Healthy Screen Habits Takeaway

"I'm the One" with Justin Bieber and DJ Khalid: youtube

Welcome to Healthy Screen Habits, Dr. Jon-Patrick Allem!

Jon-Patrick Allem, Ph.D., M.A.: (01:20)

Hi, Hillary. Thank you for having me.

Hillary Wilkinson: (01:23)

So, Jon, your research lies in this sort of convergence between the world of big tobacco, marketing, and big tech, and these, this is like the Bermuda Triangle. These are really tricky waters to swim in. And so I was kind of wondering, I mean, what, what brings a brave soul like you to this zone? What brought you to study this combination of tobacco use and screens?

Jon-Patrick Allem, Ph.D., M.A.: (01:56)

Yeah, I think a big part of it is, um, the timeframe in which I was developing skills as a scientist. So the time I was going through graduate school, um, coincided with, um, you know, the years of, uh, from 2004 to 2022, this period of time where e-cigarettes and social media both grew in popularity among youth. In other words, um, like the emergence of youth friendly tobacco products like e-cigarettes and the concurrent rise in the popularity of social media among youth over the past decade probably helps explain why I look at the combo of tobacco use and screens. Um, the program of research that I lead now, um, has broadened up, uh, over the last four to five years where the initial program of research was really looking at using social media to study e-cigarette behavior and study promotional practices of tobacco companies mm-hmm.

Jon-Patrick Allem, Ph.D., M.A.: (03:04)

. And now it's evolved into looking at, well, what are the consequences of, um, ex uh, being exposed to such kind of content on a platform or via screens and not just looking at one product, but just the, the entire process of being on social media in general? Um, and so that kind of, I think it was part I'm interested in, uh, tobacco and it's, relationship with, all these health consequences and I'm interested in, in social media and the intersection between public health and social media, especially in the adolescence context because it's, there's a lot of unknown there. the consequences of these things we're still trying to figure out. and a lot of the experts, uh, are trying to parse out, what's good screen time, what's bad screen time, you know, where in, in what context is this influencing offline behavior? So it's, it's a really interesting, um, area of research in general. And it's fun. I mean, it's fun to see all of the new methods and topics come up. 

Hillary Wilkinson: (04:30)

It makes sense to me that, that you, um, you find it fun because I think like with, there has to be an element of, um, of passion. You know, which kind of falls in that fun column that drives those of us who take, go to take on these, uh, like I said, these Bermuda Triangle waters. So . Right. So let me ask you, um, I'm a Gen Xer , and I clearly remember the, uh, the school assemblies that were put on by the American Lung Association when we were kids, and they would come out and lecture us on cigarette smoking and show us slides of cadaver lungs. Like, I don't even know if they could do that , you know? So, um, the comparison between those, like, I, I mean, I, in my brain, I can picture the smoker versus nonsmoker lungs, and it was compelling as far as convincing that cigarette smoking is bad.

Hillary Wilkinson: (05:32)

So here's the deal, when the vape pens hit the US market, and were growing in popularity in that, window of time that you talk about entering this, um, field of research. So mid two thousands to early 2010s, I was the leader of my son's Cub Scout troop . Okay. And part of the curriculum was to teach the boys about healthy eating and taking care of your body. And when it came to the smoking part, I was super confident in teaching the boys about the dangers of cigarette smoking. And then they started pushing back on, the dangers of vaping as well. And they started pushing back, telling me how it was the quote unquote safe way to smoke, and it's just water vapor. And I I did not have good responses to that. Here I am, like a clear decade later, I'm embarrassed to admit I still don't have a very good understanding about vapes. And I think my, like, my lame response at that time was “Anything other than air does not belong in your lungs!”  You know, , I mean, but I

Jon-Patrick Allem, Ph.D., M.A.: (06:52)

That's, yeah, that's true. . Yeah.

Hillary Wilkinson: (06:55)

Yeah. That being said, I feel like that is, I don't know, not that it's not enough. And so I'm, I guess I'm asking for selfish purposes. Could you educate me, ? I'm afraid I have to Sure. For one, I have to go really basic with my first question. Mm-hmm. , and that's that I hear about e-cigarettes and I hear about vape pens. Mm-hmm. Are they the same thing?

