Can exercise offset some of the harms of regular drinking?

NHS Choices - Behind the Headlines -

"Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers," the Mail Online reports.

A study suggests exercise may compensate for some, but certainly not all, of the harms associated with excessive alcohol consumption. This latest study looked at deaths from cancer and cardiovascular disease, as well as premature death in general (usually judged to be dying before the age of 75).

Researchers looked at around 10 years' worth of national survey data from UK adults aged over 40. Unsurprisingly, they found links between all-cause and cancer mortality in inactive people. But they also found increasing levels of physical activity generally removed the association with drinking habits. In fact, occasional drinking was associated with a significant reduction in all-cause mortality for the most active of people.

Although the study had strengths in its large sample size and regular follow-up, we can't be sure that any links observed were solely down to the interaction between alcohol and exercise. For example, people who are physically active may also avoid smoking and consume healthy diets. It is difficult to completely control for such influences when analysing data like this.

While regular exercise may mitigate against some of the harms associated with excessive alcohol consumption it certainly won't make you immune. Many world-class sportspeople, such as George Best and Paul Gascoigne, have had both their careers and lives blighted by drinking.


Where did the story come from?

The UK-based study was carried out by an international collaboration of researchers from Canada, Australia, Norway and the UK. The health surveys on which the study was based were commissioned by the Department of Health, UK. Individual study authors also reported receiving funding from the National Health and Medical Research Council and University of Sydney. 

The study was published in the peer-reviewed British Journal of Sports Medicine. 

The media coverage around this topic was generally overly optimistic, highlighting that by exercising, individuals can completely undo the harm caused by excessive alcohol consumption, which is untrue.

In particular, the Mail Online claimed "Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers" which could send out the wrong message to the public.


What kind of research was this?

This cohort study analysed data from British population-based surveys: Health Survey for England (HSE) and the Scottish Health Survey (SHS) to investigate whether physical activity is able to moderate the risk between alcohol consumption and mortality from cancer and cardiovascular diseases.

Cohort studies like this are useful for assessing suspected links between an exposure and outcome. However, there are potentially other factors that have a role to play in such associations and therefore the study design doesn't allow for confirmation of cause and effect.


What did the research involve?

The researchers collected data on 36,370 men and women aged 40 or above from Health Survey for England (1994; 1998; 1999; 2003; 2004; and 2006) and the Scottish Health Survey (1998 and 2003). Among other things, the participants were asked about their current alcohol consumption and physical activity.

Alcohol intake was defined by six categories (UK units/week):

  • never drink (lifetime abstainers)
  • ex-drinkers
  • occasional drinkers (haven't drank anything in past seven days)
  • within (previous) guidelines: <14 units (women) and <21 units (men)
  • hazardous: 14-15 units (women) and 21-19 units (men)
  • harmful: >35 (women) and >49 (men)

Frequency and type of physical activity in the past four weeks was questioned and converted into metabolic equivalent task-hour (MET-hours, which are an estimate of metabolic activity) per week according to national recommendations:

  • inactive (≤7 MET-hours)
  • lower level of active (>7.5 MET-hours)
  • higher level of active (>15 MET-hours)

The surveys were linked to the NHS Central Register for mortality data and the participants were followed up until 2009 (HSE) and 2011 (SHS). There were 5,735 recorded deaths; deaths from cancer and cardiovascular disease were of most interest for this study.

The data was analysed for associations between alcohol consumption and the risk of death from all-causes, cancer and cardiovascular disease. The results were then analysed according to levels of physical activity.

Potential confounders (such as sex, body mass index and smoking status) were controlled for.


What were the basic results?

Overall, the study found a direct link between all levels of alcohol consumption and risk of cancer mortality. It also found that increasing levels of physical activity reduced this association with cancer mortality, and also reduced the link with death from any cause.

