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Abstract

Bull breeds are commonly kept as companion animals, but the pit bull terrier is restricted by breed-specific legislation (BSL) in parts of the United States and throughout the United Kingdom. Shelter workers must decide which breed(s) a dog is. This decision may influence the dog's fate, particularly in places with BSL. In this study, shelter workers in the United States and United Kingdom were shown pictures of 20 dogs and were asked what breed each dog was, how they determined each dog's breed, whether each dog was a pit bull, and what they expected the fate of each dog to be. There was much variation in responses both between and within the United States and United Kingdom. UK participants frequently labeled dogs commonly considered by U.S. participants to be pit bulls as Staffordshire bull terriers. UK participants were more likely to say their shelters would euthanize dogs deemed to be pit bulls. Most participants noted using dogs' physical features to determine breed, and 41% affected by BSL indicated they would knowingly mislabel a dog of a restricted breed, presumably to increase the dog's adoption chances.

Keywords: pit bull, breed identification, animal shelter

The pit bull terrier is banned or restricted by breed-specific legislation (BSL) in parts of the United States and throughout the United Kingdom. Nevertheless, dogs who resemble pit bulls are often still kept as companion animals. American bulldogs, American Staffordshire terriers, bull terriers, English bulldogs, Staffordshire bull terriers, and pit bull terriers are frequently grouped together as bull breeds. A number of the bull breeds are categorized as pit bull terriers in some places, while in others, the pit bull terrier is considered distinct from the other bull breeds ( Rowan, 1986).

The rescue/shelter system is under much pressure to take in and rehome unwanted companion animals, which frequently include pit bulls or other bull breeds. In the United Kingdom, 89,571 dogs were received by 536 organizations during 2010 ( Stavisky, Brennan, Downes, & Dean, 2012). Attempts to quantify the entire U.S. shelter population in detail have been unsuccessful ( Rowan, 1992; Zawistowski, Morris, Salman, & Ruch-Gallie, 1998), but according to the American Society for the Prevention of Cruelty to Animals (ASPCA), an estimated 5,000 animal shelters operate in the United States and receive between 5 million and 7 million companion animals annually ( ASPCA, 2013). How the pit bull terrier is defined in a locale is likely to impact which dogs animal shelter staff identify as pit bulls, and this in turn may influence whether they are placed for adoption. In many shelters, dogs identified as pit bulls face higher euthanasia rates than dogs identified as most other breeds ( Clevenger & Kass, 2003; Lepper, Kass, & Hart, 2002; Lord et al., 2006).

In the United Kingdom, the Dangerous Dogs Act of 1991 prohibits the purchase, adoption, or ownership of pit bull terriers, Japanese Tosas, Dogo Argentinos, and Fila Brasilieros ( Department for Environment, Food and Rural Affairs [DEFRA], 2013). According to the UK government, pit bull-type dogs are distinct from Staffordshire bull terriers (which are not banned) and are sometimes called American pit bull terriers, American Staffordshire terriers, Irish Staffordshire bull terriers, Irish blues, or Irish red noses ( DEFRA, 2013). Although the UK Kennel Club does not recognize the pit bull or American pit bull terrier as a breed and therefore has no breed standard for it ( Kennel Club, 2006), dogs are considered "pit bull type" if they meet a substantial number of 15 physical features outlined by the DEFRA and copied directly from a 1977 issue of the American periodical Pit Bull Gazette ( DEFRA, 2009). A dog may be confiscated if he or she meets most of these criteria, regardless of the dog's parentage, or he or she may be placed on an exemption register subject to restrictions and management practices.

The majority of municipalities in the United States have no restrictions on pit bull-type dogs, but approximately 300 locales in the United States have BSL ( National Canine Research Council, 2013). The terms of these laws vary a great deal from place to place. Some laws completely ban pit bull-type dogs (e.g., in Shawnee, KS; Prince George's County, MD; Ashland, MO), and others place restrictions on caregivers of such dogs (e.g., in Dawson, GA; Preston, ID; Buffalo Grove, IL). Common restrictions include higher licensing fees, registering the dog as vicious or dangerous, liability insurance coverage, mandatory sterilization, muzzling when on public property, placement of signage indicating a dangerous dog is on property, and confinement on private property in secured pens.

Municipalities that ban or restrict pit bull-type dogs generally include as part of their bans American pit bull terriers, American Staffordshire terriers, and Staffordshire bull terriers, as well as dogs of mixed breeding thought to have the physical characteristics of pit bull-type dogs ( National Canine Research Council, 2013). Some municipalities also ban or restrict breeds or breed mixes not commonly considered to be pit bull types, such as American bulldogs, bull terriers, Dogo Argentinos, Presa Canarios, Rottweilers, and wolf hybrids ( National Canine Research Council, 2013).

Some of the laws in the United States banning or restricting pit bull-type dogs, such as Miami-Dade County's pit bull ordinance ( Miami-Dade County Animal Services Department, 1989), specify physical features that define pit bull-type dogs. Many do not, however, perhaps because, like the UK Kennel Club, the American Kennel Club (AKC) does not recognize or have a breed standard for the American pit bull terrier ( AKC, 2006). The United Kennel Club, which is based out of Michigan, however, does offer a breed standard for the American pit bull terrier and, as of 2013, for a new breed called the American bully ( United Kennel Club, 2013). Both the UK Kennel Club and the AKC have a breed standard for the Staffordshire bull terrier, but unlike the AKC, the UK Kennel Club does not have a breed standard for the American Staffordshire terrier.

Results from genetic testing have been used in legal cases to argue a dog is not a pit bull type (e.g., Salina, KS; Clouston, 2009), and it has been suggested that genetic testing for breed is more objective and reliable than visual identification ( Barnett, 2011). However, the validity of genetic testing to determine pit bull ancestry is also deemed questionable due to the pit bull's nature of being a "type" that may source from a range of purebred bull breeds ( Wisdom Panel, 2013). Furthermore, although the genetic tests recognize some bully-type breeds, they do not recognize the American pit bull terrier.

Because of differences across places regarding what breeds are subject to BSL, there is likely to be variation across the United States and between the United States and United Kingdom regarding what is considered a pit bull-type dog. Without knowing a dog's ancestry, shelter, pound, and rescue workers likely have to resort to their own intuition and prior experience when deciding what breed(s) a dog is to be identified as. Determining whether a dog is a banned breed, however, is not always straightforward, as even experts struggle to determine visually whether a dog is a pit bull type ( Rowan, 1986), and there can be extreme phenotypic and behavioral variation within a litter sired by the same stud and dam ( Scott & Fuller, 1965). Furthermore, recent research has shown both a lack of agreement across individuals tasked with identifying cross-breeds and a lack of consensus between visual breed identification and genetic breed identification ( Voith, Ingram, Mitsouras, & Irizarry, 2009; Voith et al., 2013). This confusion is likely to be even further compounded when dealing with the sensitive issue of bull breed identification.

In this study, we aimed to investigate the perceptions of shelter staff and the mechanisms that they use when identifying bull breeds, especially those commonly classified as pit bulls. We examined how much agreement there was regarding what constitutes a pit bull across shelter staff and volunteers working in shelters, pounds, and rescues in the United States and United Kingdom. Furthermore, we tested whether U.S. participants in places with and without BSL differed in their likelihood of identifying a dog as a pit bull. We also compared the most common reasons for euthanizing shelter dogs in the United States and United Kingdom and qualitatively assessed the features shelter staff and volunteers reported using to determine a dog's breed.

MATERIALS AND METHODS

Participants

Data for this study were analyzed from 416 U.S. participants and 54 UK participants who voluntarily completed an online survey from December 18, 2012, to February 17, 2013. Except for participants who chose to include their contact information in the comments section at the end of the survey, responses were anonymous. Ninety-one percent of American participants and 94% of UK participants were female. Fifty-one percent of participants were aged 18 to 40 years old; 42% were aged 40 to 60 years old; and 7% were older than 60 years. Participants in this analysis were self-identified as shelter staff or volunteers who have a role in assigning breed names to dogs who enter their shelters, pounds, or rescue organizations in either the United States or United Kingdom; respondents who indicated that they did not meet these inclusion criteria were excluded from our analysis.

Participants who comprised this convenience sample were recruited via emails sent directly to shelters, pounds, and rescue organizations and via the social-networking sites Facebook and Twitter. Shelter email addresses were acquired via extensive Internet searches for shelters throughout the United States and United Kingdom. Efforts were made to send emails to shelter staff who worked directly with dogs, but when this was not possible, emails were sent to shelters' general inquiry email addresses (e.g., gro.emanretlehs@ofni). Email recipients were encouraged to share the survey with other shelter staff.

