With teen mental health deteriorating over five years, there’s a likely culprit

pimchawee

Around 2012, something started going wrong in the lives of teens.

In just the five years between 2010 and 2015, the number of U.S. teens who felt useless and joyless – classic symptoms of depression – surged 33 percent in large national surveys. Teen suicide attempts increased 23 percent. Even more troubling, the number of 13- to 18-year-olds who committed suicide jumped 31 percent.

In a new paper published in Clinical Psychological Science, my colleagues and I found that the increases in depression, suicide attempts and suicide appeared among teens from every background – more privileged and less privileged, across all races and ethnicities and in every region of the country. All told, our analysis found that the generation of teens I call “iGen” – those born after 1995 – is much more likely to experience mental health issues than their millennial predecessors.

What happened so that so many more teens, in such a short period of time, would feel depressed, attempt suicide and commit suicide? After scouring several large surveys of teens for clues, I found that all of the possibilities traced back to a major change in teens’ lives: the sudden ascendance of the smartphone.

All signs point to the screen

Because the years between 2010 to 2015 were a period of steady economic growth and falling unemployment, it’s unlikely that economic malaise was a factor. Income inequality was (and still is) an issue, but it didn’t suddenly appear in the early 2010s: This gap between the rich and poor had been widening for decades. We found that the time teens spent on homework barely budged between 2010 and 2015, effectively ruling out academic pressure as a cause.

However, according to the Pew Research Center, smartphone ownership crossed the 50 percent threshold in late 2012 – right when teen depression and suicide began to increase. By 2015, 73 percent of teens had access to a smartphone.

Not only did smartphone use and depression increase in tandem, but time spent online was linked to mental health issues across two different data sets. We found that teens who spent five or more hours a day online were 71 percent more likely than those who spent less than an hour a day to have at least one suicide risk factor (depression, thinking about suicide, making a suicide plan or attempting suicide). Overall, suicide risk factors rose significantly after two or more hours a day of time online.

Of course, it’s possible that instead of time online causing depression, depression causes more time online. But three other studies show that is unlikely (at least, when viewed through social media use).

Two followed people over time, with both studies finding that spending more time on social media led to unhappiness, while unhappiness did not lead to more social media use. A third randomly assigned participants to give up Facebook for a week versus continuing their usual use. Those who avoided Facebook reported feeling less depressed at the end of the week.

The argument that depression might cause people to spend more time online doesn’t also explain why depression increased so suddenly after 2012. Under that scenario, more teens became depressed for an unknown reason and then started buying smartphones, which doesn’t seem too logical.

What’s lost when we’re plugged in

Even if online time doesn’t directly harm mental health, it could still adversely affect it in indirect ways, especially if time online crowds out time for other activities.

For example, while conducting research for my book on iGen, I found that teens now spend much less time interacting with their friends in person. Interacting with people face to face is one of the deepest wellsprings of human happiness; without it, our moods start to suffer and depression often follows. Feeling socially isolated is also one of the major risk factors for suicide. We found that teens who spent more time than average online and less time than average with friends in person were the most likely to be depressed. Since 2012, that’s what has occurred en masse: Teens have spent less time on activities known to benefit mental health (in-person social interaction) and more time on activities that may harm it (time online).

Teens are also sleeping less, and teens who spend more time on their phones are more likely to not be getting enough sleep. Not sleeping enough is a major risk factor for depression, so if smartphones are causing less sleep, that alone could explain why depression and suicide increased so suddenly.

Depression and suicide have many causes: Genetic predisposition, family environments, bullying and trauma can all play a role. Some teens would experience mental health problems no matter what era they lived in.

But some vulnerable teens who would otherwise not have had mental health issues may have slipped into depression due to too much screen time, not enough face-to-face social interaction, inadequate sleep or a combination of all three.

It might be argued that it’s too soon to recommend less screen time, given that the research isn’t completely definitive. However, the downside to limiting screen time – say, to two hours a day or less – is minimal. In contrast, the downside to doing nothing – given the possible consequences of depression and suicide – seems, to me, quite high.

It’s not too early to think about limiting screen time; let’s hope it’s not too late.

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75 Percent of Teen Girls Have Anxiety — What We Can Do About It

ParentMap

Author and researcher Rachel Simmons talks raising daughters in a toxic culture

PUBLISHED ON: JANUARY 17, 2018

 
anxious-teen-girl

Roughly three out of four teenage girls experience anxiety, according to the 2016 Washington State Healthy Youth Survey. Seventy-six percent of tenth grade girls have felt extremely nervous or anxious and 13 percent have attempted suicide.

What is going on and how can we as parents help? We turned to educator and researcher Rachel Simmons. Founder of Oakland-based outreach organization Girls Leadership and leadership development specialist at Smith College, Simmons believes there’s no one reason why so many young women feel anxious.

Still, there is one reason she often sees in her work: more pressure.

“We hope for girls to be smart and brave and interested in STEM fields, but we still expect them to be thin and sexually attractive and have a witty and appealing online presence,” she says. “No matter how many achievements they accrue, they feel that they are not enough as they are … We haven’t really upgraded our expectations, we’ve just added on to the old ones.”

