Researchers conducted a qualitative descriptive study in Erbil Governorate between July and September 2025. They used maximum variation purposive sampling to recruit 20 participants, including men and women, younger and older respondents, residents with different educational and family circumstances, and young people with varied levels of digital engagement and self-rated family support. All participants were selected from people who had responded to an earlier anonymous survey and had provided written agreement to be contacted again. Data were collected through face-to-face, semi-structured interviews, which were audio-recorded and transcribed verbatim.

The transcripts were analysed using inductive content analysis informed by the work of Graneheim and colleagues and supported by MAXQDA software. The researchers reported the study in line with the COREQ checklist. Their analysis identified three broad categories and nine subcategories. The personal and internal category included internalized stoicism, guilt or fear of becoming an emotional burden, and difficulty recognizing and articulating emotions. The social and cultural category covered norms that equate emotion with weakness, fear of emotional exploitation and interpersonal distrust, and gendered expectations and family pressure. The digital and online category included fear of permanent digital exposure, self-censorship and deletion of emotional content, and pressure to perform happiness online.

These findings suggest that the decision to suppress emotion was not presented as a single reaction to social media or digital communication. Participants linked it to the internal meanings they attached to emotional expression, the expectations of family and wider society, and the risks they associated with leaving emotional traces online. The study is restricted to 20 young people in one Iraqi setting, and its design does not allow the researchers to determine the frequency of these experiences or to assess causal relationships between digital use and emotional suppression. The authors instead emphasize that the themes reflect how participants understood their own experiences in the context of personal, cultural and digital pressures.

The researchers concluded that culturally adapted psychosocial and digital-literacy interventions, developed with young people and delivered in community and educational settings, may be worth exploring and evaluating. The source presents this as a direction for future intervention research, not as evidence that any particular program has already produced clinical benefits. Because the study was qualitative and locally focused, additional work would be needed to test the frequency, mechanisms and broader applicability of the reported patterns, as well as the effectiveness of any proposed responses.

Subject of Research: Qualitative study of emotional suppression among young people in Erbil, Iraq

Article Title: Silenced emotions in the digital age: a qualitative study of emotional suppression among young people aged 15–28 years in Erbil, Iraq

Article References: Rasool, A. A., Kareem, M. S., Zainalddin, H. K., Saber, A. F., Ali, A. N., Hussain, H. A., Mohammed, K. S., Faqe, M. G., Ahmed, K. O., & Majeed, N. K. (2026). Silenced emotions in the digital age: a qualitative study of emotional suppression among young people aged 15–28 years in Erbil, Iraq. BMC Psychology. https://doi.org/10.1186/s40359-026-05610-2

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05610-2

Keywords: emotional suppression, young people, digital communication, Erbil, Iraq, qualitative research, social media, cultural norms, self-censorship, psychosocial research, Silenced, emotions

The scale and ambition of modern health data research are difficult to overstate. Large-scale datasets drawn from electronic health records, administrative systems, disease registries, and digital technologies are transforming how researchers understand disease patterns, treatment outcomes, and population health trends. Instead of studying small groups of patients in isolation, scientists can now follow entire populations over time, spotting signals that would be invisible in conventional clinical trials. For children’s healthcare in particular, where rare conditions and long-term developmental outcomes make traditional studies slow and expensive, routinely collected data promises insights that could shape care for generations. Yet the same features that make big data powerful also raise concerns. Data collected for one purpose are often routinely reused beyond their original context, and critics have pointed to cases where information has been sold to commercial companies. Governance structures can be opaque, and participants are typically far removed, both physically and institutionally, from the researchers who analyse their information, creating a distance that can breed suspicion.

Much of what is known about public attitudes to health data sharing comes from studies of general adult populations, which have found broad but conditional support, particularly where there is perceived public benefit and trust in the organisations involved. Evidence specifically exploring the views of children and young people, especially those from groups underrepresented in research, has been far scarcer. That gap matters, because children’s data are used in research with decisions made on their behalf, and because today’s young people will become tomorrow’s adult participants in an increasingly data-saturated research environment. To address the gap, researchers from the Department of Psychiatry at the University of Cambridge carried out a systematic review of both qualitative and quantitative evidence, allowing them to combine findings from different types of research and identify common themes across the evidence base. The review included 17 studies involving 6,261 participants in total, including at least 4,710 children and young people and 1,443 parents and carers.

The overall pattern of attitudes was encouraging for the research community. Children and young people, along with their parents and carers, were broadly supportive of using health data for research where there was a clear potential benefit. Three kinds of benefit stood out in the evidence: improving healthcare directly, advancing scientific knowledge, and supporting other people with similar experiences of illness. In other words, participants were not opposed in principle to their records contributing to a larger good; they could imagine their own data helping a child they had never met receive better treatment. However, the review is emphatic that this support was conditional rather than unconditional. Participants wanted research to be carried out ethically, by trustworthy organisations, and with appropriate safeguards and transparency around how their data are used. Where those conditions were absent or unclear, support weakened considerably.

