New cancer treatments, such as immune checkpoint inhibitors (ICIs), can improve survival and health-related quality of life (HRQoL) in patients with cancer. Although long-term monitoring of HRQoL has been shown to improve survival, integration of HRQoL into everyday practice remains poorly documented.This study describes experiences and expectations of patients treated with ICIs regarding a discussion of HRQoL with health care professionals (HCPs) in cancer management.This cross-sectional study was conducted in an online patient community (Carenity) in France. Patients treated with ICIs for cancer, included between September 2018 and January 2019, completed a questionnaire to assess the involvement of HCP in a discussion of HRQoL and when and what was discussed.Of 82 patients included , 62 (76%) reported discussing HRQoL at least once with HCPs, mainly general practitioners , oncologists , and hospital nurses . Around half  of the patients were satisfied with these discussions. Discussions with the oncologist were at the patient’s initiative . Discussions occurred primarily during follow-up visits , when adverse events occurred , and at treatment initiation . The most discussed dimensions were symptoms  and physical well-being . With respect to expectations, 54/82 (66%) patients considered oncologists as the most important HCPs for discussing HRQoL. These discussions were desirable throughout the care pathway, particularly at diagnosis  and when treatment was initiated  or changed . All HRQoL dimensions were considered important to discuss.With only around half of the patients satisfied with HRQoL discussions, impactful HRQoL integration in clinical practice is critical. According to patients, this integration should involve mainly oncologists and general practitioners, should happen at every step of the care pathway, and should be extended to dimensions that are currently rarely addressed. Health-related quality of life (HRQoL) is a critical feature of the life of patients with cancer, and a number of instruments have been developed for evaluating this over the past 40 years. These include general HRQoL instruments that are not specific to cancer but can be used to compare HRQoL between cancer and other diseases, as well as instruments that are specific to cancer . Such caIn cancer, HRQoL is impacted by disease symptoms as well as by side effects and constraints associated with therapy. Moreover, HRQoL can change rapidly and sometimes unpredictably over the course of the disease. Preserving the HRQoL of patients with cancer is a major goal of clinicians and health authorities -6. For tThe introduction of immune checkpoint inhibitors (ICIs) over the past decade has represented a major advance in the treatment of many types of cancer, allowing sustained recovery and, for some tumors, potentially elimination of disease in a significant proportion of patients ,15. By pMost QoL research with ICIs has been conducted in the context of clinical trials, although some observational studies on long-term survivors who are clinically stable have been reported ,24. PoteThe objectives of this study were to describe experiences of patients treated with ICIs and their expectations with respect to how the importance of HRQoL in cancer management is considered by HCPs. This includes the description of practices of HCPs in appraising HRQoL with patients currently or previously treated with ICIs, the evaluation of patient satisfaction with their dialogue about HRQoL with their HCPs, and the identification of patient expectations with respect to discussing HRQoL.This study was a descriptive, cross-sectional web-based survey of cancer patients (or their relatives) treated with ICIs who were members of the Carenity cancer community and resident in France. Participation was voluntary. Participants were recruited over 4 months from September 10, 2018, to January 7, 2019.The study population included participants from the Carenity cancer community. Carenity is an online patient community for people with chronic conditions ,32. PatiParticipants could either be patients themselves or a relative (or friend) who was prepared to complete the study questionnaire on their own or with the patient. Relatives were asked to complete the questionnaire from the patient’s point of view. In the rest of the manuscript, the data presented represent the characteristics and opinions of the patients, regardless of whether it was the patients themselves or a relative who completed the questionnaire. Participants were eligible for the study if they or their relative were currently or previously treated with an ICI .As members of the Carenity platform, patients or relatives participating in the study provided explicit informed consent to the collection, handling, and keeping of their personal and health data. They were also provided with specific information about the goals and procedures of the study, as well as about the notion of HRQoL, and asked to agree to participate before receiving the study questionnaire. Participants received no incentives to participate in the study, and participation had no impact on their future involvement as Carenity platform members.The questionnaire was developed specifically for this study. The HRQoL domains explored are based on constructs in 2 existing validated cancer-specific HRQoL questionnaires (QLQ-C30  and FACTThe study questionnaire started with a set of screening questions to identify the participant as a patient or as a relative and to ensure that the patient had a diagnosis of cancer and was being treated (or had been treated previously) with an ICI. If this was not the case, the participant left the study at this point. Otherwise, they proceeded to the core questionnaire, which took, on average, around 15 minutes to complete.The core questionnaire consisted of 29 questions for all participants, as well as 3 additional ones to be completed only by relatives answering on behalf of a patient, which were divided into 3 sets, relating to general information, experiences with discussion of HRQoL, and expectations for discussing HRQoL with HCPs. The themes and attributes evaluated during the study are listed by theme in All questions in this web-based survey were mandatory to access the next question, except for 4 open ones. Skip patterns were used, when appropriate. Most of the questions were single or multiple choice, to which participants responded by ticking boxes. Two questions were in the form of Likert scales, and another asked patients to rate the importance of 9 HRQoL dimensions on a visual analog scale.The data analysis was purely descriptive as no prespecified hypotheses were tested. Responses to multiple-choice questions and Likert scales are presented as frequency counts and percentages with their 95% CIs.The study was conducted in accordance with good epidemiological practice. As the aim of the study was to determine patient satisfaction, the survey is considered a patient satisfaction survey and does not fall within the scope of French legislation on medical research. For this reason, submission to an ethical committee was not required.A total of 82 questionnaires were fully completed, of which 56 (68%) were completed by the patients and 26 (32%) by a friend or relative. In the latter case, 16 (61%) questionnaires were completed in the presence of the patient. The characteristics of the patients are presented in For the aspects of QoL that were most impacted by cancer and its treatment, the theme that was most frequently cited was physical well-being, cited by 52 of 82 (63%) patients. In addition, impact on activities of daily living and emotional well-being were also frequently mentioned, by 25 of 82 (30%) patients each. The most frequent responses cited in the physical-well-being theme were fatigue (26 citations), difficulty getting about (13 citations), and pain (12 citations). The most frequent responses cited in the activities-of-daily-living theme were shopping (10 citations), washing (6 citations), and do-it-yourself/gardening (5 citations). The most frequent responses cited in the emotional-well-being theme were mood (18 citations), stress/anxiety (8 citations), and solitude (4 citations). A full listing of the themes evoked is provided in Overall, 75 of 82 (91%) patients considered it important to discuss their HRQoL with an HCP, with 58 (71%) considering it very important and a further 16 (20%) considering it quite important. In addition, 62 of 82 patients (76%) patients had discussed their HRQoL with an HCP at least once. Of the 20 patients who had not done so, 9 (45%) would have liked to, 4 (20%) were not interested, and the remaining 7 (35%) did not know. In addition, 45 of 82 (55%) patients were always or often satisfied with the way in which their HRQoL had been discussed. The principal reasons for satisfaction were that the discussion had resulted in practical solutions being identified  and a good relationship with the HCP due to their human qualities . Of the 