British Columbia Research Articles

Outcomes of the Health Data Research Network (HDRN) Canada and Canadian Longitudinal Study on Aging (CLSA) Partnership

Objective and ApproachThe Canadian Longitudinal Study on Aging (CLSA) is the largest national longitudinal cohort study, following ~50,000 adults across 10 provinces for at least 20 years. Health Data Research Network (HDRN) Canada is a distributed pan-Canadian network including members in all 13 provinces and territories. In February 2021, the organizations partnered with the objective to provide researchers with efficient access to multi-regional CLSA data linked to other health/health-related data through HDRN Canada’s data centres. A Steering Committee was convened including representatives from all parties to oversee the process from data sharing agreements (DSAs), negotiating terms of access, through to data transfer and linkage. ResultsIn Spring 2024, linkage was complete at four data centres (Ontario, New Brunswick, British Columbia, and Nova Scotia), with a DSA also in place for Newfoundland and Labrador. DSAs are nearing approval at three others (Manitoba, Prince Edward Island, and Quebec), and in progress in Alberta. Saskatchewan is working towards participation. ConclusionsThe HDRN Canada-CLSA partnership is on the way to making linked provincial CLSA cohort data available in all participating jurisdictions, facilitated by streamlined agreements and processes. ImplicationsCollaborative efforts of organizations such as HDRN Canada and CLSA to foster data linkages and streamline data access at a multi-regional level offers an unparalleled opportunity to explore the intersection between aging and health care utilization. Research enabled by this initiative will inform health care decision making and evidence-based policy development at multiple levels, from the individual to multiple levels of government.

Taking Seriousness Seriously: Revisiting Gender Symmetry and Mutual Violence in Intimate Partner Violence through Role Types in Intimate Partner Violence Events Reported to the Police

The study examines gender symmetry and asymmetry in intimate partner violence (IPV) reported to the police. A large database of police-recorded IPV events in British Columbia is analyzed over a four-year period (2009–2012) to examine the nature of gender symmetry, asymmetry, and mutual violence in the context of roles (as victims and perpetrators) in IPV. In accordance with past research, the findings show a pattern of gender asymmetry for IPV offences for women generally and across repeat IPV police contacts. Across repeat contacts with the police, the results indicate that the probability of being victimized repeatedly is much greater for females, although there is a significant amount of symmetrical violence, gauged by similar levels of victim and offender role counts, and mutual violence in the histories of females. In addition, as the number of associated events increases, a greater proportion of females have perpetrator role associations in their histories. The results indicate that in the context of mutual violence, females are likely to have a small number (i.e., one) of perpetrator roles within a history of victimization.

Concurrent Opioid and Psychotropic Drug Use During Pregnancy: Descriptive Study from Two Canadian Provinces

ObjectivesThis study aims to describe the patterns of concurrent opioid and psychotropic drug use (CU) during pregnancy and the characteristics of the mothers dispensed these drugs. MethodsPregnancies between 2000-2020 were identified using administrative data from Manitoba and British Columbia, Canada. Prenatal opioid and psychotropic drug dispensations were assessed, and exposure groups created based on the number of dispensations within each drug category. Descriptive statistics are reported. ResultsApproximately 1.4% of 1,040,021 pregnancies involved CU. Odds of CU were greater for 2+ opioid pregnancies compared to pregnancies with only 1 opioid (OR=4.05). Among CU pregnancies, it was more likely for 2+ types of psychotropics to be dispensed for those involving 2+ opioids compared to 1 (OR=2.23). Percent of CU pregnancies did not change over time, while opioid pregnancies decreased, and psychotropic pregnancies increased. Average morphine equivalent dose of opioids/pregnancy was higher in CU than opioid only pregnancies. Compared to mothers without exposure, CU exposed mothers were of similar age, more likely to live rurally, in lower income areas, and have lower care continuity. ConclusionCU pregnancies remained stable over time. It was more likely for mothers dispensed 2+ opioids to be CU than mothers dispensed only 1 opioid, and more likely for CU mothers dispensed 2+ opioids to be dispensed 2+ psychotropic types. Overall strength of opioids was higher for CU mothers compared to opioid only exposed mothers. ImplicationsStudies measuring the impact of CU on maternal and child outcomes should be conducted to inform safe prescribing practices.

