Urban teens’ perspectives on social media and what digital health researchers should know: a rapid, mixed-methods design | #childpredator | #onlinepredator | #sextrafficing

Abstract

Introduction:

Young social media users in the United States (US) have recently experienced real and proposed regulatory and access changes on common platforms. Through a convergent mixed-methods design, teens from a major US city provided their perspectives on social media, recent regulatory shifts, and what they believe digital health researchers should consider when designing, implementing, and evaluating technology-based interventions that reflect their needs and lived experiences.

Methods:

An anonymous survey was deployed to teens (13–18 years) in Chicago, Illinois, in Spring 2025. Descriptive statistics characterized the sample and usage patterns; chi-square tests explored associations between demographic characteristics and recent platform use or reasons for engagement. Logistic regression explored participant perceptions of platform safety. Qualitative data were analyzed using rapid qualitative analysis and were triangulated with quantitative findings to identify convergent and divergent patterns across modalities.

Results:

Teen participants (n = 117; Mage = 15.84 years) most commonly identified as male (47.01%), African American/Black (45.30%), and from “At Risk” communities, based on the Distressed Communities Index. Participants described their use of social media as “almost constantly” or “several times a day.” Reasons for use were most often entertainment (79%) or learning new information or skills (62%); participants identifying as Middle Eastern or North African were more likely than peers to report using social media for community building (χ² = 13.90, P = 0.001). Overall, social media’s personal impact was “neither positive nor negative” (51%) or “mostly positive” (38%). Misinformation was perceived as common, and nearly half of the sample reported believing that platforms do not do enough to keep teens safe online. Self-moderating behaviors were commonly reported (e.g., changing privacy settings). Qualitative feedback emphasized a desire for greater respect, accountability, transparency, and user control in online spaces.

Conclusions:

The current study highlights a nuanced appraisal of social media, with teens describing both perceived potential benefits and risks in their engagement. Findings indicate a need for researchers to collaborate with youth, caregivers, platform developers, and policymakers to prioritize youth-informed solutions that foster transparency, accountability, and trust within digital ecosystems.

1 Introduction

Following the Surgeon General’s declaration of a youth mental health crisis in 2021 (Murthy, 2021), teens in the United States (U.S.) continue to weather an increasing prevalence of mental health symptoms and disorders, as well as continued or new sociopolitical challenges impacting mental health responses and services (Adkins-Jackson et al., 2024). In contrast to rising care needs, behavioral and mental healthcare access has not expanded. Indeed, access to care is blocked or delayed for most teens (Finkelhor et al., 2021). These barriers placed between teens and effective and timely care exist at multiple levels, including: systemic (e.g., provider shortages, restricted resources for specific communities, long waitlists, insurance/cost of care) (Garney et al., 2021), cultural/familial (e.g., stigma, required disclosure of identity/symptoms to caregiver) (Jon-Ubabuco and Dimmitt Champion, 2019; Lu et al., 2021; Mora Ringle et al., 2024), and individual (e.g., recognition of symptoms, confidence to act) (Gulliver et al., 2010; Radez et al., 2021). Consequently, many teens attempt to bridge these gaps by seeking information or care through other means, such as online resources.

Social media continues to be a central component of adolescents’ daily lives, shaping how they seek help, communicate, form identity, and access mental and behavioral health information and care (Moreno and Hoopes, 2020; Anderson, 2023). Approximately 90% of U.S. adolescents aged 13–19 report having at least one social media account, and over half spend more than 4 h per day using these platforms (McAlister et al., 2024). Recognizing the role of social media in young people’s lives, some digital health programs have focused on engaging youth with evidence-based interventions through social media platforms (Psihogios et al., 2022a; Emezue et al., 2025; Psihogios et al., 2024b; Stiles-Shields et al., 2025). While platforms such as TikTok, Instagram, Snapchat, and YouTube have become crucial sites for youth engagement and self-expression, concerns remain for the impact on wellbeing, mainly for urban youth navigating structural stressors and inequities (Odgers and Jensen, 2020a).

