A public health approach to modern slavery in the United Kingdom: a codeveloped framework.

OBJECTIVES: Modern slavery is a public health challenge. The objective of this research was to build and refine a public health approach to addressing it. STUDY DESIGN: This was a participatory qualitative study with a proof-of-concept exercise. METHODS: Nine deliberative workshops with 65 people working across the antislavery sector. Thematic analysis of qualitative data. Of the nine workshops, two were proof of concept. These explored and tested the public health framework devised. RESULTS: Participants contributed to the development of a public health framework to modern slavery that included multiple elements across national, local, and service levels. There were six 'C's to national components: policy that was coherent, co-ordinated, consistent, comprehensive, co-operative and compliant with international law. Local components centred on effective local multiagency partnerships and service design and delivery focussed on trauma-informed, flexible, person-centred care. CONCLUSIONS: A public health approach to modern slavery is a promising development in the antislavery field in the United Kingdom and globally. It was well supported by workshop participants and appeared to be operable. Barriers to its implementation exist, however, including the challenge of intersectoral working and an incongruent policy environment.

Exploring the role of palliative care occupational therapists in supporting compassionate communities in end-of-life care.

INTRODUCTION: The compassionate communities' movement is a public health approach to end-of-life care that emphasises the integral role of communities in supporting and caring for dying persons and their informal carers. Although occupational therapists have well-established roles in palliative care teams, little is known about their potential in assisting in the formation and maintenance of compassionate communities. METHOD: Data were gathered via semi-structured interviews with nine Australian occupational therapists with experience in specialist palliative care. Interview questions were based around the British Columbia Compassionate Community Ideal framework. Key themes were derived through qualitative descriptive analysis, blending deductive, and inductive reasoning. FINDINGS: Interviewees indicated that occupational therapists have a role in supporting compassionate communities that centres on the facilitation of networks and connections between palliative care professionals and in the promotion of informal care networks. The importance of education and awareness raising were also discussed as valuable to the development of community capacity. It was also suggested that occupational therapists have important skills to support dying persons and their caregivers to remain engaged and safe in their homes and communities, in a meaningful and sustainable way. However, many interviewees maintained a profession-centric view on control within compassionate communities, as opposed to approaches that are community led. CONCLUSION: Findings offer early insights into the promise and potential of occupational therapists in supporting the compassionate communities' movement. However, education regarding the ethos of the compassionate communities' movement so as to facilitate a shift away from professionally oriented modes of practice may be needed to maximise success.

Equity consideration in palliative care policies, programs, and evaluation: an analysis of selected federal and South Australian documents.

BACKGROUND: Inequity in access to palliative care and symptom relief is one of the greatest disparities in global health care. A public health approach to palliative care is underpinned by the social view of health that puts an emphasis on equity, community engagement and empowerment, a supportive policy environment, and social determinants of health. Consideration of equity in policy is critical so that it can be translated into equitable services. However, the extent to which Australian palliative care policies incorporate equity, and their translation into actual actions have not been extensively examined. This exploratory study aimed to examine the extent to which Australian federal and South Australian palliative care policies and initiatives incorporate equity, and to identify evidence gaps and research priorities that can inform equity-oriented policies and practices. METHODS: We reviewed 25 federal and South Australian documents relating to palliative care published over the past five years. Documents were publicly available from the Australian Government Department of Health website. We used search filter 'Palliative care and end of life' in the Department's resource webpage to narrow down documents to those with palliative care and end of life in the document title and/or content. The initial list was discussed in the research team to ensure key documents are included. Supplementary to document review, we conducted five key informant interviews in South Australia. Interview participants were people from the policy sector, not-for-profit organisations, a funding body and a community advocacy group in South Australia who had knowledge and experience in palliative care policy, practice and research. Documents and interview transcripts were imported into the NVivo 12 software for coding. Content analysis looked at the frequencies of relevant terms, and then more detailed inductive and deductive thematic analysis was undertaken which was guided by an equity action framework. RESULTS: Overall, we found incremental steps forward over the past few years in considering equity in Australian palliative care policies. Key themes that emerged from the study were: identifying population groups experiencing poor access to palliative care, strategies to improve access including increased awareness of palliative care, flexible models of care, building workforce capacity, and the need for greater investment in palliative care research and evaluation. Strategies to address systemic barriers as well as social, political and cultural determinants of inequity was less evident in policy documents. There was little evidence of actions to engage and empower communities. Interviews provided insight on key areas of priority for future palliative care research. CONCLUSIONS: Achieving the goal of equity in palliative care for all is complex and multifaceted. It requires strong commitment and actions at policy and government level but also in clinical practice, workforce planning and capacity building, community engagement and research investment to implement and evaluate public health approaches to palliative care.