Towards a "Biography" of Population Health Data about Substance Use Disorders: Qualitative Approaches to Communicating Context

BackgroundUnderstanding contexts of data production is necessary for using data accurately and ethically. “Biographies of data"" have developed as a complement to existing metadata as a way to critically examine and communicate social structures and power dynamics encoded in data. This project is focused on developing a “biography” of diagnostic codes, used to identify substance use disorders (SUD) in population health datasets. People with SUD regularly experience stigma and exclusion, particularly from healthcare settings. MethodsQualitative semi-structured interviews were conducted in 2024 with ""producers"" and “managers” of administrative data, including physicians and health information professionals, in British Columbia, Canada. The interviews explored processes involved with coding and billing, and the meaning of diagnostic codes from the perspective of those involved. This includes considerations of the population, social, and geographic factors, and implications of coding as inputs to decision-making. Reflexive thematic analysis was used to identify broad themes and report findings. ResultsAlthough data collection and analysis is ongoing, emerging findings have revealed structural, institutional, and social-level processes that influence coding decisions, as well as potential implications on research, policy making, and knowledge production about SUD. ConclusionAddressing the complexities of SUD and the overdose crisis will require a variety of data sources and approaches, and linked population health and administrative data will continue to be one important resource. Through better understanding the contexts and processes that inform the production and management of SUD-related population data, we will shed light on the ethical and social implications of their use.

From design to implementation: Lessons from planning the first marine protected area network in Canada

The social-ecological outcomes of marine protected areas (MPAs) can be amplified when sites are designed in networks that function cooperatively and synergistically. From 2015–2024, seventeen First Nations, the Province of British Columbia, and the Government of Canada collaboratively developed a Network Action Plan to establish an MPA Network for the Northern Shelf Bioregion (NSB). The NSB is a diverse and complex social-ecological region in British Columbia that spans an area of 102,000 km2 from Northern Vancouver Island to the Alaska border. Here, we describe the MPA Network planning process and the transition from Network planning to implementation. We discuss key elements of success that enabled the Network Action Plan’s collaborative development and lessons learned to inform and improve regional MPA Network implementation and global MPA Network planning and implementation. All phases of the planning process, including governance, development, engagement, design, and analysis, were guided by the following principles: collaborative governance, multiple ways of knowing, participatory engagement, and adaptation to new information. The Network Action Plan’s dynamic design process resulted in innovative approaches and tools to protect conservation objectives throughout the NSB. As the NSB MPA Network process transitions from planning toward implementation, collaborative governance, network monitoring, and ongoing participatory engagement processes will play a central role in advancing the goals and objectives articulated in the Network Action Plan and ensuring equitable social-ecological outcomes. Overall, the NSB MPA Network planning process provides a model for collaborative design of MPA Networks and can inform co-governance and co-management processes throughout the world.

Employment Decisions of Newly Graduated Occupational Therapists.

Introduction. Employment decision-making is essential for understanding workforce trends. Current occupational therapy workforce research describes distribution disparities of occupational therapists within geographic locations, services such as acute care or community health, and private or public sectors. New graduates of occupational therapy programs are critical to meeting the demand and distribution disparities of occupational therapy services in British Columbia. However, recent employment decision-making of new occupational therapy graduates has not been well studied. Purpose. This study aimed to examine factors that influence newly graduated occupational therapists' employment decisions. Methods. This descriptive study sampled 122 occupational therapists who were registered in one province and graduated from a Canadian occupational therapy program between 2017 and 2022. Data was collected through an online survey about intrinsic factors, extrinsic factors, and past fieldwork experiences that affected participants' employment decision-making. Descriptive data analysis was used to organize participants' responses. Findings. Results identified that work-life balance and mentorship were the highest rated factors that influenced participants' current and first employment respectively. Participants agreed that the variety and number of placements they had as students were more influential to their employment decisions than the length of the fieldwork education. Conclusion. This study identified the intrinsic and extrinsic factors in employment choices that may influence recruitment, retention, and workplace planning of new graduates.

