Top

Published in:

Open Access 01-12-2024 | Anxiety | Research

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

Authors: Lourdes Johanna Avelar Portillo, Alhelí Calderón-Villarreal, Daniela Abramovitz, Alicia Harvey-Vera, Susan Cassels, Carlos F. Vera, Sheryl Munoz, Arturo Tornez, Gudelia Rangel, Steffanie A. Strathdee, Georgia L. Kayser

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

Water, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.

Methods

From 2020–2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.

Results

Participants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02–1.58), sanitation (Adj RR:1.28; 95% CI: 1.07–1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15–1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12–1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27–1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01–1.89).

Conclusion

The lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.

Hadley C, Freeman MC. Assessing reliability, change after intervention, and performance of a water insecurity scale in rural Ethiopia. Food Security. 2016;8(4):855–64. https://doi.org/10.1007/s12571-016-0599-1.

Nounkeu C, Kamgno J, Dharod J. Assessment of the relationship between water insecurity, hygiene practices, and incidence of diarrhea among children from rural households of the Menoua Division, West Cameroon. J Public Health Afr. 2019;10(1):951. https://doi.org/10.4081/jphia.2019.951.

Miller JD, Vonk J, Staddon C, Young SL. Is household water insecurity a link between water governance and well-being? A multi-site analysis. J Water Sanitation Hygiene Dev. 2020;10(2):320–34. https://doi.org/10.2166/washdev.2020.165.

Rosinger A. Heat and hydration status: Predictors of repeated measures of urine specific gravity among Tsimane’ adults in the Bolivian Amazon. Am J Phys Anthropol. 2015;158(4):696–707. https://doi.org/10.1002/ajpa.22813.

Demyers C, Warpinski C, Wutich A. Urban Water Insecurity: A Case Study of Homelessness in Phoenix. Arizona Environmental Justice. 2017;10(3):72–80. https://doi.org/10.1089/env.2016.0043.

Beetz R. Mild dehydration: A risk factor of urinary tract infection? Eur J Clin Nutr. 2003;57:S52–8. https://doi.org/10.1038/sj.ejcn.1601902.

Sommer M, Gruer C, Smith RC, Maroko A, Hopper K. Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City. Health Place. 2020;66:102431. https://doi.org/10.1016/j.healthplace.2020.102431.

Elbanna B, Dell NA, Klier M. Women ’ s Reproductive Health Menstrual Hygiene Management among Homeless Women With Mental Illness in St . Louis Metropolitan Area : A Qualitative Study. Womens Reprod Health. 2022;0(0):1–17. https://doi.org/10.1080/23293691.2022.2124138.

Leibler JH, Zakhour CM, Gadhoke P, Gaeta JM. Zoonotic and Vector-Borne Infections Among Urban Homeless and Marginalized People in the United States and Europe, 1990–2014. Vector Borne Zoonotic Dis. 2016;16(7):435–44. https://doi.org/10.1089/vbz.2015.1863.

10.

Leibler JH, León C, Cardoso LJP, Morris JC, Miller NS, Nguyen DD, et al. Prevalence and risk factors for MRSA nasal colonization among persons experiencing homelessness in Boston. MA Journal of Medical Microbiology. 2017;66(8):1183–8. https://doi.org/10.1099/jmm.0.000552.

11.

Rosinger AY, Young SL. The toll of household water insecurity on health and human biology: Current understandings and future directions. Wiley Interdiscip Rev Water. 2020;7(6):e1468. https://doi.org/10.1002/wat2.1468.

12.

Staddon C, Everard M, Mytton J, Octavianti T, Powell W, Quinn N, et al. Water insecurity compounds the global coronavirus crisis. Water Int. 2020;45(5):416–22. https://doi.org/10.1080/02508060.2020.1769345.

13.

Gundry S, Wright J, Conroy R. A systematic review of the health outcomes related to household water quality in developing countries. J Water Health. 2004;2(1):1–13. https://doi.org/10.2166/wh.2004.0001.

14.