As such, teens, who describe their use of technology as “almost constantly” (Faverio, 2024), are the most likely consumers of mental and behavioral content online, including through social media (Bell et al., 2022; Common Common Sense and Hopelab, 2024; Coe et al., 2023). Yet, multiple issues make it difficult for efficacious digital content to reach teens (Psihogios et al., 2022b). While these issues include systemically-driven factors that perpetuate the exclusion of resources for specific communities [e.g., “digital redlining” (McCall et al., 2022)], a primary issue is that most digital tools–including social media, have not been designed with or for young people (Elkes et al., 2024). Indeed, social media algorithms are typically driven by mechanisms believed to increase use and engagement (Metzler and Garcia, 2023). This algorithmic programming neglects implementation planning to better ensure that evidence-based and helpful content reach teens in online spaces, like social media (Psihogios et al., 2024a). Further, regulatory shifts in social media may broadly impact how teens use and view resources on these platforms [e.g., platform bans, content moderation (BTLJ, 2025)]. As such, input is required from those with lived experience–teens themselves. This input can aid in addressing multiple design and implementation failures that have stood in the way of effective digital resources reaching teens in their daily lives through social media (Stiles-Shields et al., 2023).

Increasing recognition of the value and importance of lived experience has driven calls to better involve youth in co-design and other decision points for digital health on social media and other online platforms (Malloy et al., 2023; Stiles-Shields et al., 2023). Grounded in the longstanding methods of community-engaged research (Suarez-Balcazar et al., 2005), a spectrum of youth involvement may be employed. For example, involvement may range from one-time interaction models to long-standing and compensated-for-time partnerships. Rapid polling of a larger group of young people with lived experience may inform initial next steps in the case of emergent issues.

The purpose of this quality improvement study was to assess the perspectives of urban teens on: (1) their use of social media; and (2) social media in the context of sociopolitical influences on the regulation of platforms. Namely, in the late Spring of 2025, teens living in Chicago, IL, USA, were assessed through a brief, anonymous survey that queried their perspectives about social media, changes to regulations of these platforms, and what they wished digital health researchers knew about their needs and perspectives.

2 Methods

2.1 Quality improvement study design

This study employed a QUAN + QUAL convergent mixed-methods design (Palinkas et al., 2011), using cross-sectional quantitative and qualitative data collected concurrently through the University of Illinois Chicago’s (UIC) instance of REDCap (Harris et al., 2009). Namely, we employed a survey that included Likert-scale questionnaire items and open-ended questions prompting for write-in responses to explore teens’ perceptions of current social media platforms. The questions focused on: their personal platform use, engagement preferences, and digital mental health needs–with the goal of informing future digital intervention work. This study was grounded in a pragmatist orientation, recognizing a plurality of perspectives of reality, and that the knowledge generated from this multiplicity of understandings serves as a tool for guiding real-world action (Cornish and Gillespie, 2009). As such, this project was designed to gather timely, anonymous feedback from teens ages 13–18 living in historically and currently underserved neighborhoods in Chicago.

Chicago was selected as the study site given it is one of the most racially and socioeconomically diverse major cities in the United States, offering a rich cross-section of urban adolescent experiences, including youth navigating structural stressors and health inequities (Aschebrook-Kilfoy et al., 2020). In addition, adolescents in Chicago are disproportionately affected by the mental health access gaps this study sought to address, making them a population with both high relevance and high need for youth-informed digital health solutions (Lu et al., 2021; Lurie Children’s Hospital, 2021). Third, the research team had established community relationships and institutional infrastructure in Chicago that enabled rapid, trustworthy recruitment of a hard-to-reach population within a compressed timeline. This localized approach allowed for contextually grounded interpretation of findings while maintaining depth of engagement with a high-priority community.

Participants were recruited through flyers, youth programming partners, and university listservs. Flyers featured a QR code linked to a REDCap-hosted survey, and previous youth research participants who had expressed interest in future contact were also invited to participate. To qualify, participants needed to be: (1) between 13 and 18 years old, (2) residents of Chicago’s West or South Side Communities, and (3) recent social media users within the past 2 weeks. Screening questions at the beginning of the survey verified eligibility.

Participants accessed the study survey via a secure REDCap link, completed a brief digital assent process, and answered multiple-choice and open-text questions. The survey was mobile-friendly, anonymous, and designed to take approximately 7–10 min to complete. Topics included social media platform use frequency, perceived safety and usefulness, and attitudes toward recent platform policy changes. To maintain confidentiality, compensation ($10 digital gift cards) was offered to the first 30 respondents via a separate survey that collected contact information, which was not linked to survey responses. All data were stored securely in REDCap and analyzed in aggregate. The survey remained open for 4 weeks during April 2025 to allow for rolling recruitment and timely analysis. The resulting findings were intended to inform the ongoing development of culturally responsive, tech-enabled mental health interventions for youth and young adults in Chicago.

