Original Research Report

The Journal of School Nursing

2023, Vol. 39(3) 248–261
Exploring Parents’ Intentions to Monitor ª The Author(s) 2020
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and Mediate Adolescent Social Media Use sagepub.com/journals-permissions

DOI: 10.1177/1059840520983286
journals.sagepub.com/home/jsn
and Implications for School Nurses

Kimberly D. Douglas, PhD, RN, CNE1 , Kandy K. Smith, DNS, RN1,

Mary W. Stewart, PhD, RN1, Jean Walker, PhD, RN1,
Leandro Mena, MD, MPH2,3,4,5, and Lei Zhang, PhD, MBA1

Abstract
Social media may promote health and social connectedness, but its misuse and frequency of use may pose risks. Social media
use during adolescence requires parental monitoring and mediation to mitigate potentially harmful effects such as depression,
anxiety, and risk-taking behaviors. While parents and health care professionals convey concern surrounding exposure to
inappropriate content, prolonged screen time, and cyberbullying, appropriate social media monitoring remains challenging.
The purpose of this study was to explore parental monitoring and mediation of social media use in adolescents. Online
recruitment yielded a nationwide sample (n ¼ 836) of parents of adolescents. The results of the online survey indicated that
parents are concerned about adolescent social media use and endorse positive attitudes toward monitoring. Yet parents
perceived little control over monitoring. Findings from this study support the school nurse in promoting healthy social media
use, media literacy among parents and adolescents, and the use of screening tools.

Keywords
parent/family, social media, school-based clinics, middle/junior/high school, mental health

Background Social media is defined as “forms of electronic commu-

nication (such as website for social networking and micro-
Social media may promote health and social connectedness
blogging) through which users create online communities to
(Odgers & Jensen, 2020), but its misuse and frequency of
share information, ideas, personal messages, and other con-
use pose considerable risk. Children, aged 8–12 years, report
tent (such as videos)” (Merriam-Webster, n.d.). The AAP
spending a daily average of 4 hr on various screen activities,
recommends children and adolescents spend no more than
while 13- to 18-year-olds report a daily average of 7 hr, and
2 hr a day on screens (AAP Council on Communications and
this is excluding time for school and homework (Rideout &
Media, 2016b). The U.S. federal government addressed the
Robb, 2019). The majority (63%) of 13- to 18-year-olds use
amount of screen time children were viewing in the Healthy
social media every day (2019). With the onset of COVID-19
People 2020 campaign including an objective to advocate
and the switch to online learning, adolescents are spending
even more time on screens (Nagata et al., 2020).
Negative impacts on adolescent health and risky beha- 1
School of Nursing, The University of Mississippi Medical Center, Jackson,
vior related to social media including—prolonged screen MS, USA
time, poor sleep quality, cyberbullying, and sexting—have 2
Department of Population Health Science, The University of Mississippi
garnered the attention of media, parents, and the American Medical Center, Jackson, MS, USA
3
Academy of Pediatrics (AAP; AAP Council on Communi- Division of Infectious Diseases, Department of Medicine, The University
of Mississippi Medical Center, Jackson, MS, USA
cations and Media, 2016a, 2016b; ABC News, 2017; Byrne 4
School of Population Health, The University of Mississippi Medical Center,
et al., 2018; CNN, 2015; Twenge, 2017a). Moreover, a Jackson, MS, USA
disturbing increase in suicide rates among adolescents and 5
School of Medicine, The University of Mississippi Medical Center, Jackson,
young adults occurring between 2000 and 2016 (Miron MS, USA
et al., 2019) has led some researchers to attribute the simul-
Corresponding Author:
taneous launch and increase use of the smartphone and Kimberly D. Douglas, PhD, RN, CNE, School of Nursing, University of
social media with the increase in depression and suicide Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, USA.
rates (Twenge, 2017b). Email: kddouglas@umc.edu
Douglas et al. 249

