Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use.

Kira Tozer,Darlene Taylor,Jane A Buxton,Natasha Van Borek,Ashraf Amlani,Despina Tzemis,Elizabeth Saewyc,Larissa Coser

doi:10.1186/s12889-015-2153-z

Abstract

BackgroundThe Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16–24 years in Metro Vancouver, British Columbia.MethodsTen focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing.ResultsThrough ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms – including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study.ConclusionParticipants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.

Highlights

The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth aged 16–24 years in Metro Vancouver, British Columbia
A total of 47 street involved youth participated in ten Focus groups (FGs)
People who work with at-risk youth should be mindful to highlight risks and problems when conversing with the youth but where possible, ask questions that encourage strengthidentification and positive possibilities

Summary

Introduction

Street-involved youth are more likely than youth in stable housing to use drugs and to initiate drug use earlier in life [5, 6]. Studies from Montreal, Canada calculated an incidence rate of 6.8 - 8.2 per 100 person-years for street youth initiating IDU; in other words, 7 - 8 % of street youth start injecting drugs each year [14, 15]. Previous research suggests that street-involved youth make the transition from non-injection drug use to IDU for various reasons including exposure to IDU and social influence from streetinvolved peers [16] and sexual/intimate partners [17, 18] self-medicating for depression, childhood trauma, or other mental illnesses [19]; coping with homelessness [6]; and difficulties accessing treatment for drug use [20]

Methods

Results

Discussion

Conclusion