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Increased Burden of Suicidality Among Young Street-Involved Sex Workers who Use Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-11
Abstract: 

Abstract: Background: The risks of suicidality among street-involved youth who use drugs and engage in sex work is not well described. This study sought to evaluate if street-involved youth who engage in sex work were at an elevated risk for attempting suicide.

Methods: Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth who use drugs in Vancouver, Canada. Multivariable generalized estimating equation analyses were employed to examine whether youth who engaged in sex work were at elevated risk of attempting suicide, controlling for possible confounders.

Results: Between September 2005 and May 2015, 1210 youth were recruited into the cohort, of whom, 173 (14.3%) reported recently attempting suicide at some point during the study period. In multivariable analysis, youth who engaged in sex work were significantly more likely to report a recent suicide attempt (adjusted odds ratio=1.93; 95% confidence interval: 1.28-2.91).

Conclusions: Street-involved youth who engage in sex work were observed to be at a significantly higher risk for suicidality. Systematic discrimination and unaddressed trauma may contribute to the observed increased burden of suicidality among this population. Interventions that support the mental health and well-being of street-involved youth who engage in sex work are urgently needed.

Document type: 
Article

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

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-12-11
Abstract: 

Abstract: 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 neighbourhood were significantly less likely to report high perceived devaluation (AOR = 0.41, 95% CI: 0.26-0.65).

Conclusion: 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. 

Document type: 
Article

3,4-Methylenedioxymethamphetamine (MDMA; Ecstasy) Use and Transitions to Injection Drug Use Among Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-20
Abstract: 

Background: Despite the popularity of MDMA (ecstasy) among young people across North America and Europe, MDMA is rarely explored in studies of young people at highrisk of injecting drugs. We conducted a study among street-involved youth who use illicit drugs in Vancouver, Canada to understand if use of MDMA is associated with initiation of injection drugs. 

Methods: We followed injection-naïve participants in the At-Risk Youth Study (ARYS), an ongoing prospective cohort of street-involved youth who use illicit drugs aged 14-26. Bivariate and multivariate extended Cox models with time-updated variables were used to examine the association between MDMA use and initiation of injection drug use between September 2005 to May 2015. 

Results: Among 483 youth, 306 (63.4%) had a history of MDMA use and 218 (45.1%) had used MDMA in the previous six months at baseline. A total of 105 (21.7%) youth initiated injection drug use over the 10-year period, yielding an incidence density of 8.51 (95% Confidence Interval [CI]: 6.96 – 10.30) per 100 person-years. MDMA use was not significantly associated with initiating injection drugs at the bivariate- (Hazard Ratio: 0.93; 95% CI: 0.61 – 1.42) or multivariate- (Adjusted Hazard Ratio: 0.88; 95% CI: 0.57- 1.35) level after adjusting for unemployment, homelessness, and crystal methamphetamine use. 

Conclusions: Amid ongoing frequent use of MDMA among some young people in North America, we did not observe an elevated risk of injection initiation among those who used MDMA in this cohort of street-involved youth.

Document type: 
Article

"Secure Care": More Harm Than Good

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-10-15
Document type: 
Article
File(s): 

Regular MDMA Use is Associated with Decreased Risk of Drug Injection Among Street-Involved Youth Who Use Illicit Drugs.

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-01
Abstract: 

OBJECTIVES:

Childhood trauma is common among street-involved youth and is associated with injection drug use. Illicit 3,4-Methylenedioxymethamphetamine (MDMA) use is also common among street-involved youth, and data suggest this substance has clinical utility in management of post-traumatic stress disorder (PTSD) and associated harms. Despite this, little is known about co-occurring patterns of MDMA use and injection drug use.

METHODS:

Data were derived from a prospective cohort of street-involved youth using illicit drugs in Vancouver, Canada. Using multivariable generalized estimating equation logistic regression, we examined the association between MDMA use and the use of injection drugs, adjusting for confounders such as polysubstance use and sociodemographic factors.

RESULTS:

4941 surveys from 1208 participants between September 2005 and May 2015 were included. Of these, 829 (68.6%) were male, 815 (67.5%) reported white ethnicity, and median age was 21.7 years. Overall, 599 (49.6%) participants reported MDMA use, 544 (45.0%) reported injection drug use, and 244 (20.2%) reported concurrent MDMA and injection drug use at least once during the study period. In multivariable analyses, regular MDMA use was significantly negatively associated with injection drug use (Adjusted Odds Ratio [AOR] = 0.57, 95% CI: 0.46-0.69).

DISCUSSION:

After accounting for socio-demographic factors and polysubstance use, periods of reported regular MDMA use were negatively associated with reported injection drug use among this cohort. These findings suggest that, unlike the use of most other non-injection drugs, illicit MDMA use does not appear to promote injection drug use but rather is associated with a reduced likelihood of injection drug use.

Document type: 
Article

An Age-Based Analysis of Nonmedical Prescription Opioid Use Among People Who Use Illegal Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-27
Abstract: 

Background

Nonmedical prescription opioid use (NMPOU) is a serious public health problem in North America. At a population-level, previous research has identified differences in the prevalence and correlates of NMPOU among younger versus older age groups; however, less is known about age-related differences in NMPOU among people who use illegal drugs.

Methods

Data were collected between 2013 and 2015 from two linked prospective cohort studies in Vancouver, Canada: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Factors independently associated with NMPOU among younger (ARYS) and older (VIDUS) participants were examined separately using bivariate and multivariate generalized estimating equations.

