Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study

Will Small,Andrea Krusi,Danya Fast,Evan Wood,Thomas Kerr

doi:10.1186/1747-597x-4-8

Abstract

BackgroundStreet-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among street-involved youth in Vancouver, Canada.MethodsQualitative interviews with street youth who inject drugs elicited descriptions of the adoption of injection as a route of administration. Interviewees were recruited from the At-Risk Youth Study (ARYS), a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Audio recorded interviews were transcribed verbatim and a thematic analysis was conducted.Results26 youth aged 16 to 26 participated in this study, including 12 females. Among study participants the first injection episode frequently featured another drug user who facilitated the initiation of injecting. Youth narratives indicate that the transition into injecting is influenced by social interactions with drug using peers and evolving perceptions of injecting, and rejecting identification as an injector was important among youth who did not continue to inject. It appears that social conventions discouraging initiating young drug users into injection exist among established injectors, although this ethic is often ignored.ConclusionThe importance of social relationships with other drug users within the adoption of injection drug use highlights the potential of social interventions to prevent injection initiation. Additionally, developing strategies to engage current injectors who are likely to initiate youth into injection could also benefit prevention efforts.

Highlights

Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority
Street youth are one sub-population of drug users who are at heightened risk of adopting injection drug use [5,6], and the prevalence of injection drug use is known to be high among street youth in many urban settings [7,8,9,10,11,12]
Epidemiological studies have highlighted the role of social influences upon injection initiation, documenting that the majority of drug users are introduced to injection by an individual who is socially close to them [19,20,21], and in many instances new injectors are initiated by an injection drug user (IDU) who is several years older [22]

Summary

Introduction

Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. Only a small number of qualitative studies have explored the transition towards injecting, these investigations have highlighted the importance of social circumstances and networks in facilitating the adoption of injection as a route of administration [2729] Both epidemiological research and intervention efforts could benefit from further qualitative accounts documenting the social processes surrounding the initiation of injection drug use [17], and contextualized understandings of the onset of injecting may help facilitate the development of appropriate interventions to prevent injection among street youth

Methods

Results

Conclusion