Journal articles on the topic 'Adolescent dysmenorrhea self-care management self-report practices'

Background. It is estimated that more than half of all women in adolescence age suffer from dysmenorrhea and it often interferes with their daily physical and emotional aspects. It is the leading cause of short-term school absenteeism and is associated with a negative impact on academic and daily activities. Objectives. To investigate impacts of dysmenorrhea, factors associated with it, and its self-management strategies used by health science students. Methods. A cross-sectional institution based study was conducted among 246 Mekelle University health science students selected by stratified random sampling technique. Data were collected using self-administered semistructured questionnaire. Data were analyzed using SPSS 16. Results. The prevalence of dysmenorrhea was 71.8%. Participants who had long menstrual cycle interval, long menses flows, and positive family history and who were alcohol users were more likely to had dysmenorrhea. Participants reported that 28.6% feel depressed, 16.2% are absent from class, and 22.9% had poor personal relationship due to dysmenorrhea and 78.2% of them practiced self-medication. Conclusion. Dysmenorrhea is common among Mekelle University health science students and it is major problem representing the cause of feeling depressed, poor personal relationship, and class absenteeism. Majority of the study participants used self-medication to treat dysmenorrhea.

Background Internationally, governments have been investing in supporting pharmacists to take on an expanded role to support self-care for health system efficiency. There is consistent evidence that minor ailment schemes (MASs) promote efficiencies within the health care system. The cost savings and health outcomes demonstrated in the United Kingdom and Canada open up new opportunities for pharmacists to effect sustainable changes through MAS delivery in Australia. Objective This trial aims to evaluate the clinical, economic, and humanistic impact of an Australian Minor Ailments Service (AMAS) compared with usual pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney, Australia. Methods The cRCT design has an intervention group and a control group, comparing individuals receiving a structured intervention (AMAS) with those receiving usual care for specific health ailments. Participants will be community pharmacies, general practices, and patients located in Western Sydney Primary Health Network (WSPHN) region. A total of 30 community pharmacies will be randomly assigned to either intervention or control group. Each will recruit 24 patients, aged 18 years or older, presenting to the pharmacy in person with a symptom-based or product-based request for one of the following ailments: reflux, cough, common cold, headache (tension or migraine), primary dysmenorrhea, or low back pain. Intervention pharmacists will deliver protocolized care to patients using clinical treatment pathways with agreed referral points and collaborative systems boosting clinician-pharmacist communication. Patients recruited in control pharmacies will receive usual care. The coprimary outcomes are rates of appropriate recommendation of nonprescription medicines and rates of appropriate medical referral. Secondary outcomes include self-reported symptom resolution, health services resource utilization, and EuroQoL Visual Analogue Scale. Differences in primary outcomes between groups will be analyzed at the individual patient level accounting for correlation within clusters with generalized estimating equations. The economic impact of the model will be evaluated by cost-utility and cost-effectiveness analysis compared with usual care. Results The study began in July 2018. Thirty community pharmacies were recruited. Pharmacists from the 15 intervention pharmacies were trained. A total of 27 general practices consented. Pharmacy patient recruitment began in August 2018 and was completed on March 31, 2019. Conclusions This study may demonstrate the efficacy of a protocolized intervention to manage minor ailments in the community and will assess the clinical, economic, and humanistic impact of this intervention in Australian pharmacy practice. Pharmacists supporting patient self-care and appropriate self-medication may contribute to greater efficiency of health care resources and integration of self-care in the health system. The proposed model and developed educational content may form the basis of a national MAS service in Australia, using a robust framework for management and referral for common ailments. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/13973

Background: Recent recommendations suggest incorporating patient-report outcome measures (PROMs) into concussion assessment batteries. Utilizing PROMs provides information on the patient’s perspective and how the concussion may influence the patient’s health status. Past studies evaluating PROM use among athletic trainers (ATs) found varying practices and barriers to implementation. However, there is limited data on use of PROMs in managing concussion among adolescent patients. Hypothesis/Purpose: To describe the use of PROMs as part of concussion assessment and treatment practices of ATs working in middle and high school settings. Methods: An online survey regarding concussion treatment perceptions and practices was distributed to a convenience sample of 5000 ATs through the NATA Survey Research Program. The survey included personal and institutional demographics, healthcare provider access and referral practices, perceptions of concussion treatment, clinical practice characteristics of concussion treatment and PROM use. The survey was pilot tested and validated in a sample of ATs prior to distribution. Analysis of the PROM section was conducted using descriptive statistics (percentages, frequencies) for this study. Results: The survey was accessed by 304 ATs (6.1% access rate) and completed by 153 ATs (58.3% completion rate). Of those, 27.2% (n=57) were employed in the middle school or high school setting and were analyzed for this study. Just over half of respondents had <10 years of experience (52.7%, n=30). Only 35.1% (n=20) of ATs reported they use PROMs as part of their clinical management of concussion. Of those who use PROMs, 75% (n=15) indicated that they use them always or almost always. The most commonly used generic PROMs were the Short Form 12 or 36 (25%, n=5) and Patient Reported Outcomes Measurement Information System (25%, n=5) and the most common specific PROMs were the Headache Impact Test (45%, n=9) and Dizziness Handicap Inventory (15%, n=3). Figure 1 shows the level of self-reported confidence of those utilizing PROMs. Barriers for PROM use included it being too time consuming (24.6%, n=14/57), lacking a support structure (15.8%, n=9/57), and not familiar with PROMs (14%, n=8/57). Close to one-fourth (22.8%, n=13/57) of respondents would be willing to use PROMs, but lacked time. Conclusion: While the use of PROMs is recommended in the evaluation and treatment of adolescent athletes, just over one-third of ATs providing care to these patients, use PROMs. Educational efforts for ATs should look to increase their familiarity and confidence when using PROMs for concussion while suggesting strategies to incorporate PROMs into practice. [Figure: see text]

<strong>Abstract</strong> The paper emphasizes the importance of understanding the psychological characteristics and personal attributes that contribute to criminal behavior. It explores various psychological and psycho-social theories that explain delinquent conduct and highlights the role of psychologists in assessing individuals involved in criminal cases. The methodology of the paper involves a comprehensive analysis of existing literature, integrating quantitative and qualitative techniques to gain insights into the psychological profiles of individuals engaged in criminal behavior. The paper discusses the significance of employing a comprehensive approach in psychological assessments, including risk assessments, competency evaluations, and psychological evaluations. Psychologists play a vital role in understanding and evaluating delinquent behavior by utilizing assessment tools and techniques to assess an individual&#39;s mental health, cognitive abilities, personality traits, and potential psychological disorders. These evaluations contribute to understanding the underlying factors that influence criminal behavior and inform appropriate interventions or treatment plans. The paper also highlights the ethical considerations involved in criminal assessments, such as obtaining informed consent, maintaining confidentiality, and considering cultural competency. It emphasizes the importance of continuous professional development for assessors to ensure the delivery of high-quality assessments. Furthermore, the paper discusses the role of personal qualities in delinquent behavior, including impulsiveness, the prevalence of negative emotional backdrop, a quest for risky sensations, empathy, altruism, and honesty. It emphasizes the relationship between these personal characteristics and criminal behavior, providing insights into the psychological factors that contribute to delinquency. Overall, this paper aims to explore the crucial role played by psychologists in criminal assessments and understanding delinquent behavior, highlighting the need for a comprehensive approach and ethical considerations in the field of forensic psychology. <strong>Keywords</strong>: <em>Psychological, Psycho-social, Disorders, Criminal assessments, Delinquent behavior</em> &nbsp; <strong>Introduction </strong> Delinquent behavior is described as a criminal act performed by a human that violates civil society laws. The concept of crime is founded on the idea of normalization, which states that an individual&#39;s guilt is determined by the norms and regulations that apply in civil society. Society exercises control over individual behavior not just through legal legislation, but also through ethical and moral values. Crime is a sort of conduct that differs from other types of activity in terms of its contextual weight and the community&#39;s perception of it. It is critical to distinguish the characteristics that influence the development of criminal conduct while describing the personal attributes of a deviant personality (Chuasanga &amp; Victoria, 2019). Psychological and psycho-social theories that explain such conduct emphasize an individual&#39;s personal attributes and view individual idiosyncrasies as a limiting element in criminal behavior. Another interpretation of criminal conduct is that an offender commits a crime because he or she has not established a suitable attitude toward social reality, which is conditioned by his or her emotions. When discussing the commission of an offense, it is very important to consider the individual psychological characteristics, such as the motivational system and general peculiarities of the activity, which form an individual&#39;s general strategy; additionally, it is significant to consider the individual&#39;s attitudes. In terms of psychological characteristics, a large number of criminals tend to transfer responsibility onto other offenders and justify themselves in order to prove his/her innocence; this category of criminals attempts to achieve the above-mentioned by exaggerating a victim&#39;s guilt, confronting social norms, depreciating social norms, and readdressing responsibility to other/situational factors (McGuire, 2004). Psychologists and other mental health experts regularly conduct assessments for use in civil and criminal court processes (Melton et al., 2017). In the criminal context, the most common of these assessments are those for competence to stand trial (CST), which refers to the defendant&#39;s current ability to understand legal proceedings and to assist his or her lawyer in planning and conducting a defense, and those for criminal responsibility (CR, also known as insanity), which refers to the defendant&#39;s mental state at the time of the alleged offense. Despite the fact that these evaluations are performed on a regular basis, there is little information on the standard of practice for these assessments (Gowensmith et al., 2012). The role of psychologists in the context of criminal assessments is crucial in understanding and evaluating the psychological aspects of individuals involved in criminal behavior. Psychologists play a vital role in providing insights into the mental state, behavior patterns, and underlying factors that contribute to criminal acts. Psychologists employ various assessment tools and techniques to evaluate the psychological functioning of individuals involved in criminal cases. These evaluations help in understanding the individual&#39;s mental health, cognitive abilities, personality traits, and potential psychological disorders that may influence their behavior. This paper aims to explore the vital role played by psychologists in criminal assessments and understanding delinquent behavior. &nbsp; <strong>Method</strong> The methodology of this paper involves a comprehensive analysis of existing literature to highlight the importance of employing a comprehensive approach when conducting psychological assessments in the context of criminal assessments and delinquent behavior. The methodology focuses on the integration of quantitative and qualitative techniques and emphasizes the consideration of specific factors related to criminal behavior and delinquency to gain a thorough understanding of individuals&#39; psychological profiles. Relevant studies were identified to highlight the significance of employing a comprehensive approach in psychological assessments. The literature was analyzed to identify key themes related to the comprehensive approach in criminal assessments, including psychological evaluations, risk assessments, competency evaluations, and sentencing recommendations. Additionally, the literature exploration delved into understanding delinquent behavior, including its causes, risk factors, and protective factors. &nbsp; <strong>Understanding Criminal Assessments and Delinquent Behavior</strong> The systematic evaluation of persons involved in criminal proceedings to understand their psychological, behavioral, and cognitive functioning is referred to as criminal evaluation. Criminal evaluations are used to obtain information about a person&#39;s mental state, personality features, risk factors, and probable treatment requirements (American Psychological Association [APA], 2013). Psychologists perform these evaluations, which use a variety of assessment instruments, procedures, and standardized measures to collect data and give significant insights into the individual&#39;s psychological profile (Mossman, 2013). Criminal assessments serve several purposes, including: Risk Assessment: Assessing the risk factors associated with individuals involved in criminal behavior helps to determine the likelihood of future offenses or reoffending. This information assists in making decisions regarding supervision, rehabilitation programs, parole, or release. Competency Evaluation: Evaluating an individual&#39;s competency to stand trial involves assessing their understanding of legal proceedings, ability to assist in their defense, and capacity to make informed decisions. Competency evaluations help determine if individuals have the cognitive and psychological ability to participate effectively in their legal proceedings. Psychological Evaluation: Psychological evaluations provide a comprehensive assessment of an individual&#39;s mental health, cognitive abilities, personality traits, and potential psychological disorders. These evaluations contribute to understanding the individual&#39;s psychological functioning, identifying factors that may have influenced their criminal behavior, and informing appropriate interventions or treatment plans (Salekin &amp; Lynam, 2010). Delinquent behavior refers to actions that violate established laws or societal norms, typically committed by individuals who are underage or below the legal age of adulthood. These behaviors are often categorized as criminal offenses when committed by adults. Delinquency can include a wide range of acts, such as theft, vandalism, substance abuse, aggression, truancy, and involvement in gangs. Delinquent behavior is characterized by its deviant nature and potential harm to individuals or society (Piquero et al., 2007). Psychologists play a critical role in conducting assessments in the context of delinquent behavior. They utilize their expertise in psychological evaluation techniques, standardized assessment tools, and diagnostic criteria to assess the psychological functioning, risk factors, and underlying causes of delinquent behavior in individuals (Salekin, 2008). By conducting comprehensive assessments, psychologists can provide valuable insights into the psychological profiles of delinquents, which inform treatment planning, intervention strategies, and risk management (Falkenbach et al., 2008). Psychologists are important in understanding delinquent behavior because they do research, analyze data, and use psychological theories to acquire insights into the underlying causes and contributing elements of delinquency. They investigate individual features, environmental factors, social dynamics, and psychological processes in order to gain a thorough knowledge of why people engage in delinquent conduct (Odgers et al., 2008). Psychologists can help to guide preventative efforts, establish successful intervention programs, and contribute to policy creation by understanding the complexity of delinquency (Snyder &amp; Sickmund, 2006). &nbsp; <strong>The Psychologist&#39;s Contribution to Forensic Psychology</strong> The name forensic is derived from the Latin foresus, meaning &quot;Torum,&quot; the site where Roman trials were held. The term farenster is now used to signify some engagement of a certain subject of study in a legal arena. There is no universally accepted definition of forensic psychology - many differ. More narrow definitions confine forensic psychology to clinical psychology applications to legal matters (typically in the context of evaluating litigants whose mental states are at issue in legal proceedings), whereas broader definitions include applications of all areas of psychology (clinical, developmental, social, and experimental) to legal matters. The American Psychological Association&#39;s diamond of forensic psychology as a specialty provides an example of this narrower scope: <em>&quot;the professional practice by psychologists within the areas of clinical psychology, counseling psychology, neuropsychology, and school psychology. when they are engaged regularly as exports and represent themselves as such, in an activity primarily intended to provide professional psychological expertise to the judicial system&quot;</em> (Heilbrun). Although the origins of forensic psychology may be traced back to the early 1900s, with the application On the Wi ness Stand (M&uuml;nsterberg, 1908) and the use of mental psychologists in juvenile courts. It will take decades for the discipline to provide the empirical basis required for 10 qualities as an evidence expert lesion on a consistent and unquestionable basis. The application of theory is accepted by both the state and the ally. Both the state and the ally embrace the use of theory, study, and technique to civil and criminal law issues. Doctorates and forensic psychology programs have been created, and postdoctoral scholarships, albeit limited in number, are available. Continuing education programs, provided by APA-approved sponsors, are easily available to give the skills, training, and information necessary in court. &nbsp; Specialized training and expertise are essential for psychologists to effectively work in the field of criminal assessments and understanding delinquent behavior (Bartol &amp; Bartol, 2021). They require a strong foundation in clinical psychology, as well as additional training and knowledge in forensic psychology and criminology. This specialized training equips psychologists with the skills necessary to assess, evaluate, and provide insights into the psychological factors underlying criminal behavior (Heilbrun et al., 2019). &nbsp; <strong>Ethical Considerations in Criminal Assessments</strong> Criminal evaluations are important in the criminal justice system because they help with the evaluation and decision-making procedures for offenders (APA, 2017). However, the procedure of carrying out these assessments creates serious ethical concerns. To guarantee fairness, truth, and protection of the rights and well-being of the persons involved, ethical