The Heart of Living and Dying: Upstreaming Advance Care Planning into Community Conversations in the Public Domain in Northern Ireland.

This paper provides an evaluation of the Heart of Living and Dying (HLD) Initiative. This initiative is a group process that attempts to bring Advance Care Planning (ACP) into the public domain. It encourages participants to consider what matters to them in their living along with their hopes, preferences, and wishes for their final years and end-of-life care. An inductive, interpretive, and naturalistic approach allowed the researcher to study these phenomena in their natural setting i.e., the community. This qualitative study used 5 focus groups with 17 people and employed thematic data analysis to identify key themes. All participants in the HLD speak from a personal perspective irrespective of any professional background. It transpired that 16 respondents worked in health and social care, which subsequently became noteworthy in the findings. Three key themes were identified: (a) feeling emotionally safe enough to have such sensitive conversations is vital; (b) participating in the HLD process increases the confidence of those participants who worked in health and social care, to undertake ACP conversations and (c) planning ahead is a complex, staged process rather than a single record-making event. The Covid-19 pandemic crisis reinforced the need to upstream ACP initiatives such as the HLD, as the norm for everyone, since all of us will one day die. It is recommended that the HLD be incorporated within ACP training given that the experiential nature of it and the use of groups was reported to build confidence in facilitating ACP conversations. A virtual HLD process needs to be developed to adapt to restrictions on gatherings due to Covid 19.

Child Sexual Abuse: The Need for a Perpetration Prevention Focus.

In the evolution of efforts to reduce child sexual abuse (CSA) rates in the United States, there has been a gradual shift to add preventive measures to after-the-fact interventions (i.e., interventions and policies implemented after the abuse has already happened, such as services and treatment for victims and punishment, treatment, and management of offenders). Prevention of CSA perpetration, however, is often missing from these efforts, despite decades of experts calling for broader prevention solutions. The current paper describes the scope of the problem of CSA, highlights problems with an over-reliance on after-the-fact interventions, and describes promising perpetration-focused CSA prevention interventions. While most existing preventive efforts focus on teaching children to protect themselves from incurring sexual harm, perpetration prevention efforts may hold more promise by addressing the onset of harmful behavior. As such, perpetration prevention efforts can contribute to a more robust and comprehensive approach to CSA - an approach that focuses on prevention of harm from occurring in the first place, as well as responding once harm has occurred.

Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV.

PURPOSE OF REVIEW: This review offers an operational definition of systems engineering (SE) as applied to public health, reviews applications of SE in the field of HIV, and identifies opportunities and challenges of broader application of SE in global health. RECENT FINDINGS: SE involves the deliberate sequencing of three steps: diagnosing a problem, evaluating options using modeling or optimization, and providing actionable recommendations. SE includes diverse tools (from process improvement to mathematical modeling) applied to decisions at various levels (from local staffing decisions to planning national-level roll-out of new interventions). Contextual factors are crucial to effective decision-making, but there are gaps in understanding global decision-making processes. Integrating SE into pre-service training and translating SE tools to be more accessible could increase utilization of SE approaches in global health. SE is a promising, but under-recognized approach to improve public health response to HIV globally.

"If you understand you cope better with it": the role of education in building palliative care capacity in four First Nations communities in Canada.

BACKGROUND: In Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities' capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care. METHODS: Participatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010-2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required. RESULTS: Educational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities. CONCLUSIONS: This research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.

Primary and secondary prevention of child sexual abuse.