Ennis-McMillan MC. Suffering from Water: Social Origins of Bodily Distress in a Mexican Community. Med Anthropol Q. 2001;15(3):368–90. https://doi.org/10.1525/maq.2001.15.3.368.

15.

Mushavi RC, Burns BFO, Kakuhikire B, Owembabazi M, Vořechovská D, McDonough AQ, et al. “When you have no water, it means you have no peace”: A mixed-methods, whole-population study of water insecurity and depression in rural Uganda. Soc Sci Med. 2020;245:112561. https://doi.org/10.1016/j.socscimed.2019.112561.

16.

Sultana F. Suffering for water, suffering from water: Emotional geographies of resource access, control and conflict. Geoforum. 2011;42(2):163–72. https://doi.org/10.1016/j.geoforum.2010.12.002.

17.

Wutich A, Ragsdale K. Water insecurity and emotional distress: Coping with supply, access, and seasonal variability of water in a Bolivian squatter settlement. Soc Sci Med. 2008;67(12):2116–25. https://doi.org/10.1016/j.socscimed.2008.09.042.

18.

Workman CL, Ureksoy H. Water insecurity in a syndemic context: Understanding the psycho-emotional stress of water insecurity in Lesotho, Africa. Soc Sci Med. 2017;179:52–60. https://doi.org/10.1016/j.socscimed.2017.02.026.

19.

Wutich A, Brewis A, Chavez JBR, Jaiswal CL. Water, worry, and Doña Paloma: Why water security is fundamental to global mental health. In: Kohrt BA, Mendenhall E, editors. Global Mental Health: Anthropological Perspectives. New York: Routledge; 2015. p. 57–71. https://doi.org/10.4324/9781315428055.

20.

Stevenson EGJ, Ambelu A, Caruso BA, Tesfaye Y, Freeman MC. Community Water Improvement, Household Water Insecurity, and Women’s Psychological Distress: An Intervention and Control Study in Ethiopia. Tsai AC, editor. PLOS ONE. 2016;11(4):e0153432. https://doi.org/10.1371/journal.pone.0153432.

21.

Brewis A, Choudhary N, Wutich A. Household water insecurity may influence common mental disorders directly and indirectly through multiple pathways: Evidence from Haiti. Soc Sci Med. 2019;238(August):112520. https://doi.org/10.1016/j.socscimed.2019.112520.

22.

Abrahams N, Mathews S, Ramela P. Intersections of “sanitation, sexual coercion and girls” safety in schools’. Trop Med Int Health. 2006;11(5):751–6. https://doi.org/10.1111/j.1365-3156.2006.01600.x.

23.

Bisung E, Elliott SJ. Psychosocial impacts of the lack of access to water and sanitation in low- and middle-income countries: A scoping review. J Water Health. 2017;15(1):17–30. https://doi.org/10.2166/wh.2016.158.

24.

Hulland KRS, Chase RP, Caruso BA, Swain R, Biswal B, Sahoo KC, et al. Sanitation, stress, and life stage: A systematic data collection study among women in Odisha, India. PLoS ONE. 2015;10(11): e0141883. https://doi.org/10.1371/journal.pone.0141883.

25.

United Nations Children’s Fund (UNICEF) and World Health Foundation (WHO). Progress on Household Drinking Water, Sanitation and Hygiene 2000–2022: Special Focus on Gender. New York; 2023. [cited 2023 Oct 18]. Available from: https://washdata.org/reports/jmp-2023-wash-households.

26.

Avelar Portillo LJ, Kayser G, Ko C, Vasquez A, Gonzalez J, Avelar DJ, Alvarenga N, Franklin M, Chiang Y. Water, Sanitation, and Hygiene (WaSH) Insecurity in Unhoused Communities of Los Angeles, California. Int J Equity Health. 2023;22:108. https://doi.org/10.1186/s12939-023-01920-8.

27.

Ballard AM, Cooper HLF, Young AM, Caruso BA. ‘You feel how you look’: Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use. PLOS Water. 2022;1(5):e0000019. https://doi.org/10.1371/journal.pwat.0000019.

