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Adolescents are substantial users of short message service (SMS) and social media. The public health community now has more opportunities to reach this population with positive youth development and health messages through these media. Latinos are a growing and youthful population with significant health risks and needs. This population may benefit from SMS and social media health interventions.
To examine (1) SMS and social media utilization and behavior among Latino youth, and (2) how SMS and social media can be effectively used as a component of public health interventions focused on decreasing sexual risk taking among Latino youth.
A mixed-methods approach, using both quantitative survey data and qualitative interview data, was used to provide a robust understanding of SMS and social media use and behavior for public health interventions. We recruited 428 ninth and tenth grade, self-identifying Latino adolescents to participate in a quantitative survey. Additionally, we conducted five key informant interviews with staff and 15 youth.
We found that 90.8% (355/391) of respondents had access to a mobile phone either through having their own or through borrowing or sharing one. Of those who had access to a mobile phone, 94.1% (334/355) used SMS, with 41.1% (113/275) sending and receiving more than 100 text messages per day. Of 395 respondents, 384 (97.2%) had
SMS and social media are pervasive among Latino youth. Program staff and youth perceive these as credible and essential methods of communication in the context of public health programs. Public health interventions must continue to innovate and maximize new ways to reach young people to reinforce public health messages and education.
The rapid expansion of access to and reach of mobile technology among adolescents gives the public health community new opportunities for delivering critical and timely interventions to young people that can promote positive behavior change. It is projected that by 2025, one-quarter of the adolescent US population will be Latino [
Using SMS, also known as text messaging, for health promotion is particularly appealing for reaching individuals not regularly in contact with health services, and for behaviors that may be socially sensitive, such as sexual health and teen pregnancy, as they offer a confidential means of communication [
In addition to using SMS, over 150 health promotion activities for sexual health use social media websites that target young people [
Social media, including SMS, to supplement a program, or as a stand-alone program, have been useful in improving health outcomes, increasing adherence to medication schedules and appointments, and improving patient–provider communication, health information communication, data collection, and access to health records [
Although a handful of studies have focused on SMS and social media use among Latino youth, relatively few have focused on how this behavior may be integrated into public health interventions. This study used data from a larger ongoing research and demonstration project, Empowering Latino Youth Program (ELYP). The objective of this analysis was to examine (1) SMS and social media utilization and behavior among Latino youth, and (2) how SMS and social media can be effectively used as a component of public health interventions focused on decreasing sexual risk taking among Latino youth. This study was reviewed and approved by the George Washington University Internal Review Board (IRB# 011217).
We used a mixed-methods approach, using both quantitative survey data and qualitative interview data, to provide a robust understanding of SMS and social media use and behavior for public health interventions.
We recruited ninth and tenth grade, self-identifying Latino adolescents from 12 public high schools in Maryland, USA to participate in the ELYP. ELYP is an after-school intervention aimed at reducing sexual risk taking among Latino youth and includes both an intervention and a control arm. This is a demonstration project incorporating both quantitative and qualitative measures at baseline and three points of follow-up. The present study used baseline data from 428 youth participating in the first year of ELYP. Active parental consent was obtained prior to data collection, and youth assent was read and reviewed with youth prior to survey administration. To ensure privacy and reduce reporting bias, we administered surveys via individual laptop computers with audio-capability to youth with low literacy levels so that they could listen to each question and have it read to them if desired. Study participants had the choice to complete the survey in English or Spanish and were given US $10 gift cards for their efforts in completing the survey. On survey completion, the data were stored in an encrypted file to be read only by the survey design software (Snap Surveys Ltd, Portsmouth, NH, USA).