82 patients, 17 (21%) were, however, frequently dissatisfied with this discussion. Reasons for dissatisfaction were insufficient time available for discussing HRQoL , a lack of information and explanations provided by the HCP , and a lack of empathy on the part of the HCP . In addition, 29 of 82 (35%) patients considered that they had been listened to when discussing their HRQoL, whereas an identical number considered that they had not been sufficiently listened to or given the chance to express themselves.Patients reported discussing HRQoL with a variety of different HCPs, with the majority reporting multiple points of contact. On average, patients reported consulting 6.7 (95% CI 6.2-7.2) different types of HCPs and discussing HRQoL with, on average, 5.8 (95% CI 5.3-6.3) of these. The most frequently cited HCPs were the general practitioner, the oncologist or radiologist, and the hospital nurse . It shouOf 62 patients, 8 (13%) reported that they had discussed their HRQoL in settings other than medical consultations, such as with patient support groups, discussion groups, or patient groups organized by a nurse.QoL was most frequently discussed during follow-up consultations  and less frequently at the time the diagnosis was made . In particular, HRQoL was addressed when patients reported experiencing side effects or when a new treatment was initiated A. HoweveMultiple dimensions of HRQoL were usually discussed, with 27 of 62 (47%) patients having discussed 4 or more dimensions. The most frequently discussed dimensions were symptoms, and physical well-being and mobility C. These The ways that the health care team could be more attentive to HRQoL that were spontaneously cited most commonly were a better dialogue or a more personal relationship with the HCP (26 citations), more support and guidance (15 citations), and having more personalized information about the disease and treatment (14 citations). With respect to specific measures , the mosThe results of this study highlight the importance of discussions of HRQoL between patients with cancer treated, or previously treated, with ICIs and their HCPs throughout the treatment journey. Overall, 75 of 82 (91%) patients reported that it was quite or very important to discuss their HRQoL with an HCP. In practice, HRQoL was discussed with an HCP in the majority of cases , and most of these patients  were satisfied with the quality of the dialogue. Nevertheless, an important gap remains between patients’ expectations and real-life practice, with a significant minority of patients  who were either dissatisfied with the way their HRQoL had been discussed or would have liked to have had an opportunity to discuss it. The gap is even more significant in that around half of the patients who had discussed their HRQoL with an HCP  felt that they had not been listened to sufficiently or given the chance to express themselves fully.Many studies have emphasized the beneficial effects that internet use for health issues can have on the doctor-patient relationship, by bringing the “informed patient” to play a more active role in the care process and by facilitating communication ,35. PatiThis study was conducted from the patient perspective, and it would be of interest to complement these findings with a similar survey of the importance and utility of discussing HRQoL from the perspective of the HCP. This could help identify areas of convergence between patients and HCPs, as well as understanding the gap between experiences and expectations. For example, an HCP survey could help explain why some areas of HRQoL that are considered important by patients, such as memory problems, relationships, and finances, are rarely addressed by HCPs.The study revealed that only one-third of patients discussed HRQoL issues related to their work, daily activities, and leisure activities and only 1 in 10 discussed the impact of the cancer on their finances. Since many cancer patients treated with ICIs may achieve durable survival, these treatments may allow a more rapid return to work of cancer patients and a reduction in the amount of sick leave , which wThe study findings have identified several important but unfulfilled expectations for a more satisfying dialogue about HRQoL that are widely expressed by patients. Given the importance of monitoring QoL for the management of cancer, integrating a productive dialogue about HRQoL into routine clinical practice is essential, and this study suggests a number of ways in which such a dialogue could be improved so that patients’ expectations are more fully met. Such initiatives are all the more justified in the light of many studies that have reported significant clinical benefits associated with considering the patient’s perceptions of HRQoL -13.First, it would be important to broaden the discussion of HRQoL and not just focus on symptoms or side effects. Only a minority of patients discussed their emotional well-being or the impact of their cancer on their family, social life or professional life, even though they rated highly the importance of discussing these subjects. This focus on symptoms and side effects at the expense of a broader approach to HRQoL has already been emphasized in previous studies of the patient-physician dialogue in patients with advanced cancer receiving standard chemotherapy . Second,Physician education should emphasize the need to open the discussion of HRQoL with their patients proactively and systematically. In addition, getting the patient to complete an HRQoL questionnaire before each consultation may be useful for the physician to assess any evolution of HRQoL and to identify any specific issues to be discussed. Different feasibility studies are underway to systematically collect ICI-related symptom and HRQoL data ,40 and sLike all studies, this one had a number of strengths and limitations. The study included patients with many different types of cancer  representative of the principal cancers treated with ICIs in France. The study sample was relatively representative of the target population in terms of age, gender, geographical area, and the type of care received. No data were collected on stage, since there was a doubt as to whether this information could be reliably ascertained from the panel without medical ascertainment, since the patient may not remember and because the stage might have evolved between the time of treatment and the time of the survey. Likewise, panelists were not asked about the specific ICI prescribed, although the list of treatments was specified in the questionnaire, and treatments used by patients in the Carenity platform are not documented in the platform database. For these reasons, it was not possible to investigate the representativeness of responders further, nor to evaluate how these factors might influence perceptions of HRQoL. The number of patients was also relatively small, and patients were unlikely to be representative of all patients with cancer treated or eligible for treatment with ICIs in France. This diversity of cancer types may mask specific HRQoL issues that are important in particular forms of cancer.Since ICIs were only approved for locally advanced or metastatic cancers at the time of the study, the patient population was at an advanced stage of disease, with one-fifth of patients having been diagnosed for at least 5 years. This implies that all patients should be at a similar stage of their disease, with a current or at least recent experience of ICI therapies. This would ensure relative homogeneity of patients. However, since it may be difficult and arbitrary for patients to distinguish their HRQoL experience with different individual treatments that were managed by the same care providers, patients were invited to describe their experiences over the whole duration of their care since diagnosis. It was thus not possible to interpret patient perceptions and expectations as relating specifically to the period of treatment with ICIs. It was nonetheless possible that recent experiences may dominate earlier ones due to a recall effect.In conclusion, this study identified a gap between expectations and reality in the quality of the dialogue between patients and HCPs about HRQoL and also suggested ways to narrow this gap. Patients with cancer have a legitimate desire for a comprehensive and constructive dialogue with their physicians about their QoL, and in the case of patients receiving immunotherapy, this dialogue may be expected to continue for long periods. To meet patient expectations, the dialogue should consider all dimensions of HRQoL. A dialogue about HRQoL should be integrated into clinical practice at every step of the care pathway on a continuous basis from diagnosis to palliative care. It could be facilitated operationally by new modes of care provision, for example, offering specific consultations with an HCP dedicated to discussing HRQoL. Optimizing this dialogue should thus be a priority for physicians treating patients with cancer.


Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs . From a review of the literature it appears that there is no uniform criterion when selecting preventive measures; these vary according to author. Likewise, the measures recommended are usually general, so that in few cases they result in specific actions to be applied depending on the different variables involved such as the type of drug used, the duration of its application, the underlying pathology, the presence or absence of risk factors, etc. The aim of this study has been to design a preventive protocol which can be easily applied in any clinic or by any dental care service. We undertook an exhaustive literature review to find any articles related to the topic of study, namely, preventive measures for medication-related osteonecrosis of the jaw, on the one hand generically and on the other focusing on dental implant treatment. The most part the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. From 3946 items, we selected a total of 21 items. From the analysis of the selected articles, several protocols have been developed that are easy to apply in a dental clinic.: Protocol 1. Before starting treatment with antiresorptives (Patients who are going to be treated for osteoporosis / Patients who are going to be treated for cancer). Protocol 2. Once treatment is initiated with antiresorptives (Patients being treated for osteoporosis / Patients being treated for cancer). The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Along with a team of well-educated and trained dentists, it is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients. Key words:Medication-related osteonecrosis of the jaw, clinical protocols, clinical guidelines, prevention. Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse reaction experienced by some patients exposed to certain drugs , used in cases of osteoporosis or bone manifestations in different types of cancer, to reduce skeletal complications of these conditions, achieving a reduction in pain and typical pathological fractures, as well as an improvement in the life quality of these patients .According to the American Association of Oral and Maxillofacial Surgeons AAOMS 2014), patients with MRONJ should be or have been in treatment with antiresorptive or antiangiogenic drugs, present exposed bone or bone which may be probed through an intra- or extraoral fistula in the maxillofacial region, and the lesion must have persisted for more than 8 weeks with no history of radiotherapy in the region  nowadays continues to be a challenge for researchers, being a constant topic of debate. From the data available it may be deduced that the aetiology would be multifactorial, there being on the one hand inhibition of the osteoclast function by the antiresorptive drugs, which would lead to disorders in the repairing, healing and bone remodelling mechanisms, essential in protecting against infection, and microfractures which take place as a result of physiological bone function . On the In recent years, the infectious/inflammatory theory has become increasingly important as a cause for the emergence of ONJ. Different studies on animal models support the theory that infection or local inflammation could trigger a condition of osteonecrosis in these patients . AlthougTreatment with dental implants in patients who take antiresorptives or antiangiogenic drugs has always been a controversial topic. As cases of MRONJ were being published, it was highlighted that in an elevated percentage, the precipitating factor was a dental extraction (54%-61%), such that although there was not much evidence, it was deemed that the risk of triggering an ONJ after dentoalveolar surgery would be similar to the one that existed after exodontia. In this sense, the surgical procedure of inserting an implant in these patients would involve a risk of ONJ similar to that of dental exodontia ,10. SlowNotwithstanding, from the evidence published in recent years, it appears that the majority of cases of peri-implant MRONJ develop as a late complication around previously osseointegrated and successfully loaded implants, such that the condition could not be attributed to the surgical procedure of implant insertion. Several publications have suggested that the presence of peri-implantitis could be a more important risk factor for MRONJ than surgical insertion, which would reinforce the importance of the infectious/inflammatory theory in the etiopathogenesis of MRONJ in these cases -18.et al.  guidelines were followed, this review cannot be considered strictly systematic, due to the large number of variables involved in the search, given that our aim was to draw up a preventive protocol describing all the measures published in the literature. As a result of the huge spread of the data in the published articles and the heterogeneous nature of these, we deemed it inappropriate to ask a specific PICO question because we ran the risk of leaving out articles relevant to our search. For this reason, likewise, we had to resort to review or expert opinion articles, which placed more emphasis on the specific preventive measures we wished to include in the protocol.The inclusion criteria were: (a) Studies published between January 2003 and 30 January 2019; (b) Human studies; (c) Any language; (d) case series, cohort studies, case-control studies, and controlled and/or randomized controlled clinical trials (CTs/RCTs); (e) retro or prospective studies; (f) studies including patients having undergone or undergoing oral or parenteral antiresorptive or antiangiogenic drugs, with or without implant treatment, to whom any type of protocol or preventive measure was being applied; (g) review articles, systematic reviews and meta-analysis on the application of preventive measures or protocols for MRONJ in patients having taken, taking or planning to take the drugs involved. The following exclusion criteria were applied: (a) that they did not meet the inclusion criteria; (b) animal studies; (c) case reports.- Search sources and strategyAn electronic search was conducted using three databases, PubMed, (Medline), Embase (Ovid) and Cochrane database of systematic reviews. The review was completed with a manual search in scientific journals in this sector in the e-library of the University of Seville. Likewise lists of references in all the publications identified were reviewed.Search of the Medline (PubMed) database was carried out using MeSH  terms and free terms, in different combinations using Boolean Operators “AND” and “OR”. The terms used were general terms; . Terms related to drugs involved;  reviewed all the titles and abstracts independently. After ruling out all those which did not meet the eligibility criteria, the complete text of the remaining articles was reviewed. The complete text of those which offered little information in the title or abstract were also selected, to avoid missing out any relevant article. Any disagreements were resolved by discussion between the two reviewers.- Articles selectedet al., 2009 (20); Ripamonti et al., 2009 ; Otto et al., 2015 ; Freitas et al., 2016 . Reviewl., 2016 ; . Reviewl., 2018 ; , in recent years alerts have been raised about how misleading this data is, since the number of persons undergoing treatment for osteoporosis is very elevated, it is a chronic treatment, and the risk of ONJ increases over the time the drug is taken, these being reasons why some authors point to the frequency of ONJ in these patients being greater than initially suspected . WarningEtiopathogenetic mechanisms are still controversial, different etiopathogenetic theories having been postulated to explain the emergence of ONJ ,34. It iIt has been suggested that microorganisms could induce bone resorption in ONJ by producing certain substances such as lipopolysaccharides which favour resorption, or receptor activators of nuclear factor-κB ligand (RANKL) in fibroblasts, having the same effect ,15. LikePlacement of a dental implant and surgery associated with this type of treatment is deemed, from the outset, a risk for the emergence of ONJ in susceptible patients, the same as any other surgical procedure, several cases of ONJ having been published after the placement of implants in recent years ,28. Thiset al. (In recent years, several cases have been published in which osteonecrosis occurred around implants that had been in place for several months or even years and correctly osseointegrated ,14,16,28et al. , in a liThe increase in risk of ONJ around already osseointegrated implants may be justified by bone remodelling being decreased, such that the