  • In individuals who reported inactive levels of physical activity (≤7 MET-hours), there was a direct association between alcohol consumption and all-cause mortality.
  • However, in individuals who met the highest level of physical activity recommendations a protective effect of occasional drinking on all-cause mortality was observed (hazard ratio: 0.68; 95% confidence interval (CI): 0.46 to 0.99). It should be noted that this result just skimmed the cut-off point for statistical significance.
  • In this high activity group, there was no link between all-cause mortality and alcohol consumption within guidelines, or even hazardous amounts, but the risk was still increased for those drinking harmful amounts.
  • The risk of death from cancer increased with the amount of alcohol consumed in inactive participants, ranging from a 47% increased risk for those drinking within guidelines to 87% increased risk for those with harmful drinking.
  • In people with higher activity levels (above 7.5 MET hours) there was no significant link between any amount of alcohol consumption and cancer mortality.
  • No association was found between alcohol consumption and mortality from cardiovascular disease, although a protective effect was observed in individuals who reported the lower and higher levels of physical activity (>7.5 MET-hours) and (>15 MET-hours) respectively.


How did the researchers interpret the results?

The researchers concluded "we found evidence of a dose–response association between alcohol intake and cancer mortality in inactive participants but not in physically active participants. [Physical activity] slightly attenuates the risk of all-cause mortality up to a hazardous level of drinking."



This study aimed to explore whether physical activity is able to moderate the risk between alcohol consumption and mortality from cancer and cardiovascular diseases. It found that increasing levels of physical activity reduced the association for death from both all-causes and cancer.

This study has strengths in its large sample size, comprehensive assessments and long duration of follow-up. The findings are interesting, but there a few points to bear in mind:

  • As the authors mention, cohort studies such as this are unable to confirm cause and effect. Though the researchers have tried to account for various potential health and lifestyle confounding variables, there is the possibility that others are still influencing the results. A notable one is dietary habits which weren't assessed. Also, for example, the former drinkers may have quit due to other health issues which may have introduced bias.
  • The study was unable to look at binge drinking levels of alcohol consumption which would have likely had important health implications.
  • Additionally, there is always the possibility with self-reported surveys that the participants either under or over-reported their drinking habits which can increase the chance of misclassification bias.
  • Though having a large sample size, fewer people reported harmful drinking levels, so links within this category may be less reliable.
  • The study has only looked at the link between alcohol and actually dying from cancer or cardiovascular disease. Links may be different if they looked at associations between alcohol and just being diagnosed with cancer or heart disease, for example.
  • The study is also only representative of adults over the age of 40.

Overall, maintaining a healthy lifestyle seems to be the best bet for reducing the risk of any chronic disease, be it through physical activity, balanced diet or reasonable alcohol consumption.

Current alcohol recommendations for both men and women are to drink no more than 14 units per week.  

Links To The Headlines

How exercise undoes the harm from drinking: Adults who booze regularly but exercise for five hours a week are no more likely to die than teetotallers. Mail Online, September 8 2016

Two hours a week of exercise could offset the dangers of alcohol. The Daily Telegraph, September 8 2016

Exercise can cut risk from alcohol-related diseases, study suggests. The Guardian, September 8 2016

Links To Science

Perreault K, Bauman A, Johnson N, et al. Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts. British Journal of Sports Medicine. Published online August 31 2016

'Chocolate good for the heart' claims sadly too good to be true

NHS Choices - Behind the Headlines -

"Regularly tucking into a bar of chocolate may actually be good for us," reports the Mail Online.

Researchers in Denmark say people who eat chocolate one to six times a week are less likely to get a heart condition called atrial fibrillation than those who eat it hardly at all (less than once a month).

Atrial fibrillation (AF) – an irregular heartbeat – can increase the risk of blood clots forming, and so raises the risk of a stroke.

However, as is often the case with health news that sounds too good to be true, the research is not particularly persuasive. People who ate chocolate less than once a month were also more likely to have diabetes, high blood pressure and cardiovascular disease; all of which are risk factors for atrial fibrillation. So they may have been avoiding chocolate for health reasons.

