1
|
Curtis MG, Reed M, Newman A, Doraivelu K, Patel SA, Crawford ND, Holland DP, Hussen SA. Exploring the Association Between Indicators of Socioeconomic Instability, Survival Sex, and Methamphetamine Use Among Young Adult Black Gay, Bisexual, and Other Men Who Have Sex With Men: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2023; 34:538-547. [PMID: 37738524 PMCID: PMC10592098 DOI: 10.1097/jnc.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT Methamphetamine (Meth) use is a contributor to poor health outcomes among young Black American gay, bisexual, and other men who have sex with men (YB-GBMSM). Emerging research indicates that socioeconomic instability may be a salient antecedent of meth use as men may be encouraged to engage in health-eroding activities, such as survival sex, to care for themselves, and then cope with instability-related stress via use of substances. We examined the degree to which indicators of socioeconomic instability, including homelessness and food insecurity, would directly, and indirectly, predict increases in meth use, via survival sex engagement. Hypotheses were tested using mediated path analysis with data from 100 YB-GBMSM in Atlanta, Georgia. Preliminary analysis results demonstrated positive associations between engaging in survival sex, food insecurity, homelessness, and living with HIV. Findings demonstrated that homelessness and food insecurity were directly associated with increased survival sex engagement but were not directly associated with meth use. Homelessness and food insecurity were indirectly associated with increased severity of meth use, via increased engagement in survival sex. Socioeconomic instability and survival sex engagement may be important intervention targets for future meth use intervention/prevention programming. Integrating programmatic components that address homelessness and food insecurity may decrease YB-GBMSM's need to rely on survival sex to meet their needs and decrease their likelihood of using meth as a result.
Collapse
Affiliation(s)
- Michael G. Curtis
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Marcus Reed
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Antonio Newman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - David P. Holland
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sophia A. Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Maepa MP. Self-Esteem and Resilience Differences Among Street Children Compared to Non-street Children in Limpopo Province of South Africa: A Baseline Study. Front Public Health 2021; 9:542778. [PMID: 33968865 PMCID: PMC8102787 DOI: 10.3389/fpubh.2021.542778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
The phenomenon of street children is a challenging global social problem. Using an independent sample group design, this study explored the differences in self-esteem and resilience among street children and non-street children. A total of 300 (N = 300) street children with ages ranging from 8 to 18 years were selected using a purposive sampling method, while a total of 300 (N = 300) non-street children with ages ranging from 8 to 18 years were selected using a simple random sample to participate in this study. A questionnaire with three sections was used to collect data. Results of an independent sample t-test revealed that street children reported low self-esteem and poor resilience compared to non-street children. The study, therefore, concluded that street children and non-street children differ on self-esteem and resilience. It is recommended that social skills training be provided for the street children population.
Collapse
Affiliation(s)
- Mokoena Patronella Maepa
- Department of Clinical Psychology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
3
|
Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, Armoon B, Bayani A. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis 2020; 38:420-437. [DOI: 10.1080/10550887.2020.1781346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke’s Campus, University of Exeter, Exeter, UK
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Harris M, Scott J, Hope V, Wright T, McGowan C, Ciccarone D. Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London. Harm Reduct J 2020; 17:24. [PMID: 32276626 PMCID: PMC7145770 DOI: 10.1186/s12954-020-00369-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/26/2020] [Indexed: 11/16/2022] Open
Abstract
Background The United Kingdom is experiencing an increase in drug-related deaths and serious bacterial infections among its most vulnerable citizens. Cuts to essential services, coupled with a growing homeless population, create a challenging environment to tackle this public health crisis. In this paper, we highlight an underexplored environmental constraint faced by people living and injecting drugs on the streets. Access to water for injection is restricted in the UK, due to legislative and financial barriers. Austerity measures, such as public toilet closures, further restrict the ability of people made homeless to access clean water and protect themselves from health harms. Methods We generated questionnaire (n = 455) and in-depth qualitative interview (n = 32) data with people who inject drugs in London for the Care and Prevent study. Participants provided detail on their life history; drug use, injecting and living environments; health conditions and care seeking practices. Findings A high proportion of the survey sample reported lifetime history of street homelessness (78%), bacterial infections (65%) and related hospitalisation (30%). Qualitative accounts highlight unsafe, potentially dangerous, injection practices in semi-public spaces. Multiple constraints to sourcing sterile water for injection preparation were reported. Alternatives to sterile water included puddle water, toilet cistern water, whisky, cola soda and saliva. Participants who injected heroin and crack cocaine together unanimously reported adding water at two stages during injection preparation: first, adding water as a vehicle for heroin (which was then heated); second, adding cold water to the heroin mixture prior to adding the crack cocaine. This new finding of a stage addition of solvent may represent an additional risk of infection. Conclusion Currently, harm reduction equipment and resources for safe injecting are not meeting the needs of people who inject drugs who are street homeless or unstably housed. Preparation of injections with non-sterile water sources could precipitate bacterial and fungal infections, particularly when used without the application of heat. It is crucial that water for injection, also skin cleaning, is made available for the unstably housed and that harm reduction messaging is tailored to speak to the everyday realities of people who prepare and inject drugs in public spaces.
