title: Risk factors for progression to regular injection drug use among street-involved youth in a Canadian setting.
abstract: BACKGROUND
  Street-involved youth are at high risk for experimenting with injection drug use; however, little attention has been given to identifying the factors that predict progression to on-going injecting.
  
  
  METHODS
  Logistic regression was used to identify factors associated with progression to injecting weekly on a regular basis among a Canadian cohort of street-involved youth.
  
  
  RESULTS
  Among our sample of 405 youth who had initiated injecting at baseline or during study observation, the median age was 22 years (interquartile range [IQR]=21-24), and 72% (293) reported becoming a regular injector at some point after their first injection experience. Of these, the majority (n=186, 63%) reported doing so within a month of initiating injection drug use. In multivariate analysis, the drug used at the first injection initiation event (opiates vs. cocaine vs. methamphetamine vs. other; all p>0.05) was not associated with progression; however, younger age at first injection (adjusted odds ratio [AOR]=1.13), a history of childhood physical abuse (AOR=1.81), prior regular use of the drug first injected (AOR=1.77), and having a sexual partner present at the first injection event (AOR=2.65) independently predicted progression to regular injecting.
  
  
  CONCLUSIONS
  These data highlight how quickly youth progress to become regular injectors after experimentation. Findings indicate that addressing childhood trauma and interventions such as evidence-based youth focused addiction treatment that could prevent or delay regular non-injection drug use, may reduce progression to regular injection drug use among this population.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada. Electronic address: uhri-kd@cfenet.ubc.ca.
authors.forename: Kora
authors.initials: K
authors.lastname: Debeck
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: Annick
authors.initials: A
authors.lastname: Simo
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D001955:British Columbia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
keywords: Injection drug use; Injection initiation; Injection prevention; Physical abuse; Street-involved youth
references.citation: Lancet. 1998 Jul 4;352(9121):32
references.pmid: 9800745
references.citation: Harm Reduct J. 2006 May 24;3:18
references.pmid: 16723029
references.citation: Drug Alcohol Depend. 2007 Nov 2;91(1):50-6
references.pmid: 17561355
references.citation: J Adolesc Health. 2013 Apr;52(4):499-501
references.pmid: 23299006
references.citation: Soc Sci Med. 2007 Sep;65(6):1214-21
references.pmid: 17576029
references.citation: Drug Alcohol Depend. 2008 Jul 1;96(1-2):165-77
references.pmid: 18423900
references.citation: Subst Use Misuse. 1996 Jul;31(9):1167-87
references.pmid: 8853236
references.citation: Lancet. 2011 Apr 23;377(9775):1429-37
references.pmid: 21497898
references.citation: Child Abuse Negl. 2003 Feb;27(2):169-90
references.pmid: 12615092
references.citation: Prev Med. 2012 Nov;55(5):500-4
references.pmid: 22954518
references.citation: J Adolesc Health. 2009 Mar;44(3):302-4
references.pmid: 19237118
references.citation: Addict Behav. 2010 Jan;35(1):68-71
references.pmid: 19775820
references.citation: Am J Addict. 2001 Spring;10(2):101-10
references.pmid: 11444153
references.citation: Am J Psychiatry. 1995 Sep;152(9):1329-35
references.pmid: 7653689
references.citation: Lancet. 2007 Apr 21;369(9570):1391-1401
references.pmid: 17448826
references.citation: Drug Alcohol Depend. 2005 Mar 7;77(3):303-9
references.pmid: 15734230
references.citation: Drug Alcohol Rev. 2008 May;27(3):270-6
references.pmid: 18368608
references.citation: J Urban Health. 2005 Dec;82(4):622-37
references.pmid: 16195471
references.citation: Am J Drug Alcohol Abuse. 2008;34(6):810-20
references.pmid: 19016187
references.citation: Health Place. 2009 Sep;15(3):753-60
references.pmid: 19201642
references.citation: Am J Public Health. 2005 Apr;95(4):703-9
references.pmid: 15798133
references.citation: J Adolesc Health. 2009 Sep;45(3):300-2
references.pmid: 19699428
references.citation: Drug Alcohol Depend. 2007 Jul 10;89(2-3):170-5
references.pmid: 17258871
references.citation: J Urban Health. 2004 Mar;81(1):14-9
references.pmid: 15047779