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for Practice CSHCN require services from a broad array of providers across multiple systems. Unfortunately, there are certain difficulties that hamper the accessibility of these systems. These findings underscore the need for both practice-level response and systems-level reform to ensure equitable distribution of health and community resources.

Objective: Social media has been recognized as a promising tool for delivering health interventions and facilitating study recruitment. However, research is needed to understand how social media might be used to enhance the experiences of adolescent participants in ongoing studies. In a prospective cohort study addressing social and structural influences on health trajectories among 599 adolescents in a California agricultural community, we evaluated the effectiveness of and engagement with a human-centered, Instagram-based outreach campaign, with a focus on study retention, enhancement of participants' experiences, and increasing community awareness of the study.Methods: We adopted a youth-centered approach to design a three-month pilot study, which included participatory design sessions, a geo-targeted Instagram campaign, and in-person events at schools. We conducted pre-/post-pilot surveys with study participants, analyzed social media metrics, and collected process measures, such as study visit show rates.Results: After three months, the study Instagram account had 209 followers and 806 total engagements. Survey responses showed little change in study participants' attitudes about the study; most survey respondents agreed that the study is very important for the community (54% pre-pilot and 52% post-pilot). However, the study's Instagram account appeared to influence study participation, with 43% of post-pilot respondents who use Instagram (n¼65 of 153) indicating that the Instagram account influenced their decision to continue coming to study visits.Conclusion: Despite little change in the participants' attitudes about the study, the findings of this pilot study suggest that Instagram is a promising tool to support engagement of adolescent participants in ongoing research, particularly if the content is designed with adolescents as partners. In addition to assessing the effectiveness of an Instagram outreach campaign to support retention, this paper also presents suggestions and insights for creating similar social media interventions targeting youth.