Results

A total of 1162 participants were included. Among 405 eligible younger participants (Median age = 25; Inter-Quartile Range [IQR]: 22–28), 40% (n = 160) reported engaging in NMPOU at baseline; among 757 older participants (Median age = 48, IQR: 40–55), 35% (n = 262) reported engaging in NMPOU at baseline. In separate multivariate analyses of younger and older participants, NMPOU was positively and independently associated with heroin use (younger: Adjusted Odds Ratio [AOR] = 3.12, 95% Confidence Interval [CI]: 2.08–4.68; older: AOR = 2.79, 95% CI: 2.08–3.74), drug dealing (younger: AOR = 2.22, 95% CI: 1.58–3.13; older: AOR = 1.87, 95% CI: 1.40–2.49), and difficulty accessing services (younger: AOR = 1.47, 95% CI: 1.04–2.09; older: AOR = 1.74, 95% CI: 1.32–2.29). Among the youth cohort only, NMPOU was associated with younger age (AOR = 1.12, 95% CI: 1.05–1.19), crack use (AOR = 1.56, 95% CI: 1.06–2.30), and binge drug use (AOR = 1.41, 95% CI: 1.00–1.97); older participants who engaged in NMPOU were more likely to report crystal methamphetamine use (AOR = 1.97, 95% CI: 1.46–2.66), non-fatal overdose (AOR = 1.76, 95% CI: 1.20–2.60) and sex work (AOR = 1.49, 95% CI: 1.00–2.22).

Discussion

The prevalence of NMPOU is similar among younger and older people who use drugs, and independently associated with markers of vulnerability among both age groups. Adults who engage in NMPOU are at risk for non-fatal overdose, which highlights the need for youth and adult-specific strategies to address NMPOU that include better access to health and social services, as well as a range of addiction treatment options for opioid use. Findings also underscore the importance of improving pain treatment strategies tailored for PWUD.

Document type: 
Article
File(s): 

Unsafe Sexual Behaviour Associated with Hazardous Alcohol Use Among Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-04
Abstract: 

While risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [95% CI] = 1.12-1.46) and homelessness (AOR = 1.35, 95% CI = 1.19-1.54) were independently associated with hazardous alcohol use (all p < .001). Older age (AOR = 0.95, 95% CI = 0.92 0.99), Caucasian ethnicity (AOR = 0.74, 95% CI = 0.61-0.90), daily heroin use (AOR = 0.53, 95% CI = 0.42 0.67), daily crack cocaine smoking (AOR = 0.73, 95% CI = 0.59-0.91), and daily crystal methamphetamine use (AOR = 0.52, 95% CI = 0.42-0.64) were negatively associated with hazardous alcohol use (all p < .05). In sub-analysis, consistent dose-response patterns were observed between levels of alcohol use and unprotected sex, homelessness, and daily heroin injection. In sum, hazardous alcohol use was positively associated with unsafe sexual behaviour and negatively associated with high-intensity drug use. Interventions to address hazardous alcohol use should be central to HIV prevention efforts for street-involved youth.

Document type: 
Article
File(s): 

Reclaiming Indigenous Identities: Culture as Strength Against Suicide Among Indigenous Youth in Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-02
Abstract: 

In Canada, Indigenous youth suicide represents one of several health disparities burdening Indigenous populations, and like many other of these disparities, can be understood as an expression of societal, historical, cultural and familial trauma. As the number of Indigenous youth who take their own lives every year in Canada continues to far exceed national averages, it appears that conventional suicide prevention efforts remain ineffective among this population. A growing body of research argues that conventional interventions, largely rooted in Western individual-level behavioural change frameworks, are culturally discordant with Indigenous paradigms. In response, some Indigenous communities are turning to cultural revitalization as a holistic community-driven response to suicide prevention and treatment. The following commentary explores the emerging evidence base for "culture as treatment" - a novel approach to suicide that emphasizes the significance of interconnectedness in healing, alongside the revitalization of traditional values to reclaim community wellness. In doing so, we seek to contribute to a changing discourse surrounding Indigenous youth suicide by acknowledging culture as strength against this national crisis.

Document type: 
Article
File(s): 

Workplace Violence among Female Sex Workers Who Use Drugs in Vancouver, Canada: Does Client Targeted Policing Increase Safety?

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-11-06
Abstract: 

Workplace violence, by clients or predators, poses serious negative health consequences for sex workers. In 2013, the Vancouver (British Columbia), Canada Police Department changed their guidelines with the goal of increasing safety for sex workers by focusing law enforcement on clients and third parties, but not sex workers. We sought to examine the trends and correlates of workplace violence among female sex workers (FSW) before and after the guideline change, using data collected from prospective cohorts of persons who use illicit drugs in Vancouver, Canada. Among 259 FSW, 21.0% reported workplace violence at least once during the study period between 2008 and 2014. There was no statistically significant change in rates of workplace violence after the guideline change. In our multivariable analysis, daily heroin use was independently associated with workplace violence. The 2013 policing guideline change did not appear to have resulted in decreased reports of workplace violence. Increased access to opioid agonist therapies may reduce workplace violence among drug-using FSW.

Document type: 
Article
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Socioeconomic Factors Associated with Cessation of Injection Drug Use Among Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-12-07
Abstract: 

Background: Although the initiation of injection drug use has been well characterized among at-risk youth, factors that support or impede cessation of injection drug use have received less attention. We sought to identify socioeconomic factors associated with cessation of injection drug use among street-involved youth

Document type: 
Article
File(s):