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

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.