Nutritional and economic advantages for homeless families in shelters providing kitchen facilities and food

Food habits were examined in homeless families in Boston-area hotels and family shelters. Reported household income, food expenditures, food sources, and attitudes were analyzed for 77 caretakers grouped according to kitchen facilities provided and amount of food provided. Diets were analyzed using a 4-week semiquantitative food frequency questionaire for 71 female respondents grouped by type of residence (hotel or shelter). Median monthly income was $589 and was similar among groups. Mean monthly food expenditures were lower for those who lived in shelters that provided standard kitchen facilities and substantial food support compared with those who lived in hotels without these amenities ($93 vs $244; P < .05). Compared with others, respondents who lived in hotels reported purchasing food more frequently (P < .05), were more likely to use food pantries (P < .01), and had fewer food items on hand (P < .01). They were less likely to be satisfied with their diets, access to food, and cooking and food storage facilities (P < .05). Nutrient intakes were frequently below two thirds of the Recommended Dietary Allowance for vitamin B-6 (63% of respondents), calcium (44%), and iron (44%). Vitamin A intakes were lower in hotel residents, as were vitamin B-6, vitamin C, and zinc per 1,000 kcal (P < .05). We conclude that services provided to homeless families in shelters and hotels may influence food expenditures, food procurement, and women's diets. Nutrition professionals should consider the availability of kitchen facilities and food when counseling homeless families.     

Wabishki Bizhiko Skaanj: a learning pathway to foster better Indigenous cultural competence in Canadian health research

ObjectiveIn Canada, Indigenous people experience racism across diverse settings, including within the health sector. This has negatively impacted both the quality of care that Indigenous people receive as well as how research related to Indigenous populations is conducted. Therefore, an Indigenous-led council at a kidney research network, in partnership with other key stakeholders, sought to create a learning pathway that aims to distill the racism that Indigenous people face, and build cultural competence, within the health sector.ParticipantsThe learning pathway was designed for researchers, health care providers, patient partners and administrators.SettingVarious components of the pathway are established trainings in healthcare and research settings at provincial and national levels. Provincially, some components are implemented in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario.InterventionThe pathway, called Wabishki Bizhiko Skaanj (meaning “White Horse” in Anishinaabemowin), involves six key steps: a culturally tailored blanket exercise that walks participants through the history of local Indigenous Nations/peoples; a more detailed online training program (San’yas); a series of webinars on Indigenous research ethics and protocols; an educational booklet about engaging Knowledge Keepers in research, as well as sharing details about their traditional knowledge and culture; two certification programs about Indigenous ownership of data; and a “book club,” wherein the conversation of racism—and the goal for finding solutions—is continually discussed.OutcomesWabishki Bizhiko Skaanj is working to build cultural competence in the Canadian health sector.ImplicationsThis learning pathway has the potential to address racial disparities across the country and improve health outcomes for Indigenous peoples.     

Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries

BackgroundDue to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic.ObjectiveThe aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage.MethodsTo achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage.ResultsAcross all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage.ConclusionsOur findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics.     

Factors associated to breastfeeding in the first hour of life: systematic review

OBJECTIVE

To identify independent risk factors for non-breastfeeding within the first hour of life.

METHODS

A systematic review of Medline, LILACS, Scopus, and Web of Science electronic databases, till August 30, 2013, was performed without restrictions on language or date of publishing. Studies that used regression models and provided adjusted measures of association were included. Studies in which the regression model was not specified or those based on specific populations regarding age or the presence of morbidities were excluded.

RESULTS

The search resulted in 155 articles, from which 18 met the inclusion criteria. These were conducted in Asia (9), Africa (5), and South America (4), between 1999 and 2013. The prevalence of breastfeeding within the first hour of life ranged from 11.4%, in a province of Saudi Arabia, to 83.3% in Sri Lanka. Cesarean delivery was the most consistent risk factor for non-breastfeeding within the first hour of life. “Low family income”, “maternal age less than 25 years”, “low maternal education”, “no prenatal visit”, “home delivery”, “no prenatal guidance on breastfeeding” and “preterm birth” were reported as risk factors in at least two studies.