Jon-Patrick Allem, Ph.D., M.A.: (07:21)

Uh, yeah. Um, I think when people talk about vape pens and e-cigarettes, they use the term interchangeably. Okay. Um, so for this discussion, we can use the term e-cigarettes and Okay. I think in general, people would be able to find them synonymous. I mean, we could get in the weeds about all that stuff, but I think for most purposes that's, they're interchangeable.

Hillary Wilkinson: (07:46)

Okay. I just wanna, you know, I, like I said, I'm a parent of teenagers now, and so I don't wanna be, you know, totally mm-hmm. antiquated in my

Jon-Patrick Allem, Ph.D., M.A.: (07:57)

That's fair. Yeah. Well,

Hillary Wilkinson: (07:58)

Nomenclature. Yeah. Okay. So with that being said, what are, I, I'm embarrassed to even have to ask this, but what are the dangers associated with e-cigarettes?

Jon-Patrick Allem, Ph.D., M.A.: (08:12)

Sure. I mean, I appreciate you tackling this issue a decade ago when, um, there was a lot of unknowns and, um, you know, the scientific community didn't have a clear idea what was going on. I don't know how, uh, a parent or a Cub scout leader would be doing a better job than, than that uh, or, uh, a sufficient job in communicating the harms of these things. So, you know, thank you, . Yeah. Don't we? Yeah. Don't be too hard on yourself. I mean, , but I mean, we can make it, you said you want to keep it simple, and I, I like to keep it really simple. So like, let's talk about the health dangers of e-cigarette use simply for young people. Like, uh, those under the age of, let's say 25. So e-cigarettes like Juul often contain nicotine. Nicotine has been shown by a vast body of research to be an addictive substance.

Jon-Patrick Allem, Ph.D., M.A.: (09:07)

And we do know that extended exposure to nicotine can have detrimental impact on brain development during adolescence. The adolescent brain continues to develop into early adulthood, um, especially in the prefrontal cortex. So this brain region is involved in higher cognitive development, including cognitive functions related to attention, memory, and, um, cognitive flexibility. So simply using nicotine for a young person is problematic for all those reasons. Now, you can get nicotine into your system through a number of ways, aside from using e-cigarettes. But I like to focus on this kind of clear message for parents and young people, because we don't want them to expose themselves to things that are gonna have detrimental effects on their cognitive abilities. Um, I should note that human neuroimaging studies have revealed that nicotine exposure results in long-term functional and structural changes in the brain. So this is just the exposure to nicotine alone.

Jon-Patrick Allem, Ph.D., M.A.: (10:20)

And then if you want to kind of go a little further, when  we think about e-cigarette use or vaping of all kinds, the liquid, that the e-cigarette or vape pens are aerosolizing and, and people are breathing in, has a bunch of stuff in it that are known and unknown, including metals and, uh, known carcinogens and exposure to those things, uh, extended exposure to those things are gonna have a number of health consequences. And the body of research is growing to show, there isn't any real reason for young person to be vaping anything, um, for these reasons.

Hillary Wilkinson: (11:06)

Hmm. Okay. Okay. So it's multifactorial, it's brain development and lung health is what I'm hearing.

Jon-Patrick Allem, Ph.D., M.A.: (11:16)

And cardiovascular health too. 

Hillary Wilkinson: (11:18)

Sure, for sure. Yeah. Yeah, yeah. If you talk about lung, yeah, absolutely. Hmm. Thank you. Thank you for  the primer on, on, on e-cigs. So next we're gonna bring it back to kind of that three-way intersection of marketing, tobacco, and screens. But first we have to take a break.

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Hillary Wilkinson: (15:10)

I'm speaking with Jon-Patrick Allem, whose research shows the different ways that corporations influence adolescent health. His current projects are focused on identifying sources of exposure to tobacco marketing among adolescents and young adults. And this is where the interplay of screens and tobacco kind of comes in. In get in prepping for this episode, I, I, uh, did a little research and thought it was interesting. The last televised cigarette ad in the US ran on New Year's day of January, 1971, but the relationship between tobacco and the entertainment industry did not end there, . That's right. So, could you tell us about kind of product placement and how it's been historically used with, I'm just gonna refer to it as big tobacco.

Jon-Patrick Allem, Ph.D., M.A.: (16:16)

Yeah. So that's a great reference. Um, uh, as a result of the Master Settlement Agreement, um, the big tobacco companies stopped advertising on television. And I was under the assumption that the last tobacco ad ran, uh, not on New Year's Day, but at 11:58 New Year's Eve, the year prior , because it was supposed to be outlawed by the next day.