The conditions participants attached to their support reveal a sophisticated understanding of the risks involved. Respondents wanted strong protections to ensure their information is used safely and fairly, and they were concerned about the potential loss of privacy and the possibility of being identified even when data are supposedly anonymised. This concern reflects a technical reality: as datasets grow larger and more detailed, and as they are linked with other sources of information, the risk of re-identification from supposedly de-identified records increases. Participants were also worried about the misuse of data by organisations, particularly commercial companies. Trust emerged as a decisive factor in shaping attitudes. Young people were generally more comfortable sharing data when it was managed by trusted public organisations such as health services, universities, or non-profit researchers, and markedly less comfortable when private companies were involved in the chain of custody. For anyone designing data infrastructure for paediatric research, the implication is clear: who holds the data, and under what governance arrangements, matters as much to young people as what the data will be used for.

Perhaps the most striking finding concerned agency. Young people wanted a greater say in decisions about their data as they grow older. Some studies suggested that they should become increasingly involved in decisions about consent and data use as they mature, rather than having those decisions made entirely by parents or institutions on their behalf. This developmental perspective challenges the conventional binary of parental consent and child assent, pointing instead toward a graduated model in which young people’s decision-making role expands with their maturity. It also aligns with broader movements in paediatric medicine toward recognising children as active participants in their own care rather than passive subjects. Charlotte Burdge, a PhD student in the Department of Psychiatry at the University of Cambridge, who led the review, said that big data has the potential to unlock valuable insights into health and disease, but that the review shows we should not take for granted that everyone will give unqualified support for their data to be used. Young people, she noted, are generally in favour and can see the benefits, but they understandably want to ensure their data is used ethically and securely, that they have control over how it is used, and that their views are taken seriously.

The review also points toward practical measures that could build the trust and transparency young people say they need. Burdge suggests that making it clearer to participants how their data are being used and governed is one such measure. Understanding why data are being used, who may access them, and what safeguards are in place will be important as the use of data in healthcare research continues to expand. In practice, this could mean plain-language explanations of data flows, accessible governance information, and mechanisms through which participants can ask questions and raise concerns. The findings arrive at a particularly relevant moment for Cambridge itself, which is developing new approaches to using health data and other routinely collected information to improve children’s healthcare. Burdge’s work contributes to the Children and Adolescents Data Resource, known as CADRE, led by Dr Anna Moore, also from the Department of Psychiatry, which is helping to establish the digital foundations for the new Cambridge Children’s Hospital. Ensuring that children, young people, and families are involved in thinking about how data are collected, linked, and used is intended to be an integral part of developing data-driven approaches that are trusted and responsive to their needs.

Burdge also emphasised the importance of early engagement. For research such as ours, she said, it is important that we work with patients and members of the public from the outset to understand any concerns they may have and find out what would be meaningful for them, adding that this will help ensure that what researchers are doing aligns with public expectations. The researchers are careful to note, however, that their findings should not be interpreted as representing one uniform view among all underrepresented groups. People’s experiences and perspectives are shaped by their individual circumstances, backgrounds, and previous encounters with healthcare and research. A young person who has spent years in and out of hospital may view data sharing very differently from one with little contact with health services, and communities with historical reasons for distrusting medical institutions may need different forms of assurance. Treating children and young people as a single homogeneous bloc of opinion would itself undermine the review’s core message about the importance of listening to individual voices.

The research was funded by the UKRI Medical Research Council through Datamind, the Office for Life Sciences, and the National Institute for Health and Care Research Mental Health Translational Research Collaboration Mission, hosted by the NIHR Oxford Health Biomedical Research Centre, with additional support from the NIHR Cambridge Biomedical Research Centre and the NIHR Applied Research Collaboration East of England. The review, published under the title Perceptions, attitudes, and concerns of underrepresented groups regarding the use of big data in children and young people’s healthcare research, arrives as governments and health systems invest heavily in data infrastructure, from national secure data environments to hospital-scale platforms linking genomic, clinical, and administrative records. For the architects of these systems, the Cambridge findings offer both reassurance and a warning. Reassurance, because the next generation appears genuinely enthusiastic about the promise of data-driven medicine and can articulate its benefits with clarity. Warning, because that enthusiasm is contingent, and it can be lost. Young people are asking not to be excluded from the data revolution, but to be included in its governance, with safeguards they can see, organisations they can trust, and a seat at the table that grows as they do.

Subject of Research: Children's and young people's attitudes toward the use of big health data in healthcare research

Article Title: Children and young people broadly support health data research – but want safeguards

Article References: Children and young people broadly support health data research – but want safeguards. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: health data, big data, children, young people, systematic review, data privacy, consent, public trust, healthcare research, University of Cambridge, PLOS Digital Health, data governance

The rationale for targeting both substance use and gender beliefs in a single intervention rests on a growing body of evidence that the two behaviors are deeply intertwined. Across Southern Africa, an estimated 20 to 40 percent of young people report using at least one psychoactive substance, often as a coping strategy against unemployment, fragile health systems, political instability, and climate-related stressors. Early substance use elevates lifetime risks of mortality and morbidity, and is linked to HIV acquisition, traffic accidents, intimate partner violence, unemployment, and progression to substance use disorders. Meanwhile, the internalization of traditional gender norms — what researchers call inequitable gender beliefs — is established early in adolescence and reinforced throughout youth, and it frequently co-occurs with substance use. Both are independently associated with intimate partner violence, sexually transmitted infections, and poor mental health, suggesting that they may share underlying social drivers that a well-designed intervention could address together rather than one at a time.