for adolescents to limit their screen time to less than 2 hr, Parental Monitoring
excluding school and homework (U.S. Department of Health
As it relates to various types of media, research indicates
and Human Services, 2010).
parental monitoring results in less aggression and fewer
Late-night social media use and emotional investment in
risky sexual behaviors (Collier et al., 2016; Khurana
social media in adolescence have been associated with poor
et al., 2015; Padilla-Walker et al., 2012). Defined as “a set
sleep quality, anxiety, and depression (Kelly et al., 2018;
of correlated parenting behaviors involving attention to and
Woods & Scott, 2016). Furthermore, girls report more neg-
tracking of the child’s whereabouts, activities, and
ative consequences of social media use including low self- adaptations” (Dishion & McMahon, 1998, p. 61), parental
esteem, body dissatisfaction, and depressive symptoms and monitoring includes efforts to know which social media
are more likely to be a victim of cyberbullying than boys sites (SMS) their adolescent visits, how often their adoles-
(Kelly et al., 2018). According to the 2019 Youth Risk cent uses social media, and with whom the adolescent
Behavior Surveillance System, 15.7% of high school stu- interacts using social media. Parents may shadow their
dents in the United States have reported being bullied elec- adolescent by “friending” or “following” their social media
tronically through texting or some type of social media profile or search the adolescent’s activities online (e.g.,
(Centers for Disease Control and Prevention, 2020). Of searching the adolescent’s name on a search engine or
those who reported being bullied, 20.4% were female com- check websites the adolescent visited by reviewing the
pared to 10.9% of males (2020). Cyberbullying has been browsing history). Although the terms monitoring and
linked to depression, anxiety, and suicide (Byrne et al., mediation are sometimes used interchangeably, in this
2018; Hamm et al., 2015; Hutson et al., 2018). Equally study, parental monitoring was distinct from parental med-
concerning, high school students who engaged in consensual iation. Specifically, in parental monitoring, the parent can
sexting reported higher rates of sexual activity compared to track the adolescent’s activities without intervening
those who were not sexting (Frankel et al., 2018). between the child and the media (Dishion & McMahon,
Social media provide avenues for adolescents to experi- 1998). Parental mediation refers to actual strategies used
ment, explore, and express their identities in a public to help reduce negative effects of the media (Livingstone &
forum. However, adolescents have a propensity for risky Helsper, 2008).
behavior and poor decision making. These tendencies
toward risky behaviors are related to adolescent brain
development (Feldstein Ewing et al., 2016). Specifically,
Study Framework
an underdeveloped prefrontal cortex in the adolescent brain Parental Mediation
has been linked to impaired executive functioning and “Parental management of the relation between children and
decision making in situations of high emotion or high media” (Livingstone & Helsper, 2008, p. 581) served as one
reward, for example, sex, substance use, and obtaining part of the theoretical framework and the definition of
“likes” or “follows” on social media (Hartley & Somer- parental mediation in this research (Figure 1). Practices of
ville, 2015; Schiebener et al., 2015). parental mediation include three categories: active mediation,
Parental monitoring of adolescents is a known protective restrictive mediation, and co-use (Nathanson, 1999; Schofield
factor against risky behavior (Collier et al., 2016). Parents Clark, 2011; Valkenburg et al., 1999). Active mediation refers
aim to protect adolescents from harmful cyber interactions, to parent–child discussions about media content that can be
but in the digital age, parental monitoring has become more instructive or critical in efforts to help the child critically think
challenging due to the ubiquitous use of smartphone and about what is viewed (Nikken & Jansz, 2014; Schofield Clark,
social media apps. Increasing the number of parents who 2011). Restrictive mediation refers to exerting control over the
follow the AAP recommendations to place limits on the time interaction with media by setting rules and restrictions to
children and adolescents spend online is set as a high priority accessing media (Livingstone & Helsper, 2008; Nikken &
public health issue according to the Healthy People 2030 Jansz, 2014; Schofield Clark, 2011). Finally, co-use (also
objectives (U.S. Department of Health and Human Services, called co-viewing) relates to the parent watching or interacting
2020). More research is needed to understand how parents with the media together with the child (Livingstone & Helsper,
manage adolescent social media use, and evidence-based 2008; Schofield Clark, 2011).
interventions are needed to help parents mediate social
media use. While this public health crisis is relevant to all Theory of Planned Behavior (TPB)
health care providers, especially those working with pedia- The TPB served as the second theory in the framework for
tric populations, school nurses are uniquely positioned to this research (Ajzen, 1985; Ajzen & Fishbein, 1980; Figure
help with this concern. School nurses can be a great resource 1). TPB assumes a person’s intent to perform a behavior is
for adolescents and parents to provide tools and education to directly related to their attitude toward the behavior and the
implement strategies to help reduce the negative impacts of belief that people who are important to them will either
social media. support or not support the behavior, known as the subjective
250 The Journal of School Nursing 39(3)

Figure 1. Research conceptual framework (Ajzen, 1985; Nathanson, 1999; Valkenburg et al., 1999).

norm (Ajzen & Fishbein, 1980). In this study, attitude explore parental monitoring and mediation practices of
toward monitoring, the subjective norm, and perceived social media use by their adolescents. The original research
behavioral control of monitoring produced the formation questions included:
of a behavioral intention to monitor. Typically, favorable
attitudes, norms, and greater perceived control result in 1. What do parents know about the risks of adolescent
strong intentions to perform the behavior (in this case, mon- social media use?
itor adolescent social media use; Ajzen & Fishbein, 1980). 2. What are parents’ attitudes toward monitoring their
Assuming parents have complete control over the behavior adolescent’s social media use?
3. What are the parents’ intentions to monitor their
of monitoring, parents were expected to carry out their inten-
adolescent’s social media use?
tions of monitoring.
4. What mediation practices are parents using to subvert
Prior researchers have explored parental mediation of
the negative effects of social media?
internet use, and two studies focused on parental mediation
in children (aged 2–16 years; Nikken & Jansz, 2014; Sonck With new understanding of parental monitoring and
et al., 2013). Another study compared parental mediation in mediation, school nurses and others invested in adolescent
a sample of adolescents (aged 10–18 years) between Dutch health can develop interventions to support parents and
and American parents (Krcmar & Cingel, 2016). Unique to their children as they navigate the benefits and risks of
this study, we expanded exploration to parental monitoring, social media use.
mediation strategies, and parental knowledge of risks related
to social media use. The TPB, concepts of parental monitor-
ing and parental mediation theory, offered a useful frame- Method
work (Figure 1) to explore and describe parental mediation Following expedited approval by the University of Missis-
strategies of their adolescent’s social media use; however, sippi Medical Center’s institutional review board, the
relationships between the concepts were not explored in this research used an exploratory, quantitative design to describe
initial research. Therefore, the purpose of this study was to parental monitoring and mediation practices of adolescent’s
Douglas et al. 251

