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<!DOCTYPE html> <html xmlns="http://www.w3.org/1999/xhtml" xmlns:dc="http://purl.org/dc/terms/" xmlns:doi="http://dx.doi.org/" lang="en" xml:lang="en" itemscope itemtype="http://schema.org/Article" class="no-js"> <head prefix="og: http://ogp.me/ns#"> <link rel="stylesheet" href="/resource/css/desktop/metrics.css?112d78c04dc25a6fb55b68d577e0729a"/>   <link rel="stylesheet" type="text/css" href="https://fonts.googleapis.com/css?family=Open+Sans:400,400i,600"> <link media="print" rel="stylesheet" type="text/css" href="/resource/css/print.css"/> <script type="text/javascript"> var siteUrlPrefix = "/plosone/"; </script> <script src="/resource/js/vendor/modernizr-v2.7.1.js" type="text/javascript"></script> <script src="/resource/js/vendor/detectizr.min.js" type="text/javascript"></script> <link rel="shortcut icon" href="/resource/img/favicon.ico" type="image/x-icon"/> <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/> <link rel="canonical" href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0303378" /> <meta name="description" content="Background Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages—such as homelessness or drug injection practices–often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel ‘MH WASH Domain Scale-12’ among people who menstruate and who inject drugs in the Tijuana–San Diego region and identified correlates of MH access using this scale. Methods We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0–12 points and higher scores indicating better MH access. We assessed the scale’s reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020–2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Results Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our ‘MH WASH Domain Scale-12’ was reliable (Cronbach’s alpha = 0.81, McDonald’s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing ‘WASH availability’ and Factor-2 contained items related to ‘WASH security’—encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. Conclusion We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region." /> <meta name="citation_abstract" content="Background Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages—such as homelessness or drug injection practices–often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel ‘MH WASH Domain Scale-12’ among people who menstruate and who inject drugs in the Tijuana–San Diego region and identified correlates of MH access using this scale. Methods We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0–12 points and higher scores indicating better MH access. We assessed the scale’s reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020–2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Results Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our ‘MH WASH Domain Scale-12’ was reliable (Cronbach’s alpha = 0.81, McDonald’s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing ‘WASH availability’ and Factor-2 contained items related to ‘WASH security’—encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. Conclusion We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region."> <meta name="keywords" content="Sanitation,Housing,Sex work,Soaps,Urban areas,Hygiene,Measurement,Schools" /> <meta name="citation_doi" content="10.1371/journal.pone.0303378"/> <meta name="citation_author" content="Alhelí Calderón-Villarreal"/> <meta name="citation_author_institution" content="Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego (UCSD), San Diego, California, United States of America"/> <meta name="citation_author_institution" content="School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America"/> <meta name="citation_author" content="Lourdes Johanna Avelar Portillo"/> <meta name="citation_author_institution" content="Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America"/> <meta name="citation_author_institution" content="Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, United States of America"/> <meta name="citation_author" content="Daniela Abramovitz"/> <meta name="citation_author_institution" content="Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America"/> <meta name="citation_author" content="Shira Goldenberg"/> <meta name="citation_author_institution" content="School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America"/> <meta name="citation_author" content="Shawn Flanigan"/> <meta name="citation_author_institution" content="School of Public Affairs, SDSU, San, Diego, California, United States of America"/> <meta name="citation_author" content="Penelope J. E. Quintana"/> <meta name="citation_author_institution" content="School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America"/> <meta name="citation_author" content="Alicia Harvey-Vera"/> <meta name="citation_author_institution" content="Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America"/> <meta name="citation_author_institution" content="Universidad de Xochicalco, Tijuana, Baja California, Mexico"/> <meta name="citation_author" content="Carlos F. Vera"/> <meta name="citation_author_institution" content="Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, United States of America"/> <meta name="citation_author" content="Gudelia Rangel"/> <meta name="citation_author_institution" content="El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico"/> <meta name="citation_author_institution" content="Border Health Commission, Tijuana, Baja California, Mexico"/> <meta name="citation_author" content="Steffanie A. Strathdee"/> <meta name="citation_author_institution" content="Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America"/> <meta name="citation_author" content="Georgia L. Kayser"/> <meta name="citation_author_institution" content="Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America"/> <meta name="citation_title" content="A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs"/> <meta