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Initiation of drug dealing among a prospective cohort of street-involved youth Hepburn, Kirk; Barker, Brittany; Nguyen, Paul; Dong, Huiru; Wood, Evan; Kerr, Thomas; DeBeck, Kora Sep 30, 2016

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Drug dealing initiation  1 Word Count: 2,419 Tables: 2 INITIATION OF DRUG DEALING AMONG A PROSPECTIVE COHORT OF STREET-INVOLVED YOUTH  Kirk Hepburn, BA, Student Research Assistant 1,2 Brittany Barker, MPP, Research Assistant 1,3 Paul Nguyen, PhD, Statistician 1 Huiru Dong, MSc, Statistician 1 Evan Wood, MD, PhD, Co-Director 1,4 Thomas Kerr, PhD, Co-Director 1,4, Kora DeBeck, PhD, Research Scientist 1,2 1. Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada 2. School of Public Policy, Simon Fraser University, Vancouver, Canada 3. Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada 4. Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada Send correspondence to:   Kora DeBeck, PhD Research Scientist, Urban Health Research Initiative B.C. Centre for Excellence in HIV/AIDS St. Paul's Hospital 608-1081 Burrard Street, Vancouver, B.C., V6Z 1Y6 Canada Tel: [604] 682-2344 ext 66784 Fax: [604] 806-9044 Email: uhri-kd@cfenet.ubc.ca  Acknowledgments: The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. We would specifically like to thank Cody Callon, Jennifer Matthews, Deborah Graham, Peter Vann, Steve Kain, Tricia Collingham, Kristie Starr, and Carmen Rock for their research and administrative assistance. With support from: US National Institutes of Health (U01DA038886); the Canadian Institutes of Health Research (MOP–102742); and the Canada Research Chairs Drug dealing initiation  2 programme through a Tier 1 Canada Research Chair in Inner City Medicine, which supports Dr. Evan Wood. Dr. Kora DeBeck is supported by a MSFHR/St. Paul’s Hospital Foundation-Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award. Brittany Barker is supported by a Canadian Institutes of Health Research Doctoral Award. Funding sources had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors report no relevant financial conflicts.   Drug dealing initiation  3 ABSTRACT   Background: Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population.   Objectives: This longitudinal study examines drug dealing initiation among street-involved youth.  Methods: Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14 - 26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing.  Results: Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% Confidence Interval [CI]: 9.9-17.2). In multivariable Cox regression analysis, male gender (Adjusted Hazard Ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing.  Conclusion: Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.   Word Count: 245 Keywords: street youth; drug dealing; homelessness; amphetamine addiction; cocaine addiction  Drug dealing initiation  4 INTRODUCTION Street-involved youth are a vulnerable population that faces immense challenges, including a lack of economic security. They often face exclusion from the mainstream job market and may have limited options for generating income (1,2). The formal employment they do secure typically lies at the margins of the employment spectrum, lasts only for short periods of time, and provides insufficient remuneration (3). Among homeless youth stigma and discrimination, problematic substance use, mental health issues, histories of incarceration, and lower education levels pose formidable barriers to involvement in licit income-generation (1). As a result, many vulnerable youth are known to turn to the drug trade to earn income (4), despite the significant health and safety risks associated with such activity. Among adults who use injection drugs, involvement in drug dealing is associated with increased vulnerability to physical and sexual violence (5). On a societal level, drug dealing is thought to contribute to increased drug consumption by making illegal substances readily available (6), and confrontations with the drug market account for the majority of violent interactions involving people who inject drugs (7–9). These risks appear to apply to youth, as well. Drug dealing among street-involved youth has been found to be associated with an elevated risk for physically violent confrontations with police and high intensity drug use (4,10,11). Street-involved youth who deal drugs are also more likely to be involved with the criminal justice system (12), Drug dealing initiation  5 and those who are incarcerated experience elevated risk for mental health problems, a loss of social support, and an overall loss of wellbeing into adulthood (13).  