Collapse
Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Vivian Hope
- Public Health Institute, Liverpool John Moores University, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Talen Wright
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Catherine McGowan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Daniel Ciccarone
- School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA, 94143-0410, USA
| |
Collapse
|
5
|
Altena AM, Beijersbergen MD, Vermunt JK, Wolf JRLM. Subgroups of Dutch homeless young adults based on risk- and protective factors for quality of life: Results of a latent class analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e587-e597. [PMID: 29664216 DOI: 10.1111/hsc.12578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
It is important to gain more insight into specific subgroups of homeless young adults (HYA) to enable the development of tailored interventions that adequately meet their diverse needs and to improve their quality of life. Within a heterogeneous sample of HYA, we investigated whether subgroups are distinguishable based on risk- and protective factors for quality of life. In addition, differences between subgroups were examined regarding the socio-demographic characteristics, the use of cognitive coping strategies and quality of life. A total of 393 HYA using shelter facilities in the Netherlands were approached to participate, between December 2011 and March 2013. Structured face-to-face interviews were administered approximately 2 weeks after shelter admission by trained research assistants. A latent class analysis was conducted to empirically distinguish 251 HYA in subgroups based on common risk factors (former abuse, victimisation, psychological symptoms and substance use) and protective factors (resilience, family and social support and perceived health status). Additional analysis of variance and chi-square tests were used to compare subgroups on socio-demographic characteristics, the use of cognitive coping strategies and quality of life. The latent class analysis yielded four highly interpretable subgroups: the at-risk subgroup, the high-risk and least protected subgroup, the low-risk subgroup and the higher functioning and protected subgroup. Subgroups of HYA with lower scores in risk factors showed higher scores in protective factors, the adaptive cognitive coping strategies and quality of life. Our findings confirm the need for targeted and tailored interventions for specific subgroups of HYA. Social workers need to be attentive to the pattern of risk- and protective factors in each individual to determine which risk factors are prominent and need to be targeted and which protective factors need to be enhanced to improve the quality of life of HYA.
Collapse
Affiliation(s)
- Astrid M Altena
- Department of Primary and Community Care, Impuls-Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariëlle D Beijersbergen
- Department of Primary and Community Care, Impuls-Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen K Vermunt
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Judith R L M Wolf
- Department of Primary and Community Care, Impuls-Netherlands Center for Social Care Research, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Hepburn K, Barker B, Nguyen P, Dong H, Wood E, Kerr T, DeBeck K. Initiation of drug dealing among a prospective cohort of street-involved youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:507-512. [PMID: 27315200 PMCID: PMC5055453 DOI: 10.1080/00952990.2016.1186684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. OBJECTIVES This longitudinal study examines drug dealing initiation among street-involved youth. METHODS Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14-26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. RESULTS Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9-17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing. CONCLUSION Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.
Collapse
Affiliation(s)
- Kirk Hepburn
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
| | - Brittany Barker
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- c Interdisciplinary Studies Graduate Program , University of British Columbia , Vancouver , Canada
| | - Paul Nguyen
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Huiru Dong
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Evan Wood
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Kora DeBeck
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
| |
Collapse
|
7
|
A Social Capital Approach to Identifying Correlates of Perceived Social Support Among Homeless Youth. CHILD & YOUTH CARE FORUM 2016. [DOI: 10.1007/s10566-016-9352-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Aikins R, Hoefinger H, Guarino H, Rosenblum A, Magura S, Joseph H. Conducting Rapid Street Assessment of Drug Users in New York City Using Oral Fluid and Brief Interviews: A Feasibility Study. J Addict Dis 2015; 34:185-97. [PMID: 26098766 DOI: 10.1080/10550887.2015.1059118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study piloted the feasibility of rapidly collecting both self-reports of drug use and saliva specimens for drug toxicology in field settings. The use of oral fluid collection devices to supplement self-reports is unproven in street settings and may pose challenges for field research. Sixty adults who identified as recent illicit drug users were recruited in public settings in New York City and were asked to complete a brief drug screening inventory and provided saliva specimens. Descriptive findings are detailed along with critical best research practices and limitations that provide important directions for researchers looking to employ both toxicology and self-report in rapid field recruitment designs.
