title: Crack pipe sharing among street-involved youth in a Canadian setting.
abstract: OBJECTIVE
  Crack pipe sharing is a risky practice that has been associated with the transmission of hepatitis C and other harms. While previous research has exclusively focused on this phenomenon among adults, this study examines crack pipe sharing among street-involved youth.
  
  
  METHODS
  From May 2006 to May 2012, data were collected from the At-Risk Youth Study, a cohort of street-involved youth aged 14-26 in Vancouver, Canada. Survey data from active crack smokers were analysed using generalised estimating equations logistic regression.
  
  
  RESULTS
  Over the study period, 567 youth reported smoking crack cocaine and contributed 1288 observations, among which 961 (75%) included a report of crack pipe sharing. In multivariate analysis, factors that were associated with crack pipe sharing included difficulty accessing crack pipes [adjusted odds ratio (AOR) = 1.58, 95% confidence interval (CI) 1.13-2.20]; homelessness (AOR = 1.87, 95% CI 1.43-2.44); regular employment (AOR = 1.53, 95% CI 1.15-2.04); daily non-injection crystal methamphetamine use (AOR = 2.04, 95% CI 1.11-3.75); daily crack smoking (AOR = 1.37, 95% CI 1.01-1.85); encounters with the police (AOR = 1.42, 95% CI 1.01-1.99); and reporting unprotected sex (AOR = 1.95, 95% CI 1.47-2.58).
  
  
  CONCLUSIONS
  The prevalence of crack pipe sharing was high among our sample and independently associated with structural factors including difficulty accessing crack pipes and homelessness. Crack pipe sharing was also associated with high-intensity drug use and a number of other markers of risk and vulnerability. Collectively, these findings highlight opportunities for health services to better engage with this vulnerable group and reduce this risky behaviour.
authors: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors: Tessa
authors: T
authors: Cheng
authors: Evan
authors: E
authors: Wood
authors: Paul
authors: P
authors: Nguyen
authors: Julio
authors: J
authors: Montaner
authors: Thomas
authors: T
authors: Kerr
authors: Kora
authors: K
authors: DeBeck
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D016578:Crack Cocaine; D005260:Female; D040261:Harm Reduction; D006306:Health Surveys; D006526:Hepatitis C / Q000635:transmission; D006703:Ill-Housed Persons; D018453:Homeless Youth; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D055815:Young Adult
chemical_list: D016578:Crack Cocaine
keywords: crack cocaine; harm reduction; police; risk behaviour; street-involved youth