Developing community resilience in the face of COVID-19: case study from the Estrie region, Canada.

The COVID-19 pandemic undeniably impacted population health and several aspects of community organization, including service delivery and social cohesion. Intersectoral collaboration and equity, two key dimensions of community resilience, proved central to an effective and equitable response to the pandemic. Yet the factors that enabled or constrained communities' capacity to enact intersectoral collaboration and equity-focused action in such times of urgency and uncertainty remain poorly understood. This descriptive qualitative study aimed to (1) describe the processes through which intersectoral collaboration and equity-focused action were deployed during the first wave of COVID-19 and (2) identify factors enabling and constraining these processes. We conducted semi-directed interviews with 35 representatives of the governmental, institutional, and public and third sectors from four municipal regional counties of the Estrie region (Québec, Canada). We coded detailed interview notes following a codebook thematic analysis approach. We identified three processes through which intersectoral collaboration and equity-focused action were deployed: (1) networking; (2) adaptation, creation and innovation; and (3) human-centred action. Examples of levers which supported the deployment of these processes included capitalizing on pre-existing networks, adapting practices and services, and investing in solidarity and mutual aid. The influencing factors we describe represent concrete targets for resilience-building action. Although focused on the COVID-19 pandemic, our findings are relevant to other types of health, social, environmental or economic crises, and may guide health promotion and community development practitioners towards more effective community resilience-building responses.

Widening the gap? Unintended consequences of health promotion measures for young people during COVID-19 lockdown.

During the first wave of the COVID-19 pandemic, global measures preventing the spread of the new coronavirus required most of the population to lockdown at home. This sudden halt to collective life meant that non-essential services were closed and many health promoting activities (i.e. physical activity, school) were stopped in their tracks. To curb the negative health impacts of lockdown measures, activities adapting to this new reality were urgently developed. One form of activity promoted indoor physical activity to prevent the adverse physical and psychological effects of the lockdown. Another form of activity included the rapid development of online learning tools to keep children and youth engaged academically while not attending school. While these health promoting efforts were meant to benefit the general population, we argue that these interventions may have unintended consequences and inadvertently increase health inequalities affecting marginalized youth in particular, as they may not reap the same benefits, both social and physical, from the interventions promoting at-home physical activities or distance learning measures. We elaborate on several interventions and their possible unintended consequences for marginalized youth and suggest several strategies that may mitigate their impact.

Is Smoking Cessation in Young Adults Associated With Tobacco Retailer Availability in Their Activity Space?

INTRODUCTION: The presence of tobacco retailers in residential neighborhoods has been inversely associated with residents' likelihood of quitting smoking. Few studies have yet explored whether this association holds when accounting for tobacco retailers found in the multiple environments where people conduct their daily activities, that is, their activity space. METHODS: We analyzed cross-sectional data from 921 young adults (18- to 25-years old) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada). Respondents self-reported sociodemographic, smoking, and activity location data. Log-binomial regression was used to estimate prevalence ratios (PRs) for the association between smoking cessation and (1) the number of tobacco retailers (counts), and (2) the distance to the closest retailer (proximity) in participants' residential neighborhood and activity space. RESULTS: Smoking cessation was positively associated with low and intermediate tertile levels of tobacco retailer counts in both the residential neighborhood and activity space, and with the furthest distance level in the activity space [PR (95% CI) = 1.21 (1.02 to 1.43)]. CONCLUSIONS: Individuals encounter resources in the course of their regular daily activities that may hamper smoking cessation. This study highlights the relevance of considering the tobacco retail environment of both individuals' residential neighborhood and activity space to understand its association with smoking cessation. IMPLICATIONS: This article contributes to the literature on the association between the tobacco retail environment and smoking cessation in young adults by moving beyond the residential neighborhood to also assess individuals' access to tobacco retailers in the multiple areas where they regularly spend time, that is, their activity space. Findings suggest that lower numbers of tobacco retailers in both the residential neighborhood and activity space, and further distance to tobacco retailers in the activity space are associated with increased smoking cessation.

Helping women transition out of sex work: study protocol of a mixed-methods process and outcome evaluation of a sex work exiting program.