Pleistocene Glacial Transport of Nephrite Jade from British Columbia, Canada, to Coastal Washington State, USA

Since prehistoric times, indigenous residents of southwest British Columbia, Canada, collected water-worn nephrite specimens from the gravel bars along the Fraser River, using the stone for the manufacture of tools that were widely traded with other tribes. Allochthonous nephrite occurs in another geologic setting. Late Pleistocene continental glaciers transported nephrite and many other rock types from western Canada to northwest Washington State, producing extensive sediment deposits that border the Salish Sea coast in Whatcom and Island Counties, Washington. This material was little utilized by indigenous residents, but “black jade” specimens are prized by modern collectors. The depositional history and mineralogy of this material has received little attention. X-ray diffraction and SEM/EDS analyses indicate that the Salish Sea “black jade” is a form of impure nephrite that probably originated from metamorphism of a mafic igneous parent material (metabasite). The texture consists of prismatic amphibole crystals (ferro-actinolite) set in a matrix rich in plagioclase feldspar. Pyrite inclusions are locally present. A second material, sometimes erroneously labelled “muttonfat jade” by amateur collectors, consists of an intermixture of quartz and sillimanite.

Growing inequities by immigration group among older adults: population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada

BackgroundThe onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival.MethodsWe used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20–2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age.ResultsIn general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40–0.45). These disparities grew wider over the course of the pandemic.ConclusionThough among younger adults changes in access to primary care between 2019–2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed.

Outdoor Play and Learning in Elementary Schools: A Critical Participatory Action Research Project

In this study, we enacted critical participatory action research (CPAR) within an online community of practice (CoP). The CoP was designed to build a community of outdoor play and learning (OPAL) practitioners. This paper describes how a cohort (n=18) of experienced Kindergarten to grade eight (K-8) teachers from across British Columbia shared their OPAL experiences and practice and the collective action taken. Regularly scheduled meetings over a six-month period resulted in dialogue that identified the need for quality resources that were accessible for all teachers. The concept of a website, developed for teachers by teachers experienced with OPAL, was initiated within the CPAR process. This article describes findings related to participation in a CPAR CoP, and the process of deciding upon and enacting shared action to support OPAL elementary school teachers.

Addressing immortal time bias in precision medicine: Practical guidance and methods development.

To compare theoretical strengths and limitations of common immortal time adjustment methods, propose a new approach using multiple imputation (MI), and provide practical guidance for using MI in precision medicine evaluations centered on a real-world case study. Methods comparison, guidance, and real-world case study based on previous literature. We compared landmark analysis, time-distribution matching, time-dependent analysis, and our proposed MI application. Guidance for MI spanned (1) selecting the imputation method; (2) specifying and applying the imputation model; and (3) conducting comparative analysis and pooling estimates. Our case study used a matched cohort design to evaluate overall survival benefits of whole-genome and transcriptome analysis, a precision medicine technology, compared to usual care for advanced cancers, and applied both time-distribution matching and MI. Bootstrap simulation characterized imputation sensitivity to varying data missingness and sample sizes. Case study used population-based administrative data and single-arm precision medicine program data from British Columbia, Canada for the study period 2012 to 2015. While each method described can reduce immortal time bias, MI offers theoretical advantages. Compared to alternative approaches, MI minimizes information loss and better characterizes statistical uncertainty about the true length of the immortal time period, avoiding false precision. Additionally, MI explicitly considers the impacts of patient characteristics on immortal time distributions, with inclusion criteria and follow-up period definitions that do not inadvertently risk biasing evaluations. In the real-world case study, survival analysis results did not substantively differ across MI and time distribution matching, but standard errors based on MI were higher for all point estimates. Mean imputed immortal time was stable across simulations. Precision medicine evaluations must employ immortal time adjustment methods for unbiased, decision-grade real-world evidence generation. MI is a promising solution to the challenge of immortal time bias.

