See discussions, s a s, and au ho p o iles o his publica ion a : h ps://www. esea chga e.ne /publica ion/26687019
Elec onic media communica ion wi h iends om 2002 o 2006 and links o
ace- o- ace con ac s in adolescence: an HBSC s udy in 31 Eu opean and No h
Ame ican coun ies and egio...
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Elec onic media communica ion wi h iends om 2002 o 2006
and links o ace- o- ace con ac s in adolescence: an HBSC s udy
in 31 Eu opean and No h Ame ican coun ies and egions
Emmanuel Kun sche1, B uce Simons-Mo on2, Tom e Bog 3, Inmaculada Sánchez
Queija4, Vic o ia Muñoz Tinoco5, Ma ga ida Gaspa de Ma os6, Massimo San inello7,
Michela Lenzi7, and HBSC Pee Cul u e Focus G oup*
1 Swiss Ins i u e o he P e en ion o Alcohol and D ug P oblems, Resea ch Depa men , Lausanne,
Swi ze land 2 P e en ion Resea ch B anch, Na ional Ins i u e o Child Heal h and Human
De elopmen , Na ional Ins i u es o Heal h, Be hesda, USA 3 Ne he lands Ins i u e o Men al Heal h
and Addic ion, U ech Uni e si y, he Ne he lands 4 Depa men o De elopmen al and Educa ional
Psychology, Na ional Dis ance Uni e si y o Spain, Mad id, Spain 5 Depa men o De elopmen al
and Educa ional Psychology, Uni e si y o Se ille, Spain 6 Facul y o Human Kine ics, Technical
Uni e si y o Lisbon, Po ugal 7 Depa men o De elopmen al and Social Psychology, Uni e si y o
Padua, I aly
Abs ac
Objec i e—Because he po en ial o elec onic media communica ion (EMC) has inc eased
g ea ly, i is o in e es o desc ibe ends in EMC be ween adolescen s and hei iends and o
in es iga e whe he EMC acili a e o supe sede ace- o- ace con ac s among pee s.
Me hods—Answe s o 275,571 adolescen s conce ning con ac ing iends by means o he phone,
ex messages, and he in e ne (i. e. EMC), he numbe o close iends, and he numbe o a e noons
and e enings pe week spen ou wi h iends we e analysed by means o χ2- es s and mul iple
eg ession.
Resul s—In 2006, be ween mo e han one hi d (11-yea olds) and nea ly wo hi ds (15-yea olds)
communica ed elec onically wi h hei iends daily o nea ly daily. F om 2002 o 2006, EMC
inc eased in almos all pa icipa ing coun ies. Pa icula ly high inc eases we e ound in Eas e n
Eu ope. Ac oss coun ies, he highe he equency o EMC he highe he numbe o a e noons and
e enings spen wi h iends.
Conclusion—The esul s a e su p isingly consis en ac oss he 31 coun ies and sugges ha EMC
among adolescen s acili a e a he han supe sede ace- o- ace pee con ac s.
Keywo ds
Elec onic media use; Face- o- ace; Pee g oups; Adolescen s; T end s udy; C oss-cul u al esea ch
Add ess o co espondence: Emmanuel Kun sche, Swiss Ins i u e o he P e en ion o Alcohol and D ug P oblems, Resea ch
Depa men , PO Box 870, 1001 Lausanne, Swi ze land, Tel.: +41-21-321 29 52, Fax: +41-21-321 29 40, [email p o ec ed].
*Membe s o he HBSC Pee Cul u e Focus G oup: Ma ga ida Gaspa de Ma os (PT) (Coo dina o ), Lidiya Vasile a (BG), A li
Ha ho sson (IS), Bi gi Gudmundsson (IS), Massimo San inello (IT), Michela Lenzi (IT), Lina Kos a o a Unko ska (MK), Ing id
Le e sen (NO), Ma ianne Skogb o Bi keland (NO), Gina Tomé (PT), Ines Camacho (PT), Ma alda Fe ei a (PT), Rebecca Smi h (GB-
SCO), Win ied an de Sluijs (GB-SCO), Inmaculada Queija (ES), Ped o J. Pé ez Mo eno (ES), Vic o ia Muñoz Tinoco (ES), Emmanuel
Kun sche (CH), Deniz Albay ak Kaymak (TR), Ta yana Bonda (UA)
NIH Public Access
Au ho Manusc ip
In J Public Heal h. Au ho manusc ip ; a ailable in PMC 2009 Sep embe 4.
