Literature DB >> 35144936

Data handling practices and commercial features of apps related to children: a scoping review of content analyses.

Lindsay Jibb1,2, Elsie Amoako3, Melissa Heisey3, Lily Ren4, Quinn Grundy3.   

Abstract

BACKGROUND: Child interaction (including via parent proxy) with mobile apps is common, generating concern about children's privacy and vulnerability to advertising and other commercial interests. Researchers have conducted numerous app content evaluations, but there is less attention to data sharing or commercial practices.
OBJECTIVE: This scoping review of commercial app evaluation studies describes the nature of such evaluations, including assessments of data privacy, data security and app-based advertising.
METHODS: We searched Scopus, PubMed, Embase and ACM Digital Library (2005-2020). We included studies that evaluated the properties of apps available through commercial app stores and targeted children, parents of a child (0-18 years) or expectant parents. Data extracted and synthesised were study and app user characteristics, and app privacy, data sharing, security, advertisement and in-app purchase elements.
RESULTS: We included 34 studies; less than half (n=15; 44.1%) evaluated data privacy and security elements and half (n=17; 50.0%) assessed app commercial features. Common issues included frequent data sharing or lax security measures, including permission requests and third-party data transmissions. In-app purchase options and advertisements were common and involved manipulative delivery methods and content that is potentially harmful to child health.
CONCLUSIONS: Research related to the data handling and the commercial features of apps that may transmit children's data is preliminary and has not kept pace with the rapid expansion and evolution of mobile app development. Critical examinations of these app aspects are needed to elucidate risks and inform regulations aimed at protecting children's privacy and well-being. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Entities:  

Keywords:  data collection; paediatrics; technology

Mesh:

Year:  2022        PMID: 35144936      PMCID: PMC9209675          DOI: 10.1136/archdischild-2021-323292

Source DB:  PubMed          Journal:  Arch Dis Child        ISSN: 0003-9888            Impact factor:   4.920


Mobile app developers encourage users to enter personal information and routinely share collected data with third parties to enhance the user experience or monetise the app. Apps focused on children may be among the worst in terms of the number of associated third-party data trackers—posing privacy and safety concerns to children. Child and parent app content analyses are increasingly conducted, but little is known associated data privacy, data security and app-based advertising assessments. Comprehensive evaluations of the data privacy and security elements and commercial features of apps that may transmit children’s data are rarely conducted. When evaluated, child and parent apps show frequent data sharing and lax security measures, including permission requests and third-party data transmissions. In-app purchase options and advertisements appear common in child and parent apps and involved manipulative delivery methods and content that is potentially harmful to child’s health.

Introduction

Today’s children are growing up in an immersive digital media era where frequent interaction with mobile applications (apps) is the norm. In addition to their own use of technology, children’s data including photographs, videos and personal information are shared via their parents’ online behaviours. Engagement with technology spans childhood, with 49% of parents using parenting apps,1 60% of children less than 3 years having used a mobile device2 and, in the UK, 53% of children aged 7 years and 90% of children aged 11 years reporting mobile phone ownership.3 Unfortunately, children and their parents are generally engaging with apps without a fulsome understanding of the privacy implications of their actions or the commercial interests in monetising their app-based activities.4 Mobile app developers encourage users to enter personal information and routinely share collected data with third parties to enhance the user experience or commercialise the app.5 Adult apps are known to share personal and health information with an array of commercial entities, which are then capable of aggregating data across apps and re-identifying users.6 7 Recognising children’s particular vulnerabilities, regulations designed to protect child privacy include Europe’s General Data Protection Regulation (GDPR) and the United States’ Children’s Online Privacy Protection Act (COPPA). These regulations require operators of online services such as apps to give detailed notice of privacy practices and prohibit the processing of children’s personal information without consent.8 9 Still, evidence suggests that apps containing children’s data are among the worst in terms of the number of associated third-party trackers10—and developers may skirt privacy regulation by claiming their app is targeted at general audiences rather than children.11 This mobile ecosystem and current regulatory situation creates serious risks to children. The ubiquitous online presence and purchasing power of young parents and children mean these groups are now at the centre of the e-commerce market. This is highly problematic as serious child privacy and safety issues may arise if information shared with apps is used for data-driven advertising. Furthermore, there is a real danger that data aggregators may create digital dossiers that follow young people into adulthood and impact their future education, employment and health insurance acquisition opportunities.12 In parallel with these data handling issues, research attention has increasingly turned to app stores and the content and quality of commercially available apps. Given the availability of such evaluations and that these apps may transmit child data to a host of third parties, the objective of this review was to understand the scope of such evaluations, including whether and how researchers are assessing data privacy, data security and app-based advertising and what results they are finding in these areas.