28.

Calderón-Villarreal A, Terry B, Friedman J, González-Olachea SA, Chavez A, Díaz López M, et al. Deported, homeless, and into the canal: Environmental structural violence in the binational Tijuana River. Soc Sci Med. 2022;305(February):115044. https://doi.org/10.1016/j.socscimed.2022.115044.

29.

Capone D, Cumming O, Nichols D, Brown J. Water and sanitation in Urban America, 2017–2019. Am J Public Health. 2020;110(10):1567–72. https://doi.org/10.2105/AJPH.2020.305833.

30.

Flanigan S, Welsh M. Unmet needs of individuals experiencing homelessness near San Diego waterways: The roles of displacement and overburdened service systems. J Health Hum Serv Adm. 2020;43(2):105–30.

31.

Leibler JH, Nguyen DD, León C, Gaeta JM, Perez D. Personal hygiene practices among urban homeless persons in Boston, MA. Int J Environ Res Public Health. 2017;14(8):928. https://doi.org/10.3390/ijerph14080928.

32.

Armstrong G, Jorm AF, Samson L, Joubert L, Nuken A, Singh S, et al. Association of depression, anxiety, and suicidal ideation with high-risk behaviors among men who inject drugs in Delhi, India. J Acquir Immune Defic Syndr. 2013;64(5):502–10. https://www.doi.org/10.1097/QAI.0b013e3182a7ef21.

33.

Waldrop-Valverde D, Valverde E. Homelessness and psychological distress as contributors to antiretroviral nonadherence in HIV-positive injecting drug users. AIDS Patient Care STDS. 2005;19(5):326–34. https://doi.org/10.1089/apc.2005.19.326.

34.

Stein JA, Dixon EL, Nyamathi AM. Effects of Psychosocial and Situational Variables on Substance Abuse Among Homeless Adults. Psychol Addict Behav. 2008;22(3):410–6. https://psycnet.apa.org/doi/10.1037/0893-164X.22.3.410.

35.

Brouwer KC, Strathdee SA, Magis-Rodríguez C, Bravo-García E, Gayet C, Patterson TL, et al. Estimated numbers of men and women infected with HIV/AIDS in Tijuana, Mexico. J Urban Health. 2006;83(2):299–307. https://doi.org/10.1007/s11524-005-9027-0.

36.

Meacham MC, Strathdee SA, Rangel G, Armenta RF, Gaines TL, Garfein RS. Prevalence and Correlates of Heroin – Methamphetamine Co-Injection Among Persons Who Inject Drugs in San. J Stud Alcohol Drugs. 2016;77(5):774–81. https://doi.org/10.15288/jsad.2016.77.774.

37.

Mehta SR, Wertheim JO, Brouwer KC, Wagner KD, Chaillon A, Strathdee S, et al. HIV Transmission Networks in the San Diego-Tijuana Border Region. EBioMedicine. 2015;2(10):1456–63. https://doi.org/10.1016/j.ebiom.2015.07.024.

38.

Strathdee SA, Fraga WD, Case P, Firestone M, Brouwer KC, Perez SG, et al. “Vivo para consumirla y la consumo para vivir” ["I live to inject and inject to live"]: High-Risk injection behaviors in Tijuana, Mexico. J Urban Health. 2005;82(SUPPL. 4):58–73. https://doi.org/10.1093/jurban/jti108.

39.

Strathdee SA, Magis-Rodríguez C, Mays VM, Jimenez R, Patterson TL. The Emerging HIV Epidemic on the Mexico-US Border: An International Case Study Characterizing the Role of Epidemiology in Surveillance and Response. Ann Epidemiol. 2012;22(6):426–38. https://doi.org/10.1016/j.annepidem.2012.04.002.

40.

Patterson TL, Goldenberg S, Gallardo M, Lozada R, Semple SJ, Orozovich P, et al. Correlates of HIV, sexually transmitted infections, and associated high-risk behaviors among male clients of female sex workers in Tijuana. Mexico Aids. 2009;23(13):1765–71. https://doi.org/10.1097/QAD.0b013e32832f08a1.