2.2 Setting and participants

This study was conducted collaboratively by research teams from the RAÍCES-MATTERS Lab (Research on Access and Ínnovación for Community-based Empowerment in Salud mental-Making Accessible Tech for Teens Equitably, Responsively, and Safely; UIC) and the EMERGE Innova+ions Lab (Emerging Technologies for Violence, Mental Health and Early Substance Use Prevention, Rush University), both of which focus on pediatric/adolescent mental health, Digital Mental Health (DMH), and technology-based supports. A total of 117 participants completed the REDCap survey, which included both closed-ended (quantitative) items and open-ended (qualitative) questions to capture their experiences, attitudes, and coping strategies related to their social media engagement. All questions were in English and all respondents replied to the qualitative questions in English, with the exception of one respondent who answered in Spanish. This response was coded by bilingual team members. The UIC Institutional Review Board approved all procedures through a determination as “not human research” (i.e., non-research related Quality Improvement Project (QIP); IRBSTUDY 2025-0209). As this study was part of a QIP for the RAÍCES-MATTERS and EMERGE Innova+ions Labs, it was not pre-registered nor will data be shared.

2.3 Study measures

The survey was created by a multidisciplinary team working with youth advisors based on prior research experiences on adolescent mental health and digital behaviors. The study instrument included multiple-choice and open-ended questions to assess how often teens use social media, their motivations and methods, and their views on recent changes to platform policies and content regulation (See Supplementary materials for all items).

This study explored several key domains related to social media usage. Participants reported their recent use and frequency of engagement across various platforms, including TikTok, Instagram, YouTube, Snapchat, Reddit, and Facebook, using anchors adapted from the Pew Research Center surveys assessing social media use in teens (e.g., defining frequency of use as “almost constantly, several times a day, about once a day, several times a week, less often) (Faverio, 2024; Atske, 2025). Teens also indicated their motivations for platform engagement, such as social connection, activism, entertainment, emotional distraction, and information seeking. Additionally, participants assessed their perceptions of safety and the usefulness of each platform in supporting mental health. Attitudes toward platform regulation and moderation were examined by asking whether recent policy changes, such as content restrictions or bans, influenced their online behavior or mental health information-seeking [e.g., “Are you aware of…?’ (Yes, No); “Has this impacted your use?” (Yes, No)]. Demographic data, including age, gender identity, racial/ethnic identity, and zip code, were collected. Zip codes were used to identify community characteristics, using the Distressed Communities Index (DCI), which uses a 0–100 scale to score communities based on seven socioeconomic indicators (Francis, 2025). Higher scores indicate greater economic distress. Participants were selected from economically distressed neighborhoods, mainly in Chicago’s West or South Side Communities, as youths in these neighborhood areas experience some of the highest levels of subpar health outcomes, counterbalanced by extensive barriers to behavioral health care, making them a priority population for prevention and digital intervention research.

The survey also included five open-ended prompts. First, if participants indicated that they were aware of a recent TikTok ban and that this change impacted their use, they were asked to indicate how it impacted their use. Second, if participants indicated that they were aware of recent changes to hate speech rules at Meta (i.e., Instagram, Threads, Facebook) and that this change had impacted their use, they were asked to indicate how this change had impacted their use. Finally, all participants were asked to reflect on: (1) what they wish social media platforms understood about how teens feel about using them; (2) what researchers should know about how teens use and feel about social media; and (3) what the top three topics they would want researchers in Chicago to focus on for teens and social media.

2.4 Data analysis

We used a convergent merging process for data integration (Palinkas et al., 2011), with quantitative and qualitative data analyzed separately and bringing those results together at the data interpretation stage for triangulation (Palinkas et al., 2011). Descriptive statistics were calculated to summarize participant characteristics and social media use patterns. Frequencies and percentages were computed for categorical variables, and means and standard deviations were reported for continuous variables (e.g., age). Chi-square tests and examination of standardized residuals explored associations between demographic characteristics (e.g., gender, race/ethnicity, neighborhood characteristics) and recent platform use or reasons for engagement. Logistic regression, adjusting for age, gender, race, ethnicity, and DCI was utilized to explore participant perceptions of platform safety. The False Discovery Rate (Benjamini and Hochberg, 1995) was used to control error rate due to the number of significance tests.