The survey could be completed multiple times using a single IP address so that shelter staff and volunteers could choose to complete the survey while at work and could do so using the same computer. Four hundred eighty-nine individuals started the survey, and 470 of those individuals completed it, giving a completion rate of 96%. Data came from 402 unique IP addresses. The U.S. sample included individuals from 43 states, and the UK sample included individuals from 36 postal code areas.

Measures and Procedures

Participants were required to provide a response to every question they were asked in the survey. They answered questions about themselves, their work with dogs, characteristics of their shelters, and whether their shelters were subject to laws that regulate whether certain breeds can be adopted. Participants were shown the same set of 20 dog pictures twice (including 11 bull breeds or bull breed mixes, 2 each being highly probable pit bull terrier examples from the United Kingdom and United States, respectively). Twelve of the dogs pictured resided in the United States, and 8 of the dogs resided in the United Kingdom. Every participant saw the same 20 dog pictures, but the order in which the 20 pictures were presented was randomized to prevent order effects from influencing responses. During the initial presentation of these pictures, participants were asked to identify the breed or breed mix of each dog pictured and to explain why they concluded each dog was that particular breed or breed mix. The pictures of each dog are presented in Figure 1 .

The open-ended questions that asked participants to identify the breed or mix of breeds of each dog pictured were coded by categorizing the first breed a participant listed as the dog's primary breed or breed type. For example, if a participant labeled a dog a Labrador/German shepherd mix, the primary breed was considered to be a Labrador. Once all responses had been coded, we were able to determine the primary breed or breed type that UK and U.S. participants most frequently assigned to each dog. If the participant listed multiple breeds or included the word "mix" or "cross-breed" in the description of the dog's breed, the dog was classified as a mix rather than a purebred. The exception to this was when participants listed two breeds and indicated a dog was one breed or the other (e.g., "Boston terrier or French bulldog"). In such cases, the first breed listed was considered the primary breed, and we did not consider the response as indicative of the dog being a mix. Responses regarding why participants thought a dog was a particular breed or breed mix were analyzed qualitatively for common themes.

After the open-ended questions had been answered for all 20 pictures, the pictures were presented a second time in random order, and participants were asked to select "yes" or "no" regarding whether they would use the term "pit bull" to describe all or part of each dog's breed identity. In addition, they were told to assume each dog pictured did not have a caregiver searching for him/her and did not have any major medical or behavioral problems, and they were asked to select the single option that most accurately represented what their shelter would most likely do with the dog. Choices included the following: The shelter would make the dog available for adoption, transfer the dog to another organization, or euthanize the dog. Each participant could only select one option for each dog. After completing the sections of the survey that included the pictures, participants were given a list of bull breed names (e.g., American bulldog) and Mastiff breed names (e.g., Dogo Argentino) and were asked whether they considered any of the 10 names to be alternative names for pit pull or pit bull-type dogs. For each breed listed, participants could select from the following options: "Yes," "No," or "I do not know what that [breed] is."

At the end of the survey, participants whose shelters were subject to laws regulating what breeds could be adopted answered "yes" or "no" to the following question: "If the dog in question is a cross or mix, would your shelter ever classify it as a breed that is not banned? For example, if Rottweilers were illegal where your shelter is located, might your shelter label a dog that may be a Labrador and Rottweiler cross (mix) as a Labrador cross (mix)?"

Ethical Considerations

The study was approved by the University of Liverpool Veterinary Ethics Committee and the Canisius College Institutional Review Board. Participants formally consented to participation on the first page of the survey.

Statistical Analyses

Differences in responses between U.S. and UK participants, as well as between U.S. participants in areas with and without BSL, were assessed using chi-square tests. When expected cell counts were less than 5, Fisher's exact tests were used in lieu of chi-square tests.

RESULTS

There was a great deal of variation in the types of shelters represented in this sample. Thirty-one percent ( n = 147) of respondents reported that their shelters receive public funding, and 86.8% ( n = 408) indicated their shelters receive private funding. Shelter admission policies varied, with 50.4% ( n = 237) accepting every stray and 45.7% ( n = 215) accepting every caregiver-relinquished dog. Participants indicated the following reasons for not accepting every stray or caregiver-relinquished dog: There is limited space for housing dogs (59.8%, n = 281); dogs must meet certain medical requirements (12.6%, n = 59); and dogs must meet certain behavioral requirements (33.6%, n = 158).

All UK participants were under the jurisdiction of the Dangerous Dog Act, although 17 (31.5%) of the UK participants' responses to a question regarding BSL suggested they were unaware that their shelter was subject to BSL. Forty-four (11%) of the U.S. participants reported working in locales that were subject to BSL, but given the confusion represented by UK participants' responses to the BSL question, it is possible that additional U.S. participants worked in locales with BSL but were unaware of it. Three U.S. participants indicated they did not know whether their shelter was subject to BSL. For the purpose of analysis, all UK participants and 44 U.S. participants were classified as being subject to BSL because we were unable to check the accuracy of U.S. participants' responses due to the numerous variants of BSL that are scattered across U.S. cities, towns, and counties.

Eighty-three percent ( n = 390) of participants stated their shelters euthanize dogs for behavioral reasons, while 84.9% ( n = 399) reported euthanizing dogs for medical reasons. There was no difference between the United Kingdom and United States in the likelihood of euthanizing dogs for behavioral reasons, χ ²(1) = 1.17, p = .28, but dogs were more likely to be euthanized for medical reasons in the United Kingdom than in the United States (United Kingdom, 94.4%, n = 51; United States, 83.7%, n = 348), χ ²(1) = 4.34, p = .04. Twenty-three percent ( n = 110) of respondents reported their shelters euthanize dogs as a method of shelter population management, and U.S. participants were more likely than UK participants to state that dogs were euthanized for this reason (United Kingdom, 1.9%, n = 1; United States, 26.2%, n = 109), χ ²(1) = 15.81, p < .001. Five percent ( n = 24) of respondents stated their shelters euthanize dogs of specific breeds, and UK participants were more likely than U.S. participants to report that their shelters did so (United Kingdom, 29.6%, n = 16; United States, 1.9%, n = 8), χ ²(1) = 75.72, p < .001. Nine percent ( n = 44) of participants stated that their shelters never euthanize dogs, and this did not differ by country, χ ²(1) = 0.28, p = .60.

Primary Breed Identification

Table 1 includes the percentage of UK and U.S. participants who identified each dog's primary breed as the breed that was most commonly listed by participants and also shows the percentage of UK and U.S. participants who identified each dog pictured as a mix. The term "American shelter dog" was rarely used to identify a dog's breed; the dog most commonly referenced as an American shelter dog (Dog 13) was called that by 7 of the 416 American participants. For 10 of the 20 dogs pictured, the primary breed most commonly assigned by UK and U.S. participants was the same. Five of these 10 were non-bull breed dogs (Akita, Boxer, Labrador, Mastiff, and Rottweiler).

TABLE 1

Picture Number

Primary Breed/Breed Type (United Kingdom)

Primary Breed/Breed Type (United States)

% of Participants Who Listed Breed as Primary

% of Participants Who Listed Dog as Mixed Breed

United Kingdom

United States

United Kingdom

United States

8

English Bulldog a

English Bulldog

59

76

2

5

15

Pit Bull b

Pit Bull

43

74

85

84

Classification of Dogs as Pit Bulls

As shown in Table 2 , 7 of the 20 dogs were identified as pit bulls or pit bull mixes by the majority (>50%) of U.S. participants (Dogs 5, 9, 11, 15, 17, 18, and 20), whereas only 1 of the dogs was identified as a pit bull or pit-bull mix by the majority of UK participants (Dog 15). Interestingly, this dog was also a high scorer for pit bull in the United States, as was the next dog most commonly identified as a pit bull in the United Kingdom (Dog 9), indicating a tendency for U.S. shelter staff to agree that dogs who UK shelter staff deem to be pit bulls are indeed pit bulls. Chi-square analyses and, when expected cell counts were less than 5, Fisher's exact tests indicated that U.S. participants were significantly more likely than UK participants to consider 12 of the 20 dogs pictured to be pit bulls ( Table 2 ).

TABLE 2

Picture

United Kingdom

United States

When asked whether 10 bull breed and Mastiff breed names were alternative names for pit bull or pit bull-type dogs, a greater percentage of U.S. participants than UK participants responded in the affirmative for each breed listed (e.g., 26.7% of U.S. participants vs. 9.3% of UK participants equated the American bulldog to a pit bull), and these findings are reported in Table 3 . According to chi-square analyses, U.S. participants were significantly more likely than UK participants to consider the following breeds to be pit bulls: American bulldog, American Staffordshire terrier, English bull terrier, miniature bull terrier, Presa Canario, and Staffordshire bull terrier ( p < .01 for all).

