Does cyberbullying impact youth suicidal behaviors?

Traditional, cyberbullying, and suicidal behaviors in Argentinian adolescents: the protective role of school, parental, and peer connectedness

Introduction

Bullying, both in person and online, is a significant risk factor for a range of negative outcomes including suicidal behaviors among adolescents and it is crucial to explore the protective effects of parental, school, and peer connectedness on suicidal behaviors among victims.

Methods

This study is a secondary analysis of the Argentina Global School-based Student Health Survey (GSHS 2018). Logistic regression analysis, adjusting for age and sex, determines the likelihood of suicidal thoughts and attempts among bullying victims. To explore the modifying effect of school, parental, and peer connectedness on the association between bullying and suicide behaviors, the interaction term was included. Sampling design and weights were applied in all analyses in STATA 17.

Results

The study included 56,783 students in grades 8-12, with over half being female. Adolescents aged 14-15 exhibited the highest prevalence of bullying, cyberbullying, suicidal thoughts, and attempts, with females displaying a higher prevalence in all measured categories. The study found that adolescents who reported being bullied or cyberbullied demonstrated a significantly higher likelihood of experiencing suicidal thoughts and attempting suicide. Furthermore, protective factors such as school, parental, and peer connectedness were found to play a critical role in mitigating the adverse impacts of bullying and cyberbullying on suicidal thoughts and attempts.

Conclusion

The findings underscore the critical prevalence of both bullying and cyberbullying among school-going Argentinian adolescents and their profound association with suicidal behaviors. The study emphasizes the importance of supportive family environments and peer and school connectedness in mitigating the negative effects of bullying and cyberbullying on mental health and suicide risk among adolescents.

The relationship between cyberbullying perpetration/victimization and suicidal ideation in healthy young adults: the indirect effects of positive and negative psychotic experiences

BACKGROUND

Even though not all cyber bullies or victims think of (or consider) suicide, they clearly appear to be at an increased risk. One possible strategy to reduce suicide risk is to decrease cyberbullying occurrence; but this approach has its limitations, as it is certainly an illusion to believe that cyberbullying could be controlled or eliminated in a digitalized world. Another alternative and interesting strategy is to consider mediating factors that may indirectly affect suicidality. To this end, our purpose was to test the hypothesis that positive and negative psychotic experiences (PEs) mediate the relationship from cyberbullying perpetration/victimization to suicidal ideation (SI).

METHOD

The study followed a cross-sectional design, and was conducted during the period from June to September 2022. A total of 3103 healthy community participants from Lebanon were included (mean age 21.73 ± 3.80 years, 63.6% females).

RESULTS

After adjusting over potential confounders, mediation analysis models showed that both positive and negative PEs partially mediated the associations between cyberbullying victimization/perpetration and SI. Higher cyberbullying perpetration and victimization were significantly associated with greater positive and negative PEs; more severe positive and negative PEs were significantly associated with higher levels of SI. Higher cyberbullying victimization and perpetration were significantly and directly associated with higher levels of SI.

CONCLUSION

In light of our preliminary findings, there appears to be an urgent need for a new focus on carefully assessing and addressing attenuated psychotic symptoms in healthy individuals engaged in cyberbullying either as victims or bullies and who present with SI. It is important that school counselors and decision-makers consider a holistic approach taking into account both external/environmental (bullying) and internal/individual (PEs) factors in their suicide prevention programs. Future longitudinal research in larger samples are still required to confirm our findings and further elucidate the mechanisms underlying the relationship between cyberbullying and suicide.

