Experience Of Harm Research Articles

‘We were persistently othering them out’: Reconceptualising ‘safeguarding’ for young people experiencing extra-familial risks and harms during transition to adulthood

Background: The transition to adulthood may involve experiences of risk and harm – including, for some young people, abuse, violence or exploitation in peer and community contexts. In the UK, such extra-familial risks and harms have prompted safeguarding responses in policy and practice. However, safeguarding conceptualisations are significantly different for young people under 18 than for those over 18, leading to service and system gaps in transition. The concept of Transitional Safeguarding seeks to address this, advocating for more integrated approaches that centre the needs, voices and lived experiences of young people. Objectives: Based on findings from a study on early-stage innovation developments aligned with Transitional Safeguarding, this paper considers issues and dilemmas linked to reconceptualising ‘safeguarding’ so as to better protect young people experiencing extra-familial risks and harms during transition to adulthood. Methods: A 4-year study followed safeguarding innovation developments in selected local areas in England, based on a qualitative case study approach that involved ethnography, interviews and documentary analysis. Findings: The paper highlights gaps in safeguarding services and systems for young people around age 18, when support may either significantly decrease or stop altogether. The intersecting dynamics of risks, harms and unmet needs point to the importance of multi-agency collaboration, beyond service-centric threshold definitions. The need to systemically and systematically involve young people in support and innovation development is also emphasised. Conclusions: The boundary-spanning change which the Transitional Safeguarding approach advocates requires significant shifts to create conditions capable of addressing risks and harms during transition to adulthood, as well as their structural drivers. Navigating these shifts remains a key challenge for local services and systems engaged in Transitional Safeguarding innovation, and their efforts need to be supported by policy frameworks and adequate funding.

Clients' narratives of healing and harm in psychotherapy: A qualitative method

AbstractPurposeFor decades, researchers have acknowledged the potential for negative effects in psychotherapy, highlighting the need for further investigation. However, a clear understanding of the nature and definition of harm within this context has remained elusive. Efforts were made to clarify terminology such as ‘side effects’ and ‘negative effects’, but a consensus on the extent and definition of harm has continued to evade the field. Notably, existing research on negative effects has often prioritised expert and therapist perspectives, neglecting the crucial insights offered by the client's subjective experience of harm.MethodThis study adopted an exploratory approach, employing qualitative research methods. To uncover and illuminate past experiences of harm within the therapeutic context, semi‐structured interviews were conducted with 21 participants (15 female, 6 male) who reported perceiving their psychotherapy sessions as harmful. Data analysis utilised the theoretical framework of Strauss and Corbin's grounded theory approach, facilitated by the MAXQDA2020 software.ResultsThe study results offered a comprehensive examination of factors contributing to client‐perceived harm in psychotherapy, categorised as both client‐related and therapist‐related. Additionally, the definition of harm was explored through the lens of emotional and cognitive experiences. The client's reaction to perceived harm (submission, avoidance and compensation) and the therapist's course of action vs. the client's reaction (corrective and justifying) respectively, can cause consequences (strengthening the therapeutic alliance and the client's healing or individual and interpersonal impacts) from the client's perspective.ConclusionA significant finding was the lack of attention paid to the interpersonal nature of psychotherapy in past understandings of harm. The results highlight the potential for harm in any therapeutic relationship, regardless of the therapist. This potential appears to be particularly heightened when therapists display a lack of responsiveness to clients' internal experiences, especially through justifying comments in response to client‐reported negative experiences within the therapeutic relationship. Based on these findings, the study offers clinical recommendations for therapists to enhance their responsiveness and mitigate potential harm.