Previous qualitative and cross sectional studies suggest that numerous social and structural factors appear to be associated with illegal income generation among vulnerable youth. Specifically, an influential peer network, entrenchment in street-based activities, and the economic vulnerability of homelessness have been identified as factors that may push vulnerable youth towards drug dealing (1,14). However, despite the known risks and high prevalence of drug dealing among street-involved youth, few longitudinal studies have examined factors associated with initiating drug dealing among this vulnerable population. This longitudinal study aims to fill this gap by identifying factors independently associated with drug dealing initiation among a cohort of street-involved youth in Vancouver, Canada as a means to informing interventions to prevent the individual and societal harms associated with drug dealing. METHODS Data for this study were obtained from the At-Risk Youth Study (ARYS) between September 2005 and November 2014, which is an open prospective cohort study of street-involved youth in Vancouver, Canada and has been described in detail previously (15). In brief, participants at recruitment were between 14-26 years of age; used illicit drugs other than marijuana in the past 30 days, such as heroin, crack, Drug dealing initiation  6 cocaine, crystal methamphetamine; were “street involved,” defined as having been homeless in the past 6 months or recently having used a service for street-involved youth (e.g., housing or nutrition support); and provided written informed consent. At enrollment and on a biannual basis, participants completed a standardized interviewer-administered questionnaire that includes questions related to demographic information, substance use patterns, health and social service use, and involvement in income generation activities. At each study visit, participants were provided with a stipend ($30 CDN) for their time, and the Providence Health Care/University of British Columbia’s research ethics board approved the study.  Our outcome of interest was initiation of drug dealing; therefore, data from all participants who had no history of dealing drugs at enrollment and had completed at least one follow-up visit during the study period to assess for drug dealing initiation were eligible for inclusion in the present analyses. The date on which a participant initiated drug dealing was estimated as the midpoint between the last study visit with no reported drug dealing and the follow-up visit where the participant reported engaging in drug dealing. Participants who did not initiate drug dealing were censored at the date of their last follow-up visit. To identify factors associated with drug dealing initiation, we a priori selected a range of explanatory variables that were known or hypothesized to be associated with drug dealing initiation (1,8,16,17). Further, as previous research has demonstrated that Drug dealing initiation  7 people who use drugs often engage in drug dealing to support personal consumption behaviors (5,18,19), and that the specific type of drug use may have a differential impact on drug selling behaviors (20), we included individual drug use practices as covariates. These included high intensity alcohol use, defined as >= 5 drinks on average daily (yes vs. no); any injection or non-injection crystal methamphetamine use (yes vs. no); any injection or non-injection cocaine use (yes vs. no); and injection or non-injection heroin use (yes vs. no); and any crack cocaine smoking (yes vs. no). Other variables included age (per year older); gender (male vs. female); ethnicity (Caucasian vs. other); and homelessness, defined as having no fixed address, sleeping on the street, couch surfing, or staying in a shelter or hostel (yes vs. no). All drug use and behavioral variables refer to circumstances over the previous 6 months and were therefore treated as time-dependent. Only ethnicity and gender were treated as fixed variables.   As a first step, we provided a list of sociodemographic characteristics, drug use patterns and other related risk behaviors for the study sample. We then used univariate Cox models to estimate the unadjusted hazard ratio and 95% confidence intervals for factors associated with drug dealing initiation in the sample. We then constructed a multivariable model based on the Akaike Information Criterion (AIC) with the best subset selection procedure. This provided a computationally efficient method to screen possible combinations of candidate variables and identify the model with the best overall fit as indicated by the lowest AIC value (21). All statistical analyses were Drug dealing initiation  8 performed using SAS software version 9.4 (SAS, Cary, NC). All tests of significance were two sided, and a p-value of <.05 was selected for defining statistical significance. RESULTS Between September 2005 and November 2014, 1172 youth were recruited into the ARYS study. At enrollment, 272 (23%) were drug dealing naïve. 78 (27%) participants were excluded as a result of lacking a follow-up visit. The average yearly lost to follow-up rate during the study period among these participants was 2.96%.  By the time this study was conducted, a total of 194 (71%) youth completed at least one study follow-up and were therefore eligible for the current analysis. There were no significant differences with respect to gender (p = 0.205) or age (p = 0.457) between the 194 youth who were eligible for the analysis vs. the 78 drug dealing naïve youth who were excluded because they either did not have a follow-up visit at the time this analysis was conducted or were not enrolled in the cohort long enough to be due for a study follow-up visit.  Among the 194 eligible study participants, 103 (53%) were male, the median age was 21 (Interquartile Range [IQR]: 19-23), the median number of study visits was 3 (IQR= 2-5), and the median follow up time per participant was 19.7 (IQR= 10.8-34.2) months. Over the course of the study, 56 (29%) drug dealing initiation events were observed for an incidence density of 13.0 per 100 person-years (95% Confidence Interval [CI]: 9.9-17.2). Table 1 presents the sociodemographic information, drug use patterns and other risk behaviors of our study sample. Drug dealing initiation  9 In multivariable Cox regression analysis, presented in Table 2, male gender (Adjusted Hazard Ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine smoking (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing.   DISCUSSION In the current study, among street-involved youth with no history of dealing drugs, drug dealing initiation incidence was found to be significantly elevated among males and associated with specific risk factors, including crystal methamphetamine use, crack cocaine smoking, and homelessness.  The association between stimulant use and drug dealing initiation builds on previous research suggesting that specific features of stimulant drugs may perpetuate behaviors that place individuals at greater risk of street-entrenchment and related harms such as drug dealing. In our study, street-involved youth who use crystal methamphetamine were found to be more likely to initiate drug dealing; previous research has suggested that this substance’s stimulant effect and the associated need for repeated use may create a financial need to deal drugs (5,22–24). This interpretation may be especially applicable to our sample of street-involved youth, as 38% of those who use crystal methamphetamine did so on a daily basis, a level of use that may create a significant financial burden. Though drug dealers do report supporting their own Drug dealing initiation  10 drug use as a motive for dealing, this does not explain why some drugs were more likely than others to prompt a user to begin dealing. Crystal methamphetamine users may have unique social circumstances, addiction experiences, or psychological traits that prompt drug dealing. Further research into this strong association is merited. Stimulant use overall has long been associated with engagement in risky sex (including sex work), nonfatal overdose, and other markers of vulnerability, including syringe sharing, homelessness, and incarceration (25–29).  Although the risk profiles of people who use stimulants might partially account for their increased odds of engaging in drug dealing, involvement in the drug trade has been linked to delayed stimulant-use cessation among adult injection drug users (30), suggesting that income from drug dealing may also encourage and perpetuate drug use (5,31).  Regardless of the direction of the relationship between stimulant use and drug dealing, a clear implication of these findings is that an urgent need exists for easy access to evidence-based, youth-centric treatments for stimulant addiction. This includes the need for the development, implementation, and evaluation of effective psycho-social and pharmacological therapies, which have not emerged thus far (32). Improving addiction treatment access and options for youth who use stimulants can be expected to reduce engagement in drug dealing along with other risky income generating activities (33,34).  