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Cannabis Use Is Associated with Lower Rates of Initiation of Injection Drug Use Among Street-Involved Youth: A Longitudinal Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-02-12
Abstract: 

Introduction and Aims: Street-involved youth are known to be at elevated risk of initiating injection drug use. However, the impact of so-called “gateway” drugs, such as cannabis, on injection initiation is unknown. The objective of this study was to examine the association between cannabis use and initiation of injection drug use among a prospective cohort of street-involved youth in Vancouver, Canada.

 

Design and Methods: Data for this study were collected from the At-Risk Youth Study (ARYS). From September 2005 to May 2015, participants aged 14-26 who reported illicit drug use were recruited into this open prospective cohort study. An extended Cox regression model with time-updated covariates was used to identify factors independently associated with injection initiation.

 

Results: During the study period 481 street-involved youth were included in this study. Of these, 228 (47.4%) reported at least daily cannabis use, and 103 (21.4%) initiated injection drug use. In a multivariable analysis, ≥ daily cannabis use was associated with slower rates of injection initiation (Adjusted Relative Hazard [ARH]: 0.66, 95% Confidence Interval [CI]: 0.45 – 0.98; p = 0.038). Subanalyses revealed that cannabis use was negatively associated with initiation of injection stimulants but not initiation of injection opioids.

 

Discussion and Conclusions: Given the expansion of cannabis legalization throughout North America, it is encouraging that cannabis use was associated with slower time to initiation of injection drug use in this cohort. This finding challenges the view of cannabis as a gateway substance that precipitates the progression to using harder and more addictive drugs.

 

Document type: 
Article

Increasing Diversion of Methadone in Vancouver, Canada, 2005-2015

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-11-28
Abstract: 

Background and Aim: Although methadone, an opioid agonist, has been an effective medication used to treat opioid use disorder for over 40 years, recent studies have found that methadone was identified in more than a quarter of prescription opioid-related deaths among people who use illicit drugs in Vancouver, Canada. Thus, we sought to longitudinally examine the availability of diverted methadone among people who inject drugs (PWID).

Design and Methods: Data were collected from three prospective cohorts of PWID in Vancouver, Canada between December 2005 and May 2015. Multivariable generalized estimating equation logistic regression was used to identify temporal trends in the immediate availability of diverted methadone (defined as the ability to acquire illicit methadone in <10 minutes).

Results: A total of 2092 participants, including 727 (34.8%) women, were included in the present study. In the multivariable analyses after adjusting for a range of potential confounders, later calendar year (adjusted odds ratio [AOR] = 1.21 per year; 95% confidence interval [CI]: 1.19–1.23) was independently and positively associated with reporting immediate availability of diverted methadone.

Conclusions: We observed a significant increase in the reported availability of diverted methadone among PWID over a ten-year follow-up period. Further research is needed to identify strategies to limit methadone diversion and assess the impact of alternative medications that are equally effective but safer, such as buprenorphine/naloxone.

Document type: 
Article

The Costs of Crime Associated with Stimulant Use in a Canadian Setting

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-09-14
Abstract: 

Background: Costs attributable to criminal activity are a major component of the economic burden of substance use disorders, yet there is a paucity of empirical evidence on this topic. Our aim was to estimate the costs of crime associated with different forms and intensities of stimulant use.

Methods: Retrospective cohort study, including individuals from three prospective cohorts in Vancouver, Canada, measured biannually (2011-2015), reporting stimulant use at baseline assessment. Monthly crime costs included policing, court, corrections, and criminal victimization (2016 CAD). We estimated monthly crime costs associated with mutually exclusive categories of crack, cocaine, methamphetamine, and polystimulant use, stratified by daily/non-daily use, relative to stimulant abstinence, as well as the independent effects of treatment (opioid agonist (OAT) and other addiction treatment). We used a two part model, capturing the probability of criminal activity and costs of crime with generalized linear logistic and gamma regression models, respectively, controlling for age, gender, education, homelessness, mental health issues, employment, prior incarceration, alcohol and opioid use.

Results: The study sample included 1,599 individuals (median age 39, 65.9% male) assessed over 5299 biannual interviews. Estimates of associated monthly crime costs ranged from $5449 [95%C.I.: $2180, $8719] for non-daily polystimulant use, to $8893 [$4196, id="mce_marker"3,589] for daily polystimulant use. Cost differences between daily/non-daily use, injection/non-injection, and stimulant type were not statistically significant. Drug treatment was not associated with lower monthly crime costs in our sample.

Conclusions: Substantial crime-related costs were associated with stimulant use, emphasizing the urgency for development and implementation of efficacious treatment regimens.

