- Email: [email protected]
Perspectives on Smartphone Ownership and Use by Early Adolescents
ARTICLE IN PRESS Journal of Adolescent Health 000 (2018) 1−6
www.jahonline.org Original article
Perspectives on Smartphone Ownership and Use by Early Adolescents D1X XMegan A. Moreno, D2X XM.D., M.S.Ed., M.P.H.a,*, D3X XBradley R. Kerr, D4X XM.S.a, D5X XMarina JenkinsDa6X X , D7X XEsther LamD8XbX , and D9X XFaisal S. Malik, D10X XM.D, M.S.P.H.b,c a
Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin Department of Pediatrics, University of Washington, Seattle, Washington c Seattle Children’s Research Institute, Seattle, Washington b
Article History: Received June 10, 2018; Accepted August 7, 2018 Keywords: Adolescent; Tween; Technology; Parent; Media; Rules; Qualitative; Focus group
A B S T R A C T
Purpose: Increasing numbers of youth are becoming smartphone owners as early adolescents (EAs). Understanding how EAs receive and use their initial smartphones is important towards informing provider counseling and parental guidance. The purpose of this qualitative study was to understand EA perspectives and experiences with smartphone ownership. Methods: Focus groups were conducted with EAs ages 10-14 years in Washington State. We utilized purposeful sampling to represent different communities and health status. During focus groups, trained facilitators used a semi-structured facilitator guide to prompt discussion about EAs’ smartphone ownership and use. Results: A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white and 20% rural, participated in 12 focus groups. Of 3 major themes, the first was Maturity, which included EAs’ views that they should achieve milestones rather than an age for smartphone ownership. The second theme was Deference to Parents, which included EAs’ interest in engaging with parents to establish rules for smartphone use. The final theme was Accountability, as EAs described the importance of responsibility and cost-sharing. Two minor themes arose which included the role of EAs asking for phones and the individuality of phone use. Conclusions: Early adolescents supported timing of a first smartphone tied to meaningful milestones, and wanted parent engagement in developing rules to support them in initial smartphone ownership. Findings can be used to empower parent involvement in EA smartphone use to promote safe and productive behavior. © 2018 Society for Adolescent Health and Medicine. All rights reserved.
The early adolescent (EA), or “tween,” age group represents the critical transition between being a child and being an adolescent. This developmental stage usually encompasses ages 10−14 and is characterized by many ambiguities; the individual is recognized as Abbreviations: EA, Early adolescent Conflict of Interest: No authors have conflicts of interest to report. The study sponsor had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the manuscript for publication. * Address Correspondence to: Megan A. Moreno, M.D., M.S.Ed., M.P.H., Department of Pediatrics, University of Wisconsin-Madison. E-mail address: [email protected] (M.A. Moreno). 1054-139X/© 2018 Society for Adolescent Health and Medicine. All rights reserved. https://doi.org/10.1016/j.jadohealth.2018.08.017
IMPLICATIONS AND CONTRIBUTION
Debates around appropriate age for a first smartphone continue to garner attention. This qualitative study assessed early adolescents’ views and experiences with smartphone ownership and use. Findings highlight the importance of parents in partnering on decisions about smartphone acquisition and promoting rules for safe use.
beyond a child and not yet an adolescent. EAs’ cognitive development includes the shift from concrete to abstract thinking, though EAs typically lack higher executive skills [1]. EAs typically feel engaged and connected to their parents, though in this stage they begin to desire increased independence and engagement in peer groups [2]. Increasingly, debate has emerged about EAs’ engagement with digital technologies such as smartphones [3]. Previous large-scale surveys have found that early adolescence is a typical time in which engagement with digital technologies is heightened [4]. The average age at which youth obtain a first cell phone is 10 [5], and one past study showed social media use was common among 8−12 year olds [6]. The earlier introduction of digital
ARTICLE IN PRESS 2
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
technologies for tweens has raised concerns about academic, societal and critical health consequences such as decreases in sleep and physical activity [7−9]. The debate on EAs’ technology use has been heightened recently with the “Wait until 8th” campaign. This campaign was started by a parent and has received media attention, as well as over 2000 pledges from parents across the country [10]. The campaign argues that tweens should not have personal smartphones until reaching 8th grade. As smartphones often provide the gateway to independent use of digital media, the age at which EAs receive a first smartphone is an important milestone. Advice columns for parents have suggested approaches when buying a first smartphone for an adolescent [11,12]. However, little is known about tweens’ experiences with initial smartphone ownership. Thus, the current debates around establishing a minimum age for EAs’ smartphone ownership or developing best practices are hindered by a lack of evidence. Perspectives on how tweens use smartphones and ways that parents can promote safe use among this age group would contribute valuable information. In particular, this understanding could inform communication strategies between EAs and their parents in developing expectations and guidance around a first smartphone. Early experiences likely shape later ones, so understanding perspectives at the age at which youth are getting their first smartphone is an important focal point. The purpose of this study was to engage EAs to discuss smartphone ownership and use, towards the goal of bringing their perspectives to inform best practices for provider counseling and parental guidance. Methods This study used a qualitative research design to explore EA experiences and perspectives [13]. We sought to understand individual experiences, as well as new perspectives that arose through interaction between tweens. Focus group is a study design in which a group of participants are asked open-ended questions, and communication between research participants is used to generate and process ideas [14]. The end products of focus groups are themes, which illuminate critical areas of importance to participants that are present across topics and groups. The Western Institutional Review Board approved this study. Setting and participants Focus groups were held between January and June 2017 in various settings in Washington State, including private meeting rooms at the Seattle Children’s Hospital and Research Institute, community rooms in public settings such as libraries, and school classrooms. We sought to include EAs growing up in varied settings, with and without personal smartphones, and who may be using smartphones for different purposes. Thus, our recruitment strategy was purposeful. Inclusion criteria were ages 10−14 years and English speaking. Because we suspected experiences with smartphones may differ across settings, we recruited EAs from urban, suburban and rural communities. Towards our goal of diverse representation, we engaged schools in ethnically diverse neighborhoods. Additionally, we considered that EAs who are in a family in which chronic medical conditions were present may have different smartphone experiences. A growing body of literature supports phone-based evaluations and programs for patients with chronic illness [15,16]. Thus, we recruited participants from a pediatric specialty clinic as well as their siblings.
