One Health and reconciliation: media portrayals of dogs and Indigenous communities in Canada.

This qualitative media analysis explores how the Canadian Broadcasting Corporation (CBC) portrayed 'dog problems' and their solutions in Indigenous communities in Canada from 2008 through 2018. We apply a One Health framework to demonstrate how human, animal, and the socio-environmental health are interconnected, which aligns more explicitly with Indigenous worldviews. Through this analysis, we respond to the Truth and Reconciliation Commission of Canada (TRC) Calls to Action, specifically Action 19 (health inequity) and Action 84 (media). We found that the CBC portrayed dogs as "strays" and focused mainly on the removal of dogs, whether rehoming by animal rescue groups or through culling, and that rescue groups were portrayed as 'animal lovers'. Meanwhile, journalists sometimes mentioned the lack of policies to support community-driven dog population control and veterinary services, but these policy deficits did not receive emphasis. The CBC coverage did not highlight systemic injustices that can impact dog health and welfare in Indigenous communities. This media analysis outlines ways forward for reconciliation with Indigenous communities when the media reports on dogs; we recommend journalists (i) focus on lack of veterinary services in communities and the impacts rather than the removal of dogs, (ii) discuss broader systemic structures and policies that limit access to veterinary services in Indigenous communities and (iii) how such resource constraints impact human and animal health.

Responsibility-sharing for pets in disasters: lessons for One Health promotion arising from disaster management challenges.

During disasters, the behaviour of pet owners and of pets themselves may compromise the ability of emergency responders to perform their duties safely. Furthermore, pet loss can have deleterious effects on personal and community recovery. To explore these issues and their implications for health promotion and disaster management practice, we conducted semi-structured interviews with 27 emergency responders in Australia, where disaster policy embraces shared responsibility yet does not acknowledge pets. We found that responders commit to being responsible for protecting human lives, especially members of their teams. Frontline emergency responders did not regard pets as their responsibility, yet decisions made with tragic consequences for pets exacted an emotional toll. Emergency managers consider community education as a pivotal strategy to support building people's capacity to reduce their own risk in disasters. While important, we question whether this is sufficient given that human life is lived in more-than-human contexts. Reformulating the parameters of the Ottawa Charter for Health Promotion as 'One Health Promotion' may help to account for the intermeshed lives of people and pets, while acknowledging human priority in public policy and programming. To acknowledge the influence of people's pets in disaster responses and recovery, we recommend five overlapping spheres of action: (i) integrate pets into disaster management practice and policy; (ii) create pet-friendly environments and related policies; (iii) engage community action in disaster management planning; (iv) develop personal skills by engaging owners in capacity building and (v) reorient health and emergency services toward a more-than-human approach.

Pets can influence people's decision-making during disasters, potentially impacting the ability of emergency service responders to safely perform their duties. The loss of pets in disasters also has detrimental effects on people's health and wellbeing post-disaster. To better understand these issues and their implications for health promotion and disaster management practice, we conducted in-depth interviews with 27 emergency responders in Australia. We found that responders commit to a 'humans first' tenet, and while they do not consider themselves responsible for pets, decisions made with tragic consequences for pets exact an emotional toll. Community education was considered a key strategy for building people's capacity to reduce their risk in disasters. We question whether this is sufficient and adapt the five action areas of the Ottawa Charter for Health Promotion to account for the intermeshed lives of people and pets, while acknowledging human priority in disaster management policy and programming.

What Do Veterinary Students Value about Service Learning? Insights from Subsidized Clinics in an Urban Environment.

To promote accessible veterinary care in the community and to help students refine their communication skills, the University of Calgary, Faculty of Veterinary Medicine (UCVM) partnered with the Calgary Urban Project Society (CUPS), a human services organization, to develop the UCVM-CUPS Pet Health Clinics. These clinics are a service-learning experience where third-year students provide services to those facing barriers to veterinary care in Calgary, Alberta. The clinics are offered at CUPS for 6 weeks at 1 day per week. Each student participates in one 4-hour lab; running two 90-minute appointments. In this mixed-methods article, the question was asked: How does a communication-based veterinary service learning program impact students' perception and knowledge of their skills and their perceived role in community outreach to underserved populations and their animals? All third-year veterinary students (N = 30) participated in the 2018 UCVM-CUPS Pet Health Clinics. Students completed a demographics survey, and a pre- and post-clinic questionnaire. Statistical analysis was used to compare pre- and post-clinic responses, and to determine relationships between questionnaire responses and the demographics survey data. Students were significantly more in agreement with statements that demonstrated confidence in their medical knowledge, technical abilities, and communication skills after participating in the program. There was significantly more disagreement to continue volunteering after graduation, but many planned on providing community outreach. Overall, students felt a strong sense of social responsibility and were motivated to help underserved populations. The findings suggest that communication-based, service-learning experiences are related to greater social awareness and enhance students' clinical skills including communication.