We adapted most of the questions used in this study from the National Longitudinal Study of Adolescent Health [
The survey asked a series of questions to assess SMS and social media behavior. Youth self-reported access, utilization, reasons for use, and frequency of using a mobile phone, texting, the Internet, and social media sites. The following response categories were used to assess frequency of overall
We used SPSS version 20 (IBM Corporation, Somers, NY, USA) for all statistical analyses. Variables were recoded and collapsed to increase the saliency of the data. Patterns of missing data were analyzed and, although data were missing for key variables, it was for less than 10% of respondents. Therefore, the data presented include all participants (n = 428), and we used pairwise deletion for the bivariate analysis to retain as many respondents as possible in the analysis. Quantitative results were analyzed to provide summary descriptive statistics and cross-tabulations. We calculated chi-square and
The aim of the key informant interviews and youth triads was to assess staff and youth perceptions regarding feasibility of an SMS and Facebook component in the ELYP after-school program. The qualitative component consisted of (1) key informant interviews with staff delivering the
We conducted key informant interviews using a semistructured field guide. The field guide contained 7 predetermined questions with probes. Each interview took approximately 45 minutes to complete (
All interviews and triads were audio-recorded and transcribed verbatim, and 2 people from the research team read the staff interview and youth triad transcripts. The team convened before and after analyzing the transcripts to agree on a series of thematic codes to describe various categories and subcategories addressed throughout the interviews and triads. The codes were then entered and applied to the transcripts using NVivo software (version 9, QSR International Pty Ltd, Southport, UK).
The study sample consisted of 428 self-identifying Latino adolescents with a mean age of 15.7 years (
As
A total of 98.0% (385/393) of participants had access to the Internet (
Characteristics of study participants (n = 428) and their parents.
Characteristic | Participant | Father | Mother | |
Age (years), mean | 15.7 | |||
|
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Male | 178 (41.6%) | |||
Female | 244 (57.0%) | |||
No response | 6 (1%) | |||
|
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9th | 247 (57.7%) | |||
10th | 174 (57.7%) | |||
No response | 7 (2%) | |||
|
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English | 262 (61.2%) | |||
Spanish | 166 (38.8%) | |||
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Both parents | 176 (41.1%) | |||
Mother | 160 (37.4%) | |||
Other | 34 (37.3%) | |||
No response | 59 (14%) | |||
|
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Yes | 150 (35.1%) | |||
No | 238 (55.6%) | |||
No response | 40 (9%) | |||
|
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0–3 | 112 (47.1%) | |||
4–10 | 68 (29%) | |||
10+ | 27 (11%) | |||
No response | 31 (13%) | |||
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Did not have any schooling | 41 (10%) | 48 (11%) | ||
Did not finish high school | 73 (17%) | 99 (23%) | ||
Graduated from high school | 53 (12%) | 59 (14%) | ||
Attended vocational/technical school | 6 (1%) | 15 (4%) | ||
Some college | 17 (4%) | 26 (6%) | ||
Graduated from college | 35 (8%) | 37 (9%) | ||
Not sure/don’t know/no response | 203 (47.4%) | 145 (33.9%) |
Utilization of mobile phone, Internet, and social media.
Media usage | n | % | |
|
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Own a mobile phone | 291 | 74.2% | |
Have access to a mobile phone | 64 | 16% | |
Do not have access to a mobile phone | 37 | 9% | |
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Take pictures | 316 | 90.6% | |
Access the Internet | 294 | 84.8% | |
Send or receive instant messages | 280 | 80.9% | |
Play games | 276 | 80.7% | |
Send or receive email | 23 | 68% | |
SMSa use | 334 | 94.4% | |
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Low (1–20) | 84 | 30% | |
Medium (21–100) | 79 | 29% | |
High (>101) | 113 | 40.9% | |
Internet access | 385 | 98.0% | |
|
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Daily | 208 | 72.7% | |
Less than daily | 105 | 27.3% | |
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School work | 330 | 85.7% | |
299 | 81.7% | ||
Get health information | 115 | 41.6% | |
Social networking account | 384 | 97.2% | |
Mean number of social networking sites used | 3.0 (range 0–8) (394) | ||
|
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342 | 89.1% | ||
YouTube | 205 | 53.4% | |
196 | 51.0% | ||
|
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Daily | 291 | 75.8% | |
Less often | 93 | 24% | |
|
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Post photos/videos | 329 | 87.7% | |
Post comments | 329 | 86.4% | |
Use instant messaging | 318 | 86.0% | |
Update status | 320 | 85.6% | |
Send private messages | 273 | 73.0% | |
Play games | 166 | 46.6% |
a Short message service.
Social media behaviors by gender, nativity, and survey language.