In each of these recruitment settings, we identified a trusted adult who was willing to engage in recruitment, and established that adult as a key contact to assist our research team with identifying recruitment opportunities. To avoid coercion, direct service providers (physicians, educators) were not involved in recruitment. Recruitment involved phone calls, emails and presentations by the key contact to potential participants. Information sheets describing the study topic, example questions and inclusion criteria were distributed to interested participants. Facilitator guide development and training The goal of the facilitator guide was to understand EAs’ perspectives on smartphone ownership and use. Questions were designed to be open-ended and invite perspectives from smartphone owners and non-owners. Questions focused in areas such as perceived benefits and risks of smartphones. Additional questions addressed positive and negative experiences with smartphones both by tweens as well as when observing their peers. Finally, we asked participants for their views about when and how EAs obtain and maintain smartphones. Facilitator training involved reading focus group training materials, observing standardized focus groups, and conducting a minimum of one previous focus group prior to leading focus groups for this study. Focus groups Each focus group event was organized to invite between 8 and 12 tweens, such that participants could be divided into two groups for discussion while maintaining each focus group size between 3 and 8 participants. Upon arrival, EAs engaged in informed consent and assent with parents present. If parents chose to be present during the focus group, we provided them a waiting area separate from the focus group room. Participants completed a brief demographic survey and indicated if they owned their own smartphone. Participants were then invited to join either a smartphone ownership group or a non-ownership group. The lead facilitator introduced the project and explained the purpose of the focus group. For each focus group, one facilitator focused on guiding group discussion and the other focused on taking notes. The lead facilitator explained that the second facilitator would mainly take notes and observe. The focus group participants were told that all discussions would be recorded and transcribed without identifiers in order to protect their confidentiality. Focus groups lasted between 40 and 80 minutes. All focus groups were audio recorded and manually transcribed verbatim. Written notes and observations during the groups were included in study data. Participants received a $50 incentive at the end of the focus group. Analysis After completing an initial 5 focus groups, investigators reviewed data and potential themes based on transcripts and written notes. Similarities across groups and emerging themes were noted. Transcript review was again conducted after completion of 12 total groups. At that time, it was determined that based upon the similarities in response across the initial and subsequent groups that theoretical saturation had been reached. Three investigators with previous experience in qualitative analysis were involved in the analysis process. The investigators utilized a constant comparative approach. The transcripts were
ARTICLE IN PRESS M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
imported to a qualitative analysis program Dedoose (www. dedoose.com). Inductive reasoning based in grounded theory [17] guided codebook development and theme identification. Investigators first individually reviewed all transcripts and then met to begin the first cycle of data classification. The goal of the first cycle was to collaboratively develop and apply a coding schema of super-ordinate and sub-ordinate concept levels. The super-ordinate codes consisted of root codes or overarching categories, while the sub-ordinate codes included smaller specific categories within the super-ordinate codes. Once consensus was reached on the initial classification criteria, coding began. Two investigators independently coded one focus group, blinded to one another’s coding. After coding this transcript, the investigators met and the focus group transcript was reviewed with codes un-blinded. The investigators discussed and reached consensus on super-ordinate and sub-ordinate code nomenclature, as well as any additions or revisions to coding categories. The coding process was then applied to a second focus group. The purpose of this second review was to evaluate reliability and validity of the initial classification criteria. After coding review, discussion and achieving consensus on the coding categories, the coding approach was applied to each subsequent focus group using this constant comparative approach. Throughout this process, the third investigator was available to help reach consensus if the two primary coders were not in agreement. After all focus groups had been coded, the second cycle of data classification was intended to synthesize and integrate codes towards development of themes. After reviewing all super-ordinate and sub-ordinate coding categories, an initial list of major topics was developed based on a systematic review of coded excerpts. These major topics and representative quotes were extracted and reviewed, and through discussion an initial set of themes were developed. Themes were then aligned with representative topics and quotes, and reviewed by all investigators. After reaching consensus among all 3 investigators, the themes were finalized. Results A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white, 20% rural, 24.4% with personal or family experience with a chronic illness, participated in 12 focus groups. Table 1 describes demographics. Three major themes emerged from the focus group discussion, these included Maturity, Deference to Parents and Accountability. Each of these themes applied across three areas of focus: (1) when an adolescent was ready to have their own smartphone: qualities or milestones that youth perceived were needed prior to owning a phone (2) how a smartphone should be obtained: practical aspects of how a youth would become a phone owner, and (3) ongoing care and maintenance of the smartphone. Two minor themes were identified: Tweens should ask for a smartphone before receiving it, and Individual EAs have different needs and uses for smartphones. Major Theme 1: Maturity The theme of Maturity was highly salient in discussions of when an early adolescent was ready to have their own smartphone. When discussions about the appropriate age for a smartphone arose, many participants were quick to dismiss the idea of an ideal age to get a smartphone. “I think it is not an age. I think it is more of a maturity thing,” described one participant. Another participant
3
argued, “I think it’s more that, like you feel that you’re responsible enough to carry that burden.” Participants also emphasized that readiness for a smartphone could be linked to achieving certain milestones, often centering on increasing independence. For example, the transition to middle school was identified as a potential milestone event. One participant stated “because that’s when you start going after school for sports. You’re kind of more independent there. Like you can’t really depend on the teachers as much.” Several participants discussed that doing after school activities and coordinating one’s own transportation were markers of readiness for a smartphone. Maturity also arose in discussions of how a smartphone should be obtained. One common idea was that parents should provide EAs with their own smartphones at the point when a tween would need one rather than just wanting one. One participant explained, “when you kind of get busy and active. Then it’s kind of like, you more need it than want it when it gets to that.” In the area of ongoing care and maintenance of the smartphone, participants described that having a smartphone could lead to pride in the responsibility of having it. One tween argued, “in terms of like mental health, I think it can really like help you and make you more prideful.” Participants described that the increased responsibility from proper smartphone maintenance could then foster further maturity. One participant explained this process as follows, “it’s kind of teaching your child a lesson like, um, giving them more responsibility and. . .like a step to maturing and getting older, having your smartphone and taking care of it.”
Major Theme 2: Deference to parents Deference to parents was interwoven throughout focus group discussions. First, participants argued that parents should be the ultimate arbitrators of when an early adolescent was ready to have their own smartphone. Stated simply by one participant, a tween should get a smartphone “when your parents say it’s all right for you to have it.” Another participant agreed, “it’s not the kid’s choice, the parents are the ones.” One participant described, “If you’re like 15 years old and super mature, but your parents were like ‘no, you don’t get a phone until you’re 18’ then that doesn’t
Table 1 Demographic information for early adolescent focus group participants (n=45) Age
Mean (SD)
Gender Female Male Did not disclose Ethnicity White/Caucasian More than one Asian Latino Did not disclose Phone ownership Smartphone ownership Cell phone ownership No personal phone ownership Did not disclose Social media use Yes No
11.24(0.77) n (%) 23 (51.1) 20 (44.4) 2 (4.4) n (%) 29 (64.4) 5 (11.1) 2 (4.4) 1 (2.2) 8 (17.8) n (%) 29 (64.4) 1 (2.2) 6 (13.3) 9 (13.3) n (%) 33 (73.3) 12 (26.6)
ARTICLE IN PRESS 4
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
matter because you’re not getting a phone until you’re 18.” It was understood that even if an EA felt that they were mature and accountable, the rule of the parent took precedence. In the area of how a smartphone should be obtained, participants described personal experiences of getting their own phones. Most had received a smartphone either as a hand-me-down or as a gift. One participant explained, “I honestly think it should be a gift, cause that’s what, how I got my phone.” Another participant who had a hand-me-down explained, “I don’t think you should give them a brand new smartphone right away.” Most participants seemed to be happy with how they received their smartphone, describing that they were satisfied with whatever method their parents had chosen. In the area of ongoing care and maintenance of the smartphone, participants agreed that having parental rules was important. These rules could include parents’ right to check their child’s smartphone. One participant described, “I think your parents should be able to like, check your phone, to see what you’re posting.” Another participant agreed, “or like, let them check your texts to make sure there’s nothing inappropriate going on.” Parental rules could also include rules addressing when and for how long a smartphone could be used. One participant suggested that parents could set a timer, “you can be on your phone for an hour, or 10 minutes is kind of stupid, like, maybe 20 minutes or 30 minutes.” Participants emphasized that rules should be specific. One participant stated, “I think that some rules are a little too subtle, like they aren’t enforced as much as they should be. Or like they have a time, like ‘3 hours a day you should be on your phone’ which is, like way too much. So some rules are a little less than what they should be I think.” Another participant described the importance of parental rules in this quote, “I feel like parents should have some degree of control over, like, you check your phone in at night. Or plug it in downstairs or something. They should have, um, they should definitely have rules in place about it. It shouldn’t be something that you’re just, um, kind of directing yourself on, having it free-for-all. Not at first anyways. Or for a long time.”
