger, The dangers of the rabbit hole: Reflections on social media as a portal into a distorted world of edited bodies and eating disorder risk and the role of algorithms, 41 Bᴏᴅʏ Iᴍᴀɢᴇ 292 (2022). 297 There are sources that raise this specific concern. E.g., Sapna Maheshwari, Young TikTok Users Quickly Encounter Problematic Posts, Researchers Say, N.Y. Tɪᴍᴇs (Dec. 14, 2022), https://www.nytimes.com/2022/12/14/business/tiktok-safety- teens-eating-disorders-self-harm.html [https://perma.cc/FU7G-HD4G] ("[TikTok] starts recommending content tied to eating disorders and self-harm to 13-year-olds within 30 minutes of their joining the platform, and sometimes in as little as three minutes … ."). 298 WSJ Staff, Inside TikTok's Algorithm: A WSJ Video Investigation, Wᴀʟʟ Sᴛ. J. (July 21, 2021, 10:26 AM), https:// www.wsj.com/articles/tiktok-algorithm-video-investigation-11626877477 [https://perma.cc/4CFJ-UK2S]. 299 See Auditing Algorithms: The Existing Landscape, Role of Regulators and Future Outlook, Dɪɢɪᴛ. Cᴏᴏᴘ. F. (Sept. 23, 2022), https://www.gov.uk/government/publications/findings-from-the-drcf-algorithmic-processing-workstream-spring-2022/audi

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Metadata

Authors
Costello, N., Sutton, R., Jones, M., Almassian, M., Raffoul, A., Ojumu, O., Salvia, M., Santoso, M., Kavanaugh, J. R., & Austin, S. B.
Affiliations
  • Michigan State University (US)
  • Harvard University (US)
  • Stanford University (US)
Corresponding author
Costello, Nancy
ORCID
Venue
American Journal of Law & Medicine
Publisher
Cambridge University Press (CUP)
Published
2023-07
Volume
49
Issue
2-3
Pages
135-172
ISSN
  • 0098-8588 (ISSN-L)
  • 2375-835X
DOI
10.1017/amj.2023.25
OpenAlex
W4391762088
Cited by
54
References
13
Citations by year
2026: 31 · 2025: 20 · 2024: 3
FWCI
23.16
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Law & Medicine (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • Knowledge Commons (Lakehead University)
Funders
  • Canadian Institutes of Health Research (MFE- 171217)
  • Maternal and Child Health Bureau (T76‐MC‐00001, MC00001)
  • Institute of Population and Public Health (MFE‐171217)
Topics
  • Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Communication › Digital Media and Philosophy
Keywords
social media algorithms, adolescent mental health, TikTok, eating disorders, body image, suicidality, platform regulation, state policy, Section 230, First Amendment, platform liability, child online safety
MeSH terms
Adolescent, Advertising, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Mental Health, Policy, Interdisciplinary Studies, Social Media

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