Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use.
BACKGROUND
The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16-24 years in Metro Vancouver, British Columbia.


METHODS
Ten focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing.


RESULTS
Through ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms - including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study.


CONCLUSIONS
Participants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. kira.tozer@alumni.ubc.ca.
Kira
K
Tozer
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. despina.tzemis@bccdc.ca.
Despina
D
Tzemis
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. ashraf.amlani@bccdc.ca.
Ashraf
A
Amlani
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada. lacoser@gmail.com.
Larissa
L
Coser
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. Darlene.Taylor@bccdc.ca.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada. Darlene.Taylor@bccdc.ca.
Darlene
D
Taylor
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. NVanBorek@hollandbloorview.ca.
Natasha
N
Van Borek
University of British Columbia School of Nursing, T201-2211 Westbrook Mall, Vancouver, BC, V6T2B5, Canada. Elizabeth.Saewyc@ubc.ca.
Elizabeth
E
Saewyc
British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. Jane.Buxton@bccdc.ca.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada. Jane.Buxton@bccdc.ca.
Jane A
JA
Buxton
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001955:British Columbia; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D018453:Homeless Youth / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D055500:Resilience, Psychological; D012309:Risk-Taking; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000517:prevention & control* / Q000523:psychology; D019966:Substance-Related Disorders / Q000517:prevention & control; D055815:Young Adult
D013287:Illicit Drugs