Public Policy, School of

Receive updates for this collection

High-intensity Cannabis Use and Hospitalization: A Prospective Cohort Study of Street-involved Youth in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-05-17
Abstract: 

Background: There is concern that cannabis use negatively affects vulnerable groups such as youth; however, the relationship between cannabis use and health care utilization has not been well characterized in this population. We longitudinally evaluated the association between daily cannabis use and hospitalization among a prospective cohort of street-involved youth.

 

Methods: Data were collected from the At-Risk Youth Study (ARYS) in Vancouver, Canada, from September 2005 to May 2015. Participants were interviewed semi-annually and multivariable generalized estimating equation (GEE) logistic regression was used to examine the relationship between daily cannabis use and hospitalization.

 

Results: A total of 1216 participants (31.2% female) were included in this analysis, and 373 (30.7%) individuals reported hospitalization at some point during the study period. In a multivariable GEE analysis, daily cannabis use was not significantly associated with hospitalization (Adjusted Odds Ratio [AOR] = 1.17, 95% Confidence interval [CI] = 0.84, 1.65). We did observe a significant interaction between daily cannabis use and sex (AOR = 0.51, 95% CI = 0.34, 0.77), whereby cannabis use was associated with a decreased odds of hospitalization among males (AOR = 0.60, 95% CI = 0.47, 0.78), yet was not significantly associated with hospitalization among females (AOR = 1.19, 95% CI = 0.84, 1.67).

 

Conclusions: The finding that daily cannabis use was not associated with hospitalization among street-involved youth is encouraging given the high rates of cannabis use in this population and the expansion of cannabis legalization and regulation. Future studies, however, are warranted to monitor possible changes in the consequences of cannabis use as cannabis legalization and regulation increase internationally.

Document type: 
Article
File(s): 

Toward a Better Understanding of Housing Vulnerability

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2021-05-13
Abstract: 

Housing vulnerability is a complex and elusive concept. In this report, we draw upon a scoping review and partner consultation to provide a systematic review of vulnerability associated with housing in the Canadian context. We identify five conceptual approaches to housing vulnerability. They can be differentiated based on different treatments of:

 

• entities considered to be vulnerable;

• risk factors of vulnerability;

• ability to respond to vulnerability;

• outcomes of vulnerability.

 

Most studies of housing vulnerability in our review take an outcome-based approach, examining substandard housing outcomes, such as homelessness and severe housing deprivation. These studies expose both the systemic failures and individual deficiencies that drive vulnerability. The second category of approach is a risk-based approach to vulnerability. Research in this category treats poor housing conditions as indicators of the inability of households or communities to manage explicitly identified vulnerability risk factors or events that may affect them negatively in the future, such as natural hazards, food insecurity, or health risk factors. Thirdly, the household financial vulnerability model takes a similar risk-based approach, but its empirical focus is on the risks to households from their financial situation related to housing. Neither risk-based nor financial vulnerability-based approaches do an effective job of treating the outcomes that may result from these risk factors. Fourth, the capabilities approach incorporates housing vulnerability as a component of social vulnerability writ large, where social vulnerability of any kind is understood as a deficit in the freedoms and opportunities to pursue desired well-being outcomes. This approach emphasizes a composite measure of social vulnerability that takes vulnerability from housing situations into account. While appealing in offering a specific conceptualization of the human cost of housing vulnerability, negative capabilities outcomes are often poorly measured. Another strand of literature in economics distinguishes itself from other approaches by looking at the vulnerability of the housing market to economic shocks or risks. This strand is only treated in a summary way in this review.