peri-implant bone under constant demand from masticatory load could not respond properly to the functional needs and would necrotize. However, ONJ does not always occur, and furthermore different authors have shown an important reduction in the frequency of osteonecrosis in patients who undergo certain preventive measures to avoid infectious sites around their implants, which leads one to think that there must be something else facilitating the emergence of this condition around the implants. Indeed, several publications have suggested that peri-implantitis could be a risk factor for ONJ associated with implants, ,14,16,28In terms of all the above, and considering the latest knowledge or scientific consensus on the role of bacterial plaque/biofilm in the etiopathogenesis of peri-implant disease, the possibility of preventing ONJ by controlling peri-implant disease would make a lot more sense so that proper control of peri-implant health using appropriate periodontal maintenance protocols could prevent the development of peri-implant mucositis or its transition to peri-implantitis per se, with the risk of it triggering a condition of ONJ in these patients. This is the reason for the inclusion of this type of measures in our protocols.ONJ treatment using antiresorptives is a real challenge for professionals due to the large number of variables involved, the numerous therapeutic possibilities employed, and the enormous variability of the protocols used in the literature, with very disparate results. Furthermore, many of the treatments used, especially surgical ones’ entail in many cases a worsening of the condition with an extension of the lesion. In a study on different therapeutic management approaches in the literature, the authors grouped them into 7 different therapeutic protocols, of which the best results were obtained with conservative treatment, clinical and radiological follow-up, minimally invasive surgical treatment and coadjuvant measures . This shDifferent articles report the influence of preventive strategies in the reduction of the incidence of drug related ONJ. Thus, Ripamonti found an incidence of 7.8% of ONJ in patients with lung cancer which fell to 1.7% after the application of preventive measures . In patiIt is important to highlight that the quality of evidence for most of the articles which apply preventive measures and which have been described in this study is poor, either because of the small sample size, the short follow-up times, the type of retrospective control used, the application of unclear follow-up protocols, etc., such that we coincide with the authors themselves when they point to the advisability of carrying out controlled randomized prospective studies with larger samples and longer follow-up times to be able to achieve high levels of evidence.Several studies have shown the efficacy of antibiotic prophylaxis in those patients undergoing treatment with antiresorptives who need some oral surgery procedure. Normally these studies have been conducted in patients who have undergone dental extractions, achieving favourable results because no case of ONJ developed after the application of these protocols. Currently it is a widely accepted measure by the authors, not just for extractions but also when facing any oral surgery that these patients require. ,32,33,36The application of these protocols requires an interdisciplinary team which can handle the various treatments and apply the measures contained in them. Thus, it will be necessary to have qualified hygienists who have an in-depth knowledge of the disease in order to provide proper reports to the patients and answer their queries. Similarly, they should have persuasive qualities and motivation to be able to make the patient aware of the importance of looking after their oral health and maintaining it in an optimal state. Likewise, generalists should be equally well trained for undertaking conservative treatments in the most non-traumatic way possible and be able to diagnose each lesion adequately in order to apply the most suiTable treatment that manages to avoid unnecessary extractions in the future. The team of surgeons will also have to be prepared to perform surgery with the same minimal trauma and with suiTable antibiotic prophylaxis. It is equally important to maintain contact with the medical team involved in the treatment of the underlying pathology, especially rheumatologists, oncologists, internists and gynaecologists. All the above requires a great staff learning and organization effort, continuous training and coordination of the whole team involved in the preventive management of these patients.


In network models of propagation processes, the individual, microscopic level perspective is the norm, with aggregations studied as possible outcomes. On the contrary, we adopted a mesoscale perspective with groups as the core element and in this sense we present a novel agent-group dynamic model of propagation in networks. In particular, we focus on ephemeral groups that dynamically form, create new links, and dissolve. The experiments simulated 160 model configurations and produced results describing cases of consecutive and non-consecutive dynamic grouping, bounded or unbounded in the number of repetitions. Results revealed the existence of complex dynamics and multiple behaviors. An efficiency metric is introduced to compare the different cases. A Null Model analysis disclosed a pattern in the difference between the group and random models, varying with the size of groups. Our findings indicate that a mesoscopic construct like the ephemeral group, based on assumptions about social behavior and absent any microscopic level change, could produce and describe complex propagation dynamics. A conclusion is that agent-group dynamic models may represent a powerful approach for modelers and a promising new direction for future research in models of coevolution between propagation and behavior in society. The model takes inspiration from what we learned during the COVID-19 pandemic: increased urban mobility and gatherings have been observed not just as a consequence of the decision of health authorities to remove social restrictions; instead the phenomena has been documented starting right after the peak of the infection and increasing while approaching the lifting of social restrictions2. This spontaneous behavior, seemingly anticipating the decisions of health authorities, has effects that make the epidemic dynamics in the declining part a co-evolutionary process with a rich behavioral component still largely unaccounted in research. Most likely reasons for ephemeral groups formation could be the increasing psychological fatigue in complying with rules of social isolation following a period of compulsory seclusion and deprivation of social gatherings and activities5, distrust in health authorities and decay in risk awareness6, socio-economic disparities7, or seasonality effects like amenable weather conditions favoring gatherings in public places. It is probably safe to assume that a combination of several factors is at play in what appears in many cases a recurrent pattern: generalized strict social distancing has proved to be unattainable during the declining epidemic phase, even in presence of unsafe contagion rates. More generally, a large body of scientific literature exists on collective behaviors that epidemic models still do not fully address9 and the case of the COVID-19 pandemic makes no exception11.In this work, we study the effects of the spontaneous formation of ephemeral groups during the declining part of a SIR-type propagation process13. However, the vastness of the interplay between epidemic dynamics and behavioral responses remains still largely unexplored. Similarly, in the more general domain of co-evolutionary models of propagation and behavior, the study of dynamic network adaptations and the sheer variety of possible temporal phenomenon is still limited to few cases. This work moves in the direction of integrating an instance of collective behavior into agent-based network models of epidemics, with the specific focus on ephemeral groups, as we have dubbed the particular mesoscale structure of our interest. Two research goals have especially driven the work: first, to demonstrate the feasibility of our dynamic grouping technique in simulating network effects able to capture the behaviors produced by ephemeral groups of different characteristics. Secondly, to study and compare the effects of large and small ephemeral groups on the dynamics. In particular, we compare effects produced by scenarios with