TABLE 3

Breed

Pit Bull in United Kingdom and United States

Unfamiliar in United Kingdom and United States

When responses from BSL and non-BSL sites within the United States were examined separately, the percentage of participants without BSL who considered a dog to be a pit bull was greater than those with BSL for 15 of the 20 pictures, but this was only significant for 2 of those 15 pictures: Dog 9, χ ²(1) = 6.43, p = .01, and Dog 18, χ ²(1) = 5.14, p = .02. For 1 of the 20 pictures (Dog 11), an identical percentage of people from BSL and non-BSL sites considered the dog to be a pit bull. For the 4 remaining pictures, a higher percentage of BSL participants than non-BSL participants considered each dog to be a pit bull, but this difference was only significant for one dog: Dog 8, χ ²(1) = 9.90, p = .002. These findings are shown in Table 4 .

Likelihood of Euthanasia

No participants indicated that the following dogs would be euthanized if they entered their shelters: Akita (Dog 1), French bulldog/Boston terrier (Dog 3), Boxer (Dog 4), Labrador (Dog 12), mix/shepherd (Dog 13), and Rottweiler (Dog 19). At least one participant reported that his/her shelter would euthanize each of the 14 remaining dogs. Fisher's exact tests indicated that the likelihood of being euthanized in a UK versus U.S. shelter differed only for the 2 dogs who the UK participants were most likely to consider pit bulls (Dog 9, p = .04; Dog 15, p = .01). In the United Kingdom, 7.4% of participants reported Dog 9 would be euthanized in their shelters, and 11.1% of participants reported Dog 15 would be. In the United States, 1.9% of participants reported Dog 9 would be euthanized, and 3.1% indicated Dog 15 would be. Within the United States, Fisher's exact tests showed that participants who reported working in areas with BSL were more likely to report that 8 of the 20 dogs would be euthanized than were those who did not report working in areas with BSL ( p < .01 for Dogs 2, 5, 9, 11, 14, 15, 17, and 20).

Criteria Used to Determine Breed

A number of factors entered into participants' decision-making processes when determining which breed(s) should be assigned to each dog pictured. The majority of responses were dominated by describing a dog's physical features. Physical traits commonly referenced included the dog's size, estimated weight, stance, body conformation, musculature, legs, paws, chest, and tail.

The coat length, texture, and color were also mentioned in many responses. For instance, one participant reported that the "sleeky shiny short coat" was an identifying feature of one of the dogs most commonly identified as a Staffordshire bull terrier or pit bull mix (Dog 9). Another participant commented "the two brown marks above the eyes" were important features used for identifying the dog who was most commonly considered a Rottweiler mix (Dog 19), and another participant concluded that the dog most commonly thought to be a Labrador (Dog 12) was a mix based on the dog's coloring: "white markings says mix."

The head, skull shape, and face were mentioned frequently, as were the ears. Responses included descriptions such as "rose ears" and "the set of ears suggest a cross." In addition, the eyes, nose, muzzle, mouth, and jowls factored into decisions. Cosmetic alterations that participants perceived to have been made to some of the dogs pictured, such as cropped ears and docked tails, influenced breed assignment. When tails and ears were difficult to see in the pictures, many commented that it became hard to accurately identify a dog's breed.

Dog 17 was holding his ears flat against his head, and his tail was not visible in the picture. Although many commented the ear set or ear placement helped them identify this dog's breed, several commented that the ears were difficult to see and that the tail could not be seen at all. One respondent noted the following about Dog 17: "Can't see the tail, which I would want to see, and the ears are not in a relaxed position so it is difficult to assign [this dog] to a particular breed."

Not all participants referenced physical features in their responses. Some participants explicitly stated that their decisions were based on previous experience with dogs. One participant noted, "Looks like several pits that have been in our rescue." Other participants referred to the general look of the dog and mentioned the breed standard he or she was thought to resemble most closely. For example, a number of participants reported that Dog 4 met the characteristics of the breed standard for the Boxer. Four participants described the dog most commonly referred to as a Labrador (Dog 12) as having "the goofy look," and one participant described one of the dogs commonly identified as a pit bull (Dog 15) as being "kind of generic looking."

Participants in BSL locales did not explicitly reference their law's criteria regarding what constitutes a pit bull, but some traits mentioned by respondents did appear more frequently among the bull breeds. The phrase "barrel chest" was associated with a number of the bull breeds, including dogs identified primarily as English bulldog, bull terrier, pit bull, and Staffordshire bull terrier. Comments on the "medium" size and the "strong muscle mass" of the dog also appeared often for bull breeds.

"Extreme" and "wide" jowls of the dog were mentioned for bull breeds in particular. Some participants stated that "the pit smile" or "the Staffie smile" influenced their decision regarding breed assignment. In many cases, a dog's brindle color was used to justify identifying a dog as a pit bull. One participant mentioned, "The brindle coloring looks pit." Another wrote, "The brindle color pattern seems pretty common in pit bulls although we do see it in a lot of other breeds."

Among participants who reported working in shelters subject to BSL, 40.7% ( n = 33) stated they would intentionally label a dog thought to be a mix of a banned breed as a breed that is not banned. The likelihood of doing so did not differ between the United Kingdom and United States, χ ²(1) = 1.95, p = .16. A U.S. participant's comment reflected the tendency to avoid identifying a dog as a pit bull or Staffordshire bull terrier: "I would put Lab mix because they get adopted easier, but he looks like he could be Staffie (Staffordshire bull terrier)."

Distinguishing and labeling pit bulls was particularly problematic for UK participants. One participant noted how others might label one of the dogs pictured as a pit bull but expressed reluctance to classify the dog as such: "I think this dog could be considered 'of pit bull type' but I don't see that it would necessarily have any illegal breeds in it. I believe some would say the colouring, particularly of the nose, gives it away as a pit bull but I disagree, as many other breeds could have this." Another participant indicated that a dog's size was sometimes a key difference between Staffordshire bull terriers and pit bull types: "If the dog is too large to be considered a Staffie (Staffordshire bull terrier), it is probably of [pit bull] type though I think these dogs could well be bred from taller and taller Staffies and other legal breeds."

Some participants in the United Kingdom reported asking veterinarians and police for help determining if a dog was a pit bull, and one stated the following: "We would ask the police to assess, and if identified as a pit bull, would euthanize. However, if the police issued a certificate to say not [a pit bull], we would rehome [the dog]." In contrast, one U.S. participant reported using the label pit bull even when a dog was not a pit bull to ensure adopters were aware they may face extra challenges due to adopting a dog who some individuals and businesses may consider a restricted breed: "I feel like it is important to note that while I may see a difference in an American bulldog (or Dogo, etc.), the public (landlords, insurance companies, etc.) lump them all in one category. Therefore, almost for the safety of the dog, sometimes they are labeled [as] American bulldog/pit bull cross so that people adopting will be aware of the fact that landlord, insurance, etc. may discriminate."

DISCUSSION

Our findings indicate a lack of consensus, both between and within the United States and United Kingdom, about what constitutes a pit bull terrier. This conclusion echoes the general complexity and disagreement about dog breed identification found in previously published literature ( Voith et al., 2009, 2013), but our study is the first truly cross-country comparison focused primarily on bull breeds. Ironically, there are marked differences between countries regarding what a pit bull is even though the United Kingdom's Dangerous Dog Act defines pit bull-type dogs according to the American Dog Breeders Association standard of conformation as published in Volume 1, Issue 3 of the Pit Bull Gazette in 1977 ( DEFRA, 2009).

The findings from this study suggest that shelter, pound, and rescue employees and volunteers in the United Kingdom have a narrower definition of what a pit bull-type dog is. This may be due to differences in legislation between the two countries. Although some U.S. municipalities do have BSL, most do not. Furthermore, BSL in the United States varies greatly from place to place in terms of what constitutes a restricted breed and the extent of the restrictions. Due to standardization of BSL and criteria for pit bull type within the United Kingdom, people who identify breeds may have a more coherent understanding of how to identify pit bull types and are therefore more likely to agree on the breeds. Alternatively, UK shelter workers may expect to see a pit bull more rarely and so may be less inclined to indicate that a dog is a pit bull type unless it is exceptionally clear to them.