medical conditions. One participant explained, “I think that if it’s for medical purposes, like watching your number, the parents should probably pay for it.” Participants emphasized that they should have accountability in the ongoing care and maintenance of the smartphone. Many participants told stories of themselves, their siblings and their friends losing or breaking their first smartphone. Participants agreed that they should be held accountable for this in some way. One participant explained, “If they lose it and have to get a replacement, then they should pay for it.” Another participant stated, “If you break it, you should probably earn the money to buy it again.” Another opinion was that tweens generally do not have jobs or the capacity to earn much money, but should have some responsibility that could grow over time. One participant explained, “I think it should be split, because you have to teach them to be responsible with their money; but it’s also like an expensive thing, and at this age it’s not like we get uh...a lot of money.” Minor theme 1: Early adolescents should ask for a smartphone before receiving it A minor theme emerged related to how adolescents should receive a smartphone. Across several focus groups, participants expressed that obtaining a smartphone should begin with the EA asking for it. Some tweens described that they had received their smartphone as a gift. Others described getting a phone as a handme-down when a parent or sibling got a new phone, without asking for it. One participant explained, “I think the parent shouldn’t just give the phone straight out like ‘here’s a birthday surprise’ or whatever. I think the kid should actually want a smartphone and before, the parents should have some discussions with the kid. Um, like, what to do and what not to do. And it has to be really clear that the kid wants it.” Another participant stated, “If you’re a parent and you’re deciding if you should get your kid a phone, you should ask them if they’re interested.” Minor theme 2: Individual EAs have different needs and uses for smartphones
Major Theme 3: Accountability Accountability was commonly noted in discussions of when an early adolescent was ready to have their own smartphone. Participants discussed that a tween needed to be accountable for their actions when using a smartphone, and know enough to “avoid pitfalls.” A common concern knew how to avoid being a perpetrator or target of cyberbullying. One participant described the right time to get a smartphone as “probably when they know right from wrong. Like they know not to cyberbully.” A second key area that many participants discussed was being able to take steps to avoid “addiction.” One tween argued, “I don’t think there’s like a specific age. But like, I think it’s when they’re responsible enough to not be addicted to it.” Table 2 describes common quotes related to concerns about the responsibility of avoiding cyberbullying and addiction. Accountability was also a key area of focus in discussions of how a smartphone should be obtained. Most participants argued that the user should have some or all responsibility for smartphone costs. One participant argued, “I think that parents should buy the actual phone and then the kids can buy like accessories or stuff they want to put on it.” Another participant stated “no matter what, you [the tween] should pay for it.” However, some participants felt that the parents should cover costs for EAs who have
While many EAs described using their smartphones for playing games and streaming video, we noted some differences across groups and individuals when describing common smartphone uses. For example, focus groups participants from a rural area described using smartphones to avoid getting lost in locations such as forests or farmlands. One participant explained, “if a kid got lost in the woods and he has his phone, like, he’d call on his phone.” In this particular group, tweens also described that their parents would call them on their smartphones to come home for dinner, as they may be out of voice range even on one’s own property. Some participants described scenarios in which they perceived that they needed a personal smartphone. For example, among participants from the focus group with a chronic illness in the family, participants mentioned smartphone use for illness monitoring. One participant described, “my brother has one that um, connects to his insulin pod, so that’s helpful.” Table 3 describes a selection of quotations illustrating different views on smartphone uses. Discussion In this study, we engaged EAs in focus group discussions about their views on smartphone ownership and use. We found major
ARTICLE IN PRESS M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
5
Table 2 Early adolescent participant focus group quotes addressing concerns related to problematic internet use and cyberbullying Participant quote Problematic internet use/addiction
Cyberbullying
And the good thing, about um, having a parent, having a parent's permission, uh to get an app or a certain game is because I see some people, like they have 2 or 3 full pages of just games. Just straight games. And they just like really can't control themselves. So they just sit down and keep going on their phone instead of being active. They could get way too attached to it, and use it all the time. They could, um, be on it way too much and just not be spending as much time on their homework, and not as much time outside, and exercising. Yeah, like, a definite downside, kind of like he said, that like, if you never- you never could get off it ... Like, I know a bunch of peo- a bunch of my friends, like they're- like they're kind of addicted to their phones ... So like, even when they're over at, like, my house, I'm over at their house, we could be, like, hanging out, they're like, always on their phone, like texting someone on social media, so that's kind of a downside to it. Um, I would say that s- like, a definite downside that a lot of people talk about is cyberbullying. Like, I don't get cyberbullied, but I know some people that, like, have gotten cyberbullied, and, like, they got, like, really insecure about it, 'cause, like they- they were worried about, like, what if everything's true that they're saying, and they, like, just kinda got too worried about it when they shouldn't have. When they kind of become a little more responsible and like realize that you can’t really, like, bully someone. When you’re younger, you don’t really think about, like, the effect of what you’re doing. In addition to what he said about cyberbullying then, it might go on forever, and the person might get depressed and do some really bad things. Or be like wanting to, um, do stuff to themself to hurt themself. For bullies and things like that because it's so easy to just, like, type in those few words, but then it can, like, ruin someone’s day or even week or something like that.
themes around the importance of Maturity, Deference to Parents and Accountability tied to acquisition of a first smartphone. We also identified minor themes that emphasized avoiding assumptions that all EAs want smartphones, or that all EAs use their smartphones the same way. Thus, our findings present novel viewpoints to inform current discussions around the appropriate timing and parental strategies for tweens’ first smartphone. A critical finding in our study is the emphasis on parent involvement in EAs’ digital lives. Our EA participants emphasized the role of parents as determining when an EA was mature enough and independent enough to be ready for a first smartphone. This is not to say that tweens did not want involvement in these decisions, as our minor theme illustrates that some EAs were provided a first smartphone without ever having been asked if they wanted one. Tweens’ responses support that they want involvement in decisions about getting their own smartphone. Further, EA participants wanted clear parental rules around use of their first smartphone. This finding introduces different perspectives compared to previous literature around parental rules and smartphones. One previous study of older adolescents found that parent-adolescent communication about smartphone rules led to conflict, and that parents and adolescents differed in their views of how a smartphone should be used [18]. Other literature describes that parents view smartphones as a tool for monitoring their child’s safety, while teens view phones as an opportunity to connect with peers [19]. These previous studies suggest conflict and disconnect between parents and teens around smartphone use. In contrast, our study found that EAs wanted parents’ involvement and guidance. We also found that EAs often share their parents’ views of the importance of the smartphone as a safety tool, to help avoid getting lost or to track medical data, as well as for social engagement with peers. It is possible that obtaining a smartphone at a younger age, during the EA developmental stage in which high levels of parental involvement are expected, contributed to our participants’ desired involvement of parents. Another area in which our study presents novel findings is in the concerns expressed by EAs about risks of smartphone use. Previous studies have described adolescents’ perceived risks of internet use, mostly focused on external risks such as online predictors or bullies [20,21]. In our study, perceived risks of smartphone use also included internal risks such as one’s own capacity to bully.