Hillary Wilkinson: (16:41)

Yeah, no, they said the, the article I read said that they allowed cigarette advertising through the football games of New Year's Day. So the last, the last ad actually ran at 11:50 on the Carson Show of, on January 1st, and then January 2nd it started.

Jon-Patrick Allem, Ph.D., M.A.: (17:04)

Oh, alright. That's interesting. Um, yeah, so when we think about, um, tobacco products, you know, and we've been talking kind of what's going on in the last decade. So, you know, combustible cigarettes were the dominant tobacco product, uh, during this time in, in, uh, prior to the Master Settlement Agreement. They advertised on billboards, on magazines, TV, movies, et cetera. But then the master settlement agreement, which was an agreement between a number of, uh, attorney generals, um, state attorney generals and the tobacco industry, or several companies that, uh, are from the tobacco industry, said, uh, we're going to stop doing certain types of marketing, um, to prevent youth uptake and, uh,  pro-tobacco images among non-users of tobacco. So, you know, that was a few decades ago, so it, it did not include products that did not exist like electronic cigarettes and other kind of novel tobacco products that are, uh, used today.

Jon-Patrick Allem, Ph.D., M.A.: (18:08)

So when we think about, you know, this intersection of, um, pro tobacco exposure, pro e-cigarette exposure, um, among kids and screens. We look at promotional practices on social media, and, uh, it's interesting because the world of marketing and advertising has changed a lot, especially in the last 10 years with, uh, paid ads with social influencers or those with, uh, you know, growing number of followers who are looking for authentic, uh, reviews, uh, of products of all kinds, especially or including tobacco. Um, so it's become a more complicated space, and without clear regulations and or, enforcement of existing regulations, you know, young people can go online or watch, TV or films or stream and, um, get exposed to a lot of pro e-cigarette content. So we've tackled this issue in a number of ways. Um, most recently we looked at Netflix, so this is a good example, I think, for a lot of parents out there with kids.

Jon-Patrick Allem, Ph.D., M.A.: (19:27)

Um, a lot of them stream or have subscriptions to streaming services. Netflix is one of the bigger players in the space. So Netflix pledged in 2017 that it would no longer include visual depictions of smoking or e-cigarette use, except for reasons of historical or factual accuracy in original TV shows, rated TV-14 or below, or original films rated PG-13 or below. And we did a study of Netflix produced content a year or two ago that was basically looking at e-cigarette exposure, e-cigarette references, um, or, uh, e-cigarette imagery of all kinds in Netflix produced content. And just briefly, without getting to all the details of the methodology and such, you know, our study showed that content with these ratings, um, well, in other words, Netflix wasn't following through on its pledge to limit tobacco related depictions

Hillary Wilkinson: (20:32)

So what they were saying versus what's actually happening is not necessarily aligning.

Jon-Patrick Allem, Ph.D., M.A.: (20:40)

Yes. So the kind of the consequence of that is that, you know, we need third party evaluations of these companies who are pledging, um, that they're gonna take certain actions or restrict certain kind of content on their platform, especially content designed for young people, and, uh, make sure that they're holding themselves accountable or maybe they're not gonna be able to self-regulate. And, uh, government needs to step in and, and kind of take action, especially if they are not being forthright with, you know, parents or, um, who are oftentimes signing their kids up and setting the requirements for what they can and cannot see. you know, the companies upload that information on the apps for all kinds of platforms, Netflix and others. And oftentimes people are taking the word of the company. So there has to be some degree of oversight there. And if they can't, uh, regulate themselves and maybe government needs to regulate based on systematic studies like ours.

Hillary Wilkinson: (21:45)

One of the things that I was interested in seeing was the placement, and it's quite blatant of, um, marketing e-cigs in music videos. And me being like, totally old school, somehow, I, I didn't make the shift to Oh, of course.music videos are showing up on YouTube. Yeah. So if you have kids that are streaming, and, you know, I mean, a a lot of people get music off of YouTube. They can be, and I know that you were involved in one of those with DJ Khalil and, uh, Justin

Jon-Patrick Allem, Ph.D., M.A.: (22:57)

DJ Khaled. Yeah.

Hillary Wilkinson: (22:58)

Can you talk a little bit about that?