BACKGROUND: For women who want to, exiting sex work can be challenging. Numerous programs strive to help women wanting to exit sex work and secure alternative sources of income by providing targeted support at key moments during the transition, yet few of those initiatives are rigorously evaluated. In 2017 "Exit Doors Here", a 9-month sex work exiting program based on the critical time intervention (CTI) approach, was developed to provide wrap-around support services (e.g., health, addiction, housing, education, and employment supports) to women wishing to transition towards exiting sex work. METHODS: We present the design of an evaluation study of Exit Doors Here which combines quantitative and qualitative methods to assess participant recruitment and retention into the program, program fidelity, and relationships with service providers (process evaluation), as well as progress made by participants in terms of strengthening their social support networks and moving closer to achieving their housing, pre-employment (i.e., educational, training and volunteering), and income-related goals, as well as their involvement in sex work (outcome evaluation). Each year for 4 years, between 25 and 30 Exit Doors Here clients will be invited to complete an interviewer-administered questionnaire at the beginning and after completing the program, and to share data from their CTI charts and related documentation. Once a year, program staff and peer workers will be interviewed, and service providers will be surveyed. DISCUSSION: Conducting a formative (process) evaluation will allow us to inform program implementation and improve program delivery early on for maximum benefit. The summative (outcome) evaluation will provide much needed evidence on the effectiveness of CTI in supporting a traditionally underserved population to achieve the housing, pre-employment and income-related goals they value, and their progress towards reducing their involvement in, and eventually exiting, sex work.

Associations between home and school neighbourhood food environments and adolescents' fast-food and sugar-sweetened beverage intakes: findings from the Olympic Regeneration in East London (ORiEL) Study.

OBJECTIVE: To examine associations between availability of fast-food restaurants and convenience stores in the home and school neighbourhoods, considered separately and together, and adolescents' fast-food and sugar-sweetened beverage (SSB) intakes. DESIGN: Cross-sectional observational study. SETTING: East London, UK. SUBJECTS: Adolescents (n 3089; aged 13-15 years) from the Olympic Regeneration in East London (ORiEL) Study self-reported their weekly frequency of fast-food and SSB consumption. We used food business addresses collected from local authority registers to derive absolute (counts) and relative (proportions) exposure measures to fast-food restaurants and convenience stores within 800 m from home, school, and home and school combined. Associations between absolute and relative measures of the food environment and fast-food and SSB intakes were assessed using Poisson regression models with robust standard errors. RESULTS: Absolute exposure to fast-food restaurants or convenience stores in the home, school, or combined home and school neighbourhoods was not associated with any of the outcomes. High SSB intake was associated with relative exposure to convenience stores in the residential neighbourhood (risk ratio=1·45; 95 % CI 1·08, 1·96) and in the home and school neighbourhoods combined (risk ratio=1·69; 95 % CI 1·11, 2·57). CONCLUSIONS: We found no evidence of an association between absolute exposure to fast-food restaurants and convenience stores around home and school and adolescents' fast-food and SSB intakes. Relative exposure, which measures the local diversity of the neighbourhood food environment, was positively associated with SSB intake. Relative measures of the food environment may better capture the environmental risks for poor diet than absolute measures.

The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults.

BACKGROUND: Despite a declining prevalence in many countries, smoking rates remain consistently high among young adults. Targeting contextual influences on smoking, such as the availability of tobacco retailers, is one promising avenue of intervention. Most studies have focused on residential or school neighbourhoods, without accounting for other settings where individuals spend time, that is, their activity space. We investigated the association between tobacco retailer availability in the residential neighbourhood and in the activity space, and smoking status. METHODS: Cross-sectional baseline data from 1994 young adults (aged 18-25) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada, 2011-2012) were analysed. Residential and activity locations served to derive two measures of tobacco retailer availability: counts within 500 m buffers and proximity to the nearest retailer. Prevalence ratios for the association between each tobacco retailer measure and smoking status were estimated using log-binomial regression. RESULTS: Participants encountering high numbers of tobacco retailers in their residential neighbourhood, and both medium and high retailer counts in their activity space, were more likely to smoke compared to those exposed to fewer retailers. While residential proximity was not associated with smoking, we found 36% and 42% higher smoking prevalence among participants conducting activities within medium and high proximity to tobacco retailers compared to those conducting activities further from such outlets. CONCLUSIONS: This study adds to the sparse literature on contextual correlates of smoking among young adults, and illustrates the added value of considering individuals' activity space in contextual studies of smoking.