Methods

Design and reporting

We conducted a scoping review according to the framework developed by Levac et al 13 using an internal protocol that was based on a previous, similar review by a member of our group.14 Review reporting is in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews (PRISMA-ScR) checklist.15

Eligibility criteria

We included studies that evaluated apps available in commercial stores which collected data directly related to children; thus users would be children, a parent of a child (0–18 years) or an expectant parent. We excluded commentaries, topical or systematic literature reviews, protocols, book chapters and conference abstracts. No language restrictions were placed. The search was limited to studies published from 2005 onward—the timeframe where mobile apps have been publicly available.16

Information sources and evidence screening

On 18 November 2020, we conducted searches in the Scopus (Elsevier), PubMed, Embase (Ovid) and ACM Digital Library databases. Our search strategy was developed in consultation with a research librarian (online supplemental appendix 1) and piloted to validate applicability. We supplemented the search with searches of our own databases of mobile app literature. Using Covidence software, duplicates were removed and three authors independently screened titles and abstracts, and then full texts, in duplicate according to the eligibility criteria. Eligibility disagreements were resolved through discussion with a third reviewer.

Data charting

We developed, piloted and refined a data charting table with reference to those used in our previous research in this topic area14 17 and we charted data into this table. The data items charted are shown in online supplemental appendix 2.

Synthesis of results

Data abstraction fields were grouped according to key data features to enable synthesis. Quantitative data were summarised using descriptive statistics. Where appropriate, qualitative data items were categorised descriptively, and frequencies calculated. Charting and categorisation were conducted by one author and checked by a second author.

Results

Study selection

We identified 15 762 records across all databases (figure 1). After the removal of duplicate and screening of titles and abstracts, we assessed 140 full-text articles for inclusion. Following full-text screening, 34 articles were included in this review.
Figure 1

Study selection process.

Study selection process.

Study and general app characteristics

The number of published studies meeting our inclusion criteria has increased over time (figure 2). Study details are shown in table 1. Studies were conducted in the USA (n=18; 52.9%), Australia (n=9; 26.5%), Canada (n=2; 5.9%), Iran (n=1; 2.9%), India (n=1; 2.9%) and the UK (n=1; 2.9%). Two studies (5.9%) were conducted across multiple countries. Most commonly, study designs were reported as systematic reviews or evaluations (n=13; 38.2%), descriptive or content analyses (n=10; 9.4%), or reviews (n=5; 14.7%). Stated designs represented the authors’ own labelling, and we did not find meaningful correspondences between reported study designs and the methods used. Study funding was from government agencies (n=10; 29.4%), universities (n=3; 8.8%), non-for-profit organisations (n=1; 2.9%), for-profit organisations (n=1; 2.9%) or a combination of these sources (n=5; 14.7%). Nine studies (26.5%) did not identify the funding source and 5 (14.7%) received no funding.
Figure 2

Study publication number over time.