Collapse
Affiliation(s)
- Ross Aikins
- a National Development and Research Institutes Inc. , New York City , New York , USA
| | | | | | | | | | | |
Collapse
|
9
|
Waldbrook N. Exploring opportunities for healthy aging among older persons with a history of homelessness in Toronto, Canada. Soc Sci Med 2015; 128:126-33. [DOI: 10.1016/j.socscimed.2015.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Saddichha S, Linden I, Krausz MR. Physical and Mental Health Issues among Homeless Youth in British Columbia, Canada: Are they Different from Older Homeless Adults? JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2014; 23:200-206. [PMID: 25320613 PMCID: PMC4197520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 07/24/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Youth homelessness is on the rise in North America, yet this vulnerable population is rarely studied and compared with adults. This paper aimed to study the homeless youth and identify specific vulnerabilities, which rendered them different from the adult homeless population. It also aimed to describe the youth homeless population and their significant co-morbidities. METHODS DATA WAS DERIVED FROM THE BC HEALTH OF THE HOMELESS STUDY (BCHOHS), CARRIED OUT IN THREE CITIES IN BRITISH COLUMBIA, CANADA: the large urban centre Vancouver (n=250); the mid-sized city and capital of the province Victoria (n=150). Measures included socio-demographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ) and the Mini International Neuropsychiatric Interview (MINI) Plus. RESULTS Youth constituted 16.5% (n=82) of the homeless population. Compared to the adult homeless, the homeless youth were more often female (55%), were Aboriginal (47.6%), had greater substance abuse of alcohol (70.7%), amphetamines (8.5%) and cannabis (75.6%). A lower prevalence of sexually transmitted diseases (0.2%) and psychotic disorders (13.4%) was also observed. The prevalence of traumatic experiences, other psychiatric disorders and physical illnesses were similar between the adult and homeless youth. CONCLUSION Homeless youth have high rates of physical and psychiatric comorbidity, similar to the adult homeless, despite being 20 years younger. An urgent need for interventions that go beyond the standardized ones being offered to homeless populations as a whole, and to derive specific strategies that target this vulnerable population is required.
Collapse
Affiliation(s)
- Sahoo Saddichha
- Department of Psychiatry, Melbourne Health, Melbourne, Australia
| | - Isabelle Linden
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia
| | | |
Collapse
|
11
|
Cheng T, Wood E, Nguyen P, Kerr T, DeBeck K. Increases and decreases in drug use attributed to housing status among street-involved youth in a Canadian setting. Harm Reduct J 2014; 11:12. [PMID: 24721725 PMCID: PMC3999483 DOI: 10.1186/1477-7517-11-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/28/2014] [Indexed: 12/02/2022] Open
Abstract
Background Among a cohort of drug-using street-involved youth, we sought to identify the prevalence of reporting increases and decreases in illicit drug use due to their current housing status and to identify factors associated with reporting these changes. Findings This longitudinal study was based on data collected between June 2008 and May 2012 from a prospective cohort of street-involved youth aged 14–26 in Vancouver, Canada. At semi-annual study follow-up visits, youth were asked if their drug use was affected by their housing status. Using generalized estimating equations, we identified factors associated with perceived increases and decreases in drug use attributed to housing status. Among our sample of 536 participants at baseline, 164 (31%) youth reported increasing their drug use due to their housing situation and 71 (13%) reported decreasing their drug use. In multivariate analysis, factors that were positively associated with perceived increases in drug use attributed to housing status included the following: being homeless, engaging in sex work and drug dealing. Regular employment was negatively associated with increasing drug use due to housing status. Among those who reported decreasing their drug use, only homelessness was significant in bivariate analysis. Conclusion Perceived changes in drug use due to housing status were relatively common in this setting and were associated with being homeless and, among those who increased their drug use, engaging in risky income generation activities. These findings suggest that structural factors, particularly housing and economic opportunities, may be crucial interventions for reducing or limiting drug use among street-involved youth.
