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To explore the transition from correctional facilities to community among women living with HIV in Vancouver, Canada, we interviewed 19 recently incarcerated women and 6 service providers. Findings highlighted heightened risk of violence at release, a lack of immediate supports, challenges accessing safe housing and addictions treatment, and interruptions in HIV treatment and care. In the face of structural barriers, women blamed themselves for not being able to break the cycle of incarceration. There is a critical need for enhanced pre-release planning with a priority on housing and substance use services, alongside supports that are trauma-and violence-informed and culturally safe. [ABSTRACT FROM AUTHOR]

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Objective: The stigmatisation of incarceration has significant negative effects on the health and well-being of individuals and communities. At the University of British Columbia in Canada, an undergraduate course on prison health included instruction by people with lived experience of incarceration as part of a teaching approach aimed to reduce stigma. In this study, we sought to understand the impact of this course as described by students. Design: Qualitative interviews with students who completed the course in 2017 were conducted by another former student of the course. Interviews were transcribed and interpretive descriptive methods were used to elucidate findings. Results: Nine former students participated in the study, eight (89%) were women and the median age was 23 years. Analysis yielded the following themes: (1) learning from people with lived experience, (2) de-mystifying through knowledge and understanding, (3) broadened perspectives and self-reflection, (4) future choices and actions and (5) changing views on incarceration. Conclusion: Findings suggest that approaches to address stigma in teaching prison health in an undergraduate course provided students with a deepened understanding of health inequities and determinants of health; increased feelings of compassion and interest in health equity for populations impacted by incarceration; and fostered opportunities for reflection, critical thinking and broadened perspectives. [ABSTRACT FROM AUTHOR]

Introduction: Studies of the impact of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV mono and co-infections on the risk of cancer, particularly extra-hepatic cancer, have been limited and inconsistent in their findings. Methods: In the British Columbia Hepatitis Testers Cohort, we assessed the risk of colorectal, liver, and pancreatic cancers in association with HCV, HBV and HIV infection status. Using Fine and Gray adjusted proportional subdistribution hazards models, we assessed the impact of infection status on each cancer, accounting for competing mortality risk. Cancer occurrence was ascertained from the BC Cancer Registry. Results: Among 658,697 individuals tested for the occurrence of all three infections, 1407 colorectal, 1294 liver, and 489 pancreatic cancers were identified. Compared to uninfected individuals, the risk of colorectal cancer was significantly elevated among those with HCV (Hazard ration [HR] 2.99; 95% confidence interval [CI] 2.55–3.51), HBV (HR 2.47; 95% CI 1.85–3.28), and HIV mono-infection (HR 2.30; 95% CI 1.47–3.59), and HCV/HIV co-infection. The risk of liver cancer was significantly elevated among HCV and HBV mono-infected and all co-infected individuals. The risk of pancreatic cancer was significantly elevated among individuals with HCV (HR 2.79; 95% CI 2.01–3.70) and HIV mono-infection (HR 2.82; 95% CI 1.39–5.71), and HCV/HBV co-infection. Discussion/Conclusion: Compared to uninfected individuals, the risk of colorectal, pancreatic and liver cancers was elevated among those with HCV, HBV and/or HIV infection. These findings highlight the need for targeted cancer prevention and diligent clinical monitoring for hepatic and extrahepatic cancers in infected populations. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder sharply increases the risk of depression and suicide. Individuals living with post-traumatic stress disorder frequently use cannabis to treat associated symptoms. We sought to investigate whether cannabis use modifies the association between post-traumatic stress disorder and experiencing a major depressive episode or suicidal ideation.Methods: We used data from the 2012 Canadian Community Health Survey-Mental Health, a nationally representative cross-sectional survey of non-institutionalized Canadians aged ⩾15 years. The relationship between post-traumatic stress disorder and each outcome was modelled using logistic regression with an interaction term for cannabis and post-traumatic stress disorder, controlling for demographic characteristics, mental health, and substance use comorbidities. The ratio of odds ratios and relative excess risk due to interaction was calculated to measure interaction on the multiplicative and additive scales, respectively.Results: Among 24,089 eligible respondents, 420 (1.7%) reported a current clinical diagnosis of post-traumatic stress disorder. In total, 106 (28.2%) people with post-traumatic stress disorder reported past-year cannabis use, compared to 11.2% of those without post-traumatic stress disorder (p < 0.001). In multivariable analyses, post-traumatic stress disorder was significantly associated with recent major depressive episode (adjusted odds ratio = 7.18, 95% confidence interval: 4.32-11.91) and suicidal ideation (adjusted odds ratio = 4.76, 95% confidence interval: 2.39-9.47) among cannabis non-users. post-traumatic stress disorder was not associated with either outcome among cannabis-using respondents (both p > 0.05).Conclusions: This study provides preliminary epidemiological evidence that cannabis use may contribute to reducing the association between post-traumatic stress disorder and severe depressive and suicidal states. There is an emerging need for high-quality experimental investigation of the efficacy of cannabis/cannabinoids for the treatment of post-traumatic stress disorder. [ABSTRACT FROM AUTHOR]