She addresses this pressure and how parents can help their daughters thrive in her latest book, “Enough As She Is” (out Feb. 27).

It’s not a bad thing that we’re instilling more confidence in our girls, Simmons says. The problem is that we’re still raising them in a toxic culture that hasn’t caught up with those new expectations.

“That’s how girls wind up feeling something is wrong with themwhen in fact … something is deeply wrong with our culture,” she says. In the last decade alone, Simmons says she’s seen “the rise of social media, arrival of college admissions mania, and ever more ruthless pressure to be thin tighten the rules of success for girls in punishing ways.”

And that, she notes, undermines the development of their confident, authentic selves. But that doesn’t mean there’s no solution. We asked Simmons why our daughters are experiencing so much anxiety — and what parents can do to help.

Why does more opportunity lead to increased anxiety in teenage girls?

Girls have too many roles to play and too many roles conflict with each other. Add this role overload to the fact that girls continue to need to please others first and be likable. Girls are still raised with a psychology that is trained to think about other people before themselves. This all is a real recipe for unhappiness.

My goal is to give parents tools to help girls carve out a life and a sense of self that feels authentic and important to them that isn’t fully shaped by what other people expect of them. It’s not that challenges are going to go away; it’s about how to manage these challenges. For example, I never tell girls that they are going to stop overthinking things. The question is: Do you know how to manage overthinking and how to understand it?

Got any tips for how to get your teen daughter to actually, you know, talk?

Teenagers are notorious for not wanting to talk when you want to talk. Annoyingly, they’re not interested in talking on your schedule and they want to talk when it’s not convenient for you. If they are deflecting your attempt to talk, ask yourself, ’Is this the right time for them to talk?’ Can you agree upon a different time to talk?

It’s also super important for parents to find that middle way between being authoritarian versus permissive. Kind but firm, gentle, curious and humble. Try saying, ‘There’s a lot I don’t know, and I would love to hear more about what I don’t know; here’s what I am thinking as your parent.’

Every teenager wants to have respect. I’m not talking about them getting to go out until 1 a.m. I’m talking about establishing trust in your teenager’s perspective. That’s being able to say, ‘Hey, listen. There are things you have to tell me’ while [also] standing firm with the fact that you’re the parent and the boss.

And how should you respond when your daughter does tell you something big?

When your child does open up and tell you something big, it’s so important to note that. You say to your kid in that situations, ‘Thank you so much for telling me that.’ Their job is not to serve you by telling you things — their job is to be secretive — so be grateful when they tell you things.

Where does the use of social media come into this?

There’s a real trend of using fear and shame to teach about social media: ‘Your life will be ruined if you do the wrong thing online.’ But teaching through fear and shame isn’t effective for teens.

Social media in and of itself is not harmful — it’s the way in which it’s used that can be harmful. It’s important for parents to make an effort to understand why their kids love it, and to understand their kids are going to make mistakes … Parents need to be clear with their kids about parameters and expectations around use. I don’t think that means being a spy, but you must play a role in how your kids learn to be online through rules and expectations.

In your book, you recommend creating a ‘failure resume’ that lists ways you have failed in your life and sharing that with your daughter. Why?

If you create a failure resume and talk about it with your daughter, you’re desensitizing her to the power of failure. You’re talking about something that’s often taboo and lessening the shame around it. You’re also normalizing failure, making it fun and funny, which makes it less scary. To be comfortable with your setbacks is a muscle that you must flex again and again. It’s a skill.

A failure resume is an ingredient for the recipe [of how to deal with failure]. Essentially my whole book is about this recipe for building resilience. I talk about what is threatening girls and how to respond to it, how to be resilient. I’ve learned that what girls really need are the skills to lean inside as much as to lean in: to practice self-compassion, nourish their most important relations and seek support when needed.

The Harvey Weinstein Challenge: Combating Sexual Harassment In and Out of School

NAIS

I don’t know what the world record is, but I’m pretty sure I’m close: My first experience with sexual harassment occurred within the first 10 minutes on my first shift at my very first job.

Newly hired as a hostess for a local restaurant, I was excited to have landed a summer job between college semesters. I was nervous, too, because I had no idea what to expect. What I definitely didn’t expect was Mr. Leonard.

As the restaurant manager, Mr. Leonard, a married man in his mid-40s, made a point of “joking” with every new hire that while he lived on Maryland’s Eastern Shore, once his car crossed the midpoint on the Chesapeake Bay Bridge on his way to work every morning, he was “single.”

At first, and in my naïveté, I wasn’t quite sure what he meant. It soon became clear. I heard him repeatedly telling obscene “jokes” about sex, and witnessed him ogling and making disgusting comments about waitresses’ bodies to their faces and from behind them. Once, I saw him snap the bra strap of a woman who bent over to take something out of a case. One day he told me he could see the outline of my bra under my hostess dress (which he was staring at) and then sent me home to put on a slip to avoid “offending the customers.”

