Nicola Claire Newton

Background: Crystal methamphetamine (“ice”) is a drug of significant concern across Australia; however, access to culturally appropriate, community-led, and co-developed resources is limited for Aboriginal and Torres Strait Islander communities. Objective: To meet this need, the Cracks in the Ice Resources for Aboriginal and Torres Strait Islander peoples web-based toolkit was developed to support Aboriginal and Torres Strait Islander peoples, families, and communities affected by crystal methamphetamine. Methods: The community-led development of the toolkit was overseen by an expert advisory group and involved a broad-reaching, inclusive, and iterative process, with three phases over a 6-year period (from funding in 2016 to launch in 2021). The development phases with, and for, Aboriginal and Torres Strait Islander communities involved (1) initial focus groups (30‐45 min, n=15) conducted by an Aboriginal researcher across 6 locations including metropolitan cities, rural regional towns, and towns servicing remote Aboriginal communities across Australia; (2) content and web development in collaboration with First Nations digital agencies; and (3) beta-testing of the web-based toolkit via a 15‐25 minute online survey to evaluate the toolkit’s acceptability, relevance, and usability. Results: Phase 1 community consultations (n=166) highlighted the need for culturally appropriate information and resources about methamphetamine use harms, impacts, and support options. This guided phase 2, where resources were developed to address knowledge gaps (eg, drug effects) and practical needs of communities (eg, yarning about drugs), along with content-specific meaningful First Nations artwork, interactive features, and other resources. Phase 3 beta-testing results were positive, with Aboriginal and Torres Strait Islander end users (n=73) reporting that the toolkit was easy to navigate and provided appropriate and relevant information. The majority (67/73, 91.8%) of participants reported that it was clear what information the toolkit provided, and most (54/73, 73.9%) were “very likely” to recommend it to others. Areas for improvement were identified (eg, explanation of artwork development and improving the clarity of text) and addressed before launch. The web-based toolkit was officially launched on July 21, 2021 (reach as of June 2025: >2.74M page views, >1.44M unique website users, and >366K hard copy resources distributed to >1793 organizations across Australia). Conclusions: It is critical that First Nations health resources are community-led and iteratively co-developed with experts and health workers supporting communities. Conducted over 6 years and involving >240 Aboriginal and Torres Strait Islander community members, Elders, experts, and health workers, such a process was used to develop this culturally appropriate, relevant, and acceptable web-based toolkit about crystal methamphetamine for Aboriginal and Torres Strait Islander peoples. While focused on an area of high need within Australia, this process provides an effective and strengths-focused roadmap to achieve this in other areas of health and in other countries working with First Nations peoples.

Introduction: As cannabis policies become more liberal, and products increasingly potent, it is important to monitor changes in rates of cannabis use and those at risk of harm. We used data from the largest national mental health survey in Australia to examine changes in prevalence, associations and comorbidity of past 12‐month cannabis use and cannabis use disorder (CUD) from 2007 to 2020–22. Methods: Data were drawn from the two most recent Australian National Surveys of Mental Health and Wellbeing (age range: 16–85): 2007 ( n = 8841) and 2020–22 ( n = 15,893). The prevalence of use and CUD were estimated and logistic regression was used to examine associations between individual characteristics and cannabis use outcomes, as well as changes in strength of association over time. Results: Prevalence of recent cannabis use was stable from 2007 (6.7%, 95% CI 6.0%, 7.3%) to 2020–22 (6.7%, 95% CI 6.2%, 7.1%), as was CUD (1.0%, 95% CI 0.7%, 1.3%; 0.6%, 95% CI 0.4%, 0.8%). Respondents were significantly more likely to report CUD if they were younger (16–25 years), male, initiated cannabis use < 18 years, reported recent polysubstance use, exhibited other substance and mental disorders and had visited mental health services (OR 3.26–78.00). Compared to 2007, the association between younger age and CUD was stronger in 2020–22 (OR 2.39, 95% CI 1.20, 4.77), whereas the association between polysubstance use and CUD was weaker (OR 0.42, 95% CI 0.20, 0.91). Discussion and Conclusions: Findings suggest that population‐level use and CUD may have remained stable over time, but young people may now be more vulnerable to developing CUD.