rules and principles must be observed. Obtaining informed permission from the persons being examined is a crucial ethical aspect of criminal examinations. Individuals must provide informed permission if they understand the goal, nature, and potential repercussions of the evaluation and willingly choose to participate. Assessors should offer clear and intelligible information regarding the assessment process, including its purpose, potential risks and benefits, and any limits (Melton et al., 2018). Individuals have the freedom to make autonomous decisions about their involvement with informed consent, which enhances their dignity and respect. Another essential ethical aspect in criminal evaluations is maintaining confidentiality and privacy. Professionals should safeguard assessment data confidentially and guarantee that only authorized personnel have access to the information (Lamberti &amp; Weisman, 2011). Confidentiality is essential for establishing confidence between the assessor and the person being assessed, as well as enabling open and honest communication. It is critical to educate individuals on the boundaries of confidentiality, such as when information must be shared with appropriate parties in order to comply with legal and ethical commitments. Criminal investigations must be performed with cultural competency, acknowledging and respecting persons&#39; various origins and experiences. Biases can lead to faulty evaluations and unfavorable consequences; therefore, cultural competency guarantees that assessments are fair and unbiased. Assessors should be conscious of their cultural prejudices and work actively to reduce their influence on the assessment process. To achieve accurate and reliable results across diverse groups, culturally appropriate assessment methods and methodologies should be employed. The competence and training of the specialists performing the evaluations are important ethical factors in criminal assessments. Assessors must have the requisite knowledge, skills, and training to carry out their responsibilities successfully. They must keep current on the newest research and advancements in their area, as well as conform to professional norms and rules. Continuous professional development ensures that assessors keep their expertise and deliver high-quality assessments (Pirelli &amp; Gottdiener, 2018). Assessments should be carried out in a way that minimizes damage and avoids stigma. Professionals should be aware of the possible psychological influence of the evaluation process on individuals, especially when discussing sensitive material. Measures should be made to safeguard the well-being of those being examined, such as offering assistance or referring them to relevant services when necessary. Furthermore, to avoid unwarranted stigmatization and labeling, assessments should focus on the behavior rather than the individual (Clement et al., 2015). &nbsp; <strong>The Role of Personal Qualities in Delinquent Behavior</strong> Recent research revealed that the Academic Performance Index, i.e., the GPA is a better predictor for delinquent behavior than IQ. There is a correlation between academic achievement and delinquent behavior. <em>Temperament</em> is an individual characteristic that greatly influences a person&#39;s behavioral model. Despite the significant effect of external conditions, it is widely accepted that temperament is influenced by heredity. Character, sociality, activity level, reactivity, and affectivity are all components of temperament. Temperament is important in a child&#39;s contact with the environment; hence, the experience obtained in childhood is well represented in his/her environmental attitudes and socialization process at his/her following age development stages. Psychology identifies personal characteristics of an individual that are human psychological attributes. When considering these personal qualities in relation to delinquent behavior, they can be divided into two categories: 1) psychological signs that contribute to an individual&#39;s fulfillment of delinquent behavior and 2) psychological signs that prevent an individual from committing any delinquent behavior. This distinction is necessary to distinguish between personal characteristics that have positive and negative associations with criminal activity (Walsh &amp; Hemmens, 2010). <em>Impulsiveness</em> is the tendency of an individual to behave without considering the repercussions of his or her actions. Impulsiveness prohibits a person from engaging in intentional conduct. In most circumstances, an impulsive individual&#39;s behavior is dictated by the situation; hence, a person can no longer afford to predict the outcome of his or her actions. The study of the association between impulsiveness and delinquent behavior found that in 78 cases out of 80, the relationship between impulsiveness and crime was positive. It should be mentioned that a generally unfavorable emotional background reinforces the link between impulsiveness and delinquent behavior (Lyman, 2018). <em>Prevalence</em> of negative emotional backdrop - reflects an individual&#39;s tendency to analyze incoming situational signals through early annoyance and anger. Background negative emotions substantially correspond with delinquent conduct. This consistency holds true for diverse genders and civilizations. According to the findings, the reason for the negative emotional backdrop is a deficiency of serotonin, a chemical element in the human brain. A lot of experts feel that the absence of this element is a direct predictor of an individual&#39;s delinquent conduct (ILIN, 2008). <em>Quest for risky sensations</em> (low sensitivity threshold) - This attribute is connected to the adoption of active and risk perception, which leads to the individual&#39;s quest for risky circumstances. People that are intentionally seeking powerful sentiments while being socialized choose jobs such as firefighters, police officers, and so on, or they engage in extreme sports. Individuals with a poor degree of socialization yet a great drive to seek dangerous sensations - with a high likelihood - prefer to self-realize through carjacking, robbery, and other criminal activities. A review of the literature reveals a very strong positive link between risk demand and crime (Belkania, 2011). <em>Empathy</em> is the emotional and cognitive ability of an individual to comprehend, experience, and share the feelings and spiritual state of another. The emotional component of empathy allows an individual to experience the anguish of another person, while the cognitive component helps an individual to comprehend the source of the misery. There are those who suffer/bear the anguish of the entire world, while there are others who are unable to understand even the closest person. One of the determinants of criminal behavior is a lack of psychological indication of empathy (Godziashvili, 1998). <em>Altruism</em> is defined as an individual&#39;s care for others and consideration of others&#39; interests without regard for one&#39;s own. Altruism, on the other hand, might be considered as a behavioral component of empathy. If a person feels empathy for others, he or she will be encouraged to engage in such behavioral action that would relieve the tension of another person. An examination of these personal characteristics found that a lack of altruism and empathy are closely related to delinquent conduct; the lower the degree of empathy and altruism, the higher the index of anti-social behavior. <em>Honesty</em> is a psychological characteristic. It consists of specific characteristics such as self-discipline, orderliness, scrupulousness, and responsibility. The development of the aforementioned characteristics is closely related to people&rsquo;s effective adaption to the community. The absence of this characteristic is an impediment to the adaption process. <em>Acceptability</em> is a personality quality that covers the openness and perceptibility of diverse people&#39;s thoughts and ideas. Friendly, respectful, and cooperative interpersonal connections demonstrate acceptance. Trust in individuals is the most significant indicator of acceptance. Individuals with high acceptability can make concessions in the interests of others and assist others. People with this trait are concerned with implementing pro-social conduct and obtaining social desirability (Law, 2014). &nbsp; <strong>Conclusion </strong> In conclusion, the function of psychologists within the framework of criminal assessments and delinquent behavior is multifaceted and critical. Psychologists bring valuable expertise in understanding the psychological factors that contribute to criminal behavior and can assess the state of one&#39;s mind, cognitive abilities, and personality traits of individuals involved in the legal system. Their assessments aid in the decision-making processes, such as determining the ability to stand trial, assessing risk for reoffending, and informing appropriate interventions and treatment strategies. Psychologists also play a crucial role in evaluating the effectiveness of rehabilitation programs and providing expert testimony in court proceedings. By applying their abilities and knowledge, psychologists help to create a more comprehensive understanding of criminal behavior and encourage the development of evidence-based practices and strategies for prevention, intervention, and rehabilitation. Their involvement underscores the significance of resolving psychological issues and factors underlying delinquent behavior and promoting a fair and just criminal justice system. &nbsp; <strong>References </strong> &nbsp; American Psychological Association. (2013). Guidelines for psychological evaluations in child protection matters. <em>American Psychologist, 68</em>(1), 1-18. American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Retrieved from https://www.apa.org/ethics/code Bartol, C. R., &amp; Bartol, A. M. (2021). Introduction to forensic psychology: Research and application (5th ed.). SAGE Publications. Belkania, N. (2011). Conscience and Responsibility. Tbilisi: ATSMKO. Chuasanga, A., &amp; Victoria, O. A. (2019). Legal Principles Under Criminal Law in Indonesia Dan Thailand. <em>Journal Daulat Hukum, 2</em>(1), 131-138. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... &amp; Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.&nbsp;<em>Psychological medicine</em>,&nbsp;<em>45</em>(1), 11-27. Enikeev, M. (2005). Legal Psychology. Moscow: publishing house NORMA. Falkenbach, D. M., Poythress, N. G., &amp; Creevy, C. (2008). The exploration of subtypes of juvenile delinquency with the Psychopathy Checklist: Youth Version. <em>Criminal Justice and Behavior, 35</em>(1), 5-22. Godziashvili, I. (1998). Criminology. Tbilisi. POLIGRAPHIST. Gowensmith, W. N., Murrie, D. C., &amp; Boccaccini, M. T. (2012). Field reliability of competence to stand trial opinions: How often do evaluators agree, and what do judges decide when evaluators disagree?&nbsp;<em>Law and Human Behavior</em>,&nbsp;<em>36</em>(2), 130. Heilbrun, K., Grisso, T., &amp; Goldstein, A. M. (2019). Handbook of psychology, forensic psychology (2nd ed.). Wiley. Hentig, H. V. (1979). The criminal &amp; His victim. New York: Yale University Press. ILIN, E. (2008). Motivation and Motives. Moscow: PITER. Lamberti, J. S., &amp; Weisman, R. L. (2011). Ethical considerations in the forensic evaluation of competence to stand trial. <em>Journal of the American Academy of Psychiatry and the Law, 39</em>(4), 541-550. Law, L. (2014).&nbsp;<em>Nona Todua</em>&nbsp;(Doctoral dissertation, Ivane Javakhishvili Tbilisi State University). Lyman, M. D. (2018).&nbsp;<em>Criminal investigation</em>. Pearson. McGuire, J. (2004).&nbsp;<em>Understanding psychology and crime: Perspectives on theory and action</em>. McGraw-Hill Education (UK). Melton, G. B., Petrila, J., Poythress, N. G., &amp; Slobogin, C. (2018). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers (4th ed.). Guilford Press. Melton, G. B., Petrila, J., Poythress, N. G., Slobogin, C., Otto, R. K., Mossman, D., &amp; Condie, L. O. (2017).&nbsp;<em>Psychological evaluations for the courts: A handbook for mental health professionals and lawyers</em>. Guilford Publications. Mossman, D. (2013). Assessing predictions of violence: Being accurate about accuracy. <em>Journal of Consulting and Clinical Psychology, 81</em>(4), 631-643. Odgers, C. L., Moffitt, T. E., Broadbent, J. M., Dickson, N., Hancox, R. J., Harrington, H., ... &amp; Caspi, A. (2008). Female and male antisocial trajectories: From childhood origins to adult outcomes. <em>Development and Psychopathology, 20</em>(2), 673-716. Piquero, A. R., Farrington, D. P., &amp; Blumstein, A. (2007). Key issues in criminal career research: New analyses of the Cambridge Study in Delinquent Development. Cambridge University Press. Pirelli, G., &amp; Gottdiener, W. H. (2018). The ethical challenges of forensic psychiatry: Assessments, access, advocacy, and amelioration. <em>Journal of the American Academy of Psychiatry and the Law, 46</em>(2), 181-193. Salekin, R. T. (2008). Psychopathy in children and adolescents: The need for a developmental perspective. <em>Journal of Abnormal Child Psychology, 36</em>(2), 271-275. Salekin, R. T., &amp; Lynam, D. R. (2010). Child and adolescent psychopathy: Assessment issues and treatment needs. In T. J. Crowley, R. R. Watson, &amp; D. J. Eiden (Eds.), Psychopathy: Risk factors, behavioral symptoms and treatment approaches (pp. 75-98). Nova Science Publishers. Snyder, H. N., &amp; Sickmund, M. (2006). Juvenile offenders and victims: 2006 national report. US Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention. Walsh, A., &amp; Hemmens, C. (2010).&nbsp;Introduction to criminology: A text/reader. Sage. &nbsp;

Introduction: Adolescence is a period of transition from complete dependence to relative independence stage. Onset of menarche brings major physiological changes which is often associated with problems of irregular menstruation, excessive bleeding and dysmenorrhea. Objectives: Study aimed to assess the effectiveness of comprehensive nursing intervention in improving adolescent girls? knowledge and practices regarding dysmenorrhea. Methods: Study design is quasi experimental non randomized pre-test and post-test control group, 60 adolescent girls (30 in control and 30 in experimental group) from selected schools of district Sirmour, H.P. Data was collected by self-administered questionnaire and self-report practice check list. Results: In experimental group, Mean ? SD of knowledge score was 8.27?2.864 for pre-test and 29.57?2.956 and 13.10?2.482 respectively for two post-test, whereas in control group, it was 8.43?2.909 for pre-test and for post-test it was 8.50?2.921 and 8.27?2.924 respectively. Self-report practice score for pre-test and two post-tests were 3.63?1.866, 5.67?1.322 and 8.70?1.643 in experimental group. While in control group practice scores for pre-test and two post-tests were 4.20?2.058, 4.20?2.024 and 4.33?2.073. Repeated ANOVA was used to find out the relationship between pre-test, post-test 1 and post-test 2 at p &le; 0.05 level of significance. Chi test was used to find out the association at p&le; 0.05 level of significance. There was no association found between Conclusion: The result of the study suggested that there was improvement in the knowledge and practice of adolescent girls after the implementation of comprehensive nursing intervention.

BackgroundKnowledge on chronic medical conditions in childhood cancer survivors (CCSs) is constantly growing and underlines that long-term follow-up (LTFU) care is often mandatory, also in adulthood. However, many CCSs discontinue follow-up care after transition to adult care. One reason might be that the current transition practices do not meet the needs of adolescent and young adult CCSs. We therefore aim to evaluate different transition models for Swiss CCSs by assessing their cancer knowledge, cancer worries, self-management skills, and expectations for LTFU care, following transition in two different hospital-based models.MethodsWithin the Aftercare of Childhood Cancer Survivors (ACCS) study, we performed a questionnaire-based survey with a cross-sectional and longitudinal part. We included 5-year CCSs aged &amp;gt;16 years at recruitment who were transitioned to adult care in two hospitals between 2014 and 2021. Here, we report the results of the cross-sectional part. We compared the survivors’ cancer knowledge with medical record data and assessed cancer worries (6 questions), self-management skills (15 questions), and expectations (12 questions) by validated scales. We used descriptive statistics, chi-squared test, and t-tests to describe the results.ResultsWe analyzed 57 CCSs (response rate 44%), 60% of those were female, had a median age of 9 years at diagnosis and 23 years at the questionnaire. Most CCSs recalled their diagnosis (95%) and exposure to treatment modalities (98%) correctly. CCSs worried the most about potential late effects (47%) and issues with having children in the future (44%). At least 75% of CCSs agreed to 12 of the 15 self-management questions, indicating high self-management skills. The top three expectations included that physicians know the survivors’ cancer history, that visits start on time, and that physicians can always be called in case of questions.ConclusionCCSs receiving hospital-based LTFU care have good cancer knowledge and high self-management skills. The identified worries and expectations will help to improve the LTFU care of CCSs who transition to adult care, to further inform and educate survivors and healthcare professionals about and might be relevant for other countries with a similar healthcare system.

Abstract Background Concussions, a form of mild traumatic brain injury, are a current “hot topic” in sports and medicine, with current research focusing on diagnosis, treatment, and the long-term effects of repeated concussions on development of chronic traumatic encephalopathy. Concussions represent 8.9% of all high school athletic injuries, and pediatricians see many of these patients in their practices, however evolving guidelines and recommendations have resulted in varying practices among providers. Objective To assess how local pediatricians in New York Chapter 2 of the American Academy of Pediatrics (AAP) diagnose and treat concussion patients, and to evaluate the need for continuing education in this area. Design and methods Survey Monkey™ was used to query providers regarding their diagnosis and treatment of concussion patients. A total of three emails containing a link to the 22 question multiple-choice survey were sent to AAP Chapter 2 members between January 2015 and June 2015. The survey was adapted and modified with permission from one previously used by “Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers’ self-reported knowledge, practices, and attitudes about concussion. Pediatrics. 2012;130:1120–5”. Results We received 115 responses from 1436 potential participants to whom the survey link was sent, resulting in an 8% response rate. We excluded subspecialists from our data analysis, resulting in data from 95 primary care pediatricians. Of the PCPs 98.7% reported seeing at least one child or adolescent with a concussion in the previous 12 months and 76.6% reported referring some or all of their concussion patients for ongoing management. The most common reason for referral was “I am not always comfortable with management” and the most common subspecialist referral was to a neurologist. Most providers reported that they did not use any guidelines for management (58.3%) and only 57.4% were familiar with the New York State Education Department concussion guidelines. Almost half reported inadequate training in performing neurocognitive assessments (48.6%). Most were comfortable educating families about the diagnosis of concussion (81.7%), as well as recommending the appropriate time to resume school (70.4%) and prescribing and monitoring a return to play protocol (62%). A total of 84.3% also responded, however, that they would be interested in a webinar for a continuing medical education(CME) credit focused on concussion diagnosis and management. Conclusions Most pediatric providers care for patients who have suffered a concussion, however many identify barriers to diagnosis and treatment, which results in patients being referred to subspecialists for further management. Many providers are also unfamiliar with, or do not use, published concussion guidelines and report varying practices in treatment of concussion patients due to evolving recommendations. This study demonstrates that there is a need for further education for pediatric providers who see patients with concussion.