Further, EAs were concerned about and offered conceptualizations of problematic internet use (PIU) and addiction. EAs described PIU as a lack of control over activities, being “too attached to it,” and using the phone even when at a friend’s house (Table 2). These insights can inform our understanding of PIU from the
Table 3 Early adolescents’ responses indicating different ways in which tweens their age use smartphones Well um, I know uh, some use only like a couple use for entertainment, but um some uh, use for like emergencies. So like, if like, so I travel places and so my parents think that I need my phone to contact them. Like while I'm away, from them (Laughs). Uh and then so just in case of emergency, and then also I think um, because a lot of, for some people, a lot of their friends have social media stuff, so they get it so they can feel included and have something to talk, to talk about in their friend groups. Instagram ... YouTube ... The three main things that I see are entertainment, emergency, and it's also especially during, like, when you're in school. Like the period when you're in school, is uh, it's really helpful for, like, um, uh or even after school. Really helpful for finding out homework assignments, like if you're, so for educational purposes, or like googling up some, something that's not included in your history textbook or something like that. I use mine to listen to music a lot Or like if, um, you're home alone and [your parents] are shopping and like there's two choices of something they want to get you and they ask you, then once you pick it they'll know what to get you. Or like if you need, let's say for example, a new toothbrush. You can just text them and say, "Hey Mom, can you pick me this up at this store?" While they're shopping. -Playing games -Yeah, our dad said that we could just download games, play them on there Well, I've definitely noticed on the bus, I've seen kids, like, taking electronics and playing games ... a lot. Yeah, playing games is a big one. I think it can also come in handy ... if you want to call someone. Like, if you want to call your friend Yeah, and I've seen a lot of boys in our class, like I know they have social media, watching a lot, and they sort of, like, show off their phones, like, they don't say, "Oh look everybody I have my phone.” But they take it out in class, obviously everybody can see. I mostly just use mine for like diabetes stuff, like so my parents can like, monitor my blood sugar or like get in touch if my blood sugar starts to go really low Internet and Pinterest and texting Photos, I think Like if someone, like if a kid got lost in the woods and he has his phone, like, he'd call on his phone like, "I'm lost in the woods, can you help me get out?"
ARTICLE IN PRESS 6
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
perspectives of EAs themselves. Participants emphasized the importance of maturity and accountability towards prevention of these risks. The limitations to our study include our focus on EAs in Washington State; thus, findings are not generalizable to all EAs. The lack of generalizability is consistent with qualitative study design that emphasizes depth of a topic rather than representativeness of sample size. Our recruitment strategy was purposeful and we achieved EA representation from different communities, as well as EAs with exposure to or experience with medical conditions. However, we did not engage every community of EAs that exists. Rather, we focused in areas that we understood may affect smartphone ownership and use based on current knowledge. Future studies may pursue surveys to capture a larger population of EAs towards understanding this phenomenon at the population level, or comparing by groups. A further limitation is that some participants did not choose to disclose demographic variables on the short survey. Despite these limitations, our study has important implications. Obtaining a first smartphone is an important milestone in today’s digital society, and our study findings can inform these discussions. Our findings suggest that giving an unrequested hand-medown or gift for a first phone is not recommended. EAs want to be involved in decisions about when to get their phone, and value their involvement as a milestone of maturity when they are asked to participate in the decision. A key take-away from our study is EA’s emphasis on milestones indicating maturity over specific age ranges for obtaining a first smartphone. Further, parents should feel respected and empowered to play an important role in their adolescents’ first smartphone. Parents’ roles can include setting rules and expectations, as well as checking in with their EA about their experiences. Parents may consider tools that incorporate EA’s ideas and perspectives in establishing rules around phone use, such as the Family Media Use Plan [22], developed by the American Academy of Pediatrics. This online tool encourages parents and teens to communicate and use shared decision-making to develop media rules that both parents and teens are expected to follow. Our findings support that ongoing parental communication is important to understand EAs’ perspectives, wants and desired limits around this important digital tool.
Acknowledgments This study was funded by the Seattle Children’s Research Institute. We would like to acknowledge Maddie Rantala, Nikita
Midamba, Holly Gerla and Elod Boromisza for their assistance with this study. References [1] Anderson VA, et al. Development of executive functions through late childhood and adolescence in an Australian sample. Dev Neuropsychol 2001;20 (1):385–406. [2] Neinstein L, Anderson M. Adolescent development. In: Neinstein L, ed. Adolescent health care: a practical guide. Philadelphia: Lippincott Williams and Wilkins; 2002. p.767–92. [3] Brito PQ. Tweens' characterization of digital technologies. Comput Educ 2012;59:580–93. [4] EU kids online: findings, methods, recommendations , L.l. services, Editor. London, UK: EU Kids Online; 2014. [5] Influence Central. Kids & Tech: The Evolution of Today’s Digital Natives 2016. Available at http://influence-central.com/kids-tech-the-evolution-of-todaysdigital-natives/. Accessed October 9, 2018. [6] Kirkorian HL, Wartella EA, Anderson DR. Media and young children's learning. Future Child 2008;18(1):39–61. [7] Bruni O, et al. Technology Use and Sleep Quality in Preadolescence and Adolescence. J Clin Sleep Med 2015;11(12):1433–41. [8] Edwards MJ, et al. The influence of friends and siblings on the physical activity and screen viewing behaviours of children aged 5-6 years: a qualitative analysis of parent interviews. BMJ Open 2015;5(5):e006593. [9] Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics 2016;138(5):e20162592. [10] Slater Tate, A. 'Wait Until 8th' movement asks parents not to give young kids smartphones, Today.com. 2017. [11] Moreno MA. Your Child's First Cell Phone. JAMA Pediatrics 2017;171(6):608. [12] O'Keefe, G.S. Cell phones: what's the right age to start? Healthychildren.org 2011 [cited 2018 April 20]; Available from: https://www.healthychildren.org/ English/family-life/Media/Pages/Cell-Phones-Whats-the-Right-Age-to-Start. aspx. [13] Glesne C. Becoming qualitative researchers. Second ed. Reading, MA: Longman; 1999. [14] Kitzinger J. Qualitative research: introducing focus groups. BMJ 1995;311:299–300. [15] Mbuagbaw L, et al. Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer. BMC Health Serv Res 2015;15:33. [16] Badawy SM, et al. Patient-centered ehealth interventions for children, adolescents, and adults with sickle cell disease: systematic review. J Med Internet Res 2018;20(7):e10940. [17] Glaser BG, Strauss A. The discovery of grounded theory: strategies for qualitative research. Hawthorne, NY: Aldine Transaction; 1967. [18] Davis K, Kim AS. Tweens' perspectives on their parents' media-related attitudes and rules: an exploratory study in the US. J Child Med 2017;11(3). [19] Weinstein EC, Davis K. Connecting 'round the clock: mobile phones and adolescents' experiences of intimacy. In: Yan Z, ed. Encyclopedia of mobile phone behavior. IGI Global; 2015. [20] Ybarra ML, Espelage DL, Mitchell KJ. The co-occurrence of Internet harassment and unwanted sexual solicitation victimization and perpetration: associations with psychosocial indicators. J Adolesc Health 2007;41(6 Suppl 1):S31–41. [21] Ybarra ML, Espelage DL, Mitchell KJ. Differentiating youth who are bullied from other victims of peer-aggression: the importance of differential power and repetition. J Adolesc Health 2014;55(2):293–300. [22] American Academy of Pediatrics. Family media use plan. 2016 [cited 2018 July 29]; Available from: https://www.healthychildren.org/english/media/pages/ default.aspx.
