title: Homelessness independently predicts injection drug use initiation among street-involved youth in a Canadian setting.
abstract: OBJECTIVE
  This longitudinal study examines the association between homelessness and injection drug use initiation among a cohort of street-involved youth in a setting of high-prevalence crystal methamphetamine use.
  
  
  METHODS
  We derived data from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14-26 years, recruited between September 2005 and November 2011. We used Cox proportional hazards regression to identify factors independently associated with time to injection initiation.
  
  
  RESULTS
  Among 422 street-youth who had never injected at baseline, we observed 77 injection initiation events during follow-up. Homelessness was independently associated with injection initiation in multivariate Cox regression (relative hazard, 1.80 [95% confidence interval, 1.13-2.87]) after adjusting for crystal methamphetamine use and other potential confounders.
  
  
  CONCLUSIONS
  These findings highlight that homelessness is a key risk factor for injection initiation among street-involved youth. Supportive housing interventions for street youth may help prevent injection drug use initiation within this high-risk population.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Feng
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Steve
authors.initials: S
authors.lastname: Mathias
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D019969:Amphetamine-Related Disorders / Q000453:epidemiology* / Q000523:psychology*; D001955:British Columbia; D015331:Cohort Studies; D005260:Female; D018453:Homeless Youth / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000523:psychology; D008694:Methamphetamine; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000523:psychology; D016016:Proportional Hazards Models; D013223:Statistics as Topic; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult
chemical_list: D013287:Illicit Drugs; D008694:Methamphetamine