Acceptance and use of condoms among school-aged young people in Australia.

BACKGROUND: Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased. METHOD: In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms. RESULTS: Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use. CONCLUSIONS: The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.

Sexting and sexual behaviour in Australian adolescents.

BACKGROUND: Previous studies have tried to determine the relationship between sexting and risky behaviour to discover whether sexting fits into a deviance or normalcy discourse. This study investigated the relationship between sexting and sexual risk behaviours, contraception use and gender. METHODS: The design was a cross-sectional analysis of data from the sixth National Survey of Secondary Student and Adolescent Sexual Health, collected in 2018. There were 8263 Australian adolescents (aged 14-18years). Participants were fairly evenly split by gender, and 73% identified as heterosexual. Participants were asked a series of questions about their engagement in sexting, sexual behaviour and sexual health behaviours. RESULTS: A total of 52% of participants had sent a sext in the previous 2months, with most being text-based sexts. Sexters were 3.29times more likely to have engaged in anal or vaginal intercourse, and 2.88times more likely to have gotten pregnant than non-sexters. Sexters (M =2.76) had significantly more partners than non-sexters (M =2.35), t (3763)=-10.99, P X 2 (1)=0.38, P =0.535, or contraceptive use based on sexting status. CONCLUSIONS: Sexters are more likely to have engaged in sexual intercourse and have more partners than non-sexters. Sexting is not strongly associated with other risky behaviours. Evidence for differences between sexters and non-sexters in protecting against STIs and pregnancy was not found, as there were no significant differences in contraceptive use.

Descriptive norms about condom use predict odds of using a condom during last sexual experience in a large, national survey of adolescents from Australia.

BACKGROUND: Reducing sexually transmitted infections among adolescents is an important public health goal in Australia and worldwide. This study estimated the association between condom use during last heterosexual sexual experience with two descriptive norms among a large, national sample of secondary school students from Australia. METHODS: A large, national online survey of 14- to 18-year-olds in Australia was conducted in 2018; a sub-analysis of sexually active participants (n =2989) used multivariable logistic regression to estimate the relationships between condom use during last sexual experience and condom use norms. The analysis controlled for the effects of age, sex, sexual orientation, religious affiliation, remoteness and knowledge of sexually transmitted diseases. RESULTS: Overall, 1673 (56.0% [95% confidence interval: 54.2%, 57.8%]) sexually active respondents reported using condoms during their last sexual experience. Perceiving that all same-age peers used condoms conferred higher odds of using condoms during their last heterosexual sexual experience (adjusted odds ratio: 3.06 [95% CI: 1.6, 6.0]). Perceptions about whether the suggestion to initiate condom use came from boys, girls, or both boys and girls was not associated with condom use. Differences in condom use related to socio-demographic characteristics are reported. CONCLUSIONS: As part of a holistic approach to sexuality education, health educators and service providers may emphasise that young people frequently choose to use condoms.

Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents.

BACKGROUND: The development of effective health promotion practices and education programs to reduce rates of sexually transmitted infections and unintended pregnancy requires accurate, up-to-date information about young people's sexual behaviors. AIMS: To provide prevalence rates on sexual behaviors and condom and contraceptive use for Australian year 10-12 heterosexual students in a nationally representative sample. METHODS: A nationally representative sample of 2,301 male and 2,055 female year 10 through 12 heterosexual students were recruited to an online survey about their lifetime sexual behaviors and condom and contraceptive use. Means and 95% confidence intervals of weighted data, based on the national census, were reported. OUTCOMES: The main outcomes of this study were prevalence of sexual behaviors by gender (excluding trans and gender diverse) and prevalence of contraception and condom use among sexually active students by gender. RESULTS: The most common sexual behavior was masturbation (96.3% of male students, 78.9% of female students), and the least common behavior was anal or vaginal sex (43.7% of male students, 48.5% of female students). Of the sexually active students, condoms were used by 78.1% of male students and 77.5% of female students at first sexual experience and by 65.1% of male students and 56.8% of female students at their most recent sexual experience, whereas 91.6% of male students and 92.3% of female students used some form of contraception at most recent sexual experience. CLINICAL TRANSLATION: Results provide up-to-date information on the practices clinicians who are likely to encounter with heterosexual cisgender adolescent populations in Australia. STRENGTHS & LIMITAITONS: The study represents the largest representative cohort of adolescents in Australia to date. However, comparisons with previous representative studies were limited owing to differing samples by age and culture. CONCLUSIONS: Compared with earlier Australian studies, young heterosexual cisgender people today engage in slightly less oral and penetrative sexual behaviors, with the exception of more women receiving oral sex, and are generally consistent in condom and contraceptive use. Fisher CM, Kauer S, Mikolajczak G, et al. Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents. J Sex Med 2020;17:2313-2321.