social media use. Parents of adolescents were recruited Instrument

via paid targeted Facebook advertising to complete an
Based on the TPB (Ajzen, 1985, 2006), parental mediation
online survey using Research Electronic Data Capture
theory, and previous work on parental mediation of chil-
(Version 8.7.1, REDCap™, Vanderbilt University)
dren’s internet use (Nikken & Jansz, 2014; Sonck et al.,
hosted by an academic health sciences center in the
2013), the research team developed a 64-item survey. The
southeastern United States. According to Smith and
survey contained 21 items addressing demographic ques-
Anderson (2018), 68% of U.S. adults use Facebook, and
tions of parents and their teens, parents’ computer skills, and
74% of those users visit the site daily. Therefore, Face-
frequency and types of parents’ and their adolescent’s social
book was an excellent platform for the needed sample, media use. Before implementation, two content experts
reaching parents who use the internet and are more reviewed the instrument for face validity.
likely to mediate adolescent social media use.
Due to the exploratory nature of the study, a sample size
TPB. Parents’ attitude toward monitoring their adolescent’s
estimation was not recommended (Jones et al., 2003). How-
social media use was measured by one item. The parent was
ever, five published studies that explored parent mediation
asked to rate their agreement to the statement, “Parents
of children’s internet use obtained an average sample size of
should monitor their preteen/teen’s social media use.” Two
670 (range: 357–1,004; Livingstone & Helsper, 2008;
items were used to measure parents’ subjective norms of
Padilla-Walker et al., 2016, 2018; Sonck et al., 2013;
monitoring. Parents were asked to what extent they agreed
Symons et al., 2017) providing a target sample size of 700
to the following statements: “People who are important to
for this study.
me would encourage me to monitor my preteen/teen’s social
Participants included any person over the age of 18 who
media use” and “People who are important to me would
was fulfilling the responsibility of parenting for an adoles-
support me to monitor my preteen/teen’s social media use.”
cent (11–17 years), such as mother, father, guardians, grand- Responses were on a 5-point Likert-type scale (1 ¼ strongly
parents, or other family members. No participant identifiers agree to 5 ¼ strongly disagree). Parents’ perceived beha-
were collected, and no incentives were offered to vioral control of monitoring their adolescent’s social media
participants. use was measured using three items. Parents were asked to
rate the statement “Monitoring my preteen/teen’s social
media use is/would be” using a 7-point rating scale (1 ¼
Data Collection extremely hard to 7 ¼ extremely easy). Parents were then
The study was introduced to participants in one of three asked to what extent they agreed with the following state-
ways. First, a Facebook advertisement using three different ment, “I am confident I can monitor my preteen/teen’s social
images of adolescents and their smartphone targeted the media use.” Responses were on a 5-point Likert-type scale
population of interest via individual newsfeeds. The poten- (1 ¼ strongly agree to 5 ¼ strongly disagree). Finally, par-
tial participant could voluntarily click the “Learn More” ents were asked how much control they think they have in
button. The Learn More button took the participant to the monitoring their adolescent’s social media use. Responses
study landing page. The landing page contained information were on a 4-point Likert-type scale (1 ¼ no control to 4 ¼
on the study purpose, efforts to maintain privacy and con- complete control). Parental intention to monitor their ado-
fidentiality, and risks and benefits of participating. Then, the lescent’s social media use was measured by one item, “I
potential participant responded to two screening questions, intend to monitor my preteen/teen’s social media use in the
“Are you 18 years of age or older?” and “Are you fulfilling future.” Responses were on a 5-point Likert-type scale (1 ¼
the responsibilities of a parent of an adolescent between the strongly disagree to 5 ¼ strongly agree).
ages of 11 and 17 years?” If they answered “yes” to both
questions, they were taken to the “parental monitoring of Parental monitoring. Parental monitoring was measured by
your preteen’s or teen’s social media use” survey. If they eight items. First, parents were asked if the parent knows
answered “no” to either of the questions, the software dis- their adolescent’s passwords for social media accounts,
played a message thanking them for their interest and email, or mobile phone. Next, the parent was asked to indi-
explaining that they were not eligible to participate in the cate yes, no, or “n/a” to five statements about actions they
study. Second, a study Facebook page was created to link to may have taken to monitor their adolescent’s social media
the Facebook ad. Here, the potential participant could volun- use, such as “searched for your preteen/teen’s name online to
tarily click the Learn More button that took the participant to see what information is available about them” and “used
the landing page as described above. Finally, the researcher monitoring tools to track your preteen/teen’s location with
utilized a snowball technique by sharing the Facebook ad their mobile phone” (Table 1).
through networks of friends and colleagues via Facebook.
Any Facebook user who received the ad could share the Parental mediation. Parental mediation was measured by 17
Facebook ad or study Facebook page. items to measure restrictive, active, and co-use strategies
252 The Journal of School Nursing 39(3)

Table 1. Survey Items: Parental Monitoring and Mediation.

Item Response Type

Have you ever done any of the following things Yes/no/N/A

Read a privacy policy for a website or social media site your preteen/teen was using?
Searched for your preteen/teen’s name online to see what information is available about them?
Helped your preteen/teen because you were concerned about something
posted to their profile or account?
Talked with your preteen/teen because you were concerned about something on their social media account?
Posted a comment on your preteen/teen’s social media about something on their social media profile or account?
Used parental controls on your preteen/teen’s mobile phone or computer?
Checked which websites your preteen/teen visited?
Taken away your preteen/teen’s cell phone or internet privileges as
punishment?
Limited the amount of time or times of day when your preteen/teen can go online?
Used monitoring tools to track your preteen/teen’s location with their mobile phone?
Looked at the phone call records or messages on your preteen/teen’s phone?
a
How often do you use social media (e.g., look at other profiles, make posts, send messages or pictures) with your Range: 1–5
preteen/teen together?
a
How often do you talk with your preteen/teen about . . . ? Range: 1–5
What is appropriate or inappropriate online behavior toward others
Talking with strangers online
What is appropriate or inappropriate for their age
That their use of technology is something you, the parent, want and need to know about
That everything sent over the internet can be shared
Sexting and/or stories of teen’s sexting (sending or receiving sexually explicit messages or images via social media or
mobile phone)
Cyberbullying
To what extent are you concerned, if at all, about the following issues? Range: 1–5.b
How your preteen/teen maintains their reputation online
How much information advertisers can learn about your preteen/teen’s online behavior
How your preteen/teen talk with people they do not know online
Your preteen/teen watching sexually explicit material (such as pornography)
Your preteen/teen participating in “sexting” (sending or receiving sexually explicit messages or images via social media
or mobile phone)
Legal trouble because of participating in sexting
How your preteen/teen’s online activity might affect their future academic or employment opportunities
Effects on health, such as effects on sleep
Number of people who are depressed (related to cyberbullying, sexting, or technology addiction)
Watching violent behavior
Private information getting into the wrong hands