Behavior | Gender | Nativity | Survey language | ||||
Female |
Male |
US-born |
Foreign-born |
English |
Spanish |
||
Access to cell phone, n (%) | 206 (90.8%) | 143 (90.5%) | 125 (91.2%) | 195 (89.9%) | 224 (93.3%) | 126 (86.3%)* | |
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Low (1–20) | 45 (29%) | 38 (33%) | 27 (27%) | 52 (35.9%) | 42 (24%) | 41 (43%)*** | |
Medium (1–100) | 40 (26%) | 36 (32%) | 32 (31%) | 38 (26%) | 47 (27%) | 30 (32%)*** | |
High (101+) | 71 (46%) | 40 (35%) | 43 (42%) | 55 (38%) | 87 (49%) | 24 (25%)*** | |
Daily Internet use, n (%) | 170 (76.2%) | 105 (67.3%)* | 107 (77.5%) | 145 (68.7%) | 183 (76.6%) | 93 (66%)* | |
Social networking account, n (%) | 224 (98.3%) | 154 (95.7%) | 137 (98.6%) | 211 (96.4%) | 239 (98.8%) | 140 (94.6%)** | |
Facebook account, n (%) | 196 (86.0%) | 141 (87.6%) | 125 (89.9%) | 184 (84.0%) | 220 (90.9%) | 118 (79.7%)** | |
Mean number of social networking accounts | 3.11 | 2.61** | 3.41 | 2.54*** | 3.41 | 2.07*** | |
Daily logging in to social networking account, n (%) | 174 (77.7%) | 113 (73.4%) | 104 (75.9%) | 154 (73.0%) | 186 (77.8%) | 102 (72.9%) |
a Short message service.
*P < .05, **P < .01, ***P < .001.
Staff and youth interviews yielded several themes regarding perceptions of an SMS and Facebook component to the ELYP program, including both positive and negative aspects of their use with Latino youth. The themes pulled from the qualitative data are divided into SMS- and Facebook-related themes separately.
Staff and youth perceived SMS to have an overall positive impact because it would be an ideal way for staff and youth to become closer and to be more connected. One staff member stated that
some youth don’t really have adults, like positive role models, so especially a lot of them would express that they don’t do anything during the weekend, so I think it would be a nice comforting thing for them [to get a text message]. And then the reminder [message] would also obviously be a reminder and be helpful for them in that aspect, but I think overall, it’s that you are thinking about them.
When youth were asked what they had texted to staff in the past, their messages mainly concerned session times, checking whether a session had been cancelled, whether food was going to be available at a session, or other questions pertaining to group projects. While youth did not think it was necessary to have content-based reminder messages, staff thought motivational messages would be helpful reinforcements for youth.
Staff expressed the two primary concerns for including an SMS component: (1) whether all youth participating in a program would have access to a mobile phone, and (2) that it could create the expectation that staff are available all hours of a day and every day. The first concern that not all youth have a mobile phone was noted by
Overall, staff thought that youth would want to receive between 2 and 4 text messages a week from staff pertaining either to logistics of the program, or to the curriculum and motivational messages. Youth said that, while they thought the logistics reminder messages would be helpful, receiving curriculum messages would be “a little” annoying and “would be helpful, but it isn’t necessary.” Additionally, both staff and youth thought that after school and during the evenings were the best times to send or receive text messages.
When consulted about 1-way versus 2-way text messaging, the overwhelming majority of youth declared that they preferred 2-way text messaging. Some youth stated that they would want to be able to ask a question back if they received a text from the program, or to simply ask a question of the program in general. One youth stated
it would be kind of hard because you have to tell them, like “oh, I can’t make it” or “do I need to take something?” Then you don’t see them until like the next session and then you ask them this and that, so it’s easier if you can be like, “oh I got your text, its ok, whatever.”
There are four major concepts related to positive aspects of Facebook. First, according to
The major concern among staff about a health program-specific Facebook page was the possibility that it would enable cyberbullying of youth who joined the page, and that youth would post inappropriate pictures, videos, or comments to the Facebook page if it was not highly regulated and controlled by the overseeing organization. In addition, staff noted that not every student would be happy with the program all the time, “so if they get really frustrated or if they get kicked out of the program because of attendance, they could express some of that” on the Facebook page; in short, it is “a platform for [youth] to lash out.” Additionally, while youth had responded that they would initially join a program-specific Facebook page, they stated that if they were unable to post comments or pictures, or have a personal interaction with the Facebook page, then they would not check it as often.