41.

Wagner KD, Moynihan MJ, Strathdee SA, Cuevas-Mota J, Clark M, Zúñiga ML, et al. The social and environmental context of cross-border drug use in Mexico: Findings from a mixed methods study of young injection drug users living in San Diego, CA. J Ethn Subst Abuse. 2012;11(4):362–78. https://doi.org/10.1080/15332640.2012.735182.

42.

West BS, Abramovitz D, Gonzalez-Zuniga P, Rangel G, Werb D, Cepeda J, et al. Drugs, Discipline and Death: Causes and Predictors of Mortality among People who Inject Drugs in Tijuana, 2011–2018. Int J Drug Policy. 2020;75:102601. https://doi.org/10.1016/j.drugpo.2019.11.009.

43.

Beletsky L, Wagner KD, Arredondo J, Palinkas L, Magis Rodríguez C, Kalic N, et al. Implementing Mexico’s “Narcomenudeo” Drug Law Reform: A Mixed Methods Assessment of Early Experiences Among People Who Inject Drugs. J Mixed Methods Res. 2016;10(4):384–401. https://doi.org/10.1177/1558689815575862.

44.

Kori N, Roth AM, Lozada R, Vera A, Brouwer KC. Correlates of Injecting in an HIV Incidence Hotspot among Substance Users in Tijuana, Mexico. Int J Drug Policy. 2014;25(3):525–32. https://doi.org/10.1016/j.drugpo.2013.12.005.

45.

Butler LJ, Scammell MK, Benson EB. The Flint, Michigan, Water Crisis: A Case Study in Regulatory Failure and Environmental Injustice. Environ Justice. 2016;9(4):93–7. https://doi.org/10.1089/env.2016.0014.

46.

Hargrove WL, Del Rio M, Korc M. Water matters: Water insecurity and inadequate sanitation in the U.S./Mexico border Region. Environ Justice. 2018;11(6):222–7. https://doi.org/10.1089/env.2018.0022.

47.

Wutich A. Intrahousehold disparities in women and men’s experiences of water insecurity and emotional distress in urban Bolivia. Med Anthropol Q. 2009;23(4):436–54. https://doi.org/10.1111/j.1548-1387.2009.01072.x.

48.

Strathdee SA, Abramovitz D, Harvey-Vera A, Vera CF, Rangel G, Artamonova I, et al. Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region. PLoS ONE. 2021;16(11 November):1–12. https://doi.org/10.1371/journal.pone.0260286.

49.

Yeager S, Abramovitz D, Harvey-Vera AY, Vera CF, Algarin AB, Smith LR, et al. A cross-sectional study of factors associated with COVID-19 testing among people who inject drugs: missed opportunities for reaching those most at risk. BMC Public Health. 2022;22(1):842. https://doi.org/10.1186/s12889-022-13273-y.

50.

Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74. https://doi.org/10.1097/MLR.0b013e318160d093.

51.

Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.

52.

World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Joint Monitoring Programme for Water Supply and Sanitation: Monitoring Drinking Water. 2022. [cited 2022 Jan 1]. Available from: https://washdata.org/monitoring/drinking-water.

53.

World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Joint Monitoring Programme for Water Supply and Sanitation: Monitoring Hygiene. 2022. [cited 2022 Jan 1]. Available from: https://washdata.org/monitoring/hygiene.

54.

Maroko AR, Hopper K, Gruer C, Jaffe M, Zhen E, Sommer M. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLoS ONE. 2021;16(6 June):1–20. https://doi.org/10.1371/journal.pone.0252946.

55.

Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Ann Intern Med. 2007;146(5):317–25. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.

56.

Vasiliadis HM, Chudzinski V, Gontijo-Guerra S, Préville M. Screening instruments for a population of older adults: The 10-item Kessler Psychological Distress Scale (K10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Psychiatry Res. 2015;228(1):89–94. https://doi.org/10.1016/j.psychres.2015.04.019.

