Cohort Of Street-involved Youth Research Articles

"Something that actually works": Cannabis use among young people in the context of street entrenchment.

BackgroundCannabis is one of the most widely used substances among vulnerable young people (<26 years of age) experiencing street entrenchment. Although previous research has documented the role cannabis can play in harm reduction, substance use and mental health treatment and pain management, this research has predominantly been quantitative and focused on adult drug-using populations. Little qualitative work has examined how young people who use drugs understand, experience, and engage with cannabis in the context of street entrenchment and drug use trajectories that include the use of other substances such as alcohol, opioids and crystal methamphetamine (meth).MethodsSemi-structured, in-depth qualitative interviews were conducted between 2017 and 2019 with 56 young people recruited from a cohort of street-involved youth in Vancouver, Canada. We also conducted 13 interviews with 12 youth-focused care providers across the same time period. Interview data were triangulated by drawing on the findings of a program of anthropological research conducted by the senior author since 2008. Interviews were transcribed verbatim and thematic analysis was conducted.ResultsThe vast majority of study participants engaged in daily, intensive cannabis use at the same time as they cycled on and off other substances that were perceived as much more harmful (primarily alcohol, fentanyl, heroin and meth). While most participants derived significant pleasure from the use of cannabis, no participants in our study described using cannabis for purely recreational purposes. A number of participants explicitly framed cannabis as a form of mental health and substance use treatment that was more effective and “healthier” than the long-term use of psychopharmaceuticals and medication-assisted substance use treatment (e.g., opioid agonist therapies). Cannabis use was also understood to ameliorate some of the harms of, or even facilitate transitions out of, periods of street-based homelessness. While the majority of our participants highlighted the positive effects of regular cannabis consumption, some described how intensive cannabis use could generate significant harms.ConclusionIn the context of the recent legalization of non-medical cannabis use in Canada and amid ongoing overdose and housing crises, it is imperative that future policy and programming interventions and provider education and training be responsive to the ways in which vulnerable youth in our setting are actively using cannabis to navigate their everyday lives and healthcare needs.

Perceived Devaluation among a Cohort of Street-Involved Youth in Vancouver, Canada

Background: Perceived devaluation is a barrier to seeking mental and physical health services among people who use illicit drugs. Objective: Assessing the prevalence and correlates of perceived devaluation within a cohort of street-involved youth. Methods: Data were drawn from an open prospective cohort of street-involved youth who use illicit drugs (aged 14–26 at study enrollment) between December 2013 and May 2015 in Vancouver, Canada. Perceived devaluation was measured using an adapted version of Perceived Devaluation and Discrimination scale. Multivariable generalized estimating equations were constructed to examine factors independently associated with high perceived devaluation. Results: Among 411 street-involved youth, 95.1% reported high perceived devaluation at some point during the study period. In a multivariable analysis, youth who reported high perceived devaluation were significantly more likely to engage in: unprotected sex (Adjusted Odds Ratio [AOR] = 1.56, 95% Confidence Interval 1.03–2.37); heavy alcohol use (AOR = 2.31, 95% CI 1.22–4.36); and daily heroin use (AOR = 2.07, 95% CI 1.16–3.70). Youth who resided in the Downtown Eastside neighborhood were significantly less likely to report high perceived devaluation (AOR = 0.41, 95% CI 0.26–0.65). Conclusions: Perceived devaluation was extremely prevalent among street-involved youth in our sample. We also observed that youth most in need of health and social services were significantly more likely to report high levels of perceived devaluation which may result in a reluctance to seek out key services and supports. These findings highlight the need to implement stigma reduction interventions for vulnerable youth in this setting.

Perceived Devaluation and STI Testing Uptake among a Cohort of Street-Involved Youth in a Canadian Setting.

Perceived devaluation has been shown to have adverse effects on the mental and physical health outcomes of people who use drugs. However, the impact of perceived devaluation on sexually transmitted infections (STI) testing uptake among street-involved youth, who face multiple and intersecting stigmas due to their association with drug use and risky sexual practices, has not been fully characterized. Data were obtained between December 2013 and November 2014 from a cohort of street-involved youth who use illicit drugs aged 14-26 in Vancouver, British Columbia. Multivariable generalized estimating equations were constructed to assess the independent relationship between perceived devaluation and STI testing uptake. Among 300 street-involved youth, 87.0% reported a high perceived devaluation score at baseline. In the multivariable analysis, high perceived devaluation was negatively associated with STI testing uptake after adjustment for potential confounders (Adjusted Odds Ratio=0.38, 95% Confidence Interval 0.15-0.98). Perceived devaluation was high among street-involved youth in our sample and appears to have adverse effects on STI testing uptake. HIV prevention and care programs should be examined and improved to better meet the special needs of street-involved youth in non-stigmatizing ways.

History of being in government care associated with younger age at injection initiation among a cohort of street-involved youth.

Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18. Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care. Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio=1.69; 95% confidence interval: 1.15-2.48). Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher risk and suggest that interventions are needed to prevent transitions into high-risk substance use among this population.

Syringe-sharing among a prospective cohort of street-involved youth in Vancouver, Canada: Implications for structural interventions

Syringe-sharing among a prospective cohort of street-involved youth in Vancouver, Canada: Implications for structural interventions

Elevated risk of incarceration among street-involved youth who initiate drug dealing.