Growth in Suicide Rates Among Children During the Illicit Opioid Crisis

This article documents child suicide rates from 1980 to 2020 in the United States using the National Vital Statistics System Multiple Cause of Death database. After generally declining for decades, suicide rates among children aged 10-17 accelerated from 2011 to 2018 in an unprecedented rise in both duration and magnitude. I consider the role of the illicit opioid crisis in driving this mental health crisis. In August 2010, an abuse-deterrent version of OxyContin was introduced and the original formulation was removed from the market, leading to a shift to illicit opioids and stimulating growth in illicit opioid markets. Areas more exposed to reformulation-as measured by pre-reformulation rates of OxyContin misuse in the National Survey on Drug Use and Health-were more affected by the transition to illicit opioids and experienced sharper growth in child suicide rates. The evidence suggests that children's illicit opioid use did not increase, implying that the illicit opioid crisis engendered higher suicide propensities by increasing suicidal risk factors for children, such as increasing rates of child neglect and altering household living arrangements. In complementary analyses, I document how living conditions declined for children during this time period.

Moral disengagement, self-control and callous-unemotional traits as predictors of cyberbullying: a moderated mediation model

BACKGROUND

Cyberbullying has become more prevalent, more difficult to detect, and more harmful to the victims. Whereas considerable prior work has investigated predictors and consequences of cyberbullying, additional research is needed to better understand the mechanisms by which these factors relate to cyberbullying perpetration and victimization. The goal of the present study was to examine the extent to which the link between individual differences in moral disengagement and cyberbullying perpetration is mediated by low self-control and, if so, whether this mediation effect varies by individuals' degree of callous-unemotional traits.

METHOD

To explore these questions, we used cyberbullying, moral disengagement, self-control, and callous-unemotional traits scales and collected online survey data from a sample of 860 Chinese internet users aged 18 years old or older.

RESULT

As hypothesized, a significant positive relation between moral disengagement and cyberbullying emerged that was mediated by individual differences in self-control. Additionally, evidence of moderated mediation was found. That is, the indirect effect varied by degree of callous-unemotional traits, with a significantly stronger mediation effect (and association between self-control and cyberbullying) for individuals who were relatively higher in callous-unemotional traits.

CONCLUSION

We conclude that moral disengagement partially predicts cyberbullying through self-control, while callous-unemotional traits moderate the pathway between self-control and cyberbullying.

A Review on Deep-Learning-Based Cyberbullying Detection

Bullying is described as an undesirable behavior by others that harms an individual physically, mentally, or socially. Cyberbullying is a virtual form (e.g., textual or image) of bullying or harassment, also known as online bullying. Cyberbullying detection is a pressing need in today’s world, as the prevalence of cyberbullying is continually growing, resulting in mental health issues. Conventional machine learning models were previously used to identify cyberbullying. However, current research demonstrates that deep learning surpasses traditional machine learning algorithms in identifying cyberbullying for several reasons, including handling extensive data, efficiently classifying text and images, extracting features automatically through hidden layers, and many others. This paper reviews the existing surveys and identifies the gaps in those studies. We also present a deep-learning-based defense ecosystem for cyberbullying detection, including data representation techniques and different deep-learning-based models and frameworks. We have critically analyzed the existing DL-based cyberbullying detection techniques and identified their significant contributions and the future research directions they have presented. We have also summarized the datasets being used, including the DL architecture being used and the tasks that are accomplished for each dataset. Finally, several challenges faced by the existing researchers and the open issues to be addressed in the future have been presented.

Cyberbullying among college students in a Chinese population: Prevalence and associated clinical correlates

Objectives

Cyberbullying is quite common in adolescents and college students, and it influences mental health in many aspects. The purpose of this study was to investigate the prevalence of cyberbullying in Chinese college students and to look for related factors.

Methods

Eight thousand and ninety-eight college students aged 17-26 were enrolled in this cross-sectional study. We collected information of their sociodemographic data, depression (evaluated by Self-Rating Depression Scale), anxiety (evaluated by Self-Rating Anxiety Scale), lifetime suicidal behaviors (including suicidal ideation, suicidal plans, and suicide attempts), and experiences of cyberbullying for the past 12 months by online questionnaires.

Results

The prevalence of cyberbullying for the past 12 months was 7.82% (633/8,098) among college students. Binary logistic regression analysis showed that sex (odds ratio, OR = 0.522, 95%CI = 0.433-0.629, p < 0.001), suicide attempts (OR = 2.164, 95%CI = 1.589-2.948, p < 0.001), depression (OR = 2.372, 95%CI = 1.602-3.512, p < 0.001), and anxiety (OR = 1.911, 95%CI = 1.305-2.800, p = 0.001) were independently associated with cyberbullying.

