Academic literature on the topic 'Positive disability identity'

Research suggests that emerging adults (EAs) with a disabling impairment experience poor psychosocial outcomes and delayed markers of adulthood. Given the numbers of EA with a disabling impairment who do not self-identify as having a disability, we examine a multigroup structural model of positive disability identity based on disability self-identification. Participants ( n = 2,016) completed assessments of positive disability identity, psychosocial outcomes, and markers of adulthood. Most participants with a disabling impairment did not self-identify as having a disability (68%). Positive disability identity, maintaining a positive view of disability, was associated with increased life satisfaction, regardless of whether EA self-identify as having a disability. Exploratory analyses suggest that EA with psychiatric disabilities experience the most negative psychosocial outcomes. Findings suggest that maintaining a positive view of disability is associated with favorable outcomes. However, intervention with EA who do not self-identify is challenging, as they may not seek support services.

The purpose of this paper is to explore how individuals with disabilities establish and maintain a social identity that incorporates meaning and context into a personal and collective perspective defined as disability identity. Beginning with a broad lens, the concepts of identity and social identity are explored. Theories and concepts that have shaped and refined the concept of social identity, specifically within a context of disability, are introduced. Disability Identity development is explored as to the key components and constructs that bring forth a comprehensive view of identity development for individuals with disabilities. Finally, these components are brought together within the context of Independent Living in order to show how this movement supports a positive, life-enhancing worldview of disability.

This study explored the relationship between racial groups, racial identity, and attitudes toward dating a person with a physical disability. It was hypothesized that African Americans would have higher levels of racial identity than Caucasian Americans. Furthermore, it was hypothesized that because of shared minority group status, African Americans would have more positive attitudes than Caucasians toward dating someone described as having a physical disability. African American participants were found to have higher levels of racial identity than Caucasian participants, but had significantly more negative attitudes regarding dating a person with a physical disability than Caucasians. A discussion of racial identity, as well as implications for rehabilitation counselors, is included.

The purpose of this study was to explore the multiplicity and complexity of identity construction for elite disabled athletes within the arena of disability sport. This involved in-depth semistructured interviews that explored the experiences of 21 British and Taiwanese elite disabled athletes from the sports of powerlifting and track and field. The results indicate that both societal perceptions based in the medical model of disability and the participants’ impaired bodies play a key role in their identity formation and sense of self-worth. The study also highlights the role that success in international disability sport can have by offering potential for positive subjectivity, a changed self-understanding, and an increased sense of personal empowerment. Finally, the notion of multiple identities also appears to be supported by the research participants’ narratives.

Introduction: Research is beginning to support the association between positive disability identity and well-being among individuals with disabilities, including those with visual impairments (i.e., blindness and low vision). To enhance practitioner understanding of how to support individuals with visual impairments, research is needed to examine how disability identity attitudes may vary based on disability characteristics in this population. Methods: Using multiple linear regression, the author examined the association between impairment-related factors and personal disability identity (PDI; i.e., disability affirmation and disability acceptance) and group disability identity (GDI) in a sample of 212 adult U.S. residents with visual impairments. Results: Results of this study indicated that participants who use a mobility tool (cane, dog guide, or both) have higher self-reported disability affirmation ( p = .001)—an identity construct related to feelings of disability pride versus shame—after controlling for age, gender, and impairment-related factors (e.g., severity indicators). The Cohen’s f 2 value for the affirmation model was .15, a medium effect size (Cohen, 1988). The regression on GDI indicated that younger participants, in general, reported higher feelings of connection to the disability community (i.e., higher GDI; p = .001); Cohen’s f 2 was .13, a small effect. The regression on disability acceptance yielded non-significant findings. Discussion: Researchers and practitioners working with adults who have visual impairments should consider the relationship between an individual’s disability affirmation and decision-making regarding mobility tool use and training . Future research should also examine hypotheses regarding the negative association between age and GDI among adults with visual impairments. Implications for practitioners: Practitioners within the field of visual impairment may benefit from a consideration of consumer disability identity, including disability affirmation and disability group affiliation.

A growing number of concerned individuals throughout the world, including people with disabilities, their parents, and educators, are advocating that students with disabilities be educated in the mainstream of neighborhood classrooms and schools. However, some disability-rights advocates believe that if people with disabilities are to have a well-developed sense of identity as adults, they need to have had opportunities in their school years to associate with other people (both children and adults) having similar characteristics and interests. In this article, we examine this issue and provide one perspective on how it might be addressed.