Published in inal edi ed o m as:
In J Public Heal h. 2009 Sep embe ; 54(Suppl 2): 243–250. doi:10.1007/s00038-009-5416-6.
NIH-PA Au ho Manusc ip NIH-PA Au ho Manusc ip NIH-PA Au ho Manusc ip
In oduc ion
The pee g oup (i. e., iends inside o ou side he school class wi h whom adolescen s spend
hei leisu e ime in join ac i i ies1) plays an impo an ole in he psycho-social de elopmen
o adolescen s2. Pee s se e as ole models and p o ide eedback abou a i udes and beha iou .
In he con ex o hei pee g oup, adolescen s can expe imen wi h di e en iden i ies,
pe sonali ies, and oles a g ea e ease han a home3. Pee g oup in e ac ion can os e heal h ul
and socially-accep able as well as heal h- comp omising and socially-de ian beha iou s. Fo
example, esea ch has shown ha adolescen s end no only o selec hei pee s in he ligh o
hei own subs ance-use habi s bu also o ini ia e o inc ease hei subs ance use when hey
associa e wi h subs ance-using pee s4,5. Simila ly, associa ing wi h p oblem beha ing pee s
inc eases adolescen conduc p oblems6. Independen ly o he kind o ac i i ies (heal h-
enhancing o comp omising), adolescen s no mally conside he ime hey spend wi h hei
pee s as he mos enjoyable pa o he day7.
F equen in e ac ion and communica ion is a cen al elemen o pee g oups3. The inc eased
popula i y o a ious elec onic media (e. g., cell phones, sho message se ice (SMS), e-mail,
ins an communica ion so wa e such as Skype) o e s new possibili ies o pee
communica ion. In indus ialized coun ies, o example, abou 85 o 96 % o young people
own a cell phone8–11. A B i ish s udy epo ed ha a he age o 10 o 11 abou hal o he
young people owned a cell phone12. Mo eo e , communica ion by means o SMS has become
e y popula , pa icula ly among young people13.
The inc eased popula i y o elec onic media use among adolescen s aises he ques ion, does
elec onic media acili a e o supe sede ace- o- ace con ac s among pee s? Ea ly esea ch in
his a ea ound ha he equency o in e ne use was de imen al o ‘o line’ in e pe sonal
con ac s and ela ionships14–16. Howe e , o he ecen esea ch indica ed ha use s o
elec onic media spend mo e ime communica ing ace- o- ace wi h iends16,17. Fo example,
elec onic media can be used o a ange appoin men s and o coo dina e and manage ace- o-
ace con ac s among pee g oup membe s18,19. Some s udies ound ha elec onic
communica ion can acili a e no only he main enance o exis ing ela ions, bu can also help
o es ablish new con ac s wi h pee s ha la e can become new iends (wi h whom hey spend
ime and go ou in he e ening)20,21. Un o una ely, e idence o he link be ween elec onic
media communica ion (EMC) and ace- o- ace con ac s among adolescen pee g oup membe s
is limi ed o a ew single-coun y s udies. A c oss-na ional assessmen o he popula i y and
ends o EMC and links o ace- o- ace con ac s in adolescence is lacking.
The p esen s udy has he ollowing h ee aims: (1) desc ibe he p e alence o EMC in a sample
o 11-, 13-, and 15-yea olds om 31 mainly Eu opean and No h Ame ican coun ies and
egions, (2) desc ibe changes in he p e alence in EMC om 2002 o 2006; and (3) in es iga e
links be ween EMC and he numbe o close iends, he numbe o a e noons pe week spen
ou wi h iends, and he numbe o e enings pe week spen ou wi h iends.
