Megan Ranney

Below are excerpts from this grantee’s quarterly reports.

Final Report

Project 1 – IMPACT

  1. Aims: The objective of IMPACT (Intervention Media to Prevent Adolescent Cyber-conflict through Technology) was to conduct a pilot randomized trial (N=80) of at-risk youth ages 13-17 who endorsed past-year online victimization. We aimed to test the acceptability and feasibility of the IMPACT intervention (remote brief intervention delivered over the phone and 8 weeks of daily messages) recruiting teens online through social media (Instagram).
  • Accomplishments: During the first year of the grant, we developed and tested our IMPACT intervention app. IMPACT was developed in partnership with JourneyLabs to create a refined user interface with personalized functions (e.g. a graph of a teens’ mood/responses) based on feedback from the TAM Colloquium and Youth Advisory Board. Also in concert with the Youth Advisory Board, targeted Instagram advertisements were developed to recruit adolescents to test the acceptability and feasibility of the IMPACT intervention. Using the Instagram ads, we reached a total of 1,015,732 individual adolescents with over 1,069,747 impressions (i.e., how many times an ad was seen). From these impressions, 2,051 teens clicked on the ad and 1,193 (58%) began the survey. Of those, 545 (46%) completed the entire survey and 496 (42%) were eligible for enrollment. Of those, 121 (24%) completed the online assent process. After verifying contact info, 80 teens (66%) were randomized and began the study. Ultimately, 79 teens reached the 8-week timepoint and all but one completed the follow-up survey (97%). 77 of the 79 teens completed the follow-up survey at the 16-week timepoint (97%). Among those in the Intervention arm, all 36 who reached the 8-week timepoint completed the qualitative interview and download of social media data. Findings from the pilot randomized controlled trial, demonstrated that IMPACT was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Additionally, this study demonstrated that recruiting adolescents through Instagram can be an efficient and effective way to intervene with those at risk for cybervictimization.
  • Products:
    • IMPACT intervention mobile application
    • Primary outcomes for this study were published in TAM’s special edition of the Journal of Medical Internet Research-Mental Health, titled “A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial” 
      • Kutok, E. R., Dunsiger, S., Patena, J. V., Nugent, N. R., Riese, A., Rosen, R. K., & Ranney, M. L. (2021). A cyberbullying media-based prevention intervention for adolescents on Instagram: Pilot randomized controlled trial. JMIR Mental Health, 8(9), e26029. https://doi.org/10.2196/26029
    • The methods used to recruit teens for this study were published in the May 2021 volume of the Journal of Adolescent Health, titled “Feasibility and Cost of Using Instagram to Recruit Adolescents to a Remote Intervention”
      • Kutok, E. R., Doria, N., Dunsiger, S., Patena, J. V., Nugent, N. R., Riese, A., Rosen, R. K., & Ranney, M. L. (2021). Feasibility and cost of using Instagram to recruit adolescents to a remote intervention. Journal of Adolescent Health, 69(5), 838-846, https://doi.org/10.1016/j.jadohealth.2021.04.021
    • We are currently analyzing quantitative data from the social media downloads for an upcoming publication titled “Social Media Use During Mandated COVID-19 Isolation: The Effects of Active Instagram Use on Adolescent Well-Being”

Project 2 – Connect-19

  1. Aims: We aimed to recruit 1,000 adolescents (ages 13-17) on Instagram to complete a survey assessing technology use patterns (e.g., duration, timing, activity, social reasons for use) before and after a pivotal COVID-19 related date for youth: the announcement of school closures. We also assessed a wide range of social and emotional wellbeing outcomes (stress, anxiety, depression, positive affect, social support) using validated measures. A purposefully sampled subset (n=50) was assented for a video-based qualitative interview and direct download of social media content and meta-data 1 month prior and 1 month after school closure, to permit objective analysis of COVID-19’s impact on social media use. All aspects of the study were guided by a Youth Advisory Team, made up of youth who previously participated in our team’s research and are committed to advising on survey design, interview design, and data gathering and interpretation.
  • Accomplishments: We began recruitment in September 2020 using Instagram ads, designed based on feedback from the TAM Colloquium and Youth Advisory Board. From September 23 to December 16, a total of 978 teens completed our survey assessing for their technology use patterns before and after school closures and their social and emotional wellbeing. Among these participants, a purposeful sample of 48 teens assented to the qualitative interview and 47 of these teens completed a baseline survey sent prior to the interview (which assessed for additional measures related to wellbeing and social support, risky behaviors, and technology use). Ultimately, a representative sample was reached after interviewing 39 teens and downloading their social media data. We wrote “interview summaries” for all qualitative interviews and developed a coding scheme in Nvivo, which we used to code social media content and qualitative interview responses from the 39 teens. Furthermore, we completed preliminary data analysis linking survey data with social media use (i.e., the number of Instagram posts) from the 978 teens who completed the initial surveys. We are currently re-enrolling 356 adolescents (from the total 978) who provided their contact information within the initial survey for a second-round survey. We are reassessing technology use patterns (e.g., duration, timing, activity, social reasons for use) one year after school closures due to COVID-19. We are also reassessing a range of social and emotional wellbeing outcomes (stress, anxiety, depression, positive affect, social support) using validated measures.
  • Products:
    • A first analysis of Connect-19 data was accepted to General Hospital Psychiatry, titled “A national snapshot of U.S. adolescents’ mental health and changing technology use during COVID-19”
    • We are currently analyzing the qualitative interviews, examining teens’ responses regarding changes in social media use after school closures and the affect on connectivity and emotions. This will be submitted to the Journal of Internet Medical Research-Mental Health
    • We are also conducting analysis on data from the second round of surveys reassessing technology use patterns, social and emotional wellbeing outcomes one year after school closures due to COVID-19, and social media data downloaded from of the IMPACT and Connect-19 studies.  