Background: Despite several fruitful attempts in destigmatization, disability is still associated with stigma. The role of language, especially when addressing a disabling condition and people, has been the matter of social as well as scientific debates. This article poses an intriguing question about the language we apply when addressing people and disability. Method: A narrative review of different models of disability with the emphasis on how labels and more generally language affect identity formation, and the extendibility of positive psychology concepts on the field of disability studies. Results: In this theoretical paper, the authors suggest that the term disability per se is contributing to increasing the stigma and has disempowering effect. Considering previous evidence from different lines of literature, the authors suggest a new approach of destigmatization, namely changing the term disability to a less stigmatizing one. Moreover, the authors discuss some theories to support this perspective. Conclusion: Replacing ‘dis’ in ‘disability’ with the prefix ‘para’ in the term ‘Para-ability’ is suggested.

The family system is an important contributor to one’s development of health lifestyles or the patterns of health behaviors one engages in. Research has yet to explore how health lifestyles develop within families or how disability may affect this process. This study uses qualitative data collected from parents and key informants in two U.S. communities to address this gap in the literature. Findings capture a process through which health lifestyles develop in families with a child with a disability. This process revealed that parents first become more conscious of the importance of health as a result of having a child with a disability, which led to changes in parent identity and was ultimately translated into primarily positive changes to family health behaviors. This process appears to be largely driven by community norms and stigmas associated with disability.

Abstract Background and Purpose Disability in patients with facial paralysis is the result of impairment or loss of complex and multidimensional functions of the face, including expression of emotions, facial identity, and communication. However, the majority of interventions for facial paralysis are unidimensional and impairment oriented. Thus, a functional training program intended to address various dimensions of disability caused by facial paralysis was devised. This patient-centered, multidimensional approach to the rehabilitation of people with facial paralysis consists of patient education, functional training, and complementary exercises. This approach is focused on various dimensions of disability, including the physical, emotional, and social dimensions, by encouraging context-specific facial functions, positive coping strategies, and social interaction skills. Case Description The patient was a 25-year-old woman with chronic complete right facial paralysis caused by a postoperative complication of ear surgery. The patient's problems were evaluated with the Facial Disability Index (physical function subscale score=45/100, social/well-being function subscale score=28/100) and an informal interview exploring her experiences and priorities. Outcomes After 8 weeks of functional training, the patient showed considerable improvement in facial functions (physical function subscale score=95/100, social/well-being function subscale score=100/100) and reported positive changes in social interactions and interpersonal relationships. Discussion The use of a functional training program was associated with positive changes in emotional expression, psychosocial function, and social integration, thus contributing to reduced disability of a person with chronic facial paralysis.

Depictions of disability in Chinese-language films from China and Taiwan, once a rarity, have become mainstream since the 1980s and have shifted from critiquing national policies, historical accounts, and collective experiences to highlighting disabled people as complex characters and advocating for greater support for them. These films reveal how disability has become a positive source of identity in its own right. Films from the late 1980s and early 1990s such as Tian Zhuangzhuang’s The Blue Kite use disability to offer critiques of official policies or alternative accounts of historical events. Zhou Sun’s Breaking the Silence and Xue Xiaolu’s Ocean Heaven, which focus on caregiving parents and their disabled children, reveal the need for private, extragovernmental networks of support as well as greater government support for those with disabilities and their families. Finally, films such as Zhang Yimou’s Happy Times feature characters with impairments living rich and rewarding lives, countering stereotypes about disability.

A major research question in disability exercise psychology is if exercise can positively influence body image. The purpose of this chapter is to review the research on disability, exercise, and body image. Physical activity (PA) may enhance perceptions of body image because people can lose body fat and increase their muscularity. It can also enhance functionality and make activities of daily living easier and help people shift their focus from appearance to body function. PA can reduce the negative evaluations and increase the positive evaluations that individuals with disabilities receive from others. Correlational studies have provided some support for a link between body image and exercise, as social physique anxiety is negatively linked to self-esteem and athletic identity among athletes with disabilities. Qualitative researchers have documented exercisers and athletes proclaiming the importance of PA in helping them feel good about their bodies. Limited intervention research has shown that PA can produce enhanced body image cognitions, such as increased body satisfaction.