many small groups, which with the decreasing of their size are less likely to include an infected agent, with scenarios with few large groups.Several recent COVID-19 works have shifted their focus on the conditions characterizing the declining part of an epidemic process, when the rate of contagions sensibly drops and social restriction measures are lifted, and on the combination of causes allowing for a relapse of the epidemic dynamicsNull Model analysis evaluating our ephemeral groups model with respect to two random models and a special case considering a non-overlapping version of our model.Results show that a rich variety of dynamics could be reproduced with the combination of two network components, one static representing the traditional aggregated propagation based on slow social network changes and one dynamic representing the dynamic formation of ephemeral groups. Results also suggest that effects of a large group could be equally produced by simultaneous small groups, even in presence of a high rate of non-spreading groups. In the following sections, we first introduce and motivate the notion of ephemeral groups, then we describe the methodology and relevant simulation results for the different model configurations, each representing a stylized case study. We conclude discussing our findings and with some final remarks. This manuscript is completed by Supplementary Information presenting details about network characteristics, model states, and algorithms. In addition and of particular relevance is the 14; second, the characteristic burstiness of human contact networks, which has been thoroughly investigated in different domains, from human mobility and communication, to physical contacts as the contagion vector18. Group formation, instead, has been extensively studied in network science, mostly in the form of generative models and community detection algorithms21. However, with respect to the study of microscopic structural features (agent specific), mesoscopic structural features (group specific) influencing a propagation dynamic have generally received less attention24. However, some notable works with specific focus on mesoscopic features have recently appeared: in COVID-19 research25, for the most general case of high-order interactions in complex systems26, and regarding high-resolution models of human mixing patterns and mobility, which define contact patterns and adopt mesoscopic descriptions28. High-resolution models, in particular, being data-driven, could be the ideal complement of a theoretical work like ours, providing the much needed case studies and real examples of mesoscopic structures necessary for realistic simulations and further model refinements and extensions.The adoption of dynamic networks in epidemic models has frequently focused the attention of researchers on two main aspects: first, how network metrics developed for static networks should be modified when a dynamic network is consideredephemeral groups are mesoscopic structural components defined as spontaneous, temporary, and unstructured. They are mostly composed by unrelated individuals casually gathering together with no central planning, coordination, or organizational rules. They are typically small-to-medium sized and may represent, for instance, occasional parties or other unplanned assemblage in public or private spaces aimed at gregarious activities or random people finding themselves in close proximity, for a limited time span, near points-of-interests, in public transportation, or commercial locations. Ephemeral groups share the properties of possibly form simultaneously, repeatedly, and temporarily mixing individuals, often at random. Different is for large gatherings, which are likely to happen for special social events or circumstances, like conventions, sport competitions, fairs, or seasonal touristic influx in traditional locations. Usually, they are unique events, at least in a certain place and within a time period. Several cases of large social events have been studied with respect to their possible impact on contagions as superspreader events31. Ephemeral groups, individually, are not superspreader events, whereas it is possible for their combined effect. In addition, they are more difficult to study empirically than single large events. The relatively few exceptions have mostly regarded the case of people in public transportation, with data collected from turnstiles35, and scientific experiments involving limited groups of participants equipped with tracking devices 37. We are interested to study the possible effects that those ephemeral groups may have on a possible new surge in a propagation process. The model has two components, which co-evolve producing mutually dependent network effects on the dynamic:Microscopic static features An extension of the traditional Susceptible-Infected-Recovered (SIR) model based on a static proximity network and simple contagion mechanism. This part has been originally presented in Ref.38 to study the epidemic dynamics under the assumption of different rates of Mild/Acute infected. It provides the base epidemic model and static contact network. Details about the basic epidemic model and model epidemic states are provided in Supplementary Information, Section S1 and S2.Mesoscopic dynamic features The dynamic formation of ephemeral groups is modeled as a choice of randomly selected agents that, starting from a given time point in the declining epidemic phase , dynamically link pairwise in groups having the following characteristics: a variable rate of agents is involved in groups; groups are randomly created and possibly repeated for more time steps, each group may or may not include infectious agents .Figure In our model, Before ephemeral groups formation  Two groups of five agents with two new links for each agent are showed marked in orange in the central vignette. Node selection for each group is random, in this version of the model. Dynamic links are assumed to be intragroup and randomized as well. Propagation from red (I) to blue (S) agents is, therefore, a first order effect of grouping only between agents belonging to the same group. Propagation to external agents is a second order effect. For simplicity, no social learning or herding effects on propagation have been assumed. Ephemeral groups are assumed to have a typical single time step lifetime. Different configurations based on the repetition of the dynamic grouping for more time steps have been simulated and studied.After ephemeral groups dissolve and dynamic links expire (time stepmentclass2pt{minimOn the timeline of simulation steps (time steps), the network dynamic is described with the progression of three characteristic steps:38. It extends the previous model by studying the conditions of ephemeral groups leading to a second epidemic dynamic under different scenarios. It is a generalization because the analysis and conclusions have a broader aim than previous COVID-19 research, discussing cases of coevolution between propagation and behavior, when the behavioral component is expressed by a combination of individual  and dynamic groups . We have also simplified the analysis of agents’ state transition dynamics in order to better focus on the role of ephemeral groups from the previous extended SIR model . This way, combined with the assumption of fixed population, we have also restricted the effects produced by ephemeral groups only to a second propagation dynamic. Removing one of these assumptions and allowing for a renewal of the sub-population of agents that could turn into spreading ones  would make possible to sustain a series of propagation dynamics through the formation of ephemeral groups. For this study, we adopt a constant population of agents invalid when the second wave was absent or insufficient to represent an epidemic dynamic .We present a stochastic group-based network model focusing on the declining part of a schematic SIR-type propagation process in a society and considering the formation of ephemeral groups creating new dynamic links. The model is an extension and a generalization of a previously presented modelgrouping frequency  and the total number of grouping time steps. For the grouping frequency we have considered two cases: continuous when grouping occurs at consecutive time steps and periodic when grouping occurs at non-consecutive time steps. For the number of grouping time steps, we have considered two cases as well: bounded when a fixed number of grouping time steps is set and unbounded when grouping is allowed until the exhaustion of the propagation dynamics. In