Prevalencia de conductas alimentarias de riesgo en adolescentes mexicanos: Ensanut Continua 2022.

OBJETIVO: Reportar prevalencias poblacionales actualizadas de conductas alimentarias de riesgo (CAR) con respecto a edad, sexo, condiciones de bienestar, tipo de localidad y región del país. Material y métodos. Se utilizaron los datos de adolescentes (n = 3 547) de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022) obtenidos mediante el cuestionario breve de conductas alimentarias de riesgo (CBCAR) y datos sociodemográficos. Se obtuvieron prevalencias e intervalos de confianza. RESULTADOS: El 1.6% (2.0% en mujeres y 1.2% en hombres) de los adolescentes tienen riesgo de un trastorno de la conducta alimentaria, en aquéllos entre 14 y 19 años, 2.3%, en zonas urbanas 2.1%, en la región centro 2.9% y por tercer quintil de bienestar, 3.1%. Conclusión. Los datos mostrados señalan la importancia de continuar monitoreando las CAR en encuestas representativas nacionales, a diferencia de los estudios realizados en muestras no probabilísticas; la Ensanut permite contar con datos que reflejan la diversidad de la población mexicana.

Coping with climate change: The role of climate related stressors in affecting the mental health of young people in Mexico.

Young people today are predicted to experience more climate change related stressors and harms than the previous generation, yet they are often excluded from climate research, policy, and advocacy. Increasingly, this exposure is associated with experience of common mental health disorders (CMD). The VoCes-19 study collected surveys from 168,407 young people across Mexico (ages 15-24 years) through an innovative online platform, collecting information on various characteristics including CMD and experience of recent climate harms. Logistic regression models were fit to explore characteristics associated with CMD. Structural equation models were fit to explore pathways between exposure, feeling of concern about climate change, and a sense of agency (meaning the respondent felt they could help address the climate crisis) and how these relate to CMD. Of the respondents, 42% (n = 50,682) were categorized as experiencing CMD, higher among those who experienced a climate stressor (51%, n = 4,808) vs those not experiencing climate stressors (41%, n = 43,872). Adjusting for key demographic characteristics, exposure to any climate event increased the odds of CMD by 50% (Odd Ratio = 1.57; 95% Confidence Interval (CI) 1.49, 1.64), highest for heatwaves. Specific climate impacts such as housing damage, loss of or inability to work, damage to family business, leaving school and physical health affected were adversely related to CMD, though for different climate hazards. More concern and less agency were related to CMD through different pathways, particularly for those exposed to recent events. Future research regarding the cumulative exposures to climate change, not just acute events but as an ongoing crisis, and various pathways that influence the mental health and well-being of young people must be clearly understood to develop programs and policies to protect the next generation.

Changes in mental health problems during the COVID-19 pandemic in Mexican youth: Insights from the Voces-19 study.

BACKGROUND: Previous research suggests that the mental health impacts of the COVID-19 pandemic were stronger during the first months of it. It has also been proposed that those impacts depended on gender and other social determinants. AIMS: We aim to describe the change in prevalence of mental health problems (symptoms of common mental disorders [CMD], alcohol, and drug use) between two time periods during the pandemic, and the association of mental health problems with social determinants, in adolescents and young adults in Mexico. METHODS: We conducted a repeated cross-section analysis of data from VoCes-19, an online survey in November 2020 to February 2021 and November 2021 to March 2022 (combined n = ×224,099). We assessed the change in the prevalence of mental health problems, the differences in prevalence and change in the prevalence by gender, and the association of social determinants and pandemic-related variables with mental health problems, by means of multivariate regression models. RESULTS: The prevalence of CMD decreased (46.0% vs. 42.4%), while the prevalence of alcohol (frequent use 8.4% vs. 10.3%) and drug use (4.6% vs. 7.7%) increased. The three conditions increased more among girls/young women and trans/queer/non-binary participants than among boys/young men. CONCLUSIONS: The results point to the importance of considering the gendered social context of young people. A better understanding of the social circumstances that relate with mental health is required to inform interventions for these age groups.

Narrative strategies to re-signify sexual violence among gender and sexuality diverse Central American migrants in Tijuana.

