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Adherence to COVID-19 social distancing restrictions may be challenging for adolescents, especially those concerned about social status. This study examined self-perceived popularity and reputation concerns as predictors of adherence to health guidelines and the effects of self-perceived popularity on adjustment. Adolescents (n = 1,068, 14-18 years at Time 1, M[subscript age] = 16.86 years) completed three self-report surveys across 10 months during the COVID-19 pandemic. Consistent with hypotheses, greater self-perceived popularity and concerns about peer reputation predicted less adherence, controlling for COVID-19 threat. Further, greater self-perceived popularity predicted less internalizing symptoms at Time 3. Adolescents' perceptions of their popularity may simultaneously act as a public health risk and provide social protection. Results emphasize the importance of acknowledging adolescents' social pressures and concerns regarding reputations and popularity during COVID-19.

International perspectives and collaborations are critical to the health of the kinesiology discipline during this supercomplex age. To that end, the National Association for Kinesiology in Higher Education (NAKHE) has adopted internationalization goals that support international faculty, joining forces with other academic societies across the world to promote innovation in programming, and to create international scholar leaders. Ideas related to specific internationalization virtues within kinesiology that were developed with international colleagues in Montreal, Canada at the PHE Canada Research Council Forum (May 2019) and at the Association Internationale des Écoles Supérieures d'Éducation Physique (AISEP, International Association for Physical Education in Higher Education) Conference at Adelphi University, Garden City, New York (June 2019) will be discussed. Themes coalesced into specific virtues including Collaboration, Valuing Diversity, Openness to Interdisciplinarity, Innovation, and Leadership. These themes will be discussed and put into the context of NAKHE's internationalization efforts.

We examined the impact of adolescents' popularity motivations on their involvement in relational aggression perpetration and victimization, heavy drinking, and antiauthority behavior, while also considering the role of teens' perception of their own popularity and psychosocial adjustment. High school students (N = 986; 50% female; M[subscript age] = 14.98 years) completed a battery of self-report questionnaires survey in the fall and again, 6 months later. Regression analysis controlling for Time 1 scores confirmed that stronger motivations to achieve or maintain popularity predicted increases in relational aggression perpetration and victimization, and antiauthority behavior. Furthermore, self-reported popularity predicted increases in heavy drinking, but only when popularity motivations were high. Finally, more frequent heavy drinking predicted increases in self-reported popularity over time. Findings emphasize the potential value of addressing adolescents' popularity motivations in attempts at reducing the aforementioned negative behaviors and associated risks.

Background New vaccine products were recently authorized for protection against invasive pneumococcal disease (IPD) in Canada. Our aim was to determine age- and serotype-specific trends in IPD incidence and severity in Canada's largest province, Ontario. Methods We included all confirmed IPD cases reported in Ontario and defined the pre–pneumococcal 13-valent conjugate vaccine (PCV13) era (01/2007 to 12/2010), post-PCV13 era (01/2011 to 12/2019), and coronavirus disease 2019 (COVID-19) pandemic era (01/2020 to 12/2022). We estimated incidence, hospitalization, and case fatality rate (CFR) by age. We grouped IPD cases by vaccine-specific serotypes (PCV13; PCV15-non-PCV13; PCV20-non-PCV13; PCV20-non-PCV15; polysaccharide 23-valent vaccine-non-PCV20; and non-vaccine-preventable [NVP]). We then compared incidence rates by age and serotype group in the pre- and post-PCV13 eras by calculating rate ratios (RRs) and their 95% CIs. Results Incidence and hospitalizations declined from the pre- to post-PCV13 era in children aged <5 years (RR, 0.7; 95% CI, 0.6–0.8; and RR, 0.8; 95% CI, 0.7–0.9, respectively), but the CFR increased (1.4% to 2.3%). Other age groups saw smaller declines or more stable incidence rates across the years; hospitalizations increased in adults aged 50–64 years (RR, 1.2; 95% CI, 1.1–1.4) and ≥65 years (RR, 1.1; 95% CI, 1.0–1.1). For all ages, IPD cases and hospitalizations attributable to PCV13 serotypes declined, and those attributable to PCV15-non-PCV13, PCV20-non-PCV13, and NVP serotypes increased. IPD incidence declined during the COVID-19 era. Conclusions IPD incidence and hospitalizations due to PCV13 serotypes decreased after PCV13 introduction but increased for other serotypes. Continued surveillance is required to evaluate changes to pneumococcal vaccination programs and ongoing changes to the distribution of IPD-causing serotypes. [ABSTRACT FROM AUTHOR]