Fig. Figure Panels A and B introduce several elements of the dynamics we have studied. The first part of the propagation dynamic, marked with the grey area, is useful only to have a general overview of the full process and of the typical proportions between the two phases of the propagation dynamics . Other than that, the first part of the dynamic is not particularly relevant, representing equal initial conditions for ephemeral groups among all cases. Average number, with 95% CI, of Infected, Susceptible and Recovered agents at the start of ephemeral grouping are in Supplementary Table Group size represents the number of agents belonging to a group. In this study, we assume that every configuration has groups of equal size. When grouping is repeated for more time steps, at each time step groups are recreated randomly. Overlaps between groups are possible and in general high-order coupling could have relevant effects on the dynamics. For this reason, we tested a non-overlapping variant. The model analysis of statistical significance is presented in Supplementary Information, Section S4, showing that, in our case, group overlaps seems to have a negligible effect.New links per agent represents the number of new links each agent randomly creates. Dynamic links are only intragroup and have a lifetime of one time step. When grouping is repeated, continuously or periodically, dynamic links are recreated every grouping time step. In this study, we assume same number of new links per agent for each configuration. Dynamic links are removed when a group dissolves.Number of groups represents how diffuse the ephemeral grouping behavior is assumed to be in the population. As a rule of thumb, we assume an inverse proportion between number of groups and their size, that is, we investigated cases of many small groups and of few large groups in order to compare the behavior. The total number of agents involved in ephemeral groups is then calculated as N. of groupsgroup size, while the total number of dynamic links for each grouping time step is N. of groupsgroup sizenew links per agent.Pseudocode describing the algorithms could be found in Supplementary Information, Section S2.The cases we analyzed have been categorized in scenarios, each defined by the number of ephemeral groups produced per time step . Configurations in all scenarios have easily reached such strong responses in a range of parameter values , either with few loosely connected groups  or with many small tightly connected groups .Therefore, from Fig. Secondly, a plateau is not been reached only as a consequence of bounded network size, but it could be the result of a spontaneous behavior of the propagation process. This is showed in panels C  and particularly in panel D , where peaks reach a medium level around 4000, far from the dominant effect of the limited network size . More specifically, in panel D, the series with group size equals to 1000 shows that the peak stays around 4000 for a large range of new links per agent (from 100 to 500). It also exhibits a striking correspondence with the behavior of the series with 5000 as group size reaching the peak value with 8 consecutive grouping time steps and similar number of total new links produced by the group, then plateaued. Other cases in different scenarios behave similarly . Another set of cases  have a slower growth and reach the peak value only when we tested with an unbounded number of grouping time steps .A positive correlation between the peak level and the total number of links created by groups up to the peak . This is not a new result in general, on the contrary, it is typical of SIR-type dynamics39. What is possibly interesting is the fact that the relation between peak value, number of links and duration of the propagation process could be controlled, to some extent, by the grouping mechanism. This offers interesting possibilities, that we further investigate in the next section.Another correlation that is observed is that with considering the difference with consecutive cases, peaks for in Instead, with respect to the ability of a non-consecutive grouping pattern to extend the duration of the propagation, results show time to peak having increments from 50 to more than 100%. This was expected because it mostly depends from the reduced total number of links from start to peak. The more interesting result is that time to end has large increments, from 30 to more than 100%. Notable is that those are increments with respect to the consecutive case Table entclass1pt{minimaIn this work, we have proposed a new dynamic group-based network model of a propagation process, specifically focusing on modeling mesoscopic constructs. Ephemeral groups are the composite subjects of our model. Model simulations, analysis of results and Null Model analysis  permit us to draw some conclusions.First, by considering where we started from, an epidemic model inspired by COVID-19 pandemic, we observe that ephemeral groups could be a relevant factor in epidemic dynamics when people return to socialize freely. Large gatherings resulting in superspreading events have been frequently discussed, as well as repetitive gatherings protracted for long periods, such as in schools or workplaces. Ephemeral groups are instead more elusive to a rigorous assessment of the risk they pose. To this regard, future models may shed new light on the relevance of groups on epidemic dynamics. An outcome of our work is that, at least in theory, for several and diverse configurations, ephemeral groups have the power to restart and sustain an epidemic dynamic when it was headed to expiration, in the absence of contextual changes . Health authorities should exercise prudence in face of the inevitable uncertainty regarding the effects of gatherings and the difficulty of scientists in collecting precise measurements to feed epidemic models.time to end metric seemingly confirms the hypothesis that a periodic dynamic grouping mechanism could deeply influence the propagation process and could sustain it for an extended period. This result could remind of known behavioral and cognitive effects from social learning theory40 or awareness models41, all implying that periodic reinforcements could sustain an otherwise decaying process. A novelty of our work is to have derived some initial quantitative results through simulations of a group model, with the analysis suggesting that balancing the alternation of growth and decay phases, rather than simply the number of reinforcement events, is a key factor and it would be the basis for new and possibly interesting future research in this area.Secondly, the Another outcome that looks interesting comes from the Null Model analysis. It suggests a change of the relevance of groups through the different scenarios. Many small groups, most of them with no internal epidemic propagation because without infected members, seem to act similarly to a random linking model. But they could be nevertheless effective in sustaining an epidemic dynamic. In real settings, they could possibly join to form larger groups. In larger groups the difference with random linking models emerges increasingly clear. Simulation data show that the ephemeral groups model reaches often a slightly higher peak with fewer active links  than corresponding random cases. This seems to indicate that groups seed and sustain a more efficient epidemic propagation. A dynamic of groups aggregating to form larger compounds represents a behavioral phenomena potentially at the base of particularly meaningful propagation models. On the practical side, not just the creation of ephemeral groups and their characteristics are relevant in a propagation phenomena, but the temporal evolution of groups organization is important as well.Other observations are probably less relevant, but still worth mentioning. From Table entclass1pt{minimaA concluding remark is that by studying this model, we had the clear feeling of how vast and rich could become models based on dynamic groups. Moving from typical epidemic models to models designed for the propagation of ideas, news, or products will keep some common features, but will introduce new set of assumptions, radically changing the dynamics. High-order coupling, here barely touched in Supplementary Information, group membership persistence, heterogeneous groups, time dependent agent behavior and social reinforcement, the influx and outflux of new agents, as well as the representation of different cultures in agent populations could all become key factors of future challenging as well as interesting models.Supplementary Information.


