Cracks in the ice: a digital health initiative disseminating evidence-based information about ‘ice’

Background

Crystal methamphetamine (‘ice') causes significant societal harm and attracts a high level of concern in Australia. Cracks in the Ice (CITI: cracksintheice.org.au) is a digital public health initiative that was developed as part of a national response to concerns about ice. CITI is the first centralised national online portal for evidence-based information and resources about ice in Australia. It provides targeted information and resources for health workers, people who use ice, their family and friends, community groups and schools. CITI was developed collaboratively with input from drug and alcohol experts and over 500 Australian community members, including people with lived experience. A national online survey was conducted to evaluate whether CITI is meeting the needs of the Australian community.

Methods

Eligible participants were Australian residents aged 18 years and over, and were recruited via the CITI website, email direct marketing, and social media. The survey assessed participants' perceptions of CITI (e.g., usability, navigation, utility) and their knowledge and attitudes about ice.

Results

2110 participants completed the survey, including people who use ice, affected family members, health workers, and general community members. Participants' response to CITI was overall positive and their knowledge of ice was generally good, but many held negative or stigmatising attitudes towards ice and people who use it.

Conclusions

Digital public health initiatives stand to overcome structural, geographical, and attitudinal barriers to alcohol and other drug (AOD) prevention efforts. CITI ensures evidence-based information about the drug ice is readily available across all of Australia. Community evaluations have shown that CITI is meeting the needs of the Australian community.

Key messages

Crystal methamphetamine (‘ice’) attracts a high level of concern in Australia. CITI is the first centralised national online portal for evidence-based information and resources about ice. Digital health initiatives stand to overcome structural, geographical, and attitudinal barriers to AOD prevention. Community evaluations ensure these initiatives meet the needs of their end-users.

Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention

Issue

Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented.

Description of the practice

To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database.

Results

Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends.

Lessons

Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective.

Key messages

Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.

Symptoms of generalized anxiety disorder but not panic disorder at age 15 years increase the risk of depression at 18 years in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study

BACKGROUND

Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years.

METHOD

Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data.

RESULTS

In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker.

CONCLUSIONS

Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.