From more-than-human solidarity to multi-species biographical value: insights from a veterinary school about ethical dilemmas in One Health promotion.

This article features a partnership between a veterinary school and a charity that aims to enhance the wellbeing of low-income people. Through this partnership, the charity periodically hosts veterinary clinics for clients and their pets. Even as the veterinarians and veterinary students duly examine people's pets, these pop-up clinics aim to help people and their pets. Hence our analysis revolves around the ethics of 'more-than-human solidarity'. By 'more-than-human solidarity', we mean efforts to help others that either center on or that implicate non-human beings. To delve into the ethical and sociological implications of subsidised veterinary services, and to assist with program planning, we conducted several in-depth interviews with veterinarians. Most substantively, we found that the veterinary school's outreach clinics give rise to multi-species biographical value, which is prized as a pedagogical resource for veterinary students. The veterinarians whom we interviewed felt troubled by the extent to which the pop-up clinics ultimately benefited the veterinary school, but also by the shortage of subsidised veterinary services in the vicinity. Based on these interviews and our own reflections, we invite more scholarship on cultural, economic and political influences that shape the lives of human beings and non-human animals alike.

What drives distress? Rethinking the roles of emotion and diagnosis among people with diabetes in Nairobi, Kenya.

Type 2 diabetes mellitus is a condition that both results from and produces social and psychological suffering. As 'diabetes' increases among low income patients in poorer nations, new challenges arise that drive, co-occur, and result from the condition. In this article, we describe how social suffering produces diabetes by way of addressing the varied social, psychological, and biological factors that drive diabetes and are reflected in diabetes experiences among patients seeking care at a public hospital in Nairobi, Kenya. We recruited a non-probability sample to participate in a cross-sectional study of 100 patients (aged 35-65 years), where half of the participants sought care from a diabetes clinic and half sought care from the primary healthcare clinic. We obtained informed consent in writing, and collected life history narratives, surveys, anthropometrics, and biomarkers. This paper evaluates survey data using frequencies and regression tables. We found that social factors as opposed to disease factors were major drivers of psychological distress among those with and without diabetes. Psychological distress was associated with female gender and feelings of financial and personal insecurity. We also found insulin resistance was common among those undiagnosed with diabetes, suggesting that many seeking primary care for other health conditions did not receive a routine diabetes test (most likely because it is an out-of-pocket cost, or other competing social factors) and therefore delayed their diagnosis and care. Thus, social and economic factors may drive not only emotional distress among people with diabetes but also delayed care seeking, testing, and self-care as a result of cost and other social challenges.

Policies on pets for healthy cities: a conceptual framework.

Drawing on the One Health concept, and integrating a dual focus on public policy and practices of caring from the Ottawa Charter for Health Promotion, we outline a conceptual framework to help guide the development and assessment of local governments' policies on pets. This framework emphasizes well-being in human populations, while recognizing that these outcomes relate to the well-being of non-human animals. Five intersecting spheres of activity, each associated with local governments' jurisdiction over pets, are presented: (i) preventing threats and nuisances from pets, (ii) meeting pets' emotional and physical needs, (iii) procuring pets ethically, (iv) providing pets with veterinary services and (v) licensing and identifying pets. This conceptual framework acknowledges the tenets of previous health promotion frameworks, including overlapping and intersecting influences. At the same time, this framework proposes to advance our understanding of health promotion and, more broadly, population health by underscoring interdependence between people and pets as well as the dynamism of urbanized ecologies.

Physical activity patterns in urban neighbourhood parks: insights from a multiple case study.

