Reusable period products: use and perceptions among young people in Victoria, Australia.

BACKGROUND: Reusable menstrual products have expanded the choices available for menstrual care and can offer long-term cost and environmental benefits. Yet, in high-income settings, efforts to support period product access focus on disposable products. There is limited research to understand young people's product use and preferences in Australia. METHODS: Quantitative and open-text qualitative data were collected through an annual cross-sectional survey of young people (aged 15-29) in Victoria, Australia. The convenience sample was recruited through targeted social media advertisements. Young people who reported menstruating in the past 6 months (n = 596) were asked questions about their menstrual product use, use of reusable materials, product priorities and preferences. RESULTS: Among participants, 37% had used a reusable product during their last menstrual period (24% period underwear, 17% menstrual cup, 5% reusable pads), and a further 11% had tried using a reusable product in the past. Reusable product use was associated with older age (age 25-29 PR = 3.35 95%CI = 2.09-5.37), being born in Australia (PR = 1.74 95%CI = 1.05-2.87), and having greater discretionary income (PR = 1.53 95%CI = 1.01-2.32). Participants nominated comfort, protection from leakage and environmental sustainability as the most important features of menstrual products, followed by cost. Overall, 37% of participants reported not having enough information about reusable products. Having enough information was less common among younger participants (age 25-29 PR = 1.42 95%CI = 1.20-1.68) and high school students (PR = 0.68 95%CI = 0.52-0.88). Respondents highlighted the need for earlier and better information, challenges navigating the upfront cost and availability of reusables, positive experiences with reusables, and challenges for use, including cleaning reusables and changing them outside the home. CONCLUSIONS: Many young people are using reusable products, with environmental impacts an important motivator. Educators should incorporate better menstrual care information in puberty education and advocates should raise awareness of how bathroom facilities may support product choice.

"You have to drink with a little bit of shame": Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia.

Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a "normal" part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant's sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant's risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants' perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.

Non-consensual sharing of personal sexually explicit imagery among young people in Australia: results from an online survey.

Consensual sharing of personal sexually explicit imagery (SEI) is part of young people's sexual practise; however, harms arise if content is shared without consent. Australians aged 15-29 years were recruited for an online survey. Participants indicated if they had ever sent SEI of themselves to someone else, received SEI directly from the person in the imagery and whether they thought it was illegal to forward SEI without consent. Participants reported whether anyone shared their SEI without permission, if they told people, made official reports or if there were consequences for perpetrator(s). Logistic regression was used to identify associations between victimisation, gender, age group, sexual identity and knowledge of SEI-related law. In total, 1007 participants (65% female, mean age 23 years, 67% heterosexual) were recruited; 63% sent personal SEI to another person, 71% received SEI from the person pictured and 77% correctly identified it is illegal to forward SEI without consent. Thirteen percent (n = 126) indicated another person forwarded personal SEI without consent. In univariate analysis, victimisation was associated with identifying as non-heterosexual (odds ratio = 1.51, confidence interval = 1.03-2.22), but was independent from age group, gender and knowledge. In multivariate analysis, sexual identity, age group, gender and knowledge were not significantly associated with victimisation. Among participants who experienced non-consensual sharing of personal SEI, 63% told friends, 10% told family, 93% made no official report and 94% reported no consequences for perpetrator(s). Initiatives are needed to promote legal rights and enable young people to seek support.

Pathways to ensure universal and affordable access to hepatitis C treatment.

Direct-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US$ 100 to approximately US$ 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal. Pathways to accessing DAAs include developing comprehensive viral hepatitis plans to facilitate price negotiations, voluntary and compulsory licenses, patent opposition, joint procurement, and personal importation schemes. While multiple factors influence the price of DAAs, a key driver is a country's capacity and willingness to negotiate with pharmaceutical companies. If negotiations do not lead to a reasonable price, governments have the option to utilise flexibilities outlined in the Agreement on Trade-Related Aspects of Intellectual Property Rights. Affordable access to DAAs is underpinned by collaboration between government, civil society, global organisations and pharmaceutical companies to ensure that all patients can access treatment. Promoting these pathways is critical for influencing policy, improving access to affordable DAAs and achieving hepatitis C elimination.

Social media use for nutrition outcomes in young adults: a mixed-methods systematic review.