57.

Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, et al. Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: Results of a validation study. Am J Geriatric Psychiatry. 2014;22(10):1029–38. https://doi.org/10.1016/j.jagp.2013.01.076.

58.

Chen W, Qian L, Shi J, Franklin M. Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification. BMC Med Res Methodol. 2018;18(1):1–12. https://doi.org/10.1186/s12874-018-0519-5.

59.

James G, Witten D, Hastie T, Tibshirani R. An Introduction to Statistical Learning. New York: Springer New York; 2013. (Springer Texts in Statistics; vol. 103). Available from: http://link.springer.com/10.1007/978-1-4614-7138-7.

60.

Algarin AB, Yeager S, Patterson TL, Strathdee SA, Harvey-Vera A, Vera CF, et al. The moderating role of resilience in the relationship between experiences of COVID-19 response-related discrimination and disinformation among people who inject drugs. Drug Alcohol Dependence. 2023;246(May 2022):109831. https://doi.org/10.1016/j.drugalcdep.2023.109831.

61.

Hemel MMM, Reza MM, Shafiq TKI, Kabir MI, Rana AKMM, Khan SI. Correlates of sharing of needles and syringes among people who inject drugs in Dhaka city, Bangladesh. J Infect Dev Ctries. 2021;15(10):1497–506. https://doi.org/10.3855/jidc.13629.

62.

Wu K, Tie Y, Dasgupta S, Beer L, Marcus R. Injection and Non-Injection Drug Use Among Adults with Diagnosed HIV in the United States, 2015–2018. AIDS Behav. 2022;26(4):1026–38. https://doi.org/10.1007/s10461-021-03457-9.

63.

Mackesy-Amiti ME, Boodram B, Donenberg G. Negative affect, affect-related impulsivity, and receptive syringe sharing among people who inject drugs. Psychol Addict Behav. 2020;34(7):734–44. https://psycnet.apa.org/doi/10.1037/adb0000590.

64.

Caruso BA, Cooper HLF, Haardörfer R, Yount KM, Routray P, Torondel B, et al. The association between women’s sanitation experiences and mental health: A cross-sectional study in Rural, Odisha India. SSM Popul Health. 2018;5(May):257–66. https://doi.org/10.1016/j.ssmph.2018.06.005.

65.

Gaber N, Silva A, Lewis-Patrick M, Kutil E, Taylor D, Bouier R. Water insecurity and psychosocial distress: Case study of the Detroit water shutoffs. J Public Health. 2021;43(4):839–45. https://doi.org/10.1093/pubmed/fdaa157.

66.

Stevenson EGJ, Greene LE, Maes KC, Ambelu A, Tesfaye YA, Rheingans R, et al. Water insecurity in 3 dimensions: An anthropological perspective on water and women’s psychosocial distress in Ethiopia. Soc Sci Med. 2012;75(2):392–400. https://doi.org/10.1016/j.socscimed.2012.03.022.

67.

Caruso BA, Clasen TF, Hadley C, Yount KM, Haardörfer R, Rout M, et al. Understanding and defining sanitation insecurity: Women’s gendered experiences of urination, defecation and menstruation in rural Odisha, India. BMJ Global Health. 2017;2(4):e000414. http://dx.doi.org/10.1136/bmjgh-2017-000414.

68.

Meehan K. Disciplining de facto development: Water theft and hydrosocial order in Tijuana. Environ Plann D Soc Space. 2013;31(2):319–36. https://doi.org/10.1068/d20610.

69.

Scutella R, Johnson G. Psychological distress and homeless duration. Housing Studies. 2018;33(3):433–54. Available from: https://doi.org/10.1080/02673037.2017.1346787

70.

Simmons RL, Whitebeck LB, Bales A. Life on the streets. J Interpersonal Violence. 1989;4(4):379–543. Available from: https://journals.sagepub.com/doi/epdf/10.1177/088626089004004007.

71.