Note. N/A ¼ not applicable.

a
Frequently, somewhat frequently, occasionally, rarely, and never. b Extremely worried, very worried, moderately worried, slightly worried, and not at all
worried.

and is listed in Table 1. Restrictive mediation was measured by one item asking the parent “how often do you use social
by four items. Parents were asked to indicate yes, no, or n/a media (e.g., look at other profiles, make posts, send mes-
if they have ever done actions related to restrictive media- sages or pictures) with your preteen/teen?” Responses were
tion such as “used parental controls on your preteen/teen’s on a 5-point Likert-type scale (1 ¼ frequently to 5 ¼ never;
mobile phone or computer.” Active mediation was measured Table 1).
by 12 items. First, parents were asked to indicate yes, no, or
n/a to four statements related to active mediation such as Parental knowledge of risks of adolescent social media. Parental
“read a privacy policy for a website or SMS your preteen/ knowledge of risks related to social media use was measured
teen was using.” Next, the parent was asked how often they by 11 items. Parents were asked, “To what extent are you
talked with the teen about eight statements related to risky concerned, if at all, about the following issues” followed by
social media behavior, for example, “sexting and/or stories 11 statements such as “How your preteen/teen maintains
of teen’s sexting.” Responses used a 5-point Likert-type their reputation online” and “How your preteen/teen talk
scale (1 ¼ frequently to 5 ¼ never). Co-use was measured with people they do not know online” (Table 1). Responses
Douglas et al. 253

Table 2. Parent Demographics.

Characteristics n % Characteristics n %

Parent role Parent education

Mother 710 84.9 Less than high school 6 0.7
Father 11 1.3 High school diploma 67 8.0
Stepmother 15 1.8 Some college 216 25.8
Stepfather 1 0.1 College graduate 435 52.0
Grandparent 8 1.0 Total 746
Other family member 1 0.1 Household
Legal guardian 3 0.4 One parent 134 16.0
Other 1 0.1 Two parent 483 57.8
Total 750 Blended 107 12.8
Parent age (years) Other 12 1.4
Less than 35 63 7.5 Total 736
35–39 174 20.8 Children younger than 11
40–44 179 21.4 None 432 51.7
45–49 163 19.5 One 187 22.4
50–54 115 13.8 Two 80 9.6
55þ 56 6.7 Three or more 40 4.8
Total 750 Total 739
Parent race/ethnicity Children between 11 and 17
White (non-Hispanic) 672 80.4 One 440 52.6
Black (non-Hispanic) 18 2.2 Two 223 26.7
Hispanic 30 3.6 Three or more 80 9.6
Other 27 3.2 Total 743
Total 747

were on a 5-point Likert-type scale (1 ¼ extremely worried 31.3%, Midwest: 29.5%, West: 13.3%, and Pacific: 0.1%).
to 5 ¼ not at all worried). Parent-reported adolescent demographics showed a majority
of the adolescents were female (62.9%) and White (81.6%).
Data Analysis
Data analysis was conducted using IBM SPSS Version 24 TPB Constructs
(IBM Corp., 2016) after data were imported from RED- The TPB included variables of parents’ attitudes toward
Cap™. Descriptive statistics were used to describe the sam- monitoring, subjective norms, perceived behavioral control,
ple demographics. The w2 test was used to investigate and intention to monitor. Most parents (92.0%) agreed par-
whether parents’ responses differed by groups of parents. ents should monitor their adolescent’s social media use, a
Responses from parents of sons compared to parents of finding that was consistent with perceived subjective norms
daughters and parents of younger compared to parents of that would encourage (86.5%) and support (92.2%) them to
older adolescents were analyzed. Seventeen items included monitor their teen’s social media (Table 3). However, only
a response of N/A, which ranged from 1.3% to 9.4% of the 69.0% agreed or strongly agreed that they were confident to
responses for those items. In instances where N/A was an monitor their teen. Just under half (46.6%) reported moni-
option, the response was recategorized as “missing” for toring their teen would be “easy,” while 41.5% reported it
analysis purposes. Less than 10% of responses were missing would be “hard.” When asked about their intent to monitor,
for each variable. All tests were two-sided, and a signifi- most parents agreed (76.8%) they had intentions to monitor
cance threshold of p < 0.05 was used for this study. their adolescent’s social media use. Cronbach’s as for the
two subjective norm items and three perceived behavioral
control items were .85 and .76, respectively.
Results
This nationwide sample (n ¼ 836; Table 2) was primarily
Parental Monitoring
mothers (84.9%), White (80.4%), and college educated Most parents in this study reported knowing the password to
(25.8% some college; 52.0% college graduate). Survey their adolescent’s mobile phone (73.3%) and email (66.5%),
responses included participants reporting from every state but fewer parents knew the password for their adolescent’s
in the United States except Hawaii and the District of SMS (59.3%). Parents reported having posted a comment on
Columbia. Locations were aggregated according to the their adolescent’s social media profile (51.0%), checked
U.S. Census Bureau regions (Northeast: 14.4%, South: websites their adolescent has visited (77.0%), checked their
254 The Journal of School Nursing 39(3)

Table 3. Theory of Planned Behavior Descriptive Statistics.