Understanding the role of contrasting urban contexts in healthy aging: an international cohort study using wearable sensor devices (the CURHA study protocol).

BACKGROUND: Given the challenges of aging populations, calls have been issued for more sustainable urban re-development and implementation of local solutions to address global environmental and healthy aging issues. However, few studies have considered older adults' daily mobility to better understand how local built and social environments may contribute to healthy aging. Meanwhile, wearable sensors and interactive map-based applications offer novel means for gathering information on people's mobility, levels of physical activity, or social network structure. Combining such data with classical questionnaires on well-being, physical activity, perceived environments and qualitative assessment of experience of places opens new opportunities to assess the complex interplay between individuals and environments. In line with current gaps and novel analytical capabilities, this research proposes an international research agenda to collect and analyse detailed data on daily mobility, social networks and health outcomes among older adults using interactive web-based questionnaires and wearable sensors. METHODS/DESIGN: Our study resorts to a battery of innovative data collection methods including use of a novel multisensor device for collection of location and physical activity, interactive map-based questionnaires on regular destinations and social networks, and qualitative assessment of experience of places. This rich data will allow advanced quantitative and qualitative analyses in the aim to disentangle the complex people-environment interactions linking urban local contexts to healthy aging, with a focus on active living, social networks and participation, and well-being. DISCUSSION: This project will generate evidence about what characteristics of urban environments relate to active mobility, social participation, and well-being, three important dimensions of healthy aging. It also sets the basis for an international research agenda on built environment and healthy aging based on a shared and comprehensive data collection protocol.

Should we use absolute or relative measures when assessing foodscape exposure in relation to fruit and vegetable intake? Evidence from a wide-scale Canadian study.

OBJECTIVE: This paper explores which of absolute (i.e. densities of "healthy" and "unhealthy" food outlets taken separately) or relative (i.e. the percentage of "healthy" outlets) measures of foodscape exposure better predicts fruit and vegetable intake (FVI), and whether those associations are modified by gender and city in Canada. METHODS: Self-reported FVI from participants of four cycles (2007-2010) of the repeated cross-sectional Canadian Community Health Survey living in the five largest metropolitan areas of Canada (n=49,403) was analyzed. Absolute and relative measures of foodscape exposure were computed at participants' residential postal codes. Linear regression models, both in the whole sample and in gender- and city-stratified samples, were used to explore the associations between exposure measures and FVI. RESULTS: The percentage of healthy outlets was strongly associated with FVI among men both in Toronto/Montreal (ß=0.012; P<0.001), and in Calgary/Ottawa/Vancouver (ß=0.008; P<0.001), but not among women. Observed associations of absolute measures with FVI were either weak or faced multicollinearity issues. Overall, models with the relative measure showed the best fit. CONCLUSIONS: Relative measures should be more widely used when assessing foodscape influences on diet. The absence of a single effect of the foodscape on diet positions sub-group analysis as a promising avenue for research.

Is alcohol outlet availability associated with binge drinking in Canadian young adults? Findings from British Columbia and Quebec.