There is also no evidence from this study that eating chocolate will help with symptoms of atrial fibrillation if you already have it.

If anything, the opposite may be true: regularly overindulging in chocolate could increase your blood pressure and diabetes risk, which could eventually trigger the symptoms of atrial fibrillation.


Where did the story come from?

The study was carried out by researchers from Beth Israel Deaconess Medical Center in Boston, US, Aalborg University Hospital and the Institute of Cancer Epidemiology in Denmark, and Western University in Canada.

It was funded by grants from institutions including the US National Heart, Lung and Blood Institute, the European Research Council, the EU, the Harvard Clinical and Translational Science Centre, the Danish Cancer Society and the Danish Council for Strategic Research.

The study was published in the peer-reviewed journal Heart on an open-access basis, making it free to read online.

The study was covered widely in the UK media. The headlines, as you would expect, provided a simplistic "chocolate can be good for us" slant. But the actual "meat" of the reporting in most papers described the limitations and made it clear the study did not prove cause and effect.


What kind of research was this?

This was a prospective cohort study. Cohort studies are useful for spotting patterns but cannot prove that one thing (in this case chocolate consumption) directly causes another (chance of getting AF).


What did the research involve?

Researchers recruited 55,502 people in Denmark aged 50 to 64. Everyone completed a food questionnaire, had health checks and gave other information about their health and lifestyle.

Participants were followed up for an average 13.5 years. Researchers checked them against a Danish health registry to see if they were treated in hospital for AF. After adjusting for potential confounding factors they looked to see whether chocolate consumption was linked to their chances of getting AF.

The research takes advantage of the Danish National Patient Register, which makes it possible to track large numbers of people over time. Researchers included the following potential confounding factors:

  • sex
  • body mass index (BMI)
  • blood pressure
  • total cholesterol
  • total calorie intake
  • coffee consumption
  • smoking
  • years of education
  • hypertension, diabetes and cardiovascular disease

The researchers analysed figures for men and women both separately and together.


What were the basic results?

Over 13.5 years, there were 3,346 cases of AF among the 55,502 people taking part in the study. People were less likely to have AF if they ate chocolate at least once a month:

  • 10% less if they ate chocolate one to three times a month (hazard ratio [HR] 0.9, 95% confidence interval [CI] 0.82 to 0.98)
  • 17% less if they ate chocolate once a week (HR 0.83, 95% CI 0.74 to 0.92)
  • 20% less if they ate chocolate two to six times a week (HR 0.80, 95% CI 0.71 to 0.91)
  • 16% less if they ate chocolate every day – but the numbers of people who ate chocolate daily and had AF were so low that we can't be sure these results were not just down to chance (HR 0.84, 95% CI 0.65 to 1.09)

The separate figures for men and women show men seemed to have the lowest risk if they ate chocolate two to six times a week, and women if they ate it once a week. However, these differences were small and may be down to chance and the fact that fewer women had AF.


How did the researchers interpret the results?

The researchers say higher levels of chocolate consumption "were associated with an 11-20% lower rate of clinically apparent AF among men and women." They say they adjusted the figures using "extensive data" on diet, lifestyle and other illnesses, but that "we cannot preclude the possibility of residual or unmeasured confounding."

They suggest that "antioxidant, anti-inflammatory and antiplatelet properties of cocoa" may be the reason for lower rates of AF among chocolate eaters.



Health stories that suggest eating or drinking something we like, whether it's chocolate or wine, are always popular. But they don't really tell us anything we don't know already. Certain foods may have a small impact on certain types of diseases, but it's the overall diet that counts.

Previous studies have already suggested that the antioxidant properties of cocoa could reduce the risk of cardiovascular disease, so it's surprising that this study focused on one particular cardiovascular disease, atrial fibrillation.

AF is a common condition that affects heart rate, often causing a faster than normal, irregular rhythm. It isn't usually life-threatening, although you may need treatment to reduce risk of linked conditions such as stroke.