Me hods
Desc ip ion o he p ojec in gene al
The da a p esen ed he e a e d awn om he 2005/06 Wo ld Heal h O ganiza ion collabo a i e
HBSC s udy. HBSC is an in e na ional collabo a ion be ween esea ch eams ac oss Eu ope
and No h Ame ica which aim o gain insigh in o and u he unde s anding o adolescen
heal h. Da a we e collec ed h ough a school-based su ey using class oom adminis e ed sel -
comple ion ques ionnai es in each pa icipa ing coun y and egion, wi h equi emen s in e ms
o sampling, ques ionnai e i ems and su ey adminis a ion being se ou in a s anda dised
esea ch p o ocol. Pa icipa ion in he su ey was olun a y, wi h assu ances p o ided in
Kun sche e al. Page 2
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ela ion o con iden iali y and anonymi y. Each coun y espec ed e hical and legal
equi emen s in hei coun ies o his ype o su ey.
The popula ion selec ed o sampling was young people a ending school aged 11, 13 and 15,
wi h he desi ed mean age o he h ee age g oups being 11.5, 13.5 and 15.5. Pa icipa ing
coun ies we e equi ed o include a minimum o 95 pe cen o he eligible a ge popula ion
wi hin hei sample ame. In he majo i y o coun ies, na ional ep esen a i e samples we e
d awn and samples we e s a i ied o ensu e ep esen a ion by, o example, geog aphy, e hnic
g oup and school ype. Clus e sampling was used, he p ima y sampling uni being school
class (o school whe e a sampling ame o classes was no a ailable). The ecommended
sample size o each o he h ee age g oups was app oxima ely 1 500 s uden s, assuming a 95
% con idence in e al o +/- 3 pe cen a ound a p opo ion o 50 pe cen and allowing o he
clus e ed na u e o he samples.
Following da a cleaning a he s udy's in e na ional da a bank, he inal in e na ional ile
con ained 204,534 cases ac oss 41 coun ies o egions, consis ing o 100,233 (49 %) boys and
104,301 (51 %) gi ls, and 66,707 (33 %) 11-yea -olds, 69,954 (34 %) 13-yea -olds and 67 873
(33 %) 15-yea -olds. Full de ails o he s udy's de elopmen and me hods employed can be
ound in his supplemen and elsewhe e22–25.
Design o he p esen s udy
In he 2001–2002 s udy 35 coun ies and egions ook pa and in he 2005–2006 s udy he e
we e 41 coun ies. One o he 35 coun ies pa icipa ing in 2002 did no pa icipa e in 2006;
ano he did no ask ques ions ele an o his s udy. Two o he coun ies had a high numbe
o missing alues (i. e., mo e han 20 %) on he a iables used in his s udy. Consequen ly, 31
coun ies could be included o c oss-su ey compa isons. Known esponse a es a ied om
65 % o mo e han 90 % ac oss coun ies26. Each pa icipa ing coun y ob ained app o al o
conduc he su ey om he ele an e hics e iew boa d o equi alen egula o y ins i u ion.
Measu es
The ques ionnai e was de eloped by an in e disciplina y esea ch g oup om he pa icipa ing
coun ies. Unde supe ision o he na ional esea ch eams, a ansla ion/back ansla ion
p ocedu e was used o gua an ee language equi alence. Elec onic media communica ion pe
week. The ques ion was “How o en do you alk o you iend(s) on he phone o send hem
ex messages o ha e con ac h ough he in e ne ?” Response op ions we e ‘ne e o
a ely’ (coded as 0), ‘1 o 2 days a week’ (coded as 1.5), ‘3 o 4 days a week’ (coded as 3.5),
‘5 o 6 days a week’ (coded as 5.5), and ‘e e y day’ (coded as 7).