BackgroundStreet-involved youth are known to be an economically vulnerable population that commonly resorts to risky activities such as drug dealing to generate income. While incarceration is common among people who use illicit drugs and associated with increased economic vulnerability, interventions among this population remain inadequate. Although previous research has documented the role of incarceration in further entrenching youth in both the criminal justice system and street life, less is known whether recent incarceration predicts initiating drug dealing among vulnerable youth. This study examines the relationship between incarceration and drug dealing initiation among street-involved youth.MethodsBetween September 2005 and November 2014, data were collected through the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs, in Vancouver, Canada. An extended Cox model with time-dependent variables was used to examine the relationship between recent incarceration and initiation into drug dealing, controlling for relevant confounders.ResultsAmong 1172 youth enrolled, only 194 (16.6%) were drug dealing naïve at baseline and completed at least one additional study visit to facilitate the assessment of drug dealing initiation. Among this sample, 56 (29%) subsequently initiated drug dealing. In final multivariable Cox regression analysis, recent incarceration was significantly associated with initiating drug dealing (adjusted hazard ratio = 2.31; 95% confidence interval (CI) 1.21–4.42), after adjusting for potential confounders. Measures of recent incarceration lagged to the prior study follow-up were not found to predict initiation of drug dealing (hazard ratio = 1.50; 95% CI 0.66–3.42).ConclusionsThese findings suggest that among this study sample, incarceration does not appear to significantly propel youth to initiate drug dealing. However, the initiation of drug dealing among youth coincides with an increased risk of incarceration and their consequent vulnerability to the significant harms associated therein. Given that existing services tailored to street-involved youth are inadequate, evidence-based interventions should be invested and scaled up as a public health priority.

Crystal methamphetamine initiation among street-involved youth

Background: Although many settings have recently documented a substantial increase in the use of methamphetamine-type stimulants, recent reviews have underscored the dearth of prospective studies that have examined risk factors associated with the initiation of crystal methamphetamine use. Objectives: Our objectives were to examine rates and risk factors for the initiation of crystal methamphetamine use in a cohort of street-involved youth. Methods: Street-involved youth in Vancouver, Canada, were enrolled in a prospective cohort known as the At-Risk Youth Study (ARYS). A total of 205 crystal methamphetamine-naïve participants were assessed semi-annually and Cox regression analyses were used to identify factors independently associated with the initiation of crystal methamphetamine use. Results: Among 205 youth prospectively followed from 2005 to 2012, the incidence density of crystal methamphetamine initiation was 12.2 per 100 person years. In Cox regression analyses, initiation of crystal methamphetamine use was independently associated with previous crack cocaine use (adjusted relative hazard [ARH] = 2.24 [95% CI: 1.20–4.20]) and recent drug dealing (ARH = 1.98 [95% CI: 1.05–3.71]). Those initiating methamphetamine were also more likely to report a recent nonfatal overdose (ARH = 3.63 [95% CI: 1.65–7.98]) and to be male (ARH = 2.12 [95% CI: 1.06–4.25]). Conclusions: We identified high rates of crystal methamphetamine initiation among this population. Males those involved in the drug trade, and those who used crack cocaine were more likely to initiate crystal methamphetamine use. Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

Neighborhood of residence and risk of initiation into injection drug use among street-involved youth in a Canadian setting

BackgroundWhile research has suggested that exposure to environments where drug use is prevalent may be a key determinant of drug-related risk, little is known regarding the impact of such exposure on the initiation of illicit injection drug use. We assessed whether neighborhood of residence predicted rates of injecting initiation among a cohort of street-involved youth in Vancouver, British Columbia. MethodsWe followed street-involved injecting naïve youth aged 14–26 and compared rates of injecting initiation between youth residing in Vancouver's Downtown Eastside (DTES) neighborhood (the site of a large street-based illicit drug market) to those living in other parts of the city. Univariate and multivariate Cox regression analyses were employed to determine whether residence in the DTES was independently associated with increased risk of initiation of injection drug use. ResultsBetween September, 2005 and November, 2011, 422 injection-naïve individuals were followed, among whom 77 initiated injecting for an incidence density of injecting of 10.3 (95% confidence interval [CI] 5.0–18.8) per 100 person years. In a multivariate model, residence in the DTES was independently associated with initiating injection drug use (adjusted hazard ratio [AHR]=2.16, 95% CI: 1.33–3.52, p=0.002). ConclusionsThese results suggest neighborhood of residence affects the risk of initiation into injection drug use among street-involved youth. The development of prevention interventions should target high-risk neighborhoods where risk of initiating into injecting drug use may be greatest.

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

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.

High rates of homelessness among a cohort of street-involved youth

Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20–24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.

Nonfatal Overdose Among a Cohort of Street-Involved Youth

Limited data exist concerning patterns of nonfatal illicit drug overdoses among street-involved youth. We therefore evaluated factors associated with nonfatal overdose among a cohort of street-involved youth in Vancouver, Canada. Our findings indicate that nonfatal overdose was common among street-involved youth in our setting, and was associated with various forms of drug use, including methamphetamine use.