In our study, some of the largest differences between UK and U.S. participants' responses to whether each photographed dog was a pit bull were for the two dogs who more than 90% of UK participants considered to be Staffordshire bull terriers (Dogs 11 and 17). A high percentage of UK participants did not consider those two dogs to be pit bulls, whereas a high percentage of U.S. participants did consider them to be pit bulls. This is likely because in the United Kingdom, the Staffordshire bull terrier breed is perceived as separate from the pit bull and is not banned under the Dangerous Dog Act.

Although a higher percentage of American participants residing in municipalities without BSL compared with those living in municipalities with BSL judged 15 of the 20 dogs to be pit bulls, American participants with and without BSL only significantly differed in what they considered a pit bull for 3 of the 20 dogs pictured. The large degree of variation across BSL laws in the United States may explain why the differences in responses by participants in places with and without BSL followed no real pattern and why participants in places with BSL were no more unified in their thoughts regarding what dogs were pit bulls than were participants in places without BSL.

Some locales with BSL entirely ban pit bulls, yet others do not allow individuals to acquire new pit bulls but grandfather into the law pit bulls who already had caregivers when BSL took effect, and still others allow people to keep pit bulls if they meet certain requirements (e.g., acquire liability insurance, spay/neuter and/or muzzle the dogs in public). In addition, because many American homeowner insurance companies will not insure dwellings that contain dogs of particular breeds ( Cunningham, 2004), including pit bull types, the decision by shelter staff to label a dog as a pit bull has implications even in places without BSL and may result in inconsistent use of the term pit bull.

It is estimated that 60% of dogs who enter the rescue system are euthanized in both the United Kingdom ( Diesel, Smith, & Pfeiffer, 2007) and the United States ( Brown, Davidson, & Zuefle, 2013). American participants were more likely to report that their shelters euthanized dogs to manage the shelter population, and UK participants were more likely to report euthanizing dogs because they were of specific breeds and for medical reasons. The likelihood of a dog being euthanized in a U.S. or UK shelter only differed for the two dogs who the highest percentage of UK participants classified as pit bulls. Even so, only a small number of UK participants indicated that these two dogs would be euthanized if they entered their shelters, and that percentage was nowhere near the percentage of UK participants who considered the dogs to be pit bulls.

This is surprising because one might expect that most UK participants who identified a dog as a pit bull would state that the fate of the dog would be euthanasia because the law does not currently allow for transfer of guardianship of dogs designated as pit bulls ( DEFRA, 2009). This finding suggests that UK shelters may still be inclined to adopt out pit bulls, perhaps by labeling them as something other than pit bull, and a number of responses indicated a willingness to do just that. It also suggests, along with the finding that some UK participants reported that they were not subject to any form of BSL, that there may be some misunderstanding among shelter workers in the United Kingdom regarding the Dangerous Dog Act and its rules regarding what dogs can be adopted.

Although there has been a push in recent years within the United States to refer to dogs of unknown parentage as "American shelter dogs" ( Marder & Voith, 2010; Simpson, Simpson, & VanKavage, 2012), this was rarely seen. Participants tended to identify dogs as belonging to specific breeds or breed combinations, and they used a vast array of features to determine a dog's breed. Perhaps not surprisingly given the nature of breed standards, most participants referenced a dog's physical features when justifying breed assignment. Others referenced breed standards or concluded a dog was a particular breed because dogs similar to the one pictured had gone through their shelter and had been labeled that breed by other staff members.

Participants working in shelters that were subject to BSL did not reference explicitly their law's criteria regarding what constitutes a pit bull. Interestingly, some participants felt they had enough information from the pictures provided to conclude each dog's breed or breed mix, yet others saw the very same pictures and commented that some pictures were lacking information that was crucial for deciding breed. That some individuals based decisions on supposed cosmetic changes, such as docked tails and cropped ears, was surprising because such changes are not genetic. The amount of time participants had spent working in a shelter environment might have played a role in how shelter workers made breed assignments, but unfortunately, data regarding number of years spent working in a shelter were not collected.

Our findings have implications for areas where dogs deemed pit bull type are often seized or euthanized due to BSL. Given the discrepancies both within and between countries regarding how shelter workers assign breeds to dogs, particularly among the bull breeds, it is important to recognize the impact that labeling a dog a pit bull may have. Given the speed at which news reports travel, the use of the pit bull label in one locale may impact perceptions of pit bulls in other places, even globally ( Cohen & Richardson, 2002).

The results of this study do support the hypothesis that there is a lack of consensus across the United States and between the United States and United Kingdom about what a pit bull-type dog is, but the study did have some limitations. It is possible that labeling the dogs in the first round of photo presentations affected participants' judgment regarding the "pit bull" question in the second round. Participants, however, often answered the "pit bull" question in the affirmative even when they made no mention of pit bull in the open-ended "what breed" question.

Because participants had to identify dog breeds based on a single picture, they had very limited information about each dog. Participants commented that it was difficult to judge the size of some of the dogs pictured and to clearly see some of the dogs' physical features (e.g., tail, ears). One survey participant noted, however, that the pictures in the survey were "similar to those sent through by dog wardens" to other shelters and rescue organizations and were not unlike many of the pictures of dogs available for adoption that are circulated via social networking and pet adoption websites.

Our data were limited to shelter workers who had access to the Internet and were made aware of the survey as a result of social networking, our recruitment emails, or word of mouth. The variety of U.S. states, UK postal codes, and shelter types represented in the data suggests that our sample was quite diverse in terms of the shelters represented. It is possible, however, that the opinions of shelter staff and volunteers who do not have regular access to the Internet or who are not computer-literate are underrepresented in this survey. Furthermore, the results may not be generalizable to other professions or contexts where breed identity must also be determined.

This study was a preliminary exploration of the perception of what constitutes a pit bull, and it maximized response and completion rates by using photographs to minimize the amount of time it took participants to complete the survey. Future studies could be bolstered by including videos. Behavioral traits are more likely than a dog's breed to determine whether a dog is suitable for adoption and also the type of home in which a dog should be placed ( Bollen & Horowitz, 2008), yet countless individuals and organizations are using physical appearance to decide dogs' fates, often on the basis of a single picture and, in some cases, on the breed name listed beside that picture. One participant commented that this study made her "think about the quality of the photos we often get through [the Internet] and the life or death decisions we often make [based] on them."

CONCLUSION

In summary, neither participants within a country nor participants between the United States and United Kingdom strongly agreed on whether a dog was a pit bull, especially if he or she had bull breed features. Furthermore, what was perceived as a Staffordshire bull terrier in the United Kingdom tended to be classified as a pit bull in the United States. Although what is deemed a pit bull is clearly of greater importance within a specific country or within a locale subject to BSL than it is between countries, it does bring into question the validity of determining breed identity based on appearance. Finally, we did not investigate and do not wish to enter into discussion regarding the morality and efficacy of public health legislation based on breed appearance that is intended to prevent dog bites; however, this study does highlight some issues regarding the practical utility of BSL.

ACKNOWLEDGMENTS

We are extremely grateful for the shelters that let us photograph their dogs or use their pictures. We are also grateful to the participants for taking the time to complete the survey.

FUNDING

Carri Westgarth is supported by a UK Medical Research Council Population Health Scientist Fellowship.

REFERENCES

Stavisky J., Brennan M. L., Downes M., Dean R. Demographics and economic burden of un-owned cats and dogs in the UK: Results of a 2010 census. [[PMC free article] [PubMed] Google Scholar]

Articles from Journal of Applied Animal Welfare Science are provided here courtesy of Taylor & Francis

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Is That Dog a Pit Bull? A Cross-Country Comparison of Perceptions of Shelter Workers Regarding Breed Identification

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Bull breeds are commonly kept as companion animals, but the pit bull terrier is restricted by breed-specific legislation (BSL) in parts of the United States and throughout the United Kingdom. Shelter workers must decide which breed(s) a dog is. This decision ...

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President Joe Biden approved a limited TikTok ban Thursday when he signed the 4,126-page spending bill into law. The ban prohibits the use of TikTok by the federal government's nearly 4 million employees on devices owned by its agencies, with limited exceptions for law enforcement, national security and security research purposes.

The ban comes after a wave of actions against the viral video app in recent weeks amid mounting security concerns raised by media reports, China hawks and politicians. Given the increasing scrutiny of TikTok, which is owned by the Chinese company Bytedance, it could be just the beginning of challenges to come for the app.

The renewed pressure on the app under the Biden administration comes two years after a proposed ban by then-President Donald Trump was stopped in court.

Since 2020, a bubbling movement led largely by conservatives has maintained a minor interest in a TikTok ban.