Table 1

Study and associated app sample characteristics

First author and yearCountry of originReported designFunding source(s)Target userTargeted user characteristicsApp stores searchedApp store search date(s)Method for app samplingApp sample numberApp sample language restrictionChildren’s app content
Biviji et al 39 USAReview and content analysisNoneParentsPregnant people, future parents, other caregivers of infantsApple App and Google PlayNot reportedScraping software29EnglishPregnancy or early childhood health education or user decision-making support functions
Biviji et al 40 USACross-sectional reportCombinationParentsParents-to-be, other caregivers of infantsApple App and Google PlayMarch 2017Scraping software421EnglishPregnancy or early childhood health education or user decision-making support function
Bland et al 41 UKContent analysisCombinationParentsPregnant peopleApple App and Google PlayNovember 2018Keyword29EnglishPregnancy-specific nutritional support functions
Brown et al 42 AustraliaReviewNoneParentsPregnant peopleApple AppOctober 2017Keyword51EnglishNutrition or dietary information
Bry et al 43 USASystematic evaluationNot reportedParents or childrenChildren with anxiety, parents of a children with anxietyApple App and Google PlayFebruary 2016Keyword121EnglishAnxiety-related symptom treatment or management
Chen et al 44 USASystematic reviewFor-profitChildrenAdolescents and young adults who are sexually activeApple App and Google PlayJuly 2015Keyword22EnglishPregnancy prevention information
Cheng et al 24 AustraliaSystematic evaluationNot reportedParentsParents of infants up to 1 yearApple App and Google PlaySeptember 2018 to January 2019Keyword47EnglishMilk feeding behaviours, solid food feeding behaviours or infant activity information
Das et al 20 USAContent analysisGovernmentChildrenChildren or adolescents under the age of 18Apple App and Google PlayMarch 2016Store-reported highly ranked apps64Not reportedAll app content types included
Davis et al 45 USAContent analysisNot reportedParentsNew parentsApple App2016Keyword46EnglishParenting, infant health or child health information
Furlong et al 46 AustraliaSystematic reviewGovernmentChildrenChildren up to 12 years old with a speech disorderApple App and Google PlayNovember 2016 to May 2017Keyword132EnglishIncludes tasks that require production of speech by user
Hotwani et al 47 IndiaContent analysisNot reportedParents or childrenAll childrenApple AppNot reportedKeyword6EnglishTooth brushing promoting functions
Hswen et al 48 USAContent analysisNot reportedChildrenChildren aged 4 and olderApple AppMarch 2012Store-reported highly ranked apps20Not reportedAll app content types included
Liu et al 22 USANot reportedGovernmentChildrenAll childrenGoogle PlayApril 2015Classifier software67 778Not reportedAll app content types included
Meyer et al 23 USAContent analysisUniversityChildrenChildren less than 5 years oldGoogle PlayDecember 2017 to March 2017Store-reported highly ranked apps135Not reportedAll app content types included
Mousavi et al 49 IranSystematic reviewNoneParents or childrenAll parents or childrenApple App and Google PlayDecember 2017Keyword4EnglishHealth monitoring, health decision support and diagnosis support functions
Musgrave et al 50 AustraliaSystematic reviewUniversityParentsPregnant peopleApple App and Google PlayNovember 2017 to October 2019Store-reported highly ranked apps10EnglishGeneral pregnancy information
Quinn et al 51 USANot reportedNoneChildrenChildren preschool and/or kindergarten ageApple App and Google PlayNot reportedKeyword472EnglishHandwriting, spelling and/or composing training
Reyes et al 18 MultipleContent analysisCombinationChildrenChildren less than 13 years oldGoogle PlayNovember 2016 to March 2018Scraping software5855EnglishAll app content types included
