What do recently housed young people imagine for the future of third places? Using game-based inquiry to (re)imagine affirming, youth-centered third places.

Third places-public and community settings like parks and libraries-are theorized to serve as sources of social connection, community, and play. Yet, young people who hold marginalized identities, such as those experiencing homelessness and housing instability, often endure discrimination in third place settings. This study used game-based inquiry to partner with recently housed young people who have experienced chronic housing instability (N = 21) to understand how they would (re)imagine future third places. We then analyzed transcripts from these game sessions through qualitative thematic analysis. Participants suggested that certain tenets must be present in third places: they must offer opportunities for agency and individualization; they must meet everyday needs; and they must be explicitly inclusive. To actualize these tenets, participants imagined places that meet many needs and do many things; portable and adaptable physical spaces; freedom to choose how to play; attending to and subverting oppressive social hierarchies; providing choice for privacy or connection; knowing people will be around; and free amenities. These findings have implications for theoretical development, practices in present and future third places, and methodological development of games in research.

How mutual aid proliferation developed solidarity and sense of collective responsibility in the early months of COVID-19.

Although mutual aid organizing is a social movement practice long sustained by queer/trans people, immigrants, people of color, and disability communities, among other communities pushed to the margins of society, with the emergence of the COVID-19 pandemic, and subsequent government failures in addressing unmet needs, mutual aid proliferated into new (and more socially privileged) communities in the United States and across the world. Amidst this landscape of extraordinary and unique crises, our study sought to understand the benefits experienced by those engaged in mutual aid in the early months of the COVID-19 pandemic in the state of Colorado, United States. Our team conducted semistructured individual interviews with 25 individuals participating in mutual aid through groups organized on social media or through intentional communities. We found that participants, who engaged in mutual aid in the early months of the COVID-19 pandemic, built empathy, a sense of nonjudgement, and critical consciousness as they created common ground as humans. Participants also found mutual aid engagement to provide nourishing support, to hold pain among more people, and, simply to "feel good." We discuss the potential implications of these benefits for sustaining mutual aid movements through the ongoing COVID-19 pandemic in the United States and beyond.

Highlighting Trans Joy: A Call to Practitioners, Researchers, and Educators.

This practice note is a call to practitioners, researchers, and educators to reconsider how they approach work with trans and nonbinary communities. Drawing on previous work done by Tuck, and shuster and Westbrook, I encourage readers to move from a deficit-based lens to a lens where joy is part of the narrative, an aspect of trans and nonbinary lives that is often missing from much of the research on trans communities. Furthermore, I urge readers to move beyond seeing trans and nonbinary communities as primarily social and political issues to be addressed and to see and embrace the complex and nuanced humanity and lived experiences of trans and nonbinary people.

"How Do I Exist in This Body That's Outside of the Norm?" Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia.

Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark's thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.

"We Are Doing the Absolute Most That We Can, and No One Is Listening": Barriers and Facilitators to Health Literacy within Transgender and Nonbinary Communities.

Transgender and nonbinary (TNB) individuals face disparities in nearly every aspect of health. One factor associated with poor health outcomes in other marginalized populations is health literacy, yet no identified studies examine health literacy in TNB samples. Moreover, most health literacy frameworks focus primarily on the capacities of individual patients to understand and use healthcare information, with little attention given to provider literacy and environmental factors. In partnership with a statewide LGBTQ advocacy organization, we recruited 46 transgender and nonbinary individuals to participate in seven focus groups conducted in urban, suburban, and rural locations throughout Colorado. TNB participants consistently engaged in efforts to increase their own health literacy and that of their medical providers yet faced multiple barriers to improve care. Difficulty identifying and physically reaching care, insurance and out-of-pocket expenses, negative experiences with healthcare providers and staff, provider incompetence, discriminatory and oppressive practices, and exclusionary forms and processes emerged as barriers to enacted health literacy among participants. Conversely, facilitators of enacted healthcare literacy included positive experiences with healthcare providers and staff, and inclusive forms and processes.

Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician.

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender diverse individuals in accessing care, but there is a clearly indicated need for additional education for healthcare providers, especially those doing primary care, on how to offer knowledgeable, affirming, and intersectional care to their patients.

Transgender and Nonbinary Experiences of Victimization in Health care.

Transgender and nonbinary (TNB) individuals experience high rates of myriad types of victimization, including in health care settings. Many TNB people avoid medical visits for fear of mistreatment and, when they do visit a provider, report negative experiences (e.g., denial of services, misgendering, verbal abuse). These negative experiences are heightened for TNB individuals who have an intersecting marginalized identity (e.g., low socioeconomic status, disability). Using data from the 2015 United States Transgender Survey, the largest survey of TNB individuals in the United States to date, the present study examines differential experiences of victimization in health care settings by TNB identity and other demographics (i.e., race, age, class, educational level, disability). A series of multivariate logistic regressions were run to determine adjusted odds ratios (AORs) for TNB individuals recently (i.e., in the past year) experiencing four forms of victimization: (a) doctor/health care provider used harsh or abusive language; (b) doctor/health care provider was physically rough or abusive; (c) patient was verbally harassed in health care setting; and (d) patient experienced unwanted sexual contact in health care setting. Frequency of victimization varied by gender identity and type of victimization; the most prevalent form was verbal harassment by a doctor/provider (5.84%) and the least prevalent was unwanted sexual contact in a health care setting (1.20%). Although findings varied by form of violence, generally, regression models demonstrated elevated odds of experiencing some form of health care victimization for those who were transgender compared with genderqueer, biracial/multiracial compared with White, low income compared with higher income, and disabled compared to non-disabled. In addition, odds ratios for victimization increased with age and, for some forms, increased with low educational attainment. We discuss the need for increased mandatory trainings for providers to reduce discriminatory and violent behavior toward TNB patients, as well as intersectional research to better ascertain the extent and nuance of victimization within TNB health care.