What makes PEGISUS distinctive is its insistence on treating the peer group, not the individual, as the unit of change. Participants are recruited through an index case who enrolls two to five of their own peers with whom they already use substances — specifically, people who report weekly substance use or at least monthly binge drinking with peers over the previous three months. This deliberate social architecture reflects decades of research showing that peers play a decisive role in the initiation and escalation of substance use, and that most existing interventions, which focus narrowly on individual behavior, neglect the social and environmental forces that sustain risky patterns. Recent reviews suggest peer-focused mental health interventions have rarely been tested at all in low- and middle-income countries, and a prior South African friendship-group study showed decreases in certain gender-related practices and alcohol use only among female groups, leaving a substantial evidentiary gap that this new trial aims to fill.

The trial’s setting within vocational training programs is equally consequential. In South Africa, 35 percent of youth aged 15 to 24 are neither employed nor in school; in Zimbabwe, the figure is 36 percent, and in Zambia 29 percent. Vocational training offers an alternative pathway to economic opportunity for young people who have not completed formal schooling, but substance use and inequitable gender beliefs may undermine those benefits through their associations with dropout, unemployment, and violence. The study partners — Build It International in Zambia, Masvingo Polytechnic in Zimbabwe, and the Sozo Foundation in South Africa — offer training in fields ranging from bricklaying and welding to hairstyling and coding. By embedding the intervention into these programs and having program staff deliver it, the researchers hope to solve two chronic problems in global mental health: the enormous treatment gap, with an estimated 95 percent of young people needing substance use care not receiving it, and the sustainability problem of interventions that vanish once research funding ends.

Technically, the intervention builds on two established evidence-based programs: RAD-PAL, a brief substance use intervention, and Manhood 2.0, a gender equity curriculum. The eight sessions, each roughly ninety minutes, are activity-based and delivered to entire peer groups together, covering substance use, gender, and building healthy relationships. Formative work shaped the content through twelve focus group discussions with 97 young people, feedback from youth advisory boards in each country, and a pilot with 18 peer groups involving 57 participants. Interventionists — employees of the vocational training programs themselves — undergo training in good clinical practice, motivational interviewing, group facilitation, and handling distressed participants, supported by two levels of ongoing supervision including clinical oversight designed to prevent burnout among non-specialist providers. All sessions are audio-recorded, and fidelity is assessed with a session-specific checklist rating each component on a three-point scale.

The trial’s methodological rigor is a selling point in itself. Peer groups are randomized 1:1, stratified by country, using concealed allocation in REDCap, with the comparison arm receiving the standard vocational training program plus a referral for substance use services. Assessments occur at baseline, 12 weeks, and 24 weeks, with the primary outcome being the between-group difference in change on the total substance use involvement score of the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test, or ASSIST. Younger participants aged 16 and 17 complete an adapted version, the ASSIST-Y. Secondary outcomes include substance-specific ASSIST scores, changes in gender equitable beliefs measured by the 23-item Gender Equitable Men’s Scale, and — notably — vocational training attendance and completion rates, employment status, and income earned at 24 weeks. The sample size calculations assume a standardized net mean difference of −0.5, drawn from a meta-analysis of brief behavioral interventions for youth substance use, an intra-class correlation of 0.08, and an average cluster size of four, yielding 95 percent power at a two-sided significance level of 0.05.

Analysis will follow CONSORT guidelines and modified intention-to-treat principles using linear mixed-effects models with cluster-specific random effects, adjusted for baseline scores, sex, and age. Superiority will be demonstrated if the lower bound of the 95 percent confidence interval for the between-group mean difference exceeds zero. An exploratory interaction test will probe whether intervention effects differ across the three countries, though the researchers caution that such tests are typically underpowered. Sensitivity analyses with multiple imputation are planned if more than roughly five percent of primary endpoints are missing. The team’s prior trials with similar populations report attrition below 10 percent, aided by rapport-building with community-based research assistants who remain blinded to intervention arm.

The ethical architecture of the study reflects the sensitivity of working with minors, illegal substance use, and gender-related content in contexts where same-sex relations remain criminalized. Participants under 18 require caregiver consent before providing assent, and parental consent forms deliberately frame the study around general substance use risk rather than disclosing individual selection criteria, to reduce the risk of family conflict or violence. Screening occurs separately for individuals within peer groups to ensure voluntary participation free of peer coercion, and group ground rules plus facilitator training aim to manage disagreements that may arise when discussing gender beliefs in mixed groups. In Zambia and Zimbabwe, participants are asked not to disclose sexual or gender minority identities, with interventionists trained to navigate these topics with cultural sensitivity while prioritizing participant safety and dignity within local legal frameworks. Adverse events must be reported within 24 hours and assessed against standardized criteria, with referrals available to local clinicians at every site.