OBJECTIVES: Alcohol availability is associated with alcohol consumption and related harms, but there is less evidence on associations with heavy episodic drinking (HED), a drinking pattern prevalent among young adults. This study aimed to assess the associations between alcohol availability and HED among young Canadians. METHODS: We used a population-based sample of Canadian urban-dwelling young adult drinkers (18‒29 years) from the cross-sectional Canadian Community Health Survey (CCHS; cycles 2015‒2019). We linked data from CCHS respondents in British Columbia and Quebec with two measures of alcohol availability for both offsite and onsite outlets: density (AOD) and accessibility (SAI) within dissemination areas (N = 1,067,747). We used logistic regression to estimate the associations between alcohol availability and monthly HED, adjusting for covariates. RESULTS: The associations between availability and HED differed by province, and availability measure. In British Columbia, offsite and onsite accessibility using SAI was inversely associated with HED. For example, living in neighbourhoods with medium alcohol accessibility (as compared to low) was significantly associated with reduced odds of HED (offsite OR = 0.33, 95% CI 0.17‒0.64; onsite OR = 0.49, 95% CI 0.27‒0.89). In Quebec, offsite availability was positively associated with HED using SAI (although not statistically significant) while no clear trend was seen for onsite availability. CONCLUSION: Results were consistent with previous evidence. Restricting spatial availability of alcohol remains an important public health strategy for decreasing the ease/convenience of access. Understanding why patterns of availability and drinking differ across regions could inform regionally tailored policies.

RéSUMé: OBJECTIFS: La disponibilité des points de vente d'alcool (PVA) dans les quartiers est associée à la consommation d'alcool et aux méfaits qui y sont reliés, mais il y a encore peu de données probantes sur les associations avec la forte consommation épisodique, un mode de consommation d'alcool répandu chez les jeunes adultes. Cette étude visait à évaluer les associations entre la disponibilité des PVA et la forte consommation épisodique d'alcool chez les jeunes adultes canadiens. MéTHODES: Nous avons analysé les données de jeunes adultes (18 à 29 ans) ayant participé à l'Enquête sur la santé dans les collectivités canadiennes (ESCC; cycles 2015‒2019) et vivant en milieu urbain en Colombie-Britannique et au Québec. Nous avons couplé ces données à deux mesures de disponibilité des PVA : la densité et l'accessibilité calculées à l'échelle des aires de diffusion (N = 1 067 747). Nous avons estimé les associations entre la disponibilité des PVA, en distinguant les PVA à consommer sur place (p. ex., bars) et pour emporter (p. ex., dépanneurs), et la forte consommation épisodique d'alcool à l'aide de modèles de régression logistique ajustés pour les variables de confusion potentielle. RéSULTATS: Les associations entre la disponibilité des PVA et la forte consommation épisodique différaient selon la province et la mesure de disponibilité choisie. En Colombie-Britannique, l'accessibilité aux PVA à consommer sur place et à emporter était inversement associée à une forte consommation épisodique d'alcool. Par exemple, le fait de vivre dans des quartiers où l'accessibilité à l'alcool était moyenne (comparativement à faible) était significativement associé à une plus faible probabilité de forte consommation épisodique (RC PVA à consommer sur place = 0,49, IC à 95% : 0,27‒0,89; RC PVA pour emporter = 0,33, IC à 95% : 0,17‒0,64). Au Québec, l'accessibilité aux PVA pour emporter était associée positivement à la forte consommation épisodique (bien que l'association n'était pas statistiquement significative), tandis qu'aucune tendance claire n'a été observée pour la disponibilité des PVA à consommer sur place. CONCLUSION: Nos résultats concordent avec les données probantes antérieures. Restreindre la disponibilité des points de vente d'alcool dans les quartiers demeure une stratégie de santé publique intéressante pour réduire la facilité d'accès à l'alcool. Une exploration plus en profondeur des raisons pour lesquelles les associations entre disponibilité et consommation d'alcool diffèrent entre provinces servirait à énoncer des politiques publiques adaptées aux régions.

Supporting Women Exit Sex Work: A Contribution Analysis of the Exit Doors Here Integrated Care Program in Toronto, Canada.

Introduction: Exiting sex work is a complex process which can be facilitated by integrated action on health and its social determinants such as housing and employment. Few programs offer such coordinated support, and even fewer have been evaluated. We assessed if and how Exit Doors Here, a program anchored in the Critical Time Intervention (CTI) model, facilitated women's progress towards their goals, and exit from sex work. Description: We performed a contribution analysis by combining pre-post questionnaire and administrative data from 55 women enrolled in the program (2018-2021), yearly interviews with program staff and peer mentors, and literature reviews to assess program outcomes and mechanisms as described in the theory of change. Discussion: We found evidence that the program contributed to participants progressing on their pre-employment, housing, income, and sex work exiting goals. We identified four "key ingredients" facilitating success: trust building, collaborative goal setting, connecting with community supports and weekly drop-in sessions. Conclusion: This rigorous theory-based evaluation provides much needed evidence on the process and effectiveness of an integrated sex work exiting program. Findings regarding key program ingredients can inform other interventions serving similarly marginalized populations.