Disability status continues to have a significant negative impact on employment outcomes, even in countries with nondiscrimination policies, and outcomes differ by gender and age. These subpar outcomes can be linked to both environmental and psychological factors. The design of jobs and workplaces often limits the ability of workers with disabilities to contribute to their fullest capacity, while stigmatization reduces employer willingness to hire workers with disabilities and make reasonable accommodations to allow them to perform effectively. Exclusion and stigmatization create barriers to the development of a positive self-identity as a person with a disability. Considerably more research is needed to understand how the actions of organizations, leaders, and teams affect the employment outcomes of workers with disabilities and how impacts differ by gender and age. But based upon extant knowledge, there are many actions employers can take to improve outcomes for this group of workers.

Bipolar disorder is the 6th leading cause of disability worldwide and causes substantial morbidity and mortality among its sufferers. The estimated costs of bipolar disorder are enormous, approaching $50 billion annually in the United States alone. The societal and personal suffering caused by this condition is immeasurable. Nonetheless, despite its public health significance, bipolar disorder remains difficult to diagnosis and complicated to manage. A major factor contributing to these difficulties is that there is no established neurophysiological model for bipolar disorder. Such a model might provide objective measures for diagnosis, as well as physiological parameters to monitor and predict treatment response. Since the first edition of this text, neuroimaging and genetic techniques continue to advance new leads toward clarifying the neurophysiological basis of bipolar illness. In the absence of meaningful animal models of this uniquely human condition, neuroimaging has truly revolutionized the study of bipolar disorder. Moreover, because bipolar disorder is clearly familial, genetic studies are critical to define the complex molecular basis of the condition. Consequently, we are at a point in which integration of neuroimaging and genetic findings is possible and may position us to identify these very neurophysiological models needed to support the next generation of research. The goal of this 2nd edition is to provide an updated review of neuroimaging and genetic research in bipolar disorder to provide a model of illness that might inform future studies. We hope that the reader finds it useful.

Abstract Depictions of disability in Chinese-language films from China and Taiwan, once a rarity, have become mainstream since the 1980s and have shifted from critiquing national policies, historical accounts, and collective experiences to highlighting disabled people as complex characters and advocating for greater support for them. These films reveal how disability has become a positive source of identity in its own right. Films from the late 1980s and early 1990s such as Tian Zhuangzhuang’s The Blue Kite use disability to offer critiques of official policies or alternative accounts of historical events. Zhou Sun’s Breaking the Silence and Xue Xiaolu’s Ocean Heaven, which focus on caregiving parents and their disabled children, reveal the need for private, extragovernmental networks of support as well as greater government support for those with disabilities and their families. Finally, films such as Zhang Yimou’s Happy Times feature characters with impairments living rich and rewarding lives, countering stereotypes about disability.

This chapter discusses how disability has been employed as a political identity in recent years, yet there are still elements of stigma attached. Not all disabled people wish to claim disability as a positive identity, yet a growing number of those in disability communities have found ways to use humor to ease social tensions and poke back at dominant society. At the same time, this kind of humor must be performed by people with disabilities so it is not interpreted as derogatory. Not all topics can be joked about, and not all people with disabilities are able to joke with disability, due to the ambivalent nature of humor. The chapter discusses how humor is inherently flexible and may be employed within disability communities as a form of horizontal hostility, or to joke about sexuality and push back against the desexualization of people with disabilities in dominant culture.

Online environments have played an important role in the growth of disability communities and the formation of political disability identities. This chapter analyzes the writings of four bloggers, all of whom reflect on their disability identity and sexuality while incorporating humor into their writing. These individuals have created online spaces where they share their stories, express a positive disability identity, and explain the joys and frustrations of their everyday lives. These individuals also respond to dominant cultural notions of desexualized disabled people, constructing sexual identities through photographs they post of themselves. Presenting these images creates a tension, recalling how able-bodied audiences stared at disabled bodies in freak shows of the past and leaving us to ask how the bodies of these bloggers will be interpreted by viewers/readers. At the same time, these bloggers serve an important function as a touchstone for others who may not have physical access to disability communities.

This chapter explores the political act of naming, and how groups of nondisabled people trying to create “positive” terms for disability have led to conflict inside and outside disability communities. This section addresses the range of opinions within disability communities about the words “crip” and “cripple,” examining various opinions and linguistic uses of the terms, and how the words can be employed to comic effect. Because of the historically derogatory meaning of these words, some people with disabilities argue that using the terms with pride is a form of naming reclamation and asserting a political disability identity. Others reject these words since they can be used with a negative connotation, or interpreted in that manner. Like all joking behavior, the use of this insider humor is ambivalent and dependent on audience and context.

Every campus has its own rhythm that underscores the mood of the overall college experience. Cultural interactions can heighten the cadence and may result in racial tension and unrest. Whether local (e.g., racially charged incidents in classrooms) or global, such as the 2016 presidential election, these events can shift the pulse and alter narratives within the university setting. The term “cultural barometer” is often used to describe the mood, and in this chapter, the five interviewees plus additional voices provide personal perspectives on campus temperature in terms of race, sexual identity, disability, student involvement, international students' experiences, and positive steps taken to address these phenomena during their time at the university.

The Schild site in west-central Illinois comprises two Mississippian cemeteries (ca. AD 1030), one of which includes the burial of a young male (SA117) without a left hand who was buried on the periphery of the cemetery. We suggest a complicated scenario including that the forearm was burned, resulting in loss of the hand, and we argue for a deviant social identity for this unfortunate young man. SA117 was not provided with grave goods—he was buried in a semi-flexed position, and his grave is unusual in that a fire was built over the grave fill. His marginalization and his disability may reflect outsider status; in fact, based on principal components analysis, his skull differs significantly from other Mississippian males. Several American Indian groups marked unusual causes of death in mortuary practices, and survivors of some kinds of trauma—for example, scalping—were treated as if dead. The use of fire in ordeals marked the transformation of captives into slaves or adopted members of the captor community; SA117 may have been such a person.

Unfortunately, coming to terms with disability and trauma are all too familiar foes for American combat veterans, many of whom receive inadequate, delayed, or nonexistent treatment options upon returning home. We conclude this volume with chapter 10, “Falling Out of Performance: Pragmatic Breakdown in Veterans’ Storytelling,” in which Kristiana Willsey provides new insights into the ways in which U.S. military veterans of Iraq and Afghanistan make meaning and process trauma through the sharing of narratives. She argues that naturalizing the labor of narrative—by assuming stories are inherently transformative, redemptive, or unifying—obscures the responsibilities of the audience as co-authors, putting the burden on veterans to both share their experiences of war, and simultaneously scaffold those experiences for an American public that (with the ongoing privatization of the military and the ever-shifting fronts of global warfare) is increasingly alienated from its military. Importantly, Willsey asserts that the public exhortations in which veterans tell their stories in an effort to cultivate a kind of cultural catharsis can put them in an impossible position: urged to tell their war stories; necessitating the careful management of those stories for audiences uniquely historically disassociated from their wars; and then conflating the visible management of those stories with the “spoiled identity” of post-traumatic stress disorder (PTSD).

The presence of students with disabilities in the universities is increasing. Faculty need to be trained in order to attend these students and with the objective to offer and inclusice education. The aim of this communication is to identify, describe and explain the barriers and aids that students with disabilities experience in university classroom. Forty four students with disabilitis participated in the research. A biographical narrative methodology was used. The university-life histories of the students were complied by making use of in-depth interviews, lifelines and photographs. Results indicate the important of faculty training in matters concerning disabilities and new technologies, informing to the faculty of the presence of students with disabilities in their classroom, the existence of a specific service to support the faculty and the important of iimproving a positive attitude toward the disability. These results are dicussed in line with other studies. Recommendations are maded according to inclusive education and offering keys to universities to provide training plans leading to inclusive education and learning.

Childhood obesity is becoming increasingly important in children because it occurs in earlier age periods. Children with intellectual disabilities belong to a high-risk group in the area of obesity. Their disability limits them in everyday life both in the possibilities of participation in physical activities and in the field of lifestyle. Currently, there is not real data in BMI age trends for children with intellectual disabilities. The aim of the research is to find out the trends of BMI in children with mild and moderate intellectual disability in different age periods and to find out whether summer holidays have an effect in BMI trend in some age periods. The methods used were quantitative and comparative research. BMI indicators were mea-sured using an In-Body machine. T-test was used to identify statistically significant differ-ences between periods. Trends were measured in children aged 6–20 years (the number of participants in each measurement: n = 49, n = 55, n = 56, n = 55) in over two years in the region Zlín in the Czech Republic. Trends are evaluated using box charts. The conclusion is that the trend of BMI of school-age pupils is positively accelerating, summer holidays have no affect BMI values. The BMI trend in pubescence pupils is fluctuating with a decrease in BMI values during the summer holidays. The BMI trend in adolescence pupils is convex, summer holidays have no effect on BMI values. BMI trends of all ages are within the normal weight. Astatistically significant difference in BMI is only for pupils of school age between September 2017 and June 2018. It is beneficial finding for practice that children with intellectual disability in the Czech Republic have much better results in BMI indicators and trends than children with intellectual disability in abroad.

