Opportunities and threats for adolescent well-being provided by digital transformations

Authors and affiliations

1. Louise Holly, Secretariat, The Lancet and Financial Times Commission on Governing Health Futures 2030, Geneva, Switzerland.

2. Brian Li Han Wong, Secretariat, The Lancet and Financial Times Commission on Governing Health Futures 2030, Geneva, Switzerland.

3. Anurag Agrawal, Co-Chair, The Lancet and Financial Times Commission on Governing Health Futures 2030; CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.

4. Isang Awah, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom.\

5. Marwa Azelmat, Association for Progressive Communications, Rabat, Morocco.

6. Ilona Kickbusch, Co-Chair, The Lancet and Financial Times Commission on Governing Health Futures 2030; Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland.

7. Njide Ndili, Commissioner, The Lancet and Financial Times Commission on Governing Health Futures 2030; PharmAccess Foundation, Lagos, Nigeria.

Corresponding author: Louise Holly, Secretariat, The Lancet and Financial Times Commission on Governing Health Futures 2030, Global Health Centre, The Graduate Institute, Chemin Eugène Rigot 2, CP 1672, 1211 Geneva. louise.holly@graduateinstitute.ch

Acknowledgements

The authors of the paper thank Tobias Dienlin, Aoife Doyle and Ashley Yonga for helpful suggestions on a draft of this paper.

1. Introduction

Adolescence in the digital age

Today’s adolescents are growing up in a progressively digital world, with technology and computing becoming an inseparable part of their personal lives and wider society. Unlike previous generations, adolescents with digital access live simultaneous online and offline lives and use the internet to not only explore the world around them, but also find their places in it.

Devices which provide access to platforms and services powered by data analytics, machine learning, and other forms of artificial intelligence (AI) are adolescents’ main gateways to digital environments. Virtual and augmented reality technologies offer opportunities for even deeper immersion into virtual worlds.

For an increasing number of adolescents, well-being is now intimately connected with direct and indirect experiences with digital environments and technologies which facilitate and mediate these interactions. (1) As we describe in subsequent sections, digital experiences and habits beginning in childhood and adolescence can positively and negatively impact the journey to adulthood. This extends to adolescents not yet online, through the secondary effects of accelerated digitalisation within public, private, and non-governmental sectors and services.

Unequitable access and diverse lived experiences of the digital world

Adolescence – defined as the period between 10 and 19 years – spans a time of substantial development and change. The ways in which adolescents use digital technologies and interact with digital environments change dramatically as they mature and gain greater independence. (2)

Adolescents are not a homogeneous group. In addition to changing over time, adolescents’ experiences of the digital world differ according to a range of intersecting factors including gender, sexual orientation, disability, education level, physical location, and socio-economic status. Weak information and communication technology (ICT) infrastructure, plus high costs of connectivity and devices can be major obstacles to access for many adolescents. Access challenges can be further compounded by parental attitudes and wider structural and systemic barriers such as gender inequality. (3,4)

Disaggregated data on adolescents’ internet access around the world remain scarce. It is estimated that 69 percent of 15–24-year-olds globally are online using mobile or broadband internet, but only 38 percent in least developed countries. (5) Two-thirds (2.2 billion) of children and young people do not have internet access at home. (6)

Digital technologies and adolescent well-being

Discussions about adolescent well-being in the digital age tend to focus on the opportunities and threats associated with specific digital technologies, such as debates over screen time and use of social media platforms. Existing literature on the relationship between digital technologies and adolescent well-being suggests that the effects of technology use are neutral to small and depend considerably on how the technologies are used. (7–9)

Despite their evolving capacities, studies show that the effects of digital technology use on adolescents are comparable to adults. Whilst new risks have emerged in digital environments, evidence to date suggests that adolescents’ vulnerabilities to harm online reflect their vulnerabilities offline. (10)

In this background paper, we explore digital transformations – the process of integration of digital technologies and data analytics into all areas of life – across five domains of adolescent well-being: connectedness, positive values, and contribution to society; good health and optimum nutrition; safety and a supportive environment; learning, competence, education, skills, and employability; and agency and resilience. (11) We identify ways in which digital transformations can either support or undermine adolescent well-being in each domain as well as underscore implications for policy and programming.

Existing evidence on this topic has several limitations. Published literature is predominantly focused on adolescent experiences in high-income countries (HICs) and older adolescents. Many studies depend on self-reported and subjective assessments of technology use and well-being by adolescents, and these may not always be accurate as they are subject to the respondents’ biases and honesty. Finally, as a relatively new area of research, there are few large-scale or long-term studies to help us fully understand the impacts of digital transformations on adolescent well-being.

2. Connectedness, positive values and contribution to society

Adolescence is recognised as a time when children become “biologically, emotionally, and developmentally primed for engagement beyond their families.” (12) Digital platforms and tools provide adolescents with channels through which they can realise this readiness and fundamental need for social connection and engagement with wider society.