CONCLUSIONS

Besides the hospital routines, indicators for low socioeconomic status and poor access to health services were also identified as independent risk factors for non-breastfeeding within the first hour of life. Policies to promote breastfeeding, appropriate to each context, should aim to reduce inequalities in health.     

COVID-19 Vaccine Perception in South Korea: Web Crawling Approach

BackgroundThe US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss.ObjectiveThis study aimed to investigate Korean citizens’ perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance.MethodsThis cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens’ perception of COVID-19 vaccines. The keywords searched were “vaccine,” “AstraZeneca,” and “Pfizer.” In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results.ResultsThe findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with “vaccine,” “good” ranked first, with a frequency of 13.43% (312/2323). Meanwhile, “side effect” ranked highest, with a frequency of 29.2% (163/559) for “AstraZeneca,” but 0.6% (4/673) for “Pfizer.” With “vaccine,” positive words were more frequently used, whereas with “AstraZeneca” and “Pfizer” negative words were prevalent.ConclusionsThere is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires.     

Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model

BackgroundThe number of suicides in Japan increased during the COVID-19 pandemic. Predicting the number of suicides is important to take timely preventive measures.ObjectiveThis study aims to clarify whether the number of suicides can be predicted by suicide-related search queries used before searching for the keyword “suicide.”MethodsThis study uses the infoveillance approach for suicide in Japan by search trends in search engines. The monthly number of suicides by gender, collected and published by the National Police Agency, was used as an outcome variable. The number of searches by gender with queries associated with “suicide” on “Yahoo! JAPAN Search” from January 2016 to December 2020 was used as a predictive variable. The following five phrases highly relevant to suicide were used as search terms before searching for the keyword “suicide” and extracted and used for analyses: “abuse”; “work, don’t want to go”; “company, want to quit”; “divorce”; and “no money.” The augmented Dickey-Fuller and Johansen tests were performed for the original series and to verify the existence of unit roots and cointegration for each variable, respectively. The vector autoregression model was applied to predict the number of suicides. The Breusch-Godfrey Lagrangian multiplier (BG-LM) test, autoregressive conditional heteroskedasticity Lagrangian multiplier (ARCH-LM) test, and Jarque-Bera (JB) test were used to confirm model convergence. In addition, a Granger causality test was performed for each predictive variable.ResultsIn the original series, unit roots were found in the trend model, whereas in the first-order difference series, both men (minimum tau 3: −9.24; max tau 3: −5.38) and women (minimum tau 3: −9.24; max tau 3: −5.38) had no unit roots for all variables. In the Johansen test, a cointegration relationship was observed among several variables. The queries used in the converged models were “divorce” for men (BG-LM test: P=.55; ARCH-LM test: P=.63; JB test: P=.66) and “no money” for women (BG-LM test: P=.17; ARCH-LM test: P=.15; JB test: P=.10). In the Granger causality test for each variable, “divorce” was significant for both men (F₁₀₄=3.29; P=.04) and women (F₁₀₄=3.23; P=.04).ConclusionsThe number of suicides can be predicted by search queries related to the keyword “suicide.” Previous studies have reported that financial poverty and divorce are associated with suicide. The results of this study, in which search queries on “no money” and “divorce” predicted suicide, support the findings of previous studies. Further research on the economic poverty of women and those with complex problems is necessary.     

Current status of foodservice nutrition management and effects of welfare facility support for the elderly in Cheongju City