The high prevalence rates and numerous consequences associated with child sexual abuse makes preventing these offences a societal priority. Prevention strategies have traditionally involved only tertiary interventions, implemented by the criminal justice system after an offence has occurred. More recently, some have argued for a public health approach to preventing child sexual abuse, which includes interventions at the primary and secondary levels. Secondary prevention aims to provide treatment and support to those at-risk of sexually offending before any involvement with the legal system. Increased demand for secondary prevention services and early results from current initiatives demonstrate that at-risk individuals are willing to seek treatment without external pressure from the legal system, and often report numerous treatment-related benefits. These findings support the need for widespread implementation of primary and secondary prevention initiatives. The safety of children requires that society stops merely reacting to sexual offences, and instead begins implementing proactive evidence-based strategies that can prevent even initial incidents of child sexual abuse. This article explores some of the many benefits and barriers associated with primary and secondary prevention, as well as strategies for overcoming these barriers. Recommendations for the development and implementation of prevention initiatives are also included.

Examining the context of community nursing in Ireland and the impact of missed care.

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing.

Preventing Child Sexual Abuse and the Use of Child Sexual Abuse Materials: Following up on the German Prevention Project Dunkelfeld.

Sexual interest in minors (i.e., pedophilia and hebephilia) is considered a risk factor for Child Sexual Abuse (CSA) and the use of Child Sexual Abuse Material (CSAM). This study examined the long-term development of CSA, CSAM use, associated cognitions, and quality of life among self-referred, help-seeking individuals diagnosed with pedophilic or hebephilic disorder (PHD) outside the judicial system. Of the 110 eligible men who had undergone therapy for PHD due to psychological distress or risk of offending, 56 were available for follow-up assessment 1-11 years after treatment. Behavioral manifestations, offense-supportive cognitions, and quality of life were evaluated using interviews and psychometric measures. At follow-up, 7.7% of participants with a history of CSA had re-offended, whereas 89.1% of previous CSAM users reported recidivism, although with less severe material. No new CSA offenses occurred among those without prior CSA. Treatment led to increased cognitive victim empathy and reductions in CSA-supportive and CSAM-supportive attitudes, but only the latter improvement persisted through follow-up. Participants exhibited elevated CSA-supportive attitudes relative to community norms at all time points and diminished quality of life at follow-up. Pedophilic and hebephilic disorder carry a persistent risk of sexual offending, particularly regarding CSAM use. Therapeutic gains in offense-supportive cognitions may erode over time without ongoing care. A comprehensive public health approach encompassing early detection, prevention, and expanded treatment access that addresses both the risk of reoffending and overall well-being is crucial for reducing sexual victimization and improving mental health outcomes for individuals from this target group.

What is a public health approach to substance use? A qualitative systematic review and thematic synthesis.

BACKGROUND: Psychoactive substance use and the regulations that govern it both have the potential to lead to harm. A 'public health approach' (PHA) is frequently invoked as a means of addressing these harms, but the term is used in inconsistent and contradictory ways. This study systematically reviewed the English-language academic literature to understand how a public health approach to substance use is defined and described. METHODS: This review employed thematic synthesis, a methodology designed to rigorously synthesize qualitative evidence. Eligible articles were published in peer-reviewed journals, in the English language, with full text available, and focused primarily on substance use. There were no limits on year of publication. Original research, opinion/commentary, and reviews were included. The searches were conducted in October 2021 in CINAHL, Embase, Medline, PAIS Index, PsycINFO, Scopus, Sociological Abstracts, and Web of Science. RESULTS: 272 articles from 25 countries, published between 1950 and 2021, were synthesized. Definitions of a PHA have changed over time and differ by substance. The most commonly cited characteristics of a PHA were: for alcohol, regulation, e.g. of price and availability (54% of articles); for cannabis: regulation (68%); for illicit drugs: that a PHA is distinct from a criminal justice approach (63%); for opioids: substance use disorder treatment (55%); and for tobacco: regulation (62%). CONCLUSION: There is no consensus on the definition of a public health approach to substance use, but there is substantial agreement when it comes to PHAs to specific substances. There are also similarities in how they are described for legal substances versus illicit ones. This review found areas of disagreement regarding the extent to which PHAs should focus on individual-level factors. Policymakers, academics, and others developing or implementing PHAs to substance use should be explicit about their aims and objectives - as well as the premises and assumptions underlying them.