Effectiveness of a Mental Health Service Navigation Website (Link) for Young Adults: Randomized Controlled Trial.

BACKGROUND: Mental health and substance use disorders are the main causes of disability among adolescents and young adults yet fewer than half experiencing these problems seek professional help. Young people frequently search the Web for health information and services, suggesting that Web-based modalities might promote help-seeking among young people who need it. To support young people in their help-seeking, we developed a Web-based mental health service navigation website called Link. Link is based on the Theory of Planned Behavior and connects young people with treatment based on the type and severity of mental health symptoms that they report. OBJECTIVE: The study aimed to investigate the effect of Link on young people's positive affect (PA) compared with usual help-seeking strategies immediately post intervention. Secondary objectives included testing the effect of Link on negative affect (NA), psychological distress, barriers to help-seeking, and help-seeking intentions. METHODS: Young people, aged between 18 and 25 years, were recruited on the Web from an open access website to participate in a randomized controlled trial. Participants were stratified by gender and psychological distress into either the intervention arm (Link) or the control arm (usual help-seeking strategies). Baseline, immediate postintervention, 1-month, and 3-month surveys were self-reported and administered on the Web. Measures included the PA and NA scales, Kessler psychological distress scale (K10), barriers to adolescent help-seeking scale (BASH), and the general help-seeking questionnaire (GHSQ). RESULTS: In total 413 young people were recruited to the trial (intervention, n=205; control, n=208) and 78% (160/205) of those randomized to the intervention arm visited the Link website. There was no evidence to support a difference between the intervention and control arms on the primary outcome, with PA increasing equally by approximately 30% between baseline and 3 months in both arms. NA decreased for the intervention arm compared with the control arm with a difference of 1.4 (95% CI 0.2-2.5) points immediately after the intervention and 2.6 (95% CI 1.1-4.1) at 1 month. K10 scores were unchanged and remained high in both arms. No changes were found on the BASH or GHSQ; however, participants in the intervention arm appeared more satisfied with their help-seeking process and outcomes at 1 and 3 months postintervention. CONCLUSIONS: The process of prompting young people to seek mental health information and services appears to improve their affective state and increase help-seeking intentions, regardless of whether they use a Web-based dedicated youth-focused tool, such as Link, or their usual search strategies. However, young people report greater satisfaction using tools designed specifically for them, which may encourage future help-seeking. The ability of Web-based tools to match mental health needs with appropriate care should be explored further. CLINICAL TRIAL: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366731.

The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial.

BACKGROUND: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. METHODS: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life-4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. RESULTS: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus -$81 (Aus -$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. CONCLUSIONS: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731.

Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link.

OBJECTIVE: To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT. DESIGN: A pilot RCT with 1:1 randomisation to either the intervention or comparison arm. SETTING: An online study conducted Australia-wide. PARTICIPANTS: 18-25 year olds living in Australia were recruited via social media. INTERVENTION: Link is a dedicated online mental health help-seeking navigation tool that matches user's mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com. MAIN OUTCOME MEASURES: The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust. RESULTS: Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected. CONCLUSION: Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry, ACTRN12614000386639.

Health profiles of overweight and obese youth attending general practice.