While the study had some strengths, such as being very large, using a reliable database and taking account of a number of confounding factors, this type of study cannot show that chocolate actually prevents AF. It's quite possible that other factors could be more important than diet.

A plausible interpretation of this study is not that eating chocolate prevents AF, but that people with AF (or associated risk factors) avoid eating chocolate, possibly on the advice of their doctor.

It's worth remembering that – as well as cocoa – chocolate contains a lot of fat and sugar. In the study, one portion of chocolate was 30g. There's nothing wrong with eating a small amount of chocolate as part of a healthy, balanced diet – but hoping that a single "superfood" such as chocolate will make a big difference to your health is misguided.

Read more about so-called superfood claims and the evidence behind them.   

Links To The Headlines

Chocolate six days a week will save your heart, chaps... but sorry, ladies, it's only once for you. Mail Online, May 24 2017

Six bars of chocolate a week could cut risk of common heart condition. The Daily Telegraph, May 24 2017

Eating just one chocolate bar a day ‘can reduce risk of stroke by 23 per cent,’ says study. The Sun, May 24 2017

Chocolate may help reduce risk of irregular heart rate, finds research. The Independent, May 24 2017

Links To Science

Mosotofsky E, Johansen MB, Tjønneland A, et al. Chocolate intake and risk of clinically apparent atrial fibrillation: the Danish Diet, Cancer, and Health Study. Heart. Published online May 23 2017

Just half a glass of wine a day may increase breast cancer risk

NHS Choices - Behind the Headlines -

"Just half a glass of wine a day ups the risk of breast cancer by nine per cent, experts warn," The Sun reports. A major report looking at global evidence found that drinking just 10g of alcohol a day – 1.25 units – was linked to an increased risk of breast cancer.

The report was produced by the World Cancer Research Fund which reviews the global evidence on the link between diet, weight, physical activity and breast cancer. Overall, this report supports what is already known, that alcohol consumption is a risk factor for breast cancer.

The report found that for each 10g of pure alcohol consumed each day, the risk of premenopausal breast cancer increases by 5%, and the risk of postmenopausal breast cancer increases by 9%. Experts have suggested that this would equate to about one extra case of cancer per 100 women, based on current rates of breast cancer in the UK.

After a recent review by expert groups of the evidence on all of the health effects of alcohol, the UK Chief Medical Officer's advice is that men and women should not regularly drink more than 14 units in a week to try and keep overall risks at a low level.


What is the basis for these current reports?

These news stories are based on a report from the not-for-profit World Cancer Research Fund (WCRF). The WCRF has an ongoing project to regularly assess the evidence on links between diet, nutrition, physical activity and different types of cancer, and provide recommendations based on this. Its current report is an update on the links between these factors and breast cancer in women.

To prepare the report, the WCRF systematically searched for relevant studies published since its last update in 2010. It looked at randomised controlled trialscohort studies and nested case control studies.

These new studies were assessed by a panel of independent international scientists to see if they should be included in this latest report.

Those that were relevant were then interpreted along with the older evidence in the previous WCRF reports. They carried out statistical pooling of the study results where possible. All together the panel considered 119 studies looking at more than 12 million women, and over 260,000 cases of breast cancer.


What impact did the report find for alcohol on breast cancer risk? Premenopausal breast cancer

The report identified eight new or updated studies on the link between alcohol and premenopausal breast cancer. Premenopausal breast cancer cases account for around one in five cases of breast cancer in the UK.

It was possible to pool the results of 10 studies on premenopausal breast cancer, and this showed that an additional 10g of ethanol (pure drinking alcohol) a day increased risk of premenopausal breast cancer by 5% (relative risk [RR] 1.05, 95% confidence interval [CI] 1.02 to 1.08).

Postmenopausal breast cancer

The report identified 21 new or updated studies on the link between alcohol and postmenopausal breast cancer. Of these studies, 22 could be pooled, showing that an additional 10g of ethanol (pure drinking alcohol) a day increased risk of postmenopausal breast cancer by 9% (RR 1.09, 95% CI 1.07 to 1.12).