BACKGROUND: Many characteristics of urban parks and neighbourhoods have been linked to patterns of physical activity, yet untangling these relationships to promote increased levels of physical activity presents methodological challenges. Based on qualitative and quantitative data, this article describes patterns of activity within urban parks and the socio-demographic characteristics of park visitors. It also accounts for these patterns in relation to the attributes of parks and their surrounding neighbourhoods. METHODS: A multiple case study was undertaken that incorporated quantitative and qualitative data derived from first-hand observation in a purposive sample of four urban parks. Quantitative data, based on direct observation of visitors' patterns of use and socio-demographic characteristics, were collected using a structured instrument. Differences in frequencies of observed activities and socio-demographic characteristics of visitors were compared between the four parks. Qualitative data, based on direct observation of park characteristics and patterns of use, were generated through digital photography and analyzed through captioning. Quantitative data on patterns in activity and socio-demographic characteristics were synthesized with the qualitative data on park and usage characteristics. RESULTS: A comprehensive portrait of each park in the study was generated. Activity types (sedentary, walking, dog-related, cycling, and play), patterns of park use (time of day, day of week), and socio-demographic characteristics (age group, social group) differed between the four parks. Patterns in park use and activity appeared to be associated with socio-demographic characteristics of the surrounding neighbourhoods as well as the physical and social environmental characteristics specific to each park. CONCLUSIONS: Both park and neighbourhood characteristics influence patterns of use and physical activity within parks. The study findings suggest that socio-demographic characteristics of neighbourhoods surrounding parks need be considered in planning, development and management. Engaging local communities could help planners to develop and update urban parks in ways that reflect the needs and characteristics of community residents and, in turn, encourage visits and more physical activity amongst visitors.

'It was not just a walking experience': reflections on the role of care in dog-walking.

Research into physical activity and human health has recently begun to attend to dog-walking. This study extends the literature on dog-walking as a health behaviour by conceptualizing dog-walking as a caring practice. It centres on qualitative interviews with 11 Canadian dog-owners. All participants resided in urban neighbourhoods identified through previous quantitative research as conducive to dog-walking. Canine characteristics, including breed and age, were found to influence people's physical activity. The health of the dog and its position in the life-course influenced patterns of dog-walking. Frequency, duration and spatial patterns of dog-walking all depended on relationships and people's capacity to tap into resources. In foregrounding networks of care, inclusive of pets and public spaces, a relational conceptualization of dog-walking as a practice of caring helps to make sense of heterogeneity in patterns of physical activity among dog-owners.

Fecal contamination of urban parks by domestic dogs and tragedy of the commons.

Contamination of public parks by dogs is a potential source of conflict among park users, causing "tragedy of the commons" problems. Besides the social conflict, feces can pose serious health risks to both dogs and humans. In this study we analyzed the extent and patterns of the distribution of dog feces in the urban parks of the City of Calgary. We collected dog feces from randomly selected locations in the urban parks. The average density of dog feces by the different dog leash policies of the parks and the distribution pattern of the fecal density within the parks were assessed, and the total contamination of the public parks for the entire city was estimated. We found off-leash parks to be significantly more contaminated than other types of parks. We estimated 127.23 g/ha of dog feces are left unpicked in city parks in total every week. Dog feces were found more often and in greater amount in off-leash parks, and near park entrances and parking lots, than in on-leash parks and away from the park entrances. These results suggest that public park visitors, especially those visiting off-leash parks, are likely to be exposed to large amounts of dog feces. Designation of parks as on-leash and educating dog-owners may be an effective approach for reducing the fecal contamination.

Hemoglobin A1c as a diagnostic tool: public health implications from an actor-network perspective.

Public health arguments for collecting hemoglobin A1c (HbA1c) data, particularly in clinical settings, should be reframed to place more emphasis on nonmedical determinants of population health. We compare individual- with population-level interpretations of HbA1c titers. This comparison reveals that public health researchers need to pay close attention to diagnostic tests and their uses, including rhetorical uses. We also synthesize historical and current evidence to map out 2 possible scenarios for the future. In the first scenario, prevention efforts emphasize primary care and focus almost entirely downstream. The second scenario anticipates downstream interventions but also upstream interventions targeting environments. Our analysis adapts actor-network theory to strategic planning and forecasting in public health.

Testing relationships: ethical arguments for screening for type 2 diabetes mellitus with HbA1C.