Collapse
Affiliation(s)
| | | | | | | | - Kora DeBeck
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| |
Collapse
|
12
|
Calcaterra SL, Beaty B, Mueller SR, Min SJ, Binswanger IA. The association between social stressors and drug use/hazardous drinking among former prison inmates. J Subst Abuse Treat 2014; 47:41-9. [PMID: 24642070 DOI: 10.1016/j.jsat.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
Social stressors are associated with relapse to substance use among people receiving addiction treatment and people with substance use risk behaviors. The relationship between social stressors and drug use/hazardous drinking in former prisoners has not been studied. We interviewed former prisoners at baseline, 1 to 3 weeks post prison release, and follow up, between 2 and 9 months following the baseline interview. Social stressors were characterized by unemployment, homelessness, unstable housing, problems with family, friends, and/or significant others, being single, or major symptoms of depression. Associations between baseline social stressors and follow-up drug use and hazardous drinking were analyzed using multivariable logistic regression. Problems with family, friends, and/or significant others were associated with reported drug use (AOR 3.01, 95% CI 1.18-7.67) and hazardous drinking (AOR 2.69, 95% CI 1.05-6.87) post release. Further research may determine whether interventions and policies targeting social stressors can reduce relapse among former inmates.
Collapse
Affiliation(s)
- Susan L Calcaterra
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO.
| | - Brenda Beaty
- Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado
| | - Shane R Mueller
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Sung-Joon Min
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO
| | - Ingrid A Binswanger
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; Denver Health Medical Center, Denver, CO; Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, Colorado; Division of Substance Dependence, University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
13
|
Onyeka IN, Beynon CM, Uosukainen H, Korhonen MJ, Ilomäki J, Bell JS, Paasolainen M, Tasa N, Tiihonen J, Kauhanen J. Coexisting social conditions and health problems among clients seeking treatment for illicit drug use in Finland: the HUUTI study. BMC Public Health 2013; 13:380. [PMID: 23617549 PMCID: PMC3639872 DOI: 10.1186/1471-2458-13-380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use. METHODS We carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients' first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems. RESULTS The mean age of the clients was 25 years, 21% (n = 519) were homeless, 54% (n = 1363) were unemployed and 7% (n = 183) had experienced threats of violence. Half of the clients (50%, n = 1258) were self-referred and 31% (n = 788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n = 630) was more prevalent than other infectious diseases and depressive symptoms (59%, n = 1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR = 1.86; 95% CI = 1.50-2.30) and psychological problems (AOR = 1.51; 95% CI = 1.23-1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR = 3.89; 95% CI = 1.32-11.46) and for reporting a combination of social and health problems (AOR = 3.24; 95% CI = 1.58-6.65). CONCLUSION The existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients' treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.
Collapse
Affiliation(s)
- Ifeoma N Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, P,O,Box 1627, Kuopio, FI, 70211, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Moura YGD, Sanchez ZM, Opaleye ES, Neiva-Silva L, Koller SH, Noto AR. Drug use among street children and adolescents: what helps? CAD SAUDE PUBLICA 2013; 28:1371-80. [PMID: 22729267 DOI: 10.1590/s0102-311x2012000700015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/19/2012] [Indexed: 08/30/2023] Open
Abstract
The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.
Collapse
|
15
|
Feng C, DeBeck K, Kerr T, Mathias S, Montaner J, Wood E. Homelessness independently predicts injection drug use initiation among street-involved youth in a Canadian setting. J Adolesc Health 2013; 52:499-501. [PMID: 23299006 PMCID: PMC3608753 DOI: 10.1016/j.jadohealth.2012.07.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/13/2012] [Accepted: 07/14/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE This longitudinal study examines the association between homelessness and injection drug use initiation among a cohort of street-involved youth in a setting of high-prevalence crystal methamphetamine use. METHODS We derived data from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14-26 years, recruited between September 2005 and November 2011. We used Cox proportional hazards regression to identify factors independently associated with time to injection initiation. RESULTS Among 422 street-youth who had never injected at baseline, we observed 77 injection initiation events during follow-up. Homelessness was independently associated with injection initiation in multivariate Cox regression (relative hazard, 1.80 [95% confidence interval, 1.13-2.87]) after adjusting for crystal methamphetamine use and other potential confounders. CONCLUSIONS These findings highlight that homelessness is a key risk factor for injection initiation among street-involved youth. Supportive housing interventions for street youth may help prevent injection drug use initiation within this high-risk population.