Numbe o close iends. The ques ion “A p esen , how many close male and emale iends
do you ha e?” included sepa a e esponses o male and emale iends. The esponse op ions
we e ‘none’, ‘one’, ‘ wo’, and ‘ h ee o mo e’. Fo he analyses, he answe s o he ques ions
on male and emale iends we e added o make one sco e o numbe o iends. Numbe o
a e noons pe week spen ou wi h iends. The ques ion was “How many days a week do you
usually spend ime wi h iends igh a e school?” The esponse op ions anged om ze o o
six days a week.
Numbe o e enings pe week spen ou wi h iends. The ques ion was “How many e enings
pe week do you usually spend ou wi h you iends?” The esponse op ions anged om ze o
o se en e enings a week.
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Analy ic S a egy
Adolescen s who did no answe one o mo e ques ions analysed in he p esen s udy (7.9 %
in o al) we e excluded om he analyses. The inal sample consis ed o 275 571 11-, 13-,
and15-yea olds (51.8 % gi ls; see Tab. 1 o a de ailed o e iew o sample sizes acco ding o
age g oup, coun y, and su ey yea ).
To de e mine s a is ical signi icance o changes in elec onic media use ac oss he su ey yea s
in each age g oup in each coun y, χ2- es s we e used. To assess he link be ween elec onic
media use and su ey yea , he numbe o close iends, he numbe o a e noons and e enings
pe week spen wi h iends, con olling o gende and age e ec s, a mul iple eg ession
analysis was conduc ed.
The sampling uni s in he p esen s udy we e classes o schools and no indi iduals. Such a
clus e sampling usually p oduces smalle s anda d e o s, which a i icially enhance es
powe 27. To coun e ac his e ec , he sample was down-weigh ed be o e conduc ing s a is ical
analysis. Robe s e al.28 sugges ed a down-weigh ing ac o o .0833 co esponding o a
sampling design e ec o 1.2.
Resul s
In 2006, ac oss coun ies, mo e han one hi d o he 11-yea olds, mo e han hal o he 13-
yea olds and nea ly wo hi ds o he 15-yea olds communica ed elec onically wi h hei
iends on a daily o nea ly daily basis (Tab. 2). F equen media use was no ably p e alen
among adolescen s in Scandina ian coun ies (Denma k, Finland, Sweden), he UK (England,
Sco land, Wales), Is ael, and Russia. F om 2002 o 2006, EMC inc eased in almos all
pa icipa ing coun ies and egions. Pa icula ly high inc eases we e ound in Eas e n Eu opean
coun ies (La ia, Li huania, Poland, and Uk aine), Denma k (among 11- and 13-yea olds),
and F ance (among 13- and 15-yea olds). In a ew coun ies, elec onic media use dec eased
signi ican ly (among 11-yea olds in Canada and he US, 13-yea olds in Macedonia, 15-yea
olds in G eece and Macedonia). Compa ed o he la ge inc eases (up o 50 %), he ew dec eases
we e a he small (less han 10 %).
Resul s om he eg ession analyses con i med ha EMC inc eased among adolescen s in
almos all coun ies (Tab. 3). Excep ions we e Canada, I aly and he Uni ed S a es whe e no
signi ican changes we e ound. In only one coun y (i. e., he FYRO Macedonia), he e was a
signi ican dec ease in EMC o e ime. EMC inc eased ma kedly wi h age. This was he case
in each pa icipa ing coun y and egion. The g ea es inc eases ac oss he age g oups we e
ound in Wes e n Eu opean coun ies such as Po ugal, Swi ze land, and Ge many; he smalles
inc eases we e ound in Eas e n Eu opean coun ies such as Russia and Uk aine. Gi ls used
elec onic media mo e equen ly o communica e wi h hei iends han did boys. This was
consis en ac oss coun ies. The mos p onounced gende di e ences we e ound in Wes e n
coun ies such as he US, Canada, I eland, England, Wales, and Sco land, and Sou he n
Eu opean coun ies such as I aly, Po ugal, and G eece.
