{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T05:52:13Z","timestamp":1775973133735,"version":"3.50.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute of Drug Abuse","doi-asserted-by":"crossref","award":["R01DA049644"],"award-info":[{"award-number":["R01DA049644"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000026","name":"National Institute of Drug Abuse","doi-asserted-by":"crossref","award":["3R01DA049644-03S2"],"award-info":[{"award-number":["3R01DA049644-03S2"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003141","name":"Consejo Nacional de Ciencia y Tecnolog\u00eda","doi-asserted-by":"publisher","award":["UCMEXUS2020"],"award-info":[{"award-number":["UCMEXUS2020"]}],"id":[{"id":"10.13039\/501100003141","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW009343"],"award-info":[{"award-number":["D43TW009343"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000066","name":"National Institute of Environmental Health Sciences","doi-asserted-by":"publisher","award":["K01ES031697"],"award-info":[{"award-number":["K01ES031697"]}],"id":[{"id":"10.13039\/100000066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Domains of adequate menstrual health (MH) include access to water, sanitation, and hygiene (WASH). People who menstruate with social disadvantages\u2014such as homelessness or drug injection practices\u2013often 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 \u2018<jats:italic>MH WASH Domain Scale-12<\/jats:italic>\u2019 among people who menstruate and who inject drugs in the Tijuana\u2013San Diego region and identified correlates of MH access using this scale.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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\u201312 points and higher scores indicating better MH access. We assessed the scale\u2019s 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\u20132021. MH-WASH items were described, and the scale was further used as an outcome variable to identify correlates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 125 (124 cis-female and 1 trans-male) PWID that reported menstruating, our \u2018<jats:italic>MH WASH Domain Scale-12\u2019<\/jats:italic> was reliable (Cronbach\u2019s alpha = 0.81, McDonald\u2019s Omega total = 0.83) and valid. We identified two sub-domains: Factor-1 included items describing \u2018WASH availability\u2019 and Factor-2 contained items related to \u2018WASH security\u2019\u2014encompassing 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0303378","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T17:35:06Z","timestamp":1715362506000},"page":"e0303378","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["A brief instrument measuring the water, sanitation and hygiene domain of menstrual health among women who inject drugs"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1064-7097","authenticated-orcid":true,"given":"Alhel\u00ed","family":"Calder\u00f3n-Villarreal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lourdes Johanna","family":"Avelar Portillo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Abramovitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shira","family":"Goldenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9502-9839","authenticated-orcid":true,"given":"Shawn","family":"Flanigan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Penelope J. E.","family":"Quintana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8708-8169","authenticated-orcid":true,"given":"Alicia","family":"Harvey-Vera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos F.","family":"Vera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gudelia","family":"Rangel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffanie A.","family":"Strathdee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia L.","family":"Kayser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"pone.0303378.ref001","first-page":"1911618","article-title":"Menstrual health: a definition for policy, practice, and research.","volume":"29","author":"J Hennegan","year":"2021","journal-title":"Sex Reprod Health Matters"},{"key":"pone.0303378.ref002","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/S0140-6736(21)02502-2","article-title":"Inclusivity starts with language","volume":"399","author":"R Kamau","year":"2022","journal-title":"The Lancet"},{"key":"pone.0303378.ref003","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/AOG.0000000000004042","article-title":"Menstrual Hygiene Needs Among Women Undergoing Substance Use Disorder Treatment","volume":"136","author":"V Keiser","year":"2020","journal-title":"Obstet Gynecol"},{"key":"pone.0303378.ref004","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.2105\/AJPH.2022.306796","article-title":"An Ethnographic Assessment of COVID-19\u2012Related Changes to the Risk Environment for People Who Use Drugs in Tijuana, Mexico.","volume":"112","author":"J Friedman","year":"2022","journal-title":"Am J Public Health."},{"key":"pone.0303378.ref005","doi-asserted-by":"crossref","first-page":"115044","DOI":"10.1016\/j.socscimed.2022.115044","article-title":"Deported, homeless, and into the canal: Environmental structural violence in the binational Tijuana River.","volume":"305","author":"A Calder\u00f3n-Villarreal","year":"2022","journal-title":"Soc Sci Med"},{"key":"pone.0303378.ref006","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12939-023-01920-8","article-title":"Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California.","volume":"22","author":"LJ Avelar Portillo","year":"2023","journal-title":"Int J Equity Health"},{"key":"pone.0303378.ref007","doi-asserted-by":"crossref","first-page":"e0000019","DOI":"10.1371\/journal.pwat.0000019","article-title":"\u2018You feel how you look\u2019: Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use.","volume":"1","author":"AM Ballard","year":"2022","journal-title":"PLOS Water."},{"key":"pone.0303378.ref008","doi-asserted-by":"crossref","first-page":"432","DOI":"10.2471\/BLT.18.223305","article-title":"Water, sanitation and hygiene: measuring gender equality and empowerment","volume":"97","author":"GL Kayser","year":"2019","journal-title":"Bull World Health Organ"},{"key":"pone.0303378.ref009","first-page":"12","article-title":"Water, sanitation and hygiene at sex work venues to support menstrual needs.","author":"PA Phillips-Howard","year":"2024","journal-title":"Front Public Health"},{"key":"pone.0303378.ref010","doi-asserted-by":"crossref","first-page":"e0232935","DOI":"10.1371\/journal.pone.0232935","article-title":"Measurement in the study of menstrual health and hygiene: A systematic review and audit.","volume":"15","author":"J Hennegan","year":"2020","journal-title":"PLOS ONE."},{"key":"pone.0303378.ref011","doi-asserted-by":"crossref","first-page":"2633","DOI":"10.3390\/ijerph17082633","article-title":"National Monitoring for Menstrual Health and Hygiene: Is the Type of Menstrual Material Used Indicative of Needs Across 10 Countries?","volume":"17","author":"AD Smith","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0303378.ref012","first-page":"100637","article-title":"Taxing women\u2019s bodies: the state of menstrual product taxes in the Americas","volume":"29","author":"A. 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