Palliative and End-of-Life Care for People Living with Motor Neurone Disease: Ongoing Challenges and Necessity for Shifting Directions.

Although the progressive clinical trajectory of motor neurone disease (MND) is widely understood, multiple challenges remain preventing optimal end-of-life care for this population with unique needs from the patient, carer and service provider perspectives. This paper reports on the experiences, gaps in service and unmet needs of MND patients and family carers and explores public health palliative care approaches that would facilitate coordinated and integrated care to respond to their changing needs. This is a qualitative study of responses to questions in an online consumer survey (353 respondents) in Western Australia (2020), focusing on a subset of 29 current and bereaved carers of people with MND who have used health services in the last five years. The analysis identified themes, highlighting the insufficient integration of services across health and social care; poor and unequal access to coordinated palliative care; significant gaps in the knowledge base of the workforce and a failure to meet the consumer expectations of person-centred care. For palliative care to be accessible to those living with MND and other under-served conditions, there needs to be a shift to more comprehensive, inclusive and sustainable options, such as the public health approach to palliative/end-of-life care that engages the assets of local communities in partnership with health services, one example being the "Compassionate Communities Connectors" model of care. Further considerations include advocacy for policy changes, fostering partnerships and developing indicators for evaluating the impact of the proposed models of care. The end result is not only better care but substantial savings for the health system.

Applying a public health approach to identify priorities for regulating child product safety.

OBJECTIVE: To identify leading injury risk factors and jurisdictional differences in Australian and US child-related product safety regulatory responses to inform the development of Australian policy and reform priorities. METHODS: The study established and evaluated a knowledge base of child-related product safety regulatory responses (recalls, bans, standards and warnings) made in Australia and the US over the period 2011-17 to identify risk factors and potential regulatory gaps. RESULTS: The research identified 1,540 Australian and US child-related product safety regulatory responses with the most common response type being product safety recall, and the leading product hazards in responses being choking, fire, fall, strangulation and chemical hazards. Jurisdictional differences identified potential regulatory gaps in Australia related to chemical hazards and high-risk durable infant and toddler products, and some data deficiencies in Australian responses. CONCLUSIONS: Priorities include the need to improve the prevention orientation of the Australian product safety framework, to create an intelligence platform to assess injury risks more precisely and to address regulatory gaps related to the use of toxic chemicals in children's products and high-risk durable infant and toddler products. IMPLICATIONS FOR PUBLIC HEALTH: The study demonstrates the identification of policy and reform priorities for child product safety using a public health lens.

Access to rehabilitation services for road traffic injury patients in Namibia.

PURPOSE: Road traffic injuries (RTIs) are a major public health issue worldwide. The importance of physical rehabilitation following RTI is well documented. However, globally there has been very little research on the accessibility of rehabilitation services following road injury. Namibia is one of the five African countries with a fuel tax levy fund (Motor Vehicle Accident Fund, MVAF), a system of case managers, medical care, and case management system for coordination of long-term care. MATERIALS AND METHODS: We investigated the availability of physical rehabilitation services to RTI injured in Namibia, through interviews with RTI patients and health care workers. RESULTS: Unlike the few other studies done in Sub-Saharan Africa (SSA), most RTI injured individuals in Namibia report they are able to access some rehabilitation following injury. In large measure, this is due to the effective MVAF system which they felt ensures follow up care for many after having an RTI. However, we found that access to rehabilitation is skewed in favour of those living in Windhoek and other urban areas compared with those in non-urban areas. CONCLUSIONS: The MVAF model seems to enhance access to rehabilitation and is a model which could be replicated in other SSA countries and other low and middle income countries.Implications for rehabilitationRoad traffic injuries (RTIs) are a major global public health challenge with over 1.2 million people killed and a high burden of disability and Namibia is one of the worst affected countries globally.There is lack of knowledge on the availability to physical rehabilitation following road injury in Namibia.Our study shows the Motor Vehicle Accident Fund (MVAF) model seems to enhance access to rehabilitation and is a model which could be replicated in Sub-Saharan Africa and other low and middle income countries.

"It Is a Whole Different Life from the Life I Used to Live": Assessing Parents' Support Needs in Paediatric Palliative Care.

AIMS: This feasibility study aimed to systematically identify and address the support needs of parents of children with life-limiting illnesses and to assess whether the systematic approach was acceptable and relevant to parents. METHODS: The CSNAT (Paediatric) intervention consisted of two assessment visits with the paediatric palliative care team, 2-8 weeks apart, comprising conversations about sources for support in a tertiary children hospital in Western Australia (2018-2019). Audio-recorded telephone interviews were conducted with parents, and inductive thematic analysis was undertaken. RESULTS: All 28 parents who were involved in the intervention agreed to be interviewed. Five themes summarised their experience: caregiving challenges, perceived gaps and feelings of isolation; the usefulness and practicality of the systematic assessment; emotional responses to self-reflection; feelings of validation and empowerment; and received supports responsive to their needs. CONCLUSIONS: Parents appreciated the value of this systematic approach in engaging them in conversations about their needs and solutions to address them. While clinical service support was affirmed by parents, they were left wanting in other areas of practical, psychosocial, and emotional support. Palliative care services need to build stronger partnerships with supportive community networks through compassionate communities volunteer models of care to address the non-clinical needs of these families.

Perceptions of healthcare workers on road traffic injuries in Namibia: an untapped source of expertise.

BACKGROUND: Road traffic injuries (RTIs) are a major problem worldwide. Namibia is one of the worst affected countries globally; however, there has been very little research on RTIs. When RTIs are discussed, the focus usually is on statistics, and healthcare workers (HCWs) are rarely asked to share their experiences and insights on the impact of RTIs on the healthcare system in which they work. METHODS: In this study, we investigated the experiences and opinions of HCWs concerning RTIs in Namibia. In our survey, we asked them to reflect on RTIs as a public health issue, and on how they view national road safety efforts. RESULTS: HCWs were knowledgeable about RTIs and the related burden of injury, and problems with road safety in Namibia, including the lack of a coordinated multi-sectoral approach. Despite this and being often very involved with care, HCWs are rarely or never consulted by the Namibian government or ministries that deal with road safety and related matters. CONCLUSIONS: It is suggested these findings will contribute to discussions about how HCWs can contribute to addressing and improving the care provided to people injured in RTIs in Namibia and other low and middle income countries with similar contexts.Implications for rehabilitationRoad traffic injuries (RTIs) are a major global public health challenge with over 1.2 million deaths and a high burden of disability.Namibia is one of the worst affected countries globally.Despite being involved in a national programme specifically targeting victims of RTIs, healthcare workers (HCWs) in Namibia are rarely included in road safety programming and policy making.Our study shows HCWs were knowledgeable about RTIs and the related problems and their inclusion in policy making has potential benefits.

Student, Staff, and Faculty Perspectives on Intimate Partner and Sexual Violence on 3 Public University Campuses: Protocol for the UC Speaks Up Study and Preliminary Results.

