The construct validity of attitudes toward sex offenders (ATS) scale: ATS is more strongly linked to the acceptance of sex offenders than other offenders or non-offenders.

Negative attitudes toward offenders may hinder the rehabilitation process. The present study examines the relationship between attitudes toward sex offenders and stated acceptance of offenders and non-offenders into various aspects of daily life. Sixty female members of the public (18-50 years old, UK residents, recruited by word of mouth and via social media) completed an attitudes towards sex offenders (ATS) scale and indicated for each of eight vignettes describing ex-offenders and non-offenders whether they would accept them in various situations (housing, employment, day-to-day activities). Results indicate that in this group of female participants, harsher attitudes toward sex offenders are associated with lower acceptance of sex offenders (around 50% less acceptance) and other offenders (around 25% less acceptance), but not non-offenders, suggesting a tight coupling between attitudes and acceptance. The observed coupling between attitudes toward sex offenders and acceptance of offenders suggests that it will be difficult to change one without changing the other.

Implementing the European code of cancer practice in rural settings.

Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.

An Assessment of Scientific Evidence Relating to the Effect of Early Experience on the Risk of Human-Directed Aggression by Adult Dogs.

Human-directed aggression by domestic dogs is a major worldwide public health problem. The causes of aggression are complex, and research in this area often has to balance ecological validity with pragmatic controls; accordingly, it often does not meet the thresholds for quality typically used in reviews applying a classical "evidence-based" approach. Here, we propose a method of literature assessment that makes the "best use" of available evidence to identify and synthesise evidence relating to the most likely risk factors reported in the scientific literature. We used a systematic review process to initially identify relevant literature relating to potential early life experience (i.e., in the first six months of life) risk factors in the dog for human-directed aggression in the adult animal. Fourteen papers met our initial screening process and were subsequently analysed in detail, with data extracted and effect sizes calculated where possible. This highlighted the potential importance of the source of the animal, the age at which it was rehomed, the reason for the acquisition, the experience level of the owner, the animal's socialisation experiences, the consistent husbandry and management practices, the training, the sex ratio of the litter and the history of dogs that display aggression in the pedigree as risk factors. Taken together, it seems that early experiences which limit the ability to develop effective coping strategies and routines may be particularly important. We provide guidance for the future standardised reporting of risk related to human-directed aggression by dogs to allow greater synthesis of the literature in the future.

An Eye Tracking Investigation of Young People's Gaze Behaviour to Gambling and Non-Gambling Moving Adverts.

INTRODUCTION: Data from several areas of public health (e.g., harmful alcohol and tobacco) are consistent with the assertion that children's exposure to advertising strategies increases intention to consume such products. Most studies have measured self-rated impact of gambling advertising using questionnaires. Given that gambling advertisements come in different forms such as print media/television advertising and contain variable content, it is difficult to understand using subjective measures which aspects of the gambling advertisements increase craving and desire to trigger a gambling session. In the present study, we applied a novel data-driven methodology that directly tracks eye movements to reveal attentional biases towards gambling adverts and promotions by examining differences in young people's eye gaze behaviour when watching gambling and non-gambling (control) moving adverts. METHOD: A total of 98 (16-18 years old) children who self-identify as having a low or high craving to gambling watched gambling and non-gambling (control) television adverts, while their eye movements were recorded. RESULTS: The results show that the data-driven method can isolate video clips that best distinguish people on the low-high craving spectrum, reveal the type of each video clip with the largest group differences, and accurately predict young people's gambling craving on the basis of eye movement patterns. CONCLUSION: Our findings demonstrate that young people's craving for gambling can be predicted based on their eye movements to video clips of gambling advertisements and that certain features of gambling advertisements may be more appealing to some group of viewers, particularly those with high craving for gambling.

Ethnicity and risk for SARS-CoV-2 infection among the healthcare workforce: Results of a retrospective cohort study in rural United Kingdom.

