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. We interviewed 14 people who used crystal methamphetamine; most were male, aged 29—39 years, and most recognised the campaign. 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. For example, one video advertisement featured a male character stealing from and physically assaulting his mother in the presence of a young child. However, the evaluation did not report whether participants had previously used crystal methamphetamine or other illicit drugs which may have influenced their opinion of the campaign. Importantly, the evaluation did not consider the effects of the campaign for other audiences such as people who already use crystal methamphetamine. Given the indication within the literature that these campaigns can be harmful, we analysed data from two ongoing studies an online survey and a cohort study to investigate potential harms of media campaigns targeting illicit drug use. Design and setting This study analysed data from two different studies with two different population groups. We used data from a large online questionnaire with young people that included a section of questions about the Ice Destroys Lives campaign. We also analysed interviews conducted as part of a cohort study with adults who had a history of injecting drug use who report crystal methamphetamine use to gather in-depth information. Briefly, we invited Victorians aged 15—29 years to complete an online questionnaire. Participants were recruited from social network sites through advertisements on Facebook and Instagram, and posts on Facebook pages that target young people such as university pages and community youth groups. This study includes data from the 2016 questionnaire. Main outcome measures We asked if participants recognised Ice Destroys Lives by providing five still images from the campaign. Participants stated whether they strongly agreed, agreed, neither agreed nor disagreed, disagreed or strongly disagreed with each statement. All statements were informed by drug experts and pilot-tested with young people. Analysis All quantitative data were analysed using Stata version 13. Socio-demographic characteristics are presented as descriptive statistics. We used logistic regression to determine if any socio-demographic characteristics were associated with crystal methamphetamine use. We calculated the percentage of participants who agreed, disagreed or remained neutral with each statement on Ice Destroys Lives. We used multinomial logistic regression to calculate whether ever using crystal methamphetamine was correlated with agreeing, disagreeing or remaining neutral to statements about the campaign. We ran a second multinomial logistic regression model that adjusted for socio-demographic characteristics that we identified as significantly associated with using crystal methamphetamine. Participants were initially recruited through street outreach and respondent-driven sampling. Participants complete an annual interview and provide in-depth information on drug use patterns, health service utilisation and other social outcomes. Participants from MIX were eligible to complete an additional face to face in-depth interview focusing on their use of crystal methamphetamine if they 1 reported that they had used crystal methamphetamine more regularly than heroin or any other drug for a week or more since their baseline study visit, 2 could be contacted by telephone to arrange the interview and 3 provided written informed consent. Two trained interviewers authors AP and PH conducted these interviews, one section of which explored recall and perceptions of the Ice Destroys Lives campaign. Interviews with MIX participants were audio-recorded and transcribed verbatim. Main outcome measures Participants were asked if they recalled Ice Destroys Lives. All participants were asked open-ended questions about their perceptions of the campaign and whether it represented their experiences and use of crystal methamphetamine. Analysis Interview transcripts were uploaded into NVivo 11 for processing and coding in a de-identifiable form. Authors CD and EE performed thematic analysis and used inductive, iterative coding. Transcripts were initially coded with broad open codes which were refined and converged during the process as deemed necessary. Researcher triangulation was also implemented, in which transcripts were read by the interviewers AP and PH to confirm the themes that arose from the analysis. In 2016, we recruited 1029 young people. Their characteristics appear in Table. The majority were female, and the mean age was 23 years. In total, 54% of participants had ever used an illicit drug. Of all participants, 4% reported that they had used crystal methamphetamine in their lifetime and 1% had used it in the past month. Among participants who recognised the campaign, 71% were female and the mean age was 23 years. Of all participants, 75% agreed the campaign made them not want to use ice, 55% agreed it accurately portrays the risk of ice use, 46% agreed the campaign will scare young people off using ice and 84% agreed that the campaign made them think that people who use ice are dangerous. Overall, 47% disagreed that the campaign would encourage ice users to seek help. When we adjusted for age, gender, living