Collapse
Affiliation(s)
- Cindy Feng
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
- Department of Medicine, University of British Columbia
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
- Department of Medicine, University of British Columbia
| | - Steve Mathias
- Department of Psychiatry, University of British Columbia
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
- Department of Medicine, University of British Columbia
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital
- Department of Medicine, University of British Columbia
| |
Collapse
|
16
|
Patterns of cocaine and opioid co-use and polyroutes of administration among street-based cocaine users in Montréal, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013. [DOI: 10.1016/j.drugpo.2012.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
17
|
Police confrontations among street-involved youth in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:46-51. [PMID: 22883543 DOI: 10.1016/j.drugpo.2012.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 06/21/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Street-level policing has been recognized as a driver of health-related harms among people who inject drugs (IDU). However, the extent of interaction between police and street-involved youth has not been well characterized. We examined the incidence and risk factors for police confrontations among street-involved youth in a Canadian setting. METHODS Using data derived from participants enrolled in the At-Risk Youth Study (ARYS) between 2005 and 2011, we assessed factors associated with being stopped, searched, or detained by police without arrest in the previous six months using generalized estimating equations (GEE) with logit link for binary outcomes. RESULTS Among 991 participants followed during the study period, 440 (44.4%) reported being stopped, searched, or detained by police for an incidence density of 49.20 (95% confidence interval [CI]: 36.42-65.01) per 100 person years. In multivariate GEE analyses, factors associated with police confrontations included: male gender (adjusted odds ratio [AOR]=1.35), homelessness (AOR=2.05), recent incarceration (AOR=1.78), daily cannabis use (AOR=1.31), daily heroin injecting (AOR=1.36), crack pipe/syringe sharing (AOR=1.61), injection drug use (AOR=1.37), public drug use (AOR=2.19), sex work involvement (AOR=1.67), and drug dealing (AOR=1.49) (all p<0.05). In total, 19.0% of participants reported that police confiscated their drug paraphernalia without arresting them. Additionally, 16.9% of individuals reported experiencing violence at the hands of police. CONCLUSION We found that various factors, such as homelessness and markers of more severe addiction, increased the likelihood of being confronted by police, and police confrontations were associated with markers of health-related harm among street youth. These findings highlight the need for social and structural interventions that best enable police to fulfil public safety and public order objectives without negatively influencing health behaviours of street youth.
Collapse
|
18
|
Cross W, Hayter M, Jackson D, Cleary M. Editorial: Meeting the health care needs associated with poverty, homelessness and social exclusion: the need for an interprofessional approach. J Clin Nurs 2012; 21:907-8. [DOI: 10.1111/j.1365-2702.2011.03945.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Hughes JR, Clark SE, Wood W, Cakmak S, Cox A, MacInnis M, Warren B, Handrahan E, Broom B. Youth Homelessness: The Relationships among Mental Health, Hope, and Service Satisfaction. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2010; 19:274-83. [PMID: 21037918 PMCID: PMC2962540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 06/15/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This paper reports a mental health assessment of 60 homeless youth. Our study explored the mental health needs of youth accessing an overnight youth shelter (maximum stay 8 weeks). METHODS Participants completed an interview (45 to 120 minutes in duration) using one demographic form and one of two standardized questionnaires (Youth Self Report, Adult Self Report). Questions assessed youth mental health symptoms, examined various contacts that youth made with mainstream society (services, family), and identified potential motivating factors (hope, service satisfaction) that may play a role in fostering street survival during adolescence. RESULTS Forty-eight percent of the youth were clinically symptomatic and most youth accessed a range of general health services. CONCLUSION However, those most in need had significantly less service satisfaction, less hope about the future, and had not accessed mental health services.