Jon-Patrick Allem, Ph.D., M.A.: (23:04)

Sure. So yeah, we had a, a whole program of, uh, we had a whole study focused on product placement, e-cigarette or vape pen product placement in music videos. Um, so in about 2017, my team and I published an editorial describing how vain companies were using product placement in popular music videos as a way to promote their products to youth and young adults. And I think the video that you're referencing is a video that featured DJ Khaled, Justin Bieber, among other very popular artists, especially among young people called I'm The One. And this video on YouTube alone received, uh, over a billion views, a billion with a B. And so this is a lot of exposure. And what we do know about young people's screen habits, especially on YouTube, is that they watch, they don't just watch a video once.

Jon-Patrick Allem, Ph.D., M.A.: (24:02)

They often times watch it repeatedly. So they're getting kind of this, uh, prolonged exposure to this protobacco content among other kinds of content on, on the platforms. So we wrote this editorial describing this kind of new promotional practice among vape companies. And based on that, we got a, a, a, a extramural grant, so a funded grant. California has this unique, uh, tobacco program called the Tobacco Related Disease Research Program. And they help fund, uh, scientists to do studies that try to curb tobacco related diseases. So we got one of these grants to study the impact of vaping product placement in music videos among young adults, 18 to 24, years of age in California. And it was, it was a three-prong study. So the first thing we did was we documented, um, what, what companies, what vaping companies are using, uh, this promotional practice.

Jon-Patrick Allem, Ph.D., M.A.: (25:03)

What artists, are in the videos that this promotional practice takes place, and then how often are these videos viewed? And when the, the, the sampling frame that we used, or the collection of videos that we were analyzing, you know, collectively, it was exposing young people to, you know, minutes long, uh, content of pro tobacco, use pro vaping, and with billions of views, um, within a relatively short period of time.  We talked about young people using nicotine and how that's problematic for cognitive development. And so the city attorney of Los Angeles in around 2019 was also very much interested in curbing this promotional practice, uh, meaning product placement in music videos, that are targeted towards young people, uh, many young people that are under the tobacco purchasing age. So those under 21 years of age.

Jon-Patrick Allem, Ph.D., M.A.: (26:14)

So the city attorney at this time, uh, reached out to me for assistance with their case against the primary company responsible for such promotional activities. Um, and, and it was around 2019 that I started providing the city attorney's office with information for my research. Um, so keep in mind, uh, at the time I was a, a, a professor at the Keck School of Medicine of U S C, situated in Los Angeles. The city attorney of Los Angeles was also focused on this. And while this is kind of at the local level, um, it has broader implications because it's Los Angeles, the vast majority of, uh, these videos were shot in Los Angeles. So there was a lot of familiarity with, um, the production side of things, the entertainment side of things, or the talent side of things, and how we could work together to, work at a local level that had national implications. So it was, it was a quite exciting period.

Hillary Wilkinson: (27:15)

I think it also speaks to, um, the importance of co-viewing music videos. Uh, you know, um, I, I think that's, I, I've spent many an evening with my own kids watching music videos and just providing a little commentary they don't have the adult side of the perspective. They don't have, I mean, I, I watched the, I'm The One video and was, you know, kind of amused to see the bikini clad woman on horseback, you know, smoking her e-cig. And I was just thinking like, oh, it would be, uh, an interesting thing to watch with my kids and point out like, oh, well, she's not gonna stay looking like that for too long. You know, riding , riding a horse, A: without protective equipment, and, you know, partaking in cigarette culture, if you will. So is there anything else that you would like parents to know kind of about this intersection of media and e-cigs? Is there an age where there's a greatest risk of being influenced?

Jon-Patrick Allem, Ph.D., M.A.: (28:39)

That's a good question. I don't think we've been able to pin down a specific age. I mean, we know that young people, you know, in general are susceptible to social pressures. We know that, you know, there's, uh, pop popular culture, or media in general has the ability to, uh, depict what is normative, what is socially acceptable, what could be appeared as rewarding and fun, and all of these kind of factors come together as like a constellation of in influences to shape attitudes and behaviors offline of young people. So, you know, we've been focusing a lot on these financial relationships that exist, right? Like product placement, you know, imagery on a, on a streaming platform of some kind. But for parents, especially parents of young kids, they need to be aware of, like the, the peer influences that go on and peer influences that go on online oftentimes have the ability to influence, uh, what young people perceive goes on offline, you know, and the way that social media platforms are set up with network effects and the, the rules or the algorithms that kind of feed similar like content has the ability to present a certain phenomena as more popular than it is offline because of the system in place, you know, the, the app in place.