This study discusses how gender and sexuality diverse Central American migrants, currently staying at shelters in Tijuana, reconstruct experiences of sexual violence in their lives, both during childhood and throughout their migratory journey. It analyses the narrative strategies used to re-signify these experiences in the present, to construct possible futures as sexual subjects. In-depth autobiographical interviews were conducted with nine Central American migrants of diverse genders and sexualities and were analysed using an approach inspired by dramaturgical analysis. We identified the most significant events, characters and settings related to experiences of sexual violence. Three main strategies of resignification were identified: the reaffirmation of pleasure, desire, or consent; the decision to emigrate; and entry into loving-affective relationships. The focus on the analysis of sexual violence before and during the migration event represents a contribution to the ongoing debate on sexuality, gender, and migration. Strategies of resignification allow participants to imagine possible narratives future as subjects who wish to express their gender identity and sexuality freely.

[Voluntary interruption of pregnancy and sexual and reproductive health in migrant women in BarranquillaInterrupção voluntária da gravidez e saúde sexual e reprodutiva em mulheres migrantes em Barranquilla]. / Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla.

Objective: Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods: Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results: A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions: Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

Objetivo: Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos: Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados: Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões: Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

[Provision of sexual and reproductive health services to Central American migrants in TijuanaOferta de serviços de saúde sexual e reprodutiva para migrantes da América Central em Tijuana]. / Oferta de servicios de salud sexual y reproductiva a personas migrantes centroamericanas en Tijuana.

Objective: To characterize the sexual and reproductive health (SRH) services on offer to the Central American migrant population residing in shelters in Tijuana, Mexico, and identify barriers and facilitators of access to these services by this population, from the provider perspective. Methods: An observational, mixed, cross-sectional study was conducted. Different information collection techniques-consisting of 16 semi-structured interviews with civil-society providers of SRH services to the migrant population, as well as direct observation in 10 shelters in Tijuana-were employed and triangulated. A two-stage, open, selective coding process was carried out. Content analysis was then performed, using an interpretive approach based on five dimensions: approachability, acceptability, availability, affordability, and appropriateness. Results: The provision of SRH services is composed of four elements: target population, nature of providing organization (religious or secular), services offered, and venue of care. The main barriers to access involve irregular migrant status, the low priority given to SRH services, and the discrepancy between user preferences and the services offered. Among facilitating elements, lay/secular orientation of providers and inter-institutional coordination stood out. Conclusions: The provision of SRH services by civil society organizations is wide-ranging and heterogeneous. It ranges from strictly medical attention to other services that affect SRH indirectly, with a view to providing comprehensive care. This represents an opportunity in terms of aspects to facilitate access.

Objetivo: Caracterizar a oferta de serviços de saúde sexual e reprodutiva (SSR) para a população migrante da América Central residente em abrigos em Tijuana, México; e identificar as barreiras e os facilitadores de acesso a esses serviços, para essa população, partindo da perspectiva dos prestadores. Métodos: Foi utilizado um delineamento observacional, misto e transversal. Diferentes técnicas de coleta de informações ­ consistindo em 16 entrevistas semiestruturadas com prestadores de serviços de SSR da sociedade civil para a população migrante, bem como observação direta em 10 abrigos em Tijuana ­ foram utilizadas e trianguladas. A codificação dos dados foi realizada em duas etapas, aberta e seletiva. Seguiu-se uma análise de conteúdo com uma abordagem interpretativa baseada em cinco dimensões: acessibilidade, aceitabilidade, disponibilidade, exequibilidade e oportunidade. Resultados: O tipo de oferta de serviços de SSR é composto por quatro elementos: população-alvo, orientação das associações e organizações prestadoras (religiosa ou laica), serviços oferecidos e local de atendimento. As principais barreiras durante o processo de acesso relacionam-se com a situação migratória irregular, a baixa prioridade dada à atenção à SSR e a discrepância entre as preferências dos usuários e os serviços ofertados. Entre os elementos facilitadores, destacaram-se a orientação leiga dos prestadores e a coordenação interinstitucional. Conclusões: A oferta de serviços de SSR por associações e organizações da sociedade civil é ampla e heterogênea. Abrange desde serviços assistenciais estritamente médicos até outros que incidem indiretamente na SSR, com vistas à integralidade do cuidado. Isso representa uma oportunidade em termos de aspectos facilitadores do acesso.

Longitudinal health survey of women from Venezuela in Colombia (ELSA-VENCOL): First report.

