title: Use of a medically supervised injection facility among street youth.
abstract: OBJECTIVE
  Supervised injecting facilities (SIFs) provide a sanctioned space for injection drug users and are associated with decreased overdose mortality and HIV risk behaviors among adults. Little is known about SIF use among youth. We identified factors associated with use of the Vancouver SIF, the only such facility in North America, among street youth.
  
  
  METHODS
  From September 2005 to May 2012, we collected data from the At-Risk Youth Study, a prospective cohort of street youth in Vancouver, BC, Canada. Eligible youth were aged 14-26 years. Participants reporting injection completed questionnaires at baseline and semiannually. We used generalized estimating equation logistic regression to identify factors associated with SIF use.
  
  
  RESULTS
  During the study period, 42.3% of 414 injecting youth reported use of the SIF at least once. Of all SIF-using youth, 51.4% went to the facility at least weekly, and 44.5% used it for at least one-quarter of all injections. SIF-using youth were more likely to live or spend time in the neighborhood surrounding the SIF (adjusted odds ratio [AOR], 3.29; 95% confidence interval [CI], 2.38-4.54), to inject in public (AOR, 2.08; 95% CI, 1.53-2.84), or to engage in daily injection of heroin (AOR, 2.36; 95% CI, 1.72-3.24), cocaine (AOR, 2.44; 95% CI, 1.34-4.45), or crystal methamphetamine (AOR, 1.62; 95% CI, 1.13-2.31).
  
  
  CONCLUSIONS
  This study, the first to examine SIF use among street youth in North America, demonstrated that the facility attracted high-frequency young drug users most at risk of blood-borne infection and overdose and those who otherwise inject in public spaces.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Hadland
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; School of Public Policy, SFU Harbour Centre, Simon Fraser University, Vancouver, British Columbia, Canada.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Annick
authors.initials: A
authors.lastname: Simo
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Julio S
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: uhri-ew@cfenet.ubc.ca.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D040261:Harm Reduction; D006801:Humans; D013287:Illicit Drugs; D016015:Logistic Models; D008297:Male; D018671:Needle-Exchange Programs / Q000458:organization & administration*; D016017:Odds Ratio; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D015819:Substance Abuse, Intravenous / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D013287:Illicit Drugs
keywords: Adolescent; Drug abuse; HIV; Hepatitis C; Needle sharing