Lexine Ann Stapinski

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.

Climate distress is widely reported among young people and increasingly recognised as a mental health concern. While prior research has documented its prevalence and emotional impacts, less is known about how young people prefer to be supported. We analysed data from a nationally representative online survey of 1,000 Australians aged 16-25 years conducted in 2023. Survey-weighted descriptive analyses and multivariable logistic regression models examined associations between support preferences and age, gender, geographic location, and experience of extreme weather events (EWEs).Young people rated as most helpful those responses that validated climate concerns, fostered agency, and recognised shared and institutional responsibility, with visible government climate action ranking highest overall. Friends, family, digital resources, and mental health professionals were preferred sources of support, whereas doctors, helplines, and some school-based services were less frequently endorsed. In clinical contexts, participants prioritised acknowledgement and action-oriented guidance while rejecting minimisation or denial.Support preferences varied even amongst young people. Younger participants favoured visible leadership and school-based supports, whereas older youth showed greater preference for self-directed strategies. Female and gender-diverse participants more consistently support relational and multi-level supports and were less likely to support responses that dismissed or minimised climate change. Those with EWE experience showed stronger support for systemic and relational responses and lower tolerance for such dismissive framing.These findings underscore the importance of aligning climate-related mental health responses with young people’s lived experiences and expectations, highlighting the need for relational, institutional, and policy-level approaches alongside individual support.

Background: Increasingly, brief digital interventions are being implemented to combat alcohol misuse. While the utility of incorporating personalized feedback into these interventions has been explored, less work has concentrated on how consumer-driven research might be harnessed to better tailor personalized feedback. Critically, the relative efficacy of co-designed interventions vs those designed by research teams without stakeholder input has not typically been explored. Objective: This study aimed to use an exploratory sequential mixed methods approach to elicit user-designed personalized feedback to incorporate into an existing brief digital intervention developed to combat hazardous drinking; investigate differences in capacity, opportunity, and motivation (as per the Capacity, Opportunity, Motivation–Behavior model) to alter alcohol use behavior; examine whether participants prefer the co-designed product over those designed by research teams; and evaluate change in actual consumption over time as a function of co-designed (image-based) vs researcher-designed (image- or text-based) personalized feedback. Methods: Part 1 used an online co-design process involving a convenience sample of young adult focus group participants (N=40; mean age 21.87, SD 7.51 years). Part 2 surveyed a convenience sample of young adults who drank alcohol regularly (N=222; mean age 21.14, SD 4.69 years). Participants were assigned to 1 of 3 personalized feedback conditions (researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based) using block allocation with stratification based on alcohol intake and impulsivity level. Feedback was delivered via email, and impact on capacity, opportunity, and motivation to alter alcohol use behavior, plus preferred format of feedback, was examined (10.76, SD 14.05 days) via mixed and 1-way ANOVAs and post hoc tests. Change in alcohol consumption (89.70, SD 21.59 days) was investigated via a series of repeated-measures ANOVA and post hoc tests. Results: In Part 1, qualitative thematic analysis of focus group data identified 6 overarching themes: visual representation, clarity, accessibility, brevity, peer comparison, and harm. Following this analysis, personalized feedback regarding alcohol intake and brain health was available in 3 formats: researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based. In Part 2, there were no differences in capacity, opportunity, and motivation to alter alcohol use behavior as a function of feedback format (ηp2=0.01). Participants preferred co-designed, image-based feedback over researcher-designed, image-based (d=0.55) or researcher designed, text-based (d=0.83) feedback. Regardless of feedback format, all participants significantly reduced total alcohol intake (ηp2=0.11) and alcohol-related harm (ηp2=0.05). Participants in image-based conditions (researcher-designed or co-designed) reduced frequency of drinking to a greater extent (d=0.56) than those in the researcher-designed, text-based feedback condition (d=0.39). Conclusions: Though the principles of co-design are undeniably valuable, the efficacy of co-designed interventions, over and above those designed by research teams without user input, requires further research. Trial Registration: OSF Registries osf.io/rnbv8; https://osf.io/y4bhs