Strongly agree, Agree, Neutral, Disagree, Strongly disagree,

Constructs N n (%) n (%) n (%) n (%) n (%)

I intend to monitor a 827 332 (39.7) 310 (37.1) 88 (10.5) 40 (4.8) 57 (6.8)
Parents should monitor b 831 534 (63.9) 235 (28.1) 56 (6.7) 4 (0.5) 2 (0.2)
People important to me would 830 442 (52.9) 281 (33.6) 88 (10.5) 16 (1.9) 3 (0.4)
encourage me to monitor c
People important to me would 832 483 (57.8) 288 (34.4) 52 (6.2) 9 (1.1) 0
support me to monitor c
I am confident I can monitor d,e 829 237 (28.3) 342 (40.9) 125 (15.0) 109 (13.0) 16 (1.9)

Hard Somewhat hard Neither hard Somewhat easy Easy

nor easy
d
Monitoring my teen would be 833 117 (14.0) 230 (27.5) 96 (11.5) 164 (19.6) 226 (27.0)

No control Very little control Some control Complete control

How much control do have in 830 23 (2.8) 120 (14.4) 516 (61.7) 171 (20.5)
monitoring d
a
Intent. b Attitude. c Subjective norms. d Perceived behavioral control. e Item 18.

adolescent’s social media profile (81.9%), and searched for somewhat frequently), and “cyberbullying” (69.8%—fre-
their teen’s name online (62.1%). Finally, more than half quently or somewhat frequently). Cronbach’s a for the eight
(52.9%) had tracked their adolescent’s location on their ado- active mediation Likert-type scale items was .93. Co-use
lescent’s mobile phone. was used the least among parents in this study (36.4%—
frequently or somewhat frequently).
Parental Mediation
Parents’ Knowledge of Risks of Adolescent Social
Parents reported using some restrictive mediation practices. Media Use
Almost 60% of parents reported using parental controls
(58.9%) on their adolescent’s phone or computer, but only The highest concern of parents in this study expressed was
47.7% reported using web filtering software. Most often “private information getting into the wrong hands”
used restrictive mediation practices included taking away (50.9%—extremely worried or very worried). Parents also
their adolescent’s cell phone or internet privileges as punish- reported concern regarding “depression” (47.3%—extremely
ment (77.4%) and limiting the amount of time or times of worried or very worried) and the “effects on health”
day their adolescent could go online (70.6%). Parents also (44.5%—extremely worried or very worried). Parents were
used active mediation. Just over half of the parents (52.8%) less concerned about “legal trouble because of their teen par-
reported reading a privacy policy for a website or SMS their ticipating in sexting” (26.8%—extremely worried or very
adolescent was using. More than two thirds (66.9%) reported worried) and “how their teen maintains their reputation
helping their adolescent set up privacy settings for an SMS, online” (23.9%—extremely worried or very worried). Cron-
and 65% talked with their adolescent because the parent was bach’s a for the 11 parental knowledge items was .94.
concerned about something posted on their adolescent’s
social media account.
Comparing Groups
Parents in this study also reported a high frequency of After our initial analysis of the data, the w2 test was used to
talking with their adolescents about risks related to adoles- investigate for any differences among groups of parents.
cent social media. Parents talked to their adolescent most Responses from parents of sons were compared with parents
often about “everything sent over the internet can be shared” of daughters and parents of younger adolescents (11–14
(81.1%—frequently or somewhat frequently), followed by years) with parents of older adolescents (15–17 years). Few
“what is appropriate to share online” (77.5%—frequently or differences appeared in parental monitoring practices with
somewhat frequently) and “talking with strangers online” parents of sons compared with daughters. Knowing the pass-
(76.5%—frequently or somewhat frequently). Although still word to their teen’s social media and phone differed by
common, the topics parents discussed the least with their gender of the child. Of parents with daughters, 66.9% knew
adolescent were “sexting or stories of sexting” (71.0%— the password to social media accounts, and 83.6% knew the
frequently or somewhat frequently), “which online content password to the phone. Significantly different, 59.6% of
is appropriate for their age” (69.6%—frequently or parents of sons knew the password to social media, and
Douglas et al. 255

Table 4. Parental Monitoring and Mediation Strategies Among Parents of Daughters and Sons.

Parents of n (%)

All, N ¼ 836 Males, n ¼ 301 Females, n ¼ 526 p Value

Do you know the password to your teen’s

Social media password
Yes 490 (64.3) 161 (59.6) 329 (66.9) .046*
No 272 (35.7) 109 (40.4) 163 (33.1)
Missing/N/A a 65
Mobile phone password
Yes 605 (80.1) 197 (73.8) 408 (83.6) .001**
No 150 (19.9) 70 (26.2) 80 (16.4)
Missing/N/A a 73
Checked your teen’s social media profile
Yes 678 (89.1) 227 (83.8) 451 (92.0) <.001**
No 83 (10.9) 44 (16.2) 39 (8.0)
Missing/N/A a 67
Have you ever done any of the following
Helped your teen set up privacy settings
Yes 553 (71.5) 174 (62.4) 379 (76.7) <.001***
No 220 (28.5) 105 (37.6) 115 (23.3)
Missing/N/A a 54
Talked with your teen because you were concerned about something posted
Yes 537 (73.2) 117 (68.1) 360 (75.9) .021*
No 197 (26.8) 83 (31.9) 114 (24.1)
Missing/N/A a 93
Posted a comment on your teen’s social media
Yes 421 (56.7) 128 (48.9) 293 (60.9) .002**
No 322 (43.3) 134 (51.1) 188 (39.1)
Missing/N/A a 84
Items 38–45 b w2 df
Appropriate online behavior 13.444 4 .009**
Talking with strangers online 19.188 4 .001**
What is appropriate to share online 12.468 4 .014*
Which online content is appropriate for age 10.880 4 .028*
Their technology use is something you need to know about 8.783 4 .067
Everything sent over the internet can be shared 2.323 4 .677
Sexting or stories of sexting 9.322 4 .054
Cyberbullying 9.206 4 .056
a
Missing includes nonresponses and responses of not applicable (N/A) and not included in percentages. b Responses were reverse coded for analysis: range (1
¼ never to 5 ¼ frequently).
*p < .05. **p < .01. ***p < .001.