Lee KH, Jun JS, Kim YJ, Roh S, Moon SS, Bukonda N, et al. Mental health, substance abuse, and suicide among homeless adults. J Evid Informed Soc Work. 2017;14(4):229–42. https://doi.org/10.1080/23761407.2017.1316221.

72.

Sharpley CF, Murcell N, Anderson M, Bitsika V, Fourie P, Agnew LL. “How I was then and how I am now”: an evaluation of the effects of being housed upon the Anxiety of Homeless persons in Regional Australia. J Soc Distress Homeless. 2020;29(2):76–83. https://doi.org/10.1080/10530789.2019.1646478.

73.

Hopper K. Reckoning with Homelessness. 1st ed. Ithaca: Cornell University Press; 2015. Available from: https://www.degruyter.com/document/doi/10.7591/9780801471612/html.

74.

Patterson ML, Currie L, Rezansoff S, Somers JM. Exiting homelessness: Perceived changes, barriers, and facilitators among formerly homeless adults with mental disorders. Psychiatric Rehabil J. 2015;38(1):81–7. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/prj0000101.

75.

Tsemberis S. Housing first: Ending homelessness, promoting recovery and reducing cost. In: Ellen IG, Brendan O’Flaherty, editors. How to House the Homeless. New York: Russell Sage Foundation; 2010. 37–56. Available from: https://www.jstor.org/stable/10.7758/9781610447294.

76.

Wong Y-LI. Tracking Change in Psychological Distress among Homeless Adults: An Examination of the Effect of Housing Status. Health Soc Work. 2002;27(4):262–73. Available from: https://academic.oup.com/hsw/article-lookup/doi/10.1093/hsw/27.4.262.

77.

Wong Y-LI, Piliavin I. Stressors, resources, and distress among homeless persons: Soc Sci Med. 2001;52(7):1029–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0277953600002094.

78.

Young SL, Boateng GO, Jamaluddine Z, Miller JD, Frongillo EA, Neilands TB, et al. The Household Water InSecurity Experiences (HWISE) Scale: Development and validation of a household water insecurity measure for low-income and middle-income countries. BMJ Global Health. 2019;4(5):e001750. http://dx.doi.org/10.1136/bmjgh-2019-001750.

79.

Henwood BF, Shinn M, Tsemberis S, Padgett DK. Examining Provider Perspectives Within Housing First and Traditional Programs. Am J Psychiatric Rehabil. 2013;16(4):262–74. https://doi.org/10.1080/15487768.2013.847745.

80.

Johnson G, Chamberlain C. Homelessness and substance abuse: Which comes first? Aust Soc Work. 2008;61(4):342–56. https://doi.org/10.1080/03124070802428191.

81.

Padgett DK, Gulcur L, Tsemberis S. Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Res Soc Work Pract. 2006;16(1):74–83. https://doi.org/10.1177/1049731505282593.

82.

Patterson M, Moniruzzaman A, Palepu A, Zabkiewicz D, Frankish CJ, Krausz M, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol. 2013;48(8):1245–59. https://doi.org/10.1007/s00127-013-0719-6.

Title: WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region
Authors: Lourdes Johanna Avelar Portillo
Alhelí Calderón-Villarreal
Daniela Abramovitz
Alicia Harvey-Vera
Susan Cassels
Carlos F. Vera
Sheryl Munoz
Arturo Tornez
Gudelia Rangel
Steffanie A. Strathdee
Georgia L. Kayser
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Anxiety
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-023-17341-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Association of volatile organic compound exposure with metabolic syndrome and its components: a nationwide cross-sectional study

A scoping review of wildfire smoke risk communications: issues, gaps, and recommendations

Systematic review of cash plus or bundled interventions targeting adolescents in Africa to reduce HIV risk

Intimate partner violence during COVID-19: systematic review and meta-analysis according to methodological choices

Mortality and disability risk among older adults unable to complete grip strength and physical performance tests: a population-based cohort study from China

Effect of long-term care insurance policy on depression in non-disabled people: evidence from China