Digital media in early childhood: risk factors for online harm and psychosocial correlates

IntroductionEarly and middle childhood are times of rapid development, and critical periods for laying the foundations of life-long trajectories of socioemotional well-being. High levels of screen media use are of growing concern to parents, health professionals, and researchers, given the increasing body of research demonstrating detrimental impacts of excessive screen use in young children. One particular consequence is the risk that children encounter online content or experiences that are upsetting or distressing, including exposure to inappropriate or adult content, cyberbullying, and interactions with strangers that they don't know.MethodsThis research examined experiences of online harm reported in a sample of 8-year-old children, with a focus on identifying risk factors and psychosocial correlates of online harm. Data for this study were collected from children and their mothers as part of the prospective longitudinal Growing Up in New Zealand (GUiNZ) study (n = 4,920 children with data at age 8). Children were assessed at 4.5-years-old and 8-years-old.ResultsThe findings of this research indicate that approximately a quarter of New Zealand children have experienced online harm (that is, have encountered online content that worried, upset, or bothered them) by the age of 8. Our analysis indicates that children with behavioral difficulties are at greater risk of online harm, as are children with more personal devices. Experiences of online harm were found to be negatively associated with child self-worth and positively associated with depressive symptoms.DiscussionFindings highlighting the critical importance of considering online harm as a contributing factor to child and youth well-being and mental health in our media-saturated world. Our results also point to practical solutions for parents, such as limiting the number of personal media devices that children have in early and middle childhood.

‘No ability to choose freedom’: a qualitative study on people who use drugs’ experiences of compulsory isolation treatment

Background Extensive criminological literature has paid attention to the exacerbation of disadvantage due to compulsory treatment of drug use within vulnerable communities. However, understanding how compulsivity shapes users’ narrative framework and meaning construction of lives is still limited. Methods Based on an ethnography conducted at a Compulsory Isolation Treatment Center (CITC) in Central China, we collect in-depth interview data about how trainees who were convicted as drug dependents experienced and interpreted compulsory treatment in the context of life history. Our coding and case analysis of data illustrate four representative narratives on rehabilitation and reveal different ways of meaning-giving between each other. Results Our finding shows that the experience of incarcerated detoxification did not relieve the social disadvantages of people who use drugs. Instead, it was perceived as a negative encounter that intensified discrimination, deeply ingrained in social identity and constantly resurfaced in everyday life. Specifically, harmful experiences are generated by the punitive management of CITC, which underlines obedience between instructors (police officers) and trainees and encourages mutual distrust among peers. The crippling of interpersonal relationships prevents participants from developing social connections or restoring social skills. We also find trainees’ diverse coping strategies to the punitive institutions, ranging from showing physical weakness for board shelter catering to the standard of conduct for an early release to deciphering the intricacies of power relations in CITC. However, these temporary strategies cannot balance their permanent estrangement from public life and thus make them descend into the invisible confines of societal imprisonment. Implications Our ethnographic descriptions reveal the deliberated production of punishment and isolation in the process of compulsory isolation treatment and explicate the potential proximity between political correctives and drug treatment. We, thus, promote abolishing the compulsory isolation model in China, which stems not only from the inefficiency of the treatment at the medical level but also from the political motivations behind the institution and the superficiality of its moral reshaping.

Ethics in social listening in infodemic management in health emergencies

Abstract Issue During the COVID-19 pandemic and subsequent outbreaks, health organizations have increased the use of social listening to inform infodemic management and outbreak response activities. This demonstrated the need to provide ethical guidance to organizations, and individuals engaging in social listening practices before, during and after public health emergencies, whilst protecting human rights. Description of the problem Social listening as a public health activity draws on analysis of conversations in social media, internet platforms, and feedback from geographically localized communities. Infodemic insights are generated rapidly, to support agile action by health organizations that improves outbreak response, health information delivery, community engagement, or reduction of unintended harm experiences by communities. Social listening involves use of social media and internet trace data, which were traditionally not used in public health for understanding community expressions, WHO convened a panel of experts to develop a framework on ethical considerations for social listening in infodemic management to provide recommendations for health authorities and researchers on practical tools that support setting up new data analysis and use of insights hereto not used in routine. Results The guidance framework has been structured into segments that vary from ethical principles and challenges in social listening and generation of infodemic insights, alignment with human rights, substantive principles, procedural principles, and practical guidance for translating these principles into real-world practice. Lessons This guidance aims to illuminate the intricate ethical dimensions of social listening and stress the urgent need for ethical guidance in this realm. The framework is a comprehensive inquiry of the ethical scope in social listening, providing valuable insights, practical guidance, and case studies to enhance understanding of this critical global health issue. Key messages • While essential, social listening and infodemic insights come with ethical risks, including potential harm to populations in vulnerable situations, erosion of trust, and misuse of data. • This ethical framework will govern social listening practices and ensure responsible and ethical social listening.