Background: Process evaluations of preventive health interventions are essential for enhancing their implementation and impact. Purpose: This study presents the process evaluation of Health4Life, a digital school-based program designed to modify multiple health risk behaviors among adolescents. Methods: Data were derived from a cluster randomized controlled trial in 71 Australian secondary schools from 2019 to 2022, including data from 2085 students and 118 teachers. Based on the Medical Research Council guidance for process evaluations this study explored three key questions: (i) Was the Health4Life intervention delivered and received as intended? (ii) How did participants respond? and (iii) What contextual factors influenced implementation? Fidelity, dose and exposure to intervention components were assessed through teacher self-report and website analytics. Participant responsiveness included student and teacher acceptability, and factors associated with a positive program evaluation (i.e. students’ ratings of enjoyment, relevance, and utility). Contextual factors relating to schools and the intervention were assessed via teacher-reported open-ended feedback. The Consolidated Framework for Implementation Research (CFIR) was applied to support interpretation of findings. Results: Fidelity to the online modules was high based on teacher self-report, but the dose received by students was moderate (62% full dose), and use of the supplementary components varied. Program acceptability was high, with most students (73%) and teachers (84%) rating Health4Life favorably overall. Key factors associated with a positive student evaluation were identifying as female, and having higher baseline knowledge of health risk behaviors, greater self-control and higher socioeconomic advantage. Qualitative data identified key contextual barriers and facilitators relating to program design, technology and school contextual issues. Conclusions: These findings provide valuable insights to support the ongoing refinement and broader implementation of Health4Life. A set of recommendations are proposed to inform the future development, implementation, and evaluation of digital health interventions in school environments. Clinical Trial information: The Health4Life study was pre-registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123).

Introduction: Over the past two decades, the prevalence of psychological distress and mental disorders among adolescents has markedly increased. This coincides with the advent and rapid adoption of social media, resulting in a proliferation of research examining time spent on social media and its relationship with mental health. However, to date, findings have been inconclusive. The active/passive model of social media behavior theorizes that “passive” social media behaviors (e.g., scrolling/watching) are associated with worse mental health outcomes than “active” behaviors (e.g., messaging or posting). The present study investigates both cross‐sectional and longitudinal relationships between active and passive social media behaviors and both psychological distress and mental wellbeing, while also examining differential effects of gender. Methods: This study uses data from two assessment waves (2021 and 2022) of a large adolescent Australian data set ( n = 3205, T1 mean age 14.6 [SD: 0.62], 53.6% cisgender female/gender diverse). Three distinct behaviors were examined: (1) messaging/video calling friends (active), (2) posting content (active), and (3) scrolling or viewing content (passive). Results: There was little evidence of a longitudinal relationship between 12‐month change in any of the social media behaviors and psychological distress or mental wellbeing. While there were gender differences in the prevalence of the social media behaviors, there was no evidence of a gender interaction. Conclusions: Findings suggest the need to move beyond the active and passive model of social media behavior as a framework to explain the relationship between social media and adolescent mental health. We discuss several new directions for research and policy.

Background: Crystal methamphetamine use is a global health concern and highly stigmatised. Amid increased international focus on drug use as a health concern, the current study aimed to examine knowledge and attitudes around crystal methamphetamine among key groups in a contemporary Australian community sample. Methods: A cross‐sectional online survey was conducted in February–April 2022 ( n = 736), open to all Australian residents aged 18 years and over. Knowledge and attitudes were assessed among people who use crystal methamphetamine, family/friends, health workers, and the general community. Data was combined with a previous 2019 survey ( n = 2108) and linear regression examined factors associated with knowledge and attitudes. Results: Stigmatising attitudes were common among people who had not used crystal methamphetamine, and they were more likely to endorse negative statements than those who had. Family/friends and community members, females, and respondents from regional areas had the highest stigma scores. Of those who used crystal methamphetamine, 70.9% reported experiencing discrimination. Higher knowledge scores ( p < 0.001) were significantly associated with less stigmatising attitudes as was being surveyed in 2022 compared to 2019. Health workers demonstrated the highest knowledge scores. Conclusions: Stigmatising attitudes towards crystal methamphetamine remain prevalent, and experiences of discrimination towards people who use it are common. Evidence‐based education and initiatives to reduce both public and self‐stigma associated with crystal methamphetamine are needed. So What?: Stigma towards people who use methamphetamine remains common in Australia. This study highlights the need for targeted, evidence‐based stigma reduction strategies to encourage help‐seeking and improve health outcomes for people who use methamphetamine.