Richardson et al 52 CanadaSystematic reviewGovernmentParentsParents of children in the NICU (inclusive of guardians, additional family or individuals that provide care to infants in the NICU)Apple App and Google Play2017Keyword18EnglishInformation or support functions for parents of infants in NICUs
Robinson et al 53 USAContent analysisGovernmentChildrenSmoking adolescents attempting to quitApple App and Google PlayNovember 2016Keyword46Not reportedSmoking cessation education
Sardi et al 21 MultipleSystematic reviewGovernmentParentsPostpartum womenApple App and Google PlayJanuary 2019Keyword48EnglishPostnatal care support functions for the mother and/or newborn
Schoeppe et al 54 AustraliaSystematic reviewCombinationChildrenAll children and adolescentsApple App and Google PlayMay 2016 to November 2016Keyword25EnglishDiet, physical activity and sedentary behaviour improvement functions
Schoffman et al 55 USASystematic evaluationNoneChildrenChildren and adolescents with obesityApple App and web searchJune 2012Keyword57EnglishWeight loss/healthy eating/physical activity support functions
Sidhu et al 56 USAContent analysisGovernmentParentsBreastfeeding mothers of infants 0–6 monthsApple App and Google PlayAugust 2017 and October 2017Keyword41EnglishBreastfeeding education or breastfeeding experience tracking
Taki et al 57 AustraliaSystematic evaluationGovernmentParentsParents of infants up to 1 yearApple App and Google PlayDecember 2013, March 2014, and December 2014Keyword46EnglishHealthy milk or solid food feeding behaviour information
Virani et al 58 CanadaReviewNot reportedParentsAll parentsGoogle PlayJune 1 2018Keyword16EnglishParenting information and support functions
Weber et al 59 USAReviewGovernmentParentsParticipants in a special supplemental nutrition programme for women, infants, and childrenApple App and Google PlayDecember 2017 to June 2018Keyword17Not reportedRelating to the supplemental nutrition programme from women, infants and children
Weekly et al 60 USAReviewNot reportedParents or childrenPalliative paediatric patients, caregivers of palliative paediatric patientsApple App, Google Play and Blackberry World AppMay 2017 to July 2017Keyword and expert referral16English and SpanishMindfulness, relaxation or distraction education or training
Wisniewski et al 61 USASystematic evaluationGovernmentParents or childrenAll parents or childrenGoogle PlayApril 2016 to May 2016Keyword75Not reportedAdolescent online safety functions
Womack et al 62 USAContent analysisNot reportedParentsPregnant peopleApple App and Google PlayNovember 2015Keyword48EnglishPregnancy information
Zarnowiecki et al 63 AustraliaSystematic reviewNot-for-profitParents or childrenParents of children under 15, children under 15Apple App and web searchOctober 2018 to November 2018Keyword4Not reportedMeal planners, shopping list or lunchbox functions
Zhao et al 25 AustraliaComprehensive assessment and exploratory qualitative researchUniversityParentsParents of infants and young childrenApple App and 360 Android Mobile AssistantApril 2016Keyword26Accessible in simplified Chinese charactersHealthy infant feeding provision functions
Zhao et al 26 AustraliaNot reportedNot reportedParentsMothers of children 3 years of age and less or mothers-to-be360 Android Mobile AssistantFebruary 2018Store-reported highly ranked apps79Accessible in simplified Chinese charactersPregnancy and early parenting information or support functions
Zhao et al 19 USAProspective cohort studyCombinationChildrenChildren aged 3–5 yearsGoogle PlayAugust 1 2019 to November 1 2019Parent list of used apps451Not reportedAll app content types included

