title: Neighborhood of residence and risk of initiation into injection drug use among street-involved youth in a Canadian setting.
abstract: BACKGROUND
  While research has suggested that exposure to environments where drug use is prevalent may be a key determinant of drug-related risk, little is known regarding the impact of such exposure on the initiation of illicit injection drug use. We assessed whether neighborhood of residence predicted rates of injecting initiation among a cohort of street-involved youth in Vancouver, British Columbia.
  
  
  METHODS
  We followed street-involved injecting naïve youth aged 14-26 and compared rates of injecting initiation between youth residing in Vancouver's Downtown Eastside (DTES) neighborhood (the site of a large street-based illicit drug market) to those living in other parts of the city. Univariate and multivariate Cox regression analyses were employed to determine whether residence in the DTES was independently associated with increased risk of initiation of injection drug use.
  
  
  RESULTS
  Between September, 2005 and November, 2011, 422 injection-naïve individuals were followed, among whom 77 initiated injecting for an incidence density of injecting of 10.3 (95% confidence interval [CI] 5.0-18.8) per 100 person years. In a multivariate model, residence in the DTES was independently associated with initiating injection drug use (adjusted hazard ratio [AHR]=2.16, 95% CI: 1.33-3.52, p=0.002).
  
  
  CONCLUSIONS
  These results suggest neighborhood of residence affects the risk of initiation into injection drug use among street-involved youth. The development of prevention interventions should target high-risk neighborhoods where risk of initiating into injecting drug use may be greatest.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6.
authors.forename: Goldis
authors.initials: G
authors.lastname: Chami
authors.forename: Dan
authors.initials: D
authors.lastname: Werb
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: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018453:Homeless Youth / Q000523:psychology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: At Risk Youth Study; Downtown Eastside; Initiation; Injection drug use; Street-involved youth; Vancouver