I lasted two weeks. While the term “hostile work environment” had not yet been coined, I knew emotionally I was in one. Looking back, my most important lesson was recognizing that I left because I couldThe older women did not have the privilege of quitting. Most were caring for children at home, and the loss of income would have been devastating for their families. Their only option was to suffer through it in silence. Besides, to whom could they complain, since the perpetrator was also the boss?

A Pervasive Problem

Sexual harassment was a ubiquitous problem that had no name until the early 1980s, when federal courts defined it as an illegal form of “gender discrimination” in violation of the 1964 Civil Rights Act. The U.S. Office of Equal Employment Opportunity (OEEO) was charged with creating mechanisms for filing complaints and procedures for ongoing enforcement. Later court cases made these new rules applicable to school environments as well.

But, it was not until 1991, during Clarence Thomas’s U.S. Senate Supreme Court confirmation hearings—when Anita Hill famously accused Thomas of sexual harassment, while both were working at the OEEO, which he headed, no less—that the entire nation, all at once, received its first meaningful education about this scourge. Now, it had an official name as well as the force of the federal government behind its adjudication.

As recent high-profile events make clear, nonetheless, sexual harassment remains ever-present in our society, even in the lives of women (and men) who are powerful in their own right. This time, however, I’m much more optimistic about the prospects for lasting awareness and change.

The Prospects for Change

First, and really only within the past five years, American society has finally begun to treat the problem of sexual assault—sexual harassment in its most extreme form—with the seriousness it deserves. Moreover, a new standard for defining “sexual consent” has emerged: What counts is no longer “the absence of no,” but rather “the unequivocal presence of an enthusiastic verbal yes.” This is no mere linguistic change, since as a very practical matter it shifts the onus for establishing consent squarely on the person who desires sexual activity, not the person they desire. Verbal permission before crossing another person’s sexual boundaries is required.

These two developments have been hugely important in helping us and our students to better understand and help prevent sexual assault. Now, as our collective attention is drawn to highly publicized disclosures of chronic sexual harassment perpetrated by powerful, well-known men across diverse businesses and professional fields, another new and potentially transformative element is in the mix: public accountability.

The swift, hard fall from positions of enormous power, status, and wealth for many of these men delivers a resounding message: “This behavior, once and for all, is intolerable and will bring serious consequences.” Public accountability inevitably begets more public accountability, because victims feel supported in knowing they are not alone and can recognize, finally, they were in no way at fault; it also exposes to public scrutiny the hidden malignancies that keep entrenched patriarchy and “toxic masculinity” alive.

What About Our Students?

Sexual harassment statutes pertain only to schools and workplaces, because students must go to school and most people have to work. (If someone is the recipient of catcalls on a particular street, on the other hand, they can simply take another route.) Educational institutions, of course, are both workplaces and schools. Without question, it is incumbent upon all schools to establish policies and practices that provide clear, equitable procedures for reporting, investigating, and resolving sexual harassment complaints—involving students of all sexual and gender identities—and maintaining safe school environments. A recently launched campaign, #MeTooK12, aims to lobby and support schools in improving their efforts. Read about it here.

It’s vital to recognize, though, that most of the sexual harassment today’s students perpetuate and/or experience does not occur in formal settings like schools and workplaces, but within their everyday social interactions, much of it in the form of hostile, cruel, degrading, and coercive online communication. Regardless of venue, though, it is shaped and fueled by the very same patriarchal mix that defines “real” masculinity in terms of superiority, entitlement, dominance, winning at all costs, and the conflation of sex and power.

Before men are men, they are boys. Until parents and schools commit to intentionally raising both boys and girls with high expectations and a single standard of values based on empathy and fairness—with sex and gender being no exception—we can expect these harmful and oppressive patterns to continue. Now is a very good time to take on this challenge. 

Break the Cycle of Stress and Distraction by Using Your Emotional Intelligence

Being able to focus helps us succeed. Whether it’s focusing inward and attuning ourselves to our intuitions and values or outward and navigating the world around us, honing our attention is a valuable asset.

All too often though, our focus and attention get hijacked, leaving us feeling frazzled, forgetful, and unable to concentrate. In my coaching work with executives, these are the kinds of statements I most often hear when they’ve lost their focus (I may have uttered a few of them myself):

  • “I feel completely overwhelmed.”
  • “My workload is insane, and there’s never enough time to get things done when I’m in meetings and dealing with urgent issues all day long.”
  • “I’m mentally exhausted from the pressure and constant distractions in my office. I just can’t seem to focus.”

Constant distractions and a lack of time certainly interrupt our focus, but stress also plays a major role.

Chronic stress floods our nervous system with cortisol and adrenaline that short-circuits important cognitive functions. Researchers have studied the negative effects of stress on focus, memory, and other cognitive functions for decades. The findings are consistent – short-term stress raises cortisol levels (the so-called stress hormone) for short periods and can jump-start our adrenalin and motivate us to perform more efficiently in response to impending deadlines. Long-term stress, however, can lead to prolonged increases in cortisol and can be toxic to the brain. Scientists also suspect that high levels of cortisol over a long period of time are a key contributor to Alzheimer’s and other forms of dementia.