Uncovering the state of knowledge about healthcare gentrification: a scoping review protocol.

INTRODUCTION: Healthcare gentrification is the process in which the distribution of healthcare resources within a neighbourhood affects residents' access to healthcare services. To understand the complexity of healthcare access and to consider the socio-structural dimensions affecting equity in access to care, we aim to explore how healthcare gentrification has been described in the scientific literature and to document the reported relations between gentrification and healthcare access. METHODS AND ANALYSIS: We will conduct a scoping review from data published from inception to September 2024 based on the methodology developed by Arksey and O'Malley (2005) and improved by Levac et al (2010). We will search the following databases: MEDLINE (OVID), Embase (embase.com), CINAHL Plus with Full Text (EBSCO), Web of Science and Geobase (Engineering Village). The review will be conducted from February 2024 to September 2024. The search strategy will be elaborated in conjunction with a professional librarian. Screening of titles and abstracts and full-text screening will be done in duplicates. A third reviewer will arbitrate discrepancies during the screening process. We will present our results narratively. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval since it will be collected from publicly available documents. The results of this scoping review will also be presented as a scientific article, scientific conferences, research webinars also in social media, workshops and conferences organised by healthcare organisations or academic institutions or on any appropriate platform.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities.

INTRODUCTION: Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS: Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION: This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Examining the spatial congruence between data obtained with a novel activity location questionnaire, continuous GPS tracking, and prompted recall surveys.

BACKGROUND: Place and health researchers are increasingly interested in integrating individuals' mobility and the experience they have with multiple settings in their studies. In practice, however, few tools exist which allow for rapid and accurate gathering of detailed information on the geographic location of places where people regularly undertake activities. We describe the development and validation of a new activity location questionnaire which can be useful in accounting for multiple environmental influences in large population health investigations. METHODS: To develop the questionnaire, we relied on a literature review of similar data collection tools and on results of a pilot study wherein we explored content validity, test-retest reliability, and face validity. To estimate convergent validity, we used data from a study of users of a public bicycle share program conducted in Montreal, Canada in 2011. We examined the spatial congruence between questionnaire data and data from three other sources: 1) one-week GPS tracks; 2) activity locations extracted from the GPS tracks; and 3) a prompted recall survey of locations visited during the day. Proximity and convex hull measures were used to compare questionnaire-derived data and GPS and prompted recall survey data. RESULTS: In the sample, 75% of questionnaire-reported activity locations were located within 400 meters of an activity location recorded on the GPS track or through the prompted recall survey. Results from convex hull analyses suggested questionnaire activity locations were more concentrated in space than GPS or prompted-recall locations. CONCLUSIONS: The new questionnaire has high convergent validity and can be used to accurately collect data on regular activity spaces in terms of locations regularly visited. The methods, measures, and findings presented provide new material to further study mobility in place and health research.

Neighborhood Physical and Social Environments and Social Inequalities in Health in Older Adolescents and Young Adults: A Scoping Review.

Poor health and well-being are prevalent among young people. Neighborhoods may play a role in promoting good health. Little is known on if and how neighborhood characteristics affect health, and social inequalities therein, among young people. In this scoping review, we asked: (1) what features of the neighborhood physical and social environments have been studied in association with the physical and mental health and well-being of young people 15 to 30 years old; and (2) to what extent have social differentials in these associations been studied, and how? We identified peer-reviewed articles (2000 to 2023) through database and snowball searches. We summarized study characteristics, exposure(s), outcome(s) and main findings, with an eye on social inequalities in health. Out of the 69 articles reviewed, most were quantitative, cross-sectional, conducted among 18-year-olds and younger, and focused on the residential neighborhood. Neighborhood social capital and mental health were the most common exposure and outcome studied, respectively. Almost half of the studies examined social inequalities in health, mostly across sex/gender, socioeconomic status, and ethnicity. Evidence gaps remain, which include exploring settings other than residential neighborhoods, studying the older age stratum of young adulthood, and assessing a broader range of social inequalities. Addressing these gaps can support research and action on designing healthy and equitable neighborhoods for young people.