Conclusion

Cyberbullying is very common among college students in Hunan Province, China. Besides, being male, suicide attempts, depression and anxiety were independently associated with cyberbullying, which highlights the importance of paying attention to cyberbullying and addressing anxiety, depression, and suicidal behaviors among college students to better improve their mental health and prevent suicide.

Dark tetrad of personality, cyberbullying, and cybertrolling among young adults

Communication applications and social media sites serve as a platform for users to distribute information and connect to other users, potentially allowing perpetrators to perform antisocial behaviors. The current study examined the relationship between Dark Tetrad of personality (i.e., Machiavellianism, narcissism, psychopathy, sadism) and antisocial cyber-behaviors (i.e., cyberbullying, cybertrolling) by surveying young Malaysians (n = 323) aged from 18 to 26. Partial least squares structural equation modelling (PLS-SEM) revealed that Machiavellianism was not related to cyberbullying and cybertrolling, while narcissism was positively related to cyberbullying but not related to cybertrolling. Meanwhile, psychopathy and sadism were positively related to cyberbullying and cybertrolling. The results of this study contribute to the cyber-behaviors literature, knowledge about the antisocial cyber-behaviors in Malaysia, supports sadism as a dark personality and the study acts as a reference to minimize these behaviors.

Family Factors Related to Suicidal Behavior in Adolescents

Objective: This research aims to investigate what type of family patterns (specifically attachment, bonding and family functioning) and stressful life events can trigger or protect adolescents from developing suicidal behavior. Methods: For these purposes, a case-control study (adolescents with suicidal behavior vs. paired adolescents with no suicidal behavior) was conducted with one hundred 12 to 17-year-old adolescents (50 controls, 50 cases, 74% females), assessed between 2018 and 2020. Results: Negligent (p < 0.001) or affection-less control bonding (p < 0.001), insecure attachment (p = 0.001) and stressful life events (p < 0.001) revealed to be significant risk factors for suicidal behavior. On the contrary, parents’ care (p < 0.001) and security (p < 0.001) were revealed as protective factors for suicidal behavior. Conclusions: Considering these results, family interventions and improving coping skills seem to be two essential targets for any suicide prevention intervention in adolescents.

Psychological Predictors of Bystanders' Intention to Help Cyberbullying Victims Among College Students: An Application of Theory of Planned Behavior

The goal of the present study was to evaluate the Theory of Planned Behavior (TPB) as an explanation for bystanders' intention to help cyberbullying victims among college students. Participants completed an online survey in which their intention, attitude, subjective norm, and perceived behavioral control toward helping cyberbullying victims were assessed. In addition to these traditional TPB variables, empathy toward cyberbullying victims and anticipated regret from not helping victims were included in the model. Results showed that empathy and anticipated regret significantly predicted intention to help cyberbullying victims over and above the traditional TPB variables. Results also showed that gender altered how traditional TPB variables, empathy, and anticipated regret predict bystander's intention to help cyberbullying victims: Empathy and anticipated regret were most robust predictors for males and females, respectively. These results suggest that the TPB is a useful theoretical framework for understanding bystanders' intention to help cyberbullying victims. Implications for developing effective prevention and intervention strategies are discussed.

Suicide in cultural context: An ecosocial approach

This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal behavior. However, all of the major social determinants identified in suicide research are influenced or mediated by particular cultural meanings and contexts. To move beyond crude generalizations about suicide based on psychological theories developed mainly in Western contexts and culture-specific prototypes or exemplars, we need more fine-grained analysis of the experience of diverse populations. The articles in this issue provide clear illustrations of the impact of cultural and contextual factors in the causes of suicide, with implications for psychiatric research, theory, and practice. Cross-cultural research points to the possibility of developing a typology of social predicaments affecting specific sociodemographic groups and populations. This typology could be elaborated and applied in clinical and public health practice through an ecosocial approach that considers the ways that suicide is embodied and enacted in social systemic contexts.