NICU, neonatal intensive care unit.

Study publication number over time. Study and associated app sample characteristics NICU, neonatal intensive care unit. The median app sample size across studies was 46 (range 4–67 778). Parents were the intended app users in 16 studies (47.1%), children in 12 studies (35.3%), and parents or children in 6 studies (17.6%). Apps were most commonly available through both iTunes (Apple) and Google Play stores (n=19; 55.9%)—followed by Google Play (n=6; 17.6%) or iTunes alone (n=4; 11.8%). To sample apps, authors most commonly used keyword searches in app stores (n=23; 67.6%), store-reported ranking lists (n=5; 14.7%) or software to support searching of app store contents (n=4; 11.8%).

App data privacy and security-related findings

Less than half (n=15; 44.1%) of the studies evaluated any data privacy or security features. A total of two studies (5.9%) evaluated apps’ third-party data sharing practices.18 19 In both cases, studies automated the process of app execution using simulated data inputs and determined the number and domain destination of data transmissions. Results showed that 67%19 and 73%18 of apps transmitted children’s personal data to third parties including those providing advertising-related services. Transmitted data included email addresses, information enabling user geolocation and advertising IDs that can be used to create behaviour profiles for advertising. Third-party transmission counts were not associated with child sex, parent age or marital status, or family income-to-needs ratio. However, transmissions were twofold to threefold higher in the case of children whose parents did not have advanced degrees.19 Table 2 shows other app privacy-related and security-related evaluation data from studies. Eight studies (23.5%) reported on apps’ capacity to share information via social media. These studies did not explicitly evaluate whether the nature of such sharing was active (ie, user-initiated data sharing for purposes including seeking peer support) or passive (ie, data transmission to social media networks unbeknownst to the app user). The potential to share data to social media platforms occurred in 14%–63% of apps (median 28%).
Table 2

App privacy-related and security-related evaluation methods and results

Privacy policySocial mediaPermissions requestedData security
MethodsResultsMethodsResultsMethodsResultsMethodsResults
Bry et al 43 Evaluated app store page and/or downloaded app manually Privacy policy presence: Less than 5% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: Less than 5% of apps
Cheng et al 24 Evaluated app store page and/or downloaded app manually Investigator-developed security assessment scale: 6% of apps rated as excellent; 10% of apps rated as good
Das et al 20 Statistics calculated with web-based readability calculator Privacy policy readability: average reading grade level (12.8) higher than average US adult level (8.0)
Liu et al 22 Comparison of app library package names with libraries relevant to social networks Potential for social medial sharing: 20% of appsExamination of privacy grade as listed in online crowdsourced dataset Potential for permission requests: 82% of apps use few permissions for unusual purposes; 10% may use permissions in this way
Meyer et al 23 Evaluated app store page and/or downloaded app manually Social media links: 14% of appsEvaluated app store page and/or downloaded app manually Permission requests: 100% of apps Requests for notifications (100%), files/photo storage (53%), phone (13%), microphone (8%), camera (7%); and location (4%).
Musgrave et al 50 Evaluated app store page and/or downloaded app manually Login and/or password presence: 90% of apps required logins; 70% required passwords
Reyes et al 18 Automated analysis of whether data transmissions are protected Data encryption: 40% of apps do not use TLS*
Robinson et al 53 Evaluated app store page and/or downloaded app manually Social media links: 63% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 0% of apps
Sardi et al 21 Evaluated app store page and/or downloaded app manually Privacy policy presence: 63% of apps Privacy policy content: 27% of privacy policies complied with international and federal laws including COPPA†, GDPR‡ and HIPAA§.Evaluated app store page and/or downloaded app manually Social media links: 31% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 29% of apps Cloud storage backup option: 8% of apps
Schoeppe et al 54 Evaluated app store page and/or downloaded app manually Social media links: 60% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 20% of apps
Schoffman et al 55 Evaluated app store page and/or downloaded app manually Social media links: 16% of apps
Virani et al 58 Evaluated app store page and/or downloaded app manually Privacy policy presence: 100% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 33%–100% of apps
Weber et al 59 Evaluated app store page and/or downloaded app manually Social media links: Less than or equal to 35% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 70% of apps
Zarnowiecki et al 63 Evaluated app store page and/or downloaded app manually Social media links: 25% of appsEvaluated app store page and/or downloaded app manually Login and/or password presence: 0% of apps

*Transport Layer Security.

†Children’s Online Privacy Protection Act.

‡General Data Protection Regulation.