BACKGROUND: Literature suggests that overweight and obese young people use healthcare services more often, but this awaits confirmation in primary care. OBJECTIVE: To identify health profiles of underweight, overweight and obese young people attending general practice and compare them to normal-weight youth and also to explore the weight-related health risks of eating and exercise behaviour in the four different weight categories. METHODS: This study used a cross-sectional design with baseline data from a trial including 683 young people (14-24 years of age) presenting to general practice. Through computer-assisted telephone interviews data were obtained on number and type of health complaints and consultations, emotional distress, health-related quality of life (HRQoL) and eating and exercise behaviour. RESULTS: General practitioners (GPs) were consulted more often by overweight (incidence rate ratio (IRR): 1.28, 95% CI (1.04 to 1.57)) and obese youth (IRR: 1.54, 95% CI (1.21 to 1.97), but not for different health problems compared with normal-weight youth. The reason for presentation was seldom a weight issue. Obese youth reported lower physical HRQoL. Obese and underweight youth were less likely to be satisfied with their eating behaviour than their normal-weight peers. Exercise levels were low in the entire cohort. CONCLUSIONS: Our study highlights the need for effective weight management given that overweight and obese youth consult their GP more often. Since young people do not present with weight issues, it becomes important for GPs to find ways to initiate the discussion about weight, healthy eating and exercise with youth. TRIAL REGISTRATION NUMBER: ISRCTN16059206.

Road safety risks in young people attending general practice: A cross-sectional study of road risks and associated health risks.

BACKGROUND: Young people have a large burden of death and disease from risky road behaviours. Guidelines recommend injury prevention and harm minimisation counselling; however, little is known about road risks in youth attending primary care. OBJECTIVE: The aim of this study was to examine the type of road risks and associated behaviours in young people attending general practice. METHODS: A cross-sectional analysis was undertaken on health risk survey data from a sample of 901 patients, aged 14-24 years, attending 40 Victorian general practices in a stratified cluster randomised trial. RESULTS: Frequently occurring road risks included travelling with people under the influence of alcohol or drugs (55%), speeding (43%) and mobile phone use (40%). These behaviours were strongly associated with other health risks, including use of tobacco, alcohol and illicit drugs, and unprotected sex. DISCUSSION: High proportions of youth attending general practice engage in road risks, making this a potential setting to discuss road risks along with broader health risk prevention activities.

Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.

BACKGROUND: Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale. RESULTS: From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use. CONCLUSIONS: There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence.

Do online mental health services improve help-seeking for young people? A systematic review.

BACKGROUND: Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. OBJECTIVE: This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. RESULTS: Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. CONCLUSIONS: Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype.

BACKGROUND: GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people's reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. METHODS: We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project's Exit Interview. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care. CONCLUSIONS: We conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Temporal mood changes associated with different levels of adolescent drinking: using mobile phones and experience sampling methods to explore motivations for adolescent alcohol use.

INTRODUCTION AND AIMS: Alcohol use during adolescence is associated with the onset of alcohol use disorders, mental health disorders, substance abuse as well as socially and physically damaging behaviours, the effects of which last well into adulthood. Nevertheless, alcohol use remains prevalent in this population. Understanding motivations behind adolescent alcohol consumption may help in developing more appropriate and effective interventions. This study aims to increase this understanding by exploring the temporal relationship between mood and different levels of alcohol intake in a sample of young people. DESIGN AND METHODS: Forty-one secondary school students used a purpose-designed mobile phone application to monitor their daily mood and alcohol use for 20 random days within a 31 day period. Generalised estimating equations were used to examine the relationship between differing levels of alcohol consumption (light, intermediate and heavy) and positive and negative mood three days before and after drinking episodes. RESULTS: While there was no relationship between light and heavy drinking and positive mood, there was an increase in positive mood before and after the drinking event for those that drank intermediate amounts. No statistically significant relationships were found between negative mood and any of the three drinking categories. DISCUSSION AND CONCLUSION: Adolescents who drank in intermediate amounts on a single drinking occasion experienced an increase in positive mood over the three days leading up to and three days following a drinking event. These findings contribute to an understanding of the motivations that underpin adolescent alcohol use, which may help inform future interventions.

