The relationship between problematic social media use and health behavior: An exploratory specification curve analysis of large-scale survey data

While most research on social media use and health behavior focuses on non-problematic use, studies specifically examining problematic social media use (PSMU) are scarce. Existing research often investigates only one health behavior at a time, leaving a gap in understanding the broader relationship between PSMU and multiple health behaviors across various contexts. This study aimed to explore the association between PSMU and adolescent health behaviors using an exploratory specification curve analysis (SCA) approach. This approach applies SCA in an exploratory manner and, in contrast to the original approach, explicitly includes non-equivalent specifications. We analyzed data from 188,175 adolescents (aged 11–15 years) across 43 countries from the 2018 Health Behaviour in School-aged Children survey. Three SCAs were conducted, with different health behaviors (i.e., substance use, physical activity, and dietary intake) as outcomes. Specifications varied by the operationalization of dependent variables, the inclusion of potential confounders (age, relative family affluence), and gender and country subsets. Most specifications indicated a significant relationship between PSMU and health behaviors: 97% showed a positive association with substance use, 78% a negative association with physical activity, and 92% a negative association with healthy dietary intake. The combination of country subsets and outcome variables explained a considerable portion of effect variation across all three SCAs. The findings suggest that PSMU is associated with detrimental health behaviors in adolescence, a critical period for forming lifelong health patterns.