§Health Insurance Portability and Accountability Act.

App privacy-related and security-related evaluation methods and results *Transport Layer Security. †Children’s Online Privacy Protection Act. ‡General Data Protection Regulation. §Health Insurance Portability and Accountability Act. Additionally, three studies (8.8%) documented the presence of privacy policies and single studies (2.9%) evaluated each of privacy policy content and readability. These studies showed 5%–100% of apps (median 63%) had an associated privacy policy. Policy readability was poor20 and often failed to comply with international or federal regulations.21 Two studies (5.9%) documented actual or potential permission requests,22 23 showing that permission requests occurred in up to 100% of apps and may violate jurisdictional privacy regulations such as location data tracking. App data security features were evaluated in 29.4% (n=10) of studies and included presence of login or password protection element (n=7; 20.6%), login/password and cloud storage option (n=1; 2.9%), or data encryption (n=1; 2.9%), and the application of an investigator-developed security assessment scale (n=1; 2.9%). Security-related results showed: login or password protection presence in 0%–100% of apps (median: 31%), high proportions of apps not protecting data transmissions using standard methods,18 and few apps with high security assessment scale ratings.24

App commercial feature-related findings

Commercial features were assessed in 17 studies (50.0%) (table 3) and included the proportion of apps with in-app purchase options (n=15; 44.1%), the proportion of apps with in-app advertisements (n=10; 29.4%) and the type of advertisements (n=3; 8.8%). In-app purchases and advertisements were present in 0%–46% (median 25%) and 9%–95% (median 51%) of apps, respectively. To evaluate advertisement content, all studies used manual content analysis using a predefined and investigator-developed advertising coding scheme.23 25 26 Content analysis conducted by Meyer et al 23 showed advertisements were presented using traditional methods (eg, product videos as shown on television) but also in insidious ways that might prompt further advertising consumption (eg, embedding advertising videos within gamified app features). In the two studies that assessed the relationships of advertisements to health outcomes, advertisements promoted formula-feeding for premature babies, toddlers or older children,25 26 which may be in contravention of the WHO Code on the Marketing of Breast Milk Substitutes27 due to potentially harmful impacts on health.
Table 3

App commercial feature evaluation results

StudyResults of commercial feature assessment
Total number of apps sampled% of sampled apps with in-app purchases% of sample apps with advertisementsAdvertisement-related analyses
Biviji et al 40 2918%51%
Brown et al 42 5143%
Chen et al 44 220%9%
Cheng et al 24 4726%
Davis et al 45 4613%
Furlong et al 46 13233%
Liu et al 22 67 77822%Potential for advertisements in 53%
Meyer et al 23 13546%95%Apps included commercial characters (42%), full-app teasers (46%), advertisements that interrupted gameplay (35%), distracting banners (17%) or camouflaged advertisements (7%). Advertisements more prevalent in free apps.
Richardson et al 52 186%17%
Sardi et al 21 4832%
Schoeppe et al 54 2524%
Virani et al 58 1619%50%
Wisniewski et al 61 7524%
Womack et al 62 4863%
Zarnowiecki et al 63 450%25%
Zhao et al 25 2646%85%Most apps (77%) promoted infant formula
Zhao et al 26 45195%Advertisements coded as being related to formula for premature infants, term infants, toddlers and older children including in circumstances where potentially harmful or unnecessary to health
App commercial feature evaluation results

Discussion

Evaluations of the content and quality of commercially available apps that may transmit child data have proliferated steadily over time. Rigorous, independent evaluations of the data sharing practices and commercial features of these apps remain rare. However, there is rapid methodological development in the field and strategies to evaluate these practices are being increasingly developed and used by interdisciplinary research groups.10 18 19

Study and app characteristics

Reviews of apps that collect, and potentially share, children’s data are conducted most often by investigators in high-income, predominantly English-speaking countries, and commonly include only apps available in English. Most studies focused on understanding the content of apps designed for specific health or education purposes and few examined game-based and other types of apps children commonly engage with. Surrogate measures are largely used to evaluate the privacy and security features of apps as only a handful of studies have examined app data sharing and security practices directly. Still, our data show that, when data privacy and security evaluations are conducted, issues with frequent data sharing or lax security measures are uncovered.