arrangements, money spent per week and sexual identity, disagreeing with three of the five campaign statements remained significantly associated with reporting crystal methamphetamine use. Qualitative results from in-depth interviews with adults who inject drugs Sixty participants from MIX were eligible to participate in an in-depth interview focusing on crystal methamphetamine use. When researchers attempted to contact eligible participants, most phone numbers were disconnected. Of participants who could be contacted, 14 consented to participate and two declined. Almost all participants interviewed were unemployed and lived in government housing. Nine of the 14 participants reported that heroin was their drug of choice at the time of the interview, while the remaining five nominated crystal methamphetamine as their drug of choice. Campaign recognition and recall Recall of the Ice Destroys Lives campaign among adults who used crystal methamphetamine was mixed; six participants recalled seeing it, four reported they had not seen it and four participants were unsure. After being shown an excerpt of the video advertisement, those participants who were initially unsure reported that they did recognise the campaign. Perceptions of Ice Destroys Lives campaign The main theme that emerged during the interviews was that Ice Destroys Lives misrepresented the experiences of people who use crystal methamphetamine. Despite acknowledging the harms of ice, most participants felt that Ice Destroys Lives did not accurately portray their personal experiences or behaviours. I have my own things to do male, 37 years. While participants eagerly explained that the campaign misrepresented their personal circumstances and behaviours, they also believed that Ice Destroys Lives did not represent other people who use crystal methamphetamine. Ten participants mentioned that all people have different experiences when using the drug. Just not all ice users do that. Participants felt that Ice Destroys Lives exacerbated negative stereotypes and created fear throughout the community. They discussed the role of sensationalised media reporting contributing to assumptions and labels that community members imposed upon them. Just some people think that you are going to go crazy or yeah. They just show so many people who have gotten violent whilst using ice and that, bashing bus drivers and that. They think that everyone who uses it is going to get like that…They think that all ice users will, just you know, bash them or rob them or do something male, 38 years. Ice Destroys Lives was also highly recognised by participants who used crystal methamphetamine, suggesting that it is important to consider the implications this campaign had on other audiences. In our questionnaire, three quarters of participants reported that the campaign made them not want to use ice and 46% agreed it would scare young people off using ice. However, our findings show that the campaign also had adverse effects: 84% reported that the campaign made them think that people who use ice are dangerous and 47% disagreed that the campaign encouraged help-seeking behaviours. This suggests that Ice Destroys Lives also delivered stigmatised messages to its target audience. Participants who had previously used crystal methamphetamine were significantly less likely to believe that the campaign was accurate, helpful or effective. Alternatively, participants who had never used crystal methamphetamine were more likely to agree that the campaign made them think that people who use ice are dangerous. Perceptions of the campaign among adults who use crystal methamphetamine When interviewed, adults with a history of injecting drug use who had used crystal methamphetamine generally did not identify with the violent behaviours depicted in Ice Destroys Lives. Participants felt that the campaign did not encourage them to seek help nor would it prevent them from using crystal methamphetamine in the future. Limitations This study has some limitations. Only 33 participants from the online survey who were included in logistic regression had used crystal methamphetamine in their lifetime, and of these, 24% had used the drug in the past month. Consequently, confidence intervals lack precision, and results do not capture the perceptions of young people who have recently engaged in crystal methamphetamine use. Future studies should recruit a larger sample of young people engaged in drug use and differentiate results by usage patterns. All data were self-reported and may have been influenced by social desirability bias; however, this was minimised by the anonymity of the survey's online platform. We recruited participants of the existing MIX study who use crystal methamphetamine through purposive sampling. The participants we interviewed were a highly marginalised group; most were unemployed, lived in government housing and involved in treatment programs. It is likely that their past experiences increased their negative perceptions of the campaign. The MIX participants were significantly older than the target population of Ice Destroys Lives and had a history of injecting drugs; qualitative results are therefore not applicable to younger people who use crystal methamphetamine recreationally and may use by modes besides