As part of a participatory health research project seeking to support men in achieving their health goals during the transition from prison to community, a workshop program was developed and piloted in a Community Residential Facility in British Columbia, Canada. The pilot program was evaluated through feedback surveys at each of the 16 workshops and a focus group interview at the end of the program. Workshops were highly valued by participants and seen as a means for (1) building skills relevant to their health and wellness, (2) working toward changing attitudes and behaviors adopted in prison, and (3) helping others and accepting help from others. Similar programs may be an effective support for men working to achieve their health goals during other transitions (e.g., bereavement, cancer patients, returning soldiers, and veterans). [ABSTRACT FROM AUTHOR]

Objectives: The intervention objectives were to evaluate and describe the feasibility of using a community-based research (CBR) approach to adapt and implement HIV-prevention materials and tools with incarcerated men. We found no prior published reports about CBR HIV-prevention education in Canadian correctional facilities.Methods: Twelve members of the correctional Peer Education Committee (PEC) and Aboriginal PEC, whom a correctional nurse identified as being interested in preventive health, were purposively invited to participate. Eight participants were serving life sentences, three were Aboriginal and their education levels ranged from below grade 8 to 11 years of post-secondary education. The setting was a medium-security federal correctional facility, housing 324 men. The intervention was guided by CBR and 'greater involvement of people with AIDS' principles. Participants were invited to attend four workshops, over seven days in May 2014, and to provide their insights regarding future scaled-up CBR HIV prevention. Each workshop included an HIV-prevention presentation and a focus group discussion, two of which were audio-recorded.Findings: All participants attended all sessions. Synthesis of mixed-method findings, with quantitative and qualitative data triangulation, demonstrated two major outcomes: 'new knowledge was generated' regarding feasibility of CBR HIV prevention in a men's correction facility; and 'capacity building occurred' with increased participants' social capital. Thirty incarcerated men requested HIV testing following the intervention, because participants spread their knowledge about HIV prevention to others. Participants asked to become 'health ambassadors' - champion advisors for future scaled-up CBR HIV-prevention intervention for the entire correctional facility.Conclusion: CBR HIV prevention is feasible within a Canadian men's correctional facility. [ABSTRACT FROM AUTHOR]

Background: Global cases of overdose-related deaths attributed to synthetic opioids are reaching epidemic proportion in many jurisdictions. While the main focus of health agencies and the different levels of government has been to combat the cases linked to injection drug use, the deaths attributed to smoking illegal drugs have not gained the same attention. Moreover, little attention has been given to the role of people with past or current experiences of illegal drug use and how their social networks can mitigate the risk of a highly stigmatized behavior such as smoking illegal drugs. Methods: The study concerns the first social network research conducted via a community-based participatory action methodology in two distinct urban (Vancouver) and rural (Abbotsford) centers in British Columbia, Canada. The study will identify the influence of social networks on people who smoke illegal drugs (PWSID) and their adherence to interventions aimed at reducing harm. Through community consultations, members of the Vancouver Area Network of Drug Users and the British Columbia/Yukon Association of Drug War Survivors not only assisted with the design of this research project but also assisted with the data collection, management, protection and entry of demographic, and network information. Discussion: Many traditional qualitative and quantitative methods have not effectively engaged people who use drugs as researchers or collaborators due to stigma related to illegal drug use. The aim of this study is to recognize that everyone within the network of PWSID is a few steps away from harm. Therefore, we aim to reduce the harm associated with smoking of illegal drugs, especially for PWSID that are at the highest risk. At the same time, we hope that the social network research via a participatory community-based approach will mobilize PWSID in the process and offer a different method of knowledge construction from the traditional positivist approaches. [ABSTRACT FROM AUTHOR]