BACKGROUND: Social media has been widely adopted by young adults, consequently health researchers are looking for ways to leverage this engagement with social media for the delivery of interventions and health promotion campaigns. Weight gain and sub-optimal dietary choices are common in young adults, and social media may be a potential tool to facilitate and support healthier choices. METHODS: We conducted a mixed-methods systematic review of studies examining social media use for nutrition-related outcomes in young adults. Seven databases [EBscohost, ERIC, ProQuest Central, PubMed, Ovid, Scopus, and Emerald] were systematically searched; 1225 abstracts were screened, and 47 full-text articles were assessed for eligibility. Study designs included both quantitative, such as experimental and observational studies, and qualitative, such as focus groups and interviews, approaches. Quality was assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative results were examined separately, and then synthesized. RESULTS: Twenty-one studies were included although their use of social media was highly variable. The main purpose of social media was to provide information and social support to participants. In the nine randomized controlled trials, social media was used as one aspect of a multi-faceted intervention. Interventions had a positive statistically significant impact on nutritional outcomes in 1/9 trials. Engagement with the social media component of interventions varied, from 3 to 69%. Young adults appear to be open to receiving healthy eating and recipe tips through social media, however, they are reluctant to share personal weight-related information on their online social networks. CONCLUSIONS: Information-dissemination is now an acceptable use of social media by young adults. Using social media effectively for social support, either via private groups or public pages, requires careful evaluation as its effectiveness is yet to be demonstrated in experimental designs. Concerns about public social media use may be a contributing factor to poor engagement with social media in research intervention studies aimed at influencing weight. Future research should consider how to best engage with young adults using social media, how to more effectively use social media to support young adults and to facilitate social and peer-to-peer support in making healthier choices.

Correlates of in-person and technology-facilitated sexual harassment from an online survey among young Australians.

Background Technology-facilitated sexual harassment is an emerging phenomenon. This study investigates correlates of sexual harassment among young Australians. METHODS: Participants aged 15-29 were recruited for an online survey. Participants reported how often in the past year they experienced sexual harassment in person, via phone, social media and dating apps. Correlates of in-person and technology-facilitated sexual harassment were identified using logistic regression. RESULTS: Of all participants (n=1272, 70% female), two-thirds reported sexual harassment in person, 34% through social media and 26% via phone. Of participants who used a dating app in the past year (n=535), 57% experienced sexual harassment. Sexual harassment in person was correlated with being female (aOR=9.2, CI=6.9-12.2), trans and gender diverse (aOR=2.6, CI=1.2-5.7) and being aged 20-24 years (aOR=1.5, CI=1.1-2.1). Heterosexual identity reduced the odds of sexual harassment in person (aOR=0.7, CI=0.5-0.9). Technology-facilitated sexual harassment was correlated with female (aOR=3.5, CI=2.6-4.6) and trans and gender diverse identities (aOR=3.0, CI=1.4-6.5). Older age [25-29 years (aOR=0.5, CI=0.4-0.8)] and heterosexual identity (aOR=0.7, CI=0.5-0.9) significantly reduced the odds of technology-facilitated sexual harassment. CONCLUSION: Young people identifying as female, trans and gender diverse and non-heterosexual are at risk of in-person and technology-facilitated sexual harassment. Service and technology providers, academics, and policy makers must respond with innovative strategies.

"Just not all ice users do that": investigating perceptions and potential harms of Australia's Ice Destroys Lives campaign in two studies.

