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Cessation of Injecting and Preceding Drug Use Patterns Among a Prospective Cohort of Street-Involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-27
Abstract: 

Purpose: Injection drug use is prevalent among street-involved youth, but patterns of cessation are poorly described. We identified drug use patterns preceding injection cessation among street-involved youth.

Methods: From September 2005 to May 2015, we collected data from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada, and limited the sample to actively injecting youth. The primary outcome was cessation of injecting self-reported at semiannual follow-up visits. We used Cox regression to identify drug use patterns preceding cessation.

Results: Among 383 youth, 65% were male, mean age was 22.3 (SD, 2.5; range, 15-30) years, and 171 (45%) ceased injecting for 6 months or more (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19-26). Youth who ceased were less likely to have injected daily (adjusted hazard ratio [AHR], 0.40; 95% CI, 0.28-0.56), injected heroin (AHR, 0.40; 95% CI, 0.29-0.56), or injected crystal methamphetamine (AHR, 0.43; 95% CI, 0.31-0.59) prior to cessation. Non-injection heroin use was positively associated with injection cessation (AHR, 1.52; 95 CI, 1.12-2.08). Addiction treatment was not associated with cessation. At the time of cessation, 101 (59%) youth continued to use ‘hard’ non-injection drugs such as heroin and crystal methamphetamine.

Conclusions: Periods of injection cessation were common but frequently accompanied by ongoing non-injection drug use. Findings indicate that trajectories of injection drug use among youth are complex and highlight the need to further explore relationships between ongoing non-injection drug use and injection cessation.

Document type: 
Article
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“Getting Out of Downtown”: A Longitudinal Study of How Street-Entrenched Youth Attempt to Exit an Inner City Drug Scene

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Background: Urban drug “scenes” have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths’ drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences.

Methods: Between 2008 and 2016, we draw on 150 semi-structured interviews with 75 street entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between.

Results: Youth described that, in order to successfully exit Vancouver’s inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves – both physically and socially – from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth’s capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption.

Conclusions: Policies and programming interventions that can facilitate young people’s efforts to reduce engagement with Vancouver’s inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, ‘low threshold’ addiction treatment services, as well as access to supportive housing outside of the scene.

Document type: 
Article

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

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

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.

Document type: 
Article
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History of Being in Government Care Associated with Younger Age at Injection Initiation Among a Cohort of Street-involved Youth

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2017-07-25
Abstract: 

Introduction and Aims: 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.

 

Design and Methods: 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.

 

Results: Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18 years 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).

 

Discussion and Conclusions: 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 interventions are needed to prevent transitions into high-risk substance use among this population.

Document type: 
Article
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Declining Incidence of Hepatitis C Virus Infection among People Who Inject Drugs in a Canadian Setting, 1996-2012

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014-06-04
Abstract: 

Background

People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection. Trends in HCV incidence and associated risk factors among PWID recruited between 1996 and 2012 in Vancouver, Canada were evaluated.

Methods

Data were derived from a long-term cohort of PWID in Vancouver. Trends in HCV incidence were evaluated. Factors associated with time to HCV infection were assessed using Cox proportional hazards regression.

Results

Among 2,589, 82% (n = 2,121) were HCV antibody-positive at enrollment. Among 364 HCV antibody-negative participants with recent (last 30 days) injecting at enrollment, 126 HCV seroconversions were observed [Overall HCV incidence density: 8.6 cases/100 person-years (py); 95% confidence interval (95% CI): 7.2, 10.1; HCV incidence density among those with injecting during follow-up: 11.5 cases/100 py; 95% CI 9.7, 13.6]. The overall HCV incidence density declined significantly from 25.0/100 py (95% CI: 20.2, 30.3) in 1996–99, as compared to 6.0/100 py (95% CI: 4.1, 8.5) in 2000–2005, and 3.1/100 py (95% CI: 2.0, 4.8) in 2006–2012. Among those with injecting during follow-up, the overall HCV incidence density declined significantly from 27.9/100 py (95% CI: 22.6, 33.6) in 1996–99, as compared to 7.5/100 py (95% CI: 5.1, 10.6) in 2000–2005, and 4.9/100 py (95% CI: 3.1, 7.4) in 2006–2012. Unstable housing, HIV infection, and injecting of cocaine, heroin and methamphetamine were independently associated with HCV seroconversion.

Conclusions

HCV incidence has dramatically declined among PWID in this setting. However, improved public health strategies to prevent and treat HCV are urgently required to reduce HCV-associated morbidity and mortality.

Document type: 
Article
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An Intersectionality-Based Policy Analysis Framework: Critical Reflections on a Methodology for Advancing Equity

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Introduction

In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts – an Intersectionality-Based Policy Analysis (IBPA) Framework.

Methods

Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies.

Results

The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks.

Conclusion

The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

Document type: 
Article
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High Prevalence of Exposure to the Child Welfare System among Street-Involved Youth in a Canadian Setting: Implications for Policy and Practice

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Background

Street-involved youth are more likely to experience trauma and adverse events in childhood; however, little is known about exposure to the child welfare system among this vulnerable population. This study sought to examine the prevalence and correlates of being in government care among street-involved youth in Vancouver, Canada.