BACKGROUND: Colombia is currently the world's main recipient country for Venezuelan migrants, and women represent a high proportion of them. This article presents the first report of a cohort of Venezuelan migrant women entering Colombia through Cúcuta and its metropolitan area. The study aimed to describe the health status and access to healthcare services among Venezuelan migrant women in Colombia with irregular migration status, and to analyze changes in those conditions at a one-month follow-up. METHODS: We carried out a longitudinal cohort study of Venezuelan migrant women, 18 to 45 years, who entered Colombia with an irregular migration status. Study participants were recruited in Cúcuta and its metropolitan area. At baseline, we administered a structured questionnaire including sociodemographic characteristics, migration history, health history, access to health services, sexual and reproductive health, practice of early detection of cervical cancer and breast cancer, food insecurity, and depressive symptoms. The women were again contacted by phone one month later, between March and July 2021, and a second questionnaire was applied. RESULTS: A total of 2,298 women were included in the baseline measurement and 56.4% could be contacted again at the one-month follow-up. At the baseline, 23.0% of the participants reported a self-perceived health problem or condition in the past month and 29.5% in the past 6 months, and 14.5% evaluated their health as fair or poor. A significant increase was found in the percentage of women who reported a self-perceived health problem during the past month (from 23.1% to 31.4%; p<0.01); as well as in the share who reported moderate, severe, or extreme difficulty working or performing daily chores (from 5.5% to 11.0%; p = 0.03) and who rated their health as fair (from 13.0% to 31.2%; p<0.01). Meanwhile, the percentage of women with depressive symptoms decreased from 80.5% to 71.2% (p<0.01). CONCLUSION: This report presents initial information on the health status of Venezuelan migrant women in Colombia, and is a starting point for further longer longitudinal follow-ups to assess changes over time in health conditions.

Oferta de servicios de salud sexual y reproductiva a personas migrantes centroamericanas en Tijuana

[RESUMEN]. Objetivo. Caracterizar la oferta de servicios en salud sexual y reproductiva (SSR) para la población migrante centroamericana que se encuentra en albergues de Tijuana, México; e, identificar las barreras y facilitadores del acceso a estos servicios para esta población, desde la perspectiva de los proveedores. Métodos. Se realizó un estudio con un diseño observacional, mixto, transversal. Se consideró una trian- gulación de técnicas de recolección de información que consistió en 16 entrevistas semiestructuradas a proveedores de servicios de SSR de la sociedad civil para población en movilidad, y observación directa en 10 albergues de Tijuana. Se realizó una doble codificación, abierta y selectiva. El tipo de análisis fue de conte- nido con un enfoque interpretativo a partir de cinco dimensiones: accesibilidad, aceptabilidad, disponibilidad, asequibilidad y oportunidad. Resultados. El tipo de oferta de servicios en SSR se compone de cuatro elementos: población objetivo, orientación de las asociaciones y organizaciones (religiosa o laica), servicios ofertados y lugar de atención. Las principales barreras durante el proceso de acceso son: la condición migratoria irregular, la escasa prioridad al cuidado de la SSR y la discrepancia entre las preferencias de usuarios y los servicios ofer- tados. Entre los elementos facilitadores destaca la orientación laica de proveedores y la coordinación interinstitucional. Conclusiones. La oferta de servicios de SSR por parte de asociaciones y organizaciones civiles es amplia y heterogénea. Abarca servicios de atención estrictamente médica y otros que indirectamente inciden en la SSR con miras a la integralidad de la atención. Esto, representa una oportunidad en términos de aspectos facilitadores de acceso.

[ABSTRACT]. Objective. To characterize the sexual and reproductive health (SRH) services on offer to the Central American migrant population residing in shelters in Tijuana, Mexico, and identify barriers and facilitators of access to these services by this population, from the provider perspective. Methods. An observational, mixed, cross-sectional study was conducted. Different information collection techniques—consisting of 16 semi-structured interviews with civil-society providers of SRH services to the migrant population, as well as direct observation in 10 shelters in Tijuana—were employed and triangulated. A two-stage, open, selective coding process was carried out. Content analysis was then performed, using an interpretive approach based on five dimensions: approachability, acceptability, availability, affordability, and appropriateness. Results. The provision of SRH services is composed of four elements: target population, nature of providing organization (religious or secular), services offered, and venue of care. The main barriers to access involve irregular migrant status, the low priority given to SRH services, and the discrepancy between user preferences and the services offered. Among facilitating elements, lay/secular orientation of providers and inter-institutional coordination stood out. Conclusions. The provision of SRH services by civil society organizations is wide-ranging and heterogeneous. It ranges from strictly medical attention to other services that affect SRH indirectly, with a view to providing comprehensive care. This represents an opportunity in terms of aspects to facilitate access.