One unit of alcohol is 8g and is equivalent to about:

  • half a small glass (76ml) of standard 13% ABV (alcohol by volume) wine
  • 218ml of standard 4.5% cider
  • 250ml of standard 4% beer or standard 4% alcopop
  • 25ml of standard 40% whiskey

Drinking 10g of ethanol every day for a week would be equivalent to 8.75 units of alcohol, which is less than the UK's current maximum upper limit for women. The UK Chief Medical Officer's advice is that, to keep overall risks from alcohol at a low level, it is safest that men and women do not regularly drink more than 14 units in a week.

The report concluded there is strong evidence that consuming alcoholic drinks probably increases the risk of premenopausal breast cancer, and convincing evidence that it increases the risk of postmenopausal breast cancer.


What does this actually mean in terms of numbers of women with breast cancer in the UK?

The report itself did not estimate how many extra cases of cancer this was equivalent to. One expert from the UK, Professor Kevin McConway, Emeritus Professor of Applied Statistics from The Open University said:

"...according to Cancer Research UK, of 100 UK women, about 12 or 13 will develop a breast cancer at some point in their lives. Imagine that these 100 women all drank an extra small glass of wine or half a pint of beer every day, compared to what they drink now. On WCRF's figures, that would lead to 1 more of them developing a breast cancer during their lifetime."

To put this into context, Professor McConway added: "Any increase is a bad thing, but it's only one more out of the 100 women, and that has to be set against whatever pleasure the women might obtain from their drinking. Drinking alcohol has a greater effect on the risks of several other cancers (such as cancers of the mouth, oesophagus and bowel) than it does on the risk of breast cancer, so there are other reasons to give up or cut down, but that just shows the importance [of] looking at the whole picture and not just at breast cancer."


What about other factors?

The report also reported on other factors that could influence risk of breast cancer.


The report found strong evidence that vigorous physical activity (enough to get you out of breath) probably decreased risk of premenopausal breast cancer. There was also strong evidence that physical activity as a whole, including vigorous and less strenuous exercise, probably decreased risk of postmenopausal breast cancer.


The report found strong evidence that breastfeeding probably decreased risk of breast cancer overall.


There was limited evidence that including the following in your diet may reduce your risk of breast cancer:

  • non-starchy vegetables
  • dairy products (for premenopausal breast cancer only)
  • foods containing carotenoids, such as carrots, spinach and kale
  • foods high in calcium, such as sardines and broccoli
Body weight

The relationship between body weight and breast cancer risk seemed to be complex.

For premenopausal breast cancer, greater body fatness during adulthood actually had a protective effect. More body fatness between the ages of 18-30, also had a protective effect against postmenopausal breast cancer risk.

However, greater body fatness during adulthood as a whole, and greater weight gain during adulthood increased postmenopausal breast cancer risk.

So, the WCRF continues to maintain its advice that we should keep our weight in the healthy range for as long as possible for overall cancer prevention.

Read more about breast cancer prevention.

Links To The Headlines

'Half a glass of wine every day' increases breast cancer risk. BBC News, May 23 2017

Just one small glass of wine a day raises the breast cancer risk: Study means even following safe drinking guidelines could endanger health. Daily Mail, May 23 2017

Just half a glass of wine a day raises breast cancer risk by nine per cent, experts warn. The Sun, May 23 2017

Ditch alcohol and take up gardening to prevent breast cancer, experts say. The Daily Telegraph, May 23 2017

One alcoholic drink a day 'can increase the risk of breast cancer'. ITV News, May 23 2017

One small drink a day raises risk of breast cancer. The Times, May 23 2017 (subscription required)

Links To Science

World Cancer Research Fund. Diet, nutrition, physical activity and breast cancer (PDF, 4.09Mb). Published online May 2017

Dementia saliva testing 'shows early promise'

NHS Choices - Behind the Headlines -

"Simple saliva test for dementia 'shows promise' in bid to diagnose the disease early," the Daily Mirror reports.

