Objectives To examine the association between social media use and health risk behaviours in adolescents (defined as those 10-19 years). Design Systematic review and meta-analysis. Data sources EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXic, PsyArXiv, medRxiv, and Google Scholar (1 January 1997 to 6 June 2022). Methods Health risk behaviours were defined as use of alcohol, drugs, tobacco, electronic nicotine delivery systems, unhealthy dietary behaviour, inadequate physical activity, gambling, and anti-social, sexual risk, and multiple risk behaviours. Included studies reported a social media variable (ie, time spent, frequency of use, exposure to health risk behaviour content, or other social media activities) and one or more relevant outcomes. Screening and risk of bias assessments were completed independently by two reviewers. Synthesis without meta-analysis based on effect direction and random-effects meta-analyses was used. Effect modification was explored using meta-regression and stratification. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results Of 17 077 studies screened, 126 were included (73 included in meta-analyses). The final sample included 1 431 534 adolescents (mean age 15.0 years). Synthesis without meta-analysis indicated harmful associations between social media and all health risk behaviours in most included studies, except inadequate physical activity where beneficial associations were reported in 63.6% of studies. Frequent ( v infrequent) social media use was associated with increased alcohol consumption (odds ratio 1.48 (95% confidence interval 1.35 to 1.62); n=383 068), drug use (1.28 (1.05 to 1.56); n=117 646), tobacco use (1.85, 1.49 to 2.30; n=424 326), sexual risk behaviours (1.77 (1.48 to 2.12); n=47 280), anti-social behaviour (1.73 (1.44 to 2.06); n=54 993), multiple risk behaviours (1.75 (1.30 to 2.35); n=43 571), and gambling (2.84 (2.04 to 3.97); n=26 537). Exposure to content showcasing health risk behaviours on social media ( v no exposure) was associated with increased odds of use of electronic nicotine delivery systems (1.73 (1.34 to 2.23); n=721 322), unhealthy dietary behaviours (2.48 (2.08 to 2.97); n=9892), and alcohol consumption (2.43 (1.25 to 4.71); n=14 731). For alcohol consumption, stronger associations were identified for exposure to user generated content (3.21 (2.37 to 4.33)) versus marketer generated content (2.12 (1.06 to 4.24)). For time spent on social media, use for at least 2 h per day ( v <2 h) increased odds of alcohol consumption (2.12 (1.53 to 2.95); n=12 390). GRADE certainty was moderate for unhealthy dietary behaviour, low for alcohol use, and very low for other investigated outcomes. Conclusions Social media use is associated with adverse health risk behaviours in young people, but further high quality research is needed to establish causality, understand effects on health inequalities, and determine which aspects of social media are most harmful. Study registration PROSPERO, CRD42020179766. Data analysed were based on published data. Template data forms, the data extracted from included studies, and data used for analyses are available from the corresponding author on reasonable request. The study protocol is published on PROSPERO: (ID: CRD42020179766)

中文翻译：

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年轻人的社交媒体使用和健康风险行为：系统评价和荟萃分析

目标 研究青少年（定义为 10-19 岁）社交媒体使用与健康风险行为之间的关联。设计系统回顾和荟萃分析。数据来源 EMBASE、Medline、APA PsycINFO、SocINDEX、CINAHL、SSRN、SocArXic、PsyArXiv、medRxiv 和 Google Scholar（1997 年 1 月 1 日至 2022 年 6 月 6 日）。方法健康风险行为被定义为使用酒精、毒品、烟草、电子尼古丁传输系统、不健康的饮食行为、体力活动不足、赌博、反社会、性风险和多种风险行为。纳入的研究报告了社交媒体变量（即花费的时间、使用频率、接触健康风险行为内容或其他社交媒体活动）和一个或多个相关结果。筛选和偏倚风险评估由两名评审员独立完成。使用基于效应方向和随机效应荟萃分析的不进行荟萃分析的合成。使用元回归和分层来探索效果修正。使用 GRADE（建议、评估、制定和评价分级）评估证据的确定性。结果 在筛选的 17 077 项研究中，纳入了 126 项（其中 73 项纳入荟萃分析）。最终样本包括 1 431 534 名青少年（平均年龄 15.0 岁）。未经荟萃分析的综合表明，在大多数纳入的研究中，社交媒体与所有健康风险行为之间都存在有害关联，但体育活动不足除外，其中 63.6% 的研究报告了有益关联。频繁（v 不频繁）使用社交媒体与饮酒量增加相关（优势比 1.48（95% 置信区间 1.35 至 1.62）；n=383 068）、吸毒（1.28（1.05 至 1.56）；n=117 646），吸烟（1.85、1.49至2.30；n=424 326）、危险性行为（1.77（1.48至2.12）；n=47 280）、反社会行为（1.73（1.44至2.06）；n=54 993）、多种危险行为（1.75（1.30至2.35）；n=43 571）和赌博（2.84（2.04至3.97）；n=26 537）。接触社交媒体上展示健康风险行为的内容（v 没有接触）与使用电子尼古丁传送系统（1.73（1.34 至 2.23）；n=721 322）、不健康饮食行为（2.48（2.08 至 2.97）的几率增加相关。 ）；n=9892），以及饮酒量（2.43（1.25 至 4.71）；n=14 731）。对于饮酒，发现用户生成的内容（3.21（2.37 至 4.33））与营销人员生成的内容（2.12（1.06 至 4.24））之间的关联性更强。对于花在社交媒体上的时间，每天至少使用 2 小时（v <2 小时）会增加饮酒的几率（2.12（1.53 至 2.95）；n=12 390）。不健康饮食行为的等级确定性为中等，饮酒的等级确定性较低，其他调查结果的等级确定性非常低。结论 社交媒体的使用与年轻人的不良健康风险行为有关，但需要进一步高质量的研究来确定因果关系，了解对健康不平等的影响，并确定社交媒体的哪些方面最有害。研究注册 PROSPERO，CRD42020179766。分析的数据基于已发布的数据。模板数据表格、从纳入的研究中提取的数据以及用于分析的数据可根据合理要求从通讯作者处获得。研究方案发布在 PROSPERO 上：（编号：CRD42020179766）