In addition, qualitative data were analyzed using rapid qualitative analysis (RQA) (United States Department of Veterans Affairs, 2025). Consistent with RQA methods, the qualitative analysis team (EG, ES, GB, and NQ) conducted the following steps: (1) a summary template was created with domains based on the open-ended qualitative questions; (2) the responses of the same 33 participants were coded by all team members to establish consistency in using the summary template; (3) the coders independently summarized the remaining responses, meeting regularly to resolve questions and minimize drift; and (4) the team independently reviewed all data summaries in the template to generate key points for each domain. Through consensus discussions, the team integrated their summaries for each domain, using a descriptive approach to generate themes (Sandelowski, 2000). Specifically, consistent with RQA and qualitative descriptive approaches, the qualitative analysis team compared the rich, low-inference summaries across participants to identify recurring patterns and similarities, which were refined into themes that captured shared meanings while remaining closely aligned with participants’ language. Data were triangulated with quantitative findings to identify convergent and divergent patterns across modalities.

3 Results

3.1 Participant characteristics

Of the 162 adolescents screened for eligibility, 117 (72.22%) consented to participate and provided survey/interview data and were then included for qualitative analyses. As all survey items were optional, any data that were entered were included in the current study (rather than excluding participant data with missing items). Seventy-three adolescents responded to at least one of the open-ended qualitative questions and were included for qualitative analyses. Participants’ mean age was 15.84 years (SD = 1.5). Demographic characteristics are presented in Table 1. Almost half of the participants identified as cisgender male (47.01%), with the remainder identifying as cisgender female (35.04%), transgender male (4.27%), or selecting a gender option not listed (2.56%) or not providing a response (11.11%). In terms of racial socialization, 45.30% identified as African American or Black, followed by 29.91% White, 8.55% Asian, and smaller proportions identifying as American Indian or Alaska Native (2.56%), Native Hawaiian or Pacific Islander (0.85%), or selecting a race option not listed (6.84%). Regarding ethnicity, 23.93% identified as Latiné or Hispanic and 20.51% as Middle Eastern or North African (MENA), while 36.75% reported that none of the listed categories applied and 4.27% reported that the appropriate option was not listed. The participants’ zip codes indicated an average DCI score of 62.83 (SD = 29.29), placing them in the “At Risk” category (Francis, 2025). Of note, only race, ethnicity, and gender were collected to minimize respondent burden, protect anonymity, and prioritize identity variables most relevant to understanding social media use and representation among urban adolescents.

3.2 Recent frequency of platform use

Table 2 presents participants’ self-reported social media use and frequency in the past 2 weeks. Participants reported routinely using: YouTube (75.21%; n = 88), Instagram (74.36%; n = 87), TikTok (70.09%; n = 82), Snapchat (61.54%; n = 72). Less frequently used platforms included Twitter/X (32.48%; n = 38), Facebook (29.06%; n = 34), Reddit (28.21%; n = 33), and Bluesky (5.98%; n = 7). Unlisted social media platforms included Twitch (n = 2) and Discord (n = 1). Figure 1 presents a heat map of participants’ self-reported social media use and frequency in the past 2 weeks by demographic characteristics. Participants identifying as male were more likely to report recent use of Reddit (χ² = 6.81, P = 0.009), Facebook (χ² = 17.66, P < 0.001), and Twitter/X (χ² = 15.54, P < 0.001). By racial identity, youth identifying as Black or African American were more likely to report using Facebook (χ² = 23.28, P < 0.001), Reddit (χ² = 7.51, P = 0.023) and Twitter/X (χ² = 35.04, P < 0.001), while White youth were less likely to report Snapchat use (χ² = 10.02, P = 0.007) compared to the broader sample. Additionally, participants identifying as Middle Eastern or North African (MENA) were more likely to report using Facebook (χ² = 53.86, P < 0.001), Twitter/X (χ² = 28.47, P < 0.001), and Reddit (χ² = 15.56, P < 0.001), and both those identifying as Hispanic and MENA were more likely to report using Instagram (χ² = 9.79, P = 0.007), compared to the broader sample. No other differences in platform use based on demographic characteristics were significant (Ps > 0.079).

For frequency of use, participants primarily described their use of specific social media platforms as “almost constantly” or “several times a day.” In exploring differences in frequency of use based on demographic characteristics, youth identifying as Black reported higher use of Reddit than the broader sample (Ps > 0.090). Participants identifying as MENA also reported higher frequency of Reddit (χ² = 6.51, P = 0.014) and Twitter/X use (χ² = 9.38, P = 0.009) compared with the broader sample. No other demographic characteristics emerged as significant in frequency of use after correction for multiple comparisons (Ps < 0.039).