This news is based on a laboratory study that took saliva samples from 12 healthy adults, nine adults with Alzheimer’s disease, and eight with mild cognitive impairment (MCI), which is often seen as the stage just before dementia.

Researchers looked at 22 chemical substances (biomarkers) in the saliva, to see if there was a distinct pattern that could indicate whether a person was healthy, had MCI, or had Alzheimer's. They found that a specific chemical make-up of saliva could predict, with a relatively good degree of accuracy, which of these three groups a person fell into.

The findings show promise but this is only preliminary work, as the sample is too small to be conclusive. The next stage is to see if the results can be verified in a much larger sample of people. The researchers calculated that they need ideally at least 100 people in each group.


Where did the story come from?

The study was carried out by researchers from the Beaumont Research Institute and Oakland University William Beaumont School of Medicine in the US, and the University of Alberta in Canada. Funding was provided by the Fred A. and Barbara M. Erb Family Foundation.

The study was published in the peer-reviewed Journal of Alzheimer's Disease.

The Mirror and The Sun's reporting of the study was accurate and appropriately cautious, saying that the test shows promise, without suggesting a test is currently available.


What kind of research was this?

This was a proof-of-concept study. It aimed to see whether it was possible to look at levels of certain substances in saliva to determine whether a person is likely to have mild cognitive impairment (MCI) or Alzheimer's disease.

Alzheimer's is the most common form of dementia, where there is a build-up of characteristic clumps of protein called plaques and tangles in the brain. However, there is no conclusive diagnostic test for Alzheimer's as it can only be diagnosed with certainty by looking at brain tissue after death. A likely diagnosis of Alzheimer's is made on the presence of these characteristic features and by ruling out other causes.

Mild cognitive impairment (MCI), where people start to experience memory problems but fall below the threshold for dementia, can be a preliminary stage to dementia (any type). About 1 in 10 people with MCI progress to dementia each year.

A simple early biological test for Alzheimer's could allow it to be recognised at an early stage, helping people to access the right treatment and to make decisions about their future. Previous studies have already shown it may be possible to distinguish between different types of degenerative brain diseases based on the presence of certain chemical substances, or biomarkers, in body fluids or tissues.


What did the research involve?

The researchers looked at whether there were characteristic chemical differences in saliva samples from healthy people, people with MCI, and people with Alzheimer's.

Saliva samples were collected from 12 healthy adults (controls), eight people with MCI and nine people with Alzheimer's.

All participants were recruited from a centre specialising in care of the elderly. Their diagnoses were made using a variety of tried and tested assessments of brain function (cognitive function), such as the Clinical Dementia Rating Scale, Mini-Mental State Examination and Geriatric Depression Scale.

Saliva samples were analysed using a technique called nuclear magnetic resonance spectroscopy, which allowed the researchers to measure levels of the different biomarkers.


What were the basic results?

The researchers found that the different groups of people could be distinguished with good accuracy based on specific patterns of biomarkers in their saliva.

In particular:

  • high levels of acetone and imidazole and low levels of galactose could distinguish people with MCI from healthy controls
  • high levels of propionate and acetone could distinguish people with Alzheimer's from healthy controls
  • high levels of creatinine and 5-aminopentanoate could distinguish people with Alzheimer's from those with MCI
How did the researchers interpret the results?

The researchers conclude that they have provided "preliminary evidence that salivary metabolites may be useful for [Alzheimer's disease] biomarker development."

They say: "Given the convenience and the frequency with which saliva can be obtained, larger studies are justified."



The researchers are appropriately cautious in their conclusions. These findings have potential, but this is an early stage pilot – a starting point for further study.

The tests were carried out in small samples of healthy people and those with cognitive impairment. They would have to be validated in much larger groups, in which it's possible the test would give different findings. The researchers calculate that they would need at least 100 people per group to develop models that could reliably detect significant differences in biomarkers between the groups.