Document type: 
Article

Supporting The Sexual Rights of Women Living With HIV: A Critical Analysis of Sexual Satisfaction and Pleasure Across Five Relationship Types

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-04-06
Abstract: 

In the context of HIV, a focus on protecting others has overridden concern about women’s own sexual wellbeing. Drawing on feminist theories, we measured sexual satisfaction and pleasure across five relationship types among women living with HIV in Canada. Of the 1,230 women surveyed, 38.1% were completely or very satisfied with their sexual life, while 31.0% and 30.9% were reasonably or not very/not at all satisfied, respectively. Among those reporting recent sexual experiences (n=675), 41.3% always felt pleasure, with the rest reporting usually/sometimes (38.7%) or seldom/not at all (20.0%). Sex did not equate with satisfaction or pleasure, as some women were completely satisfied without sex while others were having sex without reporting pleasure. After adjusting for confounding factors, such as education, violence, depression, sex work, antiretroviral therapy, and provider discussions about transmission risk, women in long-term/happy relationships (characterized by higher levels of love, greater physical and emotional intimacy, more equitable relationship power, and mainly HIV-negative partners) had increased odds of sexual satisfaction and pleasure relative to women in all other relational contexts. Those in relationships without sex also reported higher satisfaction ratings than women in some sexual relationships. Findings put focus on women’s rights, which are critical to overall well-being.

Document type: 
Article

The Importance of Informational, Clinical and Personal Support in Patient Experience with Total Knee Replacement: A Qualitative Investigation

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-03-24
Abstract: 

Background: Total knee arthroplasty (TKA) is the most frequently performed joint replacement surgery in North America. Patient perspectives on TKA have been investigated in various ways, including finding as many as 20% of TKA patients are dissatisfied with their surgical outcomes. Understanding the patient experience with TKA broadly and in relation to patient satisfaction is a key gap in existing literature.

 Methods: We report on the qualitative component of a mixed methods prospective cohort study examining patient experience and satisfaction post-TKA for adults in British Columbia, Canada. Data collection consisted of 45 in-depth interviews about individuals’ knee surgery experiences conducted eight months after surgery. Analysis consisted of thematic coding by multiple coders.

 Results: Participants’ descriptions of their TKA experiences were primarily concerned with support, or the provision of aid and assistance. Support was insufficient when their expectations of support were not met; unmet support expectations led to an overall negative TKA experience. Support operated in three key domains: (1) informational support, (2) clinical support, and (3) personal support. Key sources of informational and clinical support included pre-optimisation clinics, surgeons, and physiotherapists. Key topics for informational support included pain, pain management, and recovery trajectories. Personal support was provided by family, friends, other TKA patients, employers, and themselves.

 Conclusions: Patient needs and expectations for support are shaped both before and after TKA surgery. Patients with an overall positive TKA experience had improvement in their knee pain, stiffness or functioning post-TKA, had their major expectations and needs for support met during their TKA recovery, and believed that any significant future expectations or needs for ongoing support would be adequately met. In contrast, patients with an overall negative TKA experience had at least one major expectation or need for support not met during their TKA recovery, even in cases where they had good TKA outcomes. Suggested interventions to improve the experience of persons receiving TKA include an expanded patient navigator model, revised pre-surgery educational materials, particularly around pain expectations and management, and comprehensive sharing of other patients’ TKA experience.

Document type: 
Article
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Helmet Use Among Personal Bicycle Riders and Bike Share Users in Vancouver, BC

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-10-01
Abstract: 

Introduction: Public bike share users have low prevalence of helmet use, and few public bike share systems make helmets available. In summer 2016, a public bike share system launched in Vancouver, BC. Each bicycle is equipped with a free helmet, in response to BC's all-ages compulsory helmet law. This study assessed the prevalence of helmet use among adult cyclists on personal and public bicycles in Vancouver.

Methods: A survey of adult cyclists (age estimated at ≥16 years) at five screen line sites and at 15 public bike share docking stations was conducted. Observations were made on fair weather days in 2016. Observers recorded the gender of the rider, bicycle type, helmet use, and helmet type. In 2016, multivariable logistic regression was used to calculate the odds of helmet use by personal and trip characteristics.

Results: Observers conducted 87.5 hours of observation and recorded 11,101 cyclists. They observed 10,704 (96.4%) cyclists on personal bicycles and 397 (3.6%) public bicycle users. Overall, the prevalence of helmet use was 78.1% (n=8,670/11,101), higher for personal bicycle riders (78.6%, n=8,416/10,704) than bike share users (64.0%, n=254/397). Helmet use was associated with gender, bicycle facility type, and day and time of travel.

Conclusions: In a city with all-ages helmet legislation, helmet use is high but differs across infrastructure types and cyclist characteristics. Bike share systems could increase helmet use by providing complementary helmets coupled with supportive measures.