73.8% knew the password to phone (p ¼ .046; p < .001, media use. The only exception was more parents of sons
respectively). More parents of daughters (92.0%) reported were concerned about their teen watching sexually explicit
checking their teen’s social media profile compared with material compared to parents of daughters (p ¼ .003).
parents of sons (83.8%; p < .001; Table 4). Several differences were seen among parents of younger
No differences existed between the gender of the child adolescents (11–14 years) compared with parents of older
and restrictive mediation practices. More parents of daugh- adolescents (15–17 years). Knowing the password to social
ters, however, reported active mediation strategies com- media accounts, email, and phone differed by age categories
pared with parents of sons. For instance, 76.7% of parents with 73.5% of parents of younger adolescents knowing the
of daughters helped their teen set up privacy settings on their password to their adolescent’s social media compared with
social media compared with 62.4% of parents of sons (p < 55.2% of parents of older adolescents (p < .001), 77.6% of
.001). Finally, slightly more parents of daughters (39.9%) parents of younger adolescents knowing the password to
reported using co-use mediation practices compared with their adolescent’s email compared with 62.4% of parents
31.6% of parents of sons (p ¼ .045). No differences were of older adolescents (p < .001), and 86.8% of parents of
noted among parents of sons compared with parents of younger adolescents knowing the password to their phone
daughters and concern regarding risks of adolescent social compared with 74.1% of parents of older adolescents (p <
256 The Journal of School Nursing 39(3)

Table 5. Parental Monitoring and Mediation Strategies Among Table 6. Active Mediation Among Parents of Younger and Older
Parents of Younger and Older Adolescents. Adolescents.
a
Parents, n (%) Active Mediation (Items 38–45) w2 df p Value

Younger Older Appropriate online behavior 17.643 4 .001

All, Adolescent, Adolescent, Talking with strangers online 29.488 4 <.001
N ¼ 830 n ¼ 441 n ¼ 389 p Value What is appropriate to share online 15.757 4 .003
Which online content is appropriate for age 30.318 4 <.001
Do you know the password to your teen’s: Their technology use is something you 30.182 4 <.001
social media need to know about
Yes 492 (64.3) 280 (73.5) 212(55.2) <.001*** Sexting or stories of sexting 22.164 4 <.001
No 273 (35.7) 101 (26.5) 172 (44.8)
Missing a 41 n ¼ 836. df ¼ degrees of freedom.
a
Email Responses were reverse coded for analysis: range (1 ¼ never to
Yes 553 (70.2) 312 (77.6) 241 (62.4) <.001*** 5 ¼ frequently).
No 235 (29.8) 90 (22.4) 145 (37.6)
Missing a 73
Mobile phone .001). More parents of younger adolescents (85.6%) checked
Yes 609 (80.4) 328 (86.8) 281 (74.1) <.001*** websites their teen had visited compared with parents of
No 148 (19.6) 50 (13.2) 98 (25.9) older adolescents (70.4%; p < .001), and 83.8% of parents
Missing a 39
of younger adolescents looked at their teen’s phone call
Have you ever done any of the following:
Searched for your teen online record or messages compared to 70.0% of parents of older
Yes 516 (63.0) 250 (57.9) 266 (68.7) .001** adolescents (p < .001; Table 5).
No 303 (37.0) 182 (42.1) 121 (31.3) Restrictive mediation practices showed greater differ-
Missing a 12 ences among age groups. More parents of younger adoles-
Checked websites your teen has visited cents used parental controls (73.4%) and web filtering
Yes 640 (78.4) 369 (85.6) 271 (70.4) <.001***
No 176 (21.6) 72 (14.4) 114 (29.6)
software (57.1%) compared with parents of older adoles-
Missing a 14 cents (45.7%, p < .001; 40.8%, p < .001, respectively). Par-
Looked at phone call records or messages on your teen’s phone ents of younger adolescents were more likely to report using
Yes 595 (77.0) 327 (83.8) 268 (70.0) <.001*** active mediation practices than parents of older adolescents.
No 178 (23.0) 63 (16.2) 115 (30.0) For example, more parents of younger adolescents (76.9%)
Missing a 57 helped their teens set up privacy settings for their social
Have you ever done any of the following:
Used parental controls
media compared with parents of older adolescents (66.1%;
Yes 490 (60.3) 314 (73.4) 176 (45.7) <.001*** p < .001). On the contrary, more parents of older adolescents
No 323 (39.7) 114 (26.6) 209 (54.3) (64.2%) posted a comment on their teen’s social media com-
Missing a 18 pared to only 48.9% of younger adolescents (p < .001).
Used web filtering software Parents of younger adolescents reported talking to their teen
Yes 397 (49.4) 242 (57.1) 155 (40.8) <.001*** more than parents of older adolescents about several risks
No 407 (50.6) 182 (42.9) 225 (59.2)
Missing a 27 related to adolescent social media use with the only excep-
Taken away your teen’s phone or internet as punishment tion being that of the topic of sexting. Parents of older ado-
Yes 643 (79.1) 354 (83.1) 289 (74.7) .003* lescents (76.8%) reported talking to their teen about sexting
No 170 (20.9) 72 (16.9) 98 (25.3) or stories of sexting statistically significantly more fre-
Missing a 17 quently compared to parents of younger adolescents
Limited the amount of time or times of day your teen can access (72.2%, p < .001; Table 6).
the internet
Yes 587 (71.9) 346 (81.0) 241 (62.0) <.001***
No 229 (28.1) 81 (19.0) 148 (38.0)
Missing a 14 Discussion
Helped your teen set up privacy settings In this study, we explored the parental monitoring and med-
Yes 555 (71.5) 300 (76.9) 255 (66.1) .001**
iation practices of their adolescent’s social media use.
No 221 (28.5) 90 (23.1) 131 (33.9)
Missing a 54 According to the literature, most parents utilize some form
Posted a comment on your teen’s social media of monitoring practices to subvert the negative effects of
Yes 423 (56.7) 179 (48.9) 244 (64.2) <.001*** media (Padilla-Walker et al., 2018). Our findings were sim-
No 323 (43.3) 187 (51.1) 136 (35.8) ilar with most parents reporting monitoring their adoles-
Missing a 84 cent’s social media, such as knowing the password to their
Note. N/A ¼ not applicable. adolescent’s social media and using monitoring tools to
a
Missing includes nonresponses and responses of “N/A.” track their adolescent’s location; however, one third of par-
*p < .05. **p < .01. ***p < .001. ents reported not doing these things.
Douglas et al. 257