If PEGISUS proves effective, the implications could ripple far beyond the 264 participants. The design tackles socioeconomic adversity head-on by pairing behavioral change with tangible employment pathways, and its delivery model — run by existing program staff within institutions that already serve the target population — offers a plausible route to scale and sustainability that most clinic-based interventions lack. The researchers acknowledge limitations, including potential homophily from index participants recruiting similar peers, the impossibility of blinding participants in a behavioral intervention, and a six-month follow-up window too short to capture longer-term employment effects. Yet the trial represents the first known study in Southern Africa to test an integrated intervention for substance use and gender equity beliefs delivered through vocational training. For a continent where more than half the population is under 24, and where young people’s coping mechanisms are shaped by structural forces as much as personal choices, the outcome of this trial may help determine whether the next generation of prevention efforts treats the whole social world of young people — their friends, their beliefs, and their economic futures — as one inseparable system.

Subject of Research: A cluster randomized controlled trial testing a peer group intervention to reduce substance use and inequitable gender beliefs among young people in vocational training programs in Southern Africa

Article Title: Protocol for a cluster randomized controlled trial among young people and their peers to reduce substance use and inequitable gender beliefs in Southern Africa

Article References: Carney, T., Menon, J. A., Chiyokoma, B., Madzeke, K., Sanchez, G., Johnson, K., Basera, M., Berweger, A., Ruckstuhl, L., Hansen, S., Hofer, L., & Belus, J. M. (2026). Protocol for a cluster randomized controlled trial among young people and their peers to reduce substance use and inequitable gender beliefs in Southern Africa. Addiction Science & Clinical Practice, 21(1), Article 74. https://doi.org/10.1186/s13722-026-00718-7

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00718-7

Keywords: substance use, gender norms, peer intervention, young people, vocational training, cluster randomized trial, Southern Africa, Zambia, Zimbabwe, South Africa, ASSIST, gender equity

The study, conducted by Meena Khatwa, Rebecca Rees, Claire Stansfield, Vidhi Bassi, Ceri-Nicole Wilkins, and Kelly Dickson, employed thematic synthesis methods, a systematic approach to qualitative research that identifies, codes, and integrates findings across multiple studies to generate overarching themes. The team searched for studies published from 2007 onwards that captured the views of young people in OECD countries who identified as having had an eating disorder, disordered eating, or eating difficulties. From the pool of eligible research, thirteen studies met the inclusion criteria, and from these the researchers distilled three key themes that structure their findings: Comparing, Curating, and Community.

The first theme, Comparing, describes how young people used online content to evaluate both others and themselves. Social media environments are saturated with images of idealised bodies, and the synthesis found that exposure to such material became a lens through which participants measured their own appearance, eating habits, and worth. This evaluative process was not a passive experience; young people described actively scanning feeds, scrutinising the bodies of peers and influencers, and turning that scrutiny inward. The researchers note that growing attention has been paid worldwide to problematic discourse around ideal bodies and to how exposure to related content might influence disordered eating and other eating disorder symptoms, and the lived experiences captured in these studies give that concern a concrete, personal dimension.

Yet the comparison theme also carries an important nuance. Participants did not uniformly describe comparison as destructive. Some young people reported that seeing others discuss recovery, or witnessing bodies different from the narrow ideals promoted online, could interrupt harmful thought patterns. The synthesis makes clear that the direction of the effect depends heavily on context: what appears in the feed, who is posting it, and what state of mind the viewer brings to the encounter. This variability is precisely why the authors frame online eating disorder content as double-edged, capable of cutting in either direction depending on circumstances that no single content moderation rule can fully anticipate.

The second theme, Curating, captures the agency young people exerted over their digital environments. Far from being passive recipients of algorithmic output, participants described deliberate strategies for managing what they saw. These included unfollowing or muting accounts that triggered distress, actively seeking out recovery-oriented content, and shaping their feeds to reduce exposure to material that glorified disordered eating. Curation, in the accounts synthesised by the researchers, was a form of self-protection and, at times, a component of self-directed recovery. However, the theme also exposes the limits of individual effort. Curating a feed requires constant vigilance, and harmful content could resurface through recommendations, hashtags, or the behaviour of other users, meaning that the burden of safety fell largely on the very young people the content endangered.

This burden is a technically significant finding for platform design and public health policy. If harm mitigation depends on users continuously filtering their own environments, then platforms that surface triggering material through recommendation systems effectively outsource risk management to vulnerable adolescents and young adults. The synthesis suggests that young people are aware of this dynamic and often frustrated by it, describing curation as exhausting work layered on top of the psychological strain of the illness itself. Any regulatory or design response, the findings imply, should account for the reality that user-side controls are neither uniformly available nor uniformly effective.

The third theme, Community, documents the pull of online spaces where connection over shared experience becomes possible. For many participants, forums, social media groups, and comment sections offered something they could not find offline: people who understood, without explanation, what it felt like to live with an eating disorder. This sense of inclusion could be profoundly supportive, normalising help-seeking, validating difficult emotions, and providing practical encouragement toward recovery. The synthesis is careful not to dismiss these spaces, because doing so would erase a genuine source of comfort reported across the included studies.

At the same time, the Community theme carries the sharpest warning in the research. The same intimacy that made these spaces supportive could also make them harmful, since communities formed around shared illness can reinforce disordered behaviours, normalise competitive symptomatology, and keep users tethered to the identity of being ill. Participants across the studies described this ambivalence directly: the spaces offered inclusion but could also be experienced as harmful, sometimes within the same conversation or the same week. The researchers’ framing of online spaces as double-edged is not a rhetorical flourish but a structural description of how these communities function, holding both protective and corrosive potential in a single environment.