TikTok poured fuel on the criticism in December when it confirmed to Forbes that its employees improperly tracked the locations of three of the magazine's journalists, using methods that Forbes said amounted to spying. One ByteDance executive resigned and another was fired, Forbes reported Dec. 22.

Insiders said the incident contributed to a growing skepticism toward the app, encouraging new bans in U.S. states and at universities.

Megan Stifel, a former Department of Justice national security official, said the incident will make it more difficult for TikTok to show that it manages data responsibly. TikTok and the Biden administration, including the Justice Department, have been locked in negotiations over a proposed security agreement that would put the company on more stable footing.

"Certainly, it gives additional leverage to DOJ to say, 'Look, the record is not positive,'" said Stifel, now the chief strategy officer for the Institute for Security and Technology, a think tank.

TikTok on Friday denounced the new ban on its app for federal agencies.

"We're disappointed that Congress has moved to ban TikTok on government devices - a political gesture that will do nothing to advance national security interests - rather than encouraging the Administration to conclude its national security review," the company said in a statement.

It added that the proposed security agreement with the Biden administration would address the security concerns of lawmakers and regulators.

"These plans have been developed under the oversight of our country's top national security agencies - plans that we are well underway in implementing - to further secure our platform in the United States, and we will continue to brief lawmakers on them," TikTok said.

Under pressure from lawmakers and regulators, the company in early December shuffled its staff to create a new U.S.-based team for trust and safety issues. The purpose was to "build further trust and confidence in the protection of US user data and compliance," it said in a blog post.

A Justice Department spokesperson declined to comment.

TikTok has been the target of numerous government and institutional bans in the past month. The House on Monday banned it from any work mobile phones. At the state levels, Texas Gov. Greg Abbott, a Republican, banned it on state phones and computers, as did about a dozen other Republican-led states including Alabama, Georgia and Virginia.

And some of the state bans apply not just to state government employees, but also to students and anyone else using campus Wi-Fi at state schools such as the University of Oklahoma and Auburn University in Alabama - part of TikTok's core user base in the U.S.

The wave of bans could be just the beginning of the challenges that TikTok could be looking at in the next year, according to national security analysts and tech policy advocates. An actual U.S. ban of the app for all citizens may still be unlikely and in the end unworkable, but the app's critics are promising a fight nonetheless.

"I have serious concerns with any app that poses a risk to Americans' personal data and information and has deep ties to China," Sen. Steve Daines, R-Mont., said in a statement to NBC News. He's one of several Republican senators who have been pressuring TikTok for more information.

"We need clear answers on TikTok's data sharing policies and must ensure the platform is being held accountable for its practices," he said.

In early December, top House Republicans, including some who will likely lead House committees next year, wrote to TikTok CEO Shou Zi Chew demanding a meeting, citing an earlier Forbes investigation into how the app handles reports of child sexual exploitation.

It's not clear if the meeting has taken place. A spokesperson for the group of Republicans did not immediately respond to a request for comment, and TikTok did not respond to a question about the meeting demand.

Congressional hearings would serve several purposes, said Joel Thayer, the president of the Digital Progress Institute, an advocacy group on tech and telecommunications issues. He said hearings would raise public awareness, get witnesses on the record and create the basis for potential future legislation.

"If I were gaming this out, I would want as much on the record as possible to justify a harsh action like banning a company from our markets," he said. He has written in support of restrictions on TikTok.

But, he added, the end result is far from clear, with less appetite in the Senate for anything approaching a ban on overseas software. He said he expects to see legislation from Republicans requiring an agency such as the Federal Trade Commission or the Federal Communications Commission to step up its privacy reviews of TikTok.

"How far are they willing to go, outside of banning it from government devices?" he said. "President Biden is more inclined to want to keep TikTok in the market."

Biden has not spoken in detail about what should happen to TikTok, but he has repeatedly courted the app's stars and the millions of people who follow them. In October, he spent more than an hour at the White House with eight TikTok influencers for a voter turnout effort ahead of the midterm elections, The Washington Post reported.

On the House side, there's no shortage of incoming committee chairs who want to take on TikTok. House Republican leader Kevin McCarthy of California has said he plans to create a select committee on China led by a former Marine counterintelligence officer, Republican Rep. Mike Gallagher of Wisconsin.

"We're not ready to release details around hearings, but the threat posed by TikTok is certainly an issue the committee will look into," Gallagher's office said in a statement to NBC News.

Gallagher has sponsored a bill to ban TikTok from operating in the U.S., and in a statement this month about the surveillance of Forbes journalists, he called TikTok "CCP-controlled spyware," referring to the ruling Chinese Communist Party.

The U.S. military banned TikTok on its devices three years ago. Wells Fargo did the same in 2020 for its devices.

Stifel, the former Justice Department official, said the types of bans that have been spreading to government employees may not be as effective as TikTok's critics hope. TikTok is available via a web browser, for example.

"The ability to really wall it off is, at the end of the day, probably quite remote," she said. "We can ban it on government devices. Companies can decide to ban it. But there are always workarounds."

It's possible that some of the anti-TikTok energy in Congress could be channeled into broader legislation. There's been a yearslong effort to write a comprehensive, nationwide data security law that would cover Americans' data held not only by overseas companies, but also by U.S. tech giants.

"We don't have a credible public approach to data privacy in America today," said Vilas Dhar, the president of the Patrick J. McGovern Foundation, a grant-making organization that focuses on the social impact of technology.

"That means the American people are interacting every day with possible threats to their privacy, and we don't have a regulatory system to respond to that," he said.

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Biden signs TikTok ban for government devices amid security concerns

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President Joe Biden approved a limited TikTok ban Thursday when he signed the 4,126-page spending bill into law. The ban prohibits the use of TikTok by the federal government's nearly 4 million employees on devices owned by its agencies, with limited exceptions for law enforcement, national security and security research purposes.

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https://doi.org/10.1016%2FS2352-4642%2819%2930092-6

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Why I Think All Schools Should Abolish Homework

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It should be the exception, not the rule

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Anthem of Hope | Christian Mental Health, Suicide Prevention, Mental Health, Depression

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Since 1974, the United States has observed National Suicide Prevention Month in the month of September. Not only does this bring much needed awareness for Christians who are suffering from mental health issues, but it also provides an opportunity for the church and/or faith-based organizations to talk about an important topic that affects people more than we often realize or like to admit.

"Depression was once a topic reserved for 'other people,'" Former LifeWay President and CEO Thom S. Rainer wrote in a Facts & Trends issue on mental health. He goes on to say, "The truth is, pastors are as likely as other Americans to experience mental illness."

Here are 13 statistics from several LifeWay Research studies that may help you better understand the issue of mental health and the people in your church:

Christian Mental Health Statistics:

23 percent of pastors acknowledge they have personally struggled with a mental illness.

49 percent of pastors say they rarely or never speak to their congregation about mental illness.

27 percent of churches have a plan to assist families affected by mental illness.

65 percent of churchgoing family members of those with mental illness want their church to talk openly about mental illness.

59 percent of those actually suffering from mental illness say the same.

53 percent of churchgoers with mental illness say the church has been supportive.

76 percent of churchgoers say suicide is a problem that needs to be addressed in their community.

32 percent of churchgoers say a close acquaintance or family member has died by suicide.

80 percent of pastors say their church is equipped to assist someone who is threatening to take his or her own life.

92 percent of pastors say their church is equipped to care for the family that experiences the suicide of a loved one.

4 percent of churchgoers who lost a loved one to suicide say church leaders were aware of their loved one's struggles.

68 percent of Americans feel they would be welcome in church if they were mentally ill.

35 percent of Americans say mental illness could be overcome with Bible study and prayer alone.

Christians still have a long way to go in regards to the conversation surrounding mental health, but that doesn't mean we can't do SOMETHING about it today. By using our voice, platforms and influence, we can be the change needed to elevate the much needed conversation surrounding mental health within the local church, faith-based organizations, and beyond.

Over 800,000 people a year lose their lives to suicide, and we believe it's about time Christians start doing something about it.

-Jarrid Wilson, Founder

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Christian Mental Health Statistics - Anthem of Hope | Christian Mental Health, Suicide Prevention, Mental Health, Depression

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Since 1974, the United States has observed National Suicide Prevention Month in the month of September. Not only does this bring much needed awareness for Christians who are suffering from mental health issues, but it also provides an opportunity for the church and/or faith-based organizations to

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ody positivity began as a powerful antidote to the media's obsession with skeletal models and beachball-breasted glamour girls. Empowering women of non-Barbie proportions to feel good about themselves, the movement has attacked impossible beauty ideals that confront us in advertising, branding and beyond, criticising everything from the thigh gap trend to green juice cleanses.