The Association Between Cyberbullying Victimization and Suicidal Ideation Among Chinese College Students: The Parallel Mediating Roles of Core Self-Evaluation and Depression

With the rapid development of science and technology, the Internet has formed a new form of aggression, which is called cyberbullying. Many studies have demonstrated that cyberbullying can cause serious damage to the physical and mental health of Chinese college students, such as depression and suicide. The main purpose of this study was to investigate the relationship between cyberbullying victimization and suicidal ideation and the parallel mediating roles of core self-evaluation and depression. A questionnaire was used to measure the research variables in this study among 1,509 college students. The results indicated that: After controlling for participants' gender, age, family structure, and family economic status, cyberbullying victimization significantly and positively related to suicidal ideation. Core self-evaluation and depression separately mediated the relationship between cyberbullying victimization and suicidal ideation. The mediating effect of depression was stronger than that of core self-evaluation. The findings support a parallel mediation model of the relationship between cyberbullying victimization and suicidal ideation. Our study may help to develop interventions and prevention measures for college students who experienced cyberbullying victimization.

The effect of TV viewing on children's obesity risk and mental well-being: Evidence from the UK digital switchover

We examine the effect of screen-based activities on obesity and mental well-being for children, using a large survey dataset representative of the UK population and an event study model that exploits exogenous variation in the entry date of the digital television transition in the UK. The digital transition increased the number of available free television channels from 5 to 40, leading to a rise in television viewing time. Our results show that receiving access to digital television signal considerably increases the mental health total difficulties score among children, and that this impact grows over time. We also find suggestive evidence that the digital transition could have increased BMI for children. Underlying the net effects appear to be decreases in participation in social and physical activities.

Relationship between stressful life events and cyberbullying perpetration: Roles of fatalism and self-compassion

Few studies have documented the relationship between stressful life events and cyberbullying perpetration, and the mechanisms connecting this link are unknown. Thus, the current study tested the association of stressful life events with cyberbullying perpetration and explored this influencing mechanism further with fatalism and self-compassion tested as a mediator and a moderator respectively. A sample of 1104 Chinese adolescents (50.72% males; mean age = 13.11) volunteered for this study. The results revealed that exposure to stressful life events was positively related to cyberbullying perpetration, and fatalism played a mediation role in this relationship. The moderated mediation model revealed that stronger self-compassion weakened and even interrupted the direct associations of stressful life events with fatalism and cyberbullying perpetration, and further weakened and even interrupted the indirect relationship between stressful life events and cyberbullying perpetration via fatalism. That is, adolescents low in self-compassion were more likely to build fatalistic beliefs and engage in cyberbullying perpetration when they experienced high levels of stressful life events; whereas, stressful life events were not related to increased risk of cyberbullying perpetration among adolescents high in self-compassion.

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey

Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents.

Early childhood parenting and adolescent bullying behavior: Evidence from a randomized intervention at ten-year follow-up

RATIONALE

Bullying in education is a significant public health problem with long-run life cycle consequences, but efforts to reduce bullying were met with mixed results. We ask whether improving early childhood parenting can reduce subsequent bullying behavior by the children.

METHOD

We analyze ten-year follow-up of a randomized intervention where the parents of preschool children received a training aimed at improving parenting techniques, such as disciplinary strategies. 280 parents in 17 preschools were cluster-randomized at the preschool level (intervention group, cluster = 11, n = 186 vs. control group, cluster = 6, n = 94). Their children were followed ten years later, at ages between 12 and 16, with overall attrition rate of 12.5%. Ordinary least squares is used to estimate the intent-to-treat effects, controlling for the baseline characteristics of the child and the mother. Multiple imputation and inverse probability weighting are used to account for attrition and wild-cluster bootstrap test is used for statistical inference with few clusters. We estimate treatment-on-the-treated effects using two-stage least squares to account for noncompliance in the intervention group. Finally, we examine the associations between bullying and externalizing behavior.