The eukaryome of modern microbialites reveals distinct colonization across aquatic ecosystems

Protists are less studied for their role and diversity in ecosystems. Notably, protists have played and still play an important role in microbialites. Microbialites, or lithified microbial mats, represent the oldest evidence of fossil biofilms (~3.5 Gyr). Modern microbialites may offer a unique proxy to study the potential role of protists within a geological context. We examined protist diversity in freshwater (Kelly and Pavilion Lake in British Columbia, Canada) and marine (Highborne Cay, Bahamas) to hypersaline (Shark Bay, Australia) microbialites to decipher their geomicrobiological role. The freshwater microbialite communities were clearly distinct from their marine and hypersaline counterparts. Chlorophytes had higher numerical abundance in freshwater microbialites; whereas pennate diatoms dominated numerically in marine microbialites. Despite the differences, protists across ecosystems may have adopted similar roles and functions. We suggest a consistent biogeochemical role of protists across microbialites globally; but that salinity may shape protist composition and evolution in these ecosystems.

Spatially heterogeneous selection and inter-varietal differentiation maintain population structure and local adaptation in a widespread conifer

BackgroundDouglas-fir (Pseudotsuga menziesii [Mirb.] Franco) plays a critical role in the ecology and economy of Western North America. This conifer species comprises two distinct varieties: the coastal variety (var. menziesii) along the Pacific coast, and the interior variety (var. glauca) spanning the Rocky Mountains into Mexico, with instances of inter-varietal hybridization in Washington and British Columbia. Recent investigations have focused on assessing environmental pressures shaping Douglas-fir’s genomic variation for a better understanding of its evolutionary and adaptive responses. Here, we characterize range-wide population structure, estimate inter-varietal hybridization levels, identify candidate loci for climate adaptation, and forecast shifts in species and variety distribution under future climates.ResultsUsing a custom SNP-array, we genotyped 540 trees revealing four distinct clusters with asymmetric admixture patterns in the hybridization zone. Higher genetic diversity observed in coastal and hybrid populations contrasts with lower diversity in inland populations of the southern Rockies and Mexico, exhibiting a significant isolation by distance pattern, with less marked but still significant isolation by environment. For both varieties, we identified candidate loci associated with local adaptation, with hundreds of genes linked to processes such as stimulus response, reactions to chemical compounds, and metabolic functions. Ecological niche modeling revealed contrasting potential distribution shifts among the varieties in the coming decades, with interior populations projected to lose habitat and become more vulnerable, while coastal populations are expected to gain suitable areas.ConclusionsOverall, our findings provide crucial insights into the population structure and adaptive potential of Douglas-fir, with the coastal variety being the most likely to preserve its evolutionary path throughout the present century, which carry implications for the conservation and management of this species across their range.

Taphonomic impact of vertebrate scavengers on degradation and dispersal of remains, southeastern British Columbia.