BACKGROUND/OBJECTIVESSouth Korea is representative of countries experiencing rapid societal aging. This study aimed to understand the current status of foodservice nutrition management provided to welfare facilities for the elderly and to understand improvements after support from “the Center for Social Welfare Foodservice Management (CSWFM)” in Cheongju City.SUBJECTS/METHODSThe status of foodservice nutrition management was assessed by dietitians and hired by the CSWFM, who visited 40 welfare facilities (registered members of the CSWFM) for the elderly in Cheongju City. After visiting each facility three times from July to December 2019, the results of inspections on four areas, that is, ‘menu’, ‘meal provision’, ‘cooking’, and ‘distribution’ management for 2nd and 3rd visits (support visits) were compared with results obtained at initial visits.RESULTSBefore support as determined during 1st visits, compliance rates with ‘menu’, ‘meal provision’, ‘cooking’, and ‘distribution’ requirements were 72.1%, 75.5%, 58.3%, and 77.5%, respectively. The mean compliance rate for all 15 items on the questionnaire used was 70.8%. Items with low compliance rates were ‘Is the soup provided by foodservice at the recommended salinity?’ (compliance rate 37.5%) and ‘Is the foodservice cooking conducted by referring to a recipe?’ (42.5%). At the two support visits, mean compliance rates increased significantly (P < 0.01, P < 0.001), mean total score had significantly increased from 71.80 to 90.26 (P < 0.001), and mean soup salinity decreased significantly from 0.82% at 1st visits to 0.68% (P < 0.001) and 0.56% (P < 0.001) at the 1st and second follow-up visits.CONCLUSIONSThese results show that the status of nutrition management at welfare facilities for the elderly was much improved by CSWFM involvement, and indicate the CSWFM should continuously provide nutrition management support to facilities and that finances and opportunities for more welfare facilities for the elderly be expanded.     

Assessing homeless population size through the use of emergency and transitional shelter services in 1998: results from the analysis of administrative data from nine US jurisdictions

OBJECTIVES: This study reports findings from the first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period. As such, it provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homeless services over time. METHODS: Each participating jurisdiction collected data through its homeless services management information systems for persons and families who use emergency shelter and transitional housing. The jurisdictions organized the data by a standardized reporting format. These data form the basis for reporting homeless population size, both in raw numbers and as adjusted for each jurisdiction's overall population size, as well as the rate of turnover and average annual length of stay in emergency shelters and transitional housing. RESULTS: Individual jurisdictions had annual rates of sheltered homelessness ranging from 0.1% to 2.1% of their overall population, and 1.3% to 10.2% of their poverty population. Annual population size was 2.5 to 10.2 times greater than the point-prevalent population size. Results are broken down for adults and families. CONCLUSIONS: The prevalence of homelessness varies greatly among the jurisdictions included in this study, and possible factors for this diversity are discussed. Future reports of this nature will furnish similar series of homeless enumerations across a growing number of jurisdictions, thereby providing a basis for exploring the effects of different contextual factors on local prevalence rates of homelessness.     

The impact of COVID-19 pandemic on health-related quality of life of adults visiting emergency departments and primary care settings in Alberta

ObjectivesTo examine the impact of COVID-19 pandemic on health-related quality of life (HRQL) of adults visiting emergency departments (ED) and primary care (PC) settings in Alberta, Canada, and explore whether this impact varies across demographic subgroups.MethodsData from two repeated cross-sectional surveys that measured HRQL using EQ-5D-5L were used; “pre-COVID” Sept 2019–Feb 2020 (ED, N=5927; PC, N=317), “Wave-1” Mar 2020–Aug 2020 (ED, N=4781; PC, N=375), and “Wave-2” Sept 2020–Jan 2021 (ED, N=4443; PC, N=327).ResultsIn the ED sample, there were decrements in mild–extreme problems of 3.7% in mobility and 4.1% in usual activities from pre-COVID to wave 2. There were very minor changes in mild–extreme problems in self-care (decrement=1.3%), pain/discomfort (decrement=2.6%), and anxiety/depression (decrement=0.9%). In the PC sample, there were increases of 4.8% in mild–extreme pain/discomfort and 10.7% in anxiety/depression from pre-COVID to wave 2. Despite these changes, HRQL of both samples pre-COVID and during waves 1 and 2 was worse than that of the general Alberta population. There were no significant variations in the impact of COVID-19 pandemic on HRQL across age, sex, and income subgroups in the ED survey; however, such variations were observed in the PC survey whereby younger adults, females, and those with high income had the largest HRQL deteriorations.ConclusionThe impact of COVID-19 pandemic on HRQL was minimal in adults seeking ED care, but more pronounced in those seen in PC, especially in terms of mental health. Policies around COVID-19 should take into account the needs of certain groups of the population, especially women and young people.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00606-4.     

