UBC Faculty Research and Publications

Methamphetamine use and malnutrition among street-involved youth Werb, Dan; Kerr, Thomas; Zhang, Ruth; Montaner, Julio S; Wood, Evan Mar 8, 2010

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata


52383-12954_2008_Article_173.pdf [ 219.24kB ]
JSON: 52383-1.0223222.json
JSON-LD: 52383-1.0223222-ld.json
RDF/XML (Pretty): 52383-1.0223222-rdf.xml
RDF/JSON: 52383-1.0223222-rdf.json
Turtle: 52383-1.0223222-turtle.txt
N-Triples: 52383-1.0223222-rdf-ntriples.txt
Original Record: 52383-1.0223222-source.json
Full Text

Full Text

BRIEF REPORT Open AccessMethamphetamine use and malnutritionamong street-involved youthDan Werb1, Thomas Kerr1, Ruth Zhang1, Julio SG Montaner1,2, Evan Wood1,2*AbstractWe sought to explore the effect of crystal methamphetamine use on the risk of experiencing malnutrition amongstreet-involved youth in Vancouver, Canada. Risk of malnutrition was defined as being hungry but not havingenough money to buy food. Socio-demographic and drug use factors associated with risk of malnutrition wereinvestigated using univariate and multivariate analysis among a prospective cohort of street-involved youth knownas the At-Risk Youth Study (ARYS). Between September 2005 and December 2006, 509 street-involved youth wereenrolled in ARYS, among whom 21% reported being at risk of malnutrition as defined above in the previous sixmonths. In multivariate analysis, only non-injection crystal methamphetamine was significantly associated withbeing at risk of malnutrition among this cohort (Adjusted Odds Ratio [AOR] = 1.60, 95% Confidence Interval [CI]:1.03 - 2.48, p = 0.036). Interventions seeking to address food insecurity among street youth may benefit from con-sidering drug use patterns since methamphetamine use predicted higher risk in this setting.FindingsOver the last decade, crystal methamphetamine use hasemerged as a unique and significant public health con-cern, and data on the prevalence of crystal methamphe-tamine use have shown that its use is increasing inNorth America, particularly among young gay men andyoung injection drug users [1,2]. Studies have alsoreported that crystal methamphetamine use is associatedwith a variety of physiological and neurological disorders[3], as well as with a number of risk behaviours for HIVtransmission, and that these risks are heightened amongstreet-involved youth [2]. This is of concern given thatthe health of street-involved youth is already often com-promised by widespread unstable housing and chronicfood insecurity [4].Little research, however, has been conducted on theassociation between patterns of drug use and foodsecurity among youth. Specifically, knowledge gaps existconcerning the potential unique impact of crystalmethamphetamine use on risks of malnutrition amongstreet-involved youth populations. We therefore soughtto explore the effect of crystal methamphetamine use onthe risk of experiencing malnutrition among a cohort ofstreet-involved youth in Vancouver, Canada.We evaluated factors associated with malnutritionamong participants enrolled in the At-Risk Youth Study(ARYS), a prospective cohort of street-involved youthaged 14 to 26 in Vancouver, Canada, which has beendescribed in detail previously [5]. In brief, at baselineand semi-annually, ARYS participants complete aninterviewer-administered questionnaire and provideblood samples for diagnostic testing. In the presentstudy, Pearson’s Chi-square test and multivariate analy-sis were used to determine factors associated with everhaving experienced malnutrition among this cohort.Our primary independent variable of interest was crys-tal methamphetamine use, though we accounted for awide array of socio-demographic, drug use and beha-vioural variables, all of which are shown in Table 1. Allvariable definitions were identical to earlier reports fromour setting [6] and all behavioural and drug use vari-ables refer to behaviours in the previous six months.We defined the dependent variable based on responsesto the following ARYS survey question: “I am often hun-gry but I don’t eat because I can’t afford enough food”.Respondents answering “Often true” or “Sometimestrue” were defined as being at risk of malnutrition;those answering “Never true” were defined as not beingat risk of malnutrition. All tests were two-tailed and thesignificance level was set at p < 0.05. All statistical* Correspondence: uhri-ew@cfenet.ubc.ca1British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital,Vancouver, CanadaWerb et al. Harm Reduction Journal 2010, 7:5http://www.harmreductionjournal.com/content/7/1/5© 2010 Werb et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.analyses were performed using SAS software version 9.0(SAS, Cary, NC).In total, 509 youth were recruited into the ARYS studybetween September 2005 and December 2006. Amongthis cohort, 149 (29%) were women, 154 (30%) werenon-Caucasian, and the median age of participants was22 years (Interquartile Range [IQR]: 20.0 - 23.9). Over-all, 105 (21%) individuals reported being at risk of