Its success has led to a series of positive changes, including the decision to ban the use of rail-thin models in several European countries. In the UK, body positivity has fuelled a backlash against the clean eating movement, with health experts linking questionable nutritional advice to a rise in eating disorders such as orthorexia. As glossy-haired treadmill unicorns continue to pout their way through Instagram with chia-seed recipes and colonoscopy recommendations, women are rejecting their raw food cleanses in favour of a balanced diet that includes the occasional doughnut.

But as we move away from the skinny goals of the mid-2000s and embrace different shapes and sizes, one group of campaigners has taken things a step too far. Fronted by plus-sized models and social media influencers, the fat acceptance movement aims to normalise obesity, letting everyone know that it's fine to be fat. With terms such as "straight size" and "fat pride" proliferating, some influential figures are now even likening the valid concerns of health officials to hate crimes.

The comedian Sofie Hagen has accused Cancer Research of bullying fat people. Photograph: Karla Gowlett

The comedian Sofie Hagen recently accused Cancer Research of bullying fat people, after the charity launched a campaign to raise awareness about the link between cancer and obesity. Through a series of expletive-laden tweets, she criticised the organisation for its damaging messages, claiming that fat didn't equal unhealthy.

While nobody should ever be bullied for their weight or food choices, it's important to make a distinction between health awareness and cruelty. Cancer Research wasn't criticising a specific person for being overweight, they were pointing out that obesity is now the second leading cause of lifestyle-related cancers, a fact only 15% of the British public are aware of.

Medications, mental health, social deprivation, self-esteem and genetics all play a role in our ability to control our weight, and judgment is never a constructive approach. But suggesting that being a size 30 is just as healthy as being a size 12 isn't a body-positive message either - it's an irresponsible form of denial.

According to the NHS, we're in the grip of an obesity epidemic, which has led to increased pressure on the struggling health service. The latest figures reveal that weight-related hospital admissions have risen by 18% in the past year, with more than a quarter (26%) of British adults now classified as obese. Another recent study, which measured the metabolic health of more than 17,000 respondents, showed that overweight people who exercise regularly and consider themselves "fat but fit" still had a 28% increased risk of heart disease, compared to their slimmer counterparts. As well as being linked to diabetes, obesity can also be responsible for osteoarthritis, gout, breathing problems, high blood pressure and other conditions. While being thin won't automatically grant you a clean bill of health or a long, smug life of squeaky clean arteries, there's no denying that health risks are higher for obese people.

Public health campaigns are not designed to flatter people's egos, but to raise awareness about potential health dangers. Since the ban on indoor smoking in 2007, tobacco enthusiasts have been turfed out through a side door to puff on their cancer sticks in the rain. Smoking is an addiction that many struggle to control, but we don't celebrate it with viral social media campaigns about smoking pride. Although we acknowledge that some smokers can run 10 miles or live into their 90s, we recognise that the overall risks of tobacco inhalation are high, and vastly increase the odds of a premature death. So what makes obesity different?

Whether we want to gorge on 3kg of chocolate, drink until we vomit in the bathtub or line our lungs with carcinogenic tar, informed adults are free to make their own choices. But while your own body is your business, actively encouraging unhealthy lifestyle choices and denying health risks in a public space isn't promoting body positivity - it's just giving the green light to different kinds of eating disorders.

Lizzie Cernik is a journalist and features writer, covering relationships, travel and women's issues

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It's not fine to be fat. Celebrating obesity is irresponsible | Lizzie Cernik

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No one should be bullied for their weight or food choices, but 'fat pride' promotes dangerous weight levels, says features writer and journalist Lizzie Cernik

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The Health Systems Achieving Top Marks Do So in Diverse Ways

The three countries with the best overall health system performance scores have strikingly different health care systems. All three provide universal coverage and access, but do so in different ways, suggesting that high performance can be achieved through a variety of payment and organizational approaches.

Experts generally group universal coverage systems into three categories: Beveridge systems, single-payer systems, and multipayer systems. These three systems are represented among our highest performers.

The U.K.'s National Health Service

The Beveridge model takes its name from the creator of Britain's modern welfare state, William Beveridge. In the NHS, initiated by Aneurin Bevan in 1948, health services are paid for through general tax revenue, as opposed to insurance premiums. Furthermore, the government plays a significant role in organizing and operating the delivery of health care. For example, most hospitals are publicly owned, and the specialists who work in them are often government employees. This is not true of all providers. Most general practitioner practices are privately owned. Health care in the U.K. and other Beveridge countries is centrally directed and has more direct management accountability to the government than in other health systems.

Australia's Single-Payer Insurance Program

In Australia, everyone is covered under the public insurance plan, Medicare. Much like the NHS, Australia's Medicare is funded through tax revenue. Medicare is distinguished, though, by lesser public involvement in care delivery. Many Australian hospitals are private, and roughly half the population purchases private health insurance to access care outside the public system. To put into an American context, Australia's Medicare resembles Medicare in the U.S.

Netherland's Competing Private Insurers

Unlike Australia and the U.K., the Dutch health system relies on private insurers to fund health services for its population. Dutch insurers are mainly financed through community-rated premiums and payroll taxes, which are pooled and then distributed to insurers based on the risk profile of their enrollees. All plans include a standard basic benefit package; subsidies are available for people with low incomes; adults are required to enroll in a plan or must pay a fine. Dutch health care providers are predominantly private. This multipayer system-partly inspired by the managed competition model-shares many similarities with the insurance marketplaces created under the Affordable Care Act.

Care Process

Care Process encompasses four subdomains relevant to health care for the general population: preventive care, safe care, coordinated care, and engagement and patient preferences.

The preventive care measures include four survey items related to counseling by health professionals on healthy behaviors, two OECD measures of mammography screening and influenza vaccination, and three OECD measures of rates (age- and sex-standardized) of avoidable hospital admissions for three prevalent chronic conditions: diabetes, asthma, and congestive heart failure.

Safe care includes three survey items: two indicators of safe care based on patient reports of experiencing medical, medication, or laboratory mistakes, and failure to receive effective prescription medication management, as well as one measure indicating whether primary care doctors use electronic clinical decision supports in their practice to improve safety.

Coordinated care uses seven measures to summarize timely sharing of information among primary care clinicians, specialists, emergency departments, and hospitals. It includes three physician-reported measures of effective communication among primary care clinicians and home care and social service providers.

Engagement and patient preferences represents 10 measures that evaluate the degree to which doctors and other health professionals deliver patient-centered care, which includes effective and respectful clinician-patient communication and care planning that reflects the patient's goals and preferences.

Access

Access encompasses two subdomains: affordability and timeliness. The six measures of affordability include patient reports of avoiding medical care or dental care because of cost, having high out-of-pocket expenses, facing insurance shortfalls, or having problems paying medical bills. One measure reflects primary care doctors' views of the difficulty patients face in paying for care.

Timeliness includes nine measures (three of which are reported by primary care clinicians) summarizing how quickly patients can obtain information, make appointments, and obtain urgent care after hours. It also addresses the length of time needed to obtain specialty and elective nonemergency surgery.

Administrative Efficiency

Administrative Efficiency includes seven measures. Four measures evaluate barriers to care experienced by patients, such as limited availability of the regular doctor, medical records, or test results. Three indicators measure patients' and primary care clinicians' reports of time and effort spent dealing with paperwork, as well as disputes related to documentation requirements of insurance plans and government agencies.

Equity

Equity compares performance for higher- and lower-income individuals within each country, using 11 selected survey measures from the Care Process and Access domains. The analysis stratifies the surveyed populations based on reported income (above-average vs. below-average relative to the country's median income) and calculates a percentage-point difference in performance between the two groups. A higher percentage-point difference-that is, a bigger gap-is interpreted as a measure of lower equity among income groups in that country.

Health Care Outcomes

The Health Care Outcomes domain includes nine measures of the health of populations. Taken together, they are intended to reflect outcomes that are attributable to the performance of the countries' health care delivery systems. The measures fall into three categories: population health outcomes (i.e., those that reflect the chronic disease and mortality of populations, regardless of whether they have received health care), mortality amenable to health care (i.e., deaths under age 75 from specific causes that are considered preventable in the presence of timely and effective health care), and disease-specific health outcomes measures (i.e., mortality rates following stroke or heart attack and the duration of survival after a cancer diagnosis).