Since the 1990s, glycated haemoglobin (HbA1C) has been the gold standard for monitoring glycaemic control in people diagnosed as having either type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM). Discussions are underway about diagnosing diabetes mellitus on the basis of HbA1C titres and using HbA1C tests to screen for T2DM. These discussions have focused on the relative benefits for individual patients, with some attention directed towards reduced costs to healthcare systems and benefits to society. We argue that there are strong ethical reasons for adopting HbA1C-based diagnosis and T2DM screening that have not yet been articulated. The rationale includes the differential impact of HbA1C-based diabetic testing on disadvantaged groups, and what we are beginning to learn about HbA1C vis-à-vis population health. Although it is arguable that screening must primarily benefit the individual, using HbA1C to diagnose and screen for T2DM may promote a more just distribution of health resources and lead to advances in investigating, monitoring and tackling the social determinants of health.

Débats autour des races canines et de la santé publique à Montréal et au Québec (2016-2019).

OBJECTIVES: We examine the public policies that have been formulated to reduce the incidence of dog bites. We do so to encourage the adoption of policies aligned with One Health promotion. METHODS: This case-study research involved an ethnographic approach. Our qualitative analysis derived from participant observation, policy documents, media coverage, and interviews with stakeholders in Montreal (Quebec). RESULTS: Following on from a human fatality due to dog bite injuries, the City of Montreal decided to ban certain types of dogs based on their 'breed.' In the ensuing discussions, the 'Calgary model' emerged as an alternative to breed-specific legislation. These discussions led to a change in policy direction for Montreal, and for Quebec as a whole. Furthermore, we discerned marked improvements with respect to intersectoral coordination in the wake of this controversy. CONCLUSION: 'Policy mobilities' offer a useful conceptual apparatus for understanding how public policies for dog bite prevention are polarized around controversial proposals, to the detriment of discussions that focus on policy implementation.

RéSUMé: OBJECTIFS: Nous étudions les politiques publiques formulées pour la prévention des morsures canines, et cherchons à promouvoir les approches « une seule santé ¼. MéTHODOLOGIE: Notre travail repose sur une étude de cas, sur laquelle nous avons posé un regard ethnographique en analysant des données qualitatives : observations de terrain, documentation institutionnelle, couverture médiatique, et entretiens avec des parties-prenantes à Montréal (Québec). RéSULTATS: Suite à un décès lié à une morsure de chien, la Ville de Montréal a décidé de l'interdiction de certains chiens sur la base de leur « race ¼. Les débats voient cependant émerger le « modèle de Calgary ¼ comme une alternative aux législations visant des races canines particulières. Ces discussions mènent à un changement de politique publique à Montréal et plus largement au Québec. En outre, nous portons également notre attention sur les améliorations en matière de coordination intersectorielle que nous constatons entre les acteurs responsables de la mise en œuvre de cette politique. CONCLUSION: Le concept de « circulation des politiques publiques ¼ permet d'éclairer les politiques de prévention des morsures canines à Montréal, en montrant notamment par quels mécanismes certaines propositions controversées polarisent l'attention publique, au détriment des discussions portant sur la mise en œuvre des politiques municipales.

Animal Protection, Law Enforcement, and Occupational Health: Qualitative Action Research Highlights the Urgency of Relational Coordination in a Medico-Legal Borderland.

Across Canada and internationally, laws exist to protect animals and to stop them from becoming public nuisances and threats. The work of officers who enforce local bylaws protects both domestic animals and humans. Despite the importance of this work, research in this area is emergent, but growing. We conducted research with officers mandated to enforce legislation involving animals, with a focus on local bylaw enforcement in the province of Alberta, Canada, which includes the city of Calgary. Some experts regard Calgary as a "model city" for inter-agency collaboration. Based on partnerships with front-line officers, managers, and professional associations in a qualitative multiple-case study, this action-research project evolved towards advocacy for occupational health and safety. Participating officers spoke about the societal benefits of their work with pride, and they presented multiple examples to illustrate how local bylaw enforcement contributes to public safety and community wellbeing. Alarmingly, however, these officers consistently reported resource inadequacies, communication and information gaps, and a culture of normalized disrespect. These findings connect to the concept of "medico-legal borderlands," which became central to this study. As this project unfolded, we seized upon opportunities to improve the officers' working conditions, including the potential of relational coordination to promote the best practices.