BACKGROUND Crystal methamphetamine (‘ice’) is a drug of significant concern across Australia, however, access to culturally appropriate, community-led, and co-developed resources is limited for Aboriginal and Torres Strait Islander communities. To meet this need, the Cracks in the Ice Resources for Aboriginal and Torres Strait Islander peoples web-based toolkit was developed to support Aboriginal and Torres Strait Islander peoples, families, and communities affected by crystal methamphetamine. OBJECTIVE This paper describes co-development and beta-testing of the Cracks in the Ice Resources for Aboriginal and Torres Strait Islander peoples web-based toolkit METHODS The community-led development of the toolkit was overseen by an Expert Advisory Group and involved a broad-reaching, inclusive, and iterative process, with three phases over a 6-year period (from funding in 2016 to launch in 2021). The development phases with, and for, Aboriginal and Torres Strait Islander communities involved: (1) initial focus groups (30-45 mins, n = 15) conducted by an Aboriginal researcher across 6 locations including metropolitan cities, rural regional towns, and towns servicing remote Aboriginal communities across Australia; (2) content and web development in collaboration with First Nations digital agencies; and (3) beta-testing of the web-based toolkit via a 15-25 min online survey among website end-users and experts to evaluate the toolkit’s acceptability, relevance, and usability. RESULTS Themes identified through Phase 1 community consultations (n = 166) highlighted the need for culturally appropriate information and resources about methamphetamine use harms, impacts, and support options. This guided Phase 2, where resources were developed to address knowledge gaps (e.g., drug effects) and practical needs of communities (e.g., yarning about drugs). Phase 2 also guided development of content specific meaningful First Nations artwork and designs, interactive features, and other resources in response to Phase 1. Overall, Phase 3 beta-testing results were positive with Aboriginal and Torres Strait Islander end-users (n=73) reporting that the toolkit was easy to navigate and provided appropriate and relevant information. The majority (67/73, 91.8%) of participants reported that it was clear what information the toolkit provided, and most (54/73, 73.9%) were “very likely” to recommend the website to others. Areas for improvement were identified (e.g., content explaining the artwork development, improving the clarity of text) and addressed prior to launch. The web-based toolkit (cracksintheice.org.au/aboriginal-and-torres-strait-islander-peoples) was officially launched on 21 July 2021(reach as of June 2025: >2.74M page views, >1.44M unique website users, >366K hardcopy resources distributed to >1,793 organisations across Australia). CONCLUSIONS It is critical that health resources for First Nations people are community-led and iteratively co-developed with experts and health workers supporting communities. Conducted over 6 years and involving > 240 Aboriginal and Torres Strait Islander community members, elders, experts, researchers, and health workers, such a process was used to develop this culturally appropriate, relevant, and acceptable web-based toolkit about crystal methamphetamine for Aboriginal and Torres Strait Islander peoples. Whilst focussed on an area of high need within Australia, this process provides an effective and strengths focused roadmap to achieve this in other areas of health and in other countries working with First Nations peoples.

Background: Despite the known psychosocial challenges associated with supporting a loved one using alcohol and other drugs (AOD), there is a scarcity of mental health and well-being interventions for affected friends and family members (AFFMs). Stigma has also been shown to discourage help-seeking among AFFMs. Web-based interventions may facilitate help-seeking by ensuring privacy and anonymity. Objective: This pilot study examines the usability, acceptability, and feasibility of the Family and Friend Support Program (FFSP), a world-first, evidence-based web-based resilience and well-being program designed with, and for, people caring for someone using AOD. This study also examined AFFM’s experiences of caring for a loved one using AOD and their help-seeking behaviors and barriers. Methods: In 2021 (November-December), participants across Australia completed a baseline web-based cross-sectional survey that assessed the impact of caring for a loved one using AOD (adapted Short Questionnaire for Family Members-Affected by Addiction), and distress levels (Kessler Psychological Distress Scale [K-10]). Following baseline, participants were invited to interact with the FFSP over 10 weeks. Postprogram and follow-up surveys (10 and 14 wk postbaseline, respectively) and semistructured interviews assessed the usability and acceptability of the program, as well as help-seeking experiences and barriers. Results: Baseline surveys were completed by 131 AFFMs, with 37% (n=49) completing the postprogram survey and 24% (n=32) completing the follow-up survey. A total of 5 participants took part in individual semistructured interviews at postprogram. On average, K-10 scores fell in the moderate to severe range at baseline (mean 28.4, SD 8.6). At postprogram, the majority of participants (n=27, 55.1%) reported that they did not seek help to cope with or manage their role supporting their loved one and the most common endorsed barrier was cost (n=11, 28.6%). Overall, participants found the FFSP easy to use and provided them with relevant, helpful, and validating information. The majority (n=35, 71.5%) of participants said they would be likely to recommend the FFSP to a person supporting a loved one using AOD. Qualitative responses highlighted the need for free, accessible support for AFFMs such as the FFSP. Limitations included low program engagement and high attrition. Conclusions: Overall, the FFSP appears to be a promising mental health intervention for AFFMs. This study builds on existing research finding high levels of distress among AFFMs, while highlighting the ongoing barriers to help-seeking. Limitations and future directions for refinements and future efficacy evaluation of the FFSP are discussed including ways to address attrition and increase engagement.