Document type: 
Article

Identifying the Leaders: Applying Diffusion of Innovation Theory to Use of a Public Bikeshare System in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2015-03-01
Abstract: 

Public bike share programs are growing in popularity globally with increasing recognition of their potential and accrued benefits for mobility, health, and the environment. Any city planning to launch a program will be keenly interested in understanding who may use it, in order to enable strategic marketing that will facilitate quick uptake and adoption. We applied the Diffusion of Innovation Theory to data from a population-based telephone survey to characterize who is most likely to use a new public bike share program. The telephone survey of 901 Vancouver residents was conducted prior to the launch of Vancouver's public bike share program. Results showed that a majority (n=614/901, 69.1%, 95% CI: 66.3%/72.7%) of respondents thought that public bike share was a good idea, however, only a quarter (n=217/901, 24.2%, 95% CI: 21.1%, 27.3%) said they would be either likely or very likely to use the program. Logistic regression identified characteristics associated with greater and lower likelihood of use. These characteristics were used to create an adoption curve that defines population segments anticipated to be the leaders in adopting the program. The theory was used to develop implementation recommendations to maximize program uptake including ensuring that the program has tangible advantages over driving or transit; is affordable and easy to try out; integrates with transit and car share opportunities; and appeals to social trends such as environmental responsibility. These results can assist planning and promotion in cities set to launch public bike share programs.

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Article
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Xpey' Relational Environments: An Analytic Framework for Conceptualizing Indigenous Health Equity

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-09
Abstract: 

Introduction: Both health equity research and Indigenous health research are driven by the goal of promoting equitable health outcomes among marginalized and underserved populations. However, the two fields often operate independently, without collaboration. As a result, Indigenous populations are underrepresented in health equity research relative to the disproportionate burden of health inequities they experience. In this methodological article, we present Xpey’ Relational Environments, an analytic framework that maps some of the barriers and facilitators to health equity for Indigenous peoples.Methods: Health equity research needs to include a focus on Indigenous populations and Indigenized methodologies, a shift that could fill gaps in knowledge with the potential to contribute to ‘closing the gap’ in Indigenous health. With this in mind, the Equity Lens in Public Health (ELPH) research program adopted the Xpey’ Relational Environments framework to add a focus on Indigenous populations to our research on the prioritization and implementation of health equity. The analytic framework introduced an Indigenized health equity lens to our methodology, which facilitated the identification of social, structural and systemic determinants of Indigenous health. To test the framework, we conducted a pilot case study of one of British Columbia’s regional health authorities, which included a review of core policies and plans as well as interviews and focus groups with frontline staff, managers and senior executives.Conclusion: ELPH’s application of Xpey’ Relational Environments serves as an example of the analytic framework’s utility for exploring and conceptualizing Indigenous health equity in BC’s public health system. Future applications of the framework should be embedded in Indigenous research methodologies.

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Article
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Exposure to PM2.5 and Blood Lead Level in Two Populations in Ulaanbaatar, Mongolia

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2016-02-15
Abstract: 

Approximately 60% of the households in Ulaanbaatar live in gers (a traditional Mongolian dwelling) in districts outside the legal limits of the city, without access to basic infrastructure, such as water, sewage systems, central heating, and paved roads, in contrast to apartment residents. This stark difference in living conditions creates different public health challenges for Ulaanbaatar residents. Through this research study we aim to test our hypothesis that women living in gers burning coal in traditional stoves for cooking and heating during the winter are exposed to higher concentrations of airborne PM2.5 than women living in apartments in Ulaanbaatar, Mongolia, and this exposure may include exposures to lead in coal with effects on blood lead levels. This cross sectional study recruited a total of 50 women, 40–60 years of age, from these two settings. Air sampling was carried out during peak cooking and heating times, 5:00 p.m.–11:00 p.m., using a direct-reading instrument (TSI SidePak™) and integrated polytetrafluoroethylene (PTFE) filters using the SKC Personal Environmental Monitor. Blood lead level (BLL) was measured using a LeadCare II rapid field test method. In our study population, measured PM2.5 geometric mean (GM) concentrations using the SidePak™ in the apartment group was 31.5 (95% CI:17–99) μg/m3, and 100 (95% CI: 67–187) μg/m3 in ger households (p < 0.001). The GM integrated gravimetric PM2.5 concentrations in the apartment group were 52.8 (95% CI: 39–297) μg/m3 and 127.8 (95% CI: 86–190) μg/m3 in ger households (p = 0.004). The correlation coefficient for the SidePak™ PM2.5 concentrations and filter based PM2.5 concentrations was r = 0.72 (p < 0.001). Blood Lead Levels were not statistically significant different between apartment residents and ger residents (p = 0.15). The BLL is statistically significant different (p = 0.01) when stratified by length of exposures outside of the home. This statistically significant difference in increased BLL could be due to occupational or frequent exposure to other sources of indoor or outdoor air pollution that were not measured. Blood lead levels from our study population are the  study measurements published on women aged 40–60 years of age in Mongolia

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Article
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The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-09
Abstract: 

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights.

Document type: 
Article