Even among this small sample, we don't know from the information provided that the people definitely had Alzheimer's disease. They were assessed using a range of cognitive assessments, but we don't know other aspects such as their medical history and results of brain imaging. It's possible, for example, that some of these people could have had vascular dementia.

Even if further research finds a profile of biomarkers that is reliable enough at identifying people with MCI or Alzheimer's, there would still be many more considerations before introducing this as a screening test. For example, who should be screened and would testing offer any benefit over current diagnostic methods based on clinic assessment?

Currently, though there are drugs that can be prescribed for people with mild to moderate dementia, there is no treatment that can prevent or cure dementia. Therefore earlier recognition at this stage would help people get the support they need, but is unlikely to change the course of the disease. This may change if there are future drug developments.

Current advice stands, that if you or a family member or friend are having problems with memory and understanding, it's important to contact a health professional to get the support needed. Memory and cognitive problems can have a wide range of causes so it would be unwise to assume that they are a sign of dementia.

For more information visit the NHS Choices dementia guide.

Links To The Headlines

Simple saliva test for dementia 'shows promise' in bid to diagnose the disease early. Daily Mirror, May 22 2017

Simple saliva test could be used to identify early signs of Alzheimer's Disease, researchers say. The Sun, May 22 2017

Links To Science

Yilmaz A, Tim G, Han B, et al. Diagnostic Biomarkers of Alzheimer's Disease as Identified in Saliva using 1H NMR-Based Metabolomics. Journal of Alzheimer's Disease. Published online  May 11 2017

Instagram 'ranked worst for mental health' in teen survey

NHS Choices - Behind the Headlines -

"Instagram is rated as the worst social media platform when it comes to its impact on young people's mental health, a UK survey suggests," BBC News reports.

The survey asked 1,479 young people aged 14-24 to score popular social media apps on issues such as anxiety, depression, loneliness, bullying, body image and "fear of missing out" – where your social media peers seem to be enjoying a better quality of life.

The survey fed into a larger report looking more generally at the impact of social media on people in this age group – so-called "digital natives", who have never lived in a world without the internet.

Despite many headlines flagging the negative effects, the report – published by the Royal Society for Public Health (RSPH) – also explored the potential positive benefits for teenagers, such as improved sense of community and self-identity.

YouTube was found to have the most positive impact on young people, and photo-sharing platform Instagram the most negative.

Acting on this information, the report calls for measures to help protect individuals when using social media platforms.

Their recommendations revolve around increased education on cyber safety and providing more help to protect the mental wellbeing of young people.

Who produced the report?

The report was produced by the Royal Society for Public Health (RSPH) and the Young Health Movement. 

The RSPH is an independent charity that works to improve the health and wellbeing of the public.

The Young Health Movement, run by RSPH, is a collective of individuals striving to raise public health awareness in young people.

How accurate were the media reports ?

The study was covered broadly accurately by the UK media, although some of the headline writers were a little unfair on some social media giants.

The Guardian led with, "Facebook and Twitter 'harm young people's mental health'," even though Twitter ranked second best and Facebook third overall.

Why is this survey so timely?

Social media use is booming: 91% of 16-24-year-olds in the UK use the internet and other social networking sites regularly.

Although social media can connect people from all over the world to provide a strong sense of community, rates of anxiety and depression in young people have increased by 70% over the last 25 years.

Recent studies have already suggested associations between social media use and a rise in teen mental health problems.

A Danish study we discussed in 2016 found regular users of Facebook encouraged to quit for a week reported greater satisfaction with their life at the end of the week.

What evidence did they look at?

Evidence was pulled from several sources, including the Office for National Statistics, looking at the effect social media has on different things like sleep, body image, self-expression (their feelings, thoughts or ideas), and self-identity (their qualities as an individual).

As part of their research, the RSPH surveyed 1,479 young people in the UK aged 14-24 to find out more about their use of five of the most popular social media platforms: Facebook, Instagram, Snapchat, Twitter, and YouTube.