When we can’t focus at work because of distractions, it may lead us to feel stressed about not being productive, which then causes us to focus less, further feeding the cycle. Unfortunately, most of us don’t notice our focus declining until we become completely overwhelmed. When mental and emotional exhaustion sets in, it further drains our ability to focus, concentrate, and recall information.

Fortunately, there are things we can do to break the cycle. I’ve found in my research that one of the reasons why some people get burned out and others don’t is because they use their emotional intelligence (EI) to manage their stress. You can use these same competencies, in particular self-awareness and self-management, to improve your focus. Here’s how.

Start by using your self-awareness to help you notice several things:

Why you feel stressed or anxious. Before you can deal with stress, you need to know what’s causing it. As simple as it may sound, it can be helpful to make a list of the sources of your stress. Write down each thing in your life and at work that’s causing you anxiety. You might categorize items into things you have the ability to change and things you don’t. For the stressors in the latter category, you will need to figure out how to change your attitude toward them.

How you lose your ability to focus. According to clinical psychologist Michael Lipson, you can learn to sharpen your focus, by understanding how exactly your concentration strays in the first place. By paying attention to the patterns that lead to your lack of focus, you can begin to develop your ability to dismiss distractions and stay with your original point of attention.

How you feel when you can’t focus. Does it make you anxious when you can’t recall information when you need it – perhaps during a job interview, a high-stakes presentation, or an important client meeting? Do you feel tense and dazed when you’re racking your brain trying to find just the right words for an important email? These can be clues that you’re more stressed than you may realize, and that your inability to concentrate is causing even more stress.

When you lose your ability to focus. If, for example, you find yourself worrying yourself sick over something while you’re driving 65 mph on the highway with a car full of kids, you’re putting yourself and others in real danger. This can be a wake-up call to bring your attention back to what you’re doing and make a decision to think about your concerns later.

Once you’ve increased your awareness of what’s causing you stress and how and when you lose your focus, you can use the following strategies, which depend on your self-management abilities, to make better choices that keep you focused.

Do a digital detox. In its 2017 Stress in America survey, The American Psychological Association (APA) found that “constant checkers” – people who check their emails, texts, and social media on a constant basis – experience more stress than those who don’t. More than 42% of respondents attribute their stress to political and cultural discussions on social media, compared with 33% of non-constant checkers. While it may feel impossible to take a cold turkey break from technology, the APA says that periodically unplugging or limiting your digital access can be great for your mental health.

Rest your brain. Most of us have experienced sleepless nights caused by ruminating over past events, or fears and anxieties about the future. But when you add a few of these nights together, sleep deprivation can set in, making it more difficult to focus, and more challenging to receive and recall information. Our interpretation of events and our judgment may be affected, too. Lack of sleep can negatively affect our decisions because it impairs our ability to accurately assess a situation, plan accordingly, and behave appropriately. Committing to the recommended 7 to 8 hours of sleep each night may seem impossible when you’re stressed and overworked, but the payoff is worth it.

Practice mindfulness. The research on mindfulness is clear and compelling. Having a mindfulness practice decreases our tendency to jump to conclusions and have knee-jerk reactions we may regret later (and potentially cause more stress). Neuroscientist Richard Davidson says that “Mindfulness boosts the classic attention network in the brain’s fronto-parietal system that works together to allocate attention.” In other words, mindfulness is key to emotional resilience, which is a key contributor in our ability to quickly recover from stress. Don’t worry, you don’t have to be a serious yogi to practice mindfulness. You can find some simple methods for everyday people here.

Shift your focus to others. When we fixate on our own worries and fears, it can take our attention away from those we care about. Studies (mine included) show that shifting our focus to others produces physiological effects that calm us and strengthen our resilience. If you pay more attention to other people’s feelings and needs, and show concern for them, you can not only take your mind off of your stress but also reap the benefits of knowing that you’re doing something meaningful for someone you care about.

Too many people feel like they need to work harder when they struggle to focus. But this strategy is likely to backfire. Instead, pay attention to the causes of your stress and inability to focus and then take actions that promote improvements in the specific brain functions that drive concentration and awareness

iPhones and Children Are a Toxic Pair, Say Two Big Apple Investors

The Wall Street Journal

Two activist shareholders want Apple to develop tools and research effects on young people of smartphone overuse and addiction

Teens took a group selfie with a smartphone in New York’s Times Square on Dec. 1.
Teens took a group selfie with a smartphone in New York’s Times Square on Dec. 1. PHOTO: DREW ANGERER/GETTY IMAGES

The iPhone has made Apple Inc. AAPL 1.03% and Wall Street hundreds of billions of dollars. Now some big shareholders are asking at what cost, in an unusual campaign to make the company more socially responsible.

A leading activist investor and a pension fund are saying the smartphone maker needs to respond to what some see as a growing public-health crisis of youth phone addiction.