 

In consultation with our CHC partners on how they view their own understandings of housing vulnerability within this framework, there was recognition of each of the identified approaches. The most common affinity was with the outcome-based approach. However, our partners also pointed out that existing concepts and measures of "housing" and "vulnerability" should take the multi-faceted manifestations of vulnerability into account. The consultation highlighted the importance of re-conceptualizing housing in order to address housing vulnerability in both research and practice. Specifically, consulted partners agree that residential autonomy (i.e., choice or control over residential space), accessibility, social capital, social connectedness, cultural appropriateness, and intersectionality should be taken into account when defining housing vulnerability or the right to housing. There is also a strong consensus that housing vulnerability, despite its various definitions, stems from systemic failures rather than any individual deficiency. Beyond housing precarity, housing vulnerability brings with it a wide range of financial, social, and environmental costs along with the trauma inflicted on households living in this state.

 

Based on our reviews and consultations, we offer a starting point for a policy research position to guide Community Housing Canada’s common work. Namely, alongside housing policy analysis, research that identifies specific negative outcomes and associated risk factors of housing vulnerability is needed for effective rights-based housing policy in Canada.

Document type: 
Report
File(s): 

Overdose Risk and Acquiring Opioids for Nonmedical Use Exclusively from Physicians in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-06-26
Abstract: 

Background: A primary response to the alarming rise in overdose and mortality due to nonmedical prescription opioid (PO) use has been to restrict opioid prescribing; however, little is known about the relationship between obtaining opioids from a physician and overdose risk among people who use POs nonmedically and illicit street drugs.

 

Objectives: Investigate the relationship between non-fatal overdose and acquiring POs exclusively from physicians for the purposes of engaging in nonmedical PO use.

 

Methods: Data were collected between 2013 and 2016 among participants in two harmonized prospective cohort studies of people who use drugs in Vancouver: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Analyses were restricted to participants who engaged in nonmedical PO use and used generalized estimating equations.

 

Results: Among 599 participants who used POs nonmedically, 82 (14%) individuals reported acquiring POs exclusively from a physician and 197 (33%) experienced a non-fatal overdose at some point over the study period. Acquiring POs exclusively from physicians was significantly and negatively associated with non-fatal overdose in the bivariate analysis (Odds Ratio=0.60, 95% Confidence Interval (CI): 0.39-0.94) but not the final multivariate analysis (Adjusted Odds Ratio =0.87, 95% CI: 0.53-1.44).

 

Conclusions: Compared to individuals who acquired POs from friends or the streets, participants who acquired POs exclusively from a physician were not at an increased risk of non-fatal overdose. Although responsible opioid prescribing is an important priority, additional strategies to address nonmedical PO use are urgently needed to reduce overdose and related morbidity and mortality.

Document type: 
Article

Beyond Sex and Gender Difference in Funding and Reporting of Health Research

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-08-28
Abstract: 

Background  Understanding sex and gender in health research can improve the quality of scholarship and enhance health outcomes. Funding agencies and academic journals are two key gatekeepers of knowledge production and dissemination, including whether and how sex/gender is incorporated into health research. Though attention has been paid to key issues and practices in accounting for sex/gender in health funding agencies and academic journals, to date, there has been no systematic analysis documenting whether and how agencies and journals require attention to sex/gender, what conceptual explanations and practical guidance are given for such inclusion, and whether existing practices reflect the reality that sex/gender cannot be separated from other axes of inequality.

Methods  Our research systematically examines official statements about sex/gender inclusion from 45 national-level funding agencies that fund health research across 36 countries (covering the regions of the EU and associated countries, North America, and Australia) and from ten top-ranking general health (the top five in “science” and the top five in “social science”) and ten sex- and/or gender-related health journals. We explore the extent to which agencies and journals require inclusion of sex/gender considerations and to what extent existing strategies reflect state of the art understandings of sex/gender, including intersectional perspectives.

Results  The research highlights the following: (a) there is no consistency in whether sex/gender are mentioned in funding and publishing guidelines; (b) there is wide variation in how sex/gender are conceptualized and how researchers are asked to address the inclusion/exclusion of sex/gender in research; (c) funding agencies tend to prioritize male/female equality in research teams and funding outcomes over considerations of sex/gender in research content and knowledge production; and (d) with very few exceptions, agency and journal criteria fail to recognize the complexity of sex/gender, including the intersection of sex/gender with other key factors that shape health.