Social disparities in alcohol consumption among Canadian emerging adults. / Disparités sociales dans la consommation d'alcool chez les jeunes adultes canadiens.

INTRODUCTION: Young adult drinking is a public health priority, but knowledge of socioeconomic status (SES) indicators and alcohol use among emerging adults (EAs; aged 18-29 years) is primarily informed by college samples, populations in their late teens and early twenties and non-Canadian data. We compared the association of three different SES indicators with monthly heavy episodic drinking (HED), less-than-monthly HED, no HED, and no drinking among Canadian EAs. METHODS: We pooled the 2015 to 2019 waves of the Canadian Community Health Survey to include participants aged 18 to 29 years (n = 29 598). Using multinomial regression, we calculated weighted estimates of alcohol use by education, household income and area-level disadvantage, adjusting for adult roles and sociodemographic characteristics. RESULTS: Approximately 30% of EAs engaged in monthly HED, whereas 16% did not drink at all in the past year. Compared to those in the lowest household incomes, being in the top income quintile was significantly associated with increased relative odds of monthly HED (e.g. in combined SES model, RRR = 1.21, 95% CI: 1.04-1.39). Higher levels of education, being in higher income quintiles and living in less disadvantaged areas were significantly associated with reduced relative odds of no HED and not drinking. Adjusting for adult roles did not substantially change the associations between SES and alcohol use. CONCLUSION: Higher SES was associated with HED among EAs, although the magnitude of association was small. Universal prevention measures addressing the affordability, availability and marketing of alcohol could be complemented by interventions targeting EA populations at higher risk of HED.

Assessing program fidelity to critically reflect on the suitability of Critical Time Intervention to facilitate exiting sex work.

An emerging approach to facilitating exiting sex work is through applying the Critical Time Intervention [CTI] model. CTI represents a time-limited approach that supports marginalized individuals during periods of transition. We performed a fidelity assessment as part of a process evaluation of Exit Doors Here [EDH], a program supporting women who wish to exit sex work. We reflect on the appropriateness of the CTI model for supporting these women, and highlight contextual and population specificities which might need to be considered for effective scaling up of similar programs. First, we applied an existing fidelity assessment tool to the EDH program. Program staff highlighted areas for adaptation. We then adapted the tool based on this feedback and assessed program fidelity by analyzing data from eight participants' CTI charts. Fidelity ratings were computed and interpreted according to established guidelines. Consultations with program staff resulted in adaptations to seven of the 12 fidelity assessment tool items. The majority of adaptations surrounded the time-limited nature of CTI and unique needs of the program participants such as their experiences with violence and substance use. The fidelity assessment of the adapted tool demonstrated that even after adaptations were made, certain items were still not appropriate for this study population. Difficulties in implementing selected program components with high fidelity can be attributed to contextual and population specificities of the study population. This study reiterates the importance of considering such factors when developing and implementing programs aimed at improving the health and livelihoods of marginalized women such as those who engage in sex work.

Limited research exists that speaks to the appropriateness of the Critical Time Intervention [CTI] model for women who attempt to exit sex work. We found that many components of the CTI model [e.g., time limited nature] were not appropriate for providing care to women who engage with sex work due to their complex and intersecting needs/realities. Considering population specificities is key to providing effective health and social care to these groups. These findings contribute to existing gaps in the implementation science literature and program development which aims to assist women exit sex work and other similarly marginalized groups.

Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: Results from a panel study in rural Burkina Faso.