www.jahonline.org Original article
Perspectives on Smartphone Ownership and Use by Early Adolescents D1X XMegan A. Moreno, D2X XM.D., M.S.Ed., M.P.H.a,*, D3X XBradley R. Kerr, D4X XM.S.a, D5X XMarina JenkinsDa6X X , D7X XEsther LamD8XbX , and D9X XFaisal S. Malik, D10X XM.D, M.S.P.H.b,c a
Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin Department of Pediatrics, University of Washington, Seattle, Washington c Seattle Children’s Research Institute, Seattle, Washington b
Article History: Received June 10, 2018; Accepted August 7, 2018 Keywords: Adolescent; Tween; Technology; Parent; Media; Rules; Qualitative; Focus group
A B S T R A C T
Purpose: Increasing numbers of youth are becoming smartphone owners as early adolescents (EAs). Understanding how EAs receive and use their initial smartphones is important towards informing provider counseling and parental guidance. The purpose of this qualitative study was to understand EA perspectives and experiences with smartphone ownership. Methods: Focus groups were conducted with EAs ages 10-14 years in Washington State. We utilized purposeful sampling to represent different communities and health status. During focus groups, trained facilitators used a semi-structured facilitator guide to prompt discussion about EAs’ smartphone ownership and use. Results: A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white and 20% rural, participated in 12 focus groups. Of 3 major themes, the first was Maturity, which included EAs’ views that they should achieve milestones rather than an age for smartphone ownership. The second theme was Deference to Parents, which included EAs’ interest in engaging with parents to establish rules for smartphone use. The final theme was Accountability, as EAs described the importance of responsibility and cost-sharing. Two minor themes arose which included the role of EAs asking for phones and the individuality of phone use. Conclusions: Early adolescents supported timing of a first smartphone tied to meaningful milestones, and wanted parent engagement in developing rules to support them in initial smartphone ownership. Findings can be used to empower parent involvement in EA smartphone use to promote safe and productive behavior. © 2018 Society for Adolescent Health and Medicine. All rights reserved.
The early adolescent (EA), or “tween,” age group represents the critical transition between being a child and being an adolescent. This developmental stage usually encompasses ages 10−14 and is characterized by many ambiguities; the individual is recognized as Abbreviations: EA, Early adolescent Conflict of Interest: No authors have conflicts of interest to report. The study sponsor had no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the manuscript for publication. * Address Correspondence to: Megan A. Moreno, M.D., M.S.Ed., M.P.H., Department of Pediatrics, University of Wisconsin-Madison. E-mail address: [email protected] (M.A. Moreno). 1054-139X/© 2018 Society for Adolescent Health and Medicine. All rights reserved. https://doi.org/10.1016/j.jadohealth.2018.08.017
IMPLICATIONS AND CONTRIBUTION
Debates around appropriate age for a first smartphone continue to garner attention. This qualitative study assessed early adolescents’ views and experiences with smartphone ownership and use. Findings highlight the importance of parents in partnering on decisions about smartphone acquisition and promoting rules for safe use.
beyond a child and not yet an adolescent. EAs’ cognitive development includes the shift from concrete to abstract thinking, though EAs typically lack higher executive skills [1]. EAs typically feel engaged and connected to their parents, though in this stage they begin to desire increased independence and engagement in peer groups [2]. Increasingly, debate has emerged about EAs’ engagement with digital technologies such as smartphones [3]. Previous large-scale surveys have found that early adolescence is a typical time in which engagement with digital technologies is heightened [4]. The average age at which youth obtain a first cell phone is 10 [5], and one past study showed social media use was common among 8−12 year olds [6]. The earlier introduction of digital
ARTICLE IN PRESS 2
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
technologies for tweens has raised concerns about academic, societal and critical health consequences such as decreases in sleep and physical activity [7−9]. The debate on EAs’ technology use has been heightened recently with the “Wait until 8th” campaign. This campaign was started by a parent and has received media attention, as well as over 2000 pledges from parents across the country [10]. The campaign argues that tweens should not have personal smartphones until reaching 8th grade. As smartphones often provide the gateway to independent use of digital media, the age at which EAs receive a first smartphone is an important milestone. Advice columns for parents have suggested approaches when buying a first smartphone for an adolescent [11,12]. However, little is known about tweens’ experiences with initial smartphone ownership. Thus, the current debates around establishing a minimum age for EAs’ smartphone ownership or developing best practices are hindered by a lack of evidence. Perspectives on how tweens use smartphones and ways that parents can promote safe use among this age group would contribute valuable information. In particular, this understanding could inform communication strategies between EAs and their parents in developing expectations and guidance around a first smartphone. Early experiences likely shape later ones, so understanding perspectives at the age at which youth are getting their first smartphone is an important focal point. The purpose of this study was to engage EAs to discuss smartphone ownership and use, towards the goal of bringing their perspectives to inform best practices for provider counseling and parental guidance. Methods This study used a qualitative research design to explore EA experiences and perspectives [13]. We sought to understand individual experiences, as well as new perspectives that arose through interaction between tweens. Focus group is a study design in which a group of participants are asked open-ended questions, and communication between research participants is used to generate and process ideas [14]. The end products of focus groups are themes, which illuminate critical areas of importance to participants that are present across topics and groups. The Western Institutional Review Board approved this study. Setting and participants Focus groups were held between January and June 2017 in various settings in Washington State, including private meeting rooms at the Seattle Children’s Hospital and Research Institute, community rooms in public settings such as libraries, and school classrooms. We sought to include EAs growing up in varied settings, with and without personal smartphones, and who may be using smartphones for different purposes. Thus, our recruitment strategy was purposeful. Inclusion criteria were ages 10−14 years and English speaking. Because we suspected experiences with smartphones may differ across settings, we recruited EAs from urban, suburban and rural communities. Towards our goal of diverse representation, we engaged schools in ethnically diverse neighborhoods. Additionally, we considered that EAs who are in a family in which chronic medical conditions were present may have different smartphone experiences. A growing body of literature supports phone-based evaluations and programs for patients with chronic illness [15,16]. Thus, we recruited participants from a pediatric specialty clinic as well as their siblings.
In each of these recruitment settings, we identified a trusted adult who was willing to engage in recruitment, and established that adult as a key contact to assist our research team with identifying recruitment opportunities. To avoid coercion, direct service providers (physicians, educators) were not involved in recruitment. Recruitment involved phone calls, emails and presentations by the key contact to potential participants. Information sheets describing the study topic, example questions and inclusion criteria were distributed to interested participants. Facilitator guide development and training The goal of the facilitator guide was to understand EAs’ perspectives on smartphone ownership and use. Questions were designed to be open-ended and invite perspectives from smartphone owners and non-owners. Questions focused in areas such as perceived benefits and risks of smartphones. Additional questions addressed positive and negative experiences with smartphones both by tweens as well as when observing their peers. Finally, we asked participants for their views about when and how EAs obtain and maintain smartphones. Facilitator training involved reading focus group training materials, observing standardized focus groups, and conducting a minimum of one previous focus group prior to leading focus groups for this study. Focus groups Each focus group event was organized to invite between 8 and 12 tweens, such that participants could be divided into two groups for discussion while maintaining each focus group size between 3 and 8 participants. Upon arrival, EAs engaged in informed consent and assent with parents present. If parents chose to be present during the focus group, we provided them a waiting area separate from the focus group room. Participants completed a brief demographic survey and indicated if they owned their own smartphone. Participants were then invited to join either a smartphone ownership group or a non-ownership group. The lead facilitator introduced the project and explained the purpose of the focus group. For each focus group, one facilitator focused on guiding group discussion and the other focused on taking notes. The lead facilitator explained that the second facilitator would mainly take notes and observe. The focus group participants were told that all discussions would be recorded and transcribed without identifiers in order to protect their confidentiality. Focus groups lasted between 40 and 80 minutes. All focus groups were audio recorded and manually transcribed verbatim. Written notes and observations during the groups were included in study data. Participants received a $50 incentive at the end of the focus group. Analysis After completing an initial 5 focus groups, investigators reviewed data and potential themes based on transcripts and written notes. Similarities across groups and emerging themes were noted. Transcript review was again conducted after completion of 12 total groups. At that time, it was determined that based upon the similarities in response across the initial and subsequent groups that theoretical saturation had been reached. Three investigators with previous experience in qualitative analysis were involved in the analysis process. The investigators utilized a constant comparative approach. The transcripts were
ARTICLE IN PRESS M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
imported to a qualitative analysis program Dedoose (www. dedoose.com). Inductive reasoning based in grounded theory [17] guided codebook development and theme identification. Investigators first individually reviewed all transcripts and then met to begin the first cycle of data classification. The goal of the first cycle was to collaboratively develop and apply a coding schema of super-ordinate and sub-ordinate concept levels. The super-ordinate codes consisted of root codes or overarching categories, while the sub-ordinate codes included smaller specific categories within the super-ordinate codes. Once consensus was reached on the initial classification criteria, coding began. Two investigators independently coded one focus group, blinded to one another’s coding. After coding this transcript, the investigators met and the focus group transcript was reviewed with codes un-blinded. The investigators discussed and reached consensus on super-ordinate and sub-ordinate code nomenclature, as well as any additions or revisions to coding categories. The coding process was then applied to a second focus group. The purpose of this second review was to evaluate reliability and validity of the initial classification criteria. After coding review, discussion and achieving consensus on the coding categories, the coding approach was applied to each subsequent focus group using this constant comparative approach. Throughout this process, the third investigator was available to help reach consensus if the two primary coders were not in agreement. After all focus groups had been coded, the second cycle of data classification was intended to synthesize and integrate codes towards development of themes. After reviewing all super-ordinate and sub-ordinate coding categories, an initial list of major topics was developed based on a systematic review of coded excerpts. These major topics and representative quotes were extracted and reviewed, and through discussion an initial set of themes were developed. Themes were then aligned with representative topics and quotes, and reviewed by all investigators. After reaching consensus among all 3 investigators, the themes were finalized. Results A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white, 20% rural, 24.4% with personal or family experience with a chronic illness, participated in 12 focus groups. Table 1 describes demographics. Three major themes emerged from the focus group discussion, these included Maturity, Deference to Parents and Accountability. Each of these themes applied across three areas of focus: (1) when an adolescent was ready to have their own smartphone: qualities or milestones that youth perceived were needed prior to owning a phone (2) how a smartphone should be obtained: practical aspects of how a youth would become a phone owner, and (3) ongoing care and maintenance of the smartphone. Two minor themes were identified: Tweens should ask for a smartphone before receiving it, and Individual EAs have different needs and uses for smartphones. Major Theme 1: Maturity The theme of Maturity was highly salient in discussions of when an early adolescent was ready to have their own smartphone. When discussions about the appropriate age for a smartphone arose, many participants were quick to dismiss the idea of an ideal age to get a smartphone. “I think it is not an age. I think it is more of a maturity thing,” described one participant. Another participant
3
argued, “I think it’s more that, like you feel that you’re responsible enough to carry that burden.” Participants also emphasized that readiness for a smartphone could be linked to achieving certain milestones, often centering on increasing independence. For example, the transition to middle school was identified as a potential milestone event. One participant stated “because that’s when you start going after school for sports. You’re kind of more independent there. Like you can’t really depend on the teachers as much.” Several participants discussed that doing after school activities and coordinating one’s own transportation were markers of readiness for a smartphone. Maturity also arose in discussions of how a smartphone should be obtained. One common idea was that parents should provide EAs with their own smartphones at the point when a tween would need one rather than just wanting one. One participant explained, “when you kind of get busy and active. Then it’s kind of like, you more need it than want it when it gets to that.” In the area of ongoing care and maintenance of the smartphone, participants described that having a smartphone could lead to pride in the responsibility of having it. One tween argued, “in terms of like mental health, I think it can really like help you and make you more prideful.” Participants described that the increased responsibility from proper smartphone maintenance could then foster further maturity. One participant explained this process as follows, “it’s kind of teaching your child a lesson like, um, giving them more responsibility and. . .like a step to maturing and getting older, having your smartphone and taking care of it.”
Major Theme 2: Deference to parents Deference to parents was interwoven throughout focus group discussions. First, participants argued that parents should be the ultimate arbitrators of when an early adolescent was ready to have their own smartphone. Stated simply by one participant, a tween should get a smartphone “when your parents say it’s all right for you to have it.” Another participant agreed, “it’s not the kid’s choice, the parents are the ones.” One participant described, “If you’re like 15 years old and super mature, but your parents were like ‘no, you don’t get a phone until you’re 18’ then that doesn’t
Table 1 Demographic information for early adolescent focus group participants (n=45) Age
Mean (SD)
Gender Female Male Did not disclose Ethnicity White/Caucasian More than one Asian Latino Did not disclose Phone ownership Smartphone ownership Cell phone ownership No personal phone ownership Did not disclose Social media use Yes No
11.24(0.77) n (%) 23 (51.1) 20 (44.4) 2 (4.4) n (%) 29 (64.4) 5 (11.1) 2 (4.4) 1 (2.2) 8 (17.8) n (%) 29 (64.4) 1 (2.2) 6 (13.3) 9 (13.3) n (%) 33 (73.3) 12 (26.6)
ARTICLE IN PRESS 4
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
matter because you’re not getting a phone until you’re 18.” It was understood that even if an EA felt that they were mature and accountable, the rule of the parent took precedence. In the area of how a smartphone should be obtained, participants described personal experiences of getting their own phones. Most had received a smartphone either as a hand-me-down or as a gift. One participant explained, “I honestly think it should be a gift, cause that’s what, how I got my phone.” Another participant who had a hand-me-down explained, “I don’t think you should give them a brand new smartphone right away.” Most participants seemed to be happy with how they received their smartphone, describing that they were satisfied with whatever method their parents had chosen. In the area of ongoing care and maintenance of the smartphone, participants agreed that having parental rules was important. These rules could include parents’ right to check their child’s smartphone. One participant described, “I think your parents should be able to like, check your phone, to see what you’re posting.” Another participant agreed, “or like, let them check your texts to make sure there’s nothing inappropriate going on.” Parental rules could also include rules addressing when and for how long a smartphone could be used. One participant suggested that parents could set a timer, “you can be on your phone for an hour, or 10 minutes is kind of stupid, like, maybe 20 minutes or 30 minutes.” Participants emphasized that rules should be specific. One participant stated, “I think that some rules are a little too subtle, like they aren’t enforced as much as they should be. Or like they have a time, like ‘3 hours a day you should be on your phone’ which is, like way too much. So some rules are a little less than what they should be I think.” Another participant described the importance of parental rules in this quote, “I feel like parents should have some degree of control over, like, you check your phone in at night. Or plug it in downstairs or something. They should have, um, they should definitely have rules in place about it. It shouldn’t be something that you’re just, um, kind of directing yourself on, having it free-for-all. Not at first anyways. Or for a long time.”