Conclusions  The conceptualization and integration of sex/gender needs to better capture the interacting and complex factors that shape health—an imperative that can be informed by an intersectional approach. This can strengthen current efforts to advance scientific excellence in the production and reporting of research. We provide recommendations and supporting questions to strengthen consideration of sex/gender in policies and practices of health journals and funding agencies.

Document type: 
Article
File(s): 

Hospitalization among Street-involved Youth Who Use Illicit Drugs in Vancouver, Canada: A Longitudinal Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-20
Abstract: 

Background: Street-involved youth who use illicit drugs are at high risk for health-related harms; however, the profile of youth at greatest risk of hospitalization has not been well described. We sought to characterize hospitalization among street-involved youth who use illicit drugs and identify the most frequent medical reasons for hospitalization among this population.

Methods: From January 2005 to May 2016, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariable generalized estimating equation (GEE) was used to identify factors associated with hospitalization.

Results: Among 1216 participants, 373 (30.7%) individuals reported hospitalization in the previous 6 months at some point during the study period. The top three reported medical reasons for hospital admission were the following: mental illness (37.77%), physical trauma (12.77%), and drug-related issues (12.59%). Factors significantly associated with hospitalization were the following: past diagnosis of a mental illness (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [95% CI] 1.47–2.33), frequent cocaine use (AOR = 2.15; 95% CI 1.37–3.37), non-fatal overdose (AOR = 1.76; 95% CI 1.37–2.25), and homelessness (AOR = 1.40; 95% CI 1.16–1.68) (all p < 0.05).

Conclusions: Findings suggest that mental illness is a key driver of hospitalization among our sample. Comprehensive approaches to mental health and substance use in addition to stable housing offer promising opportunities to decrease hospitalization among this vulnerable population.

Document type: 
Article
File(s): 

Intergenerational Trauma: The Relationship between Residential Schools and the Child Welfare System among Young People Who Use Drugs

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08
Abstract: 

Purpose: This study investigated the relationship between familial residential school system (RSS) exposure and personal child welfare system (CWS) involvement among young people who use drugs (PWUD).

Methods: Data were obtained from two linked cohorts of PWUD in Vancouver, Canada and restricted to Indigenous participants. Multivariable logistic regression analysis was used to investigate the relationship between three categories of familial RSS exposure (none; grandparent; parent) and CWS involvement. A secondary analysis assessed the likelihood of CWS involvement between non-Indigenous and Indigenous PWUD with no familial RSS exposure.

Results: Between December 2011 and May 2016, 675 PWUD (age<35) were included in this study, 40% identified as Indigenous. In multivariable analyses, compared to Indigenous participants with no RSS exposure (reference), those with a grandparent in the RSS had a higher likelihood of having been in CWS (Adjusted Odds Ratio [AOR]=1.34, 95% Confidence Interval [CI]: 0.67-2.71), as did those with a parent exposed to RSS (AOR=2.03, 95% CI: 1.03-3.99). In secondary analysis, the odds of CWS involvement was not significantly different between non-Indigenous and Indigenous PWUD with no familial RSS exposure (AOR=0.63, 95% CI: 0.38–1.06).

Conclusions: We observed a dose-response-type trend between familial RSS exposure and personal CWS involvement, and a non-significant difference in the likelihood of CWS involvement between Indigenous and non-Indigenous PWUD when controlling for RSS exposure. These data demonstrate the intergenerational impact of the RSS on the overrepresentation of Indigenous youth in the CWS. Findings have critical implications for public policy and practice including reconciliation efforts with Indigenous Peoples.

Document type: 
Article

A Gender-Based Analysis of Nonmedical Prescription Opioid Use Among People Who Use Illicit Drugs

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-05-21
Abstract: 

Abstract:  Background: Research investigating the unique impacts associated with engaging in nonmedical prescription opioid use (NMPOU) among males and females who also use illicit drugs is needed.