[RESUMO]. Objetivo. Caracterizar a oferta de serviços de saúde sexual e reprodutiva (SSR) para a população migrante da América Central residente em abrigos em Tijuana, México; e identificar as barreiras e os facilitadores de acesso a esses serviços, para essa população, partindo da perspectiva dos prestadores. Métodos. Foi utilizado um delineamento observacional, misto e transversal. Diferentes técnicas de coleta de informações – consistindo em 16 entrevistas semiestruturadas com prestadores de serviços de SSR da sociedade civil para a população migrante, bem como observação direta em 10 abrigos em Tijuana – foram utilizadas e trianguladas. A codificação dos dados foi realizada em duas etapas, aberta e seletiva. Seguiu-se uma análise de conteúdo com uma abordagem interpretativa baseada em cinco dimensões: acessibilidade, aceitabilidade, disponibilidade, exequibilidade e oportunidade. Resultados. O tipo de oferta de serviços de SSR é composto por quatro elementos: população-alvo, orien- tação das associações e organizações prestadoras (religiosa ou laica), serviços oferecidos e local de atendimento. As principais barreiras durante o processo de acesso relacionam-se com a situação migratória irregular, a baixa prioridade dada à atenção à SSR e a discrepância entre as preferências dos usuários e os serviços ofertados. Entre os elementos facilitadores, destacaram-se a orientação leiga dos prestadores e a coordenação interinstitucional. Conclusões. A oferta de serviços de SSR por associações e organizações da sociedade civil é ampla e hete- rogênea. Abrange desde serviços assistenciais estritamente médicos até outros que incidem indiretamente na SSR, com vistas à integralidade do cuidado. Isso representa uma oportunidade em termos de aspectos facilitadores do acesso.

Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla

[RESUMEN]. Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, resi- dentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xeno- fobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condi- ciones de salud actual y el goce efectivo de los derechos en SSR.

[ABSTRACT]. Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Vene- zuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

[RESUMO]. Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explo- rou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurí- dico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes vene- zuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

Oferta de servicios de salud sexual y reproductiva a personas migrantes centroamericanas en Tijuana / Provision of sexual and reproductive health services to Central American migrants in Tijuana / Oferta de serviços de saúde sexual e reprodutiva para migrantes da América Central em Tijuana

RESUMEN Objetivo. Caracterizar la oferta de servicios en salud sexual y reproductiva (SSR) para la población migrante centroamericana que se encuentra en albergues de Tijuana, México; e, identificar las barreras y facilitadores del acceso a estos servicios para esta población, desde la perspectiva de los proveedores. Métodos. Se realizó un estudio con un diseño observacional, mixto, transversal. Se consideró una triangulación de técnicas de recolección de información que consistió en 16 entrevistas semiestructuradas a proveedores de servicios de SSR de la sociedad civil para población en movilidad, y observación directa en 10 albergues de Tijuana. Se realizó una doble codificación, abierta y selectiva. El tipo de análisis fue de contenido con un enfoque interpretativo a partir de cinco dimensiones: accesibilidad, aceptabilidad, disponibilidad, asequibilidad y oportunidad. Resultados. El tipo de oferta de servicios en SSR se compone de cuatro elementos: población objetivo, orientación de las asociaciones y organizaciones (religiosa o laica), servicios ofertados y lugar de atención. Las principales barreras durante el proceso de acceso son: la condición migratoria irregular, la escasa prioridad al cuidado de la SSR y la discrepancia entre las preferencias de usuarios y los servicios ofertados. Entre los elementos facilitadores destaca la orientación laica de proveedores y la coordinación interinstitucional. Conclusiones. La oferta de servicios de SSR por parte de asociaciones y organizaciones civiles es amplia y heterogénea. Abarca servicios de atención estrictamente médica y otros que indirectamente inciden en la SSR con miras a la integralidad de la atención. Esto, representa una oportunidad en términos de aspectos facilitadores de acceso.