Introduction Autism spectrum disorder (ASD), complex neurodevelopmental condition with lifelong impacts, typically identified in early childhood. Despite the fact that 95% of all <5 years of age with developmental disabilities including ASD live in low- and middle-income countries, the prevalence of ASD in many these countries is unknown. Objectives and goals The study aimed to identify the prevalence and clinical characteristics of ASD and its comorbidities among 8-10 y old schoolchildren in Republic of Georgia. Material and Methods The study conducted in four steps: screening, sampling, diagnostic assessment, and quality control of best-estimate diagnosis with target population of 3rd grade students of five main cities (Tbilisi, Kutaisi, Batumi, Zugdidi, Telavi) of Georgia (N=22,553). To determine children at risk for ASD the Autism Spectrum Screening Questionnaire (ASSQ) was used completed by parents and teachers. Parents of children who screened positive were offered comprehensive assessment using standardized diagnostic procedures. Results and Conclusions 16654 (response rate 74%) parents were agreed to participate in the screening stage. Cut-off scores for 99-95 percentiles (top 1-5%) was defined. For the 1168 sampled screen-positive students 704 (60.3%) consented to participate in the diagnostic assessment, and 215 among them (30.5%) completed full assessment. The control group of 23 children (from non in top 10%) were fully assessed for ASD. The prevalence of ASD was estimated to be 1.34% (95%CI=2.15-4.41). From ASD group 77.5% of cases were undiagnosed to have any neurodevelopmental disorder. Comorbidity of Intellectual disability was in 22.5% of children with ASD (IQ<70), and 31% have IQ>111. The study defined need for the use of broader screening in primary healthcare and school settings to identify children with special needs and ensure their adequate services.

Background: Leprosy is a neglected, chronic and infectious tropical disease, caused by Mycobacterium leprae. It presents with skin and peripheral nerves alterations, responsible for irreversible physical disabilities. Brazil is one of the main countries endemic for the disease, persisting as a public health problem; its position is the first in the world in terms of prevalence coefficient. Objectives: To analyze the magnitude and factors associated with activity limitation in new leprosy cases diagnosed in the reference center in northeastern Brazil. Methods: This is a cross-sectional study, carried out in a reference center located in the municipality of Juazeiro - Bahia, between January and June 2018, involving 50 people diagnosed with leprosy. Clinical and sociodemographic variables were collected in addition to the application of the SALSA scale (Screening of Activity Limitation and Safety Awareness) for the analysis of functional limitation. The data were structured using Microsoft Excel software and, for analysis, IBM SPSS Statistics for Windows was used. Logistic regression was used with the calculation of the Odds Ratio to identify the factors associated with functional limitation. A 95% confidence interval and a 5% significance level were adopted. Results: The presence of functional limitations was registered in 32% (n = 16) of the cases analyzed, especially female (56.3%), elderly (37.5%), low education (87.6%), dimorphic form (62.5%), multibacillary classification (75.0%) and degree 2 of physical disability (50.0%). Functional limitation was associated with: age group ≥ 45 years (OR 3.80; p = 0.047), multibacillary age (OR 4.28; p = 0.021) and OMP score ≥ 6 (OR 4.69; p = 0.041). 75% of individuals with limitations were aged ≥ 45 years and were multibacillary. Conclusions: The factors associated with functional limitation were age equal to or greater than 45 years, multibacillary classification and OMP score greater than or equal to six. Early diagnosis and timely treatment in the routine of health services can contribute to the prevention of physical disability and functional limitations.