Although the vast majority of criminal cases in Canada and the United States are resolved through plea bargaining, research suggests that the public generally disapproves of this practice. Public disapproval toward plea bargaining may reflect the public's erroneous belief that all defendants who accept a plea are guilty and should be prosecuted to the fullest extent of the law. At this time, it is unclear whether the public is aware of the fact that innocent defendants also accept plea bargains. We administered an exploratory survey to examine undergraduate students' (N = 237) and community members' (N = 259) perceptions of the situational and dispositional factors that are associated with false guilty pleas and exposure to crime/law media programmes. Results demonstrated that both students and community members underestimated the degree to which certain situational (e.g. attorney influence, saving money) and dispositional (e.g. age, compliance) factors can influence innocent defendants' decisions to plead guilty. Results also demonstrated that greater exposure to crime/law media programmes may help to increase public awareness about false guilty pleas. [ABSTRACT FROM AUTHOR]

The article focuses on the resurgence of the Black Lives Matter movement in 2020, statements of positionality in relation to racism, territorial acknowledgements and proclamations against systemic racism have become more common. Topics include considered after the American Revolution, United Empire Loyalists leaving the United States for Mi'kma'ki/Eastern Canada were encouraged to bring their furniture, other goods and slaves.

Disclosure of LGBTQ+ identities at work may reap benefits, but may also exacerbate harms. Faced with ambiguous outcomes, people engage in complex concealment/disclosure decision-making. For health professionals, in contexts of pervasive heteronormativity where disclosure to patients/clients is deemed to violate professional boundaries, stakes are high. This qualitative study with 13 LGBTQ+ health professionals across Canada used semi-structured interviews to explore factors affecting disclosure decision-making, particularly attending to power structures at multiple levels. Most participants engaged in constant risk-benefit assessment, disclosing strategically to colleagues, rarely to clients/patients. At the individual level they were affected by degree of LGBTQ+ visibility. At the institutional level they were affected by the culture of particular professional fields and practice settings, including type of care and type of patients/clients, as well as colleague interactions. Professional power–held by them, and held by others over them–directly affected disclosures. Finally, intersections of queer identities with other privileged or marginalized identities complicated disclosures. Power relations in the health professions shape LGBTQ+ identity disclosures in complex ways, with unpredictable outcomes. Concepts of professionalism are infused with heteronormativity, serving to regulate the gender and sexual identity expression of queer professionals. Disrupting heteronormativity is essential to forge more open professional cultures. [ABSTRACT FROM AUTHOR]

Background: Occupational therapy professes commitment to equity and justice, and research is growing concerning the experiences of clients from marginalized groups. To date, almost no research explores the professional experiences of therapists from marginalized groups. This qualitative study explores how exclusion operates in the profession among colleagues. Method: Grounded in critical phenomenology, semi-structured in-depth interviews were conducted with 20 occupational therapists who self-identified as racialized, disabled, ethnic minority, minority sexual/gender identity (LGBTQ+), and/or from working-class backgrounds. Iterative analysis was conducted using constant comparison and employing ATLAS.ti for team coding. Results: Across identity groups, four processes of exclusion were identified: isolation, abrasion, presumptions of incompetence, and coerced assimilation. Garland-Thompson’s (2011) concept of “misfit” is employed to analyze how therapists are constructed as not-quite-fitting the professional space delimited by occupational therapy’s white, able-body-minded, Western, heterosexual, middle-class, cisgender norms. Conclusions: Misfits are constructed by contexts, by expectations and material arrangements that assume particular bodies. Misfits make visible the inequities built into business-as-usual, an illumination that comes at often-painful cost. Yet there is possibility for change toward equity and justice for therapist colleagues: we can all choose to do differently, enacting change at micro and macro levels. [ABSTRACT FROM AUTHOR]