Drug dealing initiation  11 The present analysis also supports the previously-identified link between dealing drugs and homelessness (1,4,35). Previous research has found that street-involved youth who engage in drug dealing are at an elevated risk for homelessness and are less likely to transition out of homelessness (36), suggesting that homelessness and drug dealing are interconnected among this population. Although one interpretation of this connection could be that homelessness and drug dealing are both markers of a larger problem of economic insecurity, homelessness has been linked with engagement in risky sex and problematic drug use patterns, including initiation into injection drug use among youth (28,37,38). This suggests that addressing the housing needs of vulnerable youth may positively influence their drug use patterns and reduce their economic vulnerability, thereby reducing their risk of initiating drug dealing; even in cases where one becomes homeless as a result of initiating drug dealing, being housed may yet aid in transitioning to the licit economy.  A ‘Housing First’ approach is an example of an evidence-based housing intervention that provides immediate, low threshold housing often coupled with intensive delivery of community and psychological care. This strategy is associated with a number of positive outcomes, including decreased substance use and improved mental health (39,40), and may be particularly well suited to addressing the housing needs of street-involved youth. Given that youth have different requirements than adults, a Housing First approach with this population may require additional supports, including education resources, expanded opportunities for Drug dealing initiation  12 youth to make their own choices about their housing, and family reconnection support (41). In addition to addressing the factors associated with drug dealing initiation, as outlined above, interventions to address street-involved youths’ overall economic vulnerability is another potential approach that can be expected to reduce initiation into drug dealing among youth. Prior studies have documented a high degree of willingness among people who use drugs to cease engaging in drug dealing if they did not need money to pay for drugs or had other opportunities to legitimately earn income (8,42). Promoting the economic security of youth through the provision of low-threshold employment opportunities may reduce one of street-involved youths’ major incentives for entering the drug trade, and it may address housing instability and drug use itself as well (5,30,43,44). The finding that males were more likely to initiate drug dealing aligns with previous research on gender-based differences in drug dealing (10,45). There are several potential explanations for this observation. It has been argued that “the streets” are defined as primarily male spaces in the culture of street-involved youth, and that young women involved in street-based illicit economic activities (i.e., drug dealing and acquisitive crime) typically must adopt subordinate roles when they do so (2); perhaps this makes females less likely to be attracted to or financially successful in the drug trade. In addition, some females in the drug trade report substantial – and possibly Drug dealing initiation  13 disproportionate (versus males) – vulnerability, and have cited the potential for violence as a deterrent to selling drugs (46). Although the current study findings support prior investigations that drug dealing is more prevalent among males, the importance of preventing female youth from entering the drug trade should not be overlooked given that street-involved females have been found to be at greater risk of experiencing violence and vulnerability while engaging with the street economy (46,47).   