Beneath all three themes, the synthesis identified a contextual factor that the authors highlight as central: a lack of supportive, offline, mental health-promoting spaces. Young people’s heavy engagement with online eating disorder content did not occur in a vacuum. Where face-to-face services were scarce, waiting lists were long, stigma was pervasive, or everyday environments offered no safe place to discuss food, body image, and distress, the internet filled the gap. This finding reframes the popular narrative that social media causes eating disorder distress in isolation. Instead, the evidence suggests that online engagement is entangled with what offline support is missing, and that digital harm cannot be meaningfully reduced without strengthening the real-world resources young people can turn to.

For clinicians, researchers, and platform designers, the practical implications are layered. Interventions that simply remove or ban eating disorder content risk cutting young people off from the community and recovery resources they genuinely value, while approaches that rely solely on user curation leave the structural drivers of harm untouched. The synthesis points instead toward strategies that acknowledge complexity: designing recommendation systems that account for vulnerability, expanding offline and clinical support so that online spaces are not the only refuge, and involving young people with lived experience in shaping both digital and real-world interventions. As eating disorders continue to be a concern worldwide, this research demonstrates that the question is no longer whether online content is good or bad for young people, but how to tip the balance of environments that are, by their nature, both at once.

Subject of Research: Young people's experiences of online eating disorder content

Article Title: The complexities and contradictions of online eating disorder content: A qualitative evidence synthesis of young people’s views and experiences

Article References: Khatwa, M., Rees, R., Stansfield, C., Bassi, V., Wilkins, C.-N., & Dickson, K. (2026). The complexities and contradictions of online eating disorder content: A qualitative evidence synthesis of young people’s views and experiences. PLOS Digital Health, 5(10), e0001066. https://doi.org/10.1371/journal.pdig.0001066

Image Credits: AI Generated

DOI: 10.1371/journal.pdig.0001066

Keywords: eating disorders, social media, qualitative evidence synthesis, young people, mental health, online communities, body image, thematic synthesis, digital health, recovery, content curation, PLOS Digital Health

At the heart of the Series lies a new umbrella review, itself a review of published reviews, covering data on nine million people under the age of 25 across 121 individual reviews. The analysis finds consistent associations between what the authors define as problematic digital media use and a range of adverse health outcomes for children, adolescents, and young adults. Crucially, the Series defines problematic use not by the sheer number of hours spent online, but by addiction-like patterns of engagement, in which digital media use becomes compulsive, displaces other activities, and proves difficult to control. Under this definition, problematic use is linked to a higher risk of common mental health problems, sleep problems, and reduced physical activity.

The picture is not uniformly negative. The umbrella review also identifies beneficial associations, including a link between moderate digital media use and higher wellbeing, and between active video game use and both higher wellbeing and healthier lifestyles. These findings underscore the authors’ insistence that the goal is not to demonise technology but to reshape the digital environment so that young people can benefit from online opportunities without substantial risk of harm. Digital media, as the Series frames it, encompasses the content people watch, make, or share online, the platforms through which it is delivered, and the devices used to access it, meaning that interventions can target any of these layers rather than treating screen time as a single undifferentiated exposure.

The authors are candid about the limitations of the evidence base. The certainty of the findings for both harms and benefits is rated low, and the associations between problematic use and health harms are modest in size, resting on observational data that cannot establish cause and effect. Series author Louise Holly of the Digital Transformations for Health Lab in the United Kingdom argues that this uncertainty is itself a product of the current system, noting that the most valuable data on how platforms actually affect users remain hidden within technology companies, limiting independent scrutiny and slowing scientific progress. A key recommendation of the Series is therefore that governments should require technology companies to share data on how their features affect users’ health with vetted public-interest researchers, and should provide the legal and technical infrastructure to make such sharing possible.

To illustrate what even a small individual risk could mean at population scale, the authors modelled the potential burden of high rates of digital media use combined with modestly elevated risks. Their estimates suggest that spending more than two hours a day on screens could be associated with roughly 2.8 million healthy years of life lost to depression and 240,000 healthy years lost to obesity worldwide each year. Dr Falk Müller-Riemenschneider of the National University of Singapore stresses that these projections are intended to be illustrative of the possible scale of harm rather than an accurate measurement, since they are based on low-certainty evidence, and that more research is needed to provide accurate estimates of health impacts at the population level. Even so, the arithmetic illustrates a core principle of public health: small risks applied across billions of users can translate into enormous burdens.

The Series places much of the responsibility not on users but on the architecture of the digital environment itself. Most digital platforms, the authors argue, are designed by companies to capture attention and collect data rather than to protect health. Features such as infinite scroll, autoplay, and personalised recommendation feeds are deliberate design choices engineered to maximise engagement, not accidents of technology that individuals can simply self-regulate away. Dr Jay Shaw of the University of Toronto calls for far more research into how these specific design choices influence the way people use technology, rather than continuing to investigate only the impact of how long people spend online. This reframing shifts the analytical focus from user behaviour to product design, echoing earlier public health battles over products engineered for dependence.