RESULTS

Adolescent children are significantly less likely to bully their peers if their parents received the parenting training when their children were in preschools. The effects are stronger for boys and for aggressive forms of bullying such as 'beating' and 'threatening'. Treatment-on-the-treated effects are greater in magnitude and more significant than intent-to-treat effects, suggesting that the effects are driven by program participants. No effect is found for cyberbullying and for victimization. The results were robust to using multiple imputation and inverse probability weighting. We also find suggestive evidence that the effects on bullying are not explained by changes in externalizing behavior.

CONCLUSION

We show that improving early childhood parenting can have important public health benefits through reduction in adolescent bullying behavior.

Cyberstalking scale: development and relations with gender, FOMO and social media engagement

Cyberstalking is a form of persecution that has proliferated with technology's evolution. The present research aimed to develop a cyberstalking measure and observe its relations with Fear of Missing Out (FOMO), social media engagement, and sociodemographic variables. To achieve these goals, two studies were performed. In the first study, 200 subjects (76.5% female, with a mean age of 21.6 years) answered the 15 items originally developed for the scale. These data went trough exploratory factor analysis and Cronbach's alpha to verify the reliability of the instrument. The results indicated the exclusion of five items, and after this removal, the scale was valid and reliable (α = 0.86). In the second study, which also had 200 subjects (65% female and an average age of 21.8 years), was realized confirmatory factor analysis (measuring the model fit), accompanied by correlations and mediation analysis. The analyzes demonstrated that the one-factor model was adequate (GFI = 0.98; CFI = 0.99; TLI = 0.99; RMSEA = 0.02; SRMR = 0.06). Path analysis showed social media engagement as a significant mediator of FOMO and gender's impact on cyberstalking: Both had direct (FOMO: λ = 0.31; CI = 0.19-0.42; p < 0.01; Gender: λ = 0.12; CI = 0.02-0.22; p < 0.05) and indirect effects (FOMO: λ = 0.07; CI = 0.03-0.11; p < 0.01; Gender: λ = 0.04; CI = 0.01-0.07; p < 0.01).

Technology-facilitated sexual violence and suicide risk: A serial mediation model investigating bullying, depression, perceived burdensomeness, and thwarted belongingness

Technology-facilitated sexual violence (TFSV) is a comprehensive term used to encompass all sexually aggressive and harassing behaviours involving technology. Although there is a growing knowledge base investigating the prevalence and consequences of TFSV, relatively little is known about the extent of aversive consequences experienced by victims and the pathways from victimization to suicidal affect, cognition, and behaviour. TFSV victimization and subsequent suicide has been a subject of several high-profile media cases in recent years. We examine TFSV in relation to two main constructs embedded within the interpersonal theory of suicide (ITS), perceived burdensomeness (PB) and thwarted belongingness (TB). Quantitative survey data ( N = 521) were used to evaluate PB and TB in the context of TFSV victimization. The objective was to analyze mechanisms underlying the relationship between TFSV victimization and suicide risk, exclusively accounting for mediating factors of interpersonal victimization, depression, TB, and PB. Pathway results showed that TFSV victimization increased suicide risk (i.e., suicidal affect, cognition, and behaviour) serially through bullying, depression, and PB—suggesting a cascade of victimization experiences. TB was not a significant mediator. The present results provide novel quantitative data substantiating the devastating risks of TFSV victimization and thus evidencing the importance of legal protections for victims of TFSV.

Aggression and Consistency of Self in Cybertrolling Behavior

While varying greatly across the population, aggression is a trait that is felt and displayed by most. Online, a form of aggression is cybertrolling, one of many types of cyberbullying. Cyberbullying is a harmful online behavior that is difficult to predict and prevent. To address this issue, this study examines offline aggression and online aggression (cybertrolling behavior) and the consistencies or discrepancies between offline and online self-presentation of aggressive individuals. It aimed to determine whether or not general aggression is a good predictor of cybertrolling behavior. An online survey for adults (N = 531) showed a significant relationship between aggression and cybertrolling behavior, suggesting aggressive individuals offline are aggressive individuals online. Regression analysis showed that offline aggression can be a good predictor of cybertrolling behavior. However, the results also showed that there are inconsistencies between offline and online self-presentation for individuals who show higher levels of aggression. This study highlights the important role aggression can play in how one presents the self online.