There are several limitations to our study. First, as with all community-recruited cohorts, the ARYS cohort is not a random sample and therefore may not generalize to other populations of street-involved youth. Second, data were collected using self-reported information and is thus vulnerable to recall bias and socially desirable responding. It may be that respondents underreported their drug use and/or involvement with drug dealing, however, we know of no reason why underreporting between exposure groups would be different, and so the impact of non-differential misclassification would be expected to bias our estimates towards the null. However, self-reported risk behavior has been shown to be largely accurate among adult substance-using populations (48) and also among various youth populations (49). In summary, this study found that drug dealing initiation was significantly more likely among male street-involved youth and associated with crystal methamphetamine use, crack-cocaine smoking, and homelessness. Given the well-documented harms associated with drug dealing, including heightened risks of violence and involvement Drug dealing initiation  14 with the criminal justice system, interventions to prevent drug dealing initiation are urgently needed. In particular, increasing youth-centric stimulant addiction treatment and supportive housing, as well as efforts to increase the economic security of vulnerable youth, such as low threshold employment, are likely to have promise in preventing drug dealing initiation.   Drug dealing initiation  15 Declaration of Interest: The authors report no conflicts of interest. Hepburn et al. Drug dealing initiation   16 REFERENCES (1) Gwadz MV, Gostnell K, Smolenski C, Willis B, Nish D, Nolan TC, Tharaken M, Ritchie AS. The initiation of homeless youth into the street economy. J Adolesc 2009;32:357–77. (2) O’Grady B, Gaetz S. Homelessness, Gender and Subsistence: The Case of Toronto Street Youth. J Youth Stud 2004;7:397–416. (3) Gaetz S, O’Grady B. Making Money Exploring the Economy of Young Homeless Workers. Work Employ Soc 2002;16:433–56. (4) Werb D, Kerr T, Li K, Montaner J, Wood E. Risks Surrounding Drug Trade Involvement Among Street-Involved Youth. Am J Drug Alcohol Abuse 2008;34:810–20. (5) Small W, Maher L, Lawlor J, Wood E, Shannon K, Kerr T. Injection drug users’ involvement in drug dealing in the downtown eastside of Vancouver: Social organization and systemic violence. Int J Drug Policy 2013;24:479–87. (6) Bretteville-Jensen AL, Sutton M. The income-generating behaviour of injecting drug-users in Oslo. Addiction 1996;91:63–79. (7) Casavant L, Collin C. Illegal Drug Use and Crime: A complex relationship: Prepared for the Special Senate Committee on Illegal Drugs. Library of Parliament, Ottawa, Ontario: Parliamentary Research Branch; 2001. Retrieved from http://www.parl.gc.ca/Content/SEN/Committee/371/ille/library/collin-e.htm. (8) DeBeck K, Shannon K, Wood E, Li K, Montaner J, Kerr T. Income generating activities of people who inject drugs. Drug Alcohol Depend 2007;91:50–6. (9) Erickson P. Drugs, violence and public health: What Does the Harm Reduction Approach Have to Offer? Vancouver, BC: The Fraser Institute; 2001. Retrieved August 24, 2015, from http://oldfraser.lexi.net/publications/books/drug_papers/UDErickson.pdf. (10) Gaetz S. Safe Streets for Whom? Homeless Youth, Social Exclusion, and Criminal Victimization. Can J Criminol Crim Justice 2004;46:423–55. (11) Ti L, Wood E, Shannon K, Feng C, Kerr T. Police confrontations among street-involved youth in a Canadian setting. Int J Drug Policy 2013;24:46–51. (12) Omura JD, Wood E, Nguyen P, Kerr T, DeBeck K. Incarceration among street-involved youth in a Canadian study: Implications for health and policy interventions. Int J Drug Policy 2014;25:291–6. (13) Lambie I, Randell I. The impact of incarceration on juvenile offenders. Clin Psychol Rev 2013;33:448–59. (14) Fast D. Senses of place among young people entrenched in a “local” drug scene : an urban ethnography. PhD. University of British Columbia, 2013. Retrieved August 8, 2015, from https://circle.ubc.ca/handle/2429/44825. Hepburn et al. Drug dealing initiation   17 (15) Wood E, Stoltz J-A, Montaner JS, Kerr T. Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Reduct J 2006;3:18. (16) DeBeck K, Feng C, Small W, Chan K, Kerr T, Wood E. Initiation into drug dealing among street-involved youth in a Canadian setting. Drug Alcohol Depend 2014;140:e45. (17) Werb D, Bouchard M, Kerr T, Shoveller J, Qi J, Montaner J, Wood E. Drug dealing cessation among a cohort of drug users in Vancouver, Canada. Drug Alcohol Depend 2011;118:459–63. (18) Sherman SG, Latkin CA. Drug users’ involvement in the drug economy: Implications for harm reduction and HIV prevention programs. J Urban Health Bull N Y Acad Med 2002;79:266–77. (19) Alex Stevens, Daniele Berto, Viktoria Kerschl, Kerralie Oeuvray, Marianne van Ooyen, Elfriede Steffan, et al. Summary Literature Review: The international literature on drugs, crime and treatment. Canterbury, UK: European Institute of Social Services, University of Kent; 2003. (20) Cross JC, Johnson BD, Davis WR, Liberty HJ. Supporting the habit: income generation activities of frequent crack users compared with frequent users of other hard drugs. Drug Alcohol Depend 2001;64:191–201. (21) Shtatland ES, Cain E, Barton MB. The perils of stepwise logistic regression and how to escape them using information criteria and the output delivery system. 