Building connections

Adolescents who are online use a range of tools such as social media, video and gaming software, and messaging services to stay in touch with family and friends. (13) Since the COVID-19 pandemic, digital platforms have become an even more predominant means of communication for adolescents restricted by physical distancing policies. Even prior to the pandemic, a UNICEF study of 18-year-olds found that 90 percent considered socialising and communicating with their friends online to be important. (14)

Digital communication platforms can be helpful for adolescents who find face-to-face interactions difficult. They also provide opportunities for adolescents to connect with others who share similar experiences and interests. Through the internet, adolescents can expand their knowledge of different subjects, communities, and viewpoints, enabling them to nurture positive values such as tolerance, empathy, and respect. Concomitantly, increased online activity may expose adolescents to radicalising content that promotes hatred or violence, and to sources of mis- or disinformation. (15,16)

Parents and others have expressed fears that spending too much time on mobile devices prevents adolescents from developing or maintaining ‘real’ relationships; however, most research to date has not supported this concern. While time spent online does displace time spent with friends and family, adolescents have expressed that virtual communication strengthens the quality of existing relationships. (17)

Participating in civic and democratic processes

Increased availability of information, coupled with digital means of communication, provides unprecedented opportunities for adolescents to develop their civic literacy and engagement, and to catalyse social change. The use of digital media to find, share, discuss, and mobilise around political issues is now a critical part of the repertoire of a digital citizen’s civic and political engagement. (18,19)

In digital environments, the distance between information and action is reduced. Adolescents can learn about an issue and immediately take action. Online, they can engage with policymakers and people in power on a more equal footing and directly hold them to account. Digital technologies also provide new mechanisms for adolescents to collect data and conduct or contribute to research on issues important to them. (20)

Always connected

Online friends and communities can be important sources of social support and provide adolescents with affirmation and a sense of belonging. However, social media and other digital platforms are deliberately designed to encourage extended and repeated use, thereby perpetuating a feeling amongst users that they must always be connected and gain approval from other internet users. Pressures on adolescents to be available 24/7 and to constantly share updated information about themselves can be difficult to manage. (21) As adolescents increase their online presence and express their views in the public domain, they may find themselves exposed to rejection and negative reactions which harm their well-being and deter positive civic engagement.

3. Good health and optimum nutrition

Digital transformations influence the various social, commercial, and economic determinants of adolescent health and nutrition. In addition, an individual’s ability to access and effectively navigate digital environments is increasingly recognised as a determinant of health in its own right. (22)

Digitally-enabled health systems

The effectiveness and efficiency of health systems in all countries are being strengthened through increased digitalisation. Use of digital technologies to support health service delivery, diagnostics, research and information systems is also expanding rapidly with the potential to accelerate progress towards universal health coverage (UHC), including for traditionally underserved adolescents and their communities such as rural populations, refugees and asylum seekers, adolescents with disabilities, poorer adolescents, and sexual and gender minorities. (23) Advancements in genomics and AI offer the potential for more personalised and predictive medicine that can identify and mitigate health risks during childhood and adolescence.

Telehealth and eHealth services enable adolescents in remote and rural areas to consult with health professionals. Frontline health workers who provide adolescent health services can enhance the coverage and quality of their care by using mobile applications to connect with patients, refer to specialists, and utilise opportunities for online training. (24,25) The COVID-19 pandemic has accelerated the shift in many parts of the world from facility-based healthcare to digitally-enabled care pathways that are centred around the patient, wherever they are located. (26)

Tools for self-management of health and nutrition

Beyond innovations in the formal health sector, digital tools are being used by adolescents with digital access to take greater control over their own health and nutrition. They can search the internet to learn about different health topics and use mobile applications and activity trackers to monitor and manage their physical and mental health. The added confidentiality offered by digital tools allows adolescents to seek information and advice on potentially embarrassing or stigmatising health issues such as sexual and reproductive health and mental health. Adolescents also actively use social media and publishing platforms to create their own health-related content and establish communities of support. (27)

Governance challenges

The proliferation of digital tools for health and nutrition present risks as well as opportunities for adolescent well-being. Adolescents’ top concerns include the quality and trustworthiness of health information online and the privacy of their personal data. (28,29) Regulation of digital health tools in most countries is weak, particularly of tools categorised as supporting fitness, well-being, or self-care. This therefore makes it difficult for adolescents to assess the quality of the many digital health tools now available.

The huge volumes of personal health and health-related data made available by digital technologies present great opportunities for researchers and policymakers looking to improve health outcomes. Health data is also a rich source of information for private companies wanting to better understand their customers, generating concerns about the growing number of technology companies entering the healthcare market to further their commercial interests. (30)

Marketing of unhealthy foods is particularly concerning for adolescent health as it has been shown to increase risks of obesity and affect lifelong eating habits. Digital media and new data-driven advertising practices substantially increase the frequency and duration of adolescents’ exposure to marketing of unhealthy foods. Techniques, such as micro-targeting and the use of social media influencers to promote unhealthy foods, amplify the power of marketing to young audiences who may not recognise the commercial nature of content. (31)

Negative health effects of technology use

Adolescents’ experiences in digital environments can influence their body images and perceptions of what an ‘ideal’ body should look like. (32) Whilst the internet offers copious amounts of resources for adolescents keen to maintain healthy diets and lifestyles, there are also a growing number of resources and communities available for adolescents looking to self-harm, for example through eating disorders or self-mutilation. (33) Other forms of unintentional self-harm amongst adolescents have also resulted from internet challenges that encourage participants to engage in risky behaviours and post about it on social media. (34)

The intentionally persuasive design of online games and social media platforms encourages adolescents to spend as long as possible in front of their screens. (35) Excessive and, particularly, night-time use of social media have been associated with poor sleep quality, increased incidence of self-doubt, anxiety, low self-esteem, and aggressive behaviour among adolescents. (36) Addiction to gaming has been recognised as a medical illness in the International Classification of Diseases (ICD-11) and there is increased awareness that excessive internet use can also generate a form of addiction. (21)

4. Safety and a supportive environment

To reach their full potential, adolescents require a safe and supportive environment that fulfils their physical and emotional needs and protects them from harm. Whilst digital transformations in different areas of adolescents’ lives can enhance their environment, discussions related to this dimension of adolescent well-being are dominated by concerns about potential threats to their safety. Not all online risks will translate into actual harm and most risks will be encountered by only a minority of adolescents. However, the potential severity of online harms demands greater action by policymakers and industry to make the digital environment safer for adolescents.

