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“Dying is Not a Fear”: Teen and Parent Perspectives on Messaging to Prevent Crystal Meth Use Among Teens in Rural North Idaho

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Crystal methamphetamine (“meth”) use is on the rise in the USA, having devastating effects on individuals and communities. Innovative prevention strategies are therefore critical. Through an exploratory qualitative study, we examined the perspectives and experiences of teenagers and parents around meth prevention messaging formats and strategies. Teens and adults were recruited through middle and high schools, libraries, local sporting events, and word of mouth in three communities in North Idaho, May–September 2016. Guided by the theoretical framework of the Extended Parallel Process Model, we conducted focus groups and small group interviews (three teen; two adults). Using a deductive content analytic approach, we developed teen- and adult-specific codebooks, analyzed the transcripts with NVivo 12-Plus, and identified themes. Teens and adults were all acutely aware of meth use in their communities, personally knowing people who were addicted to meth, and all understood the oral (“meth mouth”) and physical (“crank bugs”) consequences of meth use. Three primary themes were identified, which focused on the effects of, addiction to, and messaging around crystal meth use. For teens and adults, images illustrating the effects of meth were least effective if they appeared unrealistic or comical. Teens resonated most with messages focusing on pain and vanity (bad teeth and breath), and there was consensus that showing teens images simulating changes in their appearance over time as a result of meth use in a clinical setting would be an effective prevention strategy. Teens and adults who had exposure to meth addiction in North Idaho felt that prevention messages focused on meth are imperative, given its high prevalence and deleterious effects. Future work will entail developing and testing a communication-based meth prevention strategy along with tailored messaging that can be used with teens in dental settings.

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The authors wish to respectfully acknowledge Drs. Kimberly Dong Breen, Kenneth Chui, and Sara Folta, for their help and support during the writing of this article, as well as Tamar Boyadjian, for her work on editing and proofreading the manuscript.


The study was funded by a grant from the DentaQuest Foundation through the President's Fund mechanism.

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Correspondence to Margie R. Skeer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Tufts University Health Sciences Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Participants over 18 completed informed consent forms; participants under 18 provided completed parental consent forms and were given an information sheet explaining the purpose of the study and what would be done with the data.

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The authors declare that they have no conflict of interest.

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Skeer, M.R., Landy, D.M., Abrahams, J.M. et al. “Dying is Not a Fear”: Teen and Parent Perspectives on Messaging to Prevent Crystal Meth Use Among Teens in Rural North Idaho. Prev Sci 22, 579–589 (2021).

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