26th Annu. SAS Users Group Int. Conf. Long Beach Calif., 2001. (22) Semple SJ, Strathdee SA, Volkmann T, Zians J, Patterson TL. “High on My Own Supply”: Correlates of Drug Dealing among Heterosexually Identified Methamphetamine Users. Am J Addict 2011;20:516–24. (23) Gizzi MC, Gerkin P. Methamphetamine Use and Criminal Behavior. Int J Offender Ther Comp Criminol 2010;54:915–36. (24) Wilkins C, Sweetsur P. The association between spending on methamphetamine/amphetamine and cannabis for personal use and earnings from acquisitive crime among police detainees in New Zealand. Addiction 2011;106:789–97. (25) Chiasson MA, Stoneburner RL, Hildebrandt DS, Ewing WE, Telzak EE, Jaffe HW. Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack). AIDS 1991;5:1121–6. (26) Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, et al. Intersecting Epidemics – Crack Cocaine Use and HIV Infection among Inner-City Young Adults. N Engl J Med 1994;331:1422–7. (27) Lloyd-Smith E, Kerr T, Zhang R, Montaner JSG, Wood E. High prevalence of syringe sharing among street involved youth. Addict Res Theory 2008;16:353–8. Hepburn et al. Drug dealing initiation   18 (28) Rachlis BS, Wood E, Zhang R, Montaner JSG, Kerr T. High rates of homelessness among a cohort of street-involved youth. Health Place 2009;15:10–7. (29) Werb D, Kerr T, Lai C, Montaner J, Wood E. Non-fatal overdose among a cohort of street-involved youth. J Adolesc Health Off Publ Soc Adolesc Med 2008;42:303–6. (30) Ti L, Richardson L, DeBeck K, Nguyen P, Montaner J, Wood E, Kerr T. The impact of engagement in street-based income generation activities on stimulant drug use cessation among people who inject drugs. Drug Alcohol Depend 2014;141:58–64. (31) Long C, DeBeck K, Feng C, Montaner J, Wood E, Kerr T. Income level and drug related harm among people who use injection drugs in a Canadian setting. Int J Drug Policy 2014;25:458–64. (32) Brensilver M, Heinzerling KG, Shoptaw S. Pharmacotherapy of amphetamine-type stimulant dependence: An update. Drug Alcohol Rev 2013;32:449–60. (33) Gryczynski J, Kinlock TW, Kelly SM, O’Grady KE, Gordon MS, Schwartz RP. Opioid agonist maintenance for probationers: patient-level predictors of treatment retention, drug use, and crime. Subst Abuse 2012;33:30–9. (34) Soyka M, Träder A, Klotsche J, Haberthür A, Bühringer G, Rehm J, et al. Criminal Behavior in Opioid-Dependent Patients Before and During Maintenance Therapy: 6-year Follow-Up of a Nationally Representative Cohort Sample. J Forensic Sci 2012;57:1524–30. (35) Kerr T, Small W, Johnston C, Li K, Montaner JSG, Wood E. Characteristics of Injection Drug Users Who Participate in Drug Dealing: Implications for Drug Policy. J Psychoactive Drugs 2008;40:147–52. (36) Cheng T, Wood E, Feng C, Mathias S, Montaner J, Kerr T, DeBeck K. Transitions into and out of homelessness among street-involved youth in a Canadian setting. Health Place 2013;23:122–7. (37) Feng C, DeBeck K, Kerr T, Mathias S, Montaner J, Wood E. Homelessness Independently Predicts Injection Drug Use Initiation Among Street-Involved Youth in a Canadian Setting. J Adolesc Health 2013;52:499–501. (38) Marshall BDL, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place 2009;15:783–90. (39) Henwood BF, Matejkowski J, Stefancic A, Lukens JM. Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness. Psychiatry Res 2014;220:549–55. (40) Kirst M, Zerger S, Misir V, Hwang S, Stergiopoulos V. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug Alcohol Depend 2015;146:24–9. (41) Gaetz S. A Safe and Decent Place to Live: Towards a Housing First Framework for Youth. Canadian Homelessness Research Network; 2014. Retrieved August 10, 2015, from http://yorkspace.library.yorku.ca/xmlui/handle/10315/29388. Hepburn et al. Drug dealing initiation   19 (42) DeBeck K, Wood E, Qi J, Fu E, McArthur D, Montaner J, Kerr T. Interest in low-threshold employment among people who inject illicit drugs: Implications for street disorder. Int J Drug Policy 2011;22:376–84. (43) Richardson L, Wood E, Kerr T. The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs. Soc Sci Med 2013;76:126–33. (44) Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev 2010;29:293–300. (45) Ferguson KM, Bender K, Thompson SJ. Gender, coping strategies, homelessness stressors, and income generation among homeless young