In the population health outcomes category, two measures compare countries on the mortality of populations defined by age (infant mortality and life expectancy after age 60) and one measure focuses on the proportion of surveyed nonelderly adults who report at least two of five common chronic conditions. For each country, mortality amenable to health care includes both the current rate of deaths amenable to care and the 10-year trend. In the disease-specific health outcomes category, two measures focus on 30-day in-hospital mortality following myocardial infarction and stroke, and two measures examine five-year relative survival for breast cancer and colon cancer.

How This Study Was Conducted

This edition of Mirror, Mirror reflects refinements to methods used in past reports. No report can claim to capture every aspect of the performance of health care systems. Health care systems are complex. Even if a report included thousands of measures, nuances would remain. In that spirit, the report underwent a thorough review by an advisory panel of international, independent performance measurement experts. The framework for Mirror, Mirror 2017 was developed in consultation with the advisory panel from January through December 2016.

Using data available from Commonwealth Fund international surveys of the public and physicians and other sources of standardized data on quality and health care outcomes, we identified 72 measures relevant to health care system performance, organizing them into five performance domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. The criteria for selecting measures and grouping within domains included: that the measure be important, that the data to support the measure be standardized across the countries, and that the results be salient to policymakers and relevant to performance improvement efforts. Most of the measures are based on surveys designed to elicit the public's experience of its health care system.

The indicators were carefully selected from among the best-available measures with comparable data across the included countries. The selected measures cover a wide range of performance domains. Mirror, Mirror is unique in its use of survey measures designed to gather the perspectives of patients and professionals-the people who experience health care directly in each country every day.

Data

The data for this report were derived from several sources. Survey data are drawn from the 2014, 2015, and 2016 Commonwealth Fund International Health Policy Surveys. Since 1998, in collaboration with international partners, the Commonwealth Fund has supported these surveys of the public's and primary care physicians' experiences of their health care systems. Each year, in collaboration with researchers in the 11 countries, a common questionnaire is developed, translated, adapted, and pretested. The 2016 survey was of the general population; the 2014 survey surveyed adults age 65 and older. The 2016 and 2014 surveys examined patients' views of the health care system, quality of care, care coordination, medical errors, patient-physician communication, waiting times, and access problems. The 2015 survey was administered to primary care physicians, and examined their experiences providing care to patients, the use of information technology, and the use of teams to provide care.

The Commonwealth Fund International Health Policy Surveys (2014, 2015, 2016) are nationally representative samples drawn at random from the populations surveyed. The 2014 and 2016 surveys sampling frames were generated using probability-based overlapping landline and mobile phone sampling designs and in some countries, federal registries; the 2015 survey was drawn from government or private company lists of practicing primary care doctors in each country. Appendix 7 presents the number of respondents and response rates for each survey, and further details of the survey methods are described elsewhere.

In addition to the surveys, other standardized comparative data were drawn from the most recent reports of the Organization for Economic Cooperation and Development (OECD), the European Observatory on Health Systems and Policies, and the World Health Organization (WHO). Our study included data from the OECD on screening, immunization, preventable hospital admissions, population health, and disease-specific outcomes. The WHO and European Observatory data were used to measure population health.

Analysis

We used the following approach to calculate performance scores and rankings for comparison:

Measure performance scores: For each measure, we converted each country's result (e.g., the percentage of survey respondents giving a certain response or a mortality rate) to a measure-specific performance score. This score was calculated as the difference between the country result and the 11-country mean, measured in standard deviations. Normalizing the results based on the standard deviation accounts for differences between measures in the range of variation among country-specific results. A positive performance score indicates the country performs above the 11-country average; a negative score indicates the country performs below the 11-country average.

The 11 measures in the equity domain were derived from the 2016 population survey and calculated by stratifying the population samples based on reported income (above-average vs. below-average relative to the country's median income). Performance scores were based on the difference between the two groups, with a wider difference interpreted as a measure of lower equity between the two income strata in each country.

Domain performance scores and ranking: For each country, we calculated the mean of the measure performance scores in that domain. Then we ranked each country from 1 to 11 based on the mean domain performance score, with 1 representing the highest performance score and 11 representing the lowest performance score.

Overall performance scores and ranking: For each country, we calculated the mean of the five domain-specific performance scores. Then, we ranked each country from 1 to 11 based on this summary mean score, again with 1 representing the highest overall performance score and rank 11 representing the lowest overall performance score.

Sensitivity Analyses

We tested the stability of this ranking method by running two tests based on Monte Carlo simulation to observe how changes in the measure set or changes in the results on some measures would affect the overall rankings. For the first test, we removed three measure results from the analysis at random, and then calculated the overall rankings on the remaining 69 measure results, repeating this procedure for 1,000 combinations selected at random. For the second test, we reassigned at random the survey measure results derived from the Commonwealth Fund international surveys across a range of plus or minus 3 percentage points (approximately the 95 percent confidence interval for most measures), recalculating the overall rankings based on the adjusted data, and repeating this procedure 1,000 times.

The sensitivity tests showed that the overall performance scores for each country varied, but that the ranks clustered within three groups (Exhibit 3). Among the simulations, the U.K., Australia, and the Netherlands were nearly always ranked among the three top countries; the U.S., France and Canada were nearly always ranked among the three bottom countries. The other five countries varied order between the 4th and 8th ranks.

Limitations

This report has several limitations. Some are related to the particulars of our analysis and some inherent in any effort to assess overall health system performance.

First, as described above, our sensitivity analyses suggest that the overall country rankings are somewhat sensitive to small changes in the data or indicators included in the analysis.

Second, despite improvements in recent years, the availability of cross-national data on health system performance remains highly variable. The Commonwealth Fund surveys offer unique and detailed data on the experiences of patients and primary care physicians. However, they do not capture important dimensions that might be obtained from medical records or administrative data. Furthermore, patients' and physicians' assessments might be affected by their expectations, which could differ by country and culture. In this report, we augment our survey data with other international sources, and include several important indicators of population health and disease-specific outcomes. However, in general, the report relies predominantly on patient experience measures. Moreover, there is little cross-national data available on mental health services and on long-term care services.

Third, we base our assessment of overall health system performance on five domains-Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes-which we weight equally in calculating each countries' overall performance score. In the past some have argued there are other important elements of system performance that should be considered as well, such as innovativeness or value. After consideration, and based on discussions with our advisory panel, we decided not to add new domains to the report. We believe our current five domains capture a sufficiently broad and comprehensive view of health system performance. In addition, there was a lack of meaningful data to assess these new domains.

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Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care

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The Health Systems Achieving Top Marks Do So in Diverse Ways The three countries with the best overall health system performance scores have strikingly different health care systems. All three provide universal coverage and access, but do so in different ways, suggesting that high performance can be achieved through a variety of payment and organizational approaches.

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Researchers and industry leaders have warned that A.I. could pose an existential risk to humanity. But they’ve been light on the details.

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Biden reverses Trump’s effort to ban TikTok, orders broader review of foreign-owned apps

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The order comes after the Trump administration’s failed attempted to ban TikTok and force its parent company to sell the app.

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https://web.archive.org/web/20180507221704/https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/references

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Johnston, L.D.; O’Malley, P.M.; Bachman, J.G.; and Schulenberg, J.E. Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2013. Bethesda, MD: National Institute on Drug Abuse, 2013. Available at www.monitoringthefuture.org Sussman, S.; Skara, S.; and Ames, S.L. Substance abuse among adolescents. Substance Use & Misuse 43(12–13):1802–1828, 2008.

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As TikTok CEO Shou Zi Chew prepares for his first congressional grilling on Thursday, much of the focus will undoubtedly be on the short-form video app's potential national security risks.

Concerns about TikTok's connections to China have led governments worldwide to ban the app on official devices, and those fears have factored into the increasingly tense US-China relationship. The Biden administration has threatened TikTok with a nationwide ban unless its Chinese owners sell their stakes in the company.

But more than two years after the Trump administration first issued a similar threat to TikTok, security experts say the government's fears, while serious, currently appear to reflect only the potential for TikTok to be used for foreign intelligence, not that it has been. There is still no public evidence the Chinese government has actually spied on people through TikTok.

TikTok doesn't operate in China. But since the Chinese government enjoys significant leverage over businesses under its jurisdiction, the theory goes that ByteDance, and thus indirectly, TikTok, could be forced to cooperate with a broad range of security activities, including possibly the transfer of TikTok data.

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computer science and information technology

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international relations and national security

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Lawmakers say TikTok is a national security threat, but evidence remains unclear | CNN Business

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As TikTok CEO Shou Zi Chew prepares for his first congressional grilling on Thursday, much of the focus will undoubtedly be on the short-form video app's potential national security risks. Concerns about TikTok's connections to China have led governments worldwide to ban the app on official devices, and those fears have factored into the increasingly tense US-China relationship.