Methods

From September 2005 to November 2012, data were collected from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14–26 who use illicit drugs. Logistic regression analysis was employed to identify factors associated with a history of being in government care.

Results

Among our sample of 937 street-involved youth, 455 (49%) reported being in government care at some point in their childhood. In a multivariate analysis, Aboriginal ancestry (adjusted odds ratio [AOR] = 2.07; 95% confidence interval [CI]: 1.50 – 2.85), younger age at first “hard” substance use (AOR = 1.10; 95% CI: 1.05 – 1.16), high school incompletion (AOR = 1.40; 95% CI: 1.00 – 1.95), having a parent that drank heavily or used illicit drugs (AOR = 1.48; 95% CI: 1.09 – 2.01), and experiencing physical abuse (AOR = 1.90; 95% CI: 1.22 – 2.96) were independently associated with exposure to the child welfare system.

Conclusions

Youth with a history of being in government care appear to be at high-risk of adverse illicit substance-related behaviours. Evidence-based interventions are required to better support vulnerable children and youth with histories of being in the child welfare system, and prevent problematic substance use and street-involvement among this population.

Document type: 
Article
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Critically Examining Diversity In End-Of-Life Family Caregiving: Implications for Equitable Caregiver Support and Canada’s Compassionate Care Benefit

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2012
Abstract: 

Introduction

Family (i.e., unpaid) caregiving has long been thought of as a ‘woman’s issue’, which ultimately results not only in gendered, but also financial and health inequities. Because of this, gender-based analyses have been prioritized in caregiving research. However, trends in current feminist scholarship demonstrate that gender intersects with other axes of difference, such as culture, socio-economic status, and geography to create diverse experiences. In this analysis we examine how formal front-line palliative care providers understand the role of such diversities in shaping Canadian family caregivers’ experiences of end-of-life care. In doing so we consider the implications of these findings for a social benefit program aimed at supporting family caregivers, namely the Compassionate Care Benefit (CCB).

Methods

This analysis contributes to a utilization-focused evaluation of Canada’s CCB, a social program that provides job security and limited income assistance to Canadian family caregivers who take a temporary leave from employment to provide care for a dying family member at end-of-life. Fifty semi-structured phone interviews with front-line palliative care providers from across Canada were conducted and thematic diversity analysis of the transcripts ensued.

Results

Findings reveal that experiences of caregiving are not homogenous and access to services and supports are not universal across Canada. Five axes of difference were commonly raised by front-line palliative care providers when discussing important differences in family caregivers’ experiences: culture, gender, geography, lifecourse stage, and material resources. Our findings reveal inequities with regard to accessing needed caregiver services and resources, including the CCB, based on these axes of difference.

Conclusions

We contend that without considering diversity, patterns in vulnerability and inequity are overlooked, and thus continually reinforced in health policy. Based on our findings, we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities and inequities while identifying implications for the CCB program as it is currently administered. From a policy perspective, this analysis demonstrates why diversity needs to be acknowledged in policy circles, including in relation to the CCB, and seeks to counteract single dimensional approaches for understanding caregiver needs at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance evaluative health policy research.

Document type: 
Article
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Exploring the Promises of Intersectionality for Advancing Women's Health Research

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010
Abstract: 

Women’s health research strives to make change. It seeks to produce knowledge that promotes action on the varietyof factors that affect women’s lives and their health. As part of this general movement, important strides havebeen made to raise awareness of the health effects of sex and gender. The resultant base of knowledge has beenused to inform health research, policy, and practice. Increasingly, however, the need to pay better attention to theinequities among women that are caused by racism, colonialism, ethnocentrism, heterosexism, and able-bodism, isconfronting feminist health researchers and activists. Researchers are seeking new conceptual frameworks that cantransform the design of research to produce knowledge that captures how systems of discrimination or subordinationoverlap and “articulate” with one another. An emerging paradigm for women’s health research is intersectionality.Intersectionality places an explicit focus on differences among groups and seeks to illuminate variousinteracting social factors that affect human lives, including social locations, health status, and quality of life. Thispaper will draw on recently emerging intersectionality research in the Canadian women’s health context in orderto explore the promises and practical challenges of the processes involved in applying an intersectionality paradigm.We begin with a brief overview of why the need for an intersectionality approach has emerged within thecontext of women’s health research and introduce current thinking about how intersectionality can inform andtransform health research more broadly. We then highlight novel Canadian research that is grappling with thechallenges in addressing issues of difference and diversity. In the analysis of these examples, we focus on a largelyuninvestigated aspect of intersectionality research - the challenges involved in the process of initiating and developingsuch projects and, in particular, the meaning and significance of social locations for researchers and participantswho utilize an intersectionality approach. The examples highlighted in the paper represent important shiftsin the health field, demonstrating the potential of intersectionality for examining the social context of women’slives, as well as developing methods which elucidate power, create new knowledge, and have the potential toinform appropriate action to bring about positive social change.

Document type: 
Article