Jana Partners LLC and the California State Teachers’ Retirement System, or Calstrs, which control about $2 billion of Apple shares, sent a letter to Apple on Saturday urging it to develop new software tools that would help parents control and limit phone use more easily and to study the impact of overuse on mental health.

The Apple push is a preamble to a new several-billion-dollar fund Jana is seeking to raise this year to target companies it believes can be better corporate citizens. It is the first instance of a big Wall Street activist seeking to profit from the kind of social-responsibility campaign typically associated with a small fringe of investors.

Adding splash, rock star Sting and his wife, Trudie Styler, will be on an advisory board along with Sister Patricia A. Daly, a nun who successfully fought Exxon Mobil Corp. over environmental disclosures, and Robert Eccles, an expert on sustainable investing.

The Apple campaign would be unusual for an activist like Jana, which normally urges companies to make financial changes. But the investors believe that Apple’s highflying stock could be hurt in coming decades if it faces a backlash and that proactive moves could generate goodwill and keep consumers loyal to Apple brands.

“Apple can play a defining role in signaling to the industry that paying special attention to the health and development of the next generation is both good business and the right thing to do,” the shareholders wrote in the letter, a copy of which was reviewed by The Wall Street Journal. “There is a developing consensus around the world including Silicon Valley that the potential long-term consequences of new technologies need to be factored in at the outset, and no company can outsource that responsibility.”

Obsessive teenage smartphone usage has sparked a debate among academics, parents and even the people who helped create the iPhone.

Two teenage boys use smartphones in Vail, Colo., in June 2017.
Two teenage boys use smartphones in Vail, Colo., in June 2017. PHOTO: ROBERT ALEXANDER/GETTY IMAGES

Some have raised concerns about increased rates in teen depression and suicide and worry that phones are replacing old-fashioned human interaction. It is part of a broader re-evaluation of the effects on society of technology companies such as Google and Amazon.com Inc.and social-media companies like Facebook Inc. and Snap chat owner Snap Inc., which are facing questions about their reach into everyday life.

Apple hasn’t offered any public guidance to parents on how to manage children’s smartphone use or taken a position on at what age they should begin using iPhones.

Apple and its rivals point to features that give parents some measure of control. Apple, for instance, gives parents the ability to choose which apps, content and services their children can access.

The basic idea behind socially responsible investing is that good corporate citizenship can also be good business. Big investors and banks, including TPG, UBS Group AG and Goldman Sachs Group Inc.are making bets on socially responsible companies, boosting what they see as good actors and avoiding bad ones.

How the iPhone Was Born: Inside Stories of Missteps and Triumphs
On the iPhone’s 10th birthday, former Apple executives Scott Forstall, Tony Fadell and Greg Christie recount the arduous process of turning Steve Jobs’s vision into one of the best-selling products ever made. (Originally published June 25, 2017)

Big-name activists increasingly view bad environmental, social or governance policies as red flags. Jana plans to go further, putting its typical tools to work to drive change that may not immediately pay off.

Apple is an ambitious first target: The combined Jana-Calstrs stake is relatively small given Apple’s nearly $900 billion market value. Still, in recent years Apple has twice faced activists demanding it pare its cash holdings, and both times the company ceded some ground.

 

Chief Executive Tim Cook has led Apple’s efforts to be a more socially responsible company, for instance on environmental and immigration issues, and said in an interview with the New York Times last year that Apple has a “moral responsibility” to help the U.S. economy.

Apple has shown willingness to use software to address potentially negative consequences of phone usage. Amid rising concerns about distracted driving, the company last year updated its software with a “do not disturb while driving” feature, which enables the iPhone to detect when someone is behind the wheel and automatically silence notifications.

The iPhone is the backbone of a business that generated $48.35 billion in profit in fiscal 2017. It helped turn Apple into the world’s largest publicly listed company by market value, and anticipation of strong sales of its latest model, the iPhone X, helped its stock rise 50% in the past year. Apple phones made up 43% of U.S. smartphones in use in 2016, according to comScore , and an estimated 86 million Americans over age 13 own an iPhone.

Jana and Calstrs are working with Jean M. Twenge of San Diego State University, who chronicled the problem of what she has dubbed the “iGen” in a book that was previewed in a widely discussed article in the Atlantic magazine last fall, and with Michael Rich of Harvard Medical School and Boston Children’s Hospital, known as “the mediatrician” for his work on the impact of media on children.

The investors believe both the content and the amount of time spent on phones need to be tailored to youths, and they are raising concern about the public-health effects of failing to act. They point to research from Ms. Twenge and others about a “growing body of evidence” of “unintentional negative side effects,” including studies showing concerns from teachers. That is one reason Calstrs was eager to support the campaign, according to the letter.

The group wants Apple to help find solutions to questions like what is optimal usage and to be at the forefront of the industry’s response—before regulators or consumers potentially force it to act.

The investors say Apple should make it easier and more intuitive for parents to set up usage limits, which could head off any future moves to proscribe smartphones.

The question is “How can we apply the same kind of public-health science to this that we do to, say, nutrition?” Dr. Rich said in an interview. “We aren’t going to tell you never go to Mickey D’s, but we are going to tell you what a Big Mac will do and what broccoli will do.”

(We’d like to hear from you: Is smartphone addiction among young people a public-health concern? Should companies like Apple be held responsible for tackling the issue? Email us at socialmedia@wsj.com with your comments.)

Write to David Benoit at david.benoit@wsj.com

OPEN LETTER FROM JANA PARTNERS AND CALSTRS TO APPLE INC.

Think Differently About Kids

January 6, 2018

Board of Directors
Apple Inc.
1 Infinite Loop
Cupertino, California 95014

Ladies & Gentlemen,

JANA Partners LLC and the California State Teachers’ Retirement System (“we” or “us”) collectively own approximately $2 billion in value of shares of Apple Inc. (“Apple” or “you”).  As shareholders, we recognize your unique role in the history of innovation and the fact that Apple is one of the most valuable brand names in the world.  In partnership with experts including Dr. Michael Rich, founding director of the Center on Media and Child Health at Boston Children’s Hospital/Harvard Medical School Teaching Hospital and Associate Professor of Pediatrics at Harvard Medical School, and Professor Jean M. Twenge, psychologist at San Diego State University and author of the book iGen, we have reviewed the evidence and we believe there is a clear need for Apple to offer parents more choices and tools to help them ensure that young consumers are using your products in an optimal manner.  By doing so, we believe Apple would once again be playing a pioneering role, this time by setting an example about the obligations of technology companies to their youngest customers.  As a company that prides itself on values like inclusiveness, quality education, environmental protection, and supplier responsibility, Apple would also once again be showcasing the innovative spirit that made you the most valuable public company in the world.  In fact, we believe that addressing this issue now will enhance long-term value for all shareholders, by creating more choices and options for your customers today and helping to protect the next generation of leaders, innovators, and customers tomorrow.

More than 10 years after the iPhone’s release, it is a cliché to point out the ubiquity of Apple’s devices among children and teenagers, as well as the attendant growth in social media use by this group. What is less well known is that there is a growing body of evidence that, for at least some of the most frequent young users, this may be having unintentional negative consequences:

  • A study conducted recently by the Center on Media and Child Health and the University of Alberta found that 67% of the over 2,300 teachers surveyed observed that the number of students who are negatively distracted by digital technologies in the classroom is growing and 75% say students’ ability to focus on educational tasks has decreased. In the past 3 to 5 years since personal technologies have entered the classroom, 90% stated that the number of students with emotional challenges has increased and 86% said the number with social challenges has increased.  One junior high teacher noted that, “I see youth who used to go outside at lunch break and engage in physical activity and socialization.  Today, many of our students sit all lunch hour and play on their personal devices.”[i]
  • Professor Twenge’s research shows that U.S. teenagers who spend 3 hours a day or more on electronic devices are 35% more likely, and those who spend 5 hours or more are 71% more likely, to have a risk factor for suicide than those who spend less than 1 hour.[ii]
  • This research also shows that 8th graders who are heavy users of social media have a 27% higher risk of depression, while those who exceed the average time spent playing sports, hanging out with friends in person, or doing homework have a significantly lower risk.  Experiencing depression as a teenager significantly increases the risk of becoming depressed again later in life.[iii]
  • Also, teens who spend 5 or more hours a day (versus less than 1) on electronic devices are 51% more likely to get less than 7 hours of sleep (versus the recommended 9).  Sleep deprivation is linked to long-term issues like weight gain and high blood pressure.[iv]
  • A study by UCLA researchers showed that after 5 days at a device-free outdoor camp, children performed far better on tests for empathy than a control group.[v]
  • According to an American Psychological Association (APA) survey of over 3,500 U.S. parents, 58% say they worry about the influence of social media on their child’s physical and mental health, 48% say that regulating their child’s screen time is a “constant battle,” and 58% say they feel like their child is “attached” to their phone or tablet.[vi]

Some may argue that the research is not definitive, that other factors are also at work, and that in any case parents must take ultimate responsibility for their children.  These statements are undoubtedly true, but they also miss the point.  The average American teenager who uses a smart phone receives her first phone at age 10vii and spends over 4.5 hours a day on it (excluding texting and talking).viii  78% of teens check their phones at least hourly and 50% report feeling “addicted” to their phones.ix It would defy common sense to argue that this level of usage, by children whose brains are still developing, is not having at least some impact, or that the maker of such a powerful product has no role to play in helping parents to ensure it is being used optimally.  It is also no secret that social media sites and applications for which the iPhone and iPad are a primary gateway are usually designed to be as addictive and time-consuming as possible, as many of their original creators have publicly acknowledged.x  According to the APA survey cited above, 94% of parents have taken some action to manage their child’s technology use, but it is both unrealistic and a poor long-term business strategy to ask parents to fight this battle alone.  Imagine the goodwill Apple can generate with parents by partnering with them in this effort and with the next generation of customers by offering their parents more options to protect their health and well-being.

