Native Communities Research Articles

How community-based health workers fulfil their roles in epidemic disease surveillance: a case study from Burkina Faso

BackgroundIn 2016, Burkina Faso adopted a new community-based model for disease surveillance, appointing two community-based health workers (CBHWs) per village. The CBHWs play a crucial yet under-researched role in Burkina Faso’s health system. This study aimed to analyze the factors influencing their practices in relation to their official roles in epidemic disease surveillance.MethodsConducted in the Dandé Health District in southwestern Burkina Faso, this qualitative study collected data through semi-structured interviews with 15 CBHWs and 25 health professionals, supplemented by observations of the CBHWs’ working conditions. Data analysis employed a qualitative content analysis.ResultsAnalysis showed major challenges in the current community health strategy, particularly in capacity building and the working conditions of CBHWs (e.g., lack of monthly report sheets and financial incentives). Recognition from the community was the key motivation for volunteering as a CBHW in Dandé Health District where rural populations are under great financial pressure. Consequently, financial incentives (monthly remuneration and extra incentives) and non-financial rewards in terms of status and prestige, play a crucial role in sustaining volunteer enegagment and effectiveness.ConclusionsThis study underscores the necessity of establishing a clear policy on compensation and protection for CBHWs to motivate and optimize their work. Such policies are essential for enhancing their contribution to a robust national community surveillance system, ultimately improving public health outcomes in Burkina Faso.

Making it on the breadline – improving food security on the Anangu Pitjantjatjara Yankunytjatjara Lands, Central Australia

BackgroundThis longitudinal case study describes the efforts and impacts of community-controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security since the 1980s, with a focus on the last decade, particularly during a year of concerted action from mid-2018.MethodsThe co-designed study comprised an interrupted time series with controls. Availability, affordability, accessibility and sales of foods in the community retail stores on the APY Lands were monitored regularly from 2014 to mid-2022, including by local research teams. Store nutrition policy was updated early 2018. For a year from mid-2018, of the eight communities with stores: (i) two were the focus for concerted intervention, including support from a locally based project officer to help implement the policy and action 105 community requests for nutrition activities (ii) three received usual support to implement the policy; and (iii) three were subject to ‘business as usual’. From mid-2019, all communities/stores received usual service, from 2020 with some restrictions related to the COVID-19 pandemic. Results were compared over time, across different community/store groups and with controls.ResultsIn the 12 months from mid-2018, all food security metrics improved most in the two focus communities. Impacts were less marked in the communities without additional support to implement the revised nutrition policy, and even less apparent, although more varied, in the other three communities/stores. Dietary intake improved only in the two focus communities.In all communities from early 2020 most gains eroded due to impacts of the COVID-19 pandemic and other external stressors. Food security metrics, including price of healthy food, appeared more resilient in the focus communities, although diet quality worsened. At all times assessed, healthy diets were unaffordable for welfare-dependant households.ConclusionsThis co-designed study demonstrates the effectiveness of community-led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities. However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security.

Cultivating the Concept of the Chinese Ethnic Group Community from the Perspective of Cultural Identity

In the context of cultural diversity, cultivating a sense of shared identity among the Chinese ethnic group is not only crucial for national unity and ethnic solidarity but also promotes social harmony and development. Within the concept of the national community, cultural identity serves as a core element, playing an irreplaceable role in enhancing ethnic cohesion and centripetal force. Currently, China is in a crucial period of realizing the great rejuvenation of the Chinese ethnic group, facing various complex situations and challenges. To cultivate the concept of the Chinese ethnic group community and enhance the cultural identity and sense of belonging of all ethnic groups, efforts can be made to strengthen historical education, deepen understanding of Chinese ethnic group history and culture, and thereby enhance cultural identity among different ethnic groups. To promote cultural exchange and integration, cultural exchange platforms can be established to foster mutual respect and understanding of different ethnic cultures, promote the core socialist values, and advance the inheritance and innovation of Chinese excellent traditional culture, providing strong support for cultivating the concept of the Chinese ethnic group community.