3.3 Teen perspectives on their social media use and self-moderation

Teen participants most commonly reported using social media for entertainment (n = 92), followed by learning new information or skills (n = 73) and connecting with known peers (n = 73). Less frequently endorsed reasons included using it for distraction (n = 51), hearing about the news (n = 49), connecting with unknown peers (n = 30), community building (n = 20), and activism (n = 11). Differences in reason for use based on demographic characteristics indicated that participants identifying as MENA were more likely to report using social media for community building (χ² = 13.90, P = 0.001) compared to their non-MENA peers. There was no statistically significant evidence for differences based on demographic characteristics following adjustment for multiple comparisons (Ps > 0.031).

Reflecting on the amount of time they spent on social media, participants reported that they use social media “too much” (57.28%; n = 59), followed by “about right” (38.83%; n = 40), with few indicating “too little” and “not sure” (3.88%; n = 4). There were no significant differences in this perspective based on demographic characteristics (Ps > 0.05). However, when asked about the personal impact of social media, most participants described its effects as “neither positive nor negative” (51.46%; n = 53), while over one-third perceived “mostly positive” effects (37.81%; n = 41). Most participants indicated that it would be “very hard” (31.07%; n = 32) to “somewhat hard” (47.57%; n = 49) to give up social media. Of note, a little over half of the participants indicated that they have previously taken a break from social media because it was impacting their mood (57.28%; n = 59), with downtimes ranging from “a few hours” to 1 year. In terms of exploratory differences based on demographic characteristics, participants identifying as MENA were more likely to report difficulty taking breaks from social media (χ² = 15.53, P = 0.004) and tended to report shorter break durations overall (χ² = 15.03, P = 0.005) compared with their non-MENA peers. There were no other significant differences in tendency to take a break based on other demographic characteristics following adjustment for multiple comparisons (Ps > 0.032).

Qualitatively, the theme of a complex relationship characterized teens’ use of social media varied greatly, including both positive and negative aspects of use. Teens reported using social media for social connection, creative expression, self-exploration, emotional support, education, activism, and entertainment. While some found these uses fostered a sense of community, others expressed concerns about the negative effects of social media. Teens reported issues related to mental health, such as stress, body insecurity, anxiety, social comparison, reduced attention span, and addiction to social media. Some described social media as an “escape from reality.” They also expressed concerns about physical health, including headaches from excessive screen time, as well as issues related to safety and privacy, like online harassment and misinformation. One teen described these mixed experiences:

“[S]ocial media and teenagers have a complicated relationship. The reason for that is because social media is more than just a form of entertainment- it is a space for those to connect, self-express, and attain emotional support. But it can also overwhelm teens. The pressure to fit in can cause one to feel stressed or insecure from what they consume. At the same time, social media can be a safe haven, where teenagers feel seen, heard, and inspired” (Participant 99).

Teens wished to continue to use social media; however, they criticized social media platforms for neglecting to make online spaces safe for teen mental health and prioritizing revenue over teen well-being. One teen stated,

“They are hurting society” (Participant 133)

Teens’ experiences on social media depended on several factors, including social identities, social media content, and unique features of these platforms. Ultimately, teens described having a “complex relationship” with social media, expressing their desire to understand its nuances.

3.4 Teen perspectives on their safety habits and general safety for social media

Participants reported that they view false or misleading information on social media “all the time” (31.07%; n = 32) or “sometimes” (64.08%; n = 66). Slightly less than half of respondents indicated that social media platforms do not do enough to keep teens safe online (45.00%; n = 45), whereas about a quarter think enough is done to keep teens safe (26.00%; n = 26) or are unsure (29.00%; n = 29). There was no evidence to suggest differences in this view based on demographic characteristics, outside of participants who identified as MENA, who had higher odds of agreeing that platforms do enough to keep youth safe (OR = 11.19; 95% CI: 1.87–67.01; P = 0.008), compared to the broader sample.

Nearly two-thirds of participants reported changing their privacy settings because of concerns about safety or who could see their posts (60.20%; N = 59). Logistic regression indicated that those who identified as female had lower odds of privacy setting changes (OR = 0.31, 95% CI: 0.10–0.98, P = 0.046), though this result was not significant following adjustment for multiple comparisons.