Leashes, Litterboxes, and Lifelines: Exploring Volunteer-Based Pet Care Assistance Programs for Older Adults.

At the convergence of population aging and pet-ownership, community stakeholders are well-positioned to support older adults' relationships with companion animals through age-related transitions in health and living arrangements. In this study's setting, a volunteer-based pet care assistance program launched in 2017 to provide practical assistance with pet care for socially disadvantaged, community-dwelling older adults. This case study explored the impacts and feasibility of this and similar programs via (i) an Internet-based environmental scan to compare similar programs and (ii) qualitative interviews with a sampling of diverse community stakeholders (n = 9). A small number of comparable international programs (n = 16) were found. Among these, programs were delivered using a range of funding models; fewer than half involved collaborations across human social services and animal welfare sectors; and none addressed all dimensions of support offered by our local program. Analysis of qualitative interviews highlighted five major themes confirming the value of the volunteer-based approach and the importance of cross-sectoral collaborations in addressing older adults' under-recognized pet care-related needs. Taken together, the findings confirmed the effectiveness of our local program model. Collaborative, cross-sectoral programs that target both human and companion animal well-being hold promise to reduce barriers to pet ownership that many disadvantaged older adults face. This unique approach leverages the health-promoting potential of human-animal relationships in ways that enhance quality of life for individuals, animal welfare, and age-friendliness of communities.

Unleashing their potential: a critical realist scoping review of the influence of dogs on physical activity for dog-owners and non-owners.

BACKGROUND: Dog-owners tend to be more physically active than non-owners; however, dogs have also been shown to inhibit physical activity for non-owners, under some circumstances. METHODS: We conducted a scoping review to identify studies pertaining to the influence of dogs on physical activity for both dog-owners and non-owners, and adopted a critical realist orientation to draw inferences about the positive and negative impact of dogs via their affect on physical and social environments. RESULTS: We identified 35 studies from disparate literatures for review. These studies confirm that dog and owner behaviors affect shared physical and social environments in ways that may influence physical activity patterns, not only among dog-owners but also among non-owners. The direction of influence appears to be most positive in neighborhoods exhibiting high levels of social cohesion, socioeconomic status, perceived safety, dominant culture, or all of these. In disadvantaged neighborhoods, the health of women as well as older adults may be disproportionately affected by dog and owner behavior. CONCLUSIONS: While dogs have the potential to increase physical activity for both dog-owners and non-owners, the presence or absence of dogs will not have a standard effect across the physical and social environments of all neighborhoods. Dogs' contributions to shared environments in ways that support physical activity for all must be leveraged. Thus, specific contextual factors must be considered in relation to dogs when planning neighborhood-level interventions designed to support physical activity. We suggest this population health topic merits further investigation.

Does dog-ownership influence seasonal patterns of neighbourhood-based walking among adults? A longitudinal study.

BACKGROUND: In general dog-owners are more physically active than non-owners, however; it is not known whether dog-ownership can influence seasonal fluctuations in physical activity. This study examines whether dog-ownership influences summer and winter patterns of neighbourhood-based walking among adults living in Calgary, Canada. METHODS: A cohort of adults, randomly sampled from the Calgary metropolitan area, completed postal surveys in winter and summer 2008. Both winter and summer versions of the survey included questions on dog-ownership, walking for recreation, and walking for transportation in residential neighbourhoods. Participation in neighbourhood-based walking was compared, among dog-owners and non-owners, and in summer and winter, using general linear modeling. Stability of participation in neighbourhood-based walking across summer and winter among dog-owners and non-owners was also assessed, using logistic regression. RESULTS: A total of 428 participants participated in the study, of whom 115 indicated owning dogs at the time of both surveys. Dog-owners reported more walking for recreation in their neighbourhoods than did non-owners, both in summer and in winter. Dog-owners were also more likely than non-owners to report participation in walking for recreation in their neighbourhoods, in summer as well as in winter. Dog-owners and non-owners did not differ in the amount of walking that they reported for transportation, either in summer or in winter. CONCLUSIONS: By acting as cues for physical activity, dogs may help their owners remain active across seasons. Policies and programs related to dog-ownership and dog-walking, such as dog-supportive housing and dog-supportive parks, may assist in enhancing population health by promoting physical activity.

A media advocacy intervention linking health disparities and food insecurity.