Harnessing new technology to reach youth with positive and healthy messages could be extremely powerful, and therefore it is critical to fully understand how adolescents from different communities and cultures use technology. This study found results comparable with those of the Pew Hispanic Center teen survey on mobile and social media use [
The Pew report also found that 23% of young Latinos used social media sites such as Facebook or MySpace daily to communicate with their friends, and native-born Latinos were more likely to use social media sites. Similarly, this study found that 97% had a social media account and 89% had a Facebook account. Further, 91% of youth who took the survey in English versus 80% who took it in Spanish had a Facebook account, and 90% of US-born youth versus 84% of foreign-born youth had a Facebook account.
Overall, the qualitative findings were very positive with respect to use of SMS and social media for public health interventions. Although several negative aspects were mentioned, most could be addressed through appropriate system design and use by program staff.
The study also found that Facebook is slightly more feasible than SMS as a method of communicating health messages due to issues surrounding lack of access to mobile phones and the youth participants’ overwhelming access to and usage of Facebook. Due to the majority of youth being non-US-born, even though they completed the survey in English, each component should be available in English and Spanish, and students should be able to opt in to either language.
The differences found in survey language indicate that Spanish-language respondents had significantly less access and less frequent use of social media. Furthermore, those who took the survey in Spanish were more likely to be recent immigrants, within the last 3 years. To address these significant and disadvantageous differences, programs must ensure that any social media component is available in both languages so as not to isolate the Spanish-speaking youth from this aspect of the intervention.
Since mobile phone access may be a financial issue, programs may need to expand efforts using free social media sites such as Facebook, although this does require access to a computer. Our findings indicate that use of Facebook is extremely common and may be particularly useful with youth who do not have access to SMS. If youth are simply unaware of these social media because of recent immigration, they can be encouraged to sign up for an account, or alternative strategies will need to be developed to reach these adolescents with the same information.
Although students expressed the desire to have 2-way messages, it may be more feasible for public health programs to have 1-way messages in an effort to not overwhelm staff. Youth need to be educated about the use of SMS and social media within the context of a program to increase their understanding that the program is sending them information and is not a 24-hour service, nor a means to contact the organization if there is a crisis. Rather, youth should be given phone numbers for local organizations that are equipped to handle crises such as 911, a local teen suicide hotline, and other local organizations as necessary to avoid liability issues.
This study focused on a new and growing youth population in the United States with significant public health needs. However, there are a few limitations of the current study. This was a cross-sectional sample of youth and therefore it is not possible to examine causal relationships between nativity or language use and SMS or social media behavior. Additionally, although nativity and language are frequently used as proxy measures for acculturation, future studies should use more salient and robust measures that capture the complex and dynamic process of acculturation. Finally, this study comprised a subsample of youth participating in a research and demonstration project (ELYP) and may not be fully representative of a national sample of Latino youth. However, this sample consisted of Latino youth from Central America, primarily El Salvador and Peru, which is representative of the growing Latino population in Maryland. Further, future studies ought to examine cultural and geographic differences around SMS and social media use, as there are certainly distinct characteristics and traditions between Latino subgroups.
SMS and social media are pervasive among Latino youth, and program staff and youth perceive these as credible and essential methods of communication in the context of public health programs. In fact, the frequency of use is so significant that public health interventions must continue to innovate and maximize new ways to reach young people to reinforce public health messages and education. Furthermore, given the differences found in this study by nativity and survey language, future research must delve deeper to understand differences in utilization and behavior by acculturation and other cultural factors such as parenting and family influences. Given the substantial role of parenting and family influences on adolescents living in immigrant families, and these differences by acculturation, future research must explore how these factors may mediate SMS and social media utilization and behavior.
Quantitative survey administered to Latino youth.
Key informant field guide for staff working with Latino youth.
Triad field guide for Latino youth.
Empowering Latino Youth Program
short message service
This study was supported by a grant from the US Department of Health and Human Services, Office of Adolescent Health (grant # TP2AH000015). The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Health and Human Services or the Office of Adolescent Health.
None declared.