Objectives: Although take-home naloxone (THN) programs are integral in strategies to prevent overdose deaths among opioid users, the uptake of THN among people who use drugs (PWUD) (including non-opioid users) is unknown. The objectives of this study were to determine awareness, possession, and use of THN among PWUD in Vancouver, Canada, and identify barriers to adopting this strategy. Methods: From December 1, 2014, to May 29, 2015, participants in 2 prospective cohort studies of PWUD in Vancouver completed a standardized questionnaire, which asked about awareness, possession, and use of THN; sociodemographic characteristics; and drug use patterns. We conducted multivariable logistic regression analyses to determine factors independently associated with awareness and possession of THN. Results: Of 1137 PWUD, 727 (64%) reported at least 1 previous overdose ever, and 220 (19%) had witnessed an overdose in the previous 6 months. Although 769 (68%) participants overall reported awareness of THN, only 88 of 392 (22%) opioid users had a THN kit, 18 (20%) of whom had previously administered naloxone. Factors that were positively associated with awareness of THN included witnessing an overdose in the previous 6 months (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI], 1.49-3.34; P <.001), possession of THN (aOR = 1.85; 95% CI, 1.11-3.06; P = .02), younger age (aOR = 1.02; 95% CI, 1.01-1.04; P = .003), white race (aOR = 1.67; 95% CI, 1.27-2.19; P <.001), hepatitis C infection (aOR = 1.63; 95% CI, 1.13-2.36; P = .01), residing in Vancouver's Downtown Eastside neighborhood (aOR = 1.93; 95% CI, 1.47-2.53; P < .001), and at least daily heroin injection (aOR = 1.69; 95% CI, 1.09-2.62; P < .02). Conclusion: Efforts to improve knowledge of and participation in the THN program may contribute to reduced opioid overdose mortality in Vancouver. [ABSTRACT FROM AUTHOR]

This article uses a Positive Youth Development framework to explore the experiences of six experiential youth coresearchers (YCs) in the Youth Injection Prevention (YIP) participatory research project, and the parallel track process of empowerment and capacity building that developed. The YIP project was conducted in Metro Vancouver at the BC Centre for Disease Control and community organizations serving street-involved youth. A process evaluation was conducted to explore themes in the YCs experience in the project, as well as process strengths and challenges. Semistructured interviews with the YCs, researcher field notes, and team meeting and debrief session minutes were analyzed. The YIP project appears to have exerted a positive influence on the YCs. Positive self-identities, sense of purpose, reconceptualization of intellectual ability, new knowledge and skills, supportive relationships, finding a voice, and social and self-awareness were among the positive impacts. Process strengths included team-building activities, team check-in and checkout sessions, and professional networking opportunities. Process challenges included the time required to help YCs overcome personal barriers to participation. The YIP project demonstrates that participatory research with street-involved youth is a viable research option that contributes to positive youth development and empowerment. [ABSTRACT FROM PUBLISHER]

Despite various national and provincial tobacco, alcohol, and illicit drug surveys in Canada, tracking trends and patterns of use is difficult. These surveys often target specific populations and are prone to sampling or respondent bias. This article describes a feasibility study to provide alcohol-, illicit drug- and tobacco-related morbidity using hospital separation data. Hospital episodes for diseases and conditions wholly or partially attributable to alcohol, illicit drugs, and tobacco by health authority, age group, sex, and specific ICD-10 codes for British Columbia (BC) were obtained. The most responsible diagnosis statistics were combined with aetiologic fractions for each ICD-10 code to estimate the total burden of substance use by health authority. Hospital admissions attributable to alcohol and tobacco each cause approximately 3 and 5 times respectively, that attributable to illicit drugs. The on going analysis of morbidity data will be used to inform the health authorities, and to assist policy makers in creating and evaluating policies. [ABSTRACT FROM AUTHOR]

The Canadian Community Epidemiology Network on Drug Use (CCENDU) Vancouver-site committee is comprised of representatives from national/provincial/local health and enforcement agencies. It collects, collates and interprets recent local data relating to major drug use to produce regular reports exploring Vancouver data with provincial and national comparisons. Meetings of committee members allow identification of current concerns, inform the data and broaden the context for the members. The seventh Vancouver site report since 1996 was published in July 2007. Data trends are explored with input from committee members; changes in data collection and definitions are clarified. The committee strives to share the knowledge with health authorities, policy makers, agencies and the public. [ABSTRACT FROM AUTHOR]

This pilot project is a province-wide and nationally-supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements. [ABSTRACT FROM AUTHOR]

High rates of residential separation of fathers and children in South Africa demand reliable methods of collecting data on the parenting practices of nonresident fathers. Using questionnaire data from matched mother-father pairs, we assessed the reliability of mother's reports of father's involvement in infant care as a proxy for father's own reports. Agreement between parental reports was reasonable for father's financial provisioning and time spent with the infant, but poor for father's engagement in direct caregiving, decision-making responsibility, and assistance with household chores. Across a range of activities, fathers reported higher levels of involvement than were acknowledged by mothers. Disagreement over definitions of the underlying parenting practices being assessed and definitions of the response categories on the questionnaire appeared to contribute to low levels of overall agreement. Mother and father reports should not be treated interchangeably in research on father involvement. Ideally, future research will incorporate data from multiple observers. [ABSTRACT FROM AUTHOR]