The theme of respect and accountability characterized teens’ expressed desire for increased protection from social media platforms regarding online safety measures against cyberbullying, inappropriate content, scams, and online harassment. Suggested measures included monitoring the type of content available, access to adult chatrooms, enforcing age restrictions, and implementing measures to protect private information, such as screenshot blockers. Many teens perceived social media platforms as prioritizing monetary revenue over teen mental health and safety. One teen noted,

“[social media platforms] know how [social media] leads to tons of disorders, but they make profit off of it so they don’t care” (Participant 66)

Multiple teens expressed the desire to

“feel heard and respected, not just treated as users or data points” (Participant 33)

Teens want more transparency from social media platforms regarding how content algorithms function and the data surrounding privacy (e.g., who can view posts, what personal data is collected). One teen shared,

“Having more transparency and control would help teens feel more empowered about their social media experience” (Participant 139)

Such control, as suggested by teen participants, can consist of setting up rigid time restrictions on platforms and the option to save chat records for reporting misconduct or harassment.

3.5 Teen perspectives on social media bans and changes in regulations

In Spring 2025, two significant, publicly announced changes were seen across major social media platforms: (1) a possible ban on TikTok in the United States, which included a brief suspension of the platform; and (2) Meta reversing certain content moderation policies related to hate speech, group-based abuse, and free speech on its platforms, namely Instagram, Facebook, and Threads (BTLJ, 2025). Teen participants mostly knew about the potential TikTok ban (92.16%; n = 94), but few were aware of the updates to Meta’s rules (42.72%; n = 44). Additionally, fewer participants reported that these changes affected how they used the platforms. In fact, 84.78% denied any impact on their TikTok use (n = 78), and 88.10% denied impact on their use of Meta platforms (n = 37).

Teens’ reactions to the TikTok ban were characterized by the theme of loss and realization, with teens describing emotional, behavioral, and social impacts. Youth shared that the ban impacted their online community and social spaces, noting a loss of space across a variety of activities, including losing space for creative sharing, learning and staying informed, activism, mental health support, and social connection.

One teen shared that

“Losing access to TikTok means they might feel disconnected from their online communities, miss out on opportunities to share their talents, and have to adjust to using other platforms that don’t feel the same. Some even relied on TikTok for mental health support, study tips, or just a daily escape, so this change can feel frustrating, disappointing, and even isolating” (Participant 10)

Emotionally, youth reported feelings of disappointment, disconnection and isolation, sadness, and frustration, feeling like,

“their voices are being taken away” (Participant 19)

Behaviorally, youth shared changes in the form of less use, including deleting the app after the ban, not redownloading, and looking for alternative platforms. Interestingly, some noted that the ban forced them to realize and grapple with their “addiction” to the app.

Most teens had limited awareness of the hate speech rollback on Meta, but those who were aware saw the rollback as mostly negative, limiting their expression and increasing negative interactions. However, some noted the impact could vary depending on the nature of one’s social media feed (i.e., if the feed is focused on friends and family, the rollback would be less impactful).

3.6 What teens want researchers to do

Teens shared that there is a lot to learn about social media’s impact and use. Regarding impact, teens were interested in more research examining the social impact and consequences of social media (e.g., impact on violence, politics, and academic functioning). Many also wanted to understand the health-related outcomes, like sleep, exercise, and neurological functioning [e.g., “how each video is 15 s and most people forget what they have watched after 5 min of viewing it” (Participant 96)]. Lastly, and most commonly, they emphasized a need for studies on mental health outcomes, particularly depression, social comparison, self-esteem, and loneliness. Several also highlighted concerns about overreliance and addictive use, describing social media as both indispensable and overwhelming in daily life.

Regarding use, teens were interested in understanding who uses social media, specifically which demographic characteristics and social communities were most active online. Their curiosity often reflected broader social norms about platform use, including perceptions of what is considered “typical,” “cool,” or acceptable behavior within their peer networks. Teens were also concerned with online safety and wanted researchers to study topics like cyberbullying, hate speech, privacy, and misinformation. They were interested in examining unique platform design and features, like direct messages, commenting, and friending/following, as well as exposure to certain content, and scrolling limits [e.g., “I would say most apps should have a scroll limit for certain age groups like TikTok used to not let you like videos if you were on it scrolling too long“ (Participant 145)]. Finally, some teens were curious about the economics of social media use, including monetization, influencer culture, and how platforms might support future opportunities for jobs, college, or small business marketing.

4 Discussion

This quality improvement study aimed to center the voices of urban teens to understand how social media use intersects with evolving sociopolitical regulations of digital platforms. In late Spring 2025, a brief anonymous survey was administered to adolescents in Chicago, Illinois, USA, to capture their perspectives on social media, recent regulatory shifts, and what they believe digital health researchers should consider when designing, implementing, and evaluating technology-based interventions that reflect their needs and lived experiences.