medical conditions. One participant explained, “I think that if it’s for medical purposes, like watching your number, the parents should probably pay for it.” Participants emphasized that they should have accountability in the ongoing care and maintenance of the smartphone. Many participants told stories of themselves, their siblings and their friends losing or breaking their first smartphone. Participants agreed that they should be held accountable for this in some way. One participant explained, “If they lose it and have to get a replacement, then they should pay for it.” Another participant stated, “If you break it, you should probably earn the money to buy it again.” Another opinion was that tweens generally do not have jobs or the capacity to earn much money, but should have some responsibility that could grow over time. One participant explained, “I think it should be split, because you have to teach them to be responsible with their money; but it’s also like an expensive thing, and at this age it’s not like we get uh...a lot of money.” Minor theme 1: Early adolescents should ask for a smartphone before receiving it A minor theme emerged related to how adolescents should receive a smartphone. Across several focus groups, participants expressed that obtaining a smartphone should begin with the EA asking for it. Some tweens described that they had received their smartphone as a gift. Others described getting a phone as a handme-down when a parent or sibling got a new phone, without asking for it. One participant explained, “I think the parent shouldn’t just give the phone straight out like ‘here’s a birthday surprise’ or whatever. I think the kid should actually want a smartphone and before, the parents should have some discussions with the kid. Um, like, what to do and what not to do. And it has to be really clear that the kid wants it.” Another participant stated, “If you’re a parent and you’re deciding if you should get your kid a phone, you should ask them if they’re interested.” Minor theme 2: Individual EAs have different needs and uses for smartphones
Major Theme 3: Accountability Accountability was commonly noted in discussions of when an early adolescent was ready to have their own smartphone. Participants discussed that a tween needed to be accountable for their actions when using a smartphone, and know enough to “avoid pitfalls.” A common concern knew how to avoid being a perpetrator or target of cyberbullying. One participant described the right time to get a smartphone as “probably when they know right from wrong. Like they know not to cyberbully.” A second key area that many participants discussed was being able to take steps to avoid “addiction.” One tween argued, “I don’t think there’s like a specific age. But like, I think it’s when they’re responsible enough to not be addicted to it.” Table 2 describes common quotes related to concerns about the responsibility of avoiding cyberbullying and addiction. Accountability was also a key area of focus in discussions of how a smartphone should be obtained. Most participants argued that the user should have some or all responsibility for smartphone costs. One participant argued, “I think that parents should buy the actual phone and then the kids can buy like accessories or stuff they want to put on it.” Another participant stated “no matter what, you [the tween] should pay for it.” However, some participants felt that the parents should cover costs for EAs who have
While many EAs described using their smartphones for playing games and streaming video, we noted some differences across groups and individuals when describing common smartphone uses. For example, focus groups participants from a rural area described using smartphones to avoid getting lost in locations such as forests or farmlands. One participant explained, “if a kid got lost in the woods and he has his phone, like, he’d call on his phone.” In this particular group, tweens also described that their parents would call them on their smartphones to come home for dinner, as they may be out of voice range even on one’s own property. Some participants described scenarios in which they perceived that they needed a personal smartphone. For example, among participants from the focus group with a chronic illness in the family, participants mentioned smartphone use for illness monitoring. One participant described, “my brother has one that um, connects to his insulin pod, so that’s helpful.” Table 3 describes a selection of quotations illustrating different views on smartphone uses. Discussion In this study, we engaged EAs in focus group discussions about their views on smartphone ownership and use. We found major
ARTICLE IN PRESS M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
5
Table 2 Early adolescent participant focus group quotes addressing concerns related to problematic internet use and cyberbullying Participant quote Problematic internet use/addiction
Cyberbullying
And the good thing, about um, having a parent, having a parent's permission, uh to get an app or a certain game is because I see some people, like they have 2 or 3 full pages of just games. Just straight games. And they just like really can't control themselves. So they just sit down and keep going on their phone instead of being active. They could get way too attached to it, and use it all the time. They could, um, be on it way too much and just not be spending as much time on their homework, and not as much time outside, and exercising. Yeah, like, a definite downside, kind of like he said, that like, if you never- you never could get off it ... Like, I know a bunch of peo- a bunch of my friends, like they're- like they're kind of addicted to their phones ... So like, even when they're over at, like, my house, I'm over at their house, we could be, like, hanging out, they're like, always on their phone, like texting someone on social media, so that's kind of a downside to it. Um, I would say that s- like, a definite downside that a lot of people talk about is cyberbullying. Like, I don't get cyberbullied, but I know some people that, like, have gotten cyberbullied, and, like, they got, like, really insecure about it, 'cause, like they- they were worried about, like, what if everything's true that they're saying, and they, like, just kinda got too worried about it when they shouldn't have. When they kind of become a little more responsible and like realize that you can’t really, like, bully someone. When you’re younger, you don’t really think about, like, the effect of what you’re doing. In addition to what he said about cyberbullying then, it might go on forever, and the person might get depressed and do some really bad things. Or be like wanting to, um, do stuff to themself to hurt themself. For bullies and things like that because it's so easy to just, like, type in those few words, but then it can, like, ruin someone’s day or even week or something like that.
themes around the importance of Maturity, Deference to Parents and Accountability tied to acquisition of a first smartphone. We also identified minor themes that emphasized avoiding assumptions that all EAs want smartphones, or that all EAs use their smartphones the same way. Thus, our findings present novel viewpoints to inform current discussions around the appropriate timing and parental strategies for tweens’ first smartphone. A critical finding in our study is the emphasis on parent involvement in EAs’ digital lives. Our EA participants emphasized the role of parents as determining when an EA was mature enough and independent enough to be ready for a first smartphone. This is not to say that tweens did not want involvement in these decisions, as our minor theme illustrates that some EAs were provided a first smartphone without ever having been asked if they wanted one. Tweens’ responses support that they want involvement in decisions about getting their own smartphone. Further, EA participants wanted clear parental rules around use of their first smartphone. This finding introduces different perspectives compared to previous literature around parental rules and smartphones. One previous study of older adolescents found that parent-adolescent communication about smartphone rules led to conflict, and that parents and adolescents differed in their views of how a smartphone should be used [18]. Other literature describes that parents view smartphones as a tool for monitoring their child’s safety, while teens view phones as an opportunity to connect with peers [19]. These previous studies suggest conflict and disconnect between parents and teens around smartphone use. In contrast, our study found that EAs wanted parents’ involvement and guidance. We also found that EAs often share their parents’ views of the importance of the smartphone as a safety tool, to help avoid getting lost or to track medical data, as well as for social engagement with peers. It is possible that obtaining a smartphone at a younger age, during the EA developmental stage in which high levels of parental involvement are expected, contributed to our participants’ desired involvement of parents. Another area in which our study presents novel findings is in the concerns expressed by EAs about risks of smartphone use. Previous studies have described adolescents’ perceived risks of internet use, mostly focused on external risks such as online predictors or bullies [20,21]. In our study, perceived risks of smartphone use also included internal risks such as one’s own capacity to bully.