Data sharing practices

Most researchers included only proxy measures for actual data sharing practices, such as permission requests or the presence of a privacy policy. In the few studies that measured actual data sharing, identifying children’s data were provided to third parties.19 This is problematic as aggregation of these data can support the characterisation of parent and child users according to their app interaction patterns or demographics, and these characterisations may be commercially exploited to encourage impulse purchasing or suggest unhealthy products in ways that exacerbate health inequities.19 28

Data sharing policies

Privacy policies in child and parenting apps are variable in terms of both presence and readability. Thus, the data tracking and commercialisation practices of apps, and their associated risks, are generally unknown to children and adults alike29–31—challenging the value of the dominant ‘notice and consent’ privacy framework of the information age. Digital literacy skills-building may mitigate some risks to users and, in the case of children, such programmes have been developed.29 However, lower socioeconomic status, as well as age and gender, may be associated with lower digital literacy,31 suggesting that equitable access to literacy training remains elusive. In addition, even when privacy policies are present, they oftentimes do not reflect actual app data sharing behaviours.32 33

In-app purchasing and advertisements

Half of our included studies evaluated apps’ commercial features with results showing several areas of potential concern. In-app purchase options and advertisements are common, manipulative methods are used to deliver advertisements, and advertising information is potentially harmful to health.26 34 These issues pose a problem as research shows both parents and children may not always be able to distinguish app content from advertising.23 35 The content of advertisements within children’s apps is also often not age-appropriate with advertisement content often exceeding developer-stated app maturity levels.36 Finally, furthering digital disparities, free apps—which parents and children of lower socioeconomic status may more frequently engage with—more frequently contain these in-app purchase options and advertisements.23

Implications

Our results have important implications for regulatory bodies, app developers and parents. Although regulations such as the GDPR and COPPA have been enacted to protect children’s online privacy, our results point to the limits of these efforts. For instance, COPPA is reported as underenforced in the USA11 and, as such, non-compliance with the regulation appears widespread.18 19 These privacy regulations also rely on the idea that an informed consumer can select apps with adequate privacy protections in place.37 However, we show that privacy policies are not always present in children’s apps and, when present, vary greatly in terms of readability. As such, the onus of responsibility for personal data protection is placed on those who may not be adequately equipped for privacy decision making by default (ie, the child or parent). Combined with more stringent regulatory enforcement—app developers, who may not be consistently aware of the destinations of data transmitted from their apps,18 can reduce personal identifier collection in the spirit of data minimisation19 and systematically evaluate app privacy behaviours before release.18 Ahead of these needed regulatory and industry shifts, parents and older children may install apps from trusted developers,19 disable advertisement identifiers, adjust app permissions and use advertisement blockers to reduce the likelihood of privacy breaches.38

Limitations

First, although sensitive, the nature of our research question resulted in a search strategy that was imprecise and identified many irrelevant studies. We used duplicate screening and team discussions to resolve discrepancies and systematically exclude such studies. Second, even though we developed a broad search strategy, the cross-disciplinary nature of our research question may mean that we may not have located all studies accessible in disparate, discipline-focused databases. Third, although not the goal of a scoping review, we did not conduct a methodological quality assessment and instead included all identified studies.