The esul s in Tab. 3 u he show ha he highe he numbe o close iends he highe he
equency o EMC. A pa icula ly s ong link was ound in No dic coun ies (e. g., in Canada,
Denma k, Sco land, Finland), while in Sou he n coun ies (e. g., Po ugal, Macedonia, G eece)
he e was only a mino associa ion. An excep ion om his gene al endency was Mal a. Ac oss
coun ies, he highe he numbe o a e noons pe week ou wi h iends he highe he
equency o EMC. This was pa icula ly ue o coun ies such as Ge many, I aly, Macedonia,
Slo enia, Sweden, and Swi ze land. In Eas e n Eu opean coun ies (e. g., Es onia, La ia,
Uk aine), he associa ion was mino . Ac oss coun ies, he highe he numbe o e enings spen
ou wi h iends he highe he equency o EMC, excep Macedonia and Mal a. The link was
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pa icula ly s ong in no he n coun ies (e. g., Canada, Finland, Denma k, Sweden, Sco land.
In Eas e n Eu opean coun ies (e. g., Russia, La ia) and in I aly only a mino associa ion was
ound.
Discussion
The i s wo aims o he p esen s udy we e o desc ibe he p e alence and ends o EMC in
a c oss-cul u al sample o 11-, 13-, and 15-yea olds. The indings indica ed ha ac oss
coun ies elec onic media use is popula and widesp ead among adolescen s. In 2006, mo e
han one hi d o he 11-yea olds, mo e han hal o he 13-yea olds, and nea ly wo hi ds o
he 15-yea olds communica ed elec onically wi h hei iends on a daily o nea ly daily basis.
Ce ainly, one eason o he high p opo ion o elec onic media use s among 11- o 15-yea
olds is he high p opo ion o cell phone owne s among adolescen s8–12 which enables hem
a any ime o phone o w i e and ecei e ex messages o and om hei iends.
Resul s om he 2002–06 end compa ison showed an inc ease in EMC in mos pa icipa ing
coun ies and egions. The inc eased popula i y o di e en kinds o elec onic media (cell
phones, SMS, e-mail, ins an communica ion so wa e, e c.) among young people8–12 is likely
o ha e con ibu ed o he gene al inc ease o EMC. Pa icula ly high inc eases in EMC we e
ound in mos Eas e n Eu opean coun ies. The apid economic de elopmen in hese coun ies
migh o e adolescen s in hese coun ies a be e access o he in e ne and p i a e cell phones
which migh pa ly explain he ends in EMC in Eas e n Eu ope.
The hi d aim was o in es iga e links be ween EMC and ace- o- ace con ac s wi h iends in
he a e noons and e enings. The esul s om he eg ession analysis a e consis en wi h
p e ious e idence sugges ing ha g ea e use o elec onic media is associa ed wi h g ea e
ace- o- ace con ac wi h iends16,17. Taken in o accoun he la ge inc ease o EMC in mos
coun ies, he equency o EMC inc eased wi h inc easing numbe o a e noons and e enings
spen wi h iends. No ewo hy, his was consis en o all pa icipa ing coun ies despi e la ge
a ia ions in EMC p e alence and ends o e ime in he di e en coun ies.
These indings a e consis en wi h he idea ha EMC acili a es a he han supe sedes ace-
o- ace con ac s16,17. Fo example, elec onic media migh be used o ix appoin men s and o
coo dina e and manage ace- o- ace con ac s among pee g oup membe s in he a e noons and
e enings18,19. I has been sugges ed ha EMC migh acili a e he main enance o exis ing
ela ions and also help o es ablish new con ac s wi h pee s wi h whom o spend ime and go
ou in he e ening20,21. The link be ween EMC and ace- o- ace con ac s is sligh ly s onge
o spending he e enings oge he han o spending he a e noons oge he . I migh be he
case ha o mee ing iends o ixing appoin men s in he e enings elec onic media a e mo e
impo an han o mee ing iends in he a e noons, o which appoin men s can be ixed when
mee ing iends in school o di ec ly a e school. In e es ingly, he e was a pa icula close
associa ion be ween EMC and e enings spen ou wi h iends in coun ies wi h a high
p opo ion o elec onic media use s (e. g., Canada, Finland, Mal a, Sco land, and Sweden). I
appea s ha in coun ies wi h a la ge communi y o elec onic media use s indi iduals a e
pa icula ly likely o use he echnology o mee iends o ix appoin men s in he e enings.
