The document summarizes research on whether the internet harms children's health. It finds that while some children experience real health harms from online risks, like encouragement of suicide or eating disorders, the evidence for widespread or low-risk harms is limited. Studies often rely on surveys that show potential harms and risks but provide little data on actual harms experienced. More research is still needed, especially on whether behaviors like viewing pro-eating disorder websites cause harm. In conclusion, some children are harmed, but the level of harm across all children is unclear from current research.

1. Does the Internet harm
children’s health?
Dr Vera Slavtcheva-Petkova, University of Chester
Dr Monica Bulger, Dr Victoria Nash, Oxford
Internet Institute, University of Oxford

2. Contents
• Child protection and online harms: Academic
and policy context
• Methods
• Scope, scale and operationalisation of health-
related harms
• Conclusions

3. Academic context
• Growing body of research on level and character of
Internet by under 18s, and nature of risks and
opportunities experienced (e.g., Livingstone &
Haddon, 2009; Schrock & Boyd, 2008)
• Research suggests that risks are greatest for those
most vulnerable offline, and that overall, the
opportunities of Internet use outweigh risks (e.g.
Mitchell et al., 2010, Livingstone et al., 2011)
• Real lack of research which quantifies or analyses
level of actual harm rather than potential risk.

4. Policy context
• Wide array of policy measures across Europe: hotlines
for reporting child abuse images, industry codes of
conduct regulating use of mobile content and services,
and increasing provision of parental controls by ISPs.
• Much of this is result of self or co-regulation
• Possible and actual conflicts with other rights, e.g.
freedom of expression, legal due process.
• Policy purportedly informed by research (e.g. multi-
stakeholder UK Council for Child Internet Safety), but
susceptible to media pressure and “moral panics”

5. Perceived risks vs. actual harms
“While new discoveries almost always have both benefits and
disadvantages, breathless negative coverage of technology frightens
parents, prevents teenagers from learning responsible use, and fuels
panics, resulting in misguided or unconstitutional legislation” (Marwick
2008).

6. Our study
• Evidence on the extent of harms
experienced by children as a result of
online risks: A critical synthesis of research
• Funded by the Oxford University Press's
Fell Fund
• A review of empirical studies of harms
associated with young people’s (under
18s) Internet use, published in English
between 1997-2012 + interviews with key
stakeholders

7. Methods
• Keywords: “harm AND Internet AND children”, “harm
AND Internet AND adolescents”, “harm AND Internet
AND minors”, “harm AND Internet AND teens” and
“harm AND Internet AND teenagers”
• Categories for inclusion:
1. Empirical work
2. Published in peer-reviewed journal
3. Main focus of study was young people (aged under 18)
4. Addressed Internet use
5. Addressed incidents of harm related to online
interactions

8. Methods
• Original search yielded over 4,000 publications
• After a first-pass review, corpus narrowed to 271
studies.
• 271 were reviewed but only 148 articles were
fully coded after strict application of the
inclusion criteria.
• Coding framework adapted from the EU Kids
Online public repository. It included 21 items,
including details of method, target population,
context and how and whether harm was
operationalised.

9. Three categories of harms
• Three main categories of harms:
1. Health-related harms: 63 articles
1. Sex-related harms: 49 articles
1. Cyberbullying – 36 articles

10. Health studies: Methods
9.7%
Surveys
9.5%
44.4% Textual analysis
11%
Case studies
Interviews
25.4%
Other

11. Scope of harms
Pro-eating
disorder
Other, 19%
websites
with a focus
on
anorexia, 30
Internet %
addiction, 1
1%
Self-
Pro-suicidal harm/self-
websites, 14 injury
% websites, 16
%

12. Operationalization of harm
• Harm is operationalized in less than half of the studies –
44.5%
• Self-harm: The most common definition (33.3% of all
studies and 75% of those that operationalize the term)
• Examples:
• “Parasuicide”, “self-mutilation” or “self-injury” (Adams et
al., 2005, p. 1293)
• “A form of actively managed self-destructive behavior
that is not intended to be lethal”, which “subsumes an
extensive range of behaviours” such as self-
mutilation, self-injurious behavior, deliberate self-harm
and self-wounding (Murray et al., 2008, p. 29)

13. Other definitions of harm
2. “Desensitization to violence in real life and
impairment in the process and outcome of
moral evaluation”
3. Physical harm
4. Emotional harm