Perceptions and Cultural Practices of Vaping Among Lesbian, Bisexual, and Queer Women in Australia

Abstract Background The rising prevalence of vaping poses new challenges and opportunities for health policy and public health interventions. Given that, historically, smoking has been more prevalent among lesbian, bisexual, and queer (LBQ) women than other women, this study explores LBQ women’s perceptions and experiences of vaping. Methods Sixty LBQ women and some non-binary people (aged 18–72) participated in in-depth qualitative interviews between May and July 2023, providing insights into the emerging prevalence and nature of vaping within LBQ women’s communities. Thematic analysis techniques were employed to identify key themes, including (1) risk perceptions and social stigma, (2) gendered perceptions of vaping, and (3) experiences of vaping-related harms. Results Results highlight gendered perceptions of vaping among LBQ women, with participants describing vaping as a feminine practice, influenced by flavour choices and the visual aesthetics of vape devices. Despite perceiving vaping as more socially acceptable than smoking, some participants expressed a sense of embarrassment about vaping, while others reported substantial challenges and health concerns. Conclusion Concerns about vaping-related harms, addiction, and the evolving social dynamics of vaping contribute to LBQ women’s engagement with this emerging practice. Understanding these dynamics is crucial for developing targeted harm reduction strategies and support services tailored to LBQ women’s unique needs in the evolving landscape of vaping. Policy Implications Health and social policy may require specific responses to address higher rates of vaping among LGBTQ populations, including LBQ women.

Use of AI in Mental Health Care: Community and Mental Health Professionals Survey.

Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time.

Problematic and Harmful Social Media Use among Adolescents Receiving Intensive Psychiatric Care.

Although research has shown both positive and negative mental health correlates of social media use, few studies focus on adolescents who are receiving intensive psychiatric care. The purpose of this study was to describe problematic media use, experiences of cybervictimization and sextortion, and correlates with adolescents' health in a sample of adolescents (N = 97; 53.6% female) in a partial psychiatric hospitalization program. Approximately one-quarter of participants reported being cybervictimized at least once over the past month and 17.5% of participants reported ever experiencing sextortion. Greater problematic media use was associated with lower physical activity and greater feelings of loneliness. In a subsample of 51 participants, questions were asked regarding who they had gone to for support regarding experiences of online harm, and barriers to disclosing such experiences. The majority of youth who experienced cybervictimization indicated going to a friend for support but rarely endorsed telling a mental health clinician about it. Even fewer disclosed their experience of sextortion, with nearly half reporting not telling anyone (44.4%). Given the rates of online harm experienced by youth in acute psychiatric treatment, screening for and conducting brief interventions on problematic or risky social media use is recommended.

Experiences of harm and mental ill-health among gay, bisexual and other men-who-have-sex-with-men who use methamphetamine or GHB/GBL in different combinations: findings from the COMeT study in Taiwan