Preventing and responding to harms

The digital environment offers adolescents access to information that can help them stay safe both on- and offline. In addition to teaching them about their entitlements and ways to secure a safe and supportive environment, the internet can also provide sources of advice on positive behaviours and knowledge and skills to challenge harmful norms and practices.

Digital technologies offer alternative sources of support to adolescents who experience abuse or neglect via online discussion groups and virtual counselling. These forms of communication can not only offer safe spaces and support for adolescents who cannot access traditional support services, but also allow them to participate on terms they are comfortable with. (37–39)

Digital innovations are being effectively deployed to tackle violence against adolescents. For example, AI is used to prevent online sexual exploitation and abuse, and to bring perpetrators to justice. (40) AI can be used to detect and filter harmful content to protect young children and adolescents using the internet, and alert users if the person they are chatting to online is unlikely to be who they claim.

Risks in the online environment

Whilst digital technologies are being used to protect adolescents, they can also be exploited by offenders wishing to cause harm and often leverage the anonymity offered by the internet. Pre-existing forms of bullying, stalking, harassment, and sexual abuse have now extended online with consequences for adolescent well-being ranging in severity from upsetting interactions to life-threatening abuse and suicide. (41) Populations of adolescents whose behaviours may be stigmatised or criminalised, such as LGBTQIA+ adolescents, are at particular risk of harm from having their personal data revealed.

Many online risks are outcomes of children playing in adult spaces without the developmental capacity to negotiate adult-designed content, behaviour, or interactions. (2) Time online may increase an adolescent’s contact with strangers and expose them to ageinappropriate content such as pornography, and content that incites sexual exploitation, suicide, or self-harm. (10,15)

The proliferation of the ‘Internet of Things’ (IoT) – physical objects, including toys, that are connected to the internet – has created a new set of risks for adolescents’ privacy and security. Adolescents’ data generated by these technologies can unknowingly be used for surveillance purposes by parents, educators, or even strangers with nefarious motives. (42) ‘Sexting’ or the sharing of self-generated sexualised content via mobile devices, is another relatively new risk which allows adolescents to explore their sexuality but may expose them to extortion, harassment, and humiliation.

Commercial exploitation

As previously noted, companies – from social media platforms to education providers – harvest adolescents’ personal information and sell it to third parties who subsequently use the data to inform their digital marketing content and strategies. (43) To maximise advertising revenue, digital platforms can manipulate adolescent behaviours online by rewarding certain actions and discouraging others. Increasingly, sophisticated AI techniques are employed within games and social media platforms to learn about an individual’s preferences and target them with tailored marketing content. (44)

Commercial practices online can exacerbate inequities and increase discrimination. For example, predictive analytics used by social media platforms and advertisers group people according to their assumed interests or traits and only show them certain products or services. (43) Automated decision-making with opaque algorithms and non-transparent nudge techniques based on personal data can impact adolescents’ access to information and diversity of experiences. (45)

Challenges of age verification

Adolescents’ evolving maturity, understanding, and capacity entitle them to special rights under the UN Convention of the Rights of the Child, but this is rarely recognised or reflected in the digital environment. (2) Few online services distinguish between child and adult users, and in most social media platforms, anyone over the age of 13 (in line with the US 1998 Children’s Online Privacy Protection Act) is treated as an adult online. Furthermore, age verification techniques are easy to falsify which results in adolescents being continually subjected to both harmful content and sophisticated data collection and marketing practices. (46)

5. Learning, competence, education, skills and employability

Adolescence is a critical time for acquiring new knowledge and skills which will be pivotal for the adult roles that adolescents are destined to fulfil. In addition to the academic education that adolescents may receive, they learn how to better manage emotions and relationships, and gain attributes which will be essential for future employment.

Digitally transformed learning environments

Digital transformations in education have changed the environments in which adolescents learn over the last few decades. The use of video technologies and online platforms in educational settings (known as ‘e-learning’) allows teaching within traditional primary, secondary, and higher education settings to be augmented and has also enabled adolescents to learn outside of traditional physical classroom settings, regardless of their level of physical or mental ability. (47)

Recent innovation has seen a boom in the number of education technology (or ‘EdTech’) start-ups and learning apps in this space, providing online courses to students in more flexible and personalised formats. (48) The rapid proliferation of massive open online courses (MOOCs) has gained substantial media attention for its potential to disrupt the traditional modes of education through provision of easy access (free or low-cost) content delivery, enabling students from even the most underserved regions to access quality higher education and develop skills. (49) Outside of traditional learning environments, digital platforms, such as game-based learning frameworks, can help adolescents to expand their knowledge and develop practical life skills. (50)

Increasing accessibility to education

Digital transformations can allow underserved populations and out-of-school adolescents to learn when school and universities are closed or inaccessible. Assistive digital technologies, for example, can help to make education more inclusive for adolescents with disabilities or impairments.

An estimated 1.5 billion children and adolescents experienced interruptions to their education during the COVID-19 pandemic. Adolescents who already had reliable internet access, plus digitally-connected and proficient teachers, have been able to continue learning, whereas those without have been significantly disadvantaged. (51) Failure to address the digital divide and make digital educational platforms more inclusive exacerbate inequities in learning outcomes.

For many adolescents, especially those living in communities characterised by endemic violence, schools function as places of safety and security as well as sources of essential services and social support. Therefore, even with increased access to remote, online learning platforms, adolescents must continue to be able to access traditional learning environments. (47)

Development of digital literacy skills

Technologies and increasing digitalisation have permeated nearly every aspect of many adolescents’ daily lives, necessitating their need to develop skills to navigate such environments. The future workforce is expected to have the skills required to live, work, and thrive in a digital society. As such, for schools to ensure their students are employable, educational programming needs to form a solid foundation of ‘digital literacy’ starting in the classroom.