Indeed, the Series draws explicit parallels with tobacco and fossil fuels, arguing that technology companies are drawing on a well-worn corporate defence playbook to delay, weaken, or shape regulation in response to evidence that their products may harm health. Professor Barbara Prainsack of the University of Vienna describes the tactics as manufacturing doubt, discrediting critics, and framing regulation as a threat to freedom. A public health approach counters this, she argues, by assessing what the evidence suggests about harm across whole populations rather than what any single case can prove. Prainsack also contends that good regulation is not the enemy of innovation but a driver of good innovation, channelling it toward safety and trust, and that where regulation is absent, it does not mean a technology is ungoverned, only that companies rather than public policy are setting the rules.

On the policy side, the Series is emphatic that no single measure is sufficient. Age limits alone, a favoured tool of several national governments, cannot address the structural drivers of digital harm. Instead, the authors call for wide-ranging, coordinated action at the company, national, and global levels. Among their specific proposals are requirements that technology companies assess new products or features for harm before releasing them, analogous to pre-market safety testing in other industries, alongside mandatory data sharing with vetted researchers. They further propose a global governance treaty through the World Health Organization to set baseline standards, preventing weak regulation in one country from undermining progress elsewhere, and a dedicated international body to monitor harms to children and young people from artificial intelligence. The Series also highlights how litigation is emerging as a route to hold technology companies accountable, with Professor Ilona Kickbusch, the Series chair, noting that legal action can compel companies to disclose internal documents and shift the public conversation about responsibility for harm, though she cautions that litigation is not a substitute for regulation and should be considered one route to accountability among several.

The Series was informed by a Youth Advisory Group of six young adults aged 23 to 30, who worked with the authors to articulate aspects of lived experience that the research alone could not capture. Group member Dr Salman Fitrat Khan of India argues that the health risks associated with digital systems are preventable, and that with better governance and by empowering citizens, especially young people, to co-shape the digital systems around them, the online world can deliver connection, information, and opportunity without putting health at risk. His message to governments is blunt: they should not wait for perfect evidence before acting for this generation and the ones that follow.

Kickbusch, who leads the Digital Transformations for Health Lab in Switzerland, summarises the Series’ core claim in stark terms: digital media use is now woven into the fabric of childhood and young adult life, yet governments have allowed technology companies to write their own rules, producing business models built to capture attention and collect data with health treated as an afterthought. The evidence linking problematic use to poorer mental health, sleep, and physical activity may not be conclusive, she acknowledges, but in her view it justifies coordinated, global action on precautionary grounds. The Series, published as part of The Lancet’s examination of the digital determinants of health, signals a shift in the scientific and policy conversation, from debates about individual screen time toward a systems-level analysis of how digital environments are designed, regulated, and held to account. Whether governments respond with the coordinated framework the authors demand, or continue to defer to industry self-regulation, will determine whether the next generation inherits a digital world shaped for health or for profit.

Subject of Research: Digital media use and health impacts in children and young people

Article Title: The Lancet: Scale of young people’s digital media use and emerging evidence of harm justify action now, experts argue

Article References: The Lancet: Scale of young people’s digital media use and emerging evidence of harm justify action now, experts argue. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: digital media, young people, public health, The Lancet, mental health, screen time, technology regulation, platform design, sleep problems, physical activity, global governance, umbrella review

The research team, led by Peter Kisaakye of Makerere University in Uganda and including collaborators from institutions in Ghana and Uganda, performed a secondary analysis of data collected in 2018 and 2019. Their sample comprised 9,826 young people between the ages of 18 and 24, all drawn from surveys designed by the US Centers for Disease Control and Prevention in partnership with national governments to measure violence against children and youth. Because these surveys use household sampling frames and standardized questionnaires, they allow researchers to estimate prevalence with confidence intervals and to generalize findings to entire national populations of young adults, something that small clinic-based studies cannot do.

The headline numbers are stark. Sexual violence prevalence exceeded 20 percent in all four countries, with Ivory Coast recording the highest rate at 38.7 percent, followed by Kenya at 28.8 percent, Namibia at 23.7 percent and Lesotho at 20.5 percent. Suicide ideation, meaning serious thoughts of ending one’s own life, was highest in Kenya at 13.2 percent and lowest in Ivory Coast at 6.1 percent. Self-harm showed a different geographic pattern: it was most prevalent in Ivory Coast at 13.5 percent and least common in Lesotho at 2.8 percent. The fact that the country with the highest violence prevalence did not have the highest suicide ideation rate underscores that the relationship between victimization and suicidality is shaped by broader social and economic contexts, not by exposure alone.

Methodologically, the study relied on binary logistic regression, a statistical technique suited to modeling outcomes with two possible values, such as whether a respondent reported suicidal thoughts or not. The researchers estimated odds ratios, which express how much more likely an outcome is in one group relative to another, together with 95 percent confidence intervals that indicate the range within which the true population value likely falls. Crucially, the models were adjusted for several potential confounders, including sex, school attendance, orphanhood status, work experience, whether respondents could talk to friends, and whether they believed physical violence was justifiable. This adjustment matters because factors such as losing a parent or lacking social support are themselves linked to both violence exposure and mental health outcomes, and failing to account for them could exaggerate or distort the apparent effect of sexual violence.