Further, EAs were concerned about and offered conceptualizations of problematic internet use (PIU) and addiction. EAs described PIU as a lack of control over activities, being “too attached to it,” and using the phone even when at a friend’s house (Table 2). These insights can inform our understanding of PIU from the
Table 3 Early adolescents’ responses indicating different ways in which tweens their age use smartphones Well um, I know uh, some use only like a couple use for entertainment, but um some uh, use for like emergencies. So like, if like, so I travel places and so my parents think that I need my phone to contact them. Like while I'm away, from them (Laughs). Uh and then so just in case of emergency, and then also I think um, because a lot of, for some people, a lot of their friends have social media stuff, so they get it so they can feel included and have something to talk, to talk about in their friend groups. Instagram ... YouTube ... The three main things that I see are entertainment, emergency, and it's also especially during, like, when you're in school. Like the period when you're in school, is uh, it's really helpful for, like, um, uh or even after school. Really helpful for finding out homework assignments, like if you're, so for educational purposes, or like googling up some, something that's not included in your history textbook or something like that. I use mine to listen to music a lot Or like if, um, you're home alone and [your parents] are shopping and like there's two choices of something they want to get you and they ask you, then once you pick it they'll know what to get you. Or like if you need, let's say for example, a new toothbrush. You can just text them and say, "Hey Mom, can you pick me this up at this store?" While they're shopping. -Playing games -Yeah, our dad said that we could just download games, play them on there Well, I've definitely noticed on the bus, I've seen kids, like, taking electronics and playing games ... a lot. Yeah, playing games is a big one. I think it can also come in handy ... if you want to call someone. Like, if you want to call your friend Yeah, and I've seen a lot of boys in our class, like I know they have social media, watching a lot, and they sort of, like, show off their phones, like, they don't say, "Oh look everybody I have my phone.” But they take it out in class, obviously everybody can see. I mostly just use mine for like diabetes stuff, like so my parents can like, monitor my blood sugar or like get in touch if my blood sugar starts to go really low Internet and Pinterest and texting Photos, I think Like if someone, like if a kid got lost in the woods and he has his phone, like, he'd call on his phone like, "I'm lost in the woods, can you help me get out?"
ARTICLE IN PRESS 6
M.A. Moreno et al. / Journal of Adolescent Health 00 (2018) 1−6
perspectives of EAs themselves. Participants emphasized the importance of maturity and accountability towards prevention of these risks. The limitations to our study include our focus on EAs in Washington State; thus, findings are not generalizable to all EAs. The lack of generalizability is consistent with qualitative study design that emphasizes depth of a topic rather than representativeness of sample size. Our recruitment strategy was purposeful and we achieved EA representation from different communities, as well as EAs with exposure to or experience with medical conditions. However, we did not engage every community of EAs that exists. Rather, we focused in areas that we understood may affect smartphone ownership and use based on current knowledge. Future studies may pursue surveys to capture a larger population of EAs towards understanding this phenomenon at the population level, or comparing by groups. A further limitation is that some participants did not choose to disclose demographic variables on the short survey. Despite these limitations, our study has important implications. Obtaining a first smartphone is an important milestone in today’s digital society, and our study findings can inform these discussions. Our findings suggest that giving an unrequested hand-medown or gift for a first phone is not recommended. EAs want to be involved in decisions about when to get their phone, and value their involvement as a milestone of maturity when they are asked to participate in the decision. A key take-away from our study is EA’s emphasis on milestones indicating maturity over specific age ranges for obtaining a first smartphone. Further, parents should feel respected and empowered to play an important role in their adolescents’ first smartphone. Parents’ roles can include setting rules and expectations, as well as checking in with their EA about their experiences. Parents may consider tools that incorporate EA’s ideas and perspectives in establishing rules around phone use, such as the Family Media Use Plan [22], developed by the American Academy of Pediatrics. This online tool encourages parents and teens to communicate and use shared decision-making to develop media rules that both parents and teens are expected to follow. Our findings support that ongoing parental communication is important to understand EAs’ perspectives, wants and desired limits around this important digital tool.
Acknowledgments This study was funded by the Seattle Children’s Research Institute. We would like to acknowledge Maddie Rantala, Nikita
Midamba, Holly Gerla and Elod Boromisza for their assistance with this study. References [1] Anderson VA, et al. Development of executive functions through late childhood and adolescence in an Australian sample. Dev Neuropsychol 2001;20 (1):385–406. [2] Neinstein L, Anderson M. Adolescent development. In: Neinstein L, ed. Adolescent health care: a practical guide. Philadelphia: Lippincott Williams and Wilkins; 2002. p.767–92. [3] Brito PQ. Tweens' characterization of digital technologies. Comput Educ 2012;59:580–93. [4] EU kids online: findings, methods, recommendations , L.l. services, Editor. London, UK: EU Kids Online; 2014. [5] Influence Central. Kids & Tech: The Evolution of Today’s Digital Natives 2016. Available at http://influence-central.com/kids-tech-the-evolution-of-todaysdigital-natives/. Accessed October 9, 2018. [6] Kirkorian HL, Wartella EA, Anderson DR. Media and young children's learning. Future Child 2008;18(1):39–61. [7] Bruni O, et al. Technology Use and Sleep Quality in Preadolescence and Adolescence. J Clin Sleep Med 2015;11(12):1433–41. [8] Edwards MJ, et al. The influence of friends and siblings on the physical activity and screen viewing behaviours of children aged 5-6 years: a qualitative analysis of parent interviews. BMJ Open 2015;5(5):e006593. [9] Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics 2016;138(5):e20162592. [10] Slater Tate, A. 'Wait Until 8th' movement asks parents not to give young kids smartphones, Today.com. 2017. [11] Moreno MA. Your Child's First Cell Phone. JAMA Pediatrics 2017;171(6):608. [12] O'Keefe, G.S. Cell phones: what's the right age to start? Healthychildren.org 2011 [cited 2018 April 20]; Available from: https://www.healthychildren.org/ English/family-life/Media/Pages/Cell-Phones-Whats-the-Right-Age-to-Start. aspx. [13] Glesne C. Becoming qualitative researchers. Second ed. Reading, MA: Longman; 1999. [14] Kitzinger J. Qualitative research: introducing focus groups. BMJ 1995;311:299–300. [15] Mbuagbaw L, et al. Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer. BMC Health Serv Res 2015;15:33. [16] Badawy SM, et al. Patient-centered ehealth interventions for children, adolescents, and adults with sickle cell disease: systematic review. J Med Internet Res 2018;20(7):e10940. [17] Glaser BG, Strauss A. The discovery of grounded theory: strategies for qualitative research. Hawthorne, NY: Aldine Transaction; 1967. [18] Davis K, Kim AS. Tweens' perspectives on their parents' media-related attitudes and rules: an exploratory study in the US. J Child Med 2017;11(3). [19] Weinstein EC, Davis K. Connecting 'round the clock: mobile phones and adolescents' experiences of intimacy. In: Yan Z, ed. Encyclopedia of mobile phone behavior. IGI Global; 2015. [20] Ybarra ML, Espelage DL, Mitchell KJ. The co-occurrence of Internet harassment and unwanted sexual solicitation victimization and perpetration: associations with psychosocial indicators. J Adolesc Health 2007;41(6 Suppl 1):S31–41. [21] Ybarra ML, Espelage DL, Mitchell KJ. Differentiating youth who are bullied from other victims of peer-aggression: the importance of differential power and repetition. J Adolesc Health 2014;55(2):293–300. [22] American Academy of Pediatrics. Family media use plan. 2016 [cited 2018 July 29]; Available from: https://www.healthychildren.org/english/media/pages/ default.aspx.