Many schools’ abrupt move to remote learning in 2020 may have ultimately strengthened the digital literacy practices of students and teachers, harnessing previously untapped potential. Digital literacy, however, does not just mean being proficient with ICT systems. It also requires critical thinking skills, cognisance of online etiquette and safety, and an understanding of the social issues surrounding digital technologies. Only with these tools can adolescents truly become active digital citizens: individuals who responsibly and safely use technology to interact with the world around them.

Teachers play a crucial role in educating young people in digital citizenship and in programming innovative classroom activities to emphasise it. Teachers and educators, particularly in LMICs, should be supported to build the requisite capacity in digital educational content development and educational technology use. (52)

Challenges presented by digital transformations in learning environments

While there is boundless potential for digitally-enabled and online platforms to support learning and education, policies and programmes must seek to democratise such opportunities and increase digital inclusion. The COVID-19 pandemic has drawn muchneeded attention to the importance of connectivity, both at school and at home, as well as to the ways in which lack of digital access can exacerbate pre-existing vulnerabilities for marginalised and disadvantaged children. (53) Many schools across the world lack access to the infrastructure and hardware to make effective use of e-learning. (54) Without sufficient support, students face major barriers for online learning such as lack of community, technical problems, and difficulties in understanding instructional goals. (55)

Several key concerns persist when considering the integration of digital technologies in learning environments. These include implications of AI in assessing learning outcomes; online student profiles and publicly available data which may affect future employability; and ethical concerns about use of automated monitoring and surveillance in education settings. As a growing number of critics are beginning to argue, adolescent’s life chances and access to opportunities are increasingly becoming shaped by the types of social sorting afforded by dataveillance. (42)

6. Agency and resilience

Adolescence is a time of profound identity exploration accompanied by growing expectations of autonomy. (18) Increasing digitalisation can facilitate and unlock the potential of adolescents to develop a sense of agency, identity, purpose, resilience, and fulfilment. (56– 59)

Platforms for youth-led innovation

Adolescents can leverage a range of digital technologies to innovate, create, and pursue their interests and passions. Initiatives such as social entrepreneurship challenges, ‘hack-athons’ (60), and youth innovation hubs, allow for co-creation, ideation, and innovative thinking to surface, and allow for adolescents to be directly engaged in designing the solutions they need.

The COVID-19 pandemic has shown the extent to which adolescents are turning to digital platforms to gather information about the pandemic and to access tools for self-care and well-being. And, with increasing online use, further exploration into developed digital typologies among adolescents can help to inform the development of more tailored prevention and supportive services. (61)

Harnessing the expertise and knowledge of adolescents

When designing interventions to help adolescents improve their well-being and unlock their potential, it is important to remember that they are the experts on their own needs, the technologies they use, and how they access information. Furthermore, adolescents’ lived experiences of interacting with digital technologies differ significantly. Therefore, as there is no ‘one size fits all’ approach, contextual differences need to be taken into account by technology developers and policymakers when designing interventions aimed at improving adolescent well-being.

For adolescents to truly have agency in relation to digital technologies and approaches for which they are the intended end users or beneficiaries, they need to be enfranchised, rather than just engaged, in every step of the process: development, implementation, and evaluation. (62) Adolescents from diverse backgrounds should be consulted – in the spaces that they already occupy, rather than creating new spaces – on the kinds of on- and offline services they need to support their well-being. Only through this amplification of adolescent voices and ‘participatory methodology’ – with adolescents as co-creators, collaborators, problem solvers, champions, and change agents – will adolescents harness the full potential of digital technologies.

Youth social accountability

Much of what occurs online is public, or has the potential to be, raising concerns about privacy and the lasting effects of data collected during childhood and adolescence on an individual’s agency. (17,63) As such, adolescents need to be able to trust digital services, particularly if they involve the collection and use of personal data. New Zealand’s Algorithm Charter for Aotearoa demonstrates a government commitment to transparency and accountability to ensure citizens can have confidence in algorithms and public use of their data. (64)

As systems increasingly digitalise, they need to be responsive to adolescents’ needs and rights, improving quality and equity of services for adolescents, as well as promoting youth leadership, enfranchisement, and positive youth development. ‘Youth social accountability’ (YSA) in digital environments allows adolescents to be lead advocates for their health, rights, and well-being as well as demand transparency and hold systems and policymakers accountable, and much of YSA takes place on social media platforms. Partnerships with adolescents and adolescent-led organisations as well as collaboration with other sectors and actors at multiple levels of health systems are key to strengthening and sustaining YSA mechanisms, particularly when it comes to digital transformations in health.

Digital resilience

‘Digital resilience’ is the socio-emotional literacy and digital competency required to positively respond to and deal with risks one might be exposed to online. Building such resilience amongst adolescents is critical for them to confidently navigate both digital and non-digital environments as well as to ‘bounce back’ quickly from difficult online encounters. (65)

Studies have demonstrated that adolescents are cognisant of the social, moral, and ethical dilemmas posed by online communication, and that they exercise discernment regarding the quality of content shared by peers. (66) They also value being able to talk to their peers who share similar experiences, as it can strengthen their support networks and self-esteem. Therefore, to build adolescents’ digital resilience, it is important to develop online spaces, behavioural prompts, and tools which provide quick and easy access to informed support from peers and professionals as well as enable adolescents to manage their own mental health and well-being more effectively. (65)

Barriers and challenges to achieving agency

There are numerous household, societal, structural, and systemic barriers for adolescents when it comes to self-expression and exercising agency. (67) There is a weak enabling environment for adolescent-led content, design, and innovation as well as many gaps in the existing evidence base when it comes to the effectiveness of interventions for adolescents to develop agency and resilience. Analytics systems also appear to distribute decision-making to automated, proprietary systems where adolescents have little opportunity for involvement in the handling or use of their personal data. Even so-called ‘technology for social good’ projects often exclude adolescents from different communities from meaningful leadership opportunities. Furthermore, as adolescents get older, their priorities change; this calls for programmes which are adaptable and sustainable, beyond one tool or application.