Emergency Medical Technicians' Experiences of the Challenges of Prehospital Care Delivery During the COVID-19 Pandemic: A Qualitative Study

BackgroundExploring emergency medical technicians'' (EMTs) experiences of COVID-19 epidemic, help to identify the challenges they face in their daily work and develop strategies that address these challenges. This study aimed to explore EMTs'' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic.MethodsThis qualitative study was conducted in March-July 2020 using conventional content analysis approach. Fifteen EMTs were purposively selected from the Emergency Medical Services (EMS) Center in Qom, Iran. For data collection, semi-structured interviews were conducted until data saturation was reached.ResultsEMTs'' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic were classified into three main categories including “restless society”, “difficult care delivery conditions”, and “unprepared organization”. The emergent subcategories were “need for information”, “limited perception of the COVID-19 risk”, “obsessive use of disinfectants”, “fear over the transmission of COVID-19 to self and others”, “burnout due to heavy workload”, “altered communication with hospital staff”, “ethical conflicts”, “lack of a definite treatment plan”, “lack of protective equipment”, “staff shortage due to the affliction of EMTs by COVID-19”, and “inadequate support by authorities”.ConclusionDuring COVID-19 pandemics, EMTs face many challenges including emotional and occupational stress, social strains, risk of affliction by infections, heavy workload, and ethical conflicts and hence, experience difficulties in quality care delivery. Developing appropriate strategies, guidelines, and policies are needed to effectively manage these challenges and improve the quality of prehospital care delivery in COVID-19 epidemic.     

The Neighborhood Context of Homelessness

Objectives. We examined and compared the changing neighborhood characteristics of a group of homeless adults over time.Methods. We collected the addresses of previous housing and sleep locations from a longitudinal study of 400 homeless adults in the St. Louis, Missouri, region and compared census measures of housing and economic opportunities at different points along individual pathways from housing to homelessness and at 1- and 2-year follow-up interviews.Results. Sleep locations of homeless adults were much more concentrated in the urban core at baseline than were their previous housed and follow-up locations. These core areas had higher poverty, unemployment, and rent-to-income ratios and lower median incomes.Conclusions. The spatial concentration of homeless adults in areas with fewer opportunities and more economic and housing distress may present additional barriers to regaining stable housing and employment. A big-picture spatial and time-course viewpoint is critical for both policymakers and future homelessness researchers.Living in emergency shelters or on the streets amplifies the influence of environmental factors on homeless adults, which, in turn, makes a difficult situation even worse. People who find themselves without stable housing are vulnerable to high rates of victimization,1,2 more health problems,3,4 and less access to social support, sustainable employment, and affordable housing. Several studies have suggested that homeless people have been geographically “warehoused” in concentrated urban areas and that the particular environmental attributes of these areas make it more difficult for homeless individuals to improve their situation.5–9 For example, homeless people cite affordable housing as being critically important but also as one of the most difficult needs to meet.10 If the surrounding environment where homeless adults are concentrated has less available and affordable housing and more economic distress, this spatial segregation may be one of the many real barriers to obtaining stable housing in the future.Large urban areas with relatively high concentrations of poverty become the natural targets for the placement of emergency homeless shelters and other social services, developing into what Dear and Wolch11 referred to as service ghettos. This dynamic is typically associated with the skid row era of the early and middle parts of the 20th century, and over the past 2 decades many cities have attempted to decentralize and disperse these areas of concentrated poverty in an ongoing policy of poverty management.12 Although these policies have been mostly unsuccessful in dispersing those who are homeless, the geography of homeless individuals has become more complex and polynucleated than in previous decades.13Few studies have examined the complexities of the physical and social environments surrounding people living on streets and shelters. One promising approach to understanding these environments is to use census data as indicators of social, economic, and housing conditions in the areas in which individuals reside before, during, and after homeless episodes. Culhane et al.14 geocoded previous addresses collected from shelter admissions in New York City, New York, and Philadelphia, Pennsylvania. They matched these addresses with census tracts and corresponding census data for those areas and identified several predictors of shelter admission on the basis of previous residence, namely crowding, higher poverty rates, and higher rents. Generally, these neighborhoods also had higher proportions of African Americans and female-headed households. Using a similar data set from the Philadelphia shelter system and a factor-analytic approach, Wong and Hillier15 reported associations between homelessness risk and what they labeled distressed neighborhoods (higher proportions of African Americans, poverty, boarded-up houses, vacant houses, unemployment, female-headed households, and public assistance income) and unstable neighborhoods (higher proportions of 1-person households, recent moves, and rentals and higher rent-to-income ratios). The authors of both of these studies highlighted the importance of prior neighborhood characteristics yet were unable to identify any longitudinal patterns after the initial shelter admission because they were restricted by the single point of contact collected in the administrative database.In the current study, we explored and compared the neighborhood characteristics of where homeless people come from and end up after 1 or 2 years in a large urban area. By comparing neighborhood characteristics between these 3 points on the homeless pathway, we hoped to better understand whether and how homeless adults are concentrated or dispersed over each individual time course. Were there significant differences in demographics, economic distress, and housing from when they were last housed to where they ended up living in a shelter or on the streets? If we followed these individuals over the next 2 years, would they end up moving away from baseline homeless locations to better or worse neighborhoods? We could only explore these questions in a combined spatial and longitudinal context, which is critical to understanding not just the “who” of homelessness, but also the “where.” With this knowledge, city planners and homeless service providers can better use limited resources to address the barriers to housing on macro and individual levels.     