itemprop="name" content="A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs"/> <meta name="citation_journal_title" content="PLOS ONE"/> <meta name="citation_journal_abbrev" content="PLOS ONE"/> <meta name="citation_date" content="May 10, 2024"/> <meta name="citation_firstpage" content="e0303378"/> <meta name="citation_issue" content="5"/> <meta name="citation_volume" content="19"/> <meta name="citation_issn" content="1932-6203"/> <meta name="citation_publisher" content="Public Library of Science"/> <meta name="citation_pdf_url" content="https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0303378&type=printable"> <meta name="citation_article_type" content="Research Article"> <meta name="dc.identifier" content="10.1371/journal.pone.0303378" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:site" content="plosone"/> <meta name="twitter:title" content="A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs" /> <meta property="twitter:description" content="Background Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages—such as homelessness or drug injection practices–often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel ‘MH WASH Domain Scale-12’ among people who menstruate and who inject drugs in the Tijuana–San Diego region and identified correlates of MH access using this scale. Methods We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0–12 points and higher scores indicating better MH access. We assessed the scale’s reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020–2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Results Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our ‘MH WASH Domain Scale-12’ was reliable (Cronbach’s alpha = 0.81, McDonald’s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing ‘WASH availability’ and Factor-2 contained items related to ‘WASH security’—encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. Conclusion We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region." /> <meta property="twitter:image" content="https://journals.plos.org/plosone/article/figure/image?id=10.1371/journal.pone.0303378.g002&size=inline" /> <meta property="og:type" content="article" /> <meta property="og:url" content="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0303378"/> <meta property="og:title" content="A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs"/> <meta property="og:description" content="Background Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages—such as homelessness or drug injection practices–often face barriers to WASH access. However, validated instruments to measure MH are limited among marginalized populations, and available instruments involve lengthy surveys. We developed and evaluated psychometric properties of a novel ‘MH WASH Domain Scale-12’ among people who menstruate and who inject drugs in the Tijuana–San Diego region and identified correlates of MH access using this scale. Methods We constructed a MH-scale based on access to twelve WASH-related items: (1) menstrual products, (2) body hygiene (bathing per week), (3) water sources for bathing, (4) improved, (5) non-shared, (6) available, (7) private, (8) nearby, (9) and safe sanitation facilities, (10) availability of soap, (11) water source for handwashing, and (12) handwashing facilities with soap/water. Variables were dichotomized and summed, with scores ranging from 0–12 points and higher scores indicating better MH access. We assessed the scale’s reliability and construct and content validity using data from a binational cross-sectional study. The sample included people who inject drugs (PWID) who had ever menstruated in their lifetime and were 18+ during 2020–2021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates. Results Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our ‘MH WASH Domain Scale-12’ was reliable (Cronbach’s alpha = 0.81, McDonald’s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing ‘WASH availability’ and Factor-2 contained items related to ‘WASH security’—encompassing physical and biological safety. Scale scores were significantly lower among participants experiencing unsheltered homelessness compared to participants experiencing sheltered homelessness or living in permanent housing. Conclusion We constructed and validated a novel and reliable scale to measure MH-related WASH access that can be used to assess MH among marginalized populations in English- and Spanish-speaking contexts. Using this scale we identified disparities in MH-WASH access among PWID and who menstruate in the US-Mexico border region."/> <meta property="og:image" content="https://journals.plos.org/plosone/article/figure/image?id=10.1371/journal.pone.0303378.g002&size=inline"/>  <script type='text/javascript'> var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; (function() { var gads = document.createElement('script'); gads.async = true; gads.type = 'text/javascript'; var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 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Writing – review & editing </p> <p id="authCorresponding-0"> <span class="email">* E-mail:</span> <a href="mailto:alheli.calderon@gmail.com">alheli.calderon@gmail.com</a>, <a href="mailto:acv001@health.ucsd.edu">acv001@health.ucsd.edu</a>, <a href="mailto:acalderonvilla0207@sdsu.edu">acalderonvilla0207@sdsu.edu</a></p> <p id="authAffiliations-0"><span class="type">Affiliations</span> Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego (UCSD), San Diego, California, United States of America, School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America </p> <div> <p class="orcid" id="authOrcid-0"> <span> <a id="connect-orcid-link" href="https://orcid.org/0000-0003-1064-7097" target="_blank" title="ORCID Registry"> <img id="orcid-id-logo" src="/resource/img/orcid_16x16.png" width="16" height="16" alt="ORCID logo"/> https://orcid.org/0000-0003-1064-7097 </a> </span> </p> </div> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose0"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="1" class="author-name" > Lourdes Johanna Avelar Portillo,</a> <div id="author-meta-1" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Conceptualization, Investigation, Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-1"><span class="type">Affiliations</span> Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America, Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose1"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="2" class="author-name" > Daniela Abramovitz,</a> <div id="author-meta-2" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Data curation, Methodology, Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-2"><span class="type">Affiliation</span> Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose2"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="3" class="author-name" > Shira Goldenberg,</a> <div id="author-meta-3" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-3"><span class="type">Affiliation</span> School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose3"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="4" class="author-name" > Shawn Flanigan,</a> <div id="author-meta-4" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-4"><span class="type">Affiliation</span> School of Public Affairs, SDSU, San, Diego, California, United States of America </p> <div> <p class="orcid" id="authOrcid-4"> <span> <a id="connect-orcid-link" href="https://orcid.org/0000-0002-9502-9839" target="_blank" title="ORCID Registry"> <img id="orcid-id-logo" src="/resource/img/orcid_16x16.png" width="16" height="16" alt="ORCID logo"/> https://orcid.org/0000-0002-9502-9839 </a> </span> </p> </div> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose4"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="5" class="author-name" > Penelope J. E. Quintana,</a> <div id="author-meta-5" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-5"><span class="type">Affiliation</span> School of Public Health, San Diego State University (SDSU), San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose5"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="6" class="author-name" > Alicia Harvey-Vera,</a> <div id="author-meta-6" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Investigation, Project administration, Resources </p> <p id="authAffiliations-6"><span class="type">Affiliations</span> Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America, Universidad de Xochicalco, Tijuana, Baja California, Mexico </p> <div> <p class="orcid" id="authOrcid-6"> <span> <a id="connect-orcid-link" href="https://orcid.org/0000-0002-8708-8169" target="_blank" title="ORCID Registry"> <img id="orcid-id-logo" src="/resource/img/orcid_16x16.png" width="16" height="16" alt="ORCID logo"/> https://orcid.org/0000-0002-8708-8169 </a> </span> </p> </div> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose6"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="7" class="author-name" > Carlos F. Vera,</a> <div id="author-meta-7" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Investigation, Project administration </p> <p id="authAffiliations-7"><span class="type">Affiliation</span> Division of Global Health, Herbert Wertheim School of Public Health and Human Longevity Science, UCSD, San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose7"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="8" class="author-name" > Gudelia Rangel,</a> <div id="author-meta-8" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Funding acquisition, Project administration, Resources </p> <p id="authAffiliations-8"><span class="type">Affiliations</span> El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico, Border Health Commission, Tijuana, Baja California, Mexico </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose8"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="9" class="author-name" > Steffanie A. Strathdee,</a> <div id="author-meta-9" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Funding acquisition, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-9"><span class="type">Affiliation</span> Department of Medicine, Division of Infectious Diseases and Global Public Health, UCSD, San Diego, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose9"> ⨯ </a> </div> </li> <li data-js-tooltip="tooltip_trigger" > <a data-author-id="10" class="author-name" > Georgia L. Kayser</a> <div id="author-meta-10" class="author-info" data-js-tooltip="tooltip_target"> <p class="roles" id="authRoles"> <span class="type">Roles</span> Conceptualization, Methodology, Supervision, Validation, Writing – review & editing </p> <p id="authAffiliations-10"><span class="type">Affiliation</span> Benioff Homelessness and Housing Initiative, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America </p> <a data-js-tooltip="tooltip_close" class="close" id="tooltipClose10"> ⨯ </a> </div> </li> </ul> <script src="/resource/js/components/tooltip.js" type="text/javascript"></script> </div> <div id="floatTitleTop" data-js-floater="title_author" class="float-title" role="presentation"> <div class="set-grid"> <div class="float-title-inner"> <h1><?xml version="1.0" encoding="UTF-8"?>A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs</h1> <ul id="floatAuthorList" data-js-floater="floated_authors"> <li data-float-index="1">Alhelí Calderón-Villarreal,  </li> <li data-float-index="2">Lourdes Johanna Avelar Portillo,  </li> <li data-float-index="3">Daniela Abramovitz,  </li> <li data-float-index="4">Shira Goldenberg,  </li> <li data-float-index="5">Shawn Flanigan,  </li> <li data-float-index="6">Penelope J. E. Quintana,  </li> <li data-float-index="7">Alicia Harvey-Vera,  </li> <li data-float-index="8">Carlos F. Vera,  </li> <li data-float-index="9">Gudelia Rangel,  </li> <li data-float-index="10">Steffanie A. 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