An Exploration of Selected Anti-Money Laundering Role-Players in Zimbabwe

Although Zimbabwe has established several institutions to combat money laundering and related crimes, there is a perception that inadequate measures are taken to apprehend offenders responsible for financial crimes. Institutions such as the Financial Intelligence Unit (FIU), the Zimbabwe Anti-Corruption Commission (ZACC), the Zimbabwe Republic Police (ZRP), the National Prosecuting Authority (NPA) and the Reserve Bank of Zimbabwe (RBZ) have done little to prove that the government of Zimbabwe is resolute in combatting money laundering. On the contrary, it increasingly appears that these institutions are poorly equipped and lack the necessary capacity to enforce and uphold anti-money laundering (AML) measures in Zimbabwe. Further, there appears to be a selective application of the law, with one set of rules for individuals or institutions that are perceived as political adversaries of the incumbent establishment and a different set of rules for the political elite. Consequently, the selective application of the law projects Zimbabwe as a jurisdiction that is somehow tolerant to money laundering, corruption and related financial crimes, thereby lowering and tarnishing the standing of the country in the global economic community of nations. This paper provides a regulatory analysis of the AML role-players in Zimbabwe in order to assess their functions in combatting financial crimes. It also analyses whether these role-players are effective and substantively executing their responsibilities therein. The authors argue that while Zimbabwe is well able to effectively combat money laundering through the even application of the law to all persons regardless of their political or economic standing, it is imperative that its AML institutions operate without fear, favour or prejudice. This is crucial in combatting money laundering and instilling confidence in the general public's perception of AML institutions in Zimbabwe.

Reduced predation and energy flux in soil food webs by introduced tree species: Bottom‐up control of multitrophic biodiversity across size compartments

Abstract The introduction of non‐native tree species has become a global concern and may disrupt native communities and related ecosystem functions. Soil food webs regulate organic matter decomposition and nutrient cycling in forests with their feeding activities, but evaluating consequences of the introduction of tree species on soil invertebrates is challenging due to the complex trophic structure and wide range in body size of soil invertebrates. Here, we employed an energetic food web approach and estimated the energy flux in soil food webs using a four‐node model including soil meso‐ and macrofauna decomposers and predators. We examined pure and mixed stands of native European beech (Fagus sylvatica), introduced Douglas fir (Pseudotsuga menziesii) and native range‐expanding Norway spruce (Picea abies) across site conditions. Compared to native forests, introduced tree species reduced total fresh mass of macrofauna predators by 92% at sandy sites but not that of decomposers, suggesting trophic downgrading in soil food webs by Douglas fir. The energy flux in mixed forests was intermediate between respective monocultures, suggesting that tree mixtures mitigate potential negative impacts of introduced tree species on food web functioning. Across size classes, soil macrofauna responded more sensitively to changes in environmental conditions than soil mesofauna. Additionally, total energy flux positively correlated with species richness, pointing to the significance of soil biodiversity for trophic functionality. The energy flux through mesofauna outweighed that through macrofauna when considering energy loss to predators, highlighting the importance of mesofauna for decomposition processes in forest soil food webs. Overall, the study emphasizes the critical role of tree species composition, site conditions and soil biodiversity in driving energy flux through soil food webs and maintaining forest ecosystem functions. Read the free Plain Language Summary for this article on the Journal blog.

The Invasion Ecology of Mutualism

Successful invasive species commonly depend on the establishment of mutualistic interactions with native and nonnative biota. In turn, invasive species can affect native mutualisms and community stability. Here, we examine different forms of mutualist acquisition by invasive species and the causes and consequences of mutualism abandonment for invasion processes. Additionally, we delve into the quantitative and qualitative effects of invaders on native biota via mutualism disruption that can occur through direct and diverse indirect pathways. These effects of invasive species on native biota via mutualistic interactions can often be a consequence of the invaders’ abundance, which should be considered a prime predictor when evaluating the impact of invasive species on native mutualisms and community stability. We propose that the ecological as well as the evolutionary consequences of mutualism disruption and switches caused by invasive species can play crucial roles in determining future biodiversity.

