Employment and risk of injection drug use initiation among street involved youth in Canadian setting

Abstract

ObjectiveYouth unemployment has been associated with labour market and health disparities. However, employment as a determinant of high-risk health behaviour among marginalized young people has not been well described. We sought to assess a potential relationship between employment status and initiation of intravenous drug use among a prospective cohort of street-involved youth. MethodWe followed injecting naïve youth in the At-Risk Youth Study, a cohort of street-involved youth aged 14–26 in Vancouver, Canada, and employed Cox regression analyses to examine whether employment was associated with injection initiation. ResultsAmong 422 injecting naïve youth recruited between September 2005 and November 2011, 77 participants transitioned from non-injection to injection drug use, for an incidence density of 10.3 (95% confidence interval [CI]: 8.0–12.6) per 100 person years. Results demonstrating that employment was inversely associated with injection initiation (adjusted hazard ratio: 0.53; 95% CI: 0.33–0.85) were robust to adjustment for a range of potential confounders. ConclusionA lack of employment among street-involved youth was associated with the initiation of injection drug use, a practice that predisposes individuals to serious long-term health consequences. Future research should examine if reducing barriers to labour market involvement among street-involved youth prevents transitions into high-risk drug use.