14. Scale of Pro-ED harms
• Much of the discussion pertains to perceived or potential
harm rather than evidence of actual harm
• Pro-eating disorder websites:
1. Even “supportive” websites contain potentially harmful
content – “pro-ED websites tend to be perceived as
supportive by users, but instead appear to exacerbate or
main users’ eating disorder symptoms”
2. Three “possible risks”:
a. “Operation under the guise of ‘support’
b. Reinforcement of disordered eating
c. Prevention of help-seeking and recovery” (Rouleau and von
Ranson, 2011, p. 525)

15. Scale of Pro-ED harms
• 85% of the pro-eating disorder websites contain
“thinspiration” material – images of very thin models or
celebrities used to inspire weight loss, 70% have “tips and
tricks” on dieting and fasting or purging, laxatives and pills
(Borzekowski et al., 2010)
• 96% of users of pro-eating disorder websites and 46.4% of
users of pro-recovery sites report “learning new weight loss
or purging techniques” (Wilson et al., 2006, p. e1635)
• 19.2% of users say they feel the pro-eating disorder websites
are harmful to them because they encourage the
disorders/competition among participants and have “negative
impact on self-effect” (Csipke and Horne, 2007, p. 200)

16. Scale of Pro-ED harms
• Talbot (2010) argues that viewing pro-eating disorder websites
is linked to a number of negative effects:
1. “Higher levels of dieting and exercise
2. Higher levels of drive for thinness, body dissatisfaction and
perfectionism
3. Positive correlation between viewing pro-ED
websites, disease duration and hospitalizations” (p. 686)
BUT:
1. Viewing pro-ED websites may INCREASE eating disorder
behaviour but MIGHT NOT CAUSE it
2. More research is needed to determine if these websites DO
HARM and if so, TO WHOM and OF WHAT FORM
(Talbot, 2010, p. 694)

17. Scale of self-harm
• A “normalizing” and a “pathologizing” discourse
(Franzén & Gottzén, 2011, p. 279)
• Little evidence regarding the prevalence of self-
injurious behavior and its relationship to use of self-
harm websites or forums
• 80% of the users of self-harm message boards are
found to be between 14 and 20 years old
(Whitlock, Powers, & Eckenrode, 2006).
• The typical adolescent self-injurer is female, often
with a history of abuse and an eating disorder, most
commonly cutting her arms and legs and hiding it.

18. Scale: pro-suicidal sites
• Much more conclusive in the claims about harms
• A meta-study (Durkee et al., 2011) concludes
that “pro-suicide websites and online suicide
pacts” are “high-risk factors for facilitating
suicidal behaviours, particularly among isolated
and susceptible individuals” BUT some forums
provide opportunities for people to meet others
with similar experiences, “wherein their
thoughts and feeling are not condemned nor
lectured about” (p. 3944)

19. Scale of “Internet addiction”
• 35% of people with Problematic Internet experience
are <18
• BUT “virtually all of the Internet problem behaviors”
are “extensions of problem behaviors that pre-
existed the advent of the Internet” (Mitchell, Becker-
Blease, & Finkelhor, 2005, p. 506)
• The typical problematic Internet user is a teenager
who spends most of his/her time on the
computer, including at night. He/she is socially
isolated and plays games 12-14 hours a day
• A counsellor: “It’s the same thing as with drug
addicts” (Acier and Kern, 2011, p. 986)

20. Conclusions
• It seems indisputable that some children experience
a variety of health harms as a result of using the
Internet.
• Documented examples include young people
assisted or encouraged in their suicide attempts
after visiting pro-suicide forums and young girls
encouraged to maintain or exacerbate their eating
disorders or self-injurious behavior.
• Relatively low numbers – specific case studies based
on interviews with health professionals and/or
medical records

21. Conclusions
• Interesting textual analysis studies and surveys, suggesting
high prevalence of potential harms and risks but little
evidence on actual harms, especially in relation to low-risk
children
• For example, whether and how are healthy children affected
by using eating disorders websites – are they “harmed” by the
pro-ED websites?
• Limitations of studies: reliance on surveys – they tell us a lot
about risks and perceived harms but little about actual harms
• Limitations of our study: focus strictly on harms and studies
that use the term, hence potentially relevant studies might
have been omitted

22. Any questions?
• Dr Vera Slavtcheva-Petkova, v.petkova@chester.ac.uk
• Dr Monica Bulger, monica.bulger@oii.ox.ac.uk
• Dr Victoria Nash, victoria.nash@oii.ox.ac.uk