Linking Data on Constituent Health with Elected Officials’ Opinions: Associations Between Urban Health Disparities and Mayoral Officials’ Beliefs About Health Disparities in Their Cities

Policy Points

• Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income‐based life expectancy disparity in their city.
• Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents.
• Highly visible and publicized information about mortality disparities, such as that related to COVID‐19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.

ContextA substantive body of research has explored what factors influence elected officials’ opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official''s constituents. We assessed whether the magnitude of income‐based life expectancy disparity within a city was associated with the opinions of that city''s mayoral official (i.e., mayor or deputy mayor) about health disparities in their city.MethodsThe independent variable was the magnitude of income‐based life expectancy disparity in US cities. The magnitude was determined by linking 2010‐2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials’ opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics.FindingsIn cities in the highest income‐based life expectancy disparity quartile, 50.0% of mayoral officials “strongly agreed” that health disparities existed and 52.7% believed health disparities were “very unfair.” In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% “strongly agreed” that health disparities existed and 22.2% believed the disparities were “very unfair.” A 1‐year‐larger income‐based life expectancy disparity in a city was associated with 25% higher odds that the city''s mayoral official would “strongly agree” that health disparities existed (odds ratio [OR] = 1.25; P = .04) and twice the odds that the city''s mayoral official would believe that such disparities were “very unfair” (OR = 2.24; P <.001).ConclusionsMayoral officials’ opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income‐based life expectancy disparities among their constituents.     

Gender Difference in the Association Between E-Cigarette Use and Depression among US Adults

ObjectivesThe objective of this study was to determine the association between e-cigarette use and depression and examine how this association is different by gender among US adults.MethodsData from the 2017 Behavioral Risk Factor Surveillance System and Selected Metropolitan/Micropolitan Area Risk Trends was used, and included 174,351 of 230,875 US adults aged 18 years and older. Data were analyzed using the multivariate logistic regression models.ResultsAfter adjusting for age, race, education, income, marital status, employment status, smoking status, and physical activity, firstly, “current daily e-cigarette users” (AOR = 2.487, p < 0.001), “current non-daily e-cigarette users” (AOR = 1.623, p < 0.001), and “former e-cigarette users” (AOR = 1.573, p < 0.001) were associated with increased odds of depression compared with “never e-cigarette users.” Secondly, women were associated with increased odds of depression compared with men (AOR = 1.797, p < 0.001). Finally, male “current daily e-cigarette users” (AOR = 1.366, p < 0.01) were associated with increased odds of depression compared with female “never e-cigarette users.”ConclusionThus, even though women tend to be more vulnerable to depression compared with men, e-cigarette use was positively associated with depression among both men and women.     

The Politics of Drug Rehabilitation in the Philippines

The international consensus to end compulsory drug treatments and close forced rehabilitation facilities needs urgent transformation to country policies. In the Philippines, as with other countries in Asia, rehabilitation can be compulsory and is seen as the humane alternative to the “war on drugs.” In this paper, we present the landscape of rehabilitation and narrate the ways in which people who use drugs are forced to undergo treatment. We unpack the politics behind rehabilitation and explain the sociocultural foundations that support compulsory treatment. We argue that a transition to a human rights-based approach, including voluntary alternatives in community settings, is possible by capitalizing on the reforms that are, unwittingly, the result of the “war on drugs.”

