Risk and resiliency factors associated with injection drug use among at-risk youth in Vancouver, British Columbia

Background: Street-involved youth are a vulnerable population with respect to injection drug use (IDU) initiation; however, despite being considered an “at-risk” population, many street-involved youth do not use drugs intravenously. The objective of this thesis was to explore risk and resiliency factors associated with IDU among at-risk youth in Metro Vancouver, British Columbia and to determine if these factors differ by gender. Methods: Data were obtained from the Vancouver-subset of the Enhanced Surveillance of Canadian Street Youth Survey (E-SYS), which collected data from January to November 2006. Logistic regression was performed overall and by gender to identify factors associated with IDU among street-involved youth aged 15 to 25. Results of the E-SYS study were used to inform 16 in-depth, semi-structured interviews with service providers who work with at-risk youth populations in Metro Vancouver. Domain analysis was performed to identify risk and resiliency factors. Results: Among the 195 E-SYS participants, 55 (28.2%) youth reported injecting drugs more than once in their lifetimes. Youth who use injection drugs are entrenched within the street culture and engage in high-risk sexual activities. Males who use injection drugs reported more intense street involvement, while females who use injection drugs reported engaging in sex for trade. Six themes emerged from the service provider interviews: (i) interpersonal relationships for example with family members or peer groups; (ii) social influences such as the normalization and social acceptability of IDU; (iii) structural influences such as the lack of safe, affordable housing; (iv) family history factors including violence, abuse, and neglect as well as parental drug use; (v) individual-level factors such as the development of tolerance to non-injection drugs; and (vi) gender differences related to the youths’ social influences and vulnerabilities on the street. Conclusions: Youth who use injection drugs are more involved with the street culture and engage in sexual behaviours that may increase the risk for HIV, hepatitis C and other sexually-transmitted infections. The results of this study will inform evidence-based, youth-driven intervention strategies in the community. These findings suggest that intervention strategies should focus on the social structural influences around IDU in conjunction with individual-level risk factors.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat