Women's health and use of crack cocaine in context: structural and 'everyday' violence.
BACKGROUND
There is increasing public health evidence that women who use crack cocaine and are street-involved experience significant health problems and are more isolated with regards to accessing harm reduction and other health-related services. Simultaneously, there is growing acknowledgement that structural and 'everyday' violence are significant factors influencing the health of women who use illegal drugs. Little research has examined how these social processes play out for women who use crack cocaine.


METHODS
A critical ethnography informed by the theoretical constructs of structural and everyday violence and intersectionality was undertaken to explore women's use of crack cocaine within an inner-city neighbourhood in Western Canada. Data collection included baseline survey (n=126), participant observation and field notes, informal interviews (n=53), and in-depth interviews (n=13).


RESULTS
Based on thematic and theoretical analysis two interrelated themes were identified that reflected the interrelationships between women's use of crack, poverty, discrimination, racism, gendered relations of power, and legal policies and practices: (a) the context of health care; and (b) the smoking context.


CONCLUSIONS
Structural inequities and 'everyday' violence are perilously damaging for women who use crack. Interventions to reduce these inequities are urgently needed if we are to reduce the significant suffering of women who are street-involved and use crack cocaine.
Bungay
Vicky
V
School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, Canada. vicky.bungay@nursing.ubc.ca
Johnson
Joy L
JL
Varcoe
Colleen
C
Boyd
Susan
S
D000328:Adult; D019970:Cocaine-Related Disorders; D016578:Crack Cocaine / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D040261:Harm Reduction; D006703:Ill-Housed Persons; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D019370:Observation; D011203:Poverty; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work / Q000523:psychology; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D014505:Urban Population; D014754:Violence / Q000517:prevention & control* / Q000523:psychology; D016387:Women's Health
D016578:Crack Cocaine