Background: Client-centeredness is foundational to occupational therapy, yet virtually no research has examined this aspect of practice as experienced by therapists from marginalized groups. The discourse of client-centeredness implicitly assumes a “dominant-group” therapist. Professional power is assumed to be accompanied by social power and privilege. Here, we explore what happens when professional and social power are uncoupled. Method: In-depth interviews grounded in critical phenomenology were conducted with Canadian therapists (n = 20) who self-identified as disabled, minority sexual/gender identity (LGBTQ+), racialized, ethnic minority, and/or from working-class backgrounds. Iterative thematic analysis employed constant comparison using ATLAS.ti for team coding. Results: Clients mobilized social power conveying direct and indirect hostility toward the therapists. Clients used social power to undermine the professional credentials and competence of the therapists. In turn, the therapists strove to balance professional and social power, when possible disclosing marginalized identities only when beneficial to therapy. Strongly endorsing client-centered principles, the therapists faced considerable tension regarding how to respond to client hostility. Conclusions: The discourse of client-centeredness ignores the realities of marginalized therapists for whom professional power is not accompanied by social power. Better conceptualizing client-centeredness requires shifting the discourse to address practice dilemmas distinct to marginalized therapists working with clients who actively mobilize systemic oppression. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Many adolescents face pressure when it comes to securing social media attention in the form of views, comments and/or likes on their posted content. The purpose of this study was to examine how this pressure impacts adolescents' current relationships with friends in addition to their mental health over time. Participants were Canadian adolescents (Time 1 n = 345; M age = 17.29; 80.6% female) who reported on their felt pressure to gain social media attention, friendship closeness and internalizing symptoms in 3 surveys approximately 4 months apart (from August 2020 to June 2021). We used latent curve modeling with structured residuals (LCM-SR) to model the lagged relations between the aforementioned variables, while also controlling for time spent on social media and number of likes received. LCM-SR builds on multivariate latent curve modeling and autoregressive latent trajectory and allows for the simultaneous testing of between- and within-person stability and change over time. In line with our first hypothesis, results demonstrated that at time points when adolescents experienced more pressure to gain social media attention than usual, their friendship closeness decreased at the next time point. Social media pressure was not a significant predictor of internalizing symptoms, however. Results emphasize the importance of teasing apart within- and between-person effects when examining impacts of adolescent social media use. They also highlight the importance of targeting felt pressures to gain social media attention in order to support healthy adolescent relationships. • Across 3 time points, between 43.6% and 54.2% of adolescents felt pressure to gain social media attention. • Increased social media pressure predicted within-person decreases in friendship closeness at the next time point. • Increased social media pressure did not predict changes in internalizing symptoms. • To support healthy adolescent relationships, it is important to target felt pressure to gain social media attention. [ABSTRACT FROM AUTHOR]

Attention to school violence amongst children has grown over the last decade with increased research, civil society programmes, government policies and legislation to prevent and counter bullying and other types of violence. Yet, there is a major gap in current research and efforts due to the absence of a child rights-based approach (CRBA). What does a CRBA to anti-violence efforts involve? This paper provides a rationale in favour of a rights-based approach and then defines a CRBA. [ABSTRACT FROM AUTHOR]