Climate change poses escalating threats to psychological well-being, yet no internationally recognised certification framework for climate–mental health facilitation currently exists in the peer-reviewed literature. This protocol describes a scoping review that aimed to map international models, frameworks, and best practices for professional training and certification in climate–mental health facilitation. The review addresses five sub-questions covering competency domains, existing training models, structural features, cultural and ethical considerations, and evidence gaps. Guided by the Population–Concept–Context (PCC) framework and the PRISMA Extension for Scoping Reviews (PRISMA-ScR), six electronic databases and targeted grey literature sources will be systematically searched. Two independent reviewers will screen records and chart data using a standardised form. Findings will be synthesised through narrative description and a comparative benchmarking matrix. The expected outcome is a consolidated evidence base that will inform the development of a culturally adapted certification scheme for Southeast Asia, particularly Indonesia, and signal directions for future research and policy in climate psychology and mental health workforce development.

Social health-our ability to access and maintain meaningful human relationships-is recognized as a critical determinant of population health and climate change resilience, yet it is poorly integrated into climate change policy and research. This narrative Review synthesizes interdisciplinary evidence of the bidirectional and nuanced relationship between climate change and social health: climate change disrupts key social conditions (including housing stability and community cohesion), while widespread social disconnection limits our collective capacity to address the climate crisis. We unpack how social health can function as both a climate vulnerability and a lever for climate action. We present a new conceptual framework, describing the pathways through which social health and climate outcomes interact. Finally, we highlight existing evidence gaps and opportunities for public policy development and call for climate and health governance to centre social health as a key pillar of resilience in a changing world.

Introduction: Recent years have seen growing recognition of the mental health toll that climate change imposes on younger generations. In response, researchers, clinicians, and practitioners are increasingly seeking to address climate-related distress through a range of clinical, community and school-based approaches. There now exists emerging evidence supporting a cumulative effects relationship between exposure to climate-related disasters and overall population mental health outcomes. However, it is unclear whether this applies specifically also for young people, or towards non-pathological intermediary factors influencing climate-related distress.Methods: Using cross-sectional, nationally-representative online survey data of young Australians (aged 16-25 years), we fitted logistic regression models exploring associations between cumulative extreme weather exposure, and five outcomes of interest: (1) climate concerns, (2) climate concern’s impact on mental health, (3) self-reported overall mental health, (4) climate-related factors impacting mental health, and (5) perceived helpfulness of climate anxiety supports. Secondary stratified analyses of these regressions were conducted exploring model variations by gender, age sub-groups, and geographic remoteness. Results: Weighted analyses demonstrated clear cumulative effects relationships between cumulative exposure to extreme weather events and higher likelihood of climate concern, reporting increased concern within 12 months of survey completion, and self-reporting poor mental health. Event-specific effects were most consistent for heatwaves and bushfires/bushfire smoke, which were associated with heightened climate concern and stronger perceptions that factors such as government inaction, environmental policy uncertainty, and worry about the planet negatively affecting young people's mental health. Cumulative exposure showed the strongest and broadest associations, with those exposed to more types of events more likely to view all proposed supports (clinical, educational, and structural) as helpful. Stratified analyses suggested stronger cumulative effects patterns for female/other gender groups and for young people aged 22–25, though precision was limited by small subgroup sizes.Conclusion: Extreme weather exposure is now a near‑normative experience for Australian youth and is associated with measurable impacts on climate concern, perceived drivers of mental health burden, and preferred support pathways. The consistent cumulative effects patterns observed highlight the cumulative mental health burden of living through multiple climate hazards, with heatwaves and bushfires/smoke showing particularly salient associations. These findings reinforce the need to integrate mental health into climate adaptation and emergency management strategies and policies, and emphasise the importance of institutional and upstream responses alongside targeted supports for highly exposed young people.