Jon-Patrick Allem, Ph.D., M.A.: (30:06)

So we want to be really mindful of that, a young person could get on, uh, a specific hashtag or follow a specific thread or just be fed information or fed posts, uh, like on a platform like TikTok that most of the experience is, uh, discoverable content, meaning that the, the, the, the platform is showing you what it thinks you're gonna like. Right? So all of this comes together and can alter the perceptions of how popular something is offline. So we know, you know, young people today are, you know, vaping, you know, kids, uh, you know, going from elementary school age to high school, it's like less than 15%, 17% right around there. But if you fall down one of these, for lack of a better term, rabbit holes, you all of a sudden get the impression that everyone's doing this and everyone's having fun doing this.

Jon-Patrick Allem, Ph.D., M.A.: (30:57)

And so we want parents to be aware of these kinds of social influences as well, because, um, it's more difficult to police in a lot of ways, or regulate, you know, uh, if there's financial relationships going on, um, the government can potentially come in and say,” Hey, like, you need to disclose this”, or “You're not allowed to market that way.” But if it's two kids just making posts about how fun x, y, and Z is some certain behavior, uh, that's freedom of speech issues come up and, you know, like what exactly is the context and all of these nuances come up that are make things more complicated to communicate to a young person.

Hillary Wilkinson: (31:37)

Yes. Yes. All very good points and all, um, very good reason to establish co-viewing practices when, when streaming on YouTube and delay social media accounts for our younger sets. . Yeah. We recommend holding off on getting devices until eighth grade, and we recommend delaying social media accounts until 16. I mean, the same age as you get your driver's license. So it's, and in doing that, there's kind of a step in process. You don't just hand the keys to the 15 and a half year old once they’ve got their permit and say, “okay, see you later.” You know, so we have a step in approach as well. 

Jon-Patrick Allem, Ph.D., M.A.: (32:30)

Seems thoughtful. Yeah,

Hillary Wilkinson: (32:31)

Yeah, yeah. So we have to take a short break, but when we come back, I'm going to ask Jon-Patrick Allem for his healthy screen habit. 

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I'm speaking with Dr. Jon-Patrick Allem, who uses his scientific research to impact public health and protect the health of children. So Jon, on every episode of the Healthy Screen Habits podcast, I ask each guest for a healthy screen habit. This is a tip or takeaway our listeners can put into practice in their own home. Do you have one?

Jon-Patrick Allem, Ph.D., M.A.: (34:15)

I think being a good role model with devices you know, smartphones or tablets or you know, what you're on, if you, if if you don't want your kid to be on these things constantly, then you probably should model that behavior as well because,depending on where your kid is on the developmental path, they're, they're looking to you, they're, they're looking to you for cues and they're gonna, it's parent modeling, you know, they, they look to see what you're doing and what you're focused on and how you spend your time. And that impacts them a lot, um, until they start to rebel, of course. Right? But I think if you demonstrate good habits, meaning that if you are not on your phone all the time, or if you have a break in whatever the activity is, you don't immediately pull out your phone to kind of, uh, fill in that space with screen time.

Jon-Patrick Allem, Ph.D., M.A.: (35:19)

I think that will signal to young people that it's okay to not do this, not to avoid your phones in some of these cases. So I like that idea of being a good role model in terms of healthy screen habits like that. Um, it's pretty simple. I think it doesn't require a lot of money or expertise or anything. It's just, you know, avoid picking up your phone at every instance and, uh, and just trying to be there in that space, uh, without the screens for periods of time if, if that's workable.

Hillary Wilkinson: (35:51)

Yeah. And it will promote connection and conversation, which I mean, which is a big insulator against loneliness, which as we know is a huge issue in today's youth.

Jon-Patrick Allem, Ph.D., M.A.: (36:07)

I agree.

Hillary Wilkinson: (36:08)

So as always, you can find a complete transcript of this show and a link to any resources discussed by visiting the show notes for this episode. You do this by going to healthy screen habits.org, click the podcast button and scroll to find this episode. So Jon, thank you for all that you do in the ongoing push back against big tobacco, marketing, and screens. You, you've like taken on the trifecta there.  It's a huge job. So important. And I'm really, really grateful that you were here today to be able to talk to us about it.

Jon-Patrick Allem, Ph.D., M.A.: (36:47)

Well, I greatly appreciate the opportunity to talk to your audience and thank you, Hillary, for having me. It was a pleasurable experience.