To be clear, we are not advocating an all or nothing approach.  While expert opinions vary on this issue, there appears to be a developing consensus that the goal for parents should be ensuring the developmentally optimal amount and type of access, particularly given the educational benefits mobile devices can offer.  For example, Professor Twenge’s research cited above has revealed peak mental health levels among teenagers who use devices 1 hour or less a day, with teens engaging in this limited use happier than teens who do not use devices at all.  According to a study of more than 10,000 North American parents conducted by researcher Alexandra Samuel, the children of parents who focus primarily on denying screen access are more likely to engage in problematic behaviors online than the children of parents who take an active role in guiding their technology usage.xi  Likewise, researchers at the University of Pittsburgh Center for Research on Media, Technology, and Health have found that while using a high number of social media platforms daily is linked to depression and anxiety in young adults, using a limited number does not have the same impact.xii

While these studies (and common sense) would suggest a balanced approach, we note that Apple’s current limited set of parental controls in fact dictate a more binary, all or nothing approach, with parental options limited largely to shutting down or allowing full access to various tools and functions.  While there are apps that offer more options, there are a dizzying array of them (which often leads people to make no choice at all), it is not clear what research has gone into developing them, few if any offer the full array of options that the research would suggest, and they are clearly no substitute for Apple putting these choices front and center for parents.  As Apple understands better than any company, technology is best when it is intuitive and easy to use.  More importantly, technology will continue to evolve as time goes on and play a greater and greater role in all of our lives.  There is a developing consensus around the world including Silicon Valley that the potential long-term consequences of new technologies need to be factored in at the outset, and no company can outsource that responsibility to an app designer, or more accurately to hundreds of app designers, none of whom have critical mass.

This is a complex issue and we hope that this is the start of a constructive and well-informed dialogue, but we think there are clear initial steps that Apple can follow, including:

  • Expert Committee: Convening a committee of experts including child development specialists (we would recommend Dr. Rich and Professor Twenge be included) to help study this issue and monitor ongoing developments in technology, including how such developments are integrated into the lives of children and teenagers.
  • Research: Partnering with these and other experts and offering your vast information resources to assist additional research efforts.
  • New Tools and Options: Based on the best available research, enhancing mobile device software so that parents (if they wish) can implement changes so that their child or teenager is not being handed the same phone as a 40-year old, just as most products are made safer for younger users.  For example, the initial setup menu could be expanded so that, just as users choose a language and time zone, parents can enter the age of the user and be given age-appropriate setup options based on the best available research including limiting screen time, restricting use to certain hours, reducing the available number of social media sites, setting up parental monitoring, and many other options.
  • Education: Explaining to parents why Apple is offering additional choices and the research that went into them, to help parents make more informed decisions.
  • Reporting: Hiring or assigning a high-level executive to monitor this issue and issuing annual progress reports, just as Apple does for environmental and supply chain issues.

It is true that Apple’s customer satisfaction levels remain incredibly high, which is no surprise given the quality of its products.  However, there is also a growing societal unease about whether at least some people are getting too much of a good thing when it comes to technology,xiii which at some point is likely to impact even Apple given the issues described above.  In fact, even the original designers of the iPhone user interface and Apple’s current chief design officer have publicly worried about the iPhone’s potential for overuse,xiv and there is no good reason why you should not address this issue proactively.  As one of the most innovative companies in the history of technology, Apple can play a defining role in signaling to the industry that paying special attention to the health and development of the next generation is both good business and the right thing to do.  Doing so poses no threat to Apple, given that this is a software (not hardware) issue and that, unlike many other technology companies, Apple’s business model is not predicated on excessive use of your products. In fact, we believe addressing this issue now by offering parents more tools and choices could enhance Apple’s business and increase demand for its products.

Increasingly today the gap between “short-term” and “long-term” thinking is narrowing, on issues like public health, human capital management, environmental protection, and more, and companies pursuing business practices that make short-term sense may be undermining their own long-term viability. In the case of Apple, we believe the long-term health of its youngest customers and the health of society, our economy, and the Company itself, are inextricably linked, and thus the only difference between the changes we are advocating at Apple now and the type of change shareholders are better known for advocating is the time period over which they will enhance and protect value. As you can imagine, this is a matter of particular concern for CalSTRS’ beneficiaries, the teachers of California, who care deeply about the health and welfare of the children in their classrooms.

While you may already have started work on addressing the issues raised here, we would nonetheless appreciate the opportunity to discuss this matter further with the board to bring in a wider range of voices. We also encourage you to discuss this matter directly with Dr. Rich, Professor Twenge, or any member of JANA’s board of advisors for our new impact investing fund, which includes Patricia A. Daly, OP, Professor Robert G. Eccles, Sting, and Trudie Styler. In the meantime, should you wish to contact us we can be reached at (212) 455-0900 or (916) 414-7410.