BACKGROUND Increasingly, brief digital interventions are being implemented to combat alcohol misuse. While the utility of incorporating personalized feedback into these interventions has been explored, less work has concentrated on how consumer-driven research might be harnessed to better tailor personalized feedback. Critically, the relative efficacy of co-designed interventions vs those designed by research teams without stakeholder input has not typically been explored. OBJECTIVE This study aimed to use an exploratory sequential mixed methods approach to elicit user-designed personalized feedback to incorporate into an existing brief digital intervention developed to combat hazardous drinking; investigate differences in capacity, opportunity, and motivation (as per the Capacity, Opportunity, Motivation–Behavior model) to alter alcohol use behavior; examine whether participants prefer the co-designed product over those designed by research teams; and evaluate change in actual consumption over time as a function of co-designed (image-based) vs researcher-designed (image- or text-based) personalized feedback. METHODS Part 1 used an online co-design process involving a convenience sample of young adult focus group participants (N=40; mean age 21.87, SD 7.51 years). Part 2 surveyed a convenience sample of young adults who drank alcohol regularly (N=222; mean age 21.14, SD 4.69 years). Participants were assigned to 1 of 3 personalized feedback conditions (researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based) using block allocation with stratification based on alcohol intake and impulsivity level. Feedback was delivered via email, and impact on capacity, opportunity, and motivation to alter alcohol use behavior, plus preferred format of feedback, was examined (10.76, SD 14.05 days) via mixed and 1-way ANOVAs and post hoc tests. Change in alcohol consumption (89.70, SD 21.59 days) was investigated via a series of repeated-measures ANOVA and post hoc tests. RESULTS In Part 1, qualitative thematic analysis of focus group data identified 6 overarching themes: visual representation, clarity, accessibility, brevity, peer comparison, and harm. Following this analysis, personalized feedback regarding alcohol intake and brain health was available in 3 formats: researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based. In Part 2, there were no differences in capacity, opportunity, and motivation to alter alcohol use behavior as a function of feedback format (ηp2=0.01). Participants preferred co-designed, image-based feedback over researcher-designed, image-based (d=0.55) or researcher designed, text-based (d=0.83) feedback. Regardless of feedback format, all participants significantly reduced total alcohol intake (ηp2=0.11) and alcohol-related harm (ηp2=0.05). Participants in image-based conditions (researcher-designed or co-designed) reduced frequency of drinking to a greater extent (d=0.56) than those in the researcher-designed, text-based feedback condition (d=0.39). CONCLUSIONS Though the principles of co-design are undeniably valuable, the efficacy of co-designed interventions, over and above those designed by research teams without user input, requires further research. CLINICALTRIAL OSF Registries osf.io/rnbv8; https://osf.io/y4bhs

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.

Social health is increasingly recognised as a critical determinant of population health and climate resilience. Yet, the concept of social health—our ability to access and maintain meaningful human relationships—has not been adequately integrated into climate change policy or research. This paper presents a narrative synthesis of interdisciplinary evidence to explore the possible bidirectional and nuanced relationship between climate change and social health. These nuances include the impact of climate change on social conditions that enable individual mental and physical health, such as stable housing, supportive communities, and safe public spaces, as well as widespread social disconnection, erosion of trust, and loneliness that impacts our collective capacity to adapt to and mitigate the climate crisis. We unpack how the context of social health can be both a climate vulnerability and a lever for climate action.To support this case, we developed a synthesis of the existing key literature and propose a new conceptual framework that identifies individual, community, and systemic pathways through which social health and climate outcomes interact. We highlight emerging research, gaps in measurement, and promising opportunities for public policy. Finally, we call for a reimagining of climate and health governance—one that centres social infrastructure, lived experience expertise, and collective wellbeing as key pillars of resilience in a changing world.