Slut shaming is defined as the stigmatization of an individual based on his or her appearance, sexual availability, and actual or perceived sexual behavior. It can take place in physical or virtual spaces. The present study questions the impact of this form of sexism in virtual spaces on girls and interrogates the interaction between the values that girls integrate through their life experiences, especially in the family sphere, and slut shaming victimization. We conducted a paper-pencil questionnaire with 605 girls between the ages of 10 and 18 (average age: 15.18 years). Our data confirm the impact of slut shaming on the physical and psychological well-being of young girls as early as adolescence. Second, mediation analyses provide insights into the revictimization and Poly-victimization processes, from childhood adverse experiences to sexist victimization in virtual spaces and their combined impact on the physical and psychic health of girls. Finally, we address prevention strategies and the involvement of socializing institutions in the deconstruction of gender stereotypes. Slut shaming is defined as the stigmatization of an individual based on of his or her appearance, sexual availability, and actual or perceived sexual behavior and is primarily aimed at women and girls. This stigmatization is reflected in social and relational sanctions, such as rumors, ostracism, or insults, such as “slut” and “fag” . As slutn = 3257), 25% of the participants reported having been victims of sexual rumors in the six months preceding the study. Eighty percent of participants reported having witnessed the use of sexist (“slut”) insults online while 68% had seen homophobic insults online [Van Royen  found ths online .However, these experiences are often trivialized by young people, and slut shaming appears to be a reality that is difficult to identify and name when it occurs, both in the social and scientific spheres . Is it eIn adolescence, puberty modifies the body and relationships with others. Through the changes that their bodies undergo, adolescents see their appearance evolving from childlike to sexual, thereby making them potential objects of desire in the eyes of others. The realization during the first loving and intimate relationships is an unavoidable result of this period of life and induces intense questioning around sexuality and intimacy . This quIndeed, new technologies offer young people new opportunities to achieve their developmental goals such as identity development and relationships with others, but these new technologies may also create issues around sexuality and intimacy. Sexting, the sending of suggestive messages or images, is one of the contemporary adolescent practices that illustrates this movement . ThroughAccording to gender schema theory , young pThis gendered performance is a learning process based on trial and error and is subject to feedback from peers and people who are significant to the adolescent . This feSlut shaming is frequently conceptualized as a form of (cyber)bullying. The consequences of cyberbullying on adolescent development and well-being have been documented in the scientific literature: negative affects; depression and thoughts of suicide; academic difficulties and drop-out; relational issues; alcohol, tobacco, or substance abuse; and polyvictimization ,17,18,19However, framing slut shaming as a form of cyberbullying risks making the gendered dimension of this form of discrimination invisible ,18,19,20Self-presentation that is considered overly sexualized, a multiplicity of sexual partners, and sexual behaviors labelled as “deviant” with respect to the established norms or sexual orientation are likely to lead to slut shaming ,26,27,28Adolescents cannot be comprehended independently of the family sphere in which they live. Although differentiation and empowerment movements are beginning, adolescents are subject to the authority of their parents and are dependent on them. Through their control over their children’s activities and the values that they transmit to them, parents are important agents of socialization in the lives of adolescents and fundamental actors in their identity development and gender construction ,24.Moreover, parental practices appear as potential risk or protective factors against the victimization experiences of adolescents. While supervision seems to be a key protective factor ,30, otheRegarding the role of parents in the online lives of adolescents, a report  indicateWhile the family environment can mobilize protective and preventive strategies against violence and cyberviolence, it can also make young people vulnerable to and participate in the integration of inappropriate relational models. At the beginning of adolescence, a young person carries a certain amount of baggage, the sum of all the experiences they have had, especially with the adults who are important to them. This baggage endows them with resources but also with fragilities that are likely to modulate their relationship with the world. If the family is a place of growth and development, families can also be a living space where violence and mistreatment are experienced.Violence can play out between parents and have deleterious effects on the young people who are exposed to it. Several meta-analyses have shown that young people exposed to domestic violence during their childhood are likely to experience difficulties during their development in the short and long term: mood disorders; post-traumatic stress symptoms; substance use ; externalized behavioral disorders, such as aggression; internalized behavioral disorders, such as anxiety or depression; suicidal thoughts and actions; academic impairment; and effects on physical well-being and health ,42,43,44Moreover, children may themselves be victims of violence at the hands of their parents or caregivers. A meta-analysis including 19 studies and 115,579 participants attests to the impact of physical and sexual violence suffered in childhood and concludes that high levels of depression, anxiety, and distress are reported in adults exposed to childhood sexual and physical abuse . VariousFinally, violence may not only be psychological and physical, but also sexual. The family environment is one of the main places where this type of violence against minors occurs. Sexual victimization in childhood is a major traumatic event that can have long-term consequences for an adolescent, which includes risky sexual behaviors such as early sexual initiation, multiple partners, or early pregnancy . ExperieThe intergenerational transmission of violence theory  postulatWe recruited participants based on the distribution of the population of young people attending secondary education in Belgium Wallonia-Brussels Federation. This study focuses on three different Belgian provinces, thereby allowing access to populations from low, medium, and high socio-economic backgrounds and ensuring a balanced representation of participants from urban and rural areas. We used a purposive sampling. Quotas were established on the basis of statistics compiled by ETNIC on secondary education in the Wallonia-Brussels Federation for the 2015–2016 school year according to three criteria: school year, type of education, and gender. Two hundred and nine schools were contacted by email and telephone. Consent from the parents and the school principals was required. After a pre-test phase, paper questionnaires were collectively administered in 14 French-speaking Belgian secondary schools from March to May 2018. The questionnaires were completed during class hours without the presence of the teachers. They took place in the presence of the researcher who was there to answer any questions and support the completion of the questionnaire. Furthermore, administration of the questionnaire was followed by discussion time with each group, which allowed us to provide the participants with the contact information of helplines and support centers in case of need due to the sensitive nature of the data collected. None of the participants reported discomfort, either during the administration or during the debriefing. Written informed consent was required from the participants and their parents. A random code was attributed to each questionnaire, making it impossible to identify the participants or their schools. Paper questionnaires were kept under lock and only accessible to the research team. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of University of Liège.605 girls between the ages of 10.25 and 18 took part in this study (average age: 15.18 years).Based on the Kinsey Scale , we haveThese dimensions were assessed using five items from the control and confidence sub-dimensions  assessedPhysical well-being was assessed by the A subscale dealing with the somatic symptoms of the General Health Questionnaire . The GenDepressive affects were addressed through the D subscale of the General Health Questionnaire, on a Likert scale from 0 to 3, from “Never” to “Always” . A higheTwo items were created based on the literature and items used by previous studies, as no validated scale existed at the time that the study was conducted to assess slut shaming victimization. Almazan and Bain  asked thTo assess this dimension, one item was used: “Have you ever witnessed physical violence between your parents or the adults who care for you ?”