title: Employment and risk of injection drug use initiation among street involved youth in Canadian setting.
abstract: OBJECTIVE
  Youth unemployment has been associated with labour market and health disparities. However, employment as a determinant of high-risk health behaviour among marginalized young people has not been well described. We sought to assess a potential relationship between employment status and initiation of intravenous drug use among a prospective cohort of street-involved youth.
  
  
  METHODS
  We followed injecting naïve youth in the At-Risk Youth Study, a cohort of street-involved youth aged 14-26 in Vancouver, Canada, and employed Cox regression analyses to examine whether employment was associated with injection initiation.
  
  
  RESULTS
  Among 422 injecting naïve youth recruited between September 2005 and November 2011, 77 participants transitioned from non-injection to injection drug use, for an incidence density of 10.3 (95% confidence interval [CI]: 8.0-12.6) per 100 person years. Results demonstrating that employment was inversely associated with injection initiation (adjusted hazard ratio: 0.53; 95% CI: 0.33-0.85) were robust to adjustment for a range of potential confounders.
  
  
  CONCLUSIONS
  A lack of employment among street-involved youth was associated with the initiation of injection drug use, a practice that predisposes individuals to serious long-term health consequences. Future research should examine if reducing barriers to labour market involvement among street-involved youth prevents transitions into high-risk drug use.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Faculty of Medicine, University of British Columbia, Room 10203-2775 Laurel St., Vancouver, BC, Canada, V5Z 1M9.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Richardson
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; School of Public Policy, Simon Fraser University, SFU Harbour Centre, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada, V6B 5K3.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; School of Public Health, University of Saskatchewan, Room 3338, Health Sciences Building E-Wing, 104 Clinic Place, Saskatoon, SK, Canada, S7N 5E5.
authors.forename: Cindy
authors.initials: C
authors.lastname: Feng
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Faculty of Medicine, University of British Columbia, Room 10203-2775 Laurel St., Vancouver, BC, Canada, V5Z 1M9.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6; Faculty of Medicine, University of British Columbia, Room 10203-2775 Laurel St., Vancouver, BC, Canada, V5Z 1M9. Electronic address: uhri-ew@cfenet.ubc.ca.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D004651:Employment; D006801:Humans; D015994:Incidence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000209:etiology; D014478:Unemployment; D055815:Young Adult
keywords: Injection drug use; Injection initiation; Street-involved youth; Youth unemployment