Our findings indicate that entertainment was the most common motive for social media use, followed by the need to learn and connect with known peers. At the same time, a substantial minority cited news seeking, distraction, and community building. Despite frequent use, most teens described social media’s personal impact as “neither positive nor negative,” and more than one-third reported “mostly positive” effects, underscoring a nuanced appraisal rather than a uniformly harmful narrative. Since the time of this survey, calls for banning social media for youth have been made and an actual social media ban for youth under 16 years began in late 2025 in Australia (Champion et al., 2025). The current findings add to a growing literature that speaks to the nuance of how young people use social media, as opposed to it being a driver of the youth mental health crisis (Odgers and Jensen, 2020b; Carter et al., 2023; Odgers, 2024). Indeed, urban teens in this work echo other studies showing that social media is not a universal harm and that youth perceive potential benefits and risks exist in their engagement with these platforms (McAlister et al., 2024).

Notably, two crucial safety-related patterns emerged from this sample. First, teen participants widely perceived misinformation as commonplace, though nearly half believed platforms did not do enough to keep teens safe online. Qualitative feedback emphasized a desire for greater respect, accountability, transparency, and user control in online spaces, with several adolescents wanting to feel heard and not treated as “users or data points.” This is in line with growing calls for involving young people in technologies, ranging from social media to digital health interventions to AI (Stiles-Shields et al., 2023; Figueroa et al., 2025; Stankov et al., 2025; Welsey-Smith and Fleming, 2025). Second, many teens endorsed protective self-moderating behaviors (e.g., changing privacy settings), though the majority anticipated difficulty giving up social media, even as more than half reported prior mood-related breaks or downtimes from social media spanning a few hours to over a year. A key finding indicated that some teens continue to actively manage and self-moderate their digital risk due to significant unmet needs in current digital ecosystems. Support for such self-moderation may be promoted by trusted adults, including caregivers, teachers, and clinicians. Indeed, this is in line with recommendations made from the American Psychological Association to help trusted adults to monitor and scaffold adolescents’ social media use to help balance social connection with other health and developmental needs (American Psychological Association, 2023).

It is worth noting the difference in social media usage frequency and the difficulty faced in taking breaks from social media, more so for some youth cohorts (e.g., youth identifying as MENA). We suggest that this may reflect the significance of online spaces for them. These youth may use social media to maintain transnational connections, seek culturally-affirming peer networks, and build community in response to limited offline representation or experiences of marginalization (Hamilton et al., 2024; McAlister et al., 2024). These online platforms invariably helped subvert or mitigate cultural invisibility or underrepresentation in mainstream institutions. At the same time, they provided an avenue for them to stay connected with their diasporic families and maintain close transnational relationships), therefore, serving as vital sites for identity affirmation, a sense of belonging, and collective support.

4.1 Study limitations and implications for youth participatory action research

Several key strengths are worth mentioning. First, our study obtained timely and practice-relevant insights from adolescents residing in historically and currently underserved neighborhoods, emphasizing perspectives that are often underrepresented in DMH research and design discussions. It integrated quantitative breadth with rapid qualitative depth and translated youth priorities into a concrete, hypothesis-generating study design, with research and policy recommendations. Secondly, this study acquired timely and practically relevant insights amidst a period marked by substantial regulatory and cultural transformations within the digital ecosystem (e.g., proposed bans on TikTok and moderation policy rollbacks on other social media platforms routinely used by adolescents in our sample), thereby offering a real-time snapshot of how young individuals interpret and respond to these changes. Third, this study employed a rapid, convergent mixed-methods approach that balanced quantitative breadth with qualitative depth, enabling both pattern recognition across a diverse sample and nuanced interpretation of meaning and context within adolescents’ social networks and in their own words. In addition, our QUAL + QUANT convergent triangulation enhanced analytic rigor and internal validity by combining structured survey data with open-ended narratives, allowing us to corroborate themes across data sources.