ABSTRACT Objective. To characterize the sexual and reproductive health (SRH) services on offer to the Central American migrant population residing in shelters in Tijuana, Mexico, and identify barriers and facilitators of access to these services by this population, from the provider perspective. Methods. An observational, mixed, cross-sectional study was conducted. Different information collection techniques—consisting of 16 semi-structured interviews with civil-society providers of SRH services to the migrant population, as well as direct observation in 10 shelters in Tijuana—were employed and triangulated. A two-stage, open, selective coding process was carried out. Content analysis was then performed, using an interpretive approach based on five dimensions: approachability, acceptability, availability, affordability, and appropriateness. Results. The provision of SRH services is composed of four elements: target population, nature of providing organization (religious or secular), services offered, and venue of care. The main barriers to access involve irregular migrant status, the low priority given to SRH services, and the discrepancy between user preferences and the services offered. Among facilitating elements, lay/secular orientation of providers and inter-institutional coordination stood out. Conclusions. The provision of SRH services by civil society organizations is wide-ranging and heterogeneous. It ranges from strictly medical attention to other services that affect SRH indirectly, with a view to providing comprehensive care. This represents an opportunity in terms of aspects to facilitate access.

RESUMO Objetivo. Caracterizar a oferta de serviços de saúde sexual e reprodutiva (SSR) para a população migrante da América Central residente em abrigos em Tijuana, México; e identificar as barreiras e os facilitadores de acesso a esses serviços, para essa população, partindo da perspectiva dos prestadores. Métodos. Foi utilizado um delineamento observacional, misto e transversal. Diferentes técnicas de coleta de informações - consistindo em 16 entrevistas semiestruturadas com prestadores de serviços de SSR da sociedade civil para a população migrante, bem como observação direta em 10 abrigos em Tijuana - foram utilizadas e trianguladas. A codificação dos dados foi realizada em duas etapas, aberta e seletiva. Seguiu-se uma análise de conteúdo com uma abordagem interpretativa baseada em cinco dimensões: acessibilidade, aceitabilidade, disponibilidade, exequibilidade e oportunidade. Resultados. O tipo de oferta de serviços de SSR é composto por quatro elementos: população-alvo, orientação das associações e organizações prestadoras (religiosa ou laica), serviços oferecidos e local de atendimento. As principais barreiras durante o processo de acesso relacionam-se com a situação migratória irregular, a baixa prioridade dada à atenção à SSR e a discrepância entre as preferências dos usuários e os serviços ofertados. Entre os elementos facilitadores, destacaram-se a orientação leiga dos prestadores e a coordenação interinstitucional. Conclusões. A oferta de serviços de SSR por associações e organizações da sociedade civil é ampla e heterogênea. Abrange desde serviços assistenciais estritamente médicos até outros que incidem indiretamente na SSR, com vistas à integralidade do cuidado. Isso representa uma oportunidade em termos de aspectos facilitadores do acesso.

Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla / Voluntary interruption of pregnancy and sexual and reproductive health in migrant women in Barranquilla / Interrupção voluntária da gravidez e saúde sexual e reprodutiva em mulheres migrantes em Barranquilla

RESUMEN Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, residentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xenofobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condiciones de salud actual y el goce efectivo de los derechos en SSR.

ABSTRACT Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

RESUMO Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

Psychological discomfort and binge drinking in Mexican adults.

OBJECTIVE: To analyze the relationship between binge drin-king and psychological discomfort in Mexican adults. Mate-rials and methods. We used data from the 2011 National Survey on Addictions in Mexico. A two-stage bivariate probit model with instrumental variables was used to address the potential reverse causality in the association between binge drinking and psychological discomfort. RESULTS: Individuals who had at least one episode of binge drinking in the last year and in the last month are more likely to experience psychological discomfort. CONCLUSION: This study shows the relevance of developing prevention and treatment programs for people who consume alcohol in excess due to its negative effects on mental health.

Disordered eating behaviors and psychological correlates. Data from the Ensanut 2018-19

OBJECTIVE: To analyze the relationship between disordered eating behaviors (DEB) and depressive symptoms, suicide attempts, and alcohol and tobacco use in adolescents in a national survey in Mexico. MATERIALS AND METHODS: Data from the Encuesta Nacional de Salud y Nutrición 2018-19 were used. Three levels of DEB were established: no risk (DEB-NR), moderate risk (DEB-MR), and high risk (DEB-HR). An ordinal logistic regression model was performed with level of DEB risk as a dependent variable. RESULTS: National prevalence of DEB-MR was 6.0% (95%CI: 5.6, 6.5), while that of DEB-HR was 1.3% (95%CI: 1.1, 1.6). Suicide attempt (OR= 1.82, 95%CI: 1.02,3.25) and depressive symptoms (OR= 2.6, 95%CI: 1.40,4.98) were associated with being at a higher risk of DEB. CONCLUSION: Since both depressive symptoms and suicide attempt are associated with DEB, prevention strategies should consider interventions that simultaneously address the various mental health problems present in adolescence.

