Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers.

Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers' accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.

Clearing the air: protocol for a systematic meta-narrative review on the harms and benefits of e-cigarettes and vapour devices.

BACKGROUND: Under the shadow of the tobacco epidemic, the sale and use of e-cigarettes and other vapour devices is increasing dramatically. A contentious debate has risen within public health over the harms and benefits of these devices. Clearing the Air seeks to clarify the issues with a systematic review that informs the pressing regulatory and public health decisions to be made regarding these new products. METHODS/DESIGN: Using an integrated knowledge translation approach, public health researchers and knowledge users will work collaboratively throughout the project. Our research questions are the following: (1) What are the health risks and benefits of vapour devices, and how do these compare to cigarettes? (2) What is the harm reduction potential of vapour devices for individuals, the environment, and society? (3) Does youth vapour device experimentation lead to cigarette use? (4) Can vapour devices be effective aids for tobacco cessation? and (5) What is the potential toxicity of second-hand vapour? We are using meta-narrative review to synthesize studies from diverse research traditions because of its capacity to address contestations around a topic. The project has six phases. In the planning phase, we finalized the research questions. In the search phase, we are locating academic publications and grey literature aided by a research librarian. The mapping phase involves categorizing these papers into research traditions to understand different perspectives on the evidence for each research question. In the appraisal phase, we will select and evaluate the relevant papers. Finally, in the synthesis phase, using analytic techniques unique to meta-narrative methodology, we will compare and contrast the evidence from different research traditions to answer our research questions, identifying overarching meta-narratives. In the final stage, the full team will draft recommendations to be disseminated through a variety of knowledge translation strategies. DISCUSSION: Meta-narrative synthesis has the unique capacity to expose the debates that are influencing the interpretation of empirical studies on vapour devices. We seek to "clear the air" with an even-handed review of the evidence and an understanding of the tensions within public health so that we can offer clear-headed recommendations for policy, regulation, and future research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015025267.

Housing and harm reduction: what is the role of harm reduction in addressing homelessness?

Homelessness and drug use often overlap and the harms of substance use are exacerbated by homelessness. Responding to the twin problems of homelessness and substance use is an important aspect of strategies to end homelessness. The introduction and development of ten year plans to end homelessness in North America heralds a new era of systemic responses to homelessness. Central to many of these plans is the adoption of 'Housing First' as a policy response. Housing First focuses directly on housing people regardless of current patterns of substance use. As such, harm reduction is a key principle of Housing First. In this paper, we examine Housing First as an example of the integration of housing and harm reduction and then put forth a community level policy framework to further promote the integration of harm reduction as part of a response to homelessness. Drawing on Rhodes' risk environment framework and current evidence of Housing First and harm reduction, we describe four key policy areas for action: (1) social inclusion policies; (2) adequate and appropriate supply of housing; (3) on demand harm reduction services and supports and (4) systemic and organizational infrastructure. We conclude by identifying areas for future research.

Addiction research centres and the nurturing of creativity: the Centre for Addictions Research of British Columbia, Canada.

The Centre for Addictions Research of British Columbia (CARBC) was established as a multi-campus and multi-disciplinary research centre administered by the University of Victoria (UVic) in late 2003. Its core funding is provided from interest payments on an endowment of CAD 10.55 million dollars. It is supported by a commitment to seven faculty appointments in various departments at UVic. The Centre has two offices, an administration and research office in Victoria and a knowledge exchange unit in Vancouver. The two offices are collaborating on the implementation of CARBC's first 5-year plan which seeks to build capacity in British Columbia for integrated multi-disciplinary research and knowledge exchange in the areas substance use, addictions and harm reduction. Present challenges include losses to the endowment caused by the 2008/2009 economic crisis and difficulties negotiating faculty positions with the university administration. Despite these hurdles, to date each year has seen increased capacity for the Centre in terms of affiliated scientists, funding and staffing as well as output in terms of published reports, electronic resources and impacts on policy and practice. Areas of special research interest include: drug testing in the work-place, epidemiological monitoring, substance use and injury, pricing and taxation policies, privatization of liquor monopolies, polysubstance use, health determinants of indigenous peoples, street-involved youth and other vulnerable populations at risk of substance use problems. Further information about the Centre and its activities can be found on http://www.carbc.ca.