Of note, the participatory orientation of the study, including iterative youth feedback on survey items and framing, helped ensure the ecological and developmental relevance of our findings. Our approach aligned with well-established principles of youth participatory action research [YPAR, see (Anyon et al., 2018)], drawing on Rodríguez and Brown’s (2009) original conceptualization of YPAR (Rodríguez and Brown, 2009) and (Ozer and Douglas 2015) improvements to the YPAR principles (Ozer, 2016), centering on its three key principles. YPAR emphasizes three interrelated principles: (1) inquiry-based, grounding research in youths’ lived experiences and pressing concerns; (2) participatory, engaging youth as key collaborators in developing and implementing a youth-informed research agenda; and (3) transformative, seeking to advance advocacy, challenge inequities, and improve the lives of youth and their communities through actionable change. Finally, by translating emergent youth priorities into clear, hypothesis-informing strategies while retaining youth voice, this study provides a practical link between adolescent-focused insights and the next generation of DMH intervention and research focus and design.

However, some limitations also need to be acknowledged. First, our sociodemographic data were intentionally limited to race, ethnicity, and gender to reduce participant burden and maintain anonymity, particularly given the small, community-based sample. These variables were selected because they are key determinants of digital experiences and identity expression among youth; however, we recognize that personal identity spans several intersecting constructs. Future studies should include additional contextual variables (e.g., socioeconomic status, education level) to more fully capture the structural and environmental factors shaping online engagement.

Second, given the rapid nature of this cross-sectional study, which focuses on urban youth in one U.S. city (i.e., Chicago), our findings provide a valuable snapshot, but imposes a measure of selection bias and limited generalizability to other similar urban settings. Although it is not uncommon for time-sensitive and culturally grounded studies responding to current events and a period of momentary media salience, we further emphasize the complexities, heterogeneity, and limitations inherent in cross-sectional designs and measurement issues, such as self-report bias and correlational inference (Shannon et al., 2022). Future work should expand beyond cross-sectional evaluations, as well as examine whether findings replicate or diverge across other urban, suburban, and rural contexts. Third, the data collected in this study were self-reported and therefore subject to recall and social desirability biases. Some items were adapted from prior surveys [e.g., Pew Research (Faverio, 2024; Atske, 2025)] for brevity and feasibility. Hence, psychometric properties were not re-established here. Awareness and perceived impact of policy changes were assessed during a specific temporal window (i.e., Spring 2025), and responses may reflect momentary media salience. Applying a convergent mixed-methods approach enhances interpretability; however, causal inference remains unattainable.

Fourth, quantitative analyses included several exploratory tests. False discovery rate procedures were applied to manage Type I error; yet, small cell sizes in some subgroups may have produced unstable estimates. Replication in larger, adequately powered samples is warranted, especially for subgroup findings (e.g., differences for those identifying as MENA). Finally, online platform features and policies continue to evolve quickly. Findings related to the TikTok ban discourse or Meta policy changes should be regarded as temporally bounded, necessitating continuous monitoring and youth co-interpretation to reflect the evolving policies, algorithms, and technological affordances.

Future research and YPAR studies should employ longitudinal and experimental designs to test DMH features that teens explicitly value (e.g., safety controls, transparency cues, break supports). In addition, there is a mission-critical need to evaluate culturally-anchored community functions and moderated affinity spaces, with attention to diasporic and transnational ties highlighted by MENA youth and other minorized youth groups, whose social media use and perceptions may differ in meaningful ways from their peers. Given the current rise in misinformation, there is a need to co-develop algorithms and misinformation literacy modules with adolescents and their caregivers, to better prevent and mitigate harmful online engagement, excessive screen time, and online content, as well as the deleterious impact of social media, where present. Lastly, we must build adaptive, platform-agnostic DMH interventions that can persist across policy shifts. Embedding youth advisory structures and rapid feedback cycles can ensure that DMH tools remain aligned with adolescents’ needs and lived experiences.

4.2 Conclusion

Teens in this study characterized social media as both essential and flawed, with platforms remaining authentic channels for creativity, connection, and identity exploration. However, issues such as risk, misinformation, and uneven safety measures continue to exist. Their insights highlight the necessity for DMH initiatives to transcend deficit narratives by collaborating with youth as co-designers, evaluators, and advocates to create safer and more empowering online environments. Researchers collaborating with youth and their families, platform developers, and policymakers must prioritize youth-informed solutions that foster transparency, accountability, and trust within digital ecosystems. Furthermore, these platforms should integrate evidence-based emotion regulation and “digital hygiene” tools and resources, while ensuring equitable access to support spaces that are risk- and culturally-anchored. The next generation of DMH interventions must be portable across fast-changing platforms and continuously improved through youth feedback. By listening to and acting on adolescents’ lived experiences, we can create digital spaces that reduce harm and promote mental health, belonging, and resilience.

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