The increased awareness of concussion in sport has led to an examination of head impacts and the associated biomechanics that occur during these sporting events. The high rate of concussions in football makes it particularly relevant. The purpose of this study was to examine how frequently, and to what magnitude, Canadian University football players get hit in training camp and how this compares to practices and games in regular season. An AN OVA with repeated measures indicated that, on average, players were hit significantly more in games (45.2 hits) than training camp sessions (17.7 hits) and practices (8.0 hits), while training camp was associated with significantly more hits than practices (p < . 001, η² = .392). Multiple positional differences were found. In particular, significantly more hits were experienced by offensive linemen (36.7 hits) and defensive linemen (31.6 hits) compared with all other positions (p < .001, η² = .247). Study outcomes determined players/positions most at risk for concussion due to head impacts, which is beneficial in forming concussion prevention and assessment strategies. [ABSTRACT FROM AUTHOR]

The article discusses the relationship between monitoring procedures for international child rights and the best interests principle of child rights. According to the author, many Canadian processes and authorities do not operate based on the best interests principle but instead reflect other priorities. Several suggestions for improvement are presented, including the appointment of a national children's commissioner to monitor and advocate for child rights in Canada, the adoption of Jordan's Principle outlining payment policies for care of First Nations children, and promoting greater child rights awareness. The United Nations Convention on the Rights of the Child (CRC) and the relationship between children and adults are also discussed.

The article provides information on the usage of decision analysis in Canada. The goal of the decision analysis is to identify the most effective therapeutic or diagnostic approach. Decision analysis begins with a problem defined as a specific clinical question, and it requires multiple reviews of the literature. In the application of a decision analysis, the clinician must carefully consider the characteristics of the patient that will affect outcome.

Colorectal cancer is a common diagnosis in the elderly. Frequently concerns arise about outcomes after surgery, and little is known about postoperative quality of life in this older group after major bowel surgery. The objective of this study was to compare quality of life and functional status of elderly patients (older than aged 80 years) who have undergone surgery for colorectal cancer with a younger (younger than aged 70 years), procedure-matched control group. Patients in the case (older than aged 80 years) and control groups (younger than aged 70 years) were identified from the colorectal cancer database at Mount Sinai Hospital, Toronto, Canada. All had treatment for colorectal cancer within the last five years. Patients were surveyed by mail using the European Organization for Research and Treatment of Cancer quality of life scales specific to cancer and colorectal cancer (EORTC-C30 and EORTC-CR38) and the Short Form-36. Student’s t-test was used to test differences. There were 29 patients in each of the groups. The current average ages were 83.2 (standard deviation = 2.79) years, and 67.7 (standard deviation = 5.1) years, respectively. The two groups scored similarly on the European Organization for Research and Treatment of Cancer quality of life scales in all domains except physical functioning, functional role, micturition, and stoma-related problems. Similarly, the mean scores of the Short Form-36 were similar with the exception of the vitality domain. Most patients did not require special assistance or alternate living arrangements after discharge from the hospital, and most patients seemed to be able to return to their preoperative level of functioning. However, stoma care was a greater concern to the elderly. Elderly patients older than aged 80 years who are selected for surgery have a quality of life comparable to younger patients in most respects. Therefore, colorectal cancer surgery may be offered to the highly functioning elderly with the expectation of a good quality of life postoperatively. [ABSTRACT FROM AUTHOR]

The article presents information on a study related to the operative blood loss, blood transfusion and 30-day mortality in older patients after major noncardiac surgery. It informs that the Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS).

• Opening up dialogue with children and youth can add to research and support participation. • Young people's advisory groups contribute a valuable ethical dimension to research practice. • Institutional ethics requirements can create challenges for ethical practice with children and youth. • Young people and adults may have differing expectations of the role and process of advisory groups. • Virtual communications can facilitate dialogue, but have limitations in the Global South. Nearly thirty years ago, the world recognised the participation rights of children with the adoption by the United Nations Convention on the Rights of the Child. Since then childhood researchers in the Global South and Global North have been at the forefront of promoting these rights. The increased involvement of children and youth in research has challenged 'traditional' adult research practices in numerous ways. This article explores the role and contributions of Child and Youth Advisory Committees (CYACs) in the research process. It discusses the establishment of CYACs and how they supported the International and Canadian Child Rights Partnership (ICCRP). The ICCRP began as a three-year multi-country research project addressing children's rights to participation and protection and monitoring this connection internationally within several Global South and North countries: Brazil, Canada, China and South Africa. This article describes the creation and functioning of the ICCRP CYACs and the strengths, challenges, and creative processes in implementation. Findings presented relate to ethics regulation, differing expectations and assumptions about CYAC involvement, and virtual communication. These are discussed with the inclusion of adult researchers' and the CYAC members' perspectives. The article shares lessons learned about the role and significance of dialogue to support other child and youth advisory bodies in research at the local and global levels. [ABSTRACT FROM AUTHOR]