injecting. In future, it would be beneficial to evaluate similar campaigns with younger people based on patterns of usage. However, one aim of this study was to assess impacts of the campaign on those outside the target group; therefore, our study provides important information on the effects of media campaigns on adults with a history of injecting drugs. Initially, 60 MIX participants were eligible for interviews focusing on crystal methamphetamine; however, most of their telephone numbers were disconnected, and we were unable to contact them. Participants who were contactable by telephone may differ from the participants we were unable to reach. However, of participants who were contacted, the response rate was high and their socio-demographic characteristics reflected the MIX sample. Ice Destroys Lives was well recognised and delivered a prevention message to young people in our study; however, among young people who had ever used crystal methamphetamine, the campaign was less well perceived. Our study also provides important evidence that adults with a history of injecting drug use recalled this shock-based campaign but did not identify with the behaviours portrayed. Implications included feeling misrepresented and being negatively labelled, likely contributing further to discrimination and stigma within the community. Funding No specific funding was received for this study. Funding for the MIX study is provided by National Health and Medical Research Council NHMRC and the Centre for Research Excellence on Injecting Drug Use. The authors gratefully acknowledge the support of the Victorian Operational Infrastructure Support Program received by Burnet Institute. Cassandra Wright is supported by an Australian Government Research Training Program Scholarship. Megan Lim is supported by the Jim and Margaret Beever Foundation. Paul Dietze is supported by an ARC Future Fellowship and has received funding from Gilead Sciences and Reckitt Benckiser for work unrelated to this study. The funding bodies were not involved in study design, collection, analysis or interpretation of data or in writing the manuscript. EE and CW were involved in quantitative and qualitative data analysis. PH was involved in study design and interviewing. AP conducted interviews and assisted with data analysis. BQ provided input into data collection and analysis for both studies. PD had input into the data collection and leads the MIX study. All authors have contributed to and approved the final manuscript. Participants provided informed consent online. The MIX study received ethical approval from the Alfred Health Human Research Ethics Committee and Monash University Human Research Ethics Committee. All participants provided written informed consent. No data were published from individual participants. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4. The Creative Commons Public Domain Dedication waiver applies to the data made available in this article, unless otherwise stated. Vienna: United Nations; 2016. Accessed 06 Apr 2017. National Drug Strategy Household Survey detailed report, Drug statistics series no. Accessed 06 Apr 2017. Australian Drug Trends 2015. Findings from the Illicit Drug Reporting System IDRS. Sydney: National Drug and Alcohol Research Centre UA; 2016. Accessed 06 Apr 2017. Crystalline methamphetamine use and methamphetamine-related harms in Australia. High-frequency drug purity and price series as tools for explaining drug trends and harms in Victoria, Australia. Trends in methamphetamine use from three Victorian surveillance systems. Aust N Z J Public Health. National Drug Strategy Household Survey 2016 key findings. Accessed 26 June 2017. Sydney: Centre NDaAR; 2013. Ice addiction: graphic ad campaign on dangers of ice launched by Federal Government. Accessed 06 Apr 2017. Government response to the final report of the National Ice Action Taskforce. Accessed 06 Apr 2017. Use of mass media campaigns to change health behaviour. Are mass-media campaigns effective in preventing drug use? A Cochrane systematic review and meta-analysis. The prevention of substance use, risk and harm in Australia: a review of the evidence. Drugs: Educ Prev Policy. The Meth Project and teen meth use: new estimates from the national and state youth risk behavior surveys. National Drugs Campaign 2015 Second Evaluation Research. Paddington: Sydney NSW; 2016. Accessed 30 Jan 2017. Taking action stopping ice—facts and help. Accessed 06 Apr 2017. Aust N Z J Public Health. Establishing the Melbourne injecting drug user cohort study MIX : rationale, methods, and baseline and twelve-month follow-up results. Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia. AIVL national network submission to the national ice taskforce. Accessed 06 Apr 2017. Sexual health and stigma in urban newspaper coverage of methamphetamine. Am J Mens Health. The haunting spectacle of crystal meth: a media-created mythology? Changing the language of addiction. Theorising stigma and the experiences of injecting drug users in Australia. Aust J Prim Health. Measuring sexual behaviour: methodological challenges in survey research. Research recruitment using Facebook advertising: big potential, big challenges. The impact of individual and interpersonal factors on perceived news media bias.