7. Implications for policy and programming

Universal access to safe and affordable internet connectivity is now widely recognised as essential for achieving the Sustainable Development Goals and realising human rights. (68) To ensure all adolescents worldwide can benefit from digital transformations, policymakers should prioritise connecting every household and school to the internet and removing barriers to equitable digital access.

Industry and governments must work together to design and adapt digital environments to not only make them safe and accessible, but also to ensure they enhance the well-being of its users. Adolescents’ best interests must always precede any commercial interests. Measures to mitigate online risks should be balanced with an adolescent’s evolving capacities and rights to freedom of expression, access to information, and privacy. The UN Convention on the Rights of the Child, particularly a new General Comment on children’s rights in the digital environment, offers a helpful framework for ensuring that digital transformations support adolescents’ well-being and promote their best interests. (69)

There is a consensus that today’s adolescents and their caregivers require a combination of digital and civic literacy and skills to prepare them for a digitally connected society and to manage risks inherent to life online. (13,18) Digital skills and citizenship programmes should therefore be designed to enable all adolescents, especially those from disadvantaged populations, to leverage digital transformations to support their well-being and contribute to wider society. (70)

Stronger national and international regulatory frameworks are required to guarantee the quality of digital tools and online information available to adolescents. Governments should tightly regulate digital marketing of unhealthy products and work closely with technology companies to protect adolescents from online content and use of digital devices which could be detrimental to their health and well-being. Policymakers and regulators should create national, regional, and global governance frameworks and safeguards to provide adolescents with adequate personal and data protection in the digital environment whilst maximising opportunities to use data to improve public health and well-being.

Organisations driving and governing digital transformations must recognise adolescents from all backgrounds as change agents, innovators, and rights-holders with vital roles to play in shaping the digital world. Policymakers and industry should therefore foster meaningful, equitable, and long-term dialogues and partnerships with adolescents and adolescent-led organisations representing diverse groups so that future transformations are responsive and accountable to their needs and views.

Finally, whilst digital transformations present many opportunities for improving adolescent well-being, they are not always a panacea. Policymakers must ensure that investments in digitalisation and digital tools are complementary to, and do not displace, broader efforts to strengthen systems that can offer a range of high-tech, low-tech, and no-tech adolescentfriendly education and services. (49)

8. Conclusion

Equipped with a smartphone and internet access, a new world is available to many adolescents, full of opportunities for communication, learning, self-expression, and civic participation. At the same time, in online environments, an adolescent can be exposed to risks of commercial exploitation and multiple forms of mental and physical harm. Digital technologies in themselves are neither helpful nor harmful to adolescent well-being; they are tools that can either support or undermine well-being depending on how they are designed, used, and governed.

How an adolescent navigates the opportunities and risks of digital transformations depends on a wide range of factors including their level of digital literacy, individual characteristics and the wider social, economic and political environment in which they are situated. Further research is needed to increase our collective understanding of the opportunities and threats that digital transformations pose to adolescents’ well-being, particularly the most vulnerable and disadvantaged adolescents, and adolescents living in LMICs.

Too many adolescents remain disconnected and completely excluded from digital environments. This undermines their rights and ability to reap the benefits that digital transformations have to offer. Governments and the private sector need to close the digital divide and get all adolescents online. Simultaneously, they must create digital tools and online environments that are fit for adolescents.

As more adolescents come online and digital transformations increasingly influence their lives, the case for stronger global and national governance of digital environments, technologies, and data will continue to grow. While it will never be possible to shield

adolescents from all forms of digital harm, adolescent well-being can be protected and promoted through a combination of measures including tighter regulation of digital technologies, practices, and content; investment in digital literacy and skills; and taking a rights-based approach to digital transformations. Adolescents, in all their diversity, must be enfranchised and supported to shape digital transformations so their well-being and other goals are fulfilled, now and in the future.

References

• Burr C, Taddeo M, Floridi L. The ethics of digital well-being: A thematic review. Sci Eng Ethics [Internet]. 2020;26(4):2313–43. Available from:

1. Burr C, Taddeo M, Floridi L. The ethics of digital well-being: A thematic review. Sci Eng Ethics [Internet]. 2020;26(4):2313–43. Available from: https://doi.org/10.1007/s11948-020-00175-8
2. Kidron B, Rudkin A. Digital childhood: Addressing childhood development milestones in the digital environment [Internet]. London; 2017 Dec. Available from: http://5rightsframework.com/the-5-rights/
3. Buchholz BA, DeHart J, Moorman G. Digital citizenship during a global pandemic: Moving beyond digital literacy. J Adolesc Adult Lit [Internet]. 2020 Jul 1;64(1):11 –7. Available from: https://doi.org/10.1002/jaal.1076
4. Kardefelt Winther D, Twesigye R, Zlámal R, Saeed M, Smahel D, Stoilova M, et al. Digital connectivity during COVID-19: Access to vital information for every child [Internet]. Innocenti Research Briefs. Florence; 2020 [cited 2021 Feb 17]. (Innocenti Research Briefs). Report No.: 2020–12. Available from: https://www.unicef- irc.org/publications/1099-digital-connectivity-during-covid-19-access-to-vital- information-for-every-child.html
5. International Telecommunication Union. Measuring digital development: Facts and figures 2020 [Internet]. ITUPublications. Geneva; 2020 [cited 2021 Feb 17]. Available from: https://www.itu.int/en/ITU-D/Statistics/Pages/facts/default.aspx
6. UNICEF; ITU. How many children and youth have internet access at home? [Internet]. New York; 2020. Available from: https://data.unicef.org/resources/children-and-young-people-internet-access-at-home-during-covid19/
7. Dienlin T, Johannes N. The impact of digital technology use on adolescent well-being. Dialogues Clin Neurosci [Internet]. 2020 [cited 2021 Feb 17];22(2):135–42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366938/
8. Vuorre M, Orben A, Przybylski AK. There is no evidence that associations between adolescents’ digital technology engagement and mental health problems have increased.
9. Przybylski AK, Weinstein N. A large-scale test of the Goldilocks hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychol Sci [Internet]. 2017 Jan 13;28(2):204–15. Available from: https://doi.org/10.1177/0956797616678438
10. Livingstone S, Smith PK. Annual research review: Harms experienced by child users of online and mobile technologies: the nature, prevalence and management of sexual and aggressive risks in the digital age. J Child Psychol Psychiatry [Internet]. 2014 Jun 1;55(6):635–54. Available from: https://doi.org/10.1111/jcpp.12197
11. Ross DA, Hinton R, Melles-Brewer M, Engel D, Zeck W, Fagan L, et al. Adolescent well-being: A definition and conceptual framework. J Adolesc Health [Internet]. 2020 Oct 1 [cited 2021 Feb 17];67(4):472–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32800426
12. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet [Internet]. 2016 Jun 11 [cited 2021 Feb 17];387(10036):2423–78. Available from:http://www.ncbi.nlm.nih.gov/pubmed/27174304
13. James C, Davis K, Charmaraman L, Konrath S, Slovak P, Weinstein E, et al. Digital life a nd youth well-being, social connectedness, empathy, and narcissism. Pediatrics [Internet]. 2017 Nov 1;140(Supplement 2):S71 LP-S75. Available from: http://pediatrics.aappublications.org/content/140/Supplement_2/S71.abstract
14. UNICEF. Perils and possibilities: Growing up online [Internet]. New York; 2016. Available from: https://www.unicef.org/media/66606/file/Growing-up-online.pdf
15. UNICEF. Children at increased risk of harm online during global COVID-19 pandemic [Internet]. UNICEF. New York; 2020 [cited 2021 Feb 17]. Available from: https://www.end-violence.org/online-safety-technical-note
16. UNESCO. Youth and the internet: Fighting radicalization and extremism [Internet]. Vols. 2018-Janua. Paris: UNESCO; 2015 [cited 2021 Feb 19]. Available from: https://en.unesco.org/node/243709
17. George MJ, Odgers CL. The risks and rewards of being an adolescent in the digital age [Internet]. CYF News. 2014 [cited 2021 Feb 17]. Available from: https://www.apa.org/pi/families/resources/newsletter/2014/12/digital-age
18. George MJ, Odgers CL. The risks and rewards of being an adolescent in the digital age [Internet]. CYF News. 2014 [cited 2021 Feb 17]. Available from: https://www.apa.org/pi/families/resources/newsletter/2014/12/digital-age
19. http://pediatrics.aappublications.org/content/140/Supplement_2/S127.abstractMomoi Y. Taiwan’s leading “civic hacker” helps fix cracks in democracy [Internet]. Nikkei Asia. 2020 [cited 2021 Feb 17]. Available from: https://asia.nikkei.com/Business/Technology/Taiwan-s-leading-civic-hacker-helps-fix-cracks-in-democracy
20. Gibbs L, Kornbluh M, Marinkovic K, Bell S, Ozer EJ. Using technology to scale up youth-led participatory action research: A systematic review. J Adolesc Heal [Internet]. 2020;67(2, Supplement):S14–23. Available from: https://www.sciencedirect.com/science/article/pii/S1054139X19308687
21. Deslandes SF, Coutinho T. O uso intensivo da internet por crianças e adolescentes no contexto da COVID-19 e os riscos para violências autoinflingidas. Cien Saude Colet [Internet]. 2020 Jun 1 [cited 2021 Feb 17];25(suppl 1):2479–86. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413- 81232020006702479&tlng=pt
22. Morley J, Cowls J, Taddeo M, Floridi L. Public Health in the information age: Recognizing the infosphere as a social determinant of health. J Med Internet Res [Internet]. 2020;22(8):e19311. Available from: https://www.jmir.org/2020/8/e19311
23. Agrawal A. Harnessing the power of AI for global health | Financial Times. Financial Times [Internet]. 2019 Oct 31 [cited 2021 Feb 19]; Available from: https://www.ft.com/content/3e5d9e12-f631 -11e9-9ef3-eca8fc8f2d65
24. World Health Organization. WHO guideline: recommendations on digital interventions for health system strengthening: evidence and recommendations [Internet]. Vol. WHO/RHR/19. Geneva: World Health Organization; 2019 [cited 2021 Mar 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541902/