As health and social service professions increasingly emphasize commitments to equity, advocacy and social justice, non-traditional entrants to the professions increasingly bring much-needed diversity of social backgrounds and locations. Long the domain of elite social classes, the professions are not always welcoming cultures for those from lower social class backgrounds. This paper draws on notions of material, social and cultural capital, along with habitus , to examine the experiences of professionals with lower-class backgrounds, in educational programs and in their professions. The critical interpretive qualitative study draws on interviews with 27 professionals across Canada in medicine, nursing, social work and occupational therapy. While participants were clearly set apart from their colleagues by class origins, which posed distinct struggles, they also brought valuable assets to their work: enhanced connection and rapport with clients/patients, approachability, structural analysis and advocacy, plus nuanced re-envisioning of professional ethics to minimize power dichotomies. Rather than helping lower-class entrants adapt to the professions, it may be more beneficial to alter normative professional cultures to better suit these practitioners. • People from lower-class backgrounds may struggle in the professions. • The material, social and cultural capitals expected cast them as cultural outsiders. • They may more readily enact the social justice and equity aims of the professions. • We need transformational change to professional cultures of elitism and exclusion. [ABSTRACT FROM AUTHOR]

Abstract: The National Advisory Committee on Immunization (NACI) provides medical, scientific, and public health advice on the use of vaccines in Canada. This article describes the structure and processes of NACI, as well as its approach to evidence-based decision-making. In a rapidly evolving and complex immunization environment, NACI has faced challenges in its endeavour to make thorough and timely evidence-based recommendations. Making population-level recommendations without formally considering the full spectrum of public health science (e.g. cost-effectiveness) presents difficulties in the implementation of NACI''s recommendations. Although an improved and more transparent evidence-based NACI decision-making process is now in place, this is continuing to evolve with a current review of structures and processes underway to further improve effectiveness and efficiencies. [Copyright &y& Elsevier]

In the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self-identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working-class origins, to explore tensions between concepts of justice grounded in group-based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of 'unfair advantages.' Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy., (© 2024 The Author(s). Canadian Review of Sociology/Revue canadienne de sociologie published by Wiley Periodicals LLC on behalf of Canadian Sociological Association/La Société canadienne de sociologie.)

The objective of this narrative review was to identify real-world evidence regarding the burden of migraine in Canada. We conducted a literature search in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for studies published between August 2010 and August 2020. Of the 3269 publications identified, 29 studies were included. Prevalence estimates varied widely across Canada, and mental health comorbidities were common. Individuals with migraine have a lower quality of life, detrimental impact on workforce productivity, and higher rates of health care resource utilization (HCRU), with HCRU and costs highest among those with chronic migraine. We found inconsistencies in care, including underutilization of medications such as triptans, and varied utilization of over-the-counter and prescription medications. Increased medication use was identified among those with chronic migraine, and only a small number of patients used migraine preventive medications. The burden of migraine in Canada is substantial. Reduced quality of life and workforce productivity, increased HCRU and costs, and underutilization of triptans and migraine preventive medications highlight an important need for more effective management of individuals with migraine.