. This was scored on a Likert scale from 0 (Never) to 4 (Very often). We asked young people: “Have you ever experienced violence  at the hands of your parents or the adults who care for you?”. This was scored on a Likert scale from 0 (Never) to 4 (Very often).Based on previous studies designed to assess sexual victimization and traumatic experiences in childhood , we chosThree items were created for the purposes of this study: “It is important for a boy to be virile, macho”, “It is important for a girl to be attractive, seductive”, and “To gain respect, it is sometimes necessary to use force”. The first two items measured adherence to male and female gender stereotypes, while the third measured acceptance of violence. These items were scaled on a scale from 0  to 4 (Completely true). They were inspired by previous research on gender stereotypes and attitudes towards violence among Belgian adolescents ,66.The results showed that 7.2% of participants had already received sexually insulting messages via new technologies , and 10.6% reported having been the target of sexual rumors. In total, 14.85% of the participants had already experienced at least one form of slut shaming, and even before the age of 15, 10.47% reported having already been victims of slut shaming online. Previous research on Belgian adolescent girls aged 12 to 18 found slightly higher rates, as high as 17.4% for the whole sample and 21% for participants before the age of 15 . These dn = 7 to n = 35), the data do not allow us to conduct comparative analyses  and predicts depressive affect and suicidal thoughts .Research on slut shaming has so far been unable to quantify the damage it causes to girls and women, and for this reason, it has not yet been definitively conceptualized as a form of violence. We are trying to determine whether slut shaming does indeed have an impact on the lives of girls from adolescence onwards. To this end, we conducted regression analyses. Slut shaming predicts health problems  were set as predictors of health problems . MediatiOur study highlights an unprecedented result: slut shaming victimization significantly mediates the relationship between traumatic childhood experiences and health problems. This mediation is partially because the direct effect of traumatic experiences on health is still present. In other words, young girls that have faced traumatic experiences during childhood are more likely to have health problems, and this effect is amplified by subsequent victimization experiences, such as slut shaming victimization.We conducted a second mediation  to underAdolescence is a period of upheaval in an individual’s relationship to their body, to oneself, and to others. This transformation is not gender-neutral; it takes place under the gaze of peers and is subject to sanctions on their parts, even in virtual spaces. Slut shaming that begins at adolescence thus intervenes in this developmental process and can play a role in shaping the gendered construction of adolescents. How slut shaming experiences influence gender construction, self-esteem, body concerns, and relationships with peers are still avenues for future research. While some studies ,4 have sOur results confirmed that slut shaming affects women and girls: up to 14% of our participants have experienced slut shaming at least once. Gendered processes sanctioning the way femininity is expressed are therefore active from adolescence onwards. The gendered prescriptions to which girls are exposed to in the virtual space remain contradictory and a source of stigmatization . HoweverIn our study, slut shaming has emerged as a predictor of depressive affects and health problems. The impact of slut shaming on the psychological and physical integrity of the young people who are the victims of it invites us to conceptualize it definitively as a form of violence that is likely to affect the development and well-being of adolescents. More than trivial remarks and experiences, gender reminder can be a painful experience for adolescent girls. Slut shaming is hardly identified and recognized as a force of violence, either by social institutions, the scientific world, or the adolescents themselves . It is fVarious studies ,55,56 haExposure to domestic violence is in fact closely associated with the experience of slut shaming. A gendered reading may allow us to deepen our understanding of this relationship: the results of the Virage survey  show thaExposure to domestic violence is in fact closely associated with the experience of slut shaming. A gendered reading may allow us to deepen our understanding of this relationship: the results of the Virage survey  show thaMoreover, correlational analyses highlighted that a certain acceptance of violence is associated with slut shaming . According to the theory of cognitive processes , youths n = 7 to 35) does not allow comparative analyses. Experiences of slut shaming victimization among LBTIQ+ youth are an interesting research topic for future studies. The literature posits slut shaming as a form of gendered discrimination, closely related to prescriptions of masculinity and femininity. However, our results did not reveal any interaction between the experience of gender-based violence and the production of gender stereotypes. Yet, slut shaming definitely relates to processes of stigmatization toward youth who deviate from expected gendered models, and this is suggested by our data regarding sexual orientation. Our data suggest that youth who do not identify as exclusively heterosexual may be more likely to experience slut shaming: 12% of only heterosexual girls have already experienced slut shaming online, which concerns 25% of only lesbian girls and up to 57% of bisexual girls. This data allows us to reflect on slut shaming a form of violence intended to regulate the bodies and sexualities of young people through sexist insults, even in the virtual space. They also question its impact as a stigma for non-heterosexual youth. However, these results should be taken with caution as the sample size of the proposed categories  appear in scientific literature as protective factors at various levels during adolescence ,30,31,32Slut shaming is gender-based violence that is difficult to name, and therefore, difficult to assess. To date, there is no validated scale to measure it. One of the limitations of our study is that some measurements had been made with items not previously analysed in a pilot study. We have based our research on the manifestations of slut shaming identified in the scientific literature and have chosen to test the behaviors most frequently identified by the authors . Slut shAlthough slut shaming is a form of violence that primarily affects women and girls, exploring the nature of the victimization experiences of boys is another potentially interesting avenue of research. We intend to analyse the male participants’ responses to our questionnaire in a future publication.Our data provide insights into the specific experiences of LGBTIQ+ youth. However, because we chose to measure sexual orientation along a continuum, we only have small samples in the different modalities. These sample sizes do not allow for robust comparative analyses of heterosexual and non-heterosexual youth, although our data indicate that the latter may be more exposed to gender-based violence in the virtual space. Future studies would benefit from investigating the experiences of these youth in particular.Finally, scientific literature on the theme of harassment and, more specifically, sexual harassment underlines the importance of being able to determine whether violence occurs between peers of the same or opposite sex in order to identify the gendered dynamics of this process . We did Our results lead us to conceptualize slut shaming as a form of gender-based violence that takes place from adolescence onwards and is likely to generate physical and psychological suffering among young people. The vulnerability of girls to slut shaming has led us to interrogate how it influences perceptions of gender, and particularly, notions of femininity during adolescence. Adolescents shape their worldviews, abilities, and vulnerabilities related to their life experiences, especially in relation to the violence to which they may have been exposed in their childhood. These links allow us to connect the notions of the re-victimization and the theory of cognitive processes . Finally