Evidence on how the COVID-19 pandemic has affected women's reproductive health remains scarce, particularly for low- and middle-income countries. Deleterious indirect effects seem likely, particularly on access to contraception and risk of unwanted pregnancies, but rigorous evaluations using quasi-experimental designs are lacking. Taking a diachronic perspective, we aimed to investigate the effects of the pandemic on four indicators of women's reproductive health: history of recent adverse events during pregnancy (past), use of contraception and unwanted pregnancies (present), and childbearing intentions (future). This study was conducted in four rural health districts of Burkina Faso: Banfora, Leo, Sindou and Tenado. Two rounds of household surveys (before and during the pandemic) were conducted in a panel of 696 households using standardized questionnaires. The households were selected using a stratified two-stage random sampling method. All women aged 15-49 years living in the household were eligible for the study. The same households were visited twice, in February 2020 and February 2021. The effects were estimated by fitting hierarchical regression models with fixed effects or random intercepts at the individual level. A total of 814 and 597 women reported being sexually active before and during the COVID-19 pandemic, respectively. The odds of not wanting (any more) children were two times higher during the pandemic than before (2.0, 95% CI [1.32-3.04]). Among those with childbearing intention, the average desired delay until the next pregnancy increased from 28.7 to 32.8 months. When comparing 2021 versus 2020, there was an increase in the adjusted odds ratio of contraception use (1.23, 95% CI [1.08-1.40]), unwanted pregnancies (2.07, 95% CI [1.01-4.25]), and self-reported history of miscarriages, abortions, or stillbirths in the previous 12 months (2.4, 95% CI [1.04-5.43]). Our findings in rural Burkina Faso do not support the predicted detrimental effects of COVID-19 on the use of family planning services in LMICs, but confirm that it negatively affects pregnancy intentions. Use of contraception increased significantly among women in the panel, but arguably not enough to avoid an increase in unwanted pregnancies.

Neighbourhood crime and smoking: the role of objective and perceived crime measures.

BACKGROUND: Smoking is a major public health problem worldwide. Research has shown that neighbourhood of residence is independently associated with the likelihood of individuals' smoking. However, a fine comprehension of which neighbourhood characteristics are involved and how remains limited. In this study we examine the relative contribution of objective (police-recorded) and subjective (resident-perceived) measures of neighbourhood crime on residents' smoking behaviours. METHODS: Data from 2,418 men and women participating in the 2007/8 sweep of the West of Scotland Twenty-07 Study were analyzed. Smoking status and perceived crime were collected through face-to-face interviews with participants. Police-recorded crime rates were obtained from the Scottish Neighbourhood Statistics website at the datazone scale. Adjusted odds ratios and 95% confidence intervals were estimated for the likelihood of current smoking using logistic regression models. Adjusted mean daily amount smoked and F statistics were calculated using general linear models. Analyses were conducted for all respondents and stratified by sex and age cohort. RESULTS: Compared to individuals living in low crime areas, those residing in an area characterized by high police-recorded crime rates or those perceiving high crime in their neighbourhood were more likely to be current smokers, after controlling for individual characteristics. The association with smoking was somewhat stronger for police-recorded crime than for perceived crime. Associations were only slightly attenuated when adjusting for either the objective or subjective crime measures, suggesting that these indicators may exert an independent influence on the risk of smoking. Stronger effects were observed for women compared to men. Police-recorded crime rates were more strongly related to smoking status among older respondents than among the younger cohort, whereas the strongest effect for perceived crime was observed among younger participants. CONCLUSIONS: Our findings highlight the relevance of paying attention to both objective and perceived neighbourhood crime measures when aiming to prevent smoking.

In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world.

In-situ methodologies, including go-along and photo-elicited interviews, are ideal for harnessing people's lived experiences of place and their meanings for health and health equity. Their immersive nature means that the COVID-19 pandemic has impacted their use. Physical distancing measures combined to anxiety over the sharing of physical space have created ethical and practical challenges to the conduct of in-person in-situ methodologies. However, in-situ methodologies are precisely needed to gain deeper understandings of people's changing relationships to place post-COVID-19. In this commentary we discuss emerging challenges, highlight questions researchers should ask before engaging in these methods in the future, and explore adaptations and alternatives to traditional in-person in-situ methodologies.