The outbreak of the COVID-19 virus dramatically changed daily life and created many obstacles for adolescents to engage in physical activity (PA). This study tracked rates of self-reported PA and examined its impact on adjustment among adolescents during the first 14 months of the pandemic. Canadian adolescents (N = 1068, 14-18 y, meanage = 16.95 y) reported on their frequency of PA, context of activity, and adjustment across 4 time points (April 2020 to June 2021). In line with our hypothesis, higher average levels of vigorous PA across the pandemic predicted less anxiety and depression and higher self-esteem at our study's end. Vigorous PA also buffered the relationships COVID-19 stress had with anxiety and self-esteem. The results further support recommendations for PA throughout the pandemic and while dealing with lockdown situations.

Purpose: The overarching goal of this study was to provide key information on how adolescents' substance use has changed since the corona virus disease (COVID)-19 pandemic, in addition to key contexts and correlates of substance use during social distancing., Methods: Canadian adolescents (n = 1,054, M age  = 16.68, standard deviation = .78) completed an online survey, in which they reported on their frequency of alcohol use, binge drinking, cannabis use, and vaping in the 3 weeks before and directly after social distancing practices had taken effect., Results: For most substances, the percentage of users decreased; however, the frequency of both alcohol and cannabis use increased. Although the greatest percentage of adolescents was engaging in solitary substance use (49.3%), many were still using substances with peers via technology (31.6%) and, shockingly, even face to face (23.6%). Concerns for how social distancing would affect peer reputation was a significant predictor of face-to-face substance use with friends among adolescents with low self-reported popularity, and a significant predictor of solitary substance use among average and high popularity teens. Finally, adjustment predictors, including depression and fear of the infectivity of COVID-19, predicted using solitary substance use during the pandemic., Conclusions: Our results provide preliminary evidence that adolescent substance use, including that which occurs face to face with peers, thereby putting adolescents at risk for contracting COVID-19, may be of particular concern during the pandemic. Further, solitary adolescent substance use during the pandemic, which is associated with poorer mental health and coping, may also be a notable concern worthy of further investigation., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The Continuous Assessment of Interpersonal Dynamics (CAID) is a method in which trained observers continuously code the dominance and warmth of individuals who interact with one another in dyads. This method has significant promise for assessing dynamic interpersonal processes. The purpose of this study was to examine the impact of individual sex, dyadic familiarity, and situational conflict on patterns of interpersonal warmth, dominance, and complementarity as assessed via CAID. We used six samples with 603 dyads, including two samples of unacquainted mixed-sex undergraduates interacting in a collaborative task, two samples of couples interacting in both collaborative and conflict tasks, and two samples of mothers and children interacting in both collaborative and conflict tasks. Complementarity effects were robust across all samples, and individuals tended to be relatively warm and dominant. Results from multilevel models indicated that women were slightly warmer than men, whereas there were no sex differences in dominance. Unfamiliar dyads and dyads interacting in more collaborative tasks were relatively warmer, more submissive, and more complementary on warmth but less complementary on dominance. These findings speak to the utility of the CAID method for assessing interpersonal dynamics and provide norms for researchers who use the method for different types of samples and applications.

The perfectionism model of binge eating (PMOBE) is an integrative model explaining the link between perfectionism and binge eating. This model proposes socially prescribed perfectionism confers risk for binge eating by generating exposure to 4 putative binge triggers: interpersonal discrepancies, low interpersonal esteem, depressive affect, and dietary restraint. The present study addresses important gaps in knowledge by testing if these 4 binge triggers uniquely predict changes in binge eating on a daily basis and if daily variations in each binge trigger mediate the link between socially prescribed perfectionism and daily binge eating. Analyses also tested if proposed mediational models generalized across Asian and European Canadians. The PMOBE was tested in 566 undergraduate women using a 7-day daily diary methodology. Depressive affect predicted binge eating, whereas anxious affect did not. Each binge trigger uniquely contributed to binge eating on a daily basis. All binge triggers except for dietary restraint mediated the relationship between socially prescribed perfectionism and change in daily binge eating. Results suggested cross-cultural similarities, with the PMOBE applying to both Asian and European Canadian women. The present study advances understanding of the personality traits and the contextual conditions accompanying binge eating and provides an important step toward improving treatments for people suffering from eating binges and associated negative consequences.