After adjustment, the association between sexual violence and suicide ideation held in every country. Young people who had ever experienced sexual violence had 2.86 times higher odds of suicidal thoughts in Ivory Coast, 3.06 times higher odds in Kenya, 3.30 times higher odds in Lesotho and 2.51 times higher odds in Namibia, with confidence intervals that excluded the null value of one in all cases. The consistency of this effect across four distinct national settings is one of the study’s most significant contributions. It suggests that the psychological toll of sexual victimization is not an artifact of any single country’s data quality or cultural reporting norms, but a robust pattern that transcends borders within the region.

The link with self-harm was even stronger in some settings. Adjusted odds ratios for self-harm among survivors of sexual violence were 1.77 in Ivory Coast, 2.59 in Kenya, 2.81 in Namibia and a striking 4.75 in Lesotho, where survivors had nearly five times the odds of engaging in deliberate self-injury compared with non-survivors. Self-harm, which includes behaviors such as intentional cutting or burning, is recognized in the clinical literature as both a marker of acute psychological distress and one of the strongest predictors of future suicide attempts. The Lesotho finding, in particular, implies that in some contexts sexual violence may be intertwined with coping mechanisms that carry immediate physical danger, amplifying the case for early identification of survivors before self-directed harm begins.

Why does sexual violence exert such a profound effect on the mental health of young adults? The authors frame sexual violence as having both immediate and long-term adverse consequences, including reduced mental well-being, substance abuse and suicidality. Developmental science offers several converging explanations. The late teens and early twenties are a period of heightened vulnerability, in which identity formation, educational attainment and intimate relationships are all in flux, and the brain’s emotion-regulation circuitry is still maturing. Trauma experienced during this window can disrupt attachment, erode self-worth and instill a sense of shame that discourages disclosure. In many communities across sub-Saharan Africa, stigma surrounding sexual victimization remains intense, and survivors, particularly young men, may fear social rejection if they come forward. Silence, in turn, prevents access to the social support that the survey data themselves suggest is protective.

The study also carries implications for how mental health services are organized in low- and middle-income countries. The authors call for prioritizing sexual violence prevention and survivor-centered response, and specifically recommend integrating routine screening for sexual violence into youth mental health services, sexual and reproductive health services and primary care. This is a practical proposal with a strong evidence logic: young people are far more likely to encounter a clinic for contraception, HIV testing or a routine illness than to seek out a specialist mental health provider, and a brief, confidential screening question about violence exposure could route survivors toward counseling and crisis support they would otherwise never receive. Screening programs of this kind have shown promise elsewhere, though they require training, referral pathways and safeguards for confidentiality to avoid re-traumatizing patients.

The reliance on the Violence Against Children Surveys gives the study unusual methodological strength, but it also imposes limits that the authors acknowledge implicitly through their design. The surveys are cross-sectional, capturing a snapshot in time, which means they can establish association but not definitive causation; it remains possible that some unmeasured factor, such as family instability or prior childhood adversity, contributes to both violence exposure and suicidality. Self-reported data on sexual violence are also sensitive to disclosure bias, and stigma may lead some survivors to remain silent, which would tend to make the observed associations conservative rather than inflated. The authors tested for multicollinearity among predictors, reported in an appendix, to ensure that the adjusted estimates were not distorted by overlapping variables, a standard but important robustness check.

For policymakers across the region, the message is difficult to ignore. Suicide is among the leading causes of death for young people worldwide, and the new evidence indicates that a substantial and preventable share of the risk in these four countries is tied to sexual violence that often occurs years before the suicidal thoughts emerge. Prevention programs that address gender norms, strengthen child protection systems and engage communities have demonstrated reductions in violence exposure in trials supported by the same CDC survey infrastructure. What the present study adds is a clear quantitative bridge between that prevention agenda and mental health outcomes: every case of sexual violence averted is not only an end to a human rights violation but potentially an intervention against a lifetime of psychological suffering. As the authors conclude, sexual violence, suicide ideation and self-harm remain relatively high among young people, and treating them as separate policy problems, rather than as connected outcomes of the same trauma, risks missing the point at which help can change a life.

Subject of Research: The association between sexual violence experience and suicide ideation and self-harm among young people aged 18 to 24 in four sub-Saharan African countries

Article Title: Experience of sexual violence is associated with suicide ideation and self-harm among young people (18–24 years): evidence from a violence against children survey in four countries

Article References: Kisaakye, P., Kyei-Arthur, F., Kyei-Gyamfi, S., Afrifa-Anane, G. F., Boadu, E. S., Miezah, D., & Bukuluki, P. (2026). Experience of sexual violence is associated with suicide ideation and self-harm among young people (18–24 years): evidence from a violence against children survey in four countries. Discover Psychology. https://doi.org/10.1007/s44202-026-00892-4

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00892-4

Keywords: sexual violence, suicide ideation, self-harm, young people, sub-Saharan Africa, Violence Against Children Surveys, mental health, Ivory Coast, Kenya, Lesotho, Namibia, logistic regression

At the heart of the research is a critique of the dominant message that underpins most pornography education in schools: that porn is dangerous and must be avoided at all costs. This simple warning model, the study finds, bears little resemblance to the evidence emerging from youth sexuality research. Studies of how young people actually interact with sexual media suggest that many of them interpret such content critically, question its realism, and compare what they see online with their own experiences of relationships and intimacy. Far from absorbing sexual media unthinkingly, teenagers frequently approach it with scepticism, curiosity and a desire to talk about what it means. The problem, the researchers argue, is that the education system is not built to harness that critical instinct.