mal-nutrition in the previous six months.As shown in Table 1, in univariate analyses, factorspositively associated with being at risk of malnutritionincluded age (Odds Ratio [OR] = 1.10, 95% confidenceinterval [CI]: 1.01 - 1.19, p = 0.024), non-injection crys-tal methamphetamine use (OR = 1.62, 95% CI: 1.05 -2.49, p = 0.027), crack use (OR = 1.68, 95% CI: 1.07 -2.64, p = 0.024) and injection heroin use (OR = 1.70,95% CI: 1.04 - 2.80, p = 0.035). Those variables thatwere found to be non-significant in univariate analyses(all p > 0.05) are also shown in Table 1.As shown in Table 2, in multivariate analysis, onlynon-injection crystal methamphetamine use was asso-ciated with risk of malnutrition (Adjusted Odds Ratio[AOR] = 1.60, 95% CI: 1.03 - 2.48, p = 0.036) afteradjustment for all other variables found to be signifi-cantly associated with being at risk of malnutrition inunivariate analyses.In the present study, over 20% of participants reportedbeing at risk of malnutrition in the prior six months asTable 1 Univariate analysis of factors associated with malnutrition among a cohort of street-involved youth (n = 509)Being at risk of malnutrition in thelast six monthsCharacteristic* No (n = 404) Yes (n = 105) Total OR 95% CI p valueAgeMedian (and IQR) 21.8 (19.8 - 23.7) .522.7 (20.7 - 24.3) 1.10 (1.01 - 1.19) 0.024GenderMale 284 (70.3) 76 (72.4) 360Female 120 (29.7) 29 (27.6) 149 0.90 (0.56 - 1.46) 0.676Caucasian ethnicityNo 129 (31.2) 25 (23.8) 154Yes 275 (68.1) 80 (76.2) 355 1.50 (0.91 - 2.46) 0.107Injecting in publicNo 318 (78.7) 74 (70.5) 392Yes 86 (21.3) 31 (29.5) 117 1.55 (0.96 - 2.51) 0.074Requiring help injectingNo 378 (93.6) 97 (92.4) 475Yes 26 (6.4) 8 (7.6) 34 1.20 (0.53 - 2.73) 0.665Non-injection crystal methamphetamine useNo 237 (58.7) 49 (46.7) 286Yes 167 (41.3) 56 (53.3) 223 1.62 (1.05 - 2.49) 0.027Crack useNo 180 (44.5) 34 (32.4) 214Yes 224 (55.5) 71 (67.6) 295 1.68 (1.07 - 2.64) 0.024Injection crystal methamphetamine useNo 334 (82.7) 78 (74.3) 412Yes 70 (17.3) 27 (25.7) 97 1.65 (0.99 - 2.75) 0.051Injection heroin useNo 330 (81.7) 76 (72.4) 406Yes 74 (18.3) 29 (27.6) 103 1.70 (1.04 - 2.80) 0.035Injection cocaine useNo 364 (90.1) 96 (91.4) 460Yes 40 (9.9) 9 (8.6) 49 0.85 (0.40 - 1.82) 0.681Non-injection opiate useNo 382 (94.6) 96 (91.4) 478Yes 22 (5.5) 9 (8.6) 31 1.63 (0.73 - 3.65) 0.233Note: CI = Confidence Interval; IQR = Interquartile Range*All drug use variables were defined as ever in the last six months.Werb et al. Harm Reduction Journal 2010, 7:5http://www.harmreductionjournal.com/content/7/1/5Page 2 of 4defined as often being hungry but not having enoughmoney to buy food. In multivariate analysis, and despiteintensive adjustment for a range of drug use, beha-vioural and socio-demographic factors, only non-injec-tion crystal methamphetamine use was independentlyassociated with being at risk of malnutrition.These findings may reflect a unique risk of malnutri-tion associated with crystal methamphetamine useamong street-involved youth. While past studies oncrystal methamphetamine use among street-involvedand gay male youth populations have reported an asso-ciation between use of this drug and risk behavioursassociated with the transmission of HIV and otherblood-borne diseases [2,7], we believe our study is thefirst to identify crystal methamphetamine use as apotential determinant of malnutrition. Our findingsindicate that interventions focussed primarily on the riskof HIV transmission and the neuropsychological effectsof use of this drug among youth [8] may need to be re-evaluated in order address the broader impact of crystalmethamphetamine use on a wider variety of healthdeterminants, such as malnutrition. Similarly, the impactof interventions aimed exclusively at increasing foodsecurity and improving malnutrition among street-involved youth may be limited without the incorporationof components aimed at reducing crystal methampheta-mine use.Studies have shown that supply reduction strategies inthe United States aimed at disrupting small-scale produ-cers of crystal methamphetamine within the countryhave largely failed to stem an increase in rates of crystalmethamphetamine use [9]. Consequently, evidence-based interventions focussing on demand reduction andother adverse health sequelae of crystal methampheta-mine use must be developed.Although the ARYS study is not a random sample, allcohort studies of high-risk or marginalized populationsgenerally suffer from this limitation since there arerarely registries from which to draw random samples.As well, our data was based on self-report and couldtherefore have resulted in socially desirable reporting[10], which may have consequently lowered reportedrates of illicit drug use [11]. However, we know of noreason why risks of malnutrition would be differentiallyreported by methamphetamine users and non-users.In summary, over one-fifth of our cohort reported beingat risk of malnutrition in the previous six months asdefined by not having enough money to buy food, and inmultivariate analysis only non-injection crystal