Year 2 Quarter 3

Briefly restate the specific aims or objectives associated with this project.

In the current study “Connect-19”, we aim to recruit 1,000 adolescents (ages 13-17) on Instagram to complete a survey assessing technology use patterns (e.g., duration, timing, activity, social reasons for use) before and after a pivotal COVID-19 related date for youth: the announcement of school closure. We will also assess a wide range of social and emotional wellbeing outcomes (stress, anxiety, depression, positive affect, social support) using validated measures. A purposefully sampled subset (n=50) will be assented for a video-based qualitative interview and direct download of social media content and meta-data 1 month prior and 1 month after school closure, to permit objective analysis of COVID-19’s impact on social media use. All aspects of the study will be guided by a Youth Advisory Team, made up of youth who have previously participated in our team’s research and are committed to advising on survey design, interview design, and data gathering and interpretation.

Summarize what was accomplished with regard to these aims in the present quarter.

In Quarter 3, we successfully completed recruitment. From September 23 to December 16, a total of 978 teens completed a survey on 1) their technology use patterns before and after school closures due to COVID-19 and 2) their social and emotional wellbeing e.g. stress, anxiety, depression, positive affect, and social support. Among these participants, 48 teens completed the qualitative interview and direct download of their social media content. The study team conducted quantitative analyses on the survey data and recently submitted primary outcome results as a research letter to JAMA Pediatrics titled “U.S. adolescents’ mental health and COVID-19-related changes in technology use, Fall 2020”. We have finished writing the “interview summaries” for all qualitative interviews and we are currently in the process of developing a coding scheme in Nvivo for analysis.

Year 2 Quarter 2

Summarize what was accomplished with regard to these aims in the present quarter.

In Quarter 2, we continued to recruit adolescents through Instagram. From September 23 to November 30, we reached 283,853 teens (599,287 impressions). Among these, there were 3,208 link clicks and 873 completed surveys. A total of 185 teens completed the online assent form, and 30 teens completed the qualitative interview. We are excited to make such progress in only a month’s worth of recruitment! We plan to begin quantitative data analysis of the surveys as soon as we reach 1,000 (we anticipate by mid-December). With the qualitative interviews, we began completing “interview summaries” which we plan to use for qualitative analysis. Among the 30 completed, we are finding some content saturation, but we are continuing interviews to get a diverse (racial/ethnic/gender identify/geographic location) sample.

Briefly restate the specific aims or objectives associated with this project.

In the current study “Connect-19”, we aim to recruit 1,000 adolescents (ages 13-17) on Instagram to complete a survey assessing technology use patterns (e.g., duration, timing, activity, social reasons for use) before and after a pivotal COVID-19 related date for youth: the announcement of school closure. We will also assess a wide range of social and emotional wellbeing outcomes (stress, anxiety, depression, positive affect, social support) using validated measures. A purposefully sampled subset (n=50) will be assented for a video-based qualitative interview and direct download of social media content and meta-data 1 month prior and 1 month after school closure, to permit objective analysis of COVID-19’s impact on social media use. All aspects of the study will be guided by a Youth Advisory Team, made up of youth who have previously participated in our team’s research and are committed to advising on survey design, interview design, and data gathering and interpretation.

Year 2, Quarter 1

Summarize what was accomplished with regard to these aims in the present quarter.

In Quarter 1, we finalized the questions we will ask participants in the quantitative survey including: technology use and social media use before and after school closure; experience with cyber-victimization, dating violence, and in-person peer violence; mental health and wellbeing e.g. PROMIS, PANAS, WHO, and MSPSS; and the impact of COVID-19 on their daily lives. We programmed the questions into Qualtrics, as well as the e-assent / e-consent forms. We also designed the Instagram advertisements with feedback from a Youth Advisory Team: 1 member from the TAM YAB and 3 local Rhode Island youth who participated in past studies. We successfully obtained IRB approval for remote e-assenting of teens and e-consenting of parents.