25. World Health Organization. Youth-centred digital health interventions: a framework for planning, developing and implementing solutions with and for young people [Internet]. Geneva; 2020 [cited 2021 Mar 15]. Available from: https://www.who.int/publications/i/item/9789240011717
26. Green A. Covid-19 pandemic accelerates digital health reforms | Financial Times. Financial Times [Internet]. 2020 May 17 [cited 2021 Feb 19]; Available from: https://www.ft.com/content/31c927c6-684a-11ea-a6ac-9122541af204
27. Lupton D. Young People’s use of digital health technologies in the Global North: Narrative review. J Med Internet Res [Internet]. 2021;23(1):e18286. Available from: http://www.jmir.org/2021/1/e18286/
28. Lancet and Financial Times Commission on Governing Health Futures 2030. Results of a U-Report survey on young people and digital health.
29. Paul F, Thompson K, Gupta NK. Information.Support.Connection: How are young people engaging with digital spaces to learn about bodies, sex and relationships? [Internet]. 2020 [cited 2021 Mar 15]. (Paper commissioned for Switched on: Sexuality education in the digital space). Available from: https://unesdoc.unesco.org/ark:/48223/pf0000373884
30. BBC. Google tries to allay Fitbit-deal privacy fears – BBC News. BBC News Online [Internet]. 2021 Jan [cited 2021 Feb 19]; Available from: https://www.bbc.co.uk/news/technology-55662659
31. Tatlow-Golden M, Garde A. Digital food marketing to children: Exploitation, surveillance and rights violations. Glob Food Sec [Internet]. 2020;27:100423. Available from: https://www.sciencedirect.com/science/article/pii/S2211912420300778
32. Perloff RM. Social media effects on young women’s body image concerns: Theoretical perspectives and an agenda for research. Sex Roles [Internet]. 2014;71(11):363–77. Available from: https://doi.org/10.1007/s11199-014-0384-6
33. Pater J, Mynatt E. Defining digital self-harm. In: Proceedings of the ACM Conference on Computer Supported Cooperative Work, CSCW [Internet]. New York, NY, USA: ACM; 2017 [cited 2021 Feb 19]. p. 1501–13. Available from: https://dl.acm.org/doi/10.1145/2998181.2998224
34. Bonner M. What Is the Hot Water Challenge? Dangers, Risks, and Origins of Viral Challenge. Cosmopolitan [Internet]. 2018 Aug 1 [cited 2021 Feb 19]; Available from: https://www.cosmopolitan.com/entertainment/a22614436/hot-water-challenge/
35. Kidron B, Evans A, Afia J. Disrupted childhood: The cost of persuasive design [Internet]. London; 2018. Available from: https://5rightsfoundation.com/uploads/5rights-disrupted-childhood-digital-version.pdf
36. Woods HC, Scott H. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. J Adolesc [Internet]. 2016;51:41–9. Available from: https://www.sciencedirect.com/science/article/pii/S0140197116300343
37. UNICEF. COVID-19: Digital and remote approaches to eliminating Female Genital Mutilation and child marriage [Internet]. New York; 2020. Available from: https://aa9276f9-f487-45a2-a3e7- 8f4a61a0745d.usrfiles.com/ugd/aa9276_054b8567c3914ec7bfbaae5ab40d2673.pdf
38. Racher A, Isabelle B. Joining the dots? Tackling child exploitation during Covid-19. J Child Serv [Internet]. 2020 Jan 1;15(4):275–85. Available from: https://doi.org/10.1108/JCS-07-2020-0036
39. Jolly S, Oosterhoff P, Faith B, Braeken D, Shephard K. A review of the evidence: sexuality education for young people in digital spaces [Internet]. Paris; 2020 [cited 2021 Mar 15]. (Paper commissioned for Switched on: Sexuality education in the digital space.). Available from: https://unesdoc.unesco.org/ark:/48223/pf0000373885
40. Oriel A. Top 8 AI technologies to mitigate child abuse and child trafficking [Internet]. Analytics Insight. 2020 [cited 2021 Mar 15]. Available from: https://www.analyticsinsight.net/top-8-ai-technologies-mitigate-child-abuse-child- trafficking/
41. Livingstone S, Lansdown G, Third A. The case for a UNCRC General Comment on children’s rights and digital media: A report prepared for Children’s Commissioner for England [Internet]. London; 2017. Available from: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2017/06/Case-for- general-comment-on-digital-media.pdf
42. Lupton D, Williamson B. The datafied child: The dataveillance of children and implications for their rights. New Media Soc [Internet]. 2017;19(5):780–94. Available from: https://journals.sagepub.com/doi/full/10.1177/1461 444816686328
43. Montgomery KC, Chester J, Kopp K. Data governance for young people in the commercialized digital environment [Internet]. New York; 2020. (Good Governance of Children’s Data project. Issue brief). Report No.: 3. Available from: https://www.unicef.org/globalinsight/media/1081/file/UNICEF-Global-Insight-data- governance-commercialization-issue-brief-2020.pdf
44. Hartung P. The children’s rights-by-design standard for data use by tech companies [Internet]. New York; 2020. (Good Governance of Children’s Data project. Issue brief). Report No.: 5. Available from: https://www.unicef.org/globalinsight/media/1286/file/ UNICEF-Global-Insight-DataGov-data-use-brief-2020.pdf
45. Orlowski J. The Social Dilemma. United States of America: Netflix; 2020.
46. VicHealth. Under the radar: Harmful industries’ digital marketing to Australian children [Internet]. Melbourne; Available from: https://www.vichealth.vic.gov.au/- /media/ResearchandEvidence/Under-the-radar–Harmful-industries-digital-marketing- to-Australian- children.pdf?la=en&hash=960D0ED61D543DE331A5C8306EC87E95422FADC2
47. UNICEF. Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents [Internet]. Florence; 2020 [cited 2021 Feb 19]. Available from: https://www.unicef-irc.org/publications/1149-beyond-masks-societal-impacts-of- covid-19-and-accelerated-solutions-for-children-and-adolescents.html
48. Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. J Educ Technol Syst [Internet]. 2020 Jun 20;49(1):5–22. Available from: https://doi.org/10.1177/0047239520934018
49. Castillo N, Lee J, Zahra F, Wagner D. MOOCs for Development: Trends, challenges, and opportunities. Inf Technol Int Dev [Internet]. 2015 Jan 1 [cited 2021 Feb 19];11(2):35–42. Available from: https://repository.upenn.edu/literacyorg_articles/6
50. Game of choice, not chance [Internet]. seriousgames4change.com. Available from: https://www.seriousgames4change.com/
51. UNESCO; UNICEF; The World Bank. What have we learnt? Overview of findings from a survey of ministries of education on national responses to COVID-19. [Internet]. Paris, New York, Washington D.C.; 2020. Available from: https://data.unicef.org/resources/national-education-responses-to-covid19/
52. Laugasson E, Quaicoe JS, Jeladze E, Jesmin T. Bridging digital divide in schools in developing countries: Perceptions of teachers of free software opportunities. In: Zaphiris P, Ioannou A, editors. Cham: Springer International Publishing; 2016. p. 695–706. Available from: https://doi.org/10.1007/978-3-319-39483-1_63
53. Sepúlveda A. The digital transformation of education: connecting schools, empowering learners [Internet]. Broadband Commission for Sustainable Development. 2020 [cited 2021 Feb 19]. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000374309
54. Da Silva IS. Covid-19 reveals digital divide as Africa struggles with distance learning [Internet]. TRT World. 2020 [cited 2021 Mar 15]. Available from: https://www.trtworld.com/magazine/covid-19-reveals-digital-divide-as-africa-struggles-with-distance-learning-37299
55. Tawil S. Six months into a crisis : Reflections on international efforts to harness technology to maintain the continuity of learning [Internet]. Background Paper for Mobile Learning Week 2020 – @UNESCO. Paris; 2020 [cited 2021 Feb 19]. (Background paper for Mobile Learning Week 2020). Available from: https://unesdoc.unesco.org/ark:/48223/pf0000374561
56. DeVito MA, Walker AM, Birnholtz J, Ringland K, Macapagal K, Kraus A, et al. Social technologies for digital wellbeing among marginalized communities. In: Proceedings of the ACM Conference on Computer Supported Cooperative Work, CSCW [Internet]. New York, NY, USA: Association for Computing Machinery; 2019 [cited 2021 Feb 19]. p. 449–54. Available from: https://dl.acm.org/doi/10.1145/3311957.3359442
57. Pérez-Fuentes MD, Molero Jurado MD, Gázquez Linares JJ, Oropesa Ruiz NF, Simón Márquez MD, Saracostti M. Self-Expressive creativity in the adolescent digital domain: Personality, self-esteem, and emotions [Internet]. Vol. 16, International Journal of Environmental Research and Public Health. 2019. Available from: https://www.mdpi.com/1660-4601/16/22/4527
58. Granic I, Morita H, Scholten H. Beyond screen time: Identity development in the digital age. Psychol Inq [Internet]. 2020 Jul 2;31(3):195–223. Available from: https://doi.org/10.1080/1047840X.2020.1820214
59. Shifflet-Chila ED, Harold RD, Fitton VA, Ahmedani BK. Adolescent and family development: Autonomy and identity in the digital age. Child Youth Serv Rev [Internet]. 2016;70:364–8. Available from: https://www.sciencedirect.com/science/article/pii/S0190740916303280
60. Tauberer J. Hackathon Guide [Internet]. [cited 2021 Mar 18]. Available from: https://hackathon.guide/
61. Tzavela EC, Karakitsou C, Halapi E, Tsitsika AK. Adolescent digital profiles: A process-based typology of highly engaged internet users. Comput Human Behav [Internet]. 2017;69:246–55. Available from: https://www.sciencedirect.com/science/article/pii/S0747563216307737
62. WHO, UNFPA, UNICEF U. Youth-centred digital health interventions: a framework for planning, developing and implementing solutions with and for young people [Internet]. Geneva; 2020 [cited 2021 Feb 17]. Available from: https://www.unfpa.org/publications/youth-centred-digital-health-interventions- framework
63. Palfrey J, Gasser U. Born digital: Understanding the first generation of digital natives. Basic Books; 2008.
64. New Zealand Government. Algorithm charter for Aotearoa New Zealand [Internet]. 2020. Available from: https://data.govt.nz/use-data/data-ethics/government-algorithm- transparency-and-accountability/algorithm-charter
65. Bush M, Russell L. Resilience for the digital world: A positioning paper [Internet]. 2016. Available from: https://youngminds.org.uk/media/1491/resilience_for_the_digital_world_ym_positionin g.pdf
66. Livingstone S, Haddon L, Vincent J, Mascheroni G, Ólafsson K. Net children go mobile: the UK report [Internet]. London; 2014. Available from: http://eprints.lse.ac.uk/59098/1/_lse.ac.uk_storage_LIBRARY_Secondary_libfile_sha red_repository_Content_Livingstone%2C S_EU Kids Online_Livingstone_Net children_ go_2014_Livingstone_Net_ children_ go_2014_author.pdf
67. UNICEF. The adolescent kit for expression and innovation [Internet]. 2020 [cited 2021 Feb 19]. Available from: https://www.adolescentkit.org/index.html
68. Office of the United Nations Secretary General. Report of the Secretary General’s Roadmap for Digital Cooperation [Internet]. New York; 2020. Available from: https://www.un.org/en/content/digital-cooperation-roadmap/
69. UN Committee on the Rights of the Child. General comment No. 25 (2021) on children’s rights in relation to the digital environment [Internet]. CRC/C/GC/25; 2021. Available from: https://documents-dds- ny.un.org/doc/UNDOC/GEN/G21/053/43/pdf/G2105343.pdf?OpenElement
70. Kim M, Choi D. Development of youth digital citizenship scale and implication for educational setting. J Educ Technol Soc [Internet]. 2018 Feb 17;21(1):155–71. Available from: http://www.jstor.org/stable/26273877