Exposure to Cyberbullying, Cybervictimization, and Related Factors Among Junior High School Students

Background: While social media have an immense effect on children and adolescent interactions, they also have serious and potential effects on physical and mental health. Cyberbullying, as a form of bullying using electronic means, is an example of this trend. Objectives: The purpose of this study was to determine the prevalence of cyber-related behaviors and some of their related factors among high school students in Tehran. Methods: This was a cross-sectional analytical study examining cyber behaviors in students in grades 7, 8, and 9. Since our study was conducted in line with an international study, we used the questionnaire of that research to collect data. Some of the characteristics of the adolescents and behavioral problems associated with them were examined, and students' experiences of cyberbullying and cybervictimization were asked in this study. A multi-stage cluster sampling was performed. The statistical population consisted of students from five districts of north, south, west, east, and center regions of Tehran, in which 1,456 questionnaires were completed. Results: The prevalence rate of cyberbullying was 22.3% while that of cybervictimization was 18%. It was also demonstrated that both trends were more significant in boys than in girls. Other parameters such as substance use, body thought scale, school environment difficulties, peer, conduct, and emotional problems had significant correlations with cybervictimization (P = 0.03 for peer problems to P < 0.001 for emotional problems) and cyberbullying (P < 0.04 for peer problems to P < 0.001 for school environment). A significant relationship was also found between prosocial problems and cyberbullying (P = 0.01). Conclusions: Cyberbullying and cybervictimization are more prevalent in boys than in girls. This phenomenon is related to many physical and mental health problems. This evidence can be used to inform decision-makers in the social arena to provide strategies for preventive programs and future interventions.

The internet and children's psychological wellbeing

Late childhood and adolescence is a critical time for social and emotional development. Over the past two decades, this life stage has been hugely affected by the almost universal adoption of the internet as a source of information, communication, and entertainment. We use a large representative sample of over 6300 children in England over the period 2012-2017, to estimate the effect of neighbourhood broadband speed, as a proxy for internet use, on a number of wellbeing outcomes, which reflect how these children feel about different aspects of their life. We find that internet use is negatively associated with wellbeing across a number of domains. The strongest effect is for how children feel about their appearance, and the effects are worse for girls than boys. We test a number of potential causal mechanisms, and find support both for the 'crowding out' hypothesis, whereby internet use reduces the time spent on other beneficial activities, and for the adverse effect of social media use. Our evidence adds weight to the already strident calls for interventions that can reduce the adverse effects of internet use on children's emotional health.

Assessment of eHealth behaviors in national surveys: a systematic review of instruments

Objectives

To conduct a systematic review of instruments used in national surveys of eHealth behaviors.

Materials and Methods

Major databases and websites of federal agencies were searched with pre-determined inclusion and exclusion criteria. National surveys with measures of eHealth behaviors were identified. The survey instruments were retrieved, and their measures of eHealth behaviors were categorized and critiqued.

Results

We located 13 national surveys containing eHealth behavior assessment questions that were administered from 1999 to 2017. Most surveys were conducted annually or biennially and typically covered topics on searching health information, obtaining social support, communicating with healthcare providers, and buying medicine online; recent surveys included items related to personal health management and use of mobile tools. There were redundant measures of searching health information online but insufficient measures of use of mobile apps, social media, and wearable devices.

Discussion

Future assessment of eHealth behaviors should reflect the growing varieties of behaviors enabled by technology development and reflect the current mobile ownership patterns in diverse social groups. More studies also need to include longitudinal surveys, integrative and standardized measures, and better designs to allow data linkage and comparison.

Conclusion

The existing survey instruments covering eHealth behaviors are rather limited compared to fast technological progress. We call for more national surveys on eHealth behaviors that are more responsive to technology development; we also advocate for more analysis and dissemination of existing national data on eHealth behaviors for evidence-based health policies.