BACKGROUND: In 2015, the Australian government launched the media campaign Ice Destroys Lives targeting crystal methamphetamine use. Previous research indicates mass media campaigns may have harmful effects for people engaged in drug use. This study investigated perceptions and harms of Ice Destroys Lives among adults with a history of injecting drugs and young people. METHODS: This analysis includes data from two studies: an online questionnaire with young people and in-depth interviews with adults who use crystal methamphetamine. Young people from Victoria, Australia, were recruited through Facebook. We collected data on drug use, campaign recognition and behaviours. Participants who recognised the campaign indicated whether they agreed with five statements related to Ice Destroys Lives. We compared campaign perceptions between young people who reported ever using crystal methamphetamine and those who did not. Adults who use crystal methamphetamine were sampled from the Melbourne injecting drug user cohort study. We asked participants if they recognised the campaign and whether it represented their experiences. RESULTS: One thousand twenty-nine young people completed the questionnaire; 71% were female, 4% had used crystal methamphetamine and 69% recognised Ice Destroys Lives. Three quarters agreed the campaign made them not want to use ice. Ever using crystal methamphetamine was associated with disagreeing with three statements including this campaign makes you not want to use ice (adjusted odds ratio (AOR) = 4.3, confidence interval (CI) = 1.8-10.0), this campaign accurately portrays the risks of ice use (AOR = 3.2, CI = 1.4-7.6) and this campaign makes you think that people who use ice are dangerous (AOR = 6.6, CI = 2.2-19.8). We interviewed 14 people who used crystal methamphetamine; most were male, aged 29-39 years, and most recognised the campaign. Participants believed Ice Destroys Lives misrepresented their experiences and exaggerated "the nasty side" of drug use. Participants felt the campaign exacerbated negative labels and portrayed people who use crystal methamphetamine as "violent" and "crazy". CONCLUSION: In our study, Ice Destroys Lives was widely recognised and delivered a prevention message to young people. However, for people with a history of crystal methamphetamine use, the campaign also reinforced negative stereotypes and did not encourage help seeking. Alternative evidence-based strategies are required to reduce crystal methamphetamine-related harms.

Correlates of sexually transmissible infection testing among a sample of at-risk young Australians.

Annual chlamydia testing is recommended for all sexually active Australians aged 15-29 years; however, the testing rate is below recommended levels. Three surveys at a Melbourne music festival were conducted over 2012-14 to identify correlates of sexually transmissible infection (STI) testing among young people at risk of STIs. In total, 3588 participants were recruited; 72% reported having sex in the past year. Based on sexual behaviours, 38% of sexually active participants were classified as at risk of contracting STIs. In the past year, at-risk participants had significantly higher odds of reporting a STI test (37%) than participants classified as not at risk (24%) (OR=1.9; CI=1.6-2.3). Among at-risk participants, correlates of STI testing in the past year included being aged 20-24 years, visiting a GP, higher knowledge levels, earlier sexual debut and reporting more than five lifetime partners. Testing rates in our sample did not meet levels required to reduce chlamydia prevalence. However, the testing rate was higher in at-risk participants than participants who were not at risk. Future programs aiming to increase chlamydia testing should improve knowledge and promote the importance of testing after risk exposure, particularly among 16- to 19-year-olds.

Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies.

Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.

Social Media and Online Digital Technology Use Among Muslim Young People and Parents: Qualitative Focus Group Study.

BACKGROUND: Digital technology and social media use are common among young people in Australia and worldwide. Research suggests that young people have both positive and negative experiences online, but we know little about the experiences of Muslim communities. OBJECTIVE: This study aims to explore the positive and negative experiences of digital technology and social media use among young people and parents from Muslim backgrounds in Melbourne, Victoria, Australia. METHODS: This study involved a partnership between researchers and a not-for-profit organization that work with culturally and linguistically diverse communities. We adopted a participatory and qualitative approach and designed the research in consultation with young people from Muslim backgrounds. Data were collected through in-person and online focus groups with 33 young people aged 16-22 years and 15 parents aged 40-57 years. Data were thematically analyzed. RESULTS: We generated 3 themes: (1) maintaining local and global connections, (2) a paradoxical space: identity, belonging and discrimination, and (3) the digital divide between young Muslims and parents. Results highlighted that social media was an important extension of social and cultural connections, particularly during COVID-19, when people were unable to connect through school or places of worship. Young participants perceived social media as a space where they could establish their identity and feel a sense of belonging. However, participants were also at risk of being exposed to discrimination and unrealistic standards of beauty and success. Although parents and young people shared some similar concerns, there was a large digital divide in online experiences. Both groups implemented strategies to reduce social media use, with young people believing that having short technology-free breaks during prayer and quality family time was beneficial for their mental well-being. CONCLUSIONS: Programs that address technology-related harms must acknowledge the benefits of social media for young Muslims across identity, belonging, representation, and social connection. Further research is required to understand how parents and young people can create environments that foster technology-free breaks to support mental well-being.

Exploring stigma associated with mental health conditions and alcohol and other drug use among people from migrant and ethnic minority backgrounds: a protocol for a systematic review of qualitative studies.

