ArticleBMC public health2024
WaSH insecurity and anxiety among people who inject drugs in the Tijuana-San Diego border region.
Article in BMC public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 9 citations in OpenAlex.
- Considering water, sanitation, and hygiene as a valuable component of harm reduction.Harm reduction journal · 2026Review
- The Water Insecurity Experiences (WISE) Scales are suitable for use in high-income settings: findings from cognitive interviews and nationally representative surveys.International journal for equity in health · 2025Article
- Unmet Subsistence and Mental Health Needs in Women Experiencing Homelessness: Rethinking Care Models for Improved Outcomes.Journal of general internal medicine · 2025Article
- The Water Insecurity Experiences (WISE) Scales are suitable for use in high-income settings: findings from cognitive interviews and nationally representative surveys.Research square · 2025Article
- Risk Factors for Infective Endocarditis and Serious Injection Related Infections Among People Who Inject Drugs in Los Angeles, CA and Denver, CO.Drug and alcohol dependence · 2025Article
- Climate change and extreme weather events and linkages with HIV outcomes: recent advances and ways forward.Current opinion in infectious diseases · 2025Review
- Sleep Health among Community-Recruited Opioid-Using People Who Inject Drugs in Los Angeles, CA and Denver, CO.Journal of urban health : bulletin of the New York Academy of Medicine · 2024Article
- Water, sanitation and hygiene insecurity predict abscess incidence among people who inject drugs in a binational US-Mexico metropolitan area: A longitudinal cohort study.The International journal on drug policy · 2024Article
- A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs.PloS one · 2024Article
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Authors and funding
11 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundWater, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region.
methodsFrom 2020-2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months.
resultsParticipants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02-1.58), sanitation (Adj RR:1.28; 95% CI: 1.07-1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15-1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12-1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27-1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01-1.89).
conclusionThe lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.
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