Sincerely,

Barry Rosenstein
Managing Partner
JANA Partners LLC

Anne Sheehan
Director of Corporate Governance
The California State Teachers’ Retirement System

Spreading First Aid for Teens’ Mental Health by Training Adults to Help

MindShift

iStock/Anna_Isaeva

During the vulnerable transition from childhood to young adulthood, many kids grapple with low self-esteem, anxiety and depression. According to the National Alliance on Mental Illness, 20 percent of adolescents between the ages of 13-18 live with a mental health condition. In fact, a recent study found that nearly 25 percent of teenage girls and almost 10 percent of teen boys suffer from depression by the age of fourteen.

When kids struggle, their emotional problems often unfold in the classroom, affecting their ability to concentrate and straining interactions with teachers and peers. Left untreated, mental health concerns can contribute to high school dropout rates. A 2001 survey conducted by the Department of Education found almost 50 percent of students age 14 and older with mental illness withdraw from school, and a recent study, published in the journal BMC Public Health discovered males with psychological disorders are five times more likely to quit attending school.

While educators often want to assist these students, many feel unsure of what to say, especially during a mental health crisis. But a community-wide intervention called Mental Health First Aid seeks to equip teachers, parents and caregivers with the information and skills they need to intervene during a mental health emergency.

MHFA training, referred to as “CPR for the mind,” teaches educators and caretakers how to recognize, understand and respond to signs of psychological distress. Educators across the country can receive “Youth” First Aid training, a unique version of MHFA teaching individuals how to recognize the psychological challenges that adolescents face.

“The course taught me how to get students the help they need, especially in an emergency,” says Tori Wardrip, an art teacher at Lewis and Clark Middle School in Billings, Montana.

Wardrip completed the training in June. The full-day course taught her several First Aid skills, including how to recognize the signs of a panic attack, psychosis and PTSD. She also learned how to assess for suicide risk by asking questions like, “Are you having thoughts of hurting yourself?” and “Are you in danger?”

Spreading the Word

Since 2013, more than 200,000 educators have been trained in Youth Mental Health First Aid, according to Betsy Schwartz, vice president of public education at the National Council for Behavioral Health; hundreds of middle schools, high schools and 27 state departments of education have implemented it. Schwartz says the results have been positive, resulting in $30 million in grant funding from the Substance Abuse and Mental Health Service Administration’s (SAMHSA) Now is the Time Project AWARE grant initiative.

The initiative also has garnered support from pop star Lady Gaga, who wants to help break silence around mental health. In 2012, the singer and her mother, Cynthia Germanotta started the “Born This Way Foundation,” a nonprofit organization committed to raising awareness about mental wellness, especially for young people. Recently, the foundation partnered with the National Council for Behavioral Health to sponsor Mental Health First Aid training across the nation.

The program trains people how to support and de-escalate an emergency crisis by using a five-step action plan, called ALGEE, according to Schwartz. “ALGEE stands for assessing for suicide risk/self-harm, listening nonjudgmentally, giving reassurance and information, encouraging professional help, and encouraging self-help and additional support strategies,” says Schwartz.

She adds that educators and caregivers who participate in the daylong YMHFA training learn how to recognize risk factors and warning signs of youth mental health challenges. Individuals are also informed about the prevalence of mental illness among adolescents, learning how protective factors, like available mental health resources, can contribute to psychological resilience.

During training, YMHFA participants practice these skills by role-playing with each other. Similar to medical First Aid training, role-play mimics realistic emergencies, allowing people to rehearse what they might “say” and “do” in an actual mental health crisis.

While the training focuses on mental wellness, instructors also discuss topics, like bullying and attention difficulties, teaching educators how these behaviors contribute to mental health concerns, like depression, suicidality and eating disorders.

At Lewis and Clark, Wardrip has put her new knowledge to good use. Since completing the training, she has become the “go to” person for the faculty’s behavioral health questions, serving as a bridge between educators and counselors.

She’s also using her new knowledge to teach students how to look out for each other.

“This year, using my First Aid training, I plan to teach my kids how to recognize the signs of a mental health emergency. If a peer is in danger, I want them to know how to get help,” she says.

Additional Resources

recent report, released by the “Born This Way Foundation,” found that even though adolescents value their psychological well-being, less than half are talking about their mental health. However, research shows teaching kids how to find psychological resources can make a world of difference, helping to break the shame and stigma that surrounds mental illness.

Schwartz says, educators and caregivers who participate in the daylong YMHFA training will learn five First Aid skills, including:

  1. Recognizing risk factors and warning signs of youth mental health challenges
  2. Understanding the prevalence of mental health conditions among young people
  3. Understanding protective factors that contribute to psychological resilience
  4. Learning the ALGEE five-step action plan
  5. Identifying community resources that can help support adolescents and their families

With support from the Born This Way Foundation, the National Council for Behavioral Health hopes to train 150,000 additional educators, parents and caregivers before the end of 2017.

Educators who are interested in setting up a YMHFA training can find courses here. See Lady Gaga and Prince William chat on FaceTime about mental health from earlier this year:

Juli Fraga is a psychologist and writer in San Francisco. You can find her @dr_fraga on Twitter.