Collapse
Affiliation(s)
- Jean R. Hughes
- School of Nursing, Dalhousie University and Department of Psychiatry, IWK Health Centre, Halifax, Nova Scotia
| | - Sharon E. Clark
- Adolescent Centre for Treatment, IWK Health Centre, Halifax, Nova Scotia
| | - William Wood
- North End Community Health Centre, Halifax, Nova Scotia
| | | | - Andy Cox
- Mental Health Advocate for Children and Youth, IWK Health Centre, Halifax, Nova Scotia
| | | | - Bonnie Warren
- Shared Care, IWK Health Centre, Halifax, Nova Scotia
| | | | - Barbara Broom
- Child and Youth Mental Health Services, Health Canada, Atlantic Region, Halifax, Nova Scotia
| |
Collapse
|
20
|
Krüsi A, Fast D, Small W, Wood E, Kerr T. Social and structural barriers to housing among street-involved youth who use illicit drugs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:282-8. [PMID: 20102394 PMCID: PMC2883636 DOI: 10.1111/j.1365-2524.2009.00901.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In Canada, approximately 150,000 youth live on the street. Street-involvement and homelessness have been associated with various health risks, including increased substance use, blood-borne infections and sexually transmitted diseases. We undertook a qualitative study to better understand the social and structural barriers street-involved youth who use illicit drugs encounter when seeking housing. We conducted 38 semi-structured interviews with street-involved youth in Vancouver, Canada from May to October 2008. Interviewees were recruited from the At-risk Youth Study (ARYS) cohort, which follows youth aged 14 to 26 who have experience with illicit drug use. All interviews were thematically analyzed, with particular emphasis on participants' perspectives regarding their housing situation and their experiences seeking housing. Many street-involved youth reported feeling unsupported in their efforts to find housing. For the majority of youth, existing abstinence-focused shelters did not constitute a viable option and, as a result, many felt excluded from these facilities. Many youth identified inflexible shelter rules and a lack of privacy as outweighing the benefits of sleeping indoors. Single-room occupancy hotels (SROs) were reported to be the only affordable housing options, as many landlords would not rent to youth on welfare. Many youth reported resisting moving to SROs as they viewed them as unsafe and as giving up hope for a return to mainstream society. The findings of the present study shed light on the social and structural barriers street-involved youth face in attaining housing and challenge the popular view of youth homelessness constituting a lifestyle choice. Our findings point to the need for housing strategies that include safe, low threshold, harm reduction focused housing options for youth who engage in illicit substance use.
Collapse
Affiliation(s)
- Andrea Krüsi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada
| | - Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada
- Department of Medicine; Faculty of Medicine; University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital; Vancouver, Canada
- Department of Medicine; Faculty of Medicine; University of British Columbia, Vancouver, Canada
| |
Collapse
|
21
|
Fast D, Small W, Krüsi A, Wood E, Kerr T. 'I guess my own fancy screwed me over': transitions in drug use and the context of choice among young people entrenched in an open drug scene. BMC Public Health 2010; 10:126. [PMID: 20222984 PMCID: PMC2853507 DOI: 10.1186/1471-2458-10-126] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/12/2010] [Indexed: 12/04/2022] Open
Abstract
Background There is growing interest in describing the broader risk trajectories experienced by young people who use drugs - that is, in describing the sequences of drug use transitions experienced by youth in relation to evolving understandings of risk and harm. This study sought to examine young people's perspectives regarding the evolution of their drug use in the context of a local drug scene in Vancouver, Canada. Methods Semi-structured qualitative interviews with 38 individuals recruited from a cohort of young drug users known as the At-risk Youth Study (ARYS) were supplemented by ongoing ethnographic fieldwork (e.g., observations and informal conversations with youth) conducted within the same cohort population. Interviews were transcribed verbatim and a thematic analysis was conducted. Results The majority of youth characterized past transition events as non-exceptional, largely 'spur-of-the-moment' decisions motivated by evolving feelings of curiosity. At the same time, participants' reflections indicated that the social, structural and material contexts of drug scene entrenchment play a powerful role in shaping these decisions and transition experiences. Conclusions Importantly, as young people become increasingly entrenched in the local drug scene, drug use transitions seem to constitute increasingly relevant (and even 'inevitable') choices congruent with everyday lived experience. The implications of these findings for the development of meaningful interventions for youth are discussed.