Photo ID 280792184 © Jj Gouin| Dreamstime.com Abstract Healthcare providers should advocate for human and civil rights. They ought to recognize injustices that unfairly disadvantage certain groups of people and work to improve broader conditions that affect health. Healthcare systems have historically undervalued and even excluded certain voices from the creation of an evidence base for care, furthering health disparities for members of these groups. This is a form of testimonial injustice. Trans people experience a particular form of testimonial injustice in healthcare settings when evidence and expertise related to their lived experience are excluded from consideration, as was the case with the 2024 Cass Review. Such exclusion can lead to mistreatment and harm. Providers must be vigilant in recognizing and addressing testimonial injustice against trans patients and the health disparities it can cause. Introduction Trans individuals (people who identify as transgender, transsexual, or whose gender identity is different from the sex they were assigned at birth) face many barriers to health care. The lack of competent, knowledgeable providers poses a significant barrier to gender-affirming care, as well as other forms of everyday health care for trans people.[1] Addressing this challenge requires health professionals to actively oppose structures that perpetuate epistemic injustice, which Miranda Fricker defines as “wrong done to someone specifically in their capacity as a knower.” Testimonial injustice (a kind of epistemic injustice) undermines collective understanding of marginalized perspectives through systemic misrepresentation or dismissal of marginalized individuals’ experiences or contributions.[2] Testimonial injustice contributes to unjust conditions for accessing care and results in poorer health outcomes for transgender individuals. As professionals committed to ethical and equitable patient treatment, we believe it is imperative that healthcare providers recognize and carefully consider the experiences and expertise of trans people in order to address injustices experienced by trans people in healthcare settings. Through an analysis of the Cass Review, we demonstrate how a flawed interpretation of available evidence and the dismissal of trans testimonies generates an injustice that results in significant and unwarranted restrictions on gender-affirming care. Testimonial Injustice Trans people regularly experience testimonial injustice in health care. It occurs when providers inappropriately discount their patients’ accounts — for example, by refusing to believe patients when they say that they are trans or gender non-conforming. This results in prejudiced assumptions about health behaviors or needs, bias and stereotyping that influence clinical judgment, and harm in the form of worse physical and mental health outcomes.[3] Testimonial injustice takes several pernicious forms. For example, a Black woman whose reports of high postpartum pain are disregarded by her providers because of her Blackness has suffered testimonial injustice when she receives lower doses of pain medication compared to other postpartum patients at the same hospital.[4] Her attestation of pain, an experience at once personal and universal, has been inappropriately regarded as insufficiently credible, resulting in harmful and unequal postpartum pain management. Testimonial injustice harms the physical, mental, and social well-being of trans people, worsening health outcomes caused by systemic barriers and discriminatory practices. Negative healthcare experiences, along with mistreatment from providers, lead to disproportionately high rates of depression, psychological distress, and suicidal ideation among trans patients.[5] These harmful interactions lead to lower healthcare utilization and delayed treatment. Trans people are also less likely to receive preventative cancer screenings, including for cervical, breast, and colorectal cancers.[6] These disparities, compounded by the accumulation of daily stress from discrimination, contribute to not only an increased risk of cancer but also to worse cancer outcomes.[7] Trans people are diagnosed at later stages, they are less likely to receive treatment for cancer and also have higher mortality rates for certain cancers.[8] Similar disparities are seen in cardiovascular health;[9] trans people are at greater risk for heart attacks.[10] They are also more likely to have multiple concurrent chronic conditions, including coronary heart disease, asthma, arthritis, diabetes, cancer, stroke, kidney disease, etc.[11] Clearly, there are significant and life-threatening gaps in care for trans people. These disparities result in worsened health outcomes, increased mistrust, and preventable deaths. A key factor in addressing these disparities is awareness of testimonial injustice: providers must recognize how their personal interactions with trans individuals, in the context of broader systemic barriers to adequate healthcare, can contribute to harmful practices and negligent care. In what follows, we argue that testimonial injustice contributes to trans peoples’ well-documented experiences of healthcare discrimination. The Cass Review The 2024 Cass Review (“the Review”), an independent review of gender treatment for trans youth commissioned by the National Health Service (NHS) in England, has caused significant harm to young trans people in the UK. The NHS ordered the Review, comprising of six systematic reviews, after concerns arose regarding an increase in referrals for trans care associated with doubts about its scientific rationale. The Review’s recommendations stem from a narrow reading of the evidence base for gender-affirming care and have resulted in significant restrictions on puberty-suppressing medication, hormone therapy, and care availability for trans youth in the UK.[12] Professional organizations and transgender health providers have widely criticized the Review’s findings. They assert that it contains many errors that “conflict with well-established norms of clinical research and evidence-based health care” and “raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.”[13] For example, the Review claims that referrals for trans care have grown exponentially (even while most transgender adolescents in the UK are not referred for care, and an expert critique of the Review led by the Integrity Project at Yale University found that the exponential growth is likely the result of double-counting referrals). This critique observes that the Review makes the provision of gender-affirming care appear “rushed, careless, and common,”[14] despite a waiting time of over two years for the assessment. Further, of the patients seen during the Review’s period of study, only 27 percent were referred to endocrinology for consideration of medical intervention. The Review includes an unsubstantiated concern that early supportive interventions such as puberty blockers necessarily result in irreversible effects. Puberty blockers, or gonadotropin releasing analogue (GnRHa), cause a temporary downregulation of the production of estrogen or testosterone when used during early puberty.[15] When prescribed for cis (people whose gender identity corresponds to the sex they were assigned at birth) and trans youth alike, they pause puberty (i.e., delaying development of secondary sex characteristics) reversibly. Reproductive function is restored if endogenous puberty resumes.[16] This therapy alone does not typically cause permanent physical changes, and when treatment is stopped, puberty resumes.[17] GnRHa medications are commonly used in treatment for precocious puberty in cisgender youth without impairing reproductive development or function, and research has demonstrated that puberty was continued within one year after GnRHa discontinuation.[18],[19] Long-acting GnRHa usage is also routinely seen in fertility preservation as the only medical option to preserve ovarian function in patients with cancer.[20] Indeed, after starting GnRHa medications, the collection of sperm or ova for reproductive purposes is a well-established option.[21] Studies have consistently shown that puberty blockers lead to positive outcomes for trans youth, including significant improvements in overall functioning, reductions in depressive symptoms, and lower lifetime rates of suicidal ideation.[22] The Review’s approach to the evaluation of evidence led to the exclusion of substantial peer-reviewed evidence in support of puberty blockers and hormones, including evidence regarding the lived experiences of trans youth. For instance, the authors deemed only one of the 50 studies in the systematic review of puberty blockers to be “high quality.” This is not a value-neutral or inevitable way to frame these studies. Rather, the research studies excluded from the Review because of “low evidence” were often qualitative or observational investigations that had no control group, while the ones considered “high quality” tended to be randomized controlled trials (RCTs).[23] However, discounting observational studies inappropriately treats transness as exceptional because observational studies constitute much of the evidence that guides clinical care for all fields of medicine.[24] Indeed, the World Health Organization published a series of papers in 2019 on the value of including qualitative studies in the development of clinical guidelines, arguing that “Qualitative evidence is crucial to improve the understanding on how, and whether, people perceive health interventions to be effective and acceptable. It is also essential to understand the factors influencing the implementation of health policies and interventions.” In other words, this kind of evidence provides context and reasoning that frame, rather than flattens, the complexity of human experiences that shape and are shaped by gender-affirming care.[25] Randomized controlled trials are often considered unethical in studying gender-affirming care. One reason for this is the lack of clinical equipoise: the medical community has already accepted gender-affirming care as the clinical standard, so there is dubious value in using limited resources to study resolved research questions.[26] In a randomized clinical trial, the control group would typically receive psychotherapy for gender-incongruent puberty instead of medications, which would necessitate withholding beneficial gender-affirming care from participants when there is evidence that treatment prevents serious harm.[27] On the other hand, observational studies can include more diverse patient populations and offer greater specificity about experiences than randomized controlled studies. Larger observational studies with extended follow-ups can also identify long-term benefits or harms that are useful for clinical guidelines.[28] Treating this kind of evidence as insufficient to support trans care represents a biased approach that undermines the legitimacy of patient testimony in the development of an evidence base for trans individuals. The selective use of evidence constitutes a form of testimonial injustice, as an entire body of medical knowledge important to, and often generated by, those affected is systematically dismissed. The Review limited meaningful involvement from trans patients and providers who had experience in the provision of gender-affirming care.[29] The Review’s Assurance Group — which was intended to provide “expert advice” on the conduct of the review — explicitly left out trans voices, stating that its “Members are independent of … providers of gender dysphoria services, and of any organisation or association that could reasonably be regarded as having a significant interest in the outcome of the Review.”[30] The logic of this exclusion was to ensure that nobody with a “significant interest in the outcome of the review” would bias its results through their personal or professional commitments. This approach is analogous to attempting to eliminate bias from a panel shaping clinical guidelines for heart disease by excluding both cardiologists and heart disease patients. The problem is not merely that trans people and those with expertise in their care were excluded as experts. This approach also flies in the face of contemporary best research practices that treat both lived and professional experience as important forms of expertise. Trans people and the people who provide them with health care should have been actively involved in research that affects their lives and care. The deliberate exclusion of their voices from the review process is a clear example of testimonial injustice. The Review excludes providers with experience in gender services due to the assumption of bias. In doing so, it implies that those who are empowered to lend their expertise are without bias. By treating only support for transgender adolescents as a disqualifying bias, the Review reviews its own normativity. The framework of testimonial injustice helps us to understand the links between the discounting of individual testimony about identity and the constitution of medical authority that translates such refusal to believe into refusal to provide care. In addition to minimizing the input of patients and providers with lived experience in the Assurance Group, the Cass Review also included healthcare workers who explicitly deny trans identity in its “online multi-professional panel to explore issues around gender identity services.” When prompted with the statement There is no such thing as a trans child. Gender dysphoria is always an indicator of another underlying problem, and assessment should focus on understanding the causes of their distress. 21 percent of the panel responded that they strongly agree or agree. The authors of the Review may feel that excluding transgender people and the physicians who care for them preserves objectivity. We argue, however, that it is inappropriate to include as expert advisors individuals who do not acknowledge the existence of the group the Cass Review examines and whose access to care the Review will, in turn, shape.[31] These experts call the existence of transgender youth (not just the kind of care that they need) into question: another decisive case of testimonial injustice. The Review does not make it clear that such a significant proportion of the experts it relies on do not believe in transgender children or that the root cause of distress in this population is gender. It may be unclear to policymakers and the public that people holding such views are shaping practice norms. This insight emerges only when evaluating the Likert response answers provided by the Review’s expert consultants via auxiliary reports, not via the main document or any included disclosures, discussions, or reports of the Review's limitations. The Review has had immediate and significant ramifications for trans NHS patients’ access to gender-affirming care.[32] It was also extensively cited as evidence against adolescent gender-affirming care provision in the oral arguments of US v. Skrmetti, a case about the constitutionality of Tennessee’s ban on gender-affirming care for minors.[33] Citing its early findings, the British government ordered closures of children’s gender services and stopped accepting referrals for gender-affirming care.[34] The Review was also used to justify halting the use of puberty blockers for the treatment of youth gender dysphoria, though the same medications remained available for other pediatric health needs (e.g., precocious puberty).[35] Systemic Testimonial Injustice Trans people experience testimonial injustice far beyond what the Cass Review manifests. One such everyday form is how trans individuals must not only articulate the legitimacy of their identities but defend them against accusations of insufficient self-knowledge or the intent to deceive others about their gender.[36] Many have experienced this injustice when required to convince their healthcare providers that they are “trans enough” to receive needed care. In a focus group conducted with trans youth in 2022, participants described having their gender identity questioned by providers: I think the big question, the question I’ve come back to over and over again [the doctor] asked me is, what does being a girl mean to you? And I didn’t have an answer. He was very skeptical of my lack of an answer for that. He was like, well I just – I feel like you should be able to talk about this. I think you might be moving too fast if you can’t talk about this. And I was like, well, no I think it’s just a stupid question. But I didn’t say that because I was 14 and small and nervous… And then when my parents came back in … he said he wanted to caution us against moving too quickly because he’s against permanent changes in children at a young age. He says he doesn’t think it’s a good idea... He just doesn’t think there’s enough science behind it to back it up.[37] Trans youth suffer testimonial injustice when their identities and existence are met with unreasonable skepticism or discounted entirely. This perceived lack of credibility often results in challenges from medical providers who may frame their own skepticism as concerns regarding reversibility and potential for regret. While irreversible interventions may demand special scrutiny and regret is generally to be avoided, the fact of such risks should not automatically preclude the provision of gender-affirming care. The frame of testimonial injustice helps us to see how provider interactions like these exemplify the systemic prejudice that trans people and others who diverge from cisnormative expectations face when their credibility is discounted, and accounts of their own selves are deemed untrustworthy.[38] Clinicians’ skepticism about their adolescent patients’ need for gender-affirming care may be rooted in an assessment that there is insufficient evidence to support gender affirmation as a standard of care. While the Cass Review’s findings of such evidentiary weakness have been strongly disputed by a number of analyses discussed elsewhere in this piece, we also posit that quibbling over what the evidence reveals is only part of the task of evaluating evidence. In the case of gender transition, where the denial of care will be experienced as a significant harm to the trans person, inaction – care refusal – must not be treated as a morally neutral option. Instead, care refusal must itself be regarded as having the potential to harm. Whether someone considering the ethics of gender-affirming care begins with an assumption that care provision or care denial ought to be, the status quo is, particularly in light of the vehemence of contemporary fights over access to gender-affirming care, more a question of values than it is of evidence. Physicians often treat patients whose symptoms cannot be proven or diagnosed with “objective” data. Myriad forms of routine medical care rely solely or primarily on patient testimony; not only is gender dysphoria unexceptional in this regard as a diagnosis, hormonal and surgical intervention to alleviate distress and bring about patient well-being is similarly standard medical procedure. Psychological and psychiatric care can often only be provided on the basis of patients’ self-reported experiences of mental illness, as those illnesses may not generate measurable physical effects. For instance, conditions such as the excess breast tissue that indicates gynecomastia in cisgender men are similarly predicated on patient articulations of their own experiences and needs. In all these cases, self-related phenomena are clinically relevant, and although some may dismiss them as empirically intractable, doing so would clearly be a mistake.