IntroductionPolydrug use in the context of chemsex is commonplace among gay, bisexual, and other men-who-have-sex-with-men (GBMSM). This study aimed to examine the differences in experiences of physical, social, and psychological harms, as well as mental ill-health among GBMSM who use different combinations of methamphetamine and gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL) during chemsex.MethodAdult GBMSM participants who had experience of chemsex in the past 12 months participated in a cross-sectional online survey in Taiwan and self-reported their sociodemographic background, sexual behaviours, mental health, and experiences of harm following a chemsex session. We used univariable and multivariable logistic regression to assess the different experiences of harm and mental ill-health among GBMSM who engaged in chemsex without using methamphetamine, used methamphetamine but not GHB/GBL, and who used both drugs.ResultsOut of 510 participants who completed all items included in the analysis, 24.1% engaged in chemsex without using methamphetamine, 36.9% used methamphetamine but not GHB/GBL, and 39.0% used both drugs. Eighty five percent of men who used both methamphetamine and GHB/GBL reported at least one kind of social harm after a chemsex session, such as missing dates or appointments, or appearing “high” at work, followed by used methamphetamine but not GHB/GBL (69.7%) and those without using methamphetamine (37.4%). After controlling for polydrug and frequency of drug use in the multivariable logistic regression, those who used methamphetamine but not GHB/GBL and those who used both drugs were more likely to report experiencing physical and psychological harms compared to those who did not use methamphetamine (p < 0.003).ConclusionGBMSM who used both methamphetamine and GHB/GBL in a chemsex context were more likely to report experience of harms than those who only used a single chemsex drug or engaged in chemsex without methamphetamine or GHB/GBL. Harm reduction should focus on both preventing HIV and STI transmission and on minimising psychosocial harm to GBMSM, with varying impacts depending on drug use.

The extent and diversity of harm from the drinking of unknown others in Australia: An analysis of data from during the COVID-19 pandemic.

This paper aims to produce a comprehensive estimate of alcohol's harm to others (AHTO) from strangers among Australia adults in 2021. This survey was undertaken during COVID-19 and aims to compare AHTO results with those from 12 years before and identify differences across socio-demographics. Cross-sectional data of 2574 Australian adults were collected in November 2021 via two survey modes: random digit dialling and the Life in Australia™ panel. Questions pertained to harms from the drinking of known and unknown others ('strangers') in the previous 12 months. Multivariable logistic regression is used to analyse differences in the experience of AHTO from strangers across age, gender and other socio-demographics. Under half of Australian adults reported experiencing AHTO from a stranger (42.2%) during the period of COVID-19. Women were at significantly higher odds of reporting harm than men. Significantly higher percentages of participants aged 18-49 reported harm than those 65 and over. Rates of experience of harm from strangers' drinking varied between different Australian regions. Adults engaging in less frequent risky drinking (less than 4 days a month) reported significantly greater experiences of harm than those not engaging in risky drinking in the past year. The current study provides a national estimate of AHTO from strangers in Australia during the COVID-19 pandemic. Finding greater risk of experiencing AHTO from strangers among women than men differs from previous AHTO literature, and further research is required to determine if this is an emerging trend.

Drinker’s own drinking, experience of alcohol-related harms, and concern for drinking predict drinker’s attitudes towards non-drinkers

Objective While the stigma experienced by non-drinkers is well-documented, little is known about the factors that influence it. This study aims to test a sequential mediation model in which the amount of alcohol consumed by a drinker, predicts their experienced alcohol-related harm, which in turn predicts the concern they have for drinking and their negative attitudes towards non-drinkers. Methods A sample of 787 Australian drinkers (Mage = 38.4 years, SD = 11.4) completed online measures of alcohol consumption, alcohol-related harms, concern for drinking and the Cheers Attitudes towards Non-drinker Scale (CANS): a scale that measures the negative attitudes toward non-drinkers via three threats non-drinkers are perceived to pose to drinkers (Threat to Fun, Connection, and Self). Results The model was shown to be a good fit and demonstrated a sequential mediation with significant indirect effects from alcohol consumption via experienced alcohol-related harms and concern, to each CANS subscale: Threat to Self (β = 0.402, p < 0.001), Fun (β = 0.096, p = 0.006) and Connection (β = 0.165, p < 0.001). Conclusion The findings suggest that the stigma directed at non-drinkers may be enacted as a defence against an unwanted self-reflection from a drinker’s concern for their own drinking.

The lived experience of gambling-related harm in natural language.