Collapse
Affiliation(s)
- Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, Canada
| | | | | | | | | |
Collapse
|
22
|
Fast D, Small W, Wood E, Kerr T. Coming 'down here': young people's reflections on becoming entrenched in a local drug scene. Soc Sci Med 2009; 69:1204-10. [PMID: 19700232 DOI: 10.1016/j.socscimed.2009.07.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Indexed: 10/20/2022]
Abstract
Recent research has highlighted the ways in which social structural processes and physical environments operate to push young drug users towards risk. We undertook this study in order to explore how young people who were currently street-entrenched characterized and understood their initiation into the local drug scene in downtown Vancouver, Canada. Semi-structured qualitative interviews were conducted with 38 individuals recruited from a cohort of young drug users known as the At-Risk Youth Study (ARYS). Participant narratives reflected an understanding among young people that they are simultaneously pulled and pushed towards the local scene. Push factors were understood as circumstances that propelled young people towards this setting, in some cases because of proximity to it from a very early age, and in other cases because of adverse situations experienced elsewhere and the need to find a new place to live that was both affordable and safe. Interwoven with accounts of how youth were pushed towards the local scene were stories that emphasized a high degree of autonomy and the factors that initially attracted them to this scene, including a desire for excitement, independence and belonging. Once young people were more permanently based in downtown Vancouver, participants identified several factors that accelerated their entrenchment in this locale, including increasingly 'problematic' drug use, an intensified need to generate income, experiences of chronic homelessness, and unstable social relationships. Our findings stress the need for early intervention with youth, before they are initiated into the social networks and processes that rapidly propel young people towards risk within these contexts. Once initiation has occurred, the boundary between safety and risk quickly becomes difficult to navigate, and young people become highly vulnerable to numerous harms.
Collapse
Affiliation(s)
- Danya Fast
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada V6Z 1Y6
| | | | | | | |
Collapse
|
23
|
Fast D, Shoveller J, Shannon K, Kerr T. Safety and danger in downtown Vancouver: understandings of place among young people entrenched in an urban drug scene. Health Place 2009; 16:51-60. [PMID: 19733496 DOI: 10.1016/j.healthplace.2009.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/17/2009] [Accepted: 07/22/2009] [Indexed: 11/18/2022]
Abstract
We undertook this qualitative study to examine young people's understandings of the physical and social landscape of the downtown drug scene in Vancouver, Canada. In-depth interviews were conducted with 38 young people ranging from 16 to 26 years of age. Using the concept of symbolic violence, we describe how one downtown neighborhood in particular powerfully symbolizes 'risk' among local youth, and how the idea of this neighborhood (and what happens when young people go there) informs experiences of marginalization in society's hierarchies. We also discuss the complex role played by social networks in transcending the geographical and conceptual boundaries between distinct downtown drug-using neighborhoods. Finally, we emphasize that young people's spatial tactics within this downtown landscape - the everyday movements they employ in order to maximize their safety - must be understood in the context of everyday violence and profound social suffering.
Collapse
Affiliation(s)
- Danya Fast
- British Columbia Centre for Excellence in HIV/AIDS, Urban Health Research Initiative, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
| | | | | | | |
Collapse
|
24
|
Milloy MJ, Kerr T, Buxton J, Montaner J, Wood E. Methamphetamine use and rates of incarceration among street-involved youth in a Canadian setting: a cross-sectional analysis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:17. [PMID: 19674473 PMCID: PMC2731743 DOI: 10.1186/1747-597x-4-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 08/12/2009] [Indexed: 11/13/2022]
Abstract
Background Given concerns over rising use of methamphetamine, especially among street-involved youth, and the links between exposure to the correctional system and the production of drug-related harm, we sought to assess the relationship between ever using methamphetamine and reporting ever being incarcerated in the At-Risk Youth Survey (ARYS) in Vancouver, Canada. Methods The relationship between ever being imprisoned and ever using methamphetamine was estimated using a multivariate logistic regression analysis while also considering potentially confounding secondary demographic, social and behavioural variables. Results Of the 478 youth recruited into ARYS between September 2005 and October 2006, 385 (80.5%) reported ever being incarcerated overnight or longer. In the multivariate model, methamphetamine use was independently associated with ever being incarcerated (Adjusted Odds Ratio: 1.79, 95% Confidence Interval [CI]: 1.03 – 3.13). Conclusion Incarceration was very common in this cohort and strongly linked with ever using methamphetamine. This finding is of concern and, along with the previously identified risks of drug-related harm associated with incarceration, supports the development of novel public policy, such as community-based drug treatment, to address the use of methamphetamine among street youth.
Collapse
Affiliation(s)
- M-J Milloy
- BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | |
Collapse
|
25
|
Small W, Fast D, Krusi A, Wood E, Kerr T. Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:8. [PMID: 19405977 PMCID: PMC2685773 DOI: 10.1186/1747-597x-4-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/30/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND 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. 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. METHODS Qualitative 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. RESULTS 26 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. CONCLUSION The 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.
Collapse
Affiliation(s)
- Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrarrd St, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | |
Collapse
|