Current reports depict an adolescent mental health crisis in the United States. About 1 in 5 adolescents experience poor mental health, especially race and ethnic minoritized adolescents [1-6]. In 2021, the US Surgeon General stated that the COVID-19 pandemic further altered adolescents’ experiences at home, school, and the community, which generated devastating effects on their mental health [7]. In 2021, 42% of adolescents had persistent sadness and hopelessness and 22% of adolescents considered suicide, representing significant increases since 2019 [8]. Latinx (46%) adolescents, representing 25% of all adolescents nationally, report higher rates of sadness than Asian (35%), Black (39%), and White (41%) adolescents, with the pandemic especially worsening mental health for Latinx adolescents [9]. Despite these trends, less than half of Latinx adolescents with mental health problems receive care [5].

Given the concern about adolescent mental health, emerging public attitudes and policies have focused on how social media in particular may influence mental health outcomes and knowledge, norms, and behaviors related to mental health help-seeking and services [10-21]. While past research has focused on legacy media (eg, TV, radio, print), recent research has examined new digital media, especially social media, as a behavioral risk factor for poor mental health [22]. While the mechanisms explaining this association remain unclear, studies have shown how mental health content on social media is highly variable, portraying both positive (ie, supportive) and negative (ie, stigmatizing) content [17-21,23-28]. For instance, while #MentalHealth is one of the 3 most popular social media tags about health to increase public awareness, pejorative content such as stigma and hate speech is prevalent too [16-21,29,30]. Therefore, legacy and new digital media can deliver mixed mental health content that can potentially influence mental health knowledge, attitudes, behaviors, and outcomes. Thus, further study about adolescents’ exposure to mental health information across diverse languages, cultures, and technological media is warranted, and an assessment of how this exposure might influence mental health behaviors. This knowledge is especially relevant for adolescents as about half of social media users are 10-29 years old—the same age of onset of most mental health problems [23].

Research on legacy media has shown direct links with positive and negative mental health behaviors, while new studies on social media use and mental health among adolescents have only identified small or null associations, partly due to the predominant use of limited assessments of time spent on social media as a simple construct [11,12,19,22,31-33]. This is a substantial limitation of previous studies as social media is not experienced unidimensionally. Rather, diverse linguistic, cultural, and technological social media exists—that is, media across global languages (Spanish, Mandarin, etc); global cultures (eg, Latinx-tailored, Korean pop culture, influencer cult followings, and social movements such as #BlackLivesMatter); and technologies for delivery of communications (social media apps such as YouTube, Facebook, Instagram, Snapchat, TikTok, Sidechat, Pinterest, Reddit; mobile apps; console-, computer-, or VR-based gaming; music, podcasts, film, and TV streaming services such as Netflix, Hulu, Spotify, Pandora, etc) [22]. Thus, previous studies have not considered more robust measurements or algorithm-driven content that is characteristic of social media.

Careful consideration of measurement is important as adolescent populations are diverse, as is their access to language and cultural media across technology. For instance, Latinx populations in the United States use social media more than other races and ethnic groups, including the top 3 popular apps among all adolescents (ie, Instagram, Snapchat, TikTok) [23]. In addition, Latinx adolescents have access to media, including social media, in Spanish and from Latin America due to close global social networks from dynamic migration experiences. At the same time, Latinx communities are impacted by poor-quality, slow dissemination of health communication as industry-led and government-controlled content moderation has historically overlooked Spanish-language and Latinx communications, particularly social media [13-15,34-41].

Because research on media and social media and health has largely focused on English-language media and excluded Latinx representation relative to their share of the demographic of media consumers, new research is warranted that focuses on diverse language, cultural, and technological media among Latinx adolescents and its relationship to health [11,42-45]. To address this gap, the study aimed to generate new knowledge about the frequency of mental and physical health information scanning and seeking across diverse language, cultural, and technological media and test whether these patterns vary by mental health profiles among Latinx adolescents. Because Latinx adolescents’ social media use has been inadequately studied, we importantly use newly validated, culturally appropriate measures to capture diverse language, cultural, and technological media for health information among Latinx adolescents. Our measurement extends previous, traditional measures of media exposure among Latinx populations that focused on language competency and legacy media to now newly capture widely available Latinx-tailored digital media. We also compare these media-based outlets to help-seeking for health problems to family and friends and health care providers.

While data trends depict a national adolescent mental health crisis with simultaneous increases in social media use, our study aimed to provide a more nuanced understanding of these trends across diverse language, cultural, and technological media among Latinx youth. Our study distinguished between mental and physical health, examined diverse language and cultural media domains, distinguished passive and active media exposure (eg, scan vs seek), and accomplished these assessments for both legacy and new digital media.