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https://penntoday.upenn.edu/news/it-cult-or-new-religious-movement

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https://www.techtarget.com/whatis/feature/TikTok-bans-explained-Everything-you-need-to-know

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Guangdong’s taste for cat meat drives a brutal trade, laid bare in a new documentary from filmmaker and animal rights campaigner Guo Ke. Zhou Yiyan reports.

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UNC Gillings School of Global Public Health

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January 31, 2017

A new report, issued on Jan. 10 by the Global Council on Brain Health (GCBH), recommends seven to eight hours of sleep each day as a way to maintain brain health, even as one ages.

Established in 2015, the GCBH is an independent, international collaborative of scientists, health professionals, scholars and policy experts who work in areas of brain health related to human cognition. The collaborative is convened by AARP, with support from Age UK.

"This report reflects the collaboration of the GCBH with leading scientists and experts around the world on sleep and brain health," said Peggye Dilworth-Anderson, PhD, professor of health policy and management at the UNC Gillings School of Global Public Health and GCBH committee member. "It aims to educate policy makers, caregivers, the general public and others about the importance of sleep, brain health and cognitive functioning."

A recent AARP consumer survey found that 99 percent of adults ages 50 and older believe that sleep is important for their brain health. However, only about four in 10 (43 percent) report getting enough sleep. More than half of adults (54 percent) say they wake up too early in the morning and are unable to go back to sleep.

The new recommendations cover a wide range of sleep-related issues, including common factors that can disrupt sleep, symptoms of potential sleep disorders, and prescription medications and over-the-counter (OTC) sleep aids. A host of helpful expert tips also are included in the report, such as ways to aid falling asleep or staying asleep, when to seek professional help for a possible sleep disorder, and the pros and cons of napping.

Based on the scientific evidence, the GCBH made the following consensus statements:

Sleep is vital to brain health, including cognitive function. Sleeping on average 7-8 hours each day is related to better brain and physical health in older people.

The sleep-wake cycle is influenced by many factors. A regular sleep-wake schedule is related to better sleep and better brain health.

Regular exposure to light and physical activity supports good sleep.

People, at any age, can change their behavior to improve their sleep.

Persistent, excessive daytime sleepiness is not a normal part of aging.

Sleep disorders become more common with age but often can be treated successfully.

People with chronic inadequate sleep are at higher risk for and experience more severe health problems, including dementia, depression, heart disease, obesity and cancer.

The following are some of the tips included in the report:

Get up at the same time every day, seven days a week.

Restrict fluids and food three hours before going to bed to help avoid disrupting your sleep to use the bathroom.

Avoid using OTC medications for sleep, as these can have negative side-effects, including disrupted sleep quality and impaired cognitive functioning.

Dietary supplements such as melatonin may have benefits for some people, but scientific evidence on their effectiveness is inconclusive. Be particularly cautious of melatonin use with dementia patients.

Avoid long naps. If you must nap, limit sleep to 30 minutes in the early afternoon.

"Although sleep problems are a huge issue with older adults, it's unfortunate the importance of sleep is often not taken seriously by health care professionals," said Sarah Lock, AARP senior vice president for policy and GCBH executive director. "It's normal for sleep to change as we age, but poor-quality sleep is not normal. Our experts share the steps people can take to help maintain their brain health through better sleep habits."
The full GCBH recommendations can be found here. The 2016 AARP Sleep and Brain Health Survey can be found here.
Note: Dilworth-Anderson, former president of the Gerontological Society of America (2009) and winner of the Ronald and Nancy Reagan Award in Alzheimer's Research (2010), is an internationally recognized expert on issues related to aging, including care giving to people with dementia, minority aging and health, and chronic disease care and management in cultural context. She focuses on aging and memory issues as part of the research collaborative efforts between UNC Gillings School of Global Public Health and the University of Cambridge (U.K.)

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu

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Experts recommend 7-8 hours of sleep for better brain health - UNC Gillings School of Global Public Health

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January 31, 2017 A new report, issued on Jan. 10 by the Global Council on Brain Health, recommends ways to maintain brain health, including getting at least seven to eight hours of sleep each night. Dr. Peggye Dilworth-Anderson is a Council member.

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https://link.springer.com/article/10.1007/s11199-014-0384-6?fromPaywallRec=true

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Abstract

Although there is a voluminous literature on mass media effects on body image concerns of young adult women in the U.S., there has been relatively little theoretically-driven research on processes and effects of social media on young women's body image and self-perceptions. Yet given the heavy online presence of young adults, particularly women, and their reliance on social media, it is important to appreciate ways that social media can influence perceptions of body image and body image disturbance. Drawing on communication and social psychological theories, the present article articulates a series of ideas and a framework to guide research on social media effects on body image concerns of young adult women. The interactive format and content features of social media, such as the strong peer presence and exchange of a multitude of visual images, suggest that social media, working via negative social comparisons, transportation, and peer normative processes, can significantly influence body image concerns. A model is proposed that emphasizes the impact of predisposing individual vulnerability characteristics, social media uses, and mediating psychological processes on body dissatisfaction and eating disorders. Research-based ideas about social media effects on male body image, intersections with ethnicity, and ameliorative strategies are also discussed.

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References

Boepple, L., & Thompson, J. K. (2013). A content analysis of healthy living blogs: Evidence of content thematically consistent with dysfunctional eating attitudes and behaviors. International Journal of Eating Disorders, 47, 362-367. doi: 10.1002/eat.22244.

Duggan, M., & Brenner, J. (2013). The demographics of social media users-2012. Pew Research Center's Internet & American Life Project. Retrieved from http://pewinternet.org/Reports/2013/Social-media-users.aspx.

Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press.

Franko, D. L., Coen, E. J., Roehrig, J. P., Rodgers, R. F., Jenkins, A., Lovering, M. E., & Dela Cruz, S. (2012). Considering J.Lo and Ugly Betty: A qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women. Body Image, 9, 381-387. doi: 10.1016/j.bodyim.2012.04.003.

PubMed Google Scholar

Gillen, M. M., & Lefkowitz, E. S. (2012). Gender and racial/ethnic differences in body image development among college students. Body Image, 9, 126-130. doi: 10.1016/j.bodyim.2011.09.004.

PubMed Central PubMed Google Scholar

Hartocollis, A. (2013, October 1). City unveils a campaign to improve girls' self-esteem. The New York Times, A17.

Lenhart, A., Purcell, K., Smith, A., & Zickuhr, K. (2010). Social media and young adults -- Pew Internet and Life Project. Pew Research Center. Retrieved from http://www.pewinternet.org/Reports/2010/Social-media-and-young-adults.

Stelter, B. (2012, February 8). Youth are watching, but less often on TV. The New York Times. Retrieved from http://www.nytimes.com.

Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74, 263-275. doi: 10.1037/0022-006X.74.2.263.

PubMed Central PubMed Google Scholar

Wortham, J., & Goel, V. (2013, October 7). Nipping at Twitter's heels. The New York Times, B1, B4.

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Acknowledgments

The author gratefully acknowledges the journal's anonymous reviewers for their excellent suggestions on how to improve the paper, as well as the journal's editor, Dr. Irene H. Frieze, and managing editor, Susan Dittrich, for their extremely helpful recommendations. In addition, I appreciate the insights contributed by Cleveland eating disorder experts Ann Hull, Dr. Tara Tozzi, and Dr. Lucene Wisniewski. Thanks are also due to Jennie A. Ford and Jessica Newell for their incisive insights on the effects of contemporary social media on young women. I also thank Dr. Patricia Burant, Jim Bagwell, Peggy Giavroutas, Crystal Prizner, Chelsea Reynolds, and Dr. Julia A. Krevans for their perceptive thoughts and ideas.

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School of Communication, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA

Richard M. Perloff

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Correspondence to Richard M. Perloff.

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Perloff, R.M. Social Media Effects on Young Women's Body Image Concerns: Theoretical Perspectives and an Agenda for Research. Sex Roles 71, 363-377 (2014). https://doi.org/10.1007/s11199-014-0384-6
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# data[].attributes.attachment_link.title
Social Media Effects on Young Women's Body Image Concerns: Theoretical Perspectives and an Agenda for Research - Sex Roles

# data[].attributes.attachment_link.description
Although there is a voluminous literature on mass media effects on body image concerns of young adult women in the U.S., there has been relatively little theoretically-driven research on processes and effects of social media on young women's body image and self-perceptions.