Among he limi a ions o he s udy is he c oss-sec ional design o he esea ch, which makes
i impossible o de e mine he di ec ion o he associa ions. I could be ha g ea e numbe s o
iends and mo e ime spen wi h iends leads o inc eased ECM a he hen ECM de e mining
ime spen wi h iends. Ne e heless, i is clea ha he amoun o elec onic communica ion
inc eased om 2002 o 2006 in mos coun ies and was associa ed in all coun ies wi h inc eases
in ime spen wi h iends. Because HBSC is a mul ina ional collabo a i e s udy ha aims o
moni o a b oad a ie y o heal h beha iou s among school-aged child en, mos concep s could
Kun sche e al. Page 5
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only be measu ed by a single ques ion. Fo he p esen s udy, his means ha di e en o ms
o EMC (i. e., communica ion by phone, SMS, e-mail, ins an communica ion so wa e, e c.)
had o be combined in one ques ion. The e o e, i could no be de e mined i each o hese
o ms o EMC had a unique impac on ace- o- ace pee con ac s. Fo ins ance, i may be mo e
di icul o subs i u e ace- o- ace con ac s wi h cell phone communica ion gi en he 160
cha ac e limi o SMS and he o en expensi e phone call uni s. Thus, cell phones migh be
mo e use ul o ixing appoin men s. Ins an communica ion so wa e on he in e ne such as
Skype o e s a a ie y o ee in e ac ion acili ies such as alking o and seeing each o he
when using a web-cam, exchanging iles, playing games, e c. The e o e, ins an in e ne
communica ion p o ides acili ies ha a e simila o ace- o- ace con ac s and may ha e g ea e
po en ial o supe sede, a leas in pa , ace- o- ace in e ac ions in he u u e. Mo eo e , a a ie y
o ac o s such as amily a luence and deg ee o u baniza ion migh mode a e he link be ween
EMC and ace- o- ace con ac s wi h iends. These issues a e impo an o be in es iga ed in
u u e esea ch.
The indings we e su p isingly consis en ac oss he 31 coun ies and egions pa icipa ing in
he s udy. Ac oss coun ies and egions, mos adolescen s we e amilia wi h elec onic media
and use he echnology equen ly o communica e wi h hei iends. Mo eo e , an inc ease
in EMC was ound in all h ee age g oups in almos all coun ies and egions, despi e la ge
di e ences in cul u e, economic de elopmen , and geog aphical loca ion. Al hough he
p e alence le el and he amoun o change om 2002 o 2006 a ied ac oss he pa icipa ing
coun ies and egions, he associa ion wi h o he a iables was highly consis en . Wi hou
excep ion, EMC was highe among gi ls han among boys and inc eased wi h age, he numbe
o close iends, and ime spen in he a e noons and e enings. Thus, he p esen s udy p o ides
impo an in o ma ion on he p e alence, ank o de , and amoun o change in EMC in a ious
Eu opean and No h Ame ican coun ies and egions. The indings clea ly sugges ha EMC
among adolescen s acili a e a he han supe sede ace- o- ace con ac s in he a e noons o
e enings. E en in coun ies wi h a end owa d inc easing use o elec onic media, young
people communica ing h ough hese de ices ended o ha e mo e iends and o spend mo e
ime wi h hem.
Acknowledgmen s
HBSC is an in e na ional s udy ca ied ou in collabo a ion wi h WHO/EURO. The in e na ional coo dina o o he
2001–2002 and 2005–2006 s udy was Candace Cu ie, Uni e si y o Edinbu gh, Sco land; and he da a bank manage
was Odd un Samdal, Uni e si y o Be gen, No way. A comple e lis o he pa icipa ing esea che s can be ound on
he HBSC websi e (www.HBSC.o g).
The p incipal au ho was suppo ed by SIPA and he Swiss Fede al O ice o Public Heal h (G an No. 04.001776 /
2.24.02.-64).
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