metham-phetamine use was independently associated with this pro-blem. This finding suggests that the impact of currenthealth and preventive interventions aimed at addressingissues surrounding either crystal methamphetamine use ormalnutrition among street-involved youth may be limitedwithout taking into account the relationship betweenthese health behaviours. Finally, further prospective andqualitative research is needed into the potential role ofcrystal methamphetamine use in mediating food securityamong this population, and prospective study will berequired to examine the long term impact of crystalmethamphetamine on nutrition-related health outcomes.AcknowledgementsWe would particularly like to thank the ARYS participants for theirwillingness to participate in the study. We also thank John Charette, AmirAbubaker, Trevor Logan, and Steve Kain for their research assistance, andDeborah Graham, Jo-Anne Stoltz, Carley Taylor, and Peter Vann for theiradministrative assistance.The ARYS cohort is supported by the US National Institutes of Health (RO1DA11591) and the Canadian Institutes of Health Research (122258). ThomasKerr is supported by the Michael Smith Foundation for Health Research andthe Canadian Institutes for Health Research.Author details1British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital,Vancouver, Canada. 2Department of Medicine, Faculty of Medicine, Universityof British Columbia, Vancouver, Canada.Authors’ contributionsDW and EW drafted the original manuscript and initiated the design of thestudy. RZ performed the statistical analyses. TK and JM participated in thedesign of the study and participated in substantial revisions of themanuscript. All authors read and approved the final manuscript.Competing interestsDW, TK and EW have no conflicts of interest to declare. JM has receivedgrants from, served as an ad hoc adviser to, or spoken at events sponsoredby Abbott, Argos Therapeutics, Bioject Inc., Boehringer Ingelheim, BMS,Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Janssen-Ortho, MerckFrosst, Panacos, Pfizer Ltd., Schering, Serono Inc., TheraTechnologies, Tibotec(J&J), and Trimeris.Received: 26 November 2008Accepted: 8 March 2010 Published: 8 March 2010Table 2 Multivariate analysis of factors associated withbeing at risk of malnutrition among a cohort of street-involved youth (n = 509)Characteristic* Adjusted Odds Ratio (95% CI) p valueNon-injection crystalmethamphetamine useYes vs. No 1.60 (1.03 - 2.48) 0.036Age≤ 22 years vs. > 22 yearsold1.07 (0.99 - 1.17) 0.097Crack useYes vs. No 1.44 (0.90 - 2.31) 0.125Injection heroin useYes vs. No 1.41 (0.84 - 2.36) 0.193Note: CI = Confidence Interval*All drug use variables were defined as ever in the last six months.Werb et al. Harm Reduction Journal 2010, 7:5http://www.harmreductionjournal.com/content/7/1/5Page 3 of 4References1. Boddiger D: Metamphetamine use linked to rising HIV transmission.Lancet 2005, 365(9466):1217.2. Fairbairn N, Kerr T, Buxton JA, Li K, Montaner JS, Wood E: Increasing useand associated harms of crystal methamphetamine injection in aCanadian setting. Drug and Alcohol Dependence 2007, 88(2/3):313.3. Urbina AJK: Crystal methamphetamine, its analogues, and HIV infection:medical and psychiatric aspects of a new epidemic. Clinical infectiousdiseases Chicago, IL: The University of Chicago Press 2004, 38:890.4. Dachner N, Tarasuk V: Homeless “squeegee kids": Food insecurity anddaily survival. Social science & Medicine 2002, 54:1039.5. Wood E, Stolz J-A, Montaner JSG, Kerr T: Evaluating methamphetamineuse and risks of injection initiation among street youth: The ARYS study.Harm Reduction Journal 2006, 3(18):1.6. Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS, Montaner JS,O’Shaughnessy MV, Schechter MT: Unsafe injection practices in a cohortof injection drug users in Vancouver: Could safer injecting rooms help?.Cmaj 2001, 165(4):405.7. Schilder AJ, Lampinen TM, Miller ML, Hogg RS: Crystal methamphetamineand ecstasy differ in relation to unsafe sex among young gay men.Canadian Journal of Public Health 2005, 96(5):340.8. Crystal meth and other amphetamines: An integrated BC strategy.Victoria: Minister of State for Mental Health and Addiction Services 2004.9. Cunningham JK, Liu L: Impacts of federal ephedrine andpseudoephedrine regulations on methamphetamine-related hospitaladmissions. Addiction 2003, 98(9):1229.10. Fendrich M, Xu Y: The validity of drug use reports from juvenilearrestees. International Journal of Addiction 1994, 29(8):971.11. Mensch BS, Kandel DB: Underreporting of substance use in a nationallongitudinal youth cohort: Individual and interviewer effects. PublicOpinion Quarterly 1988, 52(1):100.doi:10.1186/1477-7517-7-5Cite this article as: Werb et al.: Methamphetamine use and malnutritionamong street-involved youth. Harm Reduction Journal 2010 7:5.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitWerb et al. Harm Reduction Journal 2010, 7:5http://www.harmreductionjournal.com/content/7/1/5Page 4 of 4


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items