BACKGROUND: The reason why Black and South Asian healthcare workers are at a higher risk for SARS-CoV-2 infection remain unclear. We aimed to quantify the risk for SARS-CoV-2 infection among healthcare staff who belong to the ethnic minority and elucidate pathways of infection. METHODS: A one-year follow-up retrospective cohort study has been conducted among National Health Service employees who were working at 123 facilities in Lincolnshire, UK. RESULTS: Overall, 13,366 professionals were included. SARS-CoV-2 incidence per person-year was 5.2% (95% CI: 3.6-7.6%) during the first COVID-19 wave (January-August 2020) and 17.2% (13.5-22.0%) during the second wave (September 2020-February 2021). Compared with White staff, Black and South Asian employees were at higher risk for SARS-CoV-2 infection during both the first wave (hazard ratio, HR 1.58 [0.91-2.75] and 1.69 [1.07-2.66], respectively) and the second wave (HR 2.09 [1.57-2.76] and 1.46 [1.24-1.71]). Higher risk for SARS-CoV-2 infection persisted even after controlling for age, sex, pay grade, residence environment, type of work, and time exposure at work. Higher adjusted risk for SARS-CoV-2 infection were also found among lower-paid health professionals. CONCLUSION: Black and South Asian health workers continue to be at higher risk for SARS-CoV-2 infection than their White counterparts. Urgent interventions are required to reduce SARS-CoV-2 infection in these ethnic groups.

Ambulance attendance for substance and/or alcohol use in a pandemic: Interrupted time series analysis of incidents.

INTRODUCTION: The ambulance attendance for substance and/or alcohol use in a pandemic (ASAP) study explores incidents during the COVID-19 lockdown in the East Midlands region of the United Kingdom (23 March-4 July 2020). METHOD: Retrospective cross-sectional count per day of ambulance attendances from the East Midlands Ambulance Service Trust. Ambulance attendances relating to alcohol or other drug use in the year prior, during lockdown and weeks following, were examined using interrupted time series analysis by patient demographics and geographical location. RESULTS: A total of 36 104 records were identified (53.7% male, 84.5% ethnicity classified as White, mean age 38.4 years). A significant drop in the number of attendances per day at the start of lockdown (-25.24, confidence interval - 38.16, -12.32) was observed, followed by a gradual increase during the ongoing lockdown period (0.36, confidence interval 0.23, 0.46). Similar patterns were found across genders, age groups 16-64 and urban/rural locations. DISCUSSION AND CONCLUSION: The pattern of ambulance attendances for alcohol or other drug use changed during the COVID-19 lockdown period. Lockdown significantly affected the use of ambulances for incidents involving alcohol or other drug use, impacting on health-care services. Further research into hazardous use of alcohol or other drugs during the lockdown periods is needed to inform policy, planning and public health initiatives.

Data-driven group comparisons of eye fixations to dynamic stimuli.

Recent advances in software and hardware have allowed eye tracking to move away from static images to more ecologically relevant video streams. The analysis of eye tracking data for such dynamic stimuli, however, is not without challenges. The frame-by-frame coding of regions of interest (ROIs) is labour-intensive and computer vision techniques to automatically code such ROIs are not yet mainstream, restricting the use of such stimuli. Combined with the more general problem of defining relevant ROIs for video frames, methods are needed that facilitate data analysis. Here, we present a first evaluation of an easy-to-implement data-driven method with the potential to address these issues. To test the new method, we examined the differences in eye movements of self-reported politically left- or right-wing leaning participants to video clips of left- and right-wing politicians. The results show that our method can accurately predict group membership on the basis of eye movement patterns, isolate video clips that best distinguish people on the political left-right spectrum, and reveal the section of each video clip with the largest group differences. Our methodology thereby aids the understanding of group differences in gaze behaviour, and the identification of critical stimuli for follow-up studies or for use in saccade diagnosis.

Alcohol and other substance use during the COVID-19 pandemic: A systematic review.

BACKGROUND: Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this. METHODS: A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020. RESULTS: The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances. CONCLUSION: There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.

Development of a 21-item short form of the Attitudes to Sexual Offenders (ATS) Scale.

The Attitudes to Sexual Offenders scale (ATS; Hogue, 1993) is one of the most widely used measurement instruments for assessing views about sexual offenders. The ATS has been used in a variety of contexts, most commonly in comparing forensic professionals and nonprofessionals in relation to their views about this population. This article offers a review of the methods used to examine attitudes toward sexual offenders currently available, before systematically outlining the validation of a 21-item shortened version of the ATS measure (the ATS-21). First, we analyzed the ATS with regards to its underlying factor structure using a general community sample (Study 1; n = 188). This identified three factors: trust, intent, and social distance. We subsequently supported this structure through confirmatory factor analysis in a new community sample (Study 2; n = 335) and Hogue's (1993) original ATS development data (Study 3; n = 170) in order to provide further evidence of its reliability. We also offer preliminary evidence of the ATS-21's test-retest reliability, consistency across multiple testing contexts, resistance to social desirability, and independence from related measures (Study 4; n = 59). We close by recommending the use of the ATS-21 for researchers examining attitudes toward sexual offenders and offer suggestions for a new unified research design to incorporate the ATS-21 into emerging research into the psychological underpinnings of attitudes and responses to sexual offenders. We offer open data at https://osf.io/ymhsw/ and open scoring resources for the ATS-21 at https://osf.io/34hsx/. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reducing Stigma and Punitive Attitudes Toward Pedophiles Through Narrative Humanization.