The impact of the COVID-19 pandemic among migrants in shelters in Tijuana, Baja California, Mexico.

INTRODUCTION: Migrants, especially those in temporary accommodations like camps and shelters, might be a vulnerable population during the COVID-19 pandemic, but little is known about the impact of the pandemic in these settings in low-income and middle-income countries. We assessed SARS-CoV-2 seropositivity and RNA prevalence, the correlates of seropositivity (emphasising socially determined conditions), and the socioeconomic impacts of the pandemic among migrants living in shelters in Tijuana, a city on the Mexico-US border. METHODS: We conducted a cross-sectional, non-probability survey of migrants living in shelters in Tijuana in November-December 2020 and February-April 2021. Participants completed a questionnaire and provided anterior nasal swab and blood samples for detection of SARS-CoV-2 RNA and antibodies (IgG and IgM), respectively. We explored whether SARS-CoV-2 infection was associated with sociodemographic and migration-related variables, access to sanitation, protective behaviours and health-related factors. RESULTS: Overall, 481 participants were enrolled, 67.7% from Northern Central America, 55.3% women, mean age 33.2 years. Seven (1.5%) participants had nasal swabs positive for SARS-CoV-2 RNA and 53.0% were SARS-CoV-2 seropositive. Avoiding public transportation (OR 0.59, 95% CI 0.39 to 0.90) and months living in Tijuana (OR 1.06, 95% CI 1.02 to 1.10) were associated with seropositivity. Sleeping on the streets or other risky places and having diabetes were marginally associated with seropositivity. Most participants (90.2%) had experienced some socioeconomic impact of the pandemic (eg, diminished income, job loss). CONCLUSION: Compared with results from other studies conducted in the general population in Mexico at a similar time, migrants living in shelters were at increased risk of acquiring SARS-CoV-2, and they suffered considerable adverse socioeconomic impacts as a consequence of the pandemic. Expanded public health and other social support systems are needed to protect migrants from COVID-19 and reduce health inequities.

Prevalence of SARS-CoV-2 infection in Baja California, Mexico: Findings from a community-based survey in February 2021 in the Mexico-United States border.

Between March 2020 and February 2021, the state of Baja California, Mexico, which borders the United States, registered 46,118 confirmed cases of COVID-19 with a mortality rate of 238.2 deaths per 100,000 residents. Given limited access to testing, the population prevalence of SARS-CoV-2 infection is unknown. The objective of this study is to estimate the seroprevalence and real time polymerase chain reaction (RT-PCR) prevalence of SARS-CoV-2 infection in the three most populous cities of Baja California prior to scale-up of a national COVID-19 vaccination campaign. Probabilistic three-stage clustered sampling was used to conduct a population-based household survey of residents five years and older in the three cities. RT-PCR testing was performed on nasopharyngeal swabs and SARS-CoV-2 seropositivity was determined by IgG antibody testing using fingerstick blood samples. An interviewer-administered questionnaire assessed participants' knowledge, attitudes, and preventive practices regarding COVID-19. In total, 1,126 individuals (unweighted sample) were surveyed across the three cities. Overall prevalence of SARS-CoV-2 infection by RT-PCR was 7.8% (95% CI 5.5-11.0) and IgG seroprevalence was 21.1% (95% CI 17.4-25.2). There was no association between border crossing in the past 6 months and SARS-CoV-2 prevalence (unadjusted OR 0.40, 95%CI 0.12-1.30). While face mask use and frequent hand washing were common among participants, quarantine or social isolation at home to prevent infection was not. Regarding vaccination willingness, 30.4% (95% CI 24.4-3 7.1) of participants said they were very unlikely to get vaccinated. Given the high prevalence of active SARS-CoV-2 infection in Baja California at the end of the first year of the pandemic, combined with its low seroprevalence and the considerable proportion of vaccine hesitancy, this important area along the Mexico-United States border faces major challenges in terms of health literacy and vaccine uptake, which need to be further explored, along with its implications for border restrictions in future epidemics.