This paper analyzes the Philippines as a case study of how politics and populism have framed the understanding and implementation of drug rehabilitation, particularly in an unstable democracy with a long history of authoritarianism and oligarchic patrimonialism.¹ The Philippines has taken global center stage since the Duterte administration’s launch of a “war on drugs” in 2016, with much attention and concern focused on extrajudicial killings—numbering at least several thousand—in connection with this campaign.²Less critically examined, however, is how this period—during which drugs have been at the forefront of political and public discourse—has shaped compulsory drug interventions in the country. Compulsory treatment in the Philippines occurs inside spectacular “mega rehabilitation centers” and in the context of a growing number of public and private drug treatment facilities.³ During the height of the “war on drugs,” the police conducted door-to-door searches in order to compel people who use drugs to “surrender”—effectively a form of forced apprehension—and undergo “voluntary” rehabilitation.⁴ Philippine drug courts continued ordering people who use drugs to undergo rehabilitation in government centers or inside jails, with rehabilitation considered a penalty under the national drug law.⁵ In recent years, promising community-based programs have operated in parallel with compulsory detention and involuntary treatment, but difficulties have arisen in implementing a fully autonomy-respecting system given the punitive legal environment for people whose lives include drugs.⁶In this case study, we argue that long-standing perceptions on drugs in the Philippines have created an uncritical acceptance that people who use drugs require “rehab” and, consequently, a permissive political environment for compulsory detention and involuntary treatment. Moreover, we argue that the punitive drug regime has reinforced similarly pernicious attitudes by presenting forced “rehab” as the humane and acceptable alternative to extrajudicial killings. To support our findings, we present figurations of “rehab” in the country over the past six years, from the Duterte administration’s statements and programs to the policy pronouncements of those who are running to succeed him in the 2022 elections. We explain this fixation on treating people who use drugs as either criminals or patients—in both cases deemed as without full autonomy to make informed and moral personal decisions—as a product of exploited populism in a predominantly Catholic country. Drawing from international human rights obligations in relation to drug policy, we conclude by identifying critical leverage points and structural factors that drug policy reformists in unstable democracies can maneuver toward a public health-centered framework that respects full patient autonomy and human dignity.     

Design Strategy for Flexible Health Sciences Facilities

A statistical analysis of spatial allocations in university teaching hospitals and medical schools in three countries supports the hypothesis that on the “macro” level of major functional zones there is a considerable degree of invariance in space ratios, despite wide divergence in size, organization, and operating policies. On the basis of these findings a model is developed that makes it possible to predict, from a variety of indicators of space “needs,” the total area of a health sciences facility defined by levels of support servicing. The outputs of the model are seen as the inputs to a design strategy for potentially flexible medical facilities served by a communication lattice capable of indefinite extension.     

A structured community engagement strategy to support uptake of TB active case-finding

BACKGROUND:In Lima, Peru, a mobile TB screening program (“TB Móvil”) was implemented in high TB prevalence districts to increase TB screening. Community engagement activities to promote TB Móvil were simultaneously conducted.OBJECTIVE:To describe a structured, theory-driven community engagement strategy to support the uptake of TB Móvil.METHODS:We adapted Popular Opinion Leader (POL), an evidence-based social networking intervention previously used in Peru to promote HIV testing, for TB Móvil. Community health workers, women who run soup kitchens, and motorcycle taxi drivers served as “popular opinion leaders” who disseminated information about TB Móvil in everyday conversations, aided by a multi-media campaign. Performance indicators of POL included the number/characteristics of persons screened; number of multimedia elements; and proportion of persons with abnormal radiographs hearing about TB Móvil before attending.RESULTS:Between February 2019 and January 2020, 63,899 people attended the TB Móvil program at 210 sites; 60.1% were female. The multimedia campaign included 36 videos, 16 audio vignettes, flyers, posters, community murals and “jingles.” Among attendees receiving an abnormal chest X-ray suggestive of TB, 48% (6,935/14,563) reported hearing about TB Móvil before attending.CONCLUSIONS:POL promotes the uptake of TB Móvil and should be considered as a strategy for increasing TB screening uptake.