Stigmatization and societal punitiveness about pedophilia have a range of potential consequences, such as the social isolation of people with sexual interest in children, and the formation of policies that are not consistent with empirical research findings. Previous research has shown that people with pedophilic sexual interests use societal thinking to self-stigmatize, which in turn may actually serve to increase their risk of committing a sexual offense. In this study, we compared two attitudinal interventions (first-person narrative vs. expert opinion) using a student sample ( N = 100). It was hypothesized that both interventions would lead to reductions in stigmatization and punitive attitudes about pedophiles on an explicit (self-report) level but that only the narrative intervention would lead to reductions of these constructs at the implicit level. Our findings supported both hypotheses. We further discuss the role of narrative humanization in this area and offer suggestions for further research based upon the theoretical and methodological implications of the findings.

Sexual cognition guides viewing strategies to human figures.

Gaze patterns to figure images have been proposed to reflect the observer's sexual interest, particularly for men. This eye-tracking study investigated how individual differences in sexual motivation tendencies are manifested in naturalistic gaze patterns. Heterosexual men and women (M = 21.0 years, SD = 2.1) free-viewed plain-clothed male and female figures, aged 10, 20, and 40 years old, while their eye movements were recorded. Questionnaires were used to measure sexual cognitions, including sensation seeking and sexual compulsivity, sexual inhibition and excitation, and approach and avoidance responses to sexual stimuli. Our analysis showed a clear role of sexual cognitions in influencing gaze strategies for men. Specifically, men who scored higher on sexual compulsivity dedicated more gaze to the waist-hip region when viewing figures of their preferred sexual partners than men who scored lower on sexual compulsivity. Women's sexual cognitions showed no clear effect on the gaze pattern in viewing figures of their preferred age and gender of sexual partners, suggesting women's gaze is unlikely to be a straightforward reflection of their sexual preferences. The findings further suggest that men's gaze allocation is driven by sexual preferences and supports the utility of eye tracking in the assessment of male sexual interest.

Differential gaze behavior towards sexually preferred and non-preferred human figures.

The gaze pattern associated with image exploration is a sensitive index of our attention, motivation, and preference. To examine whether an individual's gaze behavior can reflect his or her sexual interest, this study compared gaze patterns of young heterosexual men and women (M = 19.94 years, SD = 1.05) while they viewed photographs of plain-clothed male and female figures aged from birth to 60 years old. The analysis revealed a clear gender difference in viewing sexually preferred figure images. Men displayed a distinctive gaze pattern only when viewing 20-year-old female images, with more fixations and longer viewing times dedicated to the upper body and waist-hip regions. Women also directed more attention at the upper body on female images in comparison to male images, but this difference was not age-specific. Analysis of local image salience revealed that observers' eye-scanning strategies could not be accounted for by low-level processes, such as analyzing local image contrast and structure, but were associated with attractiveness judgments. The results suggest that the difference in cognitive processing of sexually preferred and non-preferred figures can be manifested in gaze patterns associated with figure viewing. Thus, eye-tracking holds promise as a potential sensitive measure for sexual preference, particularly in men.

Personality traits as predictors of inpatient aggression in a high-security forensic psychiatric setting: prospective evaluation of the PCL-R and IPDE dimension ratings.

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist-Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings.

Structural, item, and test generalizability of the psychopathy checklist--revised to offenders with intellectual disabilities.

The Psychopathy Checklist-Revised (PCL-R) is the most widely used measure of psychopathy in forensic clinical practice, but the generalizability of the measure to offenders with intellectual disabilities (ID) has not been clearly established. This study examined the structural equivalence and scalar equivalence of the PCL-R in a sample of 185 male offenders with ID in forensic mental health settings, as compared with a sample of 1,212 male prisoners without ID. Three models of the PCL-R's factor structure were evaluated with confirmatory factor analysis. The 3-factor hierarchical model of psychopathy was found to be a good fit to the ID PCL-R data, whereas neither the 4-factor model nor the traditional 2-factor model fitted. There were no cross-group differences in the factor structure, providing evidence of structural equivalence. However, item response theory analyses indicated metric differences in the ratings of psychopathy symptoms between the ID group and the comparison prisoner group. This finding has potential implications for the interpretation of PCL-R scores obtained with people with ID in forensic psychiatric settings.

