History of being in government care associated with younger age at injection initiation among a cohort of street-involved youth.
Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18.



Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care.



Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18 years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio = 1.69; 95% confidence interval: 1.15-2.48).



Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher risk and suggest that interventions are needed to prevent transitions into high-risk substance use among this population.
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
Brittany
B
Barker
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
Thomas
T
Kerr
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Huiru
H
Dong
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
Evan
E
Wood
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|School of Public Policy, Simon Fraser University, Vancouver, Canada.
Kora
K
DeBeck
D000293:Adolescent; D017668:Age of Onset; D002170:Canada / Q000453:epidemiology; D002669:Child Welfare / Q000706:statistics & numerical data*; D005260:Female; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
HIV risk behaviour; child welfare system; government care; injection initiation; street-involved youth