In terms of passive, casual browsing, overall, our study found that Latinx adolescents with mental health issues were more likely to engage in mental health scanning in English-language legacy and social media, but not in Spanish-language or Latinx-tailored legacy and social media, or for physical health. These patterns may arise because of more prevalent mental health content available in English-language than in Spanish-language media and social media, as previous studies confirm [48]. This is an important finding because as Latinx adolescents with mental health concerns engage with media and social media, they may become more exposed to mental health content, underscoring the need for public mental health action that leverages media to provide quality resources about symptom management and help-seeking. In contrast, passive exposure to mental or physical health content in Spanish-language and Latinx-tailored media did not vary by mental health symptoms possibly because health information is less often available in Spanish and Latinx-media, and not because of a lack of preference or interest in these media among Latinx media consumers [49]. For Latinx families with Spanish and Latinx media preferences, disparate diffusion of health communications actually may help produce health inequities [48].

With respect to the active, purposeful search for health information, our study found significant use of Latinx-tailored and English-language media for mental health information seeking and Latinx-tailored media for physical health information seeking among Latinx adolescents with moderate-severe symptoms. Latinx adolescents with mental health concerns may seek mental health information that is tailored to them and presented in their preferred language and a culturally aligned context. Public health interventionists may take note of this preference, and the availability of tailored, targeted mental and physical health information in media for Latinx adolescent audiences. Finally, family, friends, internet, and social media were more often used for both mental and physical health information than health care professionals, especially among Latinx adolescents with moderate-severe symptoms, indicating a greater preference for more easily accessible informal supports for health problems within the Latinx community. Future studies could examine the role of mistrust of health care experts and providers as sources of health information among Latinx communities to better understand these patterns.

Our study points to Spanish-language and Latinx-tailored media as important sources of health information, with English-language media as the most common source owing to more health information being available there. For example, recent studies of primetime advertising on YouTube TV revealed that English-language TV was more likely to include health promotion advertisements while Spanish-language TV was more likely to include health-adverse advertisements [50]. Inequities in health-related advertising on social media are likely similar though this remains a knowledge gap in the literature. Importantly, our study found that Latinx media is an important source of mental health information for those experiencing mental illness; thus, Latinx media may serve as an important resource for learning about and seeking support for mental health conditions. To this point, media content with greater immigrant community representation and storytelling with respect to mental and physical health issues would be important to foster in future media programming and content curation [38,51].

Findings from this growing body of literature must be implemented into public health policy and practice as Spanish is a global power language and the most common non-English language spoken in the United States. The United States also has the second-largest population of Spanish speakers worldwide behind Mexico. Finally, Latinx populations tend to use social media more than all other major social groups in the United States despite structural inequities in content moderation of Latinx media [23].

This study has some limitations. First, as Latinx populations are dynamic, especially with respect to media and linguistic preferences and behaviors, longitudinal versus cross-sectional assessments could improve causal inference among variables and help assess changes to media content over time such as media campaigns for health promotion. Second, related dimensions of trust and comprehension of health information and perceived health concerns would be important to ascertain. For example, since mental health content is inequitable across language or cultural media, it may influence perceived mental health among English-language media consumers depending on trust and comprehension levels in the content [46]. Third, the study relied on self-reported participant recall of their behaviors. However, recall bias is likely minimal and nondifferential across the subgroups by mental health as the measures asked highly relevant information about oneself that affects daily life. Relatedly, our survey-based research is unable to assess the role of social media algorithms, which influence user consumption. Finally, the study sample was recruited from a proprietary, survey panel; thus, details regarding responses among its volunteers are undisclosed which could potentially lead to bias. To address this concern, we found that the achieved study sample is robust to national data on Latinx populations while also oversampling understudied Latinx groups, as previously reported [46].

In summary, our study demonstrates a more diverse portrait of adolescent media use in the United States, specifically Latinx adolescents who have diasporic, global ties to diverse language, cultural, and technological media. While policies and public attitudes about media and social media tend to generalize these issues, our study suggests potential contexts in which diverse language, cultural, and technological media can be an important, beneficial source of health information for Latinx adolescents. Current scrutiny about the effects of social media use on adolescent health has not sufficiently approached this issue through a health equity lens, which is essential to help inform equitable policies, programs, and practices related to its safe use among adolescents. Diverse adolescent populations will have unique contexts, needs, and assets with respect to the use of diverse language, cultural, and technological media. For Latinx adolescents experiencing mental illness, social media seems to be a useful resource of support, which has implications for other minoritized populations who might find social media as a tool to prevent health risks. Thus, greater access and equity with respect to digital media remain critical to health.