BACKGROUND: Intimate partner and sexual violence are pervasive public health issues on college and university campuses in the United States. Research is recommended for creating and maintaining effective, relevant, and acceptable prevention programs and response services for student survivors. OBJECTIVE: The University of California (UC) Speaks Up study aims to examine factors contributing to intimate partner and sexual violence on 3 UC campuses and use the findings to develop and test interventions and policies to prevent violence, promote health, and lay the groundwork for subsequent large-scale quantitative research. METHODS: A mixed methods study was conducted at UC Los Angeles, UC San Diego, and UC Santa Barbara. Phase I (2017-2020) involved a resource audit; cultural consensus modeling of students' perceptions of sexual consent; in-depth interviews (IDIs) and focus group discussions with students to understand perceptions of campus environment related to experiences as well as prevention of and responses to violence; and IDIs with faculty, staff, and community stakeholders to investigate institutional and community arrangements influencing students' lives and experiences. Phase II (2020-ongoing) involves IDIs with student survivors to assess the use and perceptions of campus and community services. Qualitative content analysis is used to generate substantive codes and subthemes that emerge, using a thematic analysis approach. RESULTS: In January 2019, we conducted 149 free-listing interviews and 214 web-based surveys with undergraduate and graduate and professional students for the cultural consensus modeling. Between February 2019 and June 2019, 179 IDIs were conducted with 86 (48%) undergraduate students, 21 (11.7%) graduate and professional students, 34 (19%) staff members, 27 (15.1%) faculty members, and 11 (6.1%) community stakeholders, and 35 focus group discussions (27/35, 77% with undergraduate students and 8/35, 23% with graduate and professional students) were conducted with 201 participants. Since September 2020, 50% (15/30) of the planned student survivor interviews have been conducted. This segment of data collection was disrupted by the COVID-19 pandemic. Recruitment is ongoing. CONCLUSIONS: Data analysis and phase II data collection are ongoing. The findings will be used to develop and test interventions for preventing violence, promoting health and well-being, and ensuring that survivor services are relevant and acceptable to and meet the needs of all individuals in the campus community, including those who are typically understudied. The findings will also be used to prepare for rigorous, UC-system-wide public health prevention research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31189.

A public health based vision for the management and regulation of opioids.

Prohibition of the possession of opioids for non-medical purposes and medical/pharmaceutical commercialization of opioids are important contributors to the current opioid overdose epidemic. A new model of regulation is urgently required. Within the context of a public health framework, we explore supply control, demand reduction, health promotion, and harm reduction and describe an alternative regulatory model that includes access for medical and non-medical purposes. Oversight of this proposed new system would include a control structure with an explicit public health mandate to minimize harms and maximize benefits of opioids. Medical access would be achieved through multi-disciplinary teams who would prescribe a range of opioids for 1) pain, 2) treatment for patients who develop opioid use disorder, and 3) other medical indications. Non-medical access could be achieved through models that would allow adults to purchase and use opioids for either supervised or take-home use. We describe three possible models to support jurisdiction specific discussions around the world. The first includes education and training that could result in certification with a basic or advanced license or a purchase authorization card. The second includes mandatory training that allows general access to opioids, but excludes people with problematic opioid use. The third model has optional training and excludes people with problematic opioid use. Allowing for inclusion of people dependent on the current illegal market during transition is highlighted. With any of these models, this approach, while attending to illegal market drivers, would result in a greatly reduced illegal opioid market and its attendant toxic products, reduced violence and corruption, and at the same time, provide a sharper focus for medical use with more appropriate prescribing and indications.

Children's Vulnerability to Sexual Violence During COVID-19 in Kenya: Recommendations for the Future.

This article discusses the latest research that reveals that children seem to be facing new risks of sexual violence in Kenya during the COVID-19 pandemic. The evidence suggests there have been changes in patterns of sexual offenses against children coincident with lockdowns, curfews, and school closures. In particular, emerging evidence from Kenya suggests that child victims are younger, more likely to be victimized by a neighbor in a private residence, and in the daytime, compared to pre-pandemic. We conclude that situational crime prevention strategies that focus on providing alternative safe venues to reduce offending opportunities must be a central part of a public health approach to reduce children's vulnerability during crises such as COVID-19.

The application of harm reduction to methamphetamine use during pregnancy: a call to arms.

Compared with opioid use disorder, methamphetamine use is a public health crisis that has limited evidence-based pharmacologic interventions for long-term treatment. The prevalence of methamphetamine use during pregnancy is growing and contributes to adverse maternal and neonatal outcomes. Because of widespread stigma and social complexities associated with methamphetamine use during pregnancy, these patients often experience limited prenatal care, further contributing to poor outcomes. In public health circles, harm reduction describes a framework for conceptualizing substance use by championing health promotion and the safest use of substances, as opposed to the unachievable goal of abstinence. There is limited evidence supporting the application of harm reduction in this population. We call for action and research to investigate how the progressive concept of harm reduction might be applied to mitigate adverse outcomes for obstetrical patients who use methamphetamine.