BACKGROUND: Stigma is a social process that impedes access to support for mental health conditions and alcohol and other drug (AOD) use, particularly for people from migrant and ethnic minority backgrounds. There is limited understanding, however, of people's experiences of stigma, the underlying drivers, intersections with ethnicity, gender, and citizenship status, and how powerful discourses and social institutions create and perpetuate systems of stigma. This review aims to synthesise and critically analyse qualitative evidence to understand how stigma associated with mental health conditions and AOD use operates among people from migrant and ethnic minority groups. METHODS: Qualitative evidence will be identified using MEDLINE, Embase, PsycINFO, CINAHL, Applied Social Sciences Index and Sociological Abstracts. Two reviewers will screen the titles, abstracts and full-text articles. Eligible studies will include original, empirical, peer-reviewed qualitative evidence, published in English since 1990. Studies must examine stigma in relation to mental health conditions, illicit drug use or alcohol consumption among participants who are from migrant and ethnic minority backgrounds. Studies will be critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the level of confidence in the findings will be assessed using Confidence in the Evidence from Reviews of Qualitative research. Data will be analysed using the 'best fit' framework synthesis approach, drawing on the Health Stigma and Discrimination Framework. DISCUSSION: This review will provide an in-depth understanding of the stigma associated with mental health conditions and AOD use among people from migrant and ethnic minority backgrounds. The findings will inform culturally responsive interventions that aim to reduce the negative impact of stigma on individuals, families and communities. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021204057.

Addressing alcohol and other drug use among young people from migrant and ethnic minority backgrounds: Perspectives of service providers in Melbourne, Australia.

Young people from migrant and ethnic minority backgrounds are recognised as emerging priority populations for reducing alcohol and other drug (AOD)-related harms in Australia. Limited research has investigated how service providers address AOD challenges in migrant communities. In this qualitative study, we interviewed 15 service providers from AOD, migrant support, community and other health services in a diverse region of Melbourne. Interviews explored the challenges that service providers faced and the strategies they implemented to engage with young migrants in relation to AOD use. Thematic analysis was used to generate four themes: stigma as a barrier to service delivery, intergenerational differences between young people and parents, the need for outreach and establishing trust and understanding over time. Service providers believed that stigma prevented many young people from migrant backgrounds having open conversations about their AOD use with family members and professionals. Participants perceived that some parents had less AOD-related knowledge and lower English language proficiency than their children creating challenges for effective communication. Service providers recognised the importance of engaging with young people in settings where they felt comfortable rather than expecting them to approach their service. Participants also acknowledged the need to invest time in establishing trust and understanding with young migrants so they could facilitate conversations about AOD use as relationships evolved. Although service providers had a strong understanding of young people's needs, they found it challenging to build relationships in the context of funding and time constraints. Our results indicate the need for long-term funding and timelines that enable service providers to build strong relationships with young migrants, their families and their broader cultural communities to facilitate access to AOD support.

Comparing sexual behaviours and knowledge between domestic students and Chinese international students in Australia: findings from two cross-sectional studies.

Few studies investigate sexual health among Chinese international students in Australia. We recruited domestic (n = 623) and Chinese international (n = 500) students for separate online surveys on sexual behaviours and knowledge. Samples were compared using Chi square, Fisher's exact and equality of medians tests. Domestic students were more likely than international students to have ever touched a partner's genitals (81% vs. 53%, p < 0.01), had oral sex (76% vs. 44%, p < 0.01), vaginal intercourse (67% vs. 41%, p < 0.01) and anal intercourse (31% vs. 6%, p < 0.01). Domestic students were younger when they first touched a partner's genitals (16 vs. 18 years, p < 0.01), had oral sex (17 vs. 18 years, p < 0.01) and vaginal intercourse (17 vs. 18 years, p < 0.01). Domestic students were less likely than Chinese international students to report only one lifetime partner for touching genitals (22% vs. 50%, p < 0.01), oral sex (25% vs. 55%, p < 0.01), vaginal intercourse (30% vs. 58%, p < 0.01) and anal intercourse (54% vs. 88%, p < 0.01). Domestic students were more likely than Chinese international students to use the oral contraceptive pill (48% vs. 16%, p < 0.01) and long-acting reversible contraceptives (19% vs. 1%, p < 0.01). Domestic students scored higher than international students on a contraception and chlamydia quiz (4/5 vs. 2/5, p < 0.01). Domestic and Chinese international students differed in sexual behaviours and knowledge highlighting the need for relevant sexual health promotion for both groups.