title: The Cedar Project: Negative health outcomes associated with involvement in the child welfare system among young Indigenous people who use injection and non-injection drugs in two Canadian cities.
abstract: OBJECTIVE
  Indigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs.
  
  
  METHODS
  The Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection.
  
  
  RESULTS
  Of 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed.
  
  
  CONCLUSIONS
  This study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed.
authors.forename: Adam F
authors.initials: AF
authors.lastname: Clarkson
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Christian
authors.forename: Margo E
authors.initials: ME
authors.lastname: Pearce
authors.forename: Kate A
authors.initials: KA
authors.lastname: Jongbloed
authors.forename: Nadine R
authors.initials: NR
authors.lastname: Caron
authors.forename: Mary P
authors.initials: MP
authors.lastname: Teegee
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.forename: Martin T
authors.initials: MT
authors.lastname: Schechter
authors.affiliation: University of British Columbia. spittal@sm.hivnet.ubc.ca.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Spittal
mesh_terms: D000293:Adolescent; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D002947:Cities; D005260:Female; D015658:HIV Infections / Q000208:ethnology; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000208:ethnology*; D019966:Substance-Related Disorders / Q000208:ethnology*; D055815:Young Adult
keywords: Child welfare; HIV; Indians; North American; substance-related disorders