Effects of Phenology on Plant Community Assembly and Structure

Phenology—the timing of critical stages of growth and reproduction and the transitions between them—determines environmental conditions and biotic interactions. Hence, phenology is a key functional trait influencing organisms’ survival and fitness; however, the role of phenology in community assembly processes has been less considered. Here we review the importance of phenology in environmental and biotic filtering, structuring priority effects, and species coexistence in the context of the assembly of native communities, as well as in invasions and restoration. We highlight the complexity of the life-history aspect of phenology, which makes simple trade-offs—such as between growth timing and competitive ability—part of larger plant strategies shaped by a framework of risk, reward, and investment over multiple timescales. Embracing this complexity could yield insights into how phenology shapes communities.

Spatial and Temporal Analysis of Vulnerability Disparity of Minorities to Wildfires in California

Wildfires typically have devastating impacts on communities, both in urban and rural areas, resulting in property loss, psychological distress, physical injuries, and loss of life. A notable gap in the literature is the spatial and temporal disproportionate impact of wildfires on underrepresented communities. This lack of attention is concerning, as these underrepresented populations are likely to be more vulnerable to the devastating consequences of wildfire disasters, exacerbating pre-existing social, economic, and environmental disparities. This study aims to address this gap by conducting a comprehensive spatial and temporal analysis of the vulnerability of underrepresented communities such as the Black, Asian, Hispanic, Native American, among others, in the State of California. We deploy methodological tools such as Getis-Ord Gi* to identify areas exhibiting heightened vulnerability across diverse minority groups. Additionally, disparity degrees are measured using Location Amplitude Index among these minority populations. Our findings reveal significant spatial and temporal shifts in vulnerability disparities for Native American communities in Los Angeles County, the Black communities in Orange County, and all minority groups in San Diego County. Shedding light on the underrepresented communities' vulnerabilities to wildfires, this research contributes to the development of targeted and equitable strategies for wildfire preparedness, response, and recovery efforts. Furthermore, this study highlights the urgent need for addressing the environmental justice implications of wildfire disasters and considering minorities’ disparity in wildfire risk management and climate change adaptation planning.

Contrasting pollution responses of native and non-native fish communities in anthropogenically disturbed estuaries unveiled by eDNA metabarcoding

Contrasting pollution responses of native and non-native fish communities in anthropogenically disturbed estuaries unveiled by eDNA metabarcoding

Nursing and Volunteerism: The Vital Link.

A commitment to community involvement is a fundamental component of the American Nurses Credentialing Center's Magnet Recognition Program®. It reflects the nursing profession's spirit of service to society, as well as the personal ethos of those who pursue a nursing career. As we enter the season of gratitude and giving, we explore the role volunteerism plays in an organization's Magnet® culture, how it contributes to a greater sense of purpose, and how nurses far and wide make an impact when they give back to their local, national, and global communities.

Estimating Demographic Parameters for Bearded Seals, Erignathus barbatus, in Alaska Using Close‐Kin Mark‐Recapture Methods

ABSTRACTReliable estimates of population abundance and demographics are essential for managing harvested species. Ice‐associated phocids, “ice seals,” are a vital resource for subsistence‐dependent coastal Native communities in western and northern Alaska, USA. In 2012, the Beringia distinct population segment of the bearded seal, Erignathus barbatus nauticus, was listed as “threatened” under the US Endangered Species Act requiring greater scrutiny for management assessments. We sought to estimate requisite population parameters from harvested seals by using close‐kin mark‐recapture (CKMR) methods, the first such application for marine mammals. Samples from 1758 bearded seals harvested by Bering, Chukchi, and Beaufort Sea communities during 1998–2020 were genotyped, genetically sexed, and aged by tooth annuli. After rigorous quality control, kin relationships were established for 1484 seals including two parent–offspring pairs (POPs) and 25 potential second‐order kin pairs. Most of the second‐order kin were half‐sibling pairs (HSPs), but four were potential grandparent‐grandchild pairs (GGPs). There were no full sibling pairs, suggesting a lack of mate fidelity. Mitochondrial DNA analysis identified 17 potential HSPs as paternally related, providing substantial evidence of persistent heterogeneity in reproductive success among adult males. The statistical CKMR model incorporates probabilities associated with POPs, HSPs, and GGPs and assumes known ages and a stable population. Our top model accommodates heterogeneity in adult male breeding success and yields an abundance estimate of ~409,000 with a coefficient of variation (CV) = 0.35, which is substantially greater than the “non‐heterogeneity” model estimate of ~232,000 (CV = 0.21), an important difference for managing a harvested species. Using CKMR methods with harvested species provides estimates of abundance with the added opportunity to acquire information about adult survival, fecundity, and breeding success that could be applied to other species of concern, marine and terrestrial.

Healthy Drinks, Healthy Teeth – Ciunerkaq Tanqigtuq (The Future is Bright): A study protocol for a community-based, non-randomized sociobehavioral trial to reduce added sugar intake in Alaska Native Yup'ik children in the Yukon-Kuskokwim Delta

BackgroundThis study protocol describes a community-based intervention that will seek to reduce added sugar intake in Yup'ik Alaska Native children by targeting reductions in sugar-sweetened fruit drinks. MethodsA two-group non-randomized design will be used to evaluate the intervention in three Yup'ik communities in Alaska focusing on children age 1 to less than age 12 years with a minimum enrollment target of 192 children. Families in the intervention arm will participate in a program consisting of five sessions plus four brief check-ins, all delivered by a Yup'ik Community Health Worker. Modifications to the local store environment will be made to give families a place to purchase sugar-free water enhancers. Families in the delayed treatment control arm will receive no intervention during the main study period. There will be five data collection visits (baseline, 1-month, 3-months, 6-months, and 12-months) that will include collection of survey and dietary data, and a hair and plaque sample from each participating child. The outcomes will be change, from baseline to 6 months, in added sugar intake based on a validated hair biomarker (grams of added sugar/day). We hypothesize children in the intervention arm will have greater reductions in added sugar intake compared to children in the control arm as measured by the hair biomarker. DiscussionThis is one of the first known community-based sociobehavioral interventions aimed specifically at reducing added sugar intake in Alaska Native communities by targeting sugar-sweetened fruit drinks. Trial registrationClinicalTrials.govNCT05219448 (first posted on February 2, 2022).

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Virtual Aunts and Uncles: Identity and Community in a Diasporic National Minority

Abstract The past decade has seen mass emigration of Hungarians from Serbia to the kin-state and Western European countries. This has resulted in new ways of understanding what it means to belong to the community, both empirically and in terms of theorizing it, and both for those in Serbia and those abroad. This article claims that there are virtual platforms where members of this ethnic community (re)create their identities, and that this happens through relating to certain common themes. For this reason, I analyze the common themes of two humorous Facebook pages – namely, rurality, food, language use, ethnic others, and crossing borders – popular among Vojvodina Hungarians. The article argues that these elements of identity connect members of the community who live in Vojvodina and those who have emigrated to the kin-state or diaspora. Therefore, in order to unpack the complex dynamics of identification of a national minority community with high diasporic tendencies, an approach that connects the above topics to the concepts of community, nostalgia, home, minority, and borders, and in more general terms the lens of national minority and diaspora studies is needed.

Posting the nation: Australia’s apprenticeship in letter writing

A national postal service is an essential nation-building institution; it integrates distant regions into a national community and fosters the extension of the public sphere. But in the first decades of colonial Australia, the material conditions of sending letters were precarious and uncertain, the rhythm of exchange was slow and the cost expensive. Australia had to learn how to write letters and how to send them; by the 1890s, it had completed its apprenticeship. Using postmaster-generals’ reports on one hand, and autobiographical sources on the other, I explore the experience and difficulties of epistolary exchanges in the nineteenth century.

Cooperative community wildfire response: Pathways to First Nations’ leadership and partnership in British Columbia, Canada

With the growing scale of wildfires, many First Nations are demanding a stronger role in wildfire response. Disproportionate impacts on Indigenous communities (including First Nations, Métis, and Inuit) in Canada are motivating these demands: although approximately 5 % of the population identifies as Indigenous, about 42 % of wildfire evacuation events occur communities that are more than half Indigenous. In what is now known as British Columbia, Canada, new pathways for cooperative wildfire response between First Nations and provincial agencies are emerging. Drawing from semi-structured interviews with 15 experts from First Nations communities and agencies, and a review of 42 documents on wildfire response, our research highlights the diverse existing capacities, priority opportunities, and processes required to enhance cooperative pathways. Within First Nations communities, existing capacities include local knowledge, firefighting experience, equipment, funding, relationships, and leadership – an overlooked but fundamental capacity. Priority opportunities include ways to build capacity within and beyond wildfire response, such as fully equipped response crews, full-time year-round wildfire management crews, Emergency Management Coordinators, First Nations Liaisons, and cross-trained wildland and structural crews. Translating existing capacities into priority opportunities requires an ongoing focus on cooperative processes, including relationship-building, respecting Rights and Title, streamlining funding, and enabling “cultural safety” to overcome racism. These cooperative pathways can help transform wildfire governance toward First Nations-led partnerships.

From Family to Community: A Preliminary Discussion on Strengthening the Sence of the Chinese National Community through the Integration of Family and Country

The Chinese nation shares the same culture and ancestry, and the traditional values of the unity and homogeneity of the family and the country in Chinese civilization indicate the development prospects and process of various ethnic groups on the road of rejuvenation, which is characterized by unity and solidarity, and has become an endogenous driving force for strengthening the sense of community of the Chinese nation. At a new historical starting point, with the focus and support on the unity of family and country, we aim to strengthen the sense of community among the Chinese nation, providing important value guidance and spiritual support for consolidating the shared spiritual home of the Chinese nation and consolidating its centripetal force. We should promote the construction of modern civilization of the Chinese nation and enhance the cultural subjectivity of the Chinese nation; Focusing on "small families", melting millions of "family dreams" into the "Chinese Dream" of the great rejuvenation of the Chinese nation; Focusing on "everyone", inheriting and innovating excellent traditional Chinese culture, and enhancing the subjectivity of Chinese national culture; Looking at the world, we should enhance the conscious identification of various ethnic groups with the sense of community of the Chinese nation through cultural exchange and mutual learning.

National dispensing of evidence-based treatment for New Zealand patients before and after peripheral arterial or percutaneous coronary procedures; undertreatment in plain sight

Abstract Background/Introduction Cardiovascular management guidelines recommend that those undergoing arterial procedures for atherosclerotic disease should be on a long-term antithrombotic agent, statin and blood pressure (BP) lowering (triple therapy) to prevent or delay future ischaemic events or death. Internationally, treatment gaps have been reported for people having peripheral arterial disease (PAD) procedures. Purpose We aimed to investigate national rates of triple therapy dispensing before and after admission for a percutaneous coronary intervention (PCI) compared to a PAD procedure. Methods All people aged 18-84 years admitted for a publicly-funded PCI or PAD procedure in New Zealand between 1 January 2015 and 30 June 2020 were identified. Data were linked to national community dispensing records for antithrombotic agents, statins and BP lowering and the adjusted relative risk (adjRR) of dispensing individual medication classes and triple therapy investigated 6 months prior-procedure and 0-6 months and 7-12 months post-procedure. Analyses were controlled for age, sex, prioritised ethnicity, socioeconomic deprivation index, diabetes and prior cardiovascular disease. Results During the study period, 26,383 people were admitted for a PCI procedure and 10,938 people for PAD. Compared to PCI, those with PAD were more likely to be women, older (median age 69 vs 66 years), of Māori or Pacific ethnicity, living in more deprived communities, more likely to have diabetes (33% vs 24%) and a prior admission for cardiovascular disease (63% vs 52%). Triple therapy in the 6 months prior to procedure was 48% for PAD compared to 37% for PCI (adjRR 1.04; 1.03-1.05); however, in the 6 months post-discharge, improved for PCI more than PAD (PAD 58% vs PCI 91%, [adjRR 0.82; 0.81-0,83]) with decreased dispensing in both cohorts by 7-12 months post procedure (PAD 55% vs PCI 83%, [adjRR 0.84; 0.83-0,84]). Conclusions Patients undergoing atherosclerotic arterial procedures are at high risk of future fatal and nonfatal cardiovascular events. Less than half the patients who were admitted for a PCI or PAD procedure had been dispensed triple therapy in the 6 months prior to admission. Post procedure, 91% of PCI patients were on triple therapy but this substantial increase did not occur for PAD patients. The risk management gap for those who have peripheral arterial compared to coronary procedures indicates clear clinical and system-related deficiencies and a national quality improvement approach is required to address these issues. Figure 1. Adjusted relative risk of being dispensed preventive medications for patients who had a PAD procedure, compared to patients who had a PCI procedure [after adjusting for age, sex, ethnicity, NZDep, history of CHD (including prior PCI and CABG), stroke/TIA, haemorrhagic stroke, heart failure, PVD, and diabetes]

Transforming systems and improving lives - the social movement of compassion in Wales

Abstract Wales has embarked on a journey towards becoming an adverse childhood experiences (ACEs) and trauma-informed nation. In 2021 the Welsh government supported the co-creation and co-production of an all age, all of society framework: Trauma- Informed Wales: A Societal Approach to Understanding, Preventing and Supporting the Impacts of Trauma and Adversity (ACE Hub Wales et al 2021). This framework is not just an operating model, it has the ambition to be a social movement to embed and sustain a culture shift that is rooted in tackling the conditions of inequality in our communities and the work we do in organisations in the clinical and community settings that support, and employ, people who have experienced trauma and adversity in their lives. The starting point is that any of us can have these experiences. The trauma and ace informed toolkit sets out a process of readiness, self assessment, action planning and implementation across six domain areas which include governance and leadership, monitoring and evaluation, policy and practice. Resources and guidance are co-created and co-produced by partners already on the journey, developed and tested in environments to look at trauma-informed physical spaces, communications, workforce development, training and inclusion of marginalised voices. Supporting this work is a national community of practice, promoting good practice, sharing ideas and developing a culture of wisdom supported by reflective practice. This dynamic forum is supported by online and in person capacity and is transforming organisations and sectors including housing, education, substance misuse, criminal justice and health. It places people, compassion, kindness and empathy at the heart and is enabling traumatised systems to understand and meet the needs of the workforce and the people they serve. Key messages • Systems change is sustained by compassion, kindness and love in a social movement supported by the scaffolding of an operating model. • Public Health has a key role to play in co-developing social networks and resources to transform traumatised systems into trauma-informed places that improve lives and health outcomes.

Participation, barriers, facilitators and bullying experiences of trans people in sport and fitness: findings from a national community survey of trans people in Australia.

This study aimed to assess participation rates of transgender and gender diverse (trans) people in sport/fitness activities, compare mental health outcomes for trans people participating in sport/fitness with those who do not and explore internal/external barriers and bullying experiences faced by trans people in sport/fitness contexts. A cross-sectional online survey open to trans people aged ≥16 years living in Australia was conducted between February and April 2023 and it assessed rates of sport/fitness participation, barriers to participation and bullying experiences through multiple-choice questions. Mental health measures comprised the Kessler Psychological Distress Scale (K10) and self-reported history of self-harm and suicidality. Covariate-adjusted binary logistic regression models tested associations between interpersonal factors, sport/fitness variables and mental health outcomes. Of 664 respondents (median age 32 years), around one-third (32.8%) regularly participated in sport/fitness. Common internal barriers to participation included anxiety about others' reactions (63.9%), body dissatisfaction/dysphoria (56.5%) and fears about feeling accepted/affirmed by others (54.7%). Respondents commonly reported experiencing inadequate bathroom/changing facilities (44.4%), exclusionary rules and regulations surrounding gender (36.7%), and invasive or uncomfortable policies or procedures (23.3%). Over one-third (34.4%) of trans people had experienced gender-based bullying or exclusion. Regular sport/fitness participation was associated with significantly lower K10 scores (mean difference=-4.4, 95% CI-5.8, -2.9, p<0.001) and a 40% reduction in odds of recent thoughts of self-harm and suicide (aOR 0.6, 95% CI 0.5, 0.9, p=0.01; aOR 0.6, 95%CI 0.4, 0.9, p=0.02). Trans people face significant barriers to sport/fitness despite experiencing significant mental health and personal benefits from participation. Affirming and including trans people in sport and fitness should be a key priority for sport and fitness federations, organisations and policy-makers.