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Abstract Background Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. Methods In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020–2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. Results Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02–2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28–1.64), and bathing (aRR: 1.21, 95%CI: 1.06–1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07–3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52–2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55–6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36–4.89) than participants living in permanent housing. Conclusion WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID—especially those who are unsheltered.

Introduction: Smoking is associated with many diseases and is a target for primary preventive efforts in numerous morbidities. Studies show that smoking and depression may be associated. Never-smokers are at significantly lower risk than current and former smokers. Despite this observation, the effect of smoking on depression risk reduction has not been adequately explored. The purpose of this study was to explore the effect of smoking on depression risk reduction in adult patients seen in a primary care clinic at an academic medical center 6 months after they were identified as being at risk for depression. Findings may influence the direction and intensity of our smoking cessation endeavors in patients at risk of depression who smoke. Methods: We conducted an analytic cross-sectional study using electronic medical records of patients 18 years and older seen a primary care setting between January 1, 2019 and December 31, 2020. All participants included had an initial depression risk score (assessed by the 9-item Patient Health Questionnaire (PHQ-9)) of 5 or higher, information on smoking status and a PHQ-9 score at 6 months. We determined the percentage of patients with PHQ-9 score decrease of 5 or more at 6 months and used logistic regression to determine the association depression risk reduction (of 5 units or more) at 6 months and smoking, adjusting for demographic, clinical, and behavioral characteristics. Results: Number of patients included were 120, mean age was 55 (16), years, 88 (74%) were female, 68 (57%) were African American, and 31 (26%) were Caucasian. Fifty (44%) had a history of smoking and 31 (25.8%) had improvement (ie, a decrease of 5 units or more) in their PHQ-9 score at 6 months. Smoking was associated with decreased odds of improvement in depressive symptoms (Odds ratio = 0.32, 95% Confidence interval: 0.12-0.87). Conclusion: Risk of depression was more likely to persist in smokers than non-smokers at 6 months. Addressing smoking behavior in those with risk of depression may be beneficial.

For young women, im/migration can impact education, employment, and family dynamics in ways that shape the courses of their lives and health. The purpose of this study is to deepen understandings of how im/migration shapes young women's experiences of pregnancy, motherhood, and marriage. Guided by intersectionality theory and the structural and social determinants of health, we analyzed qualitative interviews conducted with young im/migrants ages 15-30, who identify as women, and who had experiences of pregnancy, motherhood, and/or marriage (N ​= ​34). Participants were interviewed as part of the IRIS study in British Columbia, Canada between May 2019 to February 2021. Young im/migrant women described how im/migration shaped experiences of pregnancy, motherhood, and marriage by way of health, social, legal, and economic drivers. These included being ineligible for health insurance and unable to prevent pregnancy and experiencing workplace discrimination in form of reduced hours and no maternity benefits. Demanding caregiving roles and unsafe home environments were also described as being exacerbated by unaffordable childcare in destination settings and unequal gender roles and power dynamics after im/migration. Our findings suggest structural changes necessary to improve young im/migrant women's health. We recommend that health systems decouple im/migration status from health insurance; that governments provide all people with accessible childcare and maternity benefits; and that governments fund community-based efforts towards dismantling structures of patriarchy.

Abstract Background Sex work criminalization and occupational stigma pose barriers to sex workers’ access to support services, including community participation — engagement with sex work specific community organizing at both formalized and grassroots capacities. In light of gaps in evidence regarding impacts of community participation on sex workers’ occupational health in higher-income settings, we evaluated engagement in community participation and associations with occupational sexual health outcomes among sex workers in Vancouver, Canada. Methods Prospective data from a community-based cohort of 943 women sex workers in Vancouver, British Columbia (2010–2019). We used logistic regression with generalised estimating equations (GEE) to model correlates of community participation, and a confounder modeling approach to examine the association of community participation on sexually transmitted infection (STI) seropositivity. Results Among participants, 38.1% were Indigenous, 31.4% identified as women of colour (e.g., East Asian, Southeast Asian, Black) and 29.3% were im/migrants to Canada. Over a quarter (28.3%, n = 267) serviced in informal indoor spaces, while 38.0% (n = 358) serviced clients in outdoor/public and 31.4% (n = 296) in formal in-call spaces. 8.9% of participants reported sex work community participation at least once over the 9-year study. In multivariable GEE analysis, Indigenous (adjusted odds ratio(aOR) 1.71, 95% confidence interval (CI) 0.88–3.32) and trans women (aOR 4.69, 95%CI 2.43–9.06) had higher odds of community participation; women of colour had lower odds (aOR 0.18, 95%CI 0.06–0.57). In a multivariable GEE confounder model, community participation was independently associated with lower odds of STI seropositivity (aOR 0.66, 95% CI0.45–0.96). Conclusion Sex workers who engaged in sex work community participation faced reduced odds of STI seropositivity. Building off reserach evaluating community interventions in low and middle income contexts, our study provides some of the first quantitative evidence on community participation among sex workers in Canada, and is the first to examine this in relation to sexual health outcomes. This research demonstrates the need to scale up community participation access for sex workers, via linguistically diverse community spaces, anti-stigma initiatives, and decriminalization to reduce barriers faced by racialized sex workers and support occupational health and rights for all sex workers.

Abstract Background Differential impacts of the COVID-19 pandemic have brought deeply rooted inequities to the forefront, where increasing evidence has shown that racialized immigrant and migrant (im/migrant) populations face a disproportionate burden of COVID-19. Im/migrant communities may be worst affected by lockdowns and restrictive measures, face less opportunity to physically distance or stay home sick within ‘essential’ jobs, and experience severe barriers to healthcare. Insufficient attention to experiences of racialized im/migrants in current pandemic responses globally highlights an urgent need to more fulsomely address unmet health needs through an anti-racist, equity-oriented lens. This commentary aims to highlight the need for public health and clinical training, research, and policy to thoughtfully prioritize im/migrant health equity during and beyond the COVID-19 pandemic. Main text Global pandemic responses have neglected im/migrants by continuing to ignore or insufficiently address inequities, exacerbating COVID transmission, xenophobia, and occupational injustice. Deaths, illness, stress, and other negative outcomes of the overlapping epidemics of COVID-19 and structural racism disproportionately borne by racialized im/migrants suggest the urgent need for action. As evidence mounts about how im/migrants have been left behind in times of crises, we need enhanced focus on health equity within COVID-19 research and interventions, including research that examines and pursues structural interventions necessary to mitigate these impacts, and that identifies patterns and harms of xenophobic policy, structural racism, and white supremacy in shaping im/migrant health outcomes. We must also strengthen anti-racist and equity-oriented curriculum within health education, and ensure sufficient attention to the needs of im/migrant communities within public health, clinical, and research training. Conclusion The COVID-19 pandemic has exacerbated and rendered more visible the deeply rooted health and social inequities faced by racialized im/migrants across diverse settings. We argue for a greater emphasis on equity-focused and anti-racist im/migrant health research, interventions, and training. Policymakers and practitioners must ensure that healthcare policies and practices do not exacerbate inequities, and instead meaningfully address unmet needs of communities, including racialized im/migrants. Ethical and respectful community engagement, commitment and collaboration with global, national, and local communities, policymakers, academics, and educators, as well as accountability across sectors, is critical.