On September 23, 2020, we started recruitment on Instagram. In 2 days, we were able to reach 19,044 teens (19,844 impressions). Among these, there were 137 link clicks, 47 completed surveys, and 13 teens completing e-assent for the qualitative interview. We still need to e-consent parents and schedule the first qualitative interview.

Quarter 4

Briefly restate the specific aims or objectives associated with this project

The objective of IMPACT (Intervention Media to Prevent Adolescent Cyber-conflict through Technology) is to conduct a pilot randomized trial (N=50) of at-risk youth age 13-17 who endorse past-year online victimization. We aim to test the acceptability and feasibility of the IMPACT intervention (remote brief intervention delivered over the phone and 8 weeks of daily messages) recruiting teens online through social media.

In what way did your project provide opportunities for training or professional development?

One of this study’s activities is downloading teens’ social media data. We plan to conduct a sentiment analysis of posts, similar to what we completed in a previous text-based social media study. We are training a future PhD student (recently accepted to a program), a T32 recipient, and a current PhD student in the data analysis for this project; we are also expanding our network of collaborators in order to conduct more complex analyses of the data.

Tell us about your efforts to reach a range of audiences and maximize impact through dissemination and implementation.

A key part of our work is a focus on reaching vulnerable populations, and one of the promises of social media is the ability to reach adolescents who might not otherwise enroll in this type of study. Over the course of the study, we learned how to target advertisements to intentionally reach a more diverse sample. We are currently writing a “methods” paper that describes the challenges and successes of recruiting online through social media. To maximize dissemination, we are including a methods hub focused on social media and online recruitment within our new Center for Digital Health at Brown, and will highlight findings and lessons-learned from this study.

Quarter 3

Tell us about key learnings you’ve uncovered over the course of your project, including advice you might give to investigators conducting similar work.

We have learned about the challenges and success of different ad campaigns through trial and error. We initially started with story ads (content that is ephemeral and disappears after 24 hours), based on research that adolescents utilize stories heavily. We found that “reach campaigns” using stories (ads sent to your target population e.g. 13-17 year olds) yielded few link clicks, and no one completed the screening survey. We then tried story ads using the “traffic campaigns,” which target people who tend to click on and engage with links, with higher overall number of link-clicks but a low proportion of youth completing the screening survey. We then changed from story ads to feed ads (i.e., content that permanently stays on a teen’s Instagram’s account, as they scroll through their feed). This strategy (feed ads, delivered using the traffic campaign) have gotten the greatest proportion of link clicks, screening completions, and enrollment of eligible youth. Moving forward, we will continue to assess whether traffic (feed) campaigns are the best way to advertise, and adjust as needed to meet our target enrollment goal of 50. We will also assess whether there are differences in those who complete the screening versus those who do not, and whether there are differences in eligible youth who enroll versus those who do not enroll.

Quarter 2

Tell us about the anticipated or real-time impact of this project.

We anticipate that we will provide teens across the country access to cyberbullying resources. All teens who take the screener survey will be directed to a resource link, regardless if they met eligibility for the study. For those enrolled and who complete the study, we anticipate that teens will increase their knowledge of the impacts on cyber-conflict and steps to intervene.

Tell us about problems encountered, changes to your approach, and reasons behind these changes.

The biggest problem we’ve encountered was the development timeline with JourneyLabs. We used them for a previous study (delivering messages only), and the additional functions we requested for the present study IMPACT required more time than anticipated. We went back and forth with JourneyLabs to determine which functions were necessary (having the capability to video-call within the app) versus functions that would be nice to have (participants able to customize their profile with colors and avatars). Ultimately, due to JourneyLabs’ barriers, we could not do video-call within the app, and will now have to use a native phone app (e.g. Skype, Google Hangout, Face Time). We do not anticipate this being a barrier with participants, though we would have preferred a single app to conduct all parts of the study.

Quarter 1

Tell us what excites you about the funded project.

Our team is most excited for the opportunity to reach youth across the country. Based on our prior work, we have expertise in in-person recruitment out of hospital settings. While we have reached hundreds of at-risk youth in Rhode Island, funding from TAM has allowed us to expand our reach. We are also excited about the possibility of creating and expanding our innovative methods for identifying wellness in real-time, using Instagram posts.

Tell us more about your team!

Our team consists of PI: Megan Ranney, Project Coordinator: John Patena, Research Assistant: Emily Kutok, and Co-Is: Nicole Nugent, Alison Riese, Shira Dunsiger, Rochelle Rosen, and Jeff Huang. The Emergency Digital Health Innovation program, affiliated with Brown University and Lifespan Health Systems, is a collaboration of practitioners, researchers, and experts in digital health and adolescent well-being. Our mission is to develop, test, and implement high-quality, evidence-based digital health tools for patients and providers. Currently, Dr. Ranney and John mentor a team of 25 research assistants and students.

Fun fact: Emily Kutok has a Snapchat streak with her sister of 1215 days!

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