The mismatch between what policy prescribes and what young people experience creates a serious challenge for teachers on the front line. Current classroom approaches tend to rely on warnings, scripted lessons and moral messaging designed to prevent harm before it occurs. These methods are well-intentioned, and safeguarding remains an essential priority, but the study suggests they often have the unintended effect of closing down discussion rather than opening it up. When lessons present pornography solely as a threat to be avoided, students who have already encountered sexual content, which is nearly all of them, learn quickly that honest questions are unwelcome. The result is that young people are left to make sense of complex issues about sex, consent and relationships on their own, without adult guidance or structured support.

To reach these conclusions, the research team analysed current policy frameworks, with particular attention to the UK government’s Independent Pornography Review, and compared them against interdisciplinary research into young people’s experiences of sexual media. The methodology combined a critical policy analysis with a synthesis of existing studies covering youth engagement with pornography, media literacy and sex education. By mapping how educational responses are shaped at the policy level and then testing those responses against the accumulated evidence of what young people actually report, the team was able to identify precisely where the current system falls short and why repeated calls for caution-based teaching have not resolved the underlying tensions.

Dr Emily Setty, lead author of the study and Associate Professor of Criminology at the University of Surrey, explained the central problem with prevailing assumptions. The way pornography is currently taught in many schools assumes that young people simply absorb what they see and are harmed by it, she noted, but in reality their experiences are far more varied. Many young people question what they see, recognise unrealistic portrayals and want space to talk about relationships, consent and ethics. When education shuts down those conversations, she warned, it risks leaving them to make sense of these issues alone, at precisely the moment in their lives when structured guidance could make the greatest difference.

As an alternative, the research proposes a new educational framework the authors call safe uncertainty. Rather than pretending that educators can eliminate risk or that simple prohibition will work, the approach encourages open, structured discussions about pornography that acknowledge its complexity while still maintaining clear safeguarding and ethical boundaries. The framing is deliberate: safe signals that protective boundaries remain firmly in place, while uncertainty admits that sexual media is a complicated phenomenon that cannot be reduced to a single warning. Under this model, teachers act as facilitators of critical inquiry rather than enforcers of moral messaging, guiding students through difficult questions in a managed and supportive environment.

In practical terms, the safe uncertainty model would transform what happens in the classroom. Instead of lessons built around warnings, teachers would guide students to critically explore how sexual media represents consent, power, gender and relationships. Lessons might include analysing media portrayals to identify unrealistic or harmful depictions, discussing ethical dilemmas raised by the production and distribution of sexual content, or comparing online representations with the realities of intimacy and communication in actual relationships. This kind of active, analytical engagement, the researchers argue, develops what is termed porn literacy, a specialised form of media literacy that allows young people to question the production, realism and ethics of sexual content rather than simply being told to avoid it.

Dr Setty emphasised that pornography should not be viewed in isolation, since it is only one part of a much broader landscape of sexual messaging that includes social media, television, advertising and peer culture. Focusing narrowly on porn, she cautioned, risks exaggerating its influence while ignoring the other powerful cultural forces that shape how young people understand relationships and sex. A young person navigating the digital world today encounters sexualised and gendered messaging across nearly every platform they use, and an education system that addresses only one slice of that landscape leaves students poorly equipped for the whole. The broader goal, she argued, should be to equip young people with critical thinking skills and ethical awareness so they can navigate a complex digital environment in which sexual content is increasingly visible and increasingly difficult to avoid.

Importantly, the researchers are not arguing that concerns about potential harm should be dismissed. Addressing potential harm remains essential, and the safe uncertainty framework is explicitly designed to operate within safeguarding structures, not against them. The distinction the study draws is between harm prevention as the sole purpose of education and harm awareness as one component of a richer critical curriculum. Rather than relying solely on warnings or prohibition, the authors contend, education should also develop young people’s ability to interpret media, reflect on their own relationships and engage in honest conversations about sex and consent. In a media environment where young people will almost certainly encounter sexual content regardless of what schools say, the question is not whether they will be exposed but whether they will be prepared.

The findings arrive at a moment of intense debate about relationships, sex and health education in England, with policymakers under pressure to respond to rapid changes in digital culture. By grounding its critique in both policy analysis and the lived experiences of young people, the study offers a concrete alternative for educators and officials willing to move beyond fear. The research suggests that the most effective protection schools can offer is not silence or alarm, but the confidence and critical capacity that come from honest, well-structured dialogue. If the goal of education is to prepare young people for the world as it actually exists, the authors conclude, then teaching them to think critically about sexual media, in all its complexity, is not a risk to be avoided but a responsibility to be embraced.

Subject of Research: Pornography education and youth media literacy in England

Article Title: Fear-based education around porn is failing young people, say researchers

Article References: Fear-based education around porn is failing young people, say researchers. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: pornography education, young people, media literacy, porn literacy, sex education, safe uncertainty, University of Surrey, safeguarding, consent, digital culture, Porn Studies journal, critical policy analysis