Vertebrate scavengers represent important taphonomic agents that can act on a body, particularly when in an outdoor environment. Understanding the effects of these agents will direct how and where to search for human remains and influence the likelihood of discovery in a particular region. The current study aimed to identify the taphonomic impact of scavenger guilds in the peri-urban and rural regions of southeastern British Columbia. Vertebrate scavenger activity on pig carcasses was recorded remotely using trail cameras and analyzed to determine temporal scavenging profiles. Both the peri-urban and rural environments produced comparable scavenger guilds, namely: turkey vultures, American crows/northern ravens (classified as "corvids"), American black bears, and coyotes. Although the two locations had different study lengths due to variable degrees of scavenging, for the period that was common to both locations (summer to early fall), the black bear was the most frequent scavenger followed by coyote. However, the dispersal of remains by the mammalian scavengers was distinctly different between sites. Only 12%-33% of skeletal elements were recovered at the rural sites compared to 80%-90% recovered at the peri-urban sites, even though the latter sites had a longer study timeframe. The extended timeframe of the peri-urban sites confirmed that certain scavengers (e.g., turkey vultures and black bears) are only seasonally active in this region. These findings demonstrate the variability of scavenger behavior and the need to assign caution and local ecological knowledge when predicting scavenger trends. Such taphonomic information is relevant for human remains searches in regions with comparable scavenger guilds.

Peer power: how drug user groups navigate harm reduction in Surrey, British Columbia and resist the carceral state

Abstract The article discusses the Surrey Union of Drug Users (SUDU) in British Columbia, emphasizing harm reduction, safe supply, and destigmatization for drug users. As a peer-led group, SUDU actively resists carceral state policies. The analysis explores challenges faced by peer-led groups, including formation, sustainability, and mobilization efforts. It highlights the need for supportive frameworks to enhance peer-led harm reduction initiatives and argues that such advocacy enables alternative knowledge and institutional innovations that are conducive to building a real world abolitionist future.

A case of hyperdontia in grizzly bear in British Columbia

A case of hyperdontia in grizzly bear in British Columbia

Identifying Applications of Wood Ash by Matching Its Characteristics with End-User Quality Requirements: A Case Study

Despite being a bio-based material, wood ash generated by pulp and paper mills is mainly landfilled in Canada. This is because it is perceived as waste material and the certification requirements and regulations controlling its use are complex. To promote wood ash utilization, ash samples from mills in British Columbia (BC), Canada were characterized, and the properties were compared to quality specifications for potential applications. Three types of ash samples were collected: bottom ash, multi-clone (MC) ash, and electrostatic precipitator (ESP) ash. The characteristics of each type of ash were analyzed, and their suitability for various applications was determined. The study found that ESP ash had a higher calcium carbonate equivalent (CCE) value than MC ash, making it more useful as a liming material in agricultural land. The study identified quality criteria for industries where wood ash can be used, such as construction, agriculture, composting, stabilization/solidification, liming, mining, and fire-retardant. Each type of ash was evaluated for its use in these industries, and the environmental regulations for each application were considered. It was observed that the quality criteria for one application could differ dramatically from those for another. Intuitively, an ash producer would cross-check the characteristics of their ash types against the quality requirements for potential uses near the ash source because different applications have different quality requirements This article is believed to help identify promising applications of ash thereby removing ash from landfilling and promoting the circular economy.

Modern plants and sulfur isoscapes - A review, discussion, and construction of a pilot δ34S isoscape for mobility and provenance studies.

Sulfur isotopes are increasingly used as mobility indicators in humans and animals in biology, archaeology, and forensics. However, there has been a lack of modern sulfur isotope baseline "isoscape" studies using modern plants and animals, largely due to the possibility of contamination of the S isotope values by modern pollution. We collected plants from across a 900-km east-west transect of British Columbia Canada and measured their sulfur isotope values. We then used a random forest model to determine which variables best explained the isotope data patterning and produced a sulfur isoscape for the southern region of British Columbia. We see clear patterning in the plant sulfur isotope values that relate to geographical location and rainfall. Our model also shows that for this study area, it is unlikely that there is a significant influence of anthropogenic pollution on plant δ34S values. We also discuss the use of plants as a substrate for sulfur isoscapes and possible explanations for the often-observed difference between plant and animal δ34S values from the same region, related to differing sources of sulfur in plants compared to amino acids in human and animal tissues. We found that for areas of the world where sulfur pollution is likely less widespread, it is possible to produce a modern plant S isoscape that should be an accurate baseline for mobility studies. Using random forest modelling, we have produced a baseline sulfur isoscape map of southern British Columbia that can be used for ecology, forensic and archaeological studies.