[39] Healthcare systems also pose various significant hurdles to accessing forms of gender-affirming care, including their criteria for insurance coverage approval. Insurers’ criteria are unstandardized and often arbitrary. Yet, they profoundly shape the kind of care available, particularly given the economic precarity that prevents many trans people from paying for treatment out-of-pocket.[40] To secure coverage, trans individuals must frame their experience in accordance with insurers’ standards rather than medical standards alone.[41] The need to provide persuasive accounts to unlock care forces trans people to conform to specific, deficit-based descriptions of their identities as pathological and the ambiguous definition of medical necessity used by insurance companies.[42] This system reflects a form of testimonial injustice, effectively requiring trans people to present strategic narratives to obtain care and mold their needs to fit the stringent requirements of insurance. The disparate insurance criteria for gender-affirming care undermines existing forms of evidence — which are primarily based on testimonies. It treats the knowledge that trans people possess about their bodies as insufficiently credible to warrant medical autonomy.[43] This is an unjust standard of evidence. In this way, even well-meaning providers sometimes subject trans patients to arbitrary barriers to care purely on the basis of their gender identity. Conclusion All providers should understand the risk of testimonial injustice to trans people in healthcare contexts. This is particularly urgent for providers who treat trans patients. Since all providers will treat trans patients regardless of specialty, all healthcare practitioners should address testimonial injustice. Accordingly, they must work to counter the devaluation of trans testimonies, not just in individual patient and provider experiences but across the medical community and system at large. Invalidating trans-patient experiences not only erodes trust in the healthcare system but may lead to inadequate or harmful therapeutic approaches. As a result, testimonial injustice perpetuates a cycle of negative health outcomes, which can include worsened mental health,[44] significantly greater risk of cardiovascular disease,[45] higher rates of chronic illness,[46] higher rates of disability,[47] and more preventable deaths[48] compared to cisgender individuals. The stakes here are high: testimonial justice is essential to providing good health care for all. Justice demands that we not only take the testimonies of trans people seriously but understand them as fundamental to the provision of needed health care. - [1] Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix A, Sevelius J. Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):168-71. doi: 10.1097/MED.0000000000000227. PMID: 26910276; PMCID: PMC4802845. [2] Fricker M. Epistemic Injustice: Power and the Ethics of Knowing. New York, NY: Oxford University Press; 2007. [3] Fact Sheet: Protecting and Advancing Health Care for Transgender Adult Communities. Center for American Progress. https://www.americanprogress.org/article/fact-sheet-protecting-advancing-health-care-transgender-adult-communities/#:~:text=Compared%20with%20the%20general%20population [4]Greene NH, Kilpatrick SJ. Racial/ethnic disparities in peripartum pain assessment and management. Joint Commission Journal on Quality and Patient Safety. 2024. doi:10.1016/j.jcjq.2024.03.009; Badreldin N, Grobman WA, Yee LM. Racial disparities in postpartum pain management. Obstetrics &amp; Gynecology. 2019;134(6):1147-1153. doi:10.1097/AOG.0000000000003561 [5] Levine, S., Heiden-Rootes, K., &amp; Salas, J. (2022). Associations Between Healthcare Experiences, Mental Health Outcomes, and Substance Use Among Transgender Adults. The Journal of the American Board of Family Medicine, 35(6), 1092–1102. https://doi.org/10.3122/jabfm.2022.220186r1; Inman, E. M., Juno Obedin-Maliver, Ragosta, S., Hastings, J., Berry, J., Lunn, M. R., Flentje, A., Capriotti, M. R., Lubensky, M. E., Stoeffler, A., Zubin Dastur, &amp; Moseson, H. (2023). Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. 20(11), 6007–6007. https://doi.org/10.3390/ijerph20116007 [6] Kiran, T., Davie, S., Singh, D., Hranilovic, S., Pinto, A. D., Abramovich, A., &amp; Lofters, A. (2019). Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data. 65(1), e30–e37. [7] Jackson, S. S., &amp; Hammer, A. (2023). Cancer risk among transgender adults: A growing population with unmet needs. Acta Obstetricia et Gynecologica Scandinavica, 102(11), 1428–1430. https://doi.org/10.1111/aogs.14686 [8] Jackson, S. S., &amp; Hammer, A. (2023). Cancer risk among transgender adults: A growing population with unmet needs. Acta Obstetricia et Gynecologica Scandinavica, 102(11), 1428–1430. https://doi.org/10.1111/aogs.14686 ; Jackson, S. S., Han, X., Mao, Z., Nogueira, L., Suneja, G., Jemal, A., &amp; Shiels, M. S. (2021). Cancer Stage, Treatment, and Survival Among Transgender Patients in the United States. JNCI: Journal of the National Cancer Institute, 113(9), 1221–1227. https://doi.org/10.1093/jnci/djab028 [9] Health disparities and equitable access to health care persist with transgender adults. (n.d.). American Heart Association. https://newsroom.heart.org/news/health-disparities-and-equitable-access-to-health-care-persist-with-transgender-adults [10] Alzahrani, T., Nguyen, T., Ryan, A., Dwairy, A., McCaffrey, J., Yunus, R., Forgione, J., Krepp, J., Nagy, C., Mazhari, R., &amp; Reiner, J. (2019). Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circulation: Cardiovascular Quality and Outcomes, 12(4). https://doi.org/10.1161/circoutcomes.119.005597 [11] Downing, J. M., &amp; Przedworski, J. M. (2018). Health of Transgender Adults in the U.S., 2014–2016. American Journal of Preventive Medicine, 55(3), 336–344. https://doi.org/10.1016/j.amepre.2018.04.045 [12] WPATH and USPATH COMMENT on the CASS REVIEW.; 2024. https://www.wpath.org/media/cms/Documents/Public%20Policies/2024/17.05.24%20Response%20Cass%20Review%20FINAL%20with%20ed%20note.pdf?_t=1716075965 [13] McNamara M, Baker K, Connelly K, et al. An evidence-based critique of “The Cass Review” on gender-affirming care for adolescent gender dysphoria. 2024; Rew L, Young CC, Monge M, Bogucka R. [White paper]. 2020. [14] McNamara M, Baker K, Connelly K, et al. An evidence-based critique of “The Cass Review” on gender-affirming care for adolescent gender dysphoria. 2024; Rew L, Young CC, Monge M, Bogucka R. [White paper]. 2020. [15] Guss, C., &amp; Gordon, C. M. (2022). Pubertal Blockade and Subsequent Gender-Affirming Therapy. JAMA Network Open, 5(11), e2239763. https://doi.org/10.1001/jamanetworkopen.2022.39763 [16] Riggs, D. W., Tollit, M., &amp; Lin, A. (2021). Refusing puberty blockers to trans young people is not justified by the evidence. The Lancet Child &amp; Adolescent Health, 5(9), e35–e36. https://doi.org/10.1016/s2352-4642(21)00233-9 [17] Mayo Clinic Staff. (2023, June 14). Pubertal blockers for transgender and gender diverse youth. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075 [18] Heger, S., Müller, M., Ranke, M., Schwarz, H.-P., Waldhauser, F., Partsch, C.-J., &amp; Sippell, W. G. (2006). Long-term GnRH agonist treatment for female central precocious puberty does not impair reproductive function. Molecular and Cellular Endocrinology, 254-255, 217–220. https://doi.org/10.1016/j.mce.2006.04.012 [19] Kim, E. Y. (2015). Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty. Korean Journal of Pediatrics, 58(1), 1. https://doi.org/10.3345/kjp.2015.58.1.1 [20] Massarotti, C., Stigliani, S., Gazzo, I., Lambertini, M., &amp; Anserini, P. (2023). Long-acting gonadotropin-releasing hormone agonist trigger in fertility preservation cycles before chemotherapy. ESMO Open, 8(4), 101597. https://doi.org/10.1016/j.esmoop.2023.101597 [21] Giordano, S., &amp; Holm, S. (2020). Is puberty delaying treatment “experimental treatment”?. International Journal of Transgender Health, 21(2), 113–121. https://doi.org/10.1080/26895269.2020.1747768 [22] McNamara M, Baker K, Connelly K, et al. An evidence-based critique of “The Cass Review” on gender-affirming care for adolescent gender dysphoria. 2024; Rew L, Young CC, Monge M, Bogucka R. [White paper]. 2020. ; Rew L, Young CC, Monge M, Bogucka R. Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature. Child Adolesc Ment Health. 2021;26(1):3-14. doi:10.1111/camh.12437; Mayo Clinic Staff. Pubertal blockers for transgender and gender diverse youth. Mayo Clinic. Published June 14, 2023, https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075, Lee, J. Y., &amp; Rosenthal, S. M. (2022). Gender-Affirming Care of Transgender and Gender-Diverse Youth: Current Concepts. Annual Review of Medicine, 74(1). https://doi.org/10.1146/annurev-med-043021-032007 [23] Cass H. Final Report – Cass Review. cass.independent-review.uk. Published April 2024. https://cass.independent-review.uk/home/publications/final-report/ [24] McNamara M, Baker K, Connelly K, et al. An evidence-based critique of “The Cass Review” on gender-affirming care for adolescent gender dysphoria. 2024; Rew L, Young CC, Monge M, Bogucka R. [White paper]. 2020. 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“I’m fat–and it’s okay! It doesn’t mean I’m stupid, or ugly, or lazy, or selfish. I’m fat!” so proclaims Joy Nash in her YouTube video, A Fat Rant. “Fat! It’s three little letters–what are you afraid of?!” This is the question I pose to my class on day one of Fat Studies. Sadly, many college students do fear fat, and negative attitudes toward fat people are quite prevalent in this population (Ambwani et al. 366). As I teach it, Fat Studies is cross-listed between Psychology and Gender Studies. However, most students who enrol have majors in Psychology or other behavioural health science fields in which weight bias is particularly pronounced (Watkins and Concepcion 159). Upon finding stronger bias among third- versus first-year Physical Education students, O’Brien, Hunter, and Banks (308) speculated that the weight-centric curriculum that typifies this field actively engenders anti-fat attitudes. Based on their exploration of textbook content, McHugh and Kasardo (621) contend that Psychology too is complicit in propagating weight bias by espousing weight-centric messages throughout the curriculum. Such messages include the concepts that higher body weight invariably leads to poor health, weight control is simply a matter of individual choice, and dieting is an effective means of losing weight and improving health (Tylka et al.). These weight-centric tenets are, however, highly contested. For instance, there exists a body of research so vast that it has its own name, the “obesity paradox” literature. This literature (McAuley and Blair 773) entails studies that show that “obese” persons with chronic disease have relatively better survival rates and that a substantial portion of “overweight” and “obese” individuals have levels of metabolic health similar to or better than “normal” weight individuals (e.g., Flegal et al. 71). Finally, the “obesity paradox” literature includes studies showing that cardiovascular fitness is a far better predictor of mortality than weight. In other words, individuals may be both fit and fat, or conversely, unfit and thin (Barry et al. 382). In addition, Tylka et al. review literature attesting to the complex causes of weight status that extend beyond individual behaviour, ranging from genetic predispositions to sociocultural factors beyond personal control. Lastly, reviews of research on dieting interventions show that these are overwhelmingly ineffective in producing lasting weight loss or actual improvements in health and may in fact lead to disordered eating and other unanticipated adverse consequences (e.g., Bacon and Aphramor; Mann et al. 220; Salas e79; Tylka et al.).The newfound, interdisciplinary field of scholarship known as Fat Studies aims to debunk weight-centric misconceptions by elucidating findings that counter these mainstream suppositions. Health At Every Size® (HAES), a weight-neutral approach to holistic well-being, is an important facet of Fat Studies. The HAES paradigm advocates intuitive eating and pleasurable physical activity for health rather than restrictive dieting and regimented exercise for weight loss. HAES further encourages body acceptance of self and others regardless of size. Empirical evidence shows that HAES-based interventions improve physical and psychological health without harmful side-effects or high dropout rates associated with weight loss interventions (Bacon and Aphramor; Clifford et al. “Impact of Non-Diet Approaches” 143). HAES, like the broader field of Fat Studies, seeks to eradicate weight-based discrimination, positioning weight bias as a social justice issue that intersects with oppression based on other areas of difference such as gender, race, and social class. Much like Queer Studies, Fat Studies seeks to reclaim the word, fat, thus stripping it of its pejorative connotations. As Nash asserts in her video, “Fat is a descriptive physical characteristic. It’s not an insult, or an obscenity, or a death sentence!” As an academic discipline, Fat Studies is expanding its visibility and reach. The Fat Studies Reader, the primary source of reading for my course, provides a comprehensive overview of the field (Rothblum and Solovay 1). This interdisciplinary anthology addresses fat history and activism, fat as social inequality, fat in healthcare, and fat in popular culture. Ward (937) reviews this and other recently-released fat-friendly texts. The field features its own journal, Fat Studies: An Interdisciplinary Journal of Body Weight and Society, which publishes original research, overview articles, and reviews of assorted media. Both the Popular Culture Association and National Women’s Studies Association have special interest groups devoted to Fat Studies, and the American Psychological Association’s Division on the Psychology of Women has recently formed a task force on sizism (Bergen and Carrizales 22). Furthermore, Fat Studies conferences have been held in Australia and New Zealand, and the third annual Weight Stigma Conference will occur in Iceland, September 2015. Although the latter conference is not necessarily limited to those who align themselves with Fat Studies, keynote speakers include Ragen Chastain, a well-known member of the fat acceptance movement largely via her blog, Dances with Fat. The theme of this year’s conference, “Institutionalised Weightism: How to Challenge Oppressive Systems,” is consistent with Fat Studies precepts:This year’s theme focuses on the larger social hierarchies that favour thinness and reject fatness within western culture and how these systems have dictated the framing of fatness within the media, medicine, academia and our own identities. What can be done to oppose systemised oppression? What can be learned from the fight for social justice and equality within other arenas? Can research and activism be united to challenge prevailing ideas about fat bodies?Concomitantly, Fat Studies courses have begun to appear on college campuses. Watkins, Farrell, and Doyle-Hugmeyer (180) identified and described four Fat Studies and two HAES courses that were being taught in the U.S. and abroad as of 2012. Since then, a Fat Studies course has been taught online at West Virginia University and another will soon be offered at Washington State University. Additionally, a new HAES class has been taught at Saint Mary’s College of California during the last two academic years. Cameron (“Toward a Fat Pedagogy” 28) describes ways in which nearly 30 instructors from five different countries have incorporated fat studies pedagogy into university courses across an array of academic areas. This growing trend is manifested in The Fat Pedagogy Reader (Russell and Cameron) due out later this year. In this article, I describe content and pedagogical strategies that I use in my Fat Studies course. I then share students’ qualitative reactions, drawing upon excerpts from written assignments. During the term reported here, the class was comprised of 17 undergraduate and 5 graduate students. Undergraduate majors included 47% in Psychology, 24% in Women Studies, 24% in various other College of Liberal Arts fields, and 6% in the College of Public Health. Graduate majors included 40% in the College of Public Health and 60% in the College of Education. Following submission of final grades, students provided consent via email allowing written responses on assignments to be anonymously incorporated into research reports. Assignments drawn upon for this report include weekly reading reactions to specific journal articles in which students were to summarise the main points, identify and discuss a specific quote or passage that stood out to them, and consider and discuss applicability of the information in the article. This report also utilises responses to a final assignment in which students were to articulate take-home lessons from the course.Despite the catalogue description, many students enter Fat Studies with a misunderstanding of what the course entails. Some admitted that they thought the course was about reducing obesity and the presumed health risks associated with this alleged pathological condition (Watkins). Others understood, but were somewhat dubious, at least at the outset, “Before I began this class, I admit that I was skeptical of what Fat Studies meant.” Another student experienced “a severe cognitive dissonance” between the Fat Studies curriculum and that of a previous behavioural health class:My professor spent the entire quarter spouting off statistics, such as the next generation of children will be the first generation to have a lower life expectancy than their parents and the ever increasing obesity rates that are putting such a tax on our health care system, and I took her words to heart. I was scared for myself and for the populations I would soon be working with. I was worried that I was destined to a chronic disease and bothered that my BMI was two points above ‘normal.’ I believed everything my professor alluded to on the danger of obesity because it was things I had heard in the media and was led to believe all my life.Yet another related, “At first, I will be honest, it was hard for me to accept a lot of this information, but throughout the term every class changed my mind about my view of fat people.” A few students have voiced even greater initial resistance. During a past term, one student lamented that the material represented an attack on her intended behavioural health profession. Cameron (“Learning to Teach Everybody”) describes comparable reactions among students in her Critical Obesity course taught within a behavioural health science unit. Ward (937) attests that, even in Gender Studies, fat is the topic that creates the most controversy. Similarly, she describes students’ immense discomfort when asked to entertain perspectives that challenge deeply engrained ideas inculcated by our culture’s “obesity epidemic.” Discomfort, however, is not necessarily antithetical to learning. In prompting students to unlearn “the biomedically-informed truth of obesity, namely that fat people are unfit, unhealthy, and in need of ‘saving’ through expert interventions,” Moola at al. recommend equipping them with an “ethics of discomfort” (217). No easy task, “It requires courage to ask our students to forgo the security of prescriptive health messaging in favour of confusion and uncertainty” (221). I encourage students to entertain conflicting perspectives by assigning empirically-based articles emanating from peer-reviewed journals in their own disciplines that challenge mainstream discourses on obesity (e.g., Aphramor; Bombak e60; Tomiyama, Ahlstrom, and Mann 861). Students whose training is steeped in the scientific method seem to appreciate having quantitative data at their disposal to convince themselves–and their peers and professors–that widely held weight-centric beliefs and practices may not be valid. One student remarked, “Since I have taken this course, I feel like I am prepared to discuss the fallacy of the weight-health relationship,” citing specific articles that would aid in the effort. Likewise, Cameron’s (“Learning to Teach Everybody”) students reported a need to read research reports in order to begin questioning long-held beliefs.In addition, I assign readings that provide students with the opportunity to hear the voices of fat people themselves, a cornerstone of Fat Studies. Besides chapters in The Fat Studies Reader authored by scholars and activists who identify as fat, I assign qualitative articles (e.g., Lewis et al.) and narrative reports (e.g., Pause 42) in which fat people describe their experiences with weight and weight bias. Additionally, I provide positive images of fat people via films and websites (Clifford et al. HAES®; Watkins; Watkins and Doyle-Hugmeyer 177) in order to counteract the preponderance of negative, dehumanising portrayals in popular media (e.g., Ata and Thompson 41). In response, a student stated:One of the biggest things I took away from this term was the confidence I found in fat women through films and stories. They had more confidence than I have seen in any tiny girl and owned the body they were given.I introduce “normal” weight allies as well, most especially Linda Bacon whose treatise on thin privilege tends to set the stage for viewing weight bias as a form of oppression (Bacon). One student observed, “It was a relief to be able to read and talk about weight oppression in a classroom setting for once.” Another appreciated that “The class did a great job at analysing fat as oppression and not like a secondhand oppression as I have seen in my past classes.” Typically, fat students were already aware of weight-based privilege and oppression, often painfully so. Thinner students, however, were often astonished by this concept, several describing Bacon’s article as “eye-opening.” In reaction, many vowed to act as allies:This class has really opened my eyes and prepared me to be an ally to fat people. It will be difficult for some time while I try to get others to understand my point of view on fat people but I believe once there are enough allies, people’s minds will really start changing and it will benefit everyone for the better.Pedagogically, I choose to share my own experiences as they relate to course content and encourage students, at least in their written assignments, to do the same. Other instructors refrain from this practice for fear of reinforcing traditional discourses or eliciting detrimental reactions from students (Watkins, Farrell, and Doyle-Hugmeyer 191). Nevertheless, this tack seems to work well in my course, with many students opting to disclose their relevant circumstances during classroom discussions: Throughout the term I very much valued and appreciated when classmates would share their experiences. I love listening and hearing to others experiences and I think that is a great way to understand the material and learn from one another.It really helped to read different articles and hear classmates discuss and share stories that I was able to relate to. The idea of hearing people talk about issues that I thought I was the only one who dealt with was so refreshing and enlightening.The structure of this class allowed me to learn how this information is applicable to my life and made it deeper than just memorising information.Thus far, across three terms, no student has described iatrogenic effects from this process. In fact, most attribute positive transformations to the class. These include enhanced body acceptance of self and others: This class decreased my fat phobia towards others and gave me a better understanding about the intersectionality of one’s weight. For example, I now feel that I no longer view my family in a fat phobic way and I also feel responsible for educating my brother and helping him develop a strong self-esteem regardless of his size.I never thought this class would change my life, almost save my life. Through studies shown in class and real life people following their dreams, it made my mind completely change about how I view my body and myself.I can only hope that in the future, I will be more forgiving, tolerant, and above all accepting of myself, much less others. Regardless of a person’s shape and size, we are all beautiful, and while I’m just beginning to understand this, it can only get better from here.Students also reported becoming more savvy consumers of weight-centric media messages as well as realigning their eating and exercise behaviour in accordance with HAES: I find myself disgusted at the television now, especially with the amount of diet ads, fitness club ads, and exercise equipment ads all aimed at making a ‘better you.’ I now know that I would never be better off with a SlimFast shake, P90X, or a Total Gym. I would be better off eating when I’m hungry, working out because it is fun, and still eating Thin Mints when I want to. Prior to this class, I would work out rigorously, running seven miles a day. Now I realise why at times I dreaded to work out, it was simply a mathematical system to burn the energy that I had acquired earlier in the day. Instead what I realise I should do is something I enjoy, that way I will never get tired of whatever I am doing. While I do enjoy running, other activities would bring more joy while engaging in a healthy lifestyle like hiking or mountain biking.I will never go on another diet. I will stop choosing exercises I don’t love to do. I will not weigh myself every single day hoping for the number on the scale to change.A reduction in self-weighing was perhaps the most frequent behaviour change that students expressed. This is particularly valuable in that frequent self-weighing is associated with disordered eating and unhealthy weight control behaviours (Neumark-Sztainer et al. 811):I have realised that the number on the scale is simply a number on the scale. That number does not define who you are. I have stopped weighing myself every morning. I put the scale in the storage closet so I don’t have to look at it. I even encouraged my roommate to stop weighing herself too. What has been most beneficial for me to take away from this class is the notion that the number on the scale has so much less to do with fitness levels than most people understand. Coming from a numbers obsessed person like myself, this class has actually gotten me to leave the scales behind. I used to weigh myself every single day and my self-confidence reflected whether I was up or down in weight from the day before. It seems so silly to me now. From this class, I take away a new outlook on body diversity. I will evaluate who I am for what I do and not represent myself with a number. I’m going to have my cake this time, and actually eat it too!Finally, students described ways in which they might carry the concepts from Fat Studies into their future professions: I want to go to law school. This model is something I will work toward in the fight for social justice.As a teacher and teacher of teachers, I plan to incorporate discussions on size diversity and how this should be addressed within the field of adapted physical education.I do not know how I would have gone forward if I had never taken this class. I probably would have continued to use weight loss as an effective measure of success for both nutrition and physical activity interventions. I will never be able to think about the obesity prevention movement in the same way.Since I am working toward being a clinical psychologist, I don’t want to have a client who is pursuing weight loss and then blindly believe that they need to lose weight. I’d rather be of the mindset that every person is unique, and that there are other markers of health at every size.Jones and Hughes-Decatur (59) call for increased scholarship illustrating and evaluating critical body pedagogies so that teachers might provide students with tools to critique dominant discourses, helping them forge healthy relationships with their own bodies in the process. As such, this paper describes elements of a Fat Studies class that other instructors may choose to adopt. It additionally presents qualitative data suggesting that students came to think about fat and fat people in new and divergent ways. Qualitative responses also suggest that students developed better body image and more adaptive eating and exercise behaviours throughout the term. Although no students have yet described lasting adverse effects from the class, one stated that she would have preferred less of a focus on health and more of a focus on issues such as fat fashion. Indeed, some Fat Studies scholars (e.g., Lee) advocate separating discussions of weight bias from discussions of health status to avoid stigmatising fat people who do experience health problems. While concerns about fostering healthism within the fat acceptance movement are valid, as a behavioural health professional with an audience of students training in these fields, I have chosen to devote three weeks of our ten week term to this subject matter. Depending on their academic background, others who teach Fat Studies may choose to emphasise different aspects such as media representations or historical connotations of fat.Nevertheless, the preponderance of positive comments evidenced throughout students’ assignments may certainly be a function of social desirability. Although I explicitly invite critique, and in fact assign readings (e.g., Welsh 33) and present media that question HAES and Fat Studies concepts, students may still feel obliged to articulate acceptance of and transformations consistent with the principles of these movements. As a more objective assessment of student outcomes, I am currently conducting a quantitative evaluation, in which I remain blind to students’ identities, of this year’s Fat Studies course compared to other upper division/graduate Psychology courses, examining potential changes in weight bias, body image and dieting behaviour, adherence to appearance-related media messages, and obligatory exercise behaviour. I postulate results akin to those of Humphrey, Clifford, and Neyman Morris (143) who found reductions in weight bias, improved body image, and improved eating behaviour among college students as a function of their HAES course. As Fat Studies pedagogy proliferates, instructors are called upon to share their teaching strategies, document the effects, and communicate these results within and outside of academic spheres.ReferencesAmbwani, Suman, Katherine M. Thomas, Christopher J. Hopwood, Sara A. Moss, and Carlos M. Grilo. “Obesity Stigmatization as the Status Quo: Structural Considerations and Prevalence among Young Adults in the U.S.” Eating Behaviors 15.3 (2014): 366-370. Aphramor, Lucy. “Validity of Claims Made in Weight Management Research: A Narrative Review of Dietetic Articles.” Nutrition Journal 9 (2010): n. pag. 15 May 2015 ‹http://www.nutritionj.com/content/9/1/30›.Ata, Rheanna M., and J. 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Introduction This paper offers a survey of familiar popular music performers and songwriters who reference coffee in their work. It examines three areas of discourse: the psychoactive effects of caffeine, coffee and courtship rituals, and the politics of coffee consumption. I claim that coffee carries a cultural and musicological significance comparable to that of the chemical stimulants and consumer goods more readily associated with popular music. Songs about coffee may not be as potent as those featuring drugs and alcohol (Primack; Schapiro), or as common as those referencing commodities like clothes and cars (Englis; McCracken), but they do feature across a wide range of genres, some of which enjoy archetypal associations with this beverage. m.o.m.m.y. Needs c.o.f.f.e.e.: The Psychoactive Effect of Coffee The act of performing and listening to popular music involves psychological elements comparable to the overwhelming sensory experience of drug taking: altered perceptions, repetitive grooves, improvisation, self-expression, and psychological empathy—such as that between musician and audience (Curry). Most popular music genres are, as a result, culturally and sociologically identified with the consumption of at least one mind-altering substance (Lyttle; Primack; Schapiro). While the analysis of lyrics referring to this theme has hitherto focused on illegal drugs and alcoholic beverages (Cooper), coffee and its psychoactive ingredient caffeine have been almost entirely overlooked (Summer). The most recent study of drugs in popular music, for example, defined substance use as “tobacco, alcohol, marijuana, cocaine and other stimulants, heroin and other opiates, hallucinogens, inhalants, prescription drugs, over-the-counter drugs, and nonspecific substances” (Primack 172), thereby ignoring a chemical stimulant consumed by 90 per cent of adult Americans every day (Lovett). The wide availability of coffee and the comparatively mild effect of caffeine means that its consumption rarely causes harm. One researcher has described it as a ubiquitous and unobtrusive “generalised public activity […] ‘invisible’ to analysts seeking distinctive social events” (Cooper 92). Coffee may provide only a relatively mild “buzz”—but it is now accepted that caffeine is an addictive substance (Juliano) and, due to its universal legality, coffee is also the world’s most extensively traded and enthusiastically consumed psychoactive consumer product (Juliano 1). The musical genre of jazz has a longstanding relationship with marijuana and narcotics (Curry; Singer; Tolson; Winick). Unsurprisingly, given its Round Midnight connotations, jazz standards also celebrate the restorative impact of coffee. Exemplary compositions include Burke/Webster’s insomniac torch song Black Coffee, which provided hits for Sarah Vaughan (1949), Ella Fitzgerald (1953), and Peggy Lee (1960); and Frank Sinatra’s recordings of Hilliard/Dick’s The Coffee Song (1946, 1960), which satirised the coffee surplus in Brazil at a time when this nation enjoyed a near monopoly on production. Sinatra joked that this ubiquitous drink was that country’s only means of liquid refreshment, in a refrain that has since become a headline writer’s phrasal template: “There’s an Awful Lot of Coffee in Vietnam,” “An Awful Lot of Coffee in the Bin,” and “There’s an Awful Lot of Taxes in Brazil.” Ethnographer Aaron Fox has shown how country music gives expression to the lived social experience of blue-collar and agrarian workers (Real 29). Coffee’s role in energising working class America (Cooper) is featured in such recordings as Dolly Parton’s Nine To Five (1980), which describes her morning routine using a memorable “kitchen/cup of ambition” rhyme, and Don't Forget the Coffee Billy Joe (1973) by Tom T. Hall which laments the hardship of unemployment, hunger, cold, and lack of healthcare. Country music’s “tired truck driver” is the most enduring blue-collar trope celebrating coffee’s analeptic powers. Versions include Truck Drivin' Man by Buck Owens (1964), host of the country TV show Hee Haw and pioneer of the Bakersfield sound, and Driving My Life Away from pop-country crossover star Eddie Rabbitt (1980). Both feature characteristically gendered stereotypes of male truck drivers pushing on through the night with the help of a truck stop waitress who has fuelled them with caffeine. Johnny Cash’s A Cup of Coffee (1966), recorded at the nadir of his addiction to pills and alcohol, has an incoherent improvised lyric on this subject; while Jerry Reed even prescribed amphetamines to keep drivers awake in Caffein [sic], Nicotine, Benzedrine (And Wish Me Luck) (1980). Doye O’Dell’s Diesel Smoke, Dangerous Curves (1952) is the archetypal “truck drivin’ country” song and the most exciting track of its type. It subsequently became a hit for the doyen of the subgenre, Red Simpson (1966). An exhausted driver, having spent the night with a woman whose name he cannot now recall, is fighting fatigue and wrestling his hot-rod low-loader around hairpin mountain curves in an attempt to rendezvous with a pretty truck stop waitress. The song’s palpable energy comes from its frenetic guitar picking and the danger implicit in trailing a heavy load downhill while falling asleep at the wheel. Tommy Faile’s Phantom 309, a hit for Red Sovine (1967) that was later covered by Tom Waits (Big Joe and the Phantom 309, 1975), elevates the “tired truck driver” narrative to gothic literary form. Reflecting country music’s moral code of citizenship and its culture of performative storytelling (Fox, Real 23), it tells of a drenched and exhausted young hitchhiker picked up by Big Joe—the driver of a handsome eighteen-wheeler. On arriving at a truck stop, Joe drops the traveller off, giving him money for a restorative coffee. The diner falls silent as the hitchhiker orders up his “cup of mud”. Big Joe, it transpires, is a phantom trucker. After running off the road to avoid a school bus, his distinctive ghost rig now only reappears to rescue stranded travellers. Punk rock, a genre closely associated with recreational amphetamines (McNeil 76, 87), also features a number of caffeine-as-stimulant songs. Californian punk band, Descendents, identified caffeine as their drug of choice in two 1996 releases, Coffee Mug and Kids on Coffee. These songs describe chugging the drink with much the same relish and energy that others might pull at the neck of a beer bottle, and vividly compare the effects of the drug to the intense rush of speed. The host of “New Music News” (a segment of MTV’s 120 Minutes) references this correlation in 1986 while introducing the band’s video—in which they literally bounce off the walls: “You know, while everybody is cracking down on crack, what about that most respectable of toxic substances or stimulants, the good old cup of coffee? That is the preferred high, actually, of California’s own Descendents—it is also the subject of their brand new video” (“New Music News”). Descendents’s Sessions EP (1997) featured an overflowing cup of coffee on the sleeve, while punk’s caffeine-as-amphetamine trope is also promulgated by Hellbender (Caffeinated 1996), Lagwagon (Mr. Coffee 1997), and Regatta 69 (Addicted to Coffee 2005). Coffee in the Morning and Kisses in the Night: Coffee and Courtship Coffee as romantic metaphor in song corroborates the findings of early researchers who examined courtship rituals in popular music. Donald Horton’s 1957 study found that hit songs codified the socially constructed self-image and limited life expectations of young people during the 1950s by depicting conservative, idealised, and traditional relationship scenarios. He summarised these as initial courtship, honeymoon period, uncertainty, and parting (570-4). Eleven years after this landmark analysis, James Carey replicated Horton’s method. His results revealed that pop lyrics had become more realistic and less bound by convention during the 1960s. They incorporated a wider variety of discourse including the temporariness of romantic commitment, the importance of individual autonomy in relationships, more liberal attitudes, and increasingly unconventional courtship behaviours (725). Socially conservative coffee songs include Coffee in the Morning and Kisses in the Night by The Boswell Sisters (1933) in which the protagonist swears fidelity to her partner on condition that this desire is expressed strictly in the appropriate social context of marriage. It encapsulates the restrictions