Utilizing the TPB as a framework for exploring parental media (Krcmar & Cingel, 2016; Padilla-Walker & Coyne,
monitoring of adolescent social media use provided insight 2011; Padilla-Walker et al., 2012; Sonck et al., 2013). Nev-
into parents’ intentions to monitor. Most parents agreed or ertheless, slightly fewer parents discussed risks such as sext-
strongly agreed that parents should monitor their adoles- ing and cyberbullying. Prevalence of sexting and
cent’s social media use and reported positive responses to cyberbullying ranges 23%–30% among adolescents (Byrne
subject norms; however, parents reported less confidence in et al., 2018; Frankel et al., 2018; Hamm et al., 2015; Romo
their perceived control of monitoring. These results were et al., 2017). Parents talking to their adolescents about these
similar to other studies both in the United States and inter- risky behaviors can reduce the risk of them engaging in these
nationally (Krcmar & Cingel, 2016; Sonck et al., 2013). activities (Pechmann & Catlin, 2020), but starting these con-
According to the TPB, perceived behavioral control is versations can be difficult for some parents. School nurses
instrumental in predicting intention to perform a behavior can help facilitate these conversations by providing educa-
when behavior is under volitional control and may explain tion for parents on effective communication on difficult
the reduced reports of intention to monitor compared to topics.
attitudes toward monitoring (Ajzen, 1985). When comparing groups, more parents of daughters
Parental monitoring during the adolescent years is chal- reported knowing the passwords of the various communica-
lenging for parents and is somewhat dependent on the ado- tion devices (phone, email, and social media) and checked
lescent to willingly disclose their activities to the parent their adolescent’s profile compared to parents of sons. These
(Kerr et al., 2010). School nurses may be the first to witness results are similar to those of Khurana et al. (2015) who
such things as cyberbullying or the consequences of cyber- found girls reported increased rates of parental monitoring
bullying and are in a position to assist parents in addressing compared to boys. Yet Kelly et al (2018) found girls were
the negative effects (Byrne et al., 2018). Parents can monitor more at risk for spending more time on social media, to
their adolescent’s activity online by being their “friend” on experience cyberbullying, have low self-esteem, and to
social media to monitor what is posted on their adolescent’s report depressive symptoms. On the contrary, Liau et al.
social media (Romo et al., 2017). Nevertheless, adolescents (2008) found parents reported greater levels of parental
are resourceful, long for privacy, and have found ways to monitoring in the activities of supervision and tracking of
sabotage some monitoring efforts such as blocking their boys compared to girls.
parents from their SMS and creating fake profiles not dis- More parents of younger adolescents reported monitoring
closed to parents. As the landscape of monitoring adoles- and mediation practices compared with parents of older ado-
cent’s activities changes, parents benefit from understanding lescents. These results are consistent with other studies
how to monitor their adolescent social media use in other (Livingstone & Helsper, 2008; Nikken & Jansz, 2014;
ways. Likewise, school nurses need to understand the neg- Padilla-Walker & Coyne, 2011; Sonck et al., 2013) that
ative effects of social media to screen students who may found parents utilize more monitoring and mediation prac-
come to them to receive care (Byrne et al., 2018). Common tices of children’s internet use when their child is younger
Sense Media®, a nonprofit organization providing informa- and then adjust their monitoring efforts as the child ages.
tion and advice to parents and educators about various media Parents rely less on monitoring practices with adolescents to
types, is an easily accessible website for parents, nurses, and allow them greater autonomy. Providing resources to parents
teachers to learn the latest research on social media use before middle school can help parents set standards and
(Common Sense, 2020). healthy social media use behaviors for preadolescents and
Results from this study showed most parents reported guide parents who may want to limit their child’s access or
using restrictive mediation such as using parental controls delay their participation in social media. Another source for
on their adolescent’s phone or computer and limiting the nurses and parents is Families Managing Media®, which
amount of time their adolescent can go online. Nevertheless, provides information, resources, and tools for parents related
just under half of the parents reported using web filtering to delaying and limiting screen time for children and ado-
software. These results are similar to those of Livingstone lescents (Families Managing Media, 2020).
and Helsper (2008) who found parents restricted their child Consistent with prior research regarding parental media-
or adolescent from using the internet, but only a few used tion of adolescent’s internet use, these results showed par-
web filtering software. Web filtering software can help track ents are very concerned about many of the known risks of
and monitor adolescent social media use. School nurses adolescent social media use. In this study, parents’ greatest
could develop educational material to help parents who have concerns were private information getting into the wrong
fewer technical skills to understand the options in web filter- hands followed by depression and effects on health such
ing software and tools already built in some smartphones as sleep. These findings reveal that the greatest concerns
such as “Screen Time” on the Apple iPhone (Apple, 2018). of parents were related to health issues, supporting adoles-
This study’s findings were consistent with other studies cent social media use as an important topic specifically for
regarding active mediation as the most common mediation school nurses as they interact with preadolescents and
strategy used by parents to counteract the negative effects of adolescents.
258 The Journal of School Nursing 39(3)