Media advocacy is a well-established strategy for transmitting health messages to the public. This paper discusses a media advocacy intervention that raised issues about how the public interprets messages about the negative effects of poverty on population health. In conjunction with the publication of a manuscript illustrating how income-related food insecurity leads to disparities related to the consumption of a popular food product across Canada (namely, Kraft Dinner®), we launched a media intervention intended to appeal to radio, television, print and Internet journalists. All the media coverage conveyed our intended message that food insecurity is a serious population health problem, confirming that message framing, personal narratives and visual imagery are important in persuading media outlets to carry stories about poverty as a determinant of population health. Among politicians and members of the public (through on-line discussions), the coverage provoked on-message as well as off-message reactions. Population health researchers and health promotion practitioners should anticipate mixed reactions to media advocacy interventions, particularly in light of new Internet technologies. Opposition to media stories regarding the socio-economic determinants of population health can provide new insights into how we might overcome challenges in translating evidence into preventive interventions.

11 years of regular access to subsidized veterinary services is associated with improved dog health and welfare in remote northern communities.

Access to veterinary services can have positive impacts on animal health and welfare, and on human mental and physical health and well-being; however, many communities worldwide lack access to such services. At their request, the 5 communities of the Sahtu Settlement Area, Northwest Territories, Canada, have received annual access to preventive veterinary services through the University of Calgary's Northern Community Health Rotation since 2008. To determine the reach of the program, we conducted a dog census in 2017. We then conducted a chart review of 11 years of dog medical records from 2008 to 2018 to evaluate how the reach of the program, the uptake of veterinary services, and dog population demographics, health and welfare measures changed over the duration of the program. In the chart review, we used either multi-level logistic regression or generalized linear models, to determine how seven variables, including age, sex, breed, body condition, deworming, vaccination, and sterilization status upon clinic entry, changed over the course of program delivery. Our results suggest that program reach, veterinary service uptake, and dog demographic, health and welfare measures improved over time. We observed high rabies vaccination coverage in some communities (48 %-83 % of the dog population) and moderate overall sterilization status (25 %-56 % of the dog population) with female dog sterilization more common than male (75 % of dogs leaving the 2017 clinics, compared to 43 %). Several dog demographic, health, and welfare measures, including age, body condition, and vaccination, deworming, and sterilization status, were significantly better in later years of the program (all p < 0.001). Differences among communities, both in dog population numbers from the 2017 census (40-89 dogs) and in the uptake of veterinary services in 2017 (48 %-83 % of the dog population), were notable. Vaccination uptake was directly related to clinic attendance, but sterilization was impacted by additional factors, including community members' acceptance of the procedure. Some unintended consequences were noted, however, including the potential effect of sterilization on the availability of traditional dog breeds in the communities. Overall, our study findings demonstrate that subsidized veterinary services provided over a regular and extended period of time benefit animal population demographics, health and welfare, and could have positive impacts on human well-being. The framework of community collaboration and long-term commitment developed through this program serves as a model for achieving common health goals among communities in need and veterinary service providers.

Harnessing social networks along with consumer-driven electronic communication technologies to identify and engage members of 'hard-to-reach' populations: a methodological case report.

BACKGROUND: Sampling in the absence of accurate or comprehensive information routinely poses logistical, ethical, and resource allocation challenges in social science, clinical, epidemiological, health service and population health research. These challenges are compounded if few members of a target population know each other or regularly interact. This paper reports on the sampling methods adopted in ethnographic case study research with a 'hard-to-reach' population. METHODS: To identify and engage a small yet diverse sample of people who met an unusual set of criteria (i.e., pet owners who had been treating cats or dogs for diabetes), four sampling strategies were used. First, copies of a recruitment letter were posted in pet-friendly places. Second, information about the study was diffused throughout the study period via word of mouth. Third, the lead investigator personally sent the recruitment letter via email to a pet owner, who then circulated the information to others, and so on. Fourth, veterinarians were enlisted to refer people who had diabetic pets. The second, third and fourth strategies rely on social networks and represent forms of chain referral sampling. RESULTS: Chain referral sampling via email proved to be the most efficient and effective, yielding a small yet diverse group of respondents within one month, and at negligible cost. CONCLUSIONS: The widespread popularity of electronic communication technologies offers new methodological opportunities for researchers seeking to recruit from hard-to-reach populations.