Horton identified on courtship discourse in popular song prior to the arrival of rock and roll. The Henderson/DeSylva/Brown composition You're the Cream in My Coffee, recorded by Annette Hanshaw (1928) and by Nat King Cole (1946), also celebrates the social ideal of monogamous devotion. The persistence of such idealised traditional themes continued into the 1960s. American pop singer Don Cherry had a hit with Then You Can Tell Me Goodbye (1962) that used coffee as a metaphor for undying and everlasting love. Otis Redding’s version of Butler/Thomas/Walker’s Cigarettes and Coffee (1966)—arguably soul music’s exemplary romantic coffee song—carries a similar message as a couple proclaim their devotion in a late night conversation over coffee. Like much of the Stax catalogue, Cigarettes and Coffee, has a distinctly “down home” feel and timbre. The lovers are simply content with each other; they don’t need “cream” or “sugar.” Horton found 1950s blues and R&amp;B lyrics much more sexually explicit than pop songs (567). Dawson (1994) subsequently characterised black popular music as a distinct public sphere, and Squires (2002) argued that it displayed elements of what she defined as “enclave” and “counterpublic” traits. Lawson (2010) has argued that marginalised and/or subversive blues artists offered a form of countercultural resistance against prevailing social norms. Indeed, several blues and R&amp;B coffee songs disregard established courtship ideals and associate the product with non-normative and even transgressive relationship circumstances—including infidelity, divorce, and domestic violence. Lightnin’ Hopkins’s Coffee Blues (1950) references child neglect and spousal abuse, while the narrative of Muddy Waters’s scorching Iodine in my Coffee (1952) tells of an attempted poisoning by his Waters’s partner. In 40 Cups of Coffee (1953) Ella Mae Morse is waiting for her husband to return home, fuelling her anger and anxiety with caffeine. This song does eventually comply with traditional courtship ideals: when her lover eventually returns home at five in the morning, he is greeted with a relieved kiss. In Keep That Coffee Hot (1955), Scatman Crothers supplies a counterpoint to Morse’s late-night-abandonment narrative, asking his partner to keep his favourite drink warm during his adulterous absence. Brook Benton’s Another Cup of Coffee (1964) expresses acute feelings of regret and loneliness after a failed relationship. More obliquely, in Coffee Blues (1966) Mississippi John Hurt sings affectionately about his favourite brand, a “lovin’ spoonful” of Maxwell House. In this, he bequeathed the moniker of folk-rock band The Lovin’ Spoonful, whose hits included Do You Believe in Magic (1965) and Summer in the City (1966). However, an alternative reading of Hurt’s lyric suggests that this particular phrase is a metaphorical device proclaiming the author’s sexual potency. Hurt’s “lovin’ spoonful” may actually be a portion of his seminal emission. In the 1950s, Horton identified country as particularly “doleful” (570), and coffee provides a common metaphor for failed romance in a genre dominated by “metanarratives of loss and desire” (Fox, Jukebox 54). Claude Gray’s I'll Have Another Cup of Coffee (Then I’ll Go) (1961) tells of a protagonist delivering child support payments according to his divorce lawyer’s instructions. The couple share late night coffee as their children sleep through the conversation. This song was subsequently recorded by seventeen-year-old Bob Marley (One Cup of Coffee, 1962) under the pseudonym Bobby Martell, a decade prior to his breakthrough as an international reggae star. Marley’s youngest son Damian has also performed the track while, interestingly in the context of this discussion, his older sibling Rohan co-founded Marley Coffee, an organic farm in the Jamaican Blue Mountains. Following Carey’s demonstration of mainstream pop’s increasingly realistic depiction of courtship behaviours during the 1960s, songwriters continued to draw on coffee as a metaphor for failed romance. In Carly Simon’s You’re So Vain (1972), she dreams of clouds in her coffee while contemplating an ostentatious ex-lover. Squeeze’s Black Coffee In Bed (1982) uses a coffee stain metaphor to describe the end of what appears to be yet another dead-end relationship for the protagonist. Sarah Harmer’s Coffee Stain (1998) expands on this device by reworking the familiar “lipstick on your collar” trope, while Sexsmith &amp; Kerr’s duet Raindrops in my Coffee (2005) superimposes teardrops in coffee and raindrops on the pavement with compelling effect. Kate Bush’s Coffee Homeground (1978) provides the most extreme narrative of relationship breakdown: the true story of Cora Henrietta Crippin’s poisoning. Researchers who replicated Horton’s and Carey’s methodology in the late 1970s (Bridges; Denisoff) were surprised to find their results dominated by traditional courtship ideals. The new liberal values unearthed by Carey in the late 1960s simply failed to materialise in subsequent decades. In this context, it is interesting to observe how romantic coffee songs in contemporary soul and jazz continue to disavow the post-1960s trend towards realistic social narratives, adopting instead a conspicuously consumerist outlook accompanied by smooth musical timbres. This phenomenon possibly betrays the influence of contemporary coffee advertising. From the 1980s, television commercials have sought to establish coffee as a desirable high end product, enjoyed by bohemian lovers in a conspicuously up-market environment (Werder). All Saints’s Black Coffee (2000) and Lebrado’s Coffee (2006) identify strongly with the culture industry’s image of coffee as a luxurious beverage whose consumption signifies prominent social status. All Saints’s promotional video is set in a opulent location (although its visuals emphasise the lyric’s romantic disharmony), while Natalie Cole’s Coffee Time (2008) might have been itself written as a commercial. Busting Up a Starbucks: The Politics of Coffee Politics and coffee meet most palpably at the coffee shop. This conjunction has a well-documented history beginning with the establishment of coffee houses in Europe and the birth of the public sphere (Habermas; Love; Pincus). The first popular songs to reference coffee shops include Jaybird Coleman’s Coffee Grinder Blues (1930), which boasts of skills that precede the contemporary notion of a barista by four decades; and Let's Have Another Cup of Coffee (1932) from Irving Berlin’s depression-era musical Face The Music, where the protagonists decide to stay in a restaurant drinking coffee and eating pie until the economy improves. Coffee in a Cardboard Cup (1971) from the Broadway musical 70 Girls 70 is an unambiguous condemnation of consumerism, however, it was written, recorded and produced a generation before Starbucks’ aggressive expansion and rapid dominance of the coffee house market during the 1990s. The growth of this company caused significant criticism and protest against what seemed to be a ruthless homogenising force that sought to overwhelm local competition (Holt; Thomson). In response, Starbucks has sought to be defined as a more responsive and interactive brand that encourages “glocalisation” (de Larios; Thompson). Koller, however, has characterised glocalisation as the manipulative fabrication of an “imagined community”—whose heterogeneity is in fact maintained by the aesthetics and purchasing choices of consumers who make distinctive and conscious anti-brand statements (114). Neat Capitalism is a more useful concept here, one that intercedes between corporate ideology and postmodern cultural logic, where such notions as community relations and customer satisfaction are deliberately and perhaps somewhat cynically conflated with the goal of profit maximisation (Rojek). As the world’s largest chain of coffee houses with over 19,400 stores in March 2012 (Loxcel), Starbucks is an exemplar of this phenomenon. Their apparent commitment to environmental stewardship, community relations, and ethical sourcing is outlined in the company’s annual “Global Responsibility Report” (Vimac). It is also demonstrated in their engagement with charitable and environmental non-governmental organisations such as Fairtrade and Co-operative for Assistance and Relief Everywhere (CARE). By emphasising this, Starbucks are able to interpellate (that is, “call forth”, “summon”, or “hail” in Althusserian terms) those consumers who value environmental protection, social justice and ethical business practices (Rojek 117). Bob Dylan and Sheryl Crow provide interesting case studies of the persuasive cultural influence evoked by Neat Capitalism. Dylan’s 1962 song Talkin’ New York satirised his formative experiences as an impoverished performer in Greenwich Village’s coffee houses. In 1995, however, his decision to distribute the Bob Dylan: Live At The Gaslight 1962 CD exclusively via Starbucks generated significant media controversy. Prominent commentators expressed their disapproval (Wilson Harris) and HMV Canada withdrew Dylan’s product from their shelves (Lynskey). Despite this, the success of this and other projects resulted in the launch of Starbucks’s in-house record company, Hear Music, which released entirely new recordings from major artists such as Ray Charles, Paul McCartney, Joni Mitchell, Carly Simon and Elvis Costello—although the company has recently announced a restructuring of their involvement in this venture (O’Neil). Sheryl Crow disparaged her former life as a waitress in Coffee Shop (1995), a song recorded for her second album. “Yes, I was a waitress. I was a waitress not so long ago; then I won a Grammy” she affirmed in a YouTube clip of a live performance from the same year. More recently, however, Crow has become an avowed self-proclaimed “Starbucks groupie” (Tickle), releasing an Artist’s Choice (2003) compilation album exclusively via Hear Music and performing at the company’s 2010 Annual Shareholders’s Meeting. Songs voicing more unequivocal dissatisfaction with Starbucks’s particular variant of Neat Capitalism include Busting Up a Starbucks (Mike Doughty, 2005), and Starbucks Takes All My Money (KJ-52, 2008). The most successful of these is undoubtedly Ron Sexsmith’s Jazz at the Bookstore (2006). Sexsmith bemoans the irony of intense original blues artists such as Leadbelly being drowned out by the cacophony of coffee grinding machines while customers queue up to purchase expensive coffees whose names they can’t pronounce. In this, he juxtaposes the progressive patina of corporate culture against the circumstances of African-American labour conditions in the deep South, the shocking incongruity of which eventually cause the old bluesman to turn in his grave. Fredric Jameson may have good reason to lament the depthless a-historical pastiche of postmodern popular culture, but this is no “nostalgia film”: Sexsmith articulates an artfully framed set of subtle, sensitive, and carefully contextualised observations. Songs about coffee also intersect with politics via lyrics that play on the mid-brown colour of the beverage, by employing it as a metaphor for the sociological meta-narratives of acculturation and assimilation. First popularised in Israel Zangwill’s 1905 stage play, The Melting Pot, this term is more commonly associated with Americanisation rather than miscegenation in the United States—a nuanced distinction that British band Blue Mink failed to grasp with their memorable invocation of “coffee-coloured people” in Melting Pot (1969). Re-titled in the US as People Are Together (Mickey Murray, 1970) the song was considered too extreme for mainstream radio airplay (Thompson). Ike and Tina Turner’s Black Coffee (1972) provided a more accomplished articulation of coffee as a signifier of racial identity; first by associating it with the history of slavery and the post-Civil Rights discourse of African-American autonomy, then by celebrating its role as an energising force for African-American workers seeking economic self-determination. Anyone familiar with the re-casting of black popular music in an industry dominated by Caucasian interests and aesthetics (Cashmore; Garofalo) will be unsurprised to find British super-group Humble Pie’s (1973) version of this song more recognisable. Conclusion Coffee-flavoured popular songs celebrate the stimulant effects of caffeine, provide metaphors for courtship rituals, and offer critiques of Neat Capitalism. Harold Love and Guthrie Ramsey have each argued (from different perspectives) that the cultural micro-narratives of small social groups allow us to identify important “ethnographic truths” (Ramsey 22). Aesthetically satisfying and intellectually stimulating coffee songs are found where these micro-narratives intersect with the ethnographic truths of coffee culture. 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Introduction In 2021, the (Irish) “National Survey of Children, Their Parents, and Adults Regarding Online Safety” (NACOS) showed that 18% of 9- to 17-year-olds reported seeing sexual content on the Internet in the past year. For comparison, the “EU Kids Online” 2020 study of 19 European countries reported an average of 33% of 9- to 16-year-olds seeing such images in the past year, positioning Ireland very much at the lower end of the European spectrum (Smahel et al.). Since 2011, as indicated in the “EU Kids Online” Irish data (Livingstone et al.), the trend in Ireland regarding exposure to sexual content among children aged 9–16 has not changed significantly. Ireland continues to maintain one of the lowest rates of children being exposed to sexual content in Europe. But significantly, in recent research, almost half of children impacted upon (47%) declared not to have been bothered by the experience of seeing sexual images (NACOS). In fact, just 15% said they were upset by this exposure and, comparing this with the finding from the original EU Kids Online study (Livingstone et al.), where 38% of Irish children reported being “bothered” by seeing sexual images online, this indicates a remarkable shift in children’s attitudes and perceptions. So, is it the case that young people have “normalised” their experiences with digitally delivered sexual content? This article charts the findings from the Australian Research Council (ARC)-funded Discovery Project (DP190102435) Adolescents’ Perceptions of Harm from Accessing Online Sexual Content. This component of the four-nation comparative research draws on interviews with four Irish adolescents (and their parents, not included here) to uncover contemporary Irish teens’ perceptions around who they would talk with if they had concerns or were bothered about sexual content they saw online. Ireland was once known for its homogeneous society and culture, a strongly Catholic and sexually reticent nation (Inglis, Moral Monopoly). Over the past 50 years, however, the cultural landscape of Ireland has undergone significant changes. It has evolved into a multinational, cosmopolitan, and globalised society, with over 200 nationalities and more than 20% of residents identifying as non-Catholics (CSO). The country has experienced remarkable transformations in policy and politics, now widely recognised as progressive. It emerged as one of the pioneering nations to legalise same-sex marriage through a national referendum in 2015, followed by the legalisation of abortion in 2018. In June 2017, Ireland voted for Leo Varadkar as Taoiseach (Prime Minister), making him the country’s first openly gay, mixed-race leader (Gorman). These political transformations have been described as seismic, but what of the personal politics within Irish families? This article examines what Irish teens shared with their interviewer (Dr Thuy Dinh) about their experience of sexual content online, the harms they believed they may have encountered, the risks that they or their peers may run, and their perspectives upon how they have “positioned” these experiences. While the individual stories across four teens from four Irish families differ in important respects, most teens indicated that their peers were their go-to preference in terms of someone to talk to about any encounters they might have with sexual content online. Given the research question “what does listening to young people tell us about the best policy interventions to support healthy sexual development around sexually explicit materials?”, the article starts with a discussion of peer-group dynamics around sexual content and broadens to consider the principal adults in teenagers’ lives: parents and teachers. Having discussed the contribution made by the interviewees to an understanding of the Irish teen experience, the article considers some policy implications of the findings and draws a brief conclusion. Peers and Sexual Content The Irish teenagers agreeing to take part were aged either 16 or 17, with an average age of 16 years, 6 months. In the context of the full ARC project (11–17), this was a comparatively mature aged group. Further, three of the four Irish teens recruited were female. In addition to the informed consent of the participant adolescents, the teens’ parents also needed to consent to their child taking part. Cillian (M, 16), the only male in the group, uses an adolescent “yeah, no” negation structure to rule out talking with his parents about any concerns around encounters with digital sexual content. Working out his response as he answers, Cillian starts by saying “if it was affecting me or anything, I probably would [talk to parents], but I wouldn’t. No … . I’d probably talk to a friend first”. Quinn (F, 16) also suggests this might be the norm: “group chat to us are really handy and you can talk to multiple people at once … . You have all your friends added on”. But groups of friends aren’t always supportive. As with high-school children in other western countries (Korkiamäki; Pabian et al.), an Irish adolescent’s peer group can be one or both of “a support”, and “a threat”. When peer dynamics are viewed in the context of digital access to porn, sexting, and other sexual communication, the Irish teen participants raise a range of challenges. As Niamh (F, 17) says: Image-sharing was a big thing when I was younger and still is, I suppose, of people sharing nude images with other people, and if that gets into the wrong hands it is – could be – very dangerous … . There was plenty of people I would have heard of that had content like that shared on them and that is scary for anybody. Niamh sees this as part of the educational ecosystem: “things like bullying … well obviously you see a lot of it online and I feel we experience a lot of that in the real world, as well, especially being at schools”. Orla (F, 17) also echoes that perspective: “lots of people my age, probably worried about online bullying or photos of them getting leaked and stuff”. As she thinks about these issues, Orla (F, 17) remembers that: “I think the first time I ever saw something like that was 11 or 12 … . I don’t know like, obviously, that 18 thing wasn’t stopping anyone … . I think my friend was like ‘Do you want to see this video?’ – Just showed me porn”. Clearly, in the same way that porn can’t be unseen, it’s difficult for a young person in Orla’s position to imagine how things might have been without that peer intervention. As the teenage interviewee attempts to work through the implications of this early exposure, she weighs up her belief that she hasn’t been impacted upon with the feeling that maybe it would have been better to have encountered porn later: I don’t think I’ve been permanently scarred or anything, but it definitely wasn’t beneficial to my development … . I wish I hadn’t seen it, but I don’t think about it. I’m not like, ‘Oh God, I wish I’d never’ – do you know? ‘Cause I would have seen it eventually … . Like, I’m not sad that I saw it young. Like, maybe when I’m older I will [be], but I don’t care at the moment. It’s as if Orla (F, 17) believes her early experience with sexual content colours her subsequent encounters, and may yet be shown to be problematic, but that’s not the case, as yet. Niamh (F, 17) also notes ready access to porn across the high school age range, and the lack of an effective barrier: I suppose there’s not very much age restriction on any content like that. Like, other schools, back in the past, it would always have been something not so easily accessible, but now there’s not even just specific apps. You go on Instagram, and you see women and men and very sexualised situations and that is open from any ages, from 11 all the way up to 80. Orla, echoing Quinn (F, 16) above makes the point that adolescents go online together. If schoolfriends are on one social media channel, the entire friendship circle uses that app, or those channels: “when I’m online it’s just ‘cause I’m talking to my friends and when I’m in real life, I’m talking to my friends again. Like, it’s the same thing, it’s just on or off”. For Quinn (F, 16), the online inter-group dynamics used to be a challenge, but aren’t any longer: I remember in second year [of high school] we used to always fight online … like obviously, in person, you can hear your tone, or how people are saying stuff, but if you’re texting someone something it’s hard for them to understand it … . It would be just like small fights with my friends over like Snapchat, but on group chat, but now we grew out of it, we don’t really fight anymore, you know what I mean? It’s a maturity thing. Together, these participants paint a picture of shared peer engagement with digital media as being a possible channel for amplifying risks around both the form of communication, and the content being communicated, including sexual content. Risks appear to be exacerbated by multiple online participants, the views the group shares, and the comments made. Cillian (M, 16) highlights the critical dimension of individual difference as part of being a victim of group aggression: “it’s pretty bad online, like bullying and just bad stuff. I just don’t let it affect me, but some people aren’t able to do that”. This is a clear risk for young people’s preference to refer sexual issues to their peer group. Teachers and Parents as Mediators of Pornography Parents and teachers frequently came up in teens’ discussions of adult mediation of their online use and encounters with sexual content. Niamh (F, 17) argues that it’s the adults’ role to worry about their children. As a 17-year-old girl, Niamh feels “old enough to make a decision and say, ‘OK, I don’t want to see this’, or ‘Block this’, or ‘Get rid of TikTok altogether’”. At the same time, Niamh knows “people that were younger that would have had the same app [Instagram] and it would be a worry, I suppose, for parents and teachers and stuff as to what they were being exposed to when they have no control over what comes up on their feed”. Given that adults worry about what children are encountering online, Niamh (F, 17) regrets that the curriculum educates “around” pornography, rather than “about” pornography: There’s lots of worries about children accessing adult content like that [porn] that wouldn’t necessarily show a consensual relationship and that was a big one that we always had so many classes and talks on, like how to properly consent because of that. But other than [that], I’m not sure there was much expressed to us personally. Quinn’s (F, 16) educational experience around online sexual content focussed on warning her against it: “we had a class in school that taught us about how it’s really bad to watch it [adult videos] … how bad addiction to that can affect you and what it does and how it affects you, basically”. She positions the harm as being in the age group of the viewer, rather than the content – for example, the modelling (or not) of practices around consent: “it’s very harmful for people my age ‘cause they’re not fully developed”. Niamh’s (F, 17) view is that education around porn and sexting is too little, too late: In school it would be very taboo, ‘Don’t tell the younger years that this is out there’. I broached the conversation many times in general, especially non-consensual image-sharing or anything like that, and it would always be said ‘Oh, don’t say that in front of the first years [at high school], like, it might upset them’. But I think it’s the younger years that need that kind of education because it’s them that experience it more than we would because by then we’ve lived through it and come out the other side, but it’s the 12- to 14-year-olds that need that support and need, I suppose, the education on how to deal with such things. It may be in the absence of any active, anticipatory adult engagement around these topics that teenagers turn to their peers. It is clear that significant numbers of Irish teens are encountering sexual content and sexual images, but sense they shouldn’t be, and that the adults in their lives are reluctant to talk about such matters. Orla (F, 17) indicates that it is these experiences that drive the development of skills in managing different apps and content: “on Snapchat you block people ‘cause teenage boys’d send you photos you don’t want to see”. There are multiple indications that Irish teens (and Australian teens – see Woodley) believe it’s easier for educators to talk about a “safe” concern, rather than a sexual concern. For example, Orla (F, 17) notes that: Like, we do SPHE [social, personal and health education], but the main thing that they think is harmful is the body image issues that you come up with. They aren’t worried that we are under 18 watching it because I think there’s a bigger worry, that we think we’re expected to look like that, or do things like that – that’s more of the worry. She goes on to say: “I have got friends who have become very insecure because of porn, because they don’t look like how the girls do in porn”. This latter perspective seems to call for wider-ranging sex education-focussed discussions about adult content dealing, amongst other matters, with gender dynamics, the production ethos of pornography, the imagined audience and what they want to see (and why), etc. Given that such an agenda might appear daunting to Irish educators, even as the country becomes more liberal, might it be a role that parents should take on? The teens seem to think not. Quinn (F, 16) shares her experience of watching adult content with her parents: Quinn: Sometimes, if we’re watching a young movie all together, and it’s got explicit or something, we’d not watch it anymore.Int.: So, it is like, they stop it? Or they tell you to go out?Quinn: Stop it, or skip through it, kind of… But Quinn (F, 16) doesn’t have confidence that her parents understand what does, and doesn’t, bother her: Int.: Do you think your parent would know what might upset you?Quinn: No. Like, in what way?Int.: Well, if something online, or even in daily life, what can upset you?Quinn: No, not really. Maybe some[things], like, not specific things, I guess. This means that Quinn (F, 16) may be positioning her parents as not best-placed to help her navigate challenging content. Indeed, the implication is that some of the reluctance around the suitability of the viewing content may say more about her parents’ vulnerabilities than Quinn’s. This kind of scenario was also hinted at by Orla (F, 17): Orla: I may have told my mum I had been sent an explicit photo I didn’t ask for, but it was in jest, like. I didn’t care. I just blocked the person. It’s so normal nowadays to get sent a picture of some teenage boy’s dick that it’s not like – you take it in your stride. So, I think I may have made a joke about it, like, nothing more than that … it happens all the time, that’s why everyone is blocking people on Snapchat…[Continuing] My dad I think would throw up if I told him. He’d be quite mortified. …Int.: So, who’re you talking to if you need some advice, or need to confide?Orla: My friends and I will talk [about sexual content] but I wouldn’t talk to my parents about it … . I don’t think my friends would mention it at all to their parents, I don’t think that there’d be any conversation around it … . I think it would make things awful and uncomfortable and I’m so happy not doing it. I really would not like to talk to them about it … if I had a child I don’t know if I’d want to be talking to them about it … this isn’t something that I think anyone talks to their parents about. In fact, I think it’s kind of weird if you did. In a subsequent section of her interview, Quinn (F, 16) indicated that there had been a conversation about the reason why her parents skipped, or turned off, broadcast sexual content in an “explicit” young adult movie. She told the interviewer that they had a “talk about it”. The interviewer pressed Quinn: Int.: So, are you happy with the way they deal with the issues?Quinn: … They deal with it fine. Like, it’s not a problem, not a common issue but they’ve explained it to me, and I know not to watch. This seems to indicate that the main aim of Quinn’s parents’ communication was to close down discussions around sexual content, rather than ventilating them, or responding to any of her questions and concerns. This seemed to be at odds with Niamh’s experience. Niamh recommended that young people should “have a trusted adult, whether it be a parent or a guardian or a teacher, someone that you can go to with things that you don’t want to see online and ask them for advice because adults usually have fairly good sound advice”. She added, subsequently, “I think as you grow up, like, my parents and I would have similar views now and I would have influenced their views and they would have influenced mine”. This reciprocity of impact was a little less self-confident (although maybe more realistic) than Cillian’s response to a question about whether parents worry when their children go online. “Not really”, says Cillian (M, 16). “I don’t know. I feel like I’m pretty smart when it comes to stuff online”. Discussion The Irish teenage participants were a far-from-random selection of adolescent interviewees. At the same time, the project was not designed to be representative, but to investigate meaning-making within small cohorts of teenage high-school students from three separate countries (Greece, Ireland, and Norway), while offering a counterpoint to the majority of the data: the 30 teenagers interviewed in Australia. While each teenager’s story is unique, a common thread runs through the narrative of this study relating to Irish teens’ encounters with pornography and adult content. Peers appear to be the primary sexual content confidantes for each of the research participants. These teens indicate they speak quite openly with their peers, primarily their same-sex friends, about online experiences with pornographic content. This includes talking openly about sharing intimate content, and about having one’s own intimate content shared non-consensually. The conversations seem to be part of teens’ management of sexual risks when they occur online. While parents naturally maintain an important presence in teenagers’ lives at this stage, the teens’ perspectives shared in this research appear to indicate a growing gap as to what they feel they can easily share with parents and teachers about their lives, norms, and experiences. Interestingly, while peer groups are shown in this study to provide support around issues that arise around online sexual content, they can also pose risks. Peer group culture is clearly identified as a key influence in introducing young people to sexual content. Online pornography and unsolicited sexts are readily shared among teens who, almost universally equipped with smartphones, have ready access to such content. Notably, for younger teens, this exposure is something for which teens feel ill-prepared, adding additional pressure to the transition to secondary schooling. Peer aggression, toxicity, and cyberbullying must also be managed and tolerated as part of growing up, at least for this group of research participants. The teens in the study were noticeably dismissive about online safety protections such as age restrictions for adult content sites or, indeed, about efforts made by mainstream social media sites to provide age-appropriate experiences. Many sites were regarded as highly sexualised environments exerting their own pressures as to how to look, behave, and interact both offline and online. Teachers’ efforts to discuss this in the classroom were regarded as largely ineffective and too narrowly focussed on dominant tropes about avoiding online sexual content, risky body image issues, and a lack of focus on matters of consent. Indeed, it may be that Irish sociologist Inglis’s view – from a generation ago – may still have currency. He argued that Irish attitudes towards sex and sexuality represent an unsettled culture and reflect a deep and continuing ideological conflict with inherited repressive morality. More open or positive attitudes towards sex, he suggested, or support for reformed sexuality education in schools, is made more complex and challenging when significant portions of the adult population are still coming to terms with their own sexuality (Inglis, "Origins"). Insights from discussions with the teens in this study point clearly towards the need for new policy interventions. There are obvious implications for online service providers, for educators, and for parents. On the industry side, the lack of effective content controls, often in contravention of their terms of service and community guidelines, is palpable. Whether it relates to toxicity, cyberbullying, or inadequate privacy provisions, reforms that meet the needs of young people are urgently needed. Educators and schools likewise have a key role to play in supporting young people at this formative stage of their development. The important influence of peer-group culture noted in this study is frequently centred around the school and, in this context, there are ample opportunities for schools to proactively foster positive and safe environments. This resonates with an Irish Minister for Education-commissioned 2018 review of “Relationships and Sexuality Education” (RSE). That review found current RSE education to be largely “too little, too late and too biological”, focussing too much on the risks and dangers associated with relationships and sexuality (NCCA). The new senior cycle curriculum, currently open for consultation, includes a new proposed learning outcome “to investigate the influence of pornography on attitudes, behaviours and relationship expectations” (NCCA 14). Finally, in relation to parents, also interviewed as part of this study, while noting the importance of autonomy and privacy in teenagers’ lives, parents can provide more direct support for their children by informing themselves of the risks and opportunities young people face online and developing appropriate and sensitive parenting responses. Conclusion This article focusses on the circumstances affecting a small cohort of Irish teens’ experiences of dealing with online sexual content. It offers contrasts between the pervasive experiences among teens of dealing with such content and the wider social context which reflects a society in transition, sometimes struggling to escape from its sexually repressive past. The article provides insight into Irish teens’ attitudes towards pornography and whom they discuss sexual issues with, particularly in the context of Ireland’s more recent progressive political atmosphere, something not necessarily reflected in parents’ and teachers’ behaviours. Teens themselves articulate some of these dilemmas in expressing concerns about the highly sexualised environments they encounter online, and share among their peers, while claiming that they are not bothered by these experiences. The major finding of this article is that peers are the primary confidantes for teenagers’ discussions about sexual content, including sexting and pornography. The data indicate a growing gap between what teenagers feel they can share with parents and teachers versus their peers. It also suggests that current sex education in Ireland is insufficient, aligning with views that Irish attitudes towards sex and sexuality remain conflicted. Notwithstanding the strides made nationally in advancing a liberal social agenda, these teens indicate that the responses of their parents, and of educators, fall short of meeting their needs. New initiatives in reforming the RSE curriculum in schools, therefore, come at an important time and should prioritise addressing gaps highlighted by these young people’s voices. In summary, the research calls for a multi-faceted approach to address the complexities of teens’ interactions with online sexual content, emphasising the roles of peer support, improved education curriculum, parental involvement, and industry accountability. References CSO. “7 Migration and Diversity.” Census 2016 Profile. Ireland: Central Statistics Office, 2016. &lt;https://www.cso.ie/en/csolatestnews/presspages/2017/census2016profile7-migrationanddiversity&gt;. Gorman, Tommie. “Shy, Complex and a Political Outsider: Leo Varadker Confounded the Brexiters—and Everyone Else.” The Guardian, 23 Mar. 2024. &lt;https://www.theguardian.com/commentisfree/2024/mar/22/leo-varadkar-brexiters-irish-politics-ireland-taoiseach&gt;. Inglis, Tom. Moral Monopoly: The Rise and Fall of the Catholic Church in Modern Ireland. Dublin: U College Dublin P, 1998. Inglis, Tom. “Origins and Legacies of Irish Prudery: Sexuality and Social Control in Modern Ireland.” Éire-Ireland 40.3 (2005): 9–37. &lt;https://doi.org/10.1353/eir.2005.0022&gt;. Korkiamäki, Riikka. “Friendship as Potential? The Recognition of Teenagers’ Peer Relationships at School.” Open Journal of Social Sciences 49 (2016): 34–43. &lt;https://doi.org/10.4236/jss.2016.49005&gt;. Livingstone, Sonia, et al. Risks and Safety on the Internet: The Perspective of European Children: Full Findings and Policy Implications from the EU Kids Online Survey of 9-16 Year Olds and Their Parents in 25 Countries. London: \London School of Economics and Political Science / EU Kids Online, 2011. &lt;http://www.eukidsonline.net/&gt;. NACOS. National Survey of Children, Their Parents and Adults Regarding Online Safety. Dublin: National Advisory Council for Child Online Safety, 2021 &lt;https://www.gov.ie/pdf/?file=https://assets.gov.ie/204409/b9ab5dbd-8fdc-4f97-abfc-a88afb2f6e6f.pdf&gt;. NCCA. Report on the Review of Relationships and Sexuality Education (RSE) in Primary and Postprimary Schools. Dublin: National Council for Curriculum and Assessment, 2019. &lt;https://ncca.ie/en/resources/report-on-the-review-of-relationships-and-sexuality-education-in-primary-and-post-primary-school/&gt;. Pabian, Sara, et al. ‘“Arguments Online, But in School We Always Act Normal’: The Embeddedness of Early Adolescent Negative Peer Interactions within the Whole of Their Offline and Online Peer Interactions.” Children and Youth Services Review 86 (2018): 1–13. &lt;https://doi.org/10.1016/j.childyouth.2018.01.007&gt;. Smahel, David, et al. EU Kids Online 2020: Survey Results from 19 Countries. London: The London School of Economics and Political Science, 2020. &lt;http://www.lse.ac.uk/media-and-communications/research/research-projects/eu-kids-online&gt;. Woodley, Giselle. “‘We Haven’t Been Taught about Sex’: Teens Talk about How to Fix School Sex Education.” The Conversation 25 May 2023. &lt;https://theconversation.com/we-havent-been-taught-about-sex-teens-talk-about-how-to-fix-school-sex-education-206001&gt;.