Risk assessment in offenders with intellectual disability: a comparison across three levels of security.

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.

Sexual reconviction rates in the United Kingdom and actuarial risk estimates.

OBJECTIVE: Assessing the risk of further offending behavior by adult sexual perpetrators of children is highly relevant and important to professionals involved in child protection. Recent progress in assessing risk in sexual offenders has established the validity of actuarial measures, although there continues to be some debate about the application of these instruments. This paper summarizes the debate between clinical and actuarial approaches and reviews the "base rate" for United Kingdom sexual offense reconviction. METHOD: A review of the literature revealed 16 UK sexual reconviction studies, 8 using incarcerated samples (N=5,915) and 8 using non-incarcerated samples (N=1,274). UK estimates of sexual reconviction rates are compared with European and North American studies. RESULTS: The mean sexual reconviction rates for the incarcerated sample at 2 years (6.0%), 4 years (7.8%) and 6 years or more (19.5%) were higher than that of the comparative non-incarcerated sample at 2 years (5.7%), up to 4 years (5.9%), and 6 years or more (15.5%). The overall sexual reconviction rate for both samples combined was 5.8% at 2 years, and 17.5% at 6 years or more. CONCLUSIONS: The sexual reconviction rate for incarcerated sexual offenders is higher than that of non-incarcerated sexual offenders. The UK sexual reconviction rates were comparable with European and North American studies.

Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: treatment progress.

BACKGROUND: Among mainstream offenders, the severe personality disorder of psychopathy has considerable importance as a construct. The disorder has long been associated with failure to make treatment progress. Previous work has identified that psychopathy as a disorder occurs in samples of offenders with intellectual disability (ID), and suggests that the Psychopathy Checklist - Revised (PCL-R: Hare, 1991, 2003) as a measure of the disorder has adequate reliability and validity (Morrissey et al., 2005). The present study aimed to compare the predictive power of the PCL-R in relation to treatment progress with a more general assessment of violence risk, the HCR-20 (Webster, Douglas, Eaves, & Hart, 1997). METHOD: A sample of 73 residents in a high security intellectual disability service, who had previously been assessed using the PCL-R and the HCR-20, were followed up at 2 years post-assessment, and their outcome determined in terms of two distinct dichotomous variables reflecting definite positive treatment progress and definite negative treatment progress respectively. RESULTS: In line with predictions, the PCL-R Total score and Factor 1 score (Interpersonal and Affective aspects of psychopathy) and the HCR-20 Total score were significantly inversely associated with a positive move from high to medium security hospital conditions within 2 years of assessment. However against prediction, the PCL-R Total score had incremental validity over the HCR-20. The PCL-R Total and Factor 1, but not the HCR-20 Total score, were also significantly associated with negative treatment progress in terms of a move to more restricted treatment conditions. CONCLUSION: Psychopathy, and in particular its interpersonal and affective manifestations, is a construct which appears to be associated with indirect measures of treatment progress in this high security ID group. However, caution should be applied in the use of a construct with potentially negative connotations in an already devalued population.

Internal consistency and factor structure of personality disorders in a forensic intellectual disability sample.

BACKGROUND: The publication of the DSM-III (American Psychiatric Association (APA), 1980) prompted a significant increase in interest and research on personality disorder (PD), and the concept has subsequently been incorporated into mental health legislation in the developed world. Despite this, such research on people with intellectual disability (ID) has been sporadic, with widely varying results. The present study addresses a number of criticisms directed at previous research. METHOD: DSM-IV (APA, 2000) diagnoses of PD were made on 164 participants with ID on the basis of four independent sources of classification. RESULTS: Reliability data for each PD was acceptable and alpha was .74 or above, with the exception of schizotypal PD (.63). Exploratory and confirmatory factor analyses were conducted, with the former revealing a 4-factor solution accounting for 58.9% of the variance, and a 2-factor solution accounting for 37.2% of the variance emerging for the latter. The factors were orthogonal, and we called the first factor "avoidant/rumination/inhibited" and the second factor "acting out". DISCUSSION: We review these findings in relation to previous research on PD and alternative frameworks for the understanding of personality. We hypothesise consistencies between these findings and previous work on personality and ID. A number of drawbacks to the research are discussed, including a caution on the pejorative nature of a diagnosis of PD in an already devalued population.

A comparison of offenders with intellectual disability across three levels of security.

BACKGROUND: A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security. METHOD: A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69). RESULTS: Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.