Gambling-related harms can have a significant negative impact on disordered gamblers, lower risk gamblers, and affected others. Yet, most disordered and lower risk gamblers will never seek formal treatment, often due to the stigma and shame surrounding gambling. Online self-help forums are a popular alternative way for gamblers to anonymously seek help from others. Analysis of these interactions can provide a deeper understanding of gambling than more commonly used research methodologies. In the present study, we leverage recent developments in natural language processing to analyze posts on a U.K.-based online self-help gambling forum. Using correlated topic modeling, we canvass the various types of discussions among forum members. We also combine this approach with semantic similarity analysis based on sentence embeddings, to map first the posts, and then the 10 topics, onto six previously established gambling-related harm domains. The topic modeling revealed a cluster of discussions of many negative emotions, a topic regarding the positive emotions underlying the potential for change, a distinct topic regarding gambling's relationship harms, and numerous environmental factors that contributed to harm. Emotional/psychological and health harms were most strongly associated with users' posts, illustrating the multidimensionality of severe gambling-related harm. Our results reveal the co-occurrence of different harms, such as the frequent mentions of financial harms and concomitant emotional/psychological harms. The analysis of the lived experiences of gambling-related harm in natural language represents a useful tool for gambling research and can provide a different perspective to inform policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ontological politics in competing tourismscapes: The rise of a public on the Nayarit Riviera, Mexico

This article examines a conflict over land on Las Islitas beach in San Blas, Nayarit, Mexico, between the owners of small beachfront eateries or enramadas and an Indigenous communal agrarian organization. We interpret this conflict as being not only a struggle over land but also as a struggle between the enactment of different tourismscapes and the corresponding ontological premises upon which these are based. To build our argument, we explore the historical production of tourismscapes in San Blas and the crucial part that a colonial parchment and littoral drift play in this. As we show, the conflict has created a public, that is, a confederation of dissimilar actors who are united by a shared experience of harm and who take important decisions and engage in politics. We conclude with some ideas as concerns the need to account for the ontological politics that emerge from tourism-related conflicts.

Different concepts of neighborhood safety and child internalizing and externalizing behaviors.

Neighborhood safety is defined inconsistently across epidemiologic studies - a conceptual problem that results in incomparable measurements, hampering the design of health interventions. Using child behavior problems (measured via the Child Behavior Checklist) as the outcome of interest, this study directly compared four measures of neighborhood safety: two of experienced safety and two of perceived safety, with each one measured at family and community levels. These included children's direct experience of harm, parental perceptions, community crime statistics, and community perceptions. In a sample of 3291 ten-year-olds from the Generation R cohort (living in municipal Rotterdam, Netherlands, 2013), all four measures were correlated (χ2 ≥ 9.2, P < 0.002 in pairwise chi-square comparisons), but ultimately identified different levels of risk for behavioral health. Direct experiences of harm, parental perceptions, and community crime statistics were all associated with increased child internalizing behaviors (β = 3.12, β = 2.10, and β = 1.77, respectively), while only experiences of harm and parental perceptions were associated with increased externalizing behaviors (β = 2.75 and β = 1.31, respectively). These results provide novel evidence that the conceptual distinctions underlying different measures of neighborhood safety are meaningful for child mental health and should be considered in intervention design.

Adverse Childhood Experiences and Police Contact in Canada.

A growing body of research has demonstrated that adverse childhood experiences (ACEs) are a risk factor for criminal justice system contact. However, much of this research is limited by (1) being conducted in the United States and (2) a lack of details on specific types of harmful experiences of criminal justice system contact, such as police contact characterized by intrusion or harassment. Using survey data from 940 individuals aged 16 to 30 in Canada from the Canadian Study of Adolescent Health Behaviors, this study investigates the relationship between ACEs and police contact, focusing on encounters involving intrusion or harassment. Results from logistic and multinomial logistic regression analyses reveal that individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact, including experiences of intrusion and harassment. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare. The study highlights the importance of early interventions to mitigate the effects of ACEs and prevent adverse outcomes in police interactions.