Introduction Exploring the ways in which children merge education, play and connection in their digital device use, this article critiques the established definitions of the Internet of Things and the Internet of Toys and suggests an alternative. Using evidence emerging from The Internet of Toys: Benefits and Risks of Connected Toys for Children, we deconstruct these traditional terms, and advocate for a revised terminology. Such a reconsideration helps frame children’s use of digital devices and the important roles these play in children’s everyday lives. The Internet of Things is defined by Mascheroni and Holloway as “physical objects that are embedded with electronics, sensors, software and connectivity that support the exchange of data”. These objects have become omnipresent in Western society, resulting in different subsets of the Internet of Things, such as the Internet of Toys. Such connected toys are physical toys that are (just as the Internet of Things is) connected to the Internet through Bluetooth and/or Wi-Fi (Mascheroni and Holloway). The features of such toys include network connectivity, sensors and voice/image recognition software, and controllability and programmability via apps on smartphones or tablets (Holloway and Green). CogniToys Dino, Fisher-Price Smart Toy Bear, Skylanders, Hello Barbie, Cloudpets, and Wiggy Piggy Bank are just a few examples of these connected playthings (Ihamäki and Heljakka; Mascheroni and Holloway; Shasha et al.). The ‘Internet of Toys’ category can thus be understood as physical toys with digital features (Ihamäki and Heljakka). However, Ling et al. argue that, “if the item is to be included in the IoT[hings] devices and … if the object is also used for play, then despite its designed purpose, this internet connected item becomes a member of the subset of the IoToys” (Ling et al.). Therefore, the conceptualisation of toys should not be limited to products designed for play. This raises questions about the concept of the Internet of Toys, and whether the distinction between the Internet of Things and the Internet of Toys is (still) relevant. We argue that there is no longer a meaningful distinction to be made between the Internet of Toys and the Internet of Things: instead, all such phrases indicate fragmentary attention to the Internet of Life. The Internet of Life can be defined as: devices which encompass all facets of online connectivity and technological management, and the interpolation of the digital with the everyday. The Research Project In 2018, the Australian Research Council funded a Discovery grant investigating The Internet of Toys: Benefits and Risks of Connected Toys for Children. Initially the project gave each household involved in the case study a Cozmo robot, to see how the toy was used and integrated into the household. The project foundered somewhat as the robot was initially played with but after a short while the children stopped engaging with Cozmo. Researchers believed this was due to novelty, Internet connectivity issues and the overly complicated nature of the toy. Parents had hoped their children would learn to code through using the robot but were not always willing to or capable of helping the child to navigate this aspect of the toy. In this regard Cozmo failed their expectations. After a short hiatus on the project, it was stripped back to its original purpose, to explore how households define Internet-connected toys, and the risks and benefits of playing with them. The qualitative data forming the basis of this article come from the second iteration of the project and interviews conducted in 2021 and 2022. The academics working on this research are increasingly questioning the relevance of these terms in today’s world. Ethnographic (Rinaldo and Guhin) one-on-one interviews with Australian children aged 6–12 have revealed just how diverse the digital technologies they play with have become. Those conversations and technology tours (Plowman) demonstrate the extent to which these digital devices are seamlessly integrated into children’s daily lives. Referring to many digital devices (such as the iPad and other tablets) as “toys”, children appear unaware of the distinction made by adults. Indeed, children mobilise elements of education, communication, self-actualisation, curiosity, and play within all their digital engagements. While parents may still be encouraged to distinguish between the educational use of digital devices and children’s use of such technology for entertainment, the boundary between the two is becoming more and more blurred. The bring-your-own-device (BYOD) policies that have been implemented within many Australian, English, and American schools expose children to digital devices within multiple contexts, frameworks, and environments, encouraging ubiquity of use. Laptops and tablets originally provided for school and educational purposes are also used for play. Seiter suggested that parents believe that a computer should be used by their children for serious matters such as learning or “purposeful” play, but children’s use patterns convert the tool into the toy. This elision of purpose may be referred to as “edutainment”, or the “toyification of education”, which suggests that education is increasingly reinforced by, and benefits from, “toyish” elements or dimensions (Ihamäki and Heljakka). Tablets offer children a diverse range of digital play options. Touch and swipe technology means that, from before their first birthday, “children are no longer only observants of digital technologies, but they are players and users, with tablets becoming the digital toy of choice” (Fróes 43). This is reinforced in much recent academic literature, with Brito et al., Healey et al., and Nixon and Hateley, for example, referring to tablets as “toys”. This is in line with the evolution of these devices from computer to educational tool to child-friendly toy. Fróes argues that the tablet supports “playful literacy”: “the ability to use, interact, relate, communicate, create, have fun with and challenge digital tools through playful behavior”. Having fun encourages and reassures children while they learn about, and become familiar with, these technologies. This, in turn, supports the valuable skill-building and scaffolding (Verenikina, citing Vygotsky) necessary for when a child begins using a tablet in an educational context once they start school. The omnipresence of screens challenges parents who believe that to be a good parent is to mediate their child’s digital engagement (Page Jeffery). Although the focus on “screen time” (the amount of time that children spend on their screens) is increasingly critiqued (e.g. Livingstone and Blum-Ross), some research suggests that, on average, parents underestimate their child’s daily screen time by more than 60 minutes (Radesky et al.). This conflicts with other research that argues that parents' preferred approach to mediation is setting clear rules regarding media usage, particularly in terms of time spent in device use (Valcke et al.; Brito et al.). Ironically, even though parents voice concern regarding their children’s technology use and digital footprints (Buchanan, Southgate, and Smith), they feel a “necessary culture of care” (Leaver) that may incite them to use their own technology to monitor their children’s data and behaviour. Such strategies can lead to “intimate surveillance” becoming a normalised parenting practice (Mascheroni and Holloway), while modelling to children their caregivers’ own reliance on devices. Hadlington et al. state that tablets may offer a barrier against the offline, “real” world. Children may become immersed in digital engagement, losing awareness of their surroundings, or they may actively use the tablet as a barrier between themselves and their environment. Parents may feel concern that their child is cutting themselves off from the family, potentially undermining family relationships and delaying the development of social skills (Radesky et al.). In contrast, Desjarlais and Willoughby’s article describes how children’s digital activities, for example chatting with friends, can be a useful starting point for social relationships. Hietajarvi et al. could not identify significant negative effects from using chat functions whilst studying, and suggest that digital engagement has a negligible effect on academic progress. While it is possible to characterise tablets and other digital devices as “toys”, this fails to capture the full contribution of such technology in children’s daily lives. Tablets, such as the iPad and Samsung’s Galaxy’s Tab range, function as a significant bridge that connects both children’s and adults’ everyday lives. The Internet of Life While the suggestion of an Internet of Life may require further investigation and refinement, this article proposes to define the term as follows: devices which encompass all facets of online connectivity and technological management, and the interpolation of the digital with the everyday. We argue that there is no longer a meaningful distinction to be made between the Internet of Toys and the Internet of Things: all such phrases indicate fragmentary attention to the Internet of Life. Digital devices cannot be bound by narrow definitions and distinctions between “things” and “toys”. Instead, these devices transcend the boundaries of “toys” and “things”, becoming relevant to all facets of people’s everyday lives. This is increasingly evident in lives of young children, as demonstrated by the one-on-one interviews with Australian child participants (aged 6–12). When asked if they could show the researcher some of their toys, every child produced their tablet, or spoke about it, if it was not within their reach at that time. Defining their tablets as toys, children nonetheless described myriad ways in which they were used: for leisure and entertainment, education, sociality, self-expression, and to satisfy their curiosity amongst others. Parents sometimes wondered at how children navigated technology without seeming to need assistance and noted that children could easily outstrip their parents’ skill level. Even so, parents described their struggle to “allow” their children screen time, finding it difficult to believe that it’s okay for their child to use a device for extended periods of time. Interestingly, when parents were asked if they were willing to model the behaviour they expected of their children—time limits on devices, going outside and playing—they struggled to imagine themselves doing so. As one parent said: “everything's there [on the device]. It's just so hard because everything I do, and need, is there”. This perspective reinforces our assertion that digital devices are inherently and instinctively interwoven within daily life: not toys, not things. Maybe the concept of the Internet of Life will support parents’, educators’, policy-makers’, and academics’ richer appreciation of the multitude of ways in which children use devices. It may also recognise how device use includes the acquisition of life skills, in both digital and IRL (“in real life”) domains. A reframing of digital devices may aid recognition of the benefits and experiences they offer the young (and old). Such a perspective might assuage significant parental guilt and take the sting out of increasingly frequent debates around screen time quality versus quantity (Livingstone and Pothong). This article now addresses some parents’ and children’s comments relating to their engagement with the Internet of Life. Parents’ Perspectives Seeking to explain what parents understand by the concept of play, Hayes (a father of three) suggested: “children entertaining themselves hopefully positively … . [They’re] doing something either physical or educational or it’s benefitting them in some way and having fun and relaxing”, while the mum from a different family, Farida, feels that play is “something that brings about joy, really” (a mother of two). Parents experience challenges in assigning different regulations around digital device usage to children in the same family, reflecting their different circumstances. Thus Bethany, mother to Aiden (11, below) and older sibling Sophie (13), differentiates her approach to regulating her children’s play in digital spaces: With him [Aiden] I don’t feel so bad when he – having a downtime because I know he’s quite active whereas [Sophie] my daughter’s not, she’s the complete opposite and she will sit on there usually, ‘cause she’s chatting to her friend Gemma who’s over east but, she’ll try and sit on there for two or three hours just doing really mundane boring stuff. (Mum, Bethany) Interestingly, for both Sophie and Aiden, their use of digital devices is a reassuring opportunity to retreat. One of the many advantages of chatting online to a distant friend is that it’s a space separate from the everyday contexts of classroom politics. Mum to Bryce (8, male), Farida identifies specific benefits in her son’s digital device use across a range of skills and competencies. [He] has actually improved significantly with his communication skills and his maths skills like his problem-solving and reasoning. Like he’s trying to, for instance, work out how much money he’s got to scam off me to get the things that he wants, adds it all up, works out his amount of money that he’s got to ask for so he can buy all the stuff that he’s looking for. So that has really improved. (Farida) Some parents might see games that teach children how to calculate what they need to achieve what they want as an annoyance due to a trivial extra expense, but Bryce has a range of learning challenges. Consequently, Farida is delighted with the progress she sees: “his trajectory has actually been quite astounding, and I do think that a lot of it is to do with the fact that he’s built up so many of these other skills from his hand eye co-ordination, his communication skills and stuff from digital play”. Children’s Perspectives Children’s own perspectives on their use of digital devices were varied but speak to the development of individual competencies and the managing of important friend- and family-based relationships. So, Aiden (11) characterised his use of such digital media as “calming. Since there’s nothing to really lose in the game or anything, it’s not like ‘oh you stuffed something up, you have to restart the whole thing’.” He adds, as if this is a significant benefit, “it’s more if you stuff something up it’s fine, you can just get it back again”. Aiden is in a children’s elite sport squad and explains “I do football for four hours. Then I have piano lesson for 30 minutes. I’m really tired”. His digital sphere is a welcoming place of safety and relaxation where there are no consequences when things go wrong. For Lisa, also 11, her digital device is for communicating. Explaining that she has “Snapchat, Messages and TikTok and I think that’s it”, Lisa says that she and her friend from school “normally just chat to each other and we’ll chat about what we’re doing”. She adds that sometimes “we’ll roleplay”. As Lisa continues there’s an implicit acknowledgement of the risks around collaborating with others in play spaces. Speaking of her friend, she notes “she used to play this game, Brook Game, and she doesn’t really do it anymore. In Brooking Gaming you roleplay with people and you can do jobs and stuff”. Digital play and device use may be a place of relaxation, but it’s also a place of negotiation and of learning to compromise as a price of sharing experiences with friends. Killian’s (12 years old, male) example of gaming implicates the ways he negotiates autonomy and connection with his older brother. Explaining that “I talk to my friends over Discord which is a social thing and that”, Killian explains how (older brother) “Xander helped me set up the safety settings”. The boys worked together to find a means through which their toys and games allowed them to bypass technical barriers preventing full service on their mobile devices. They had originally thought: “we could text each other” but because their devices were set so they “won’t allow us—Xander had Discord on his phone and—he did. I could text him via that”. A variety of remote communication strategies support Killian’s and Xander’s connected play in different spaces. The interviewer notes, “so you prefer playing individually like that because you just have that one screen to yourself, that solo experience, but still playing together?”, allowing Killian to add “Yes, and also Xander doesn’t hit me every time I do something that Xander doesn’t like”. Killian subsequently identifies himself as something of negotiator, working out the different rules and settings for the different areas in his life. Saying he uses his iPad “kust for stuff I’m interested in, or something that I found out is good, that I want”, he also says he has a workaround for if “the website’s blocked or then—stuff like that—or, I want to watch it at home”. One of the implications of these examples is that parents tend to develop over-arching narratives about their children’s digital device use and compartmentalise concerns, differentiating them from positive aspects of children’s online activities. Children’s experiences, however, speak to lessons around learning skills, managing relationships and conflicts, negotiating autonomy, absence, and different rules in different spaces. In these respects, children’s multifaceted use of digital devices is indeed creating an Internet of Life. Reimagining Children’s Digital Activity Engagement with digital devices and online activities has become a core part of childhood development (Borisova). The reimagining of the concepts of the Internet of Things and the Internet of Toys as the Internet of Life allows children, parents, researchers, and policy-makers to broaden their understanding of what it means to grow up in a digital world. Defining an Internet of Life and conceptualising digital devices as an inherent part of the everyday, allows greater understanding and appreciation of how, what, and why children use such devices, and the potential benefits (and risks) they may afford. This perspective also empowers children’s understandings of what digital devices are, and how the digital environment relates to them, and their daily lives. This article argues for a need to widen understandings of children’s digital device use, including the role that Internet-connected toys play in fostering social and digital literacies, to explore the multifaceted and ubiquitous nature of tablets and other digital devices (Ihamäki and Heljakka). Previous research on children’s digital engagement, along with a large portion of public reporting, has focussed on the risks and harms that children are exposed to, rather than the potential benefits of digital engagement, along with the rights of a child to digital access (CRC; Odgers and Jensen; Third et al.). The Internet of Life recognises that children’s digital engagement includes some exposure to risks, but also reflects the potential benefits that this exposure can have in terms of helping navigate these risks and problem-solving. It allows digital engagement to be reframed as a normal part of daily life and everyday routines, expanding understandings of how children engage with digital devices. Parents and children alike spoke about their tablets and the myriad of ways in which they used them: as a toy, for leisure, entertainment, formal education, sociality, and to satisfy their own curiosities to name but a few. Not only do these devices satisfy parental expectations, in that children can navigate them without assistance, but children can also outstrip a parent’s skill level rapidly. This is pleasing to some parents who do not possess such skills to teach their child. However, parents still struggle to “allow” their children screentime and justify to themselves that it is okay for their child to be on their own device for extended periods of time. The distinction between the overarching Internet of Things and the subset of the Internet of Toys, as well as the categorisation of these devices as “education-only” or “entertainment-only”, does not accurately represent children’s engagement with and use of digital devices. Children’s multi-faceted and multi-layered digital activities offer a complex interplay of motivations and intentions, pleasures and challenges, intrinsic and extrinsic. 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