Methods:  Data were collected between 2013 and 2017 from two linked prospective cohort studies in Vancouver: the At-Risk Youth Study and Vancouver Injection Drug Users Study. Generalized estimating equations were used to identify factors associated with engaging in NMPOU among females and males separately.

Results:  Among 1,459 participants, 534 were female (37%). Similar proportions of females (46%) and males (48%) engaged in NMPOU at their first visit during the study period. In multivariable analyses, factors associated with NMPOU among both males and females included heroin use, overdose, drug dealing, and difficulty accessing health and social services. Among females, those who engaged in NMPOU were more likely to report Caucasian or white ethnicity, cocaine use, crystal methamphetamine use, and sex work; among males, those who engaged in NMPOU were older, reported crack use and engaged in binge drug use (all p<0.05).

Conclusion:  The prevalence of NMPOU was similar among males and females who use illicit drugs in Vancouver, and NMPOU was independently associated with markers of vulnerability among both genders. Findings highlight the need for a comprehensive public health approach to address NMPOU that integrates overdose prevention and reversal services, employment opportunities, and better access to services for both women and men.

Document type: 
Article

Gender, Victimization, and Commercial Sex: A Comparative Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2109-11-07
Abstract: 

This article critically examines and compares adult male and female experiences selling sex in Canada’s off-street sex industry. Findings indicate that gender disparities exist when it comes to the work of selling sex: male providers are better insulated from violence and exploitation because of their gender, while female sex workers are forced to navigate multiple layers of oppression to assure safer working conditions. Despite these differences, this data suggests that prioritizing overarching labour issues, instead of gendered experiences working in commercial sex, can function to increase all sex workers’ safety and access to justice.

Document type: 
Article
File(s): 

Coercion Into Addiction Treatment and Subsequent Substance Use Patterns Among People Who Use Illicit Drugs in Vancouver, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-09-06
Abstract: 

Background and Aims: Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment.

 

Design: Data from three linked prospective cohort studies of PWUD were used. McNemar’s test and non-linear growth curve modeling were employed to: a) assess changes in substance use patterns before and after coerced addiction treatment and b) compare these changes with changes in PWUD who 1) voluntarily accessed and 2) did not access treatment.

 

Setting: Vancouver, Canada.

 

Participants: 3,196 community-recruited PWUD.

 

Measurements: The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment.

 

Findings: Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar’s test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all p>0.05). In sub-analyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician.

 

Conclusions: Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.

Document type: 
Article

Street-Involved Youth Engaged In Sex Work at Increased Risk of Syringe Sharing

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-07-12
Abstract: 

Syringe sharing places street-involved young people at risk of acquiring HIV and hepatitis C. While markers of economic marginalization, such as homelessness, have been linked with syringe sharing and have led to targeted interventions, the relationship between syringe sharing and other markers of economic vulnerability, such as sex work, are not well documented among young people. This study examines whether those engaged in sex work are at increased risk of syringe borrowing and syringe lending among street-involved youth who use injection drugs in Vancouver, Canada. Between September 2005 and May 2014, data was collected from the At-Risk Youth Study (ARYS), a prospective cohort of street involved youth aged 14-26. Generalized estimating equations with a confounding model building approach was used to examine the relationship between sex work and syringe borrowing and lending. 498 youth reported injecting drugs at some point during the study period and were therefore included in the analysis. In multivariable analysis, youth who engaged in sex work were at an elevated risk of both syringe borrowing (Adjusted Odds Ratio (AOR) = 2.17, 95% Confidence Interval [CI] = 1.40-3.36) and syringe lending (AOR = 1.66, 95% CI = 1.07-2.59). Our study found that youth engaged in street-based sex work were at a significantly higher risk of both syringe borrowing and lending among youth who use injection drugs in Vancouver. Ready access to clean syringes, safer working conditions for sex workers to enable risk reduction measures, and increased access to addiction treatment are identified as promising opportunities for reducing syringe sharing in this setting.

Document type: 
Article
File(s):