A PSA I’m here too: Exploring the Harmful Experiences of Black Students through Critical Narratives

The paper illustrates the digital narratives of 219 Black students within the K-12 educational setting of a large West coast state in the United States. The researchers employed the method of storytelling to analyze Instagram posts created by students, which aimed to shed light on the various forms of injustice experienced by Black students. These online contributions effectively revitalized the significance of Black students' narratives and encounters with racism. The authors posit that educational institutions should reconsider their approach to mitigating the negative consequences encountered by Black students within educational environments. The present study serves as a call to action for educators and stakeholders to confront systemic anti-Blackness and create inclusive educational environments that prioritize the well-being and success of all students. Through collective effort and a commitment to antiracist practices, we can work towards a more equitable and just educational system. Addressing objectification and Whiteness requires a comprehensive approach that surpasses individual actions. Educators must acknowledge the ramifications of racially insensitive behavior and its impact on Black students in K-12 environments.

The feasibility and acceptability of an inoculative intervention video for gambling advertising: a focus group study of academics and experts-by-experience.

Gambling advertising employs a range of persuasive strategies. We therefore aimed to evaluate a counter-advertising intervention video to increase resilience to gambling advertising persuasion. Three in-depth focus groups were conducted, and each group contained a mixture of gambling-related academics (N=12) and experts with lived experience of gambling-related harm (N=10). Participants were given access to the intervention video and provided feedback during the focus groups. Qualitative data were audio recorded and thematically analysed by the research team. Three main themes were identified. First, participants recommended a shorter video that had a simplified and digestible structure. Second, frequent real-world examples of gambling advertisements within the video were discouraged, and the inclusion of a relatable human voiceover was considered imperative to the receptiveness of the video. Finally, participants deemed it important to deliver psychologically grounded yet jargon-free content via a conversational style. An overall narrative framed by consumer-protection was also preferred in order to increase acceptance of the video content, rather than a more didactic framing. Evaluating the acceptability of a counter advertising intervention video provided valuable insight from both an academic and lived-experience perspective. Such insight is instrumental to the meaningful co-design of counter-advertising interventions.

Improving the integration of care for trans adults: ICTA a mixed-methods study.

This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. The main objectives were to understand: Which factors make services more or less accessible and acceptable to the variety of trans adults? How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved? An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Six case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed. The following undermine person-centred co-ordinated care and can lead to experiences of harm: lack of respectful treatment of trans people by general practitioner practices; inadequate funding of services; lack of support during waiting; the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; lack of National Health Service psychological support for trans people. Case studies indicated ways to improve care, although each has significant unresolved issues: training in trans health care for general practitioners; third-sector peer-support workers for trans people who come to National Health Services; gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; psychology services that support trans people rather than assess them. Some contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation. The findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations. This study is registered as Research Registry, no. 5235. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.

Lived Experiences of Diversity, Equity, and Inclusion Leaders in U.S. Music Education Professional Associations

Abstract Music education professional associations (MEPAs) are membership-based nonprofit organizations focused on advancing music education through actions including professional development, policy work, and advocacy. In this instrumental case study, we interviewed diversity, equity, and inclusion (DEI) leaders from MEPAs in the United States (N = 16) to elicit self-reports of their leadership experiences. Participants identified the deep, personal work involved in enacting and sustaining DEI efforts. They reported experiences of harm in DEI work and described progress toward liberation for people of color as a slow, exhausting slog. Participants’ responses also indicated movement toward intersectional approaches to equity and justice. MEPA DEI leader experiences have important implications for advancing equity and justice in music education, including the need for MEPA leadership to consider ways institutional logics create harm and take steps to support and uplift people who are striving for equity and justice within the organizations, including through compensation, solidarity, and structural changes.

Demographic characteristics, gambling engagement, mental health, and associations with harmful gambling risk among UK Armed Forces serving personnel

IntroductionHarmful gambling negatively impacts individuals, families and communities. Growing international evidence indicates that the Armed Forces (AF) community may be at a comparatively higher risk of experiencing harm from gambling...