ABSTRACT Introduction: The aims of our study were to identify the available functional examination tests (FET) and patient-reported outcome measures (PROM) instruments designed for subacromial impingement, to analyze and evaluate them and to develop a methodology for functional assessment of patients with shoulder impingement. Methods: A comprehensive search for all available FET and PROM and published review articles for subacromial impingement was undertaken on PubMed, PEDRO, Google Scholar, and Physiopedia up to June 2021. All full-text articles reporting evaluation, validation, surgical, and non-surgical treatment outcomes of these subacromial impingement FET and PROM were retrieved and analyzed by us, and a methodology for functional assessment of patients with subacromial impingement was developed. The methodology includes the following methods and tests: patient history, observation, palpation, examination of the movements, Visual Analogue Scale (VAS) for pain, examination of muscle balance (muscle length and tonus, isometric test, manual muscle testing), goniometry of the shoulder active range of motion (AROM), special tests (Neer test, Hawkins-Kennedy test), Shoulder Pain and Disability Index (SPADI). Results And Discussion: For a period of 1 year, we accessed 36 subjects diagnosed with primary shoulder impingement. They were randomly assigned to one of two physiotherapy groups: 1) supervised exercise only, and 2) supervised exercise with manual therapy techniques. Physiotherapy protocol involved twelve treatment sessions over a 6-weeks period. The analysis of the results confirms the positive effect of physiotherapy to decreases in pain, improved function, and increases in shoulder active range of motion. Conclusion: A methodology for functional examination of patients with subacromial impingement allows objective monitoring of the results of physiotherapy. Physiotherapy is effective in reducing pain and improving shoulder function in patients with subacromial impingement.

India has a unique and complex religious history, with faith and spirituality playing an important role in everyday life. Hinduism is the majority religion, and there are many minority religions. India also has a complicated class system and entrenched gender structures. Disability is another important identity. Many of these factors determine people’s experiences of social inclusion or exclusion. This paper explores how these intersecting identities influence the experience of inequality and marginalisation, with a particular focus on people with disabilities from minority religious backgrounds. A participatory qualitative methodology was employed in Chennai, to gather case studies that describe in-depth experiences of participants. Our findings show that many factors that make up a person’s identity intersect in India and impact how someone is included or excluded by society, with religious minority affiliation, caste, disability status, and gender all having the potential to add layers of marginalisation. These various identity factors, and how individuals and society react to them, impact on how people experience their social existence. Identity factors that form the basis for discrimination can be either visible or invisible, and discrimination may be explicit or implicit. Despite various legal and human rights frameworks at the national and international level that aim to prevent marginalisation, discrimination based on these factors is still prevalent in India. While some tokenistic interventions and schemes are in place to overcome marginalisation, such initiatives often only focus on one factor of identity, rather than considering intersecting factors. People with disabilities continue to experience exclusion in all aspects of their lives. Discrimination can exist both between, as well as within, religious communities, and is particularly prevalent in formal environments. Caste-based exclusion continues to be a major problem in India. The current socioeconomic environment and political climate can be seen to perpetuate marginalisation based on these factors. However, when people are included in society, regardless of belonging to a religious minority, having a disability, or being a certain caste, the impact on their life can be very positive.

Basic figures: – A large majority of respondents agreed or strongly agreed that gay men and lesbians (88%), bisexual people (87%) and transgender people (85%) “should be free to live their own life as they wish”. – Women were significantly more likely than men to agree with the above statement in respect to every identity group. People aged 25-34 years were significantly more likely than the general population to disagree with the statement. – On average, respondents were comfortable having people with a minority sexual orientation or gender identity as neighbours. Responses were significantly more positive towards having lesbians (M=8.51), bisexual people (M=8.40) and gay men (M=8.38) as neighbours compared to transgender people (M=7.98). – High levels of empathy were expressed with crime victims across all identity categories. Respondents were similarly empathetic towards heterosexual couples (M= 9.01), lesbian couples (M=9.05) and transgender persons (M=8.86) who are physically assaulted on the street. However, gay couples (M= 8.55) attracted significantly less empathy than a lesbian couple in similar circumstances. – Respondents were significantly more likely to intervene on behalf of a victim with a disability (M=7.86), than on behalf of an LGBT victim (M=6.96), but significantly more likely to intervene on behalf of an LGBT victim than an Irish Traveller (M= 5.82). – Respondents reported similar willingness to intervene on behalf of a lesbian pushed and slapped on the street by a stranger (M=7.38) and a transgender person (M= 7.03) in the same situation. Respondents were significantly more unlikely to intervene on behalf of a gay man (M=6.63) or bisexual person (M= 6.89) compared to a lesbian. – A third of respondents (33%) disagreed that violence against lesbians, gay men, bisexual and transgender people is a “serious problem in my country”, but more than half (58%) agreed that hate crimes hurt more than equivalent, non-bias, crimes.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.