Homelessness among pregnant and parenting people in Canada is rising, with grave consequences for both parents and children. On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the scope of the problem and the supports that can improve outcomes for parents and children.

Dr. Stéphanie Manoni-Millar, co-author of the CMAJ commentary Tackling the crisis of homelessness amongst pregnant and parenting people in Canada, explains who is most affected and what risks they face. She describes a predominantly young population, many of whom are homeless or experiencing precarious housing. She highlights the health consequences for children, including developmental delays, infections, and increased rates of anxiety and depression, and stresses the importance of affordable housing and integrated services to support families.

Nerina Chiodo, a social worker in Toronto with MotherCraft Breaking the Cycle, shares insights from more than two decades of supporting pregnant people who are homeless. She describes what stability can look like when housing, addiction treatment, mental health services, and social supports are coordinated, an approach often described as wraparound care. Chiodo also reflects on the stigma many of her clients face in medical settings and underscores the importance of small acts of validation and compassion from clinicians.

Both guests emphasized that people experiencing homelessness during pregnancy often want to parent and demonstrate resilience despite immense challenges. They urged clinicians to approach this population without stigma, to recognize the risks faced by children, and to understand how even brief, supportive interactions can influence whether patients return for care.

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The CMAJ Podcast is produced by PodCraft Productions

Smoking remains the leading cause of preventable disease and death in Canada. A new clinical practice guideline published in CMAJ on tobacco smoking cessation outlines evidence-based behavioural and pharmacological interventions to help patients quit. On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham speak with Dr. Eddy Lang, co-author of the guideline, and Dr. Andrew Pipe, a pioneer in smoking cessation research and practice, about how clinicians can better support patients ready to stop smoking.

Dr. Eddy Lang, an emergency physician and professor at the Cumming School of Medicine, describes how the Canadian Task Force on Preventive Health assessed a wide range of interventions to make sense of a complex evidence base. He outlines the strong recommendations in favour of pharmacological therapies such as nicotine replacement therapy, bupropion, varenicline, and cytosine, as well as behavioural interventions including counselling, group therapy, and quit lines. He also explains the conditional recommendation against e-cigarettes, citing limited long-term safety data and concerns about normalizing their use among youth.

Dr. Andrew Pipe, professor of medicine at the Ottawa Heart Institute and co-creator of the Ottawa Model of Smoking Cessation, offers practical guidance for everyday practice. He highlights how a state-of-the-art smoking cessation intervention can be delivered in as little as 26 seconds. This brief approach is non-judgemental, empathetic, and emphasizes that help is available whenever the patient is ready.

He also stresses that clinicians should treat cessation pharmacotherapy like any other chronic disease medication—titrated to patient response and continued as long as needed. Pipe emphasizes that nicotine replacement therapy is often underdosed, which undermines its effectiveness. He encourages physicians to combine long-acting patches with rapid-acting forms such as gum or lozenges, and to adjust dosing based on patient comfort, allowing individuals to guide their own titration.

This episode underscores that even brief encounters can open the door to meaningful change for patients ready to stop smoking. Asking about smoking status, offering practical, evidence-based assistance, and prescribing cessation therapies in sufficient doses can effectively help patients quit.

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Comments or questions? Text us.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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The CMAJ Podcast is produced by PodCraft Productions

—This is an encore presentation of an episode previously published June 30—

On this episode of the CMAJ Podcast, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with two authors of the latest “Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care”

The discussion reflects a shared urgency: despite past successes, Canada’s hypertension control rates are declining. The new guidelines aim to reverse this trend by simplifying diagnosis and treatment for frontline clinicians.

Dr. Rémi Goupil, a nephrologist and clinician researcher at Sacré-Cœur Hospital in Montreal, and Dr. Greg Hundemer, a nephrologist and clinician scientist at The Ottawa Hospital, explain that the updated guideline is deliberately designed for primary care providers. They highlight key shifts: lowering the diagnostic threshold for hypertension to ≥ 130/80 mm Hg, simplifying blood pressure targets, and emphasizing accurate, standardized measurement techniques both in clinic and at home. The guidelines were created with input from a majority-primary care committee—including family physicians, nurses, pharmacists, and patient partners—to ensure clinical applicability.

Together, the panel outlines a streamlined nine-step treatment algorithm, emphasizing combination therapy as first-line pharmacologic management. They explain the evidence supporting ARB–thiazide combinations, discuss cost considerations for drug selection, and address adherence challenges. They also explore red flags for secondary hypertension and how the algorithm supports—but does not replace—clinical judgment.

For physicians, this guideline offers a clear and practical roadmap: measure blood pressure correctly, aim for systolic pressure below 130 mm Hg, and use the simplified treatment sequence to improve adherence and outcomes. Designed to be easy to implement, the new approach aims to empower primary care providers to act with confidence.

Comments or questions? Text us.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

X (in English): @CMAJ
X (en français): @JAMC
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The CMAJ Podcast is produced by PodCraft Productions