Implications for School Nurses researcher’s knowledge, no validated instrument exists to

measure parental monitoring and mediation of adolescent
Study results indicated that while parents desire and intend
social media use. The development of psychometrically
to monitor social media use, there remains an inability by
sound instruments to measure parental mediation of adoles-
many to implement the monitoring and mediation that is
cent social media use is needed.
perceived to be necessary to mitigate social media use and
misuse. This educational deficit presents an opportunity for
the school nurse to discuss options for monitoring and med- Conclusion
iating social media. First, by screening adolescents for
depression, anxiety, and problematic social media use, This study highlighted areas of concern and need for educa-
school nurses can help identify at-risk adolescents (Allison tion of parents regarding the risks and benefits of adolescent
et al., 2014). Nevertheless, few tools have been developed social media use and the resources available to parents to
specifically for school nurses. For example, the AAP’s monitor their adolescent. Parents are concerned about sev-
Bright Futures: Guidelines for Health Supervision of eral risks and believe they should be monitoring their ado-
Infants, Children, and Adolescents (Hagan et al., 2017) gives lescent’s social media use; however, they lack confidence in
directions for health care providers for screening media and their ability to do this effectively. Resources are available to
anticipatory guidance, but it lacks information on specific parents, but most parents are left searching for these
concerns related to problematic social media use. Second, resources on their own. Some parents lack the knowledge
school nurses can advocate for and equip parents with and/or technical skills to utilize the tools available to them.
resources and training to understand the benefits and risks Efforts to increase the number of parents following AAP
of social media and the use of monitoring tools such as web recommendations to place limits on the time their child
filtering software. Efforts to increase media literacy can spends using media is a high-priority public health issue
have a positive impact on the confidence parents need to (U.S. Department of Health and Human Services, 2020).
monitor and mediate their adolescent’s social media use. With the onset of COVID-19 and the switch to online learn-
Likewise, school nurses can help parents start conversations ing, adolescents are now spending even more time on
about sensitive topics such as sexting. Finally, school nurses screens (Nagata et al., 2020). School nurses cannot address
can help parents set standards or even delay social media this alone, but they can be a great resource for parents for
use, if parents so choose, in order to promote the healthy use tools and education to implement strategies to help monitor
of social media and improve the health of adolescents in and mediate their adolescent’s social media use. Parents,
their schools. Introducing this education for parents when schools, and health care providers need to be aware and
children are in elementary school may also help reduce the involved in the activities of adolescents to maintain a pulse
negative effects associated with adolescent social media use. of what occurs on SMS and its effect on their health. Future
research should include the development of psychometri-
Limitations cally sound instruments to measure parental monitoring and
mediation of adolescent social media use. Finally, more
Limitations of this study included the sample demographics research is needed to explore the development of interven-
and limited generalizability. Most participants were White tions for school nurses to use for the education of parents and
mothers with high levels of education. Therefore, the find- measure student health and education outcomes (Best et al.,
ings have limited generalizability to highly educated White 2018).
females. For example, less than 15% of our sample was
male. The way Facebook chooses who views the Facebook
Acknowledgment
ad may also play a role in those who engaged in the study.
Females may post, like, or share information related to par- We would like to thank Dr Kathleen Rhodes, PhD, RN, FNP-C,
enting more often than males and may inevitably have been assistant professor of Nursing and Nurse Practitioner in a school-
based clinic for her expertise and contribution to this article.
shown the ad related to parenting more often. Also, the use
of snowball sampling may have contributed to the homoge-
nous sample as the demographics of this sample were similar Author Contributions
to those of the primary researcher. Using only one SMS, K.D.D., K.K.S., M.W.S., J.W., L.M., and L.Z. contributed to con-
Facebook, does not account for parents or guardians who ception or design; contributed to acquisition, analysis, or interpre-
either do not use social media or may use a different SMS, tation; critically revised the article; gave final approval; and agreed
such as Instagram or Twitter. While social media may to be accountable for all aspects of work ensuring integrity and
encourage participation, one cannot confirm the identity of accuracy. K.D.D. drafted the article.
the one completing an anonymous survey.
Finally, the novel instrument requires interpreting the Declaration of Conflicting Interests
results with caution. Although instruments have been devel- The author(s) declared no potential conflicts of interest with respect
oped to measure parental mediation constructs to the to the research, authorship, and/or publication of this article.
Douglas et al. 259

Funding substance use, and sexual behavior. Developmental Psychology,

The author(s) disclosed receipt of the following financial support 52, 798–812. https://doi.org/10.1037/dev0000108
for the research, authorship, and/or publication of this article: Common Sense. (2020). About us. https://www.commonsenseme
Funding for this study was made possible by the Mississippi Nurses dia.org/
Foundation’s PhD Nursing Research Grant. Dishion, T. J., & McMahon, R. J. (1998). Parental monitoring and
the prevention of child and adolescent problem behavior: A
ORCID iD conceptual and empirical formulation. Clinical Child and Fam-
ily Psychology Review, 1(1), 61–75.
Kimberly D. Douglas, PhD, RN, CNE https://orcid.org/0000-
0003-1804-3239 Families Managing Media. (2020). Screen strong. https://screen
strong.com/
Feldstein Ewing, S. W., Ryman, S. G., Gillman, A. S., Weiland, B. J.,
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Douglas et al. 261

Author Biographies Jean Walker, PhD, RN, is a professor in School of Nursing at the
University of Mississippi Medical Center.
Kimberly D. Douglas, PhD, RN, CNE, is an assistant professor in
School of Nursing at the University of Mississippi Medical Center. Leandro Mena, MD, MPH, is a professor and chair of the Depart-
ment of Population Health Science, a professor of Medicine in Divi-
Kandy K. Smith, DNS, RN, is a professor in School of Nursing at
sion of Infectious Diseases, and School of Population Health/School
the University of Mississippi Medical Center.
of Medicine at the University of Mississippi Medical Center.
Mary W. Stewart, PhD, RN, is a professor in School of Nursing at
Lei Zhang, PhD, MBA, is a professor in School of Nursing at the
the University of Mississippi Medical Center.
University of Mississippi Medical Center.
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