The survey aimed to better understand how social media affects the health and wellbeing of young people, making comparisons between the different platforms.

Young people were asked about:

  • their awareness and understanding of other people's health experiences
  • access to trustworthy expert health information
  • emotional support
  • anxiety
  • depression
  • loneliness
  • sleep
  • body image
  • real-world relationships
  • self-expression
  • self-identity
  • community building
  • bullying
  • "fear of missing out" (FOMO)

The results from the survey were used to rank the social media platforms in terms of positive and negative impact on mental wellbeing.

What are the main findings?

Based on the health and wellbeing questions, the researchers ranked the social media platforms as follows, from having the most positive impact to the most negative:

1. YouTube
2. Twitter
3. Facebook
4. Snapchat
5. Instagram

Across all five social media platforms, the greatest negative impact was around sleep, bullying and FOMO.

The greatest positive impact was felt around self-expression, self-identity and community building.

What recommendations did the report make?

The report rounded off with several calls to action, summarised below. It's hoped these will be adopted to help safeguard young people when online.

A pop-up heavy usage warning on social media

Social media sites can track a person's usage and provide a pop-up warning when they've been online for a length of time deemed potentially harmful. The user can decide whether or not to act on the warning.

An icon to highlight when photos of people have been digitally manipulated

The use of a small watermark or icon to be added to the bottom of a person's photo when an airbrush or filter has been added that may significantly alter their appearance.

Health information on social media to be certified as trustworthy

The Information Standard certification scheme, as used by NHS Choices, should be applied to social media so individuals can know when health information available on social media is trustworthy.

Safe social media use to be taught during lessons in schools

Education should feature information around the safe use of social media, covering topics on cyber bullying, social media addiction and other potentially harmful effects on mental wellbeing. The curriculum should also include information on where young people can seek help.

Social media platforms to identify vulnerable users and signpost to support

Technology can be used to identify posts that suggest the user is affected by mental health problems. The user can then be provided with discreet information on how and where they could seek help, such as The Samaritans.

Youth workers to have social media training

Training should be available for all adults working with young people so they can better understand the potential risks and benefits of social media.

More research to be carried out into the effects of social media on young people's mental health

RSPH calls for more research into the effects of social media on younger people's mental wellbeing, as this research is currently lacking.


This timely report should be welcomed, given that almost all young people use social media, and it undoubtedly can affect their wellbeing. It also offers well-considered recommendations.

However, the study does have some limitations. Researchers gauged the potential positive and negative effects of different social media platforms by asking young people to answer whether they felt better or worse by using them. This can't prove that social media is directly responsible for increasing rates of depression and anxiety.

It's difficult to explore all the various ways the social media sites may make people feel better or worse. It could be that it's dependent on the content and subject matter people are viewing or participating in.

For example, sites like YouTube and Twitter may have been generally rated more positively because individuals were mostly viewing things more removed from their immediate lives, such as celebrity figures, or amusing or interesting video clips, whereas Facebook, Snapchat or Instagram tend to involve friends and family, and be more directly related to their users' lives. 

And there will be various forms of "negative" content available on YouTube, so it shouldn't be concluded too strongly that this is necessarily "better" or "safer" than all other platforms.

It would be valuable to further explore why certain platforms could have different effects on wellbeing. The report raises important questions, and we have yet to see the response to the society's recommendations.

If you or a friend or relative are experiencing low self-esteem or symptoms of low mood or anxiety, it's very important to seek help from your GP or speak to someone from school or college so you can get the support you need.   

Links To The Headlines

Instagram 'worst for young mental health'. BBC News, May 19 2017

Instagram rated worst media for mental health. Sky News, May 19 2017

Facebook and Twitter 'harm young people's mental health'. The Guardian, May 19 2017

Instagram ranked worst social network for young people's mental health. Sky News, May 19 2017

Links To Science

Royal Society for Public Health. #StatusOfMind – Social media and young people's mental health and wellbeing (PDF, 13.70Mb). May 2017


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