Conclusion

Research related to the data handling behaviours and commercial aspects of apps that may transmit children’s data is emerging but has not kept pace with the rapid expansion and evolution of the mobile ecosystem. The lack of evaluations may be related to the technical difficulty in doing so—an issue that may be solved by collaborative research efforts spanning the disciples of computer science, child health and commercial regulatory policy. These collaborations may be fruitful in rooting out and acting on risks to children’s privacy and well-being within mobile ecosystems.19 Studies are needed to understand the intersection between transmitted data and advertisements within apps and how this commercial exposure effects children’s health and well-being. Ultimately, enforced and stricter regulation may be key to protecting children’s online privacy and dampening any impacts of data sharing.
  40 in total

1.  Digital junk: food and beverage marketing on Facebook.

Authors:  Becky Freeman; Bridget Kelly; Louise Baur; Kathy Chapman; Simon Chapman; Tim Gill; Lesley King
Journal:  Am J Public Health       Date:  2014-10-16       Impact factor: 9.308

2.  VIRTUAL AVATARS, GAMING, AND SOCIAL MEDIA: DESIGNING A MOBILE HEALTH APP TO HELP CHILDREN CHOOSE HEALTHIER FOOD OPTIONS.

Authors:  Yulin Hswen; Vaidhy Murti; Adenugbe A Vormawor; Robbie Bhattacharjee; John A Naslund
Journal:  J Mob Technol Med       Date:  2013

3.  Scoping studies: advancing the methodology.

Authors:  Danielle Levac; Heather Colquhoun; Kelly K O'Brien
Journal:  Implement Sci       Date:  2010-09-20       Impact factor: 7.327

4.  PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.

Authors:  Andrea C Tricco; Erin Lillie; Wasifa Zarin; Kelly K O'Brien; Heather Colquhoun; Danielle Levac; David Moher; Micah D J Peters; Tanya Horsley; Laura Weeks; Susanne Hempel; Elie A Akl; Christine Chang; Jessie McGowan; Lesley Stewart; Lisa Hartling; Adrian Aldcroft; Michael G Wilson; Chantelle Garritty; Simon Lewin; Christina M Godfrey; Marilyn T Macdonald; Etienne V Langlois; Karla Soares-Weiser; Jo Moriarty; Tammy Clifford; Özge Tunçalp; Sharon E Straus
Journal:  Ann Intern Med       Date:  2018-09-04       Impact factor: 25.391

5.  Infant Feeding Websites and Apps: A Systematic Assessment of Quality and Content.

Authors:  Sarah Taki; Karen J Campbell; Catherine G Russell; Rosalind Elliott; Rachel Laws; Elizabeth Denney-Wilson
Journal:  Interact J Med Res       Date:  2015-09-29

6.  A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP).

Authors:  Elizabeth Chen; Emily Rose Mangone
Journal:  JMIR Mhealth Uhealth       Date:  2016-11-10       Impact factor: 4.773

7.  Privacy Policies for Apps Targeted Toward Youth: Descriptive Analysis of Readability.

Authors:  Gitanjali Das; Cynthia Cheung; Camille Nebeker; Matthew Bietz; Cinnamon Bloss
Journal:  JMIR Mhealth Uhealth       Date:  2018-01-04       Impact factor: 4.773

Review 8.  Top Mobile Applications in Pediatrics and Children's Health: Assessment and Intelligent Analysis Tools for a Systematic Investigation.

Authors:  Seyed Mohamad Hosein Mousavi Jazayeri; Amir Jamshidnezhad
Journal:  Malays J Med Sci       Date:  2019-02-28

Review 9.  Smartphone applications available to pregnant women in the United Kingdom: An assessment of nutritional information.

Authors:  Catherine Bland; Kathryn V Dalrymple; Sara L White; Amanda Moore; Lucilla Poston; Angela C Flynn
Journal:  Matern Child Nutr       Date:  2019-12-12       Impact factor: 3.660

10.  Mobile Phone Apps in Australia for Improving Pregnancy Outcomes: Systematic Search on App Stores.

Authors:  Loretta M Musgrave; Nathalie V Kizirian; Caroline S E Homer; Adrienne Gordon
Journal:  JMIR Mhealth Uhealth       Date:  2020-11-16       Impact factor: 4.773

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