Balancing Act: Reassessing the Canadian Government Environmental Priorities in the Wake of the Sydney Tar Ponds Disaster

"Does the government of Canada care about us, or even this land?" is a sentiment often voiced by many Sydney, Nova Scotia locals. Here, there is growing concern that the Canadian government's approach to environmental issues may be overly centred on human health, neglecting the vital dimension of animal health. While the Canadian government is known to prioritize human wellbeing as can be seen during the 2016 Fort McMurray wildfires and the 2013 Alberta floods, it is equally crucial to recognize the interconnectedness of ecological systems, wherein the welfare of animals plays a pivotal role. As Canada grapples with pressing environmental challenges like wildfires in British Columbia and depleting salmon populations on the Atlantic Coast, there is a predominant need for a paradigm shift in the government's approach—one that places equal emphasis on safeguarding both human and animal health. Throughout history, the Canadian government has been recognized for prioritizing the mitigation of human health concerns over those related to animal health, exemplified by the case of the Sydney Tar Ponds. The government's remediation efforts for the Tar Ponds were grossly inadequate, as they failed to sufficiently mitigate environmental hazards, focusing solely on human hazards, a pattern evident in many of their previous interventions. The holistic cleanup necessary for the preservation of aquatic life and the environment was missing, which raises concerns about the potential resurgence of animal and human health concerns in the future.

Geomorphology and sediment mobility on sand banks: A study of Dogfish Bank, Hecate Strait, Northeast Pacific Ocean

AbstractMovement of sediment along shallow continental shelves is a natural process with wide‐ranging environmental and economic implications, making it of high importance to marine spatial planning efforts in the offshore. Development of marine renewable energy, for instance, requires detailed understanding of the morphodynamics of mobile bedforms to select foundation types and ensure safe installation of infrastructure in shallow shelf environments. This study evaluates geomorphology and sediment mobility of Dogfish Bank (&lt; 20 mbsl) in the Hecate Strait offshore British Columbia, Canada, using hydroacoustic and airborne bathymetric data combined with seismic profiles and grain‐size information. These data reveal current‐swept features ranging from sediment‐depleted lag to sediment‐abundant sand ridges and dunes, with sand ribbons and furrows in‐between. Seismic reflection data show up to 15 m of surficial sand concentrated beneath north‐aligned sand ridges that dominate the bathymetry of northwest Hecate Strait. Sand ribbons (typically understood sediment‐limited features in shallow marine environments) are notably maintained over seabed with comparable sand thickness to adjacent dunes (i.e. sediment‐abundant features), suggesting local spatial variability in hydrodynamics and sediment characteristics (principally grain size) influence expression of mobile bedforms. Repeat mapping between 2008 and 2019 shows dunes and ribbons both migrate northwards, with largest seafloor changes along northeast‐facing lee sides of dunes, matching closely with published models of sediment mobility which suggest northward bedform migration is largely driven by storms. Median total migration distance is 164 m (northward) for dunes (time‐averaged rate of 14.9 m/year). Sand ribbons show less migration (median northward distance of 73 m) and migrate in a depth‐dependent manner. Because sand ribbons are typically flow‐parallel features, their lateral migration likely results from varying current directions and flow acceleration over shallower seabed. Sand ribbon migration should therefore a consideration in studies examining seabed change, particularly when they are formed over unconsolidated sediment.

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada

BackgroundSubstance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs. MethodsUsing linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016-2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region. ResultsThe population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60% (N=1,745) of people with perinatal substance use; however, these regions represented only 35% of BC’s specialized acute care and supportive housing beds (N=140). ConclusionsExpanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.