Using a mobile phone application in youth mental health - an evaluation study.

BACKGROUND: This study evaluates a mobile phone self monitoring tool designed to assist paediatricians in assessing and managing youth mental health. METHODS: Patients from an adolescent outpatient clinic monitored mental health symptoms throughout each day for 2-4 weeks. Paediatricians specialising in adolescent health and participants reviewed the collated data displayed online and completed quantitative and qualitative feedback. RESULTS: Forty-seven adolescents and six paediatricians participated. Completion was high, with 91% of entries completed in the first week. Paediatricians found the program helpful for 92% of the participants and understood 88% of their patients' functioning better. Participants reported the data reflected their actual experiences (88%) and was accurate (85%), helpful (65%) and assisted their paediatrician to understand them better (77%). Qualitative results supported these findings. DISCUSSION: Self monitoring facilitates communication of mental health issues between these paediatricians and patients and is a promising tool for the assessment and management of mental health problems in young people.

Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial.

BACKGROUND: The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression. OBJECTIVES: We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms. METHODS: We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs). RESULTS: Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (-6.366 to -0.029). The proportion of the maximum possible indirect effect estimated was κ(2 )=.54 (95% CI .426-.640). CONCLUSIONS: This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k).

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.

BACKGROUND: Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. METHODS: We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. CONCLUSIONS: Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: lessons and recommendations.

INTRODUCTION AND AIMS: The trajectory from alcohol use to alcohol use disorders in adolescence is yet to be understood. Momentary sampling may assist in capturing 'real-time' data on young people's alcohol use and associated motivational factors. This paper aims to review the feasibility and usefulness of a mobile phone momentary sampling program to capture data about alcohol use and related behaviours. DESIGN AND METHODS: Two studies were conducted: a school-based study with 18 Year 9 and 11 students and a clinical study with eight high-risk adolescent drinkers. Participants answered questions about their daily activities, alcohol use, stressors and negative mood four times a day for 1 week using a mobile phone momentary sampling program. RESULTS: In the school-based study, 61% of participants reported drinking alcohol. On drinking days participants spent less time studying (14% vs. 26%), more time sleeping or resting (35% vs. 12%) and more time hanging out (21% vs. 11%) than on non-drinking days. In the high-risk sample, 88% of participants reported drinking alcohol. On drinking days, these participants spent a greater proportion of their waking time with their boyfriend or girlfriend (19.2% vs. 6%) and generally had higher negative mood than on non-drinking days. DISCUSSION AND CONCLUSIONS: The current mobiletype program was well suited to capturing data on alcohol use in younger, school-attending adolescents. However, to capture alcohol use in older adolescents who lead less routine lives, it is necessary to make some amendments including targeting particular behaviours and symptoms. Recommendations for future studies are proposed.

A mobile phone program to track young people's experiences of mood, stress and coping. Development and testing of the mobiletype program.

BACKGROUND: Research examining adolescent mood, stresses, and coping has tended to use retrospective questionnaires which are affected by recall biases. The aim of this study was to develop, pilot, and evaluate a youth-friendly mobile phone program to monitor, in real-time, young people's everyday experiences of mood, stress, and their coping behaviours. METHOD AND DESIGN: A momentary sampling program was designed for mobile phones, and ran for 7 days, administering a brief questionnaire four random times each day, capturing information on current activity, mood, responses to negative mood, stresses, alcohol and cannabis use. Eleven high school students reviewed the program in focus groups, and 18 students completed 7 days of monitoring. RESULTS: Engagement with the mobiletype program was high with 76% of 504 possible entries completed and 94% (17/18) of the participants reporting that the program adequately captured their moods, thoughts, and activities. The mobiletype program captured meaningful and analyzable data on the way young people's moods, stresses, coping strategies, and alcohol and cannabis use, vary both between and within individuals. CONCLUSIONS: The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.