title: Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study.
abstract: BACKGROUND
  Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among street-involved youth in Vancouver, Canada.
  
  
  METHODS
  Qualitative interviews with street youth who inject drugs elicited descriptions of the adoption of injection as a route of administration. Interviewees were recruited from the At-Risk Youth Study (ARYS), a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Audio recorded interviews were transcribed verbatim and a thematic analysis was conducted.
  
  
  RESULTS
  26 youth aged 16 to 26 participated in this study, including 12 females. Among study participants the first injection episode frequently featured another drug user who facilitated the initiation of injecting. Youth narratives indicate that the transition into injecting is influenced by social interactions with drug using peers and evolving perceptions of injecting, and rejecting identification as an injector was important among youth who did not continue to inject. It appears that social conventions discouraging initiating young drug users into injection exist among established injectors, although this ethic is often ignored.
  
  
  CONCLUSIONS
  The importance of social relationships with other drug users within the adoption of injection drug use highlights the potential of social interventions to prevent injection initiation. Additionally, developing strategies to engage current injectors who are likely to initiate youth into injection could also benefit prevention efforts.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrarrd St, Vancouver, BC V6Z 1Y6, Canada. wsmall@cfenet.ubc.ca
authors.forename: Will
authors.initials: W
authors.lastname: Small
authors.forename: Danya
authors.initials: D
authors.lastname: Fast
authors.forename: Andrea
authors.initials: A
authors.lastname: Krusi
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D015331:Cohort Studies; D005260:Female; D018453:Homeless Youth / Q000523:psychology*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012931:Social Environment; D015819:Substance Abuse, Intravenous / Q000523:psychology*