In-Transit Migrants And Asylum Seekers: Inclusion Gaps In Mexico's COVID-19 Health Policy Response.

During the COVID-19 pandemic, as immigration and asylum processes were delayed or interrupted, migrants and asylum seekers were stranded at Mexico's northern border. In-transit migrants and asylum seekers are an underserved population, and pandemic preparedness has seldom taken their needs into account. In this article we analyze public health policies developed in Mexico in response to the COVID-19 pandemic and describe how these policies have largely overlooked the needs of vulnerable mobile populations. We reviewed eighty publicly available documents issued by federal, state, and municipal authorities in Mexico between January and September 2020. Only seven policy documents explicitly considered in-transit migrants and asylum seekers and their health care needs. In addition, we identified six major gaps in these policies that, if addressed, would promote greater inclusion of persons in mobility in future pandemic response plans, to protect the health of migrant populations.

Healthcare-related expenditures among immigrants and non-immigrants living with HIV in colombia.

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare-related expenditures of Venezuelan immigrants and non-migrants living with HIV in Colombia. We analysed data from the Colombian High-cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non-hospital expenditures per patient for Venezuelan immigrants and non-migrant patients, in both the state-subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per-capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non-hospital care. For non-migrants, the average costs were 1,796.53. In the state-subsidised scheme expenditures were higher on average, but still lower for immigrants than for non-migrants. After adjusting by clinical and sociodemographic characteristics, non-hospital per capita expenditures were lower for immigrants as compared with non-migrants (25,37% lower in the state-subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects.

Utilización de anticonceptivos en población migrante: el caso de las gestantes migrantes venezolanas en dos ciudades receptoras de la costa norte de Colombia / Contraceptive use in the migrant population: the case of pregnant Venezuelan migrants in two receiving cities on the north coast of Colombia / Uso de anticoncepcionais em população migrante: O caso das gestantes migrantes venezuelanas em duas cidades receptoras do litoral norte da Colômbia

Resumen Objetivo: Describir la utilización de métodos anticonceptivos de gestantes migrantes venezolanas, en dos ciudades de la costa norte de Colombia (Barranquilla y Riohacha), entre 2018 y 2019. Metodología: Se diseñó un estudio descriptivo de corte transversal. Las participantes se seleccionaron mediante muestreo sistemático en hospitales y muestreo en bola de nieve en la comunidad. Un cuestionario estandarizado permitió la recolección de variables sociodemográficas, de migración, de uso de anticonceptivos, entre otras. Resultados: Fueron encuestadas 552 mujeres gestantes provenientes de Venezuela, principalmente jóvenes, casadas o en unión libre; la minoría de los embarazos fueron planificados (37,7 %), aun cuando las mujeres conocían sobre métodos de anticoncepción. El preservativo (condón) y la píldora fueron los métodos más conocidos (94,7 y 96,1 %, respectivamente). Conclusión: Casi todas las mujeres conocen métodos anticonceptivos y los lugares dónde obtenerlos; no obstante, solo la mitad logró conseguirlos la última vez que los buscó; así, la mayoría de los embarazos fueron no planificados. La garantía de los derechos sexuales y reproductivos, incluyendo la satisfacción de necesidades de planificación familiar, debe ser una prioridad en las acciones de atención a la población migrante, en el marco del fenómeno migratorio colombo-venezolano.

Abstract Objective: To describe the use of contraceptive methods by pregnant Venezuelan migrants in two cities on the north coast of Colombia (Barranquilla and Riohacha), between 2018 and 2019. Methodology: A descriptive cross-sectional study was designed. Participants were selected through systematic sampling in hospitals and snowball sampling in the community. A standardized questionnaire allowed the sociodemographic, migration, contraceptive use and other variables to be collected. Results: 552 pregnant, mainly young, women from Venezuela who are married or living with their partner were surveyed. The minority of pregnancies were planned (37.7%), even though the women knew about contraception methods. The condom and the pill were the most well-known methods (94.7 and 96.1%, respectively). Conclusion: Nearly all of the women knew about birth control and where it can be accessed. However, only half managed to get them the last time they looked for them, meaning that most of the pregnancies were unplanned. Guaranteed sexual and reproductive rights, including satisfactory family planning requirements, must be a priority in actions aimed at the migrant population, within the framework of the Colombian-Venezuelan migratory phenomenon.

Resumo Objetivo: Descrever o uso de métodos anticoncepcionais de gestantes migrantes venezuelanas, em duas cidades do litoral norte da Colômbia (Barranquilla e Riohacha), entre 2018 e 2019. Metodologia: Foi desenhado um estudo de corte transversal descritivo. As participantes foram selecionadas através de uma amostragem sistemática em hospitais e amostragem em bola de neve feita na comunidade. Um questionário padrão permitiu a coleta de variáveis sócio demográficas, de informação relacionada à migração, ao uso de anticoncepcionais, entre outras. Resultados: O questionário foi aplicado a 552 mulheres gestantes vindas da Venezuela, principalmente jovens, casadas ou em união estável; a minoria das gestações foi planejada (37,7%), mesmo conhecendo os métodos anticoncepcionais. O preservativo (camisinha) e a pílula foram os métodos mais identificados (94,7 e 96,1% respectivamente). Conclusão: Quase todas as mulheres conhecem métodos anticoncepcionais e os lugares onde podem obtê-los; porém somente a metade delas conseguiu adquiri-los quando procuraram pela última vez; assim que a maioria das gestações não foi planejada. A garantia dos direitos sexuais e reprodutivos, incluindo a satisfação das necessidades de planejamento familiar, deve ser uma prioridade nos programas de atenção à população migrante, dentro do marco do fenômeno migratório colombo-venezuelano.

Health policies for international migrants: A comparison between Mexico and Colombia.

Objective: The aim of this study was to compare the health policies for international migrants in Mexico and Colombia. Methods: A descriptive comparative study of the documents issued by the national-level government of the most recent past administrations in each country (2012-2018 for Mexico, 2013-2018 for Colombia) was conducted. We identified the documents' objectives, strategies, and evaluation of results, and the representation of international migrants and migrant health in the policy. Results: Both countries situate health care policies for international migrants in a human rights framework. In both, migrants are entitled to health care, but access is limited by migration status. The main contrasts are the focus on different migrant populations (Mexican migrants in the Mexico-US migration circuit in Mexico; Venezuelan immigrants and Colombians returning from Venezuela in Colombia), and the discursive framing of policies as a response to the crisis in Colombia. As a result, while concrete actions are detailed in the Colombian policies, most documents in Mexico are limited to general strategies. These differences can be explained by the context in which each set of policies was issued: a relatively stable Mexico-US migration flow in Mexico, and the reception of hundreds of thousands of migrants from Venezuela in a very short time in Colombia. Conclusions: Tradition in matters of migration, and the current migration context, influence health policies for migrant populations.

Situación de salud de gestantes migrantes venezolanas en el Caribe colombiano: primer reporte para una respuesta rápida en Salud Pública / Health situation of Venezuelan pregnant migrants in the Colombian Caribbean: first report for a rapid response in Public Health

Resumen Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.

Abstract Introduction: In the current migration from Venezuela to Colombia, women represent a significant proportion of the irregular migrant population, and those who are pregnant have been a priority given their particularly vulnerable condition. Nevertheless, their health conditions are not known. Objectives: To obtain a multi-dimensional characterization of the health situation of irregular Venezuelan migrants who are pregnant and residing in the main receiving the Caribbean region of Colombia: Barranquilla and Riohacha. Methods: We carried out a descriptive, cross-sectional study with 520 pregnant women surveyed from August 2018 to May 2019 with a systematic sampling in public hospitals and an active community search using snowball sampling. We used a standardized questionnaire to evaluate the main health problems, nutritional status, food security, presence of depressive symptoms and accessibility/ satisfaction with health services. Results: Half of the participants perceived their health during pregnancy as good or very good (53.4%), 51.3% presented iron deficiency anemia, and the majority (87.5%) experienced some lack of food security. The prevalence of clinically significant depressive symptoms was 32.1%. A high proportion reported some type of intimate partner violence (90.2%). 25.9% required urgent medical care, irrespective of the prenatal care they received. With regard to quality of care in the emergency service, 62.7% rated it as very good or good, and 73.1% reported that they received the care that was needed for their health problem. Conclusions: Food insecurity, anemia, depressive symptoms, violence committed by the partner and lack of prenatal care were the main health problems for pregnant women who participated in the study. Their health situation should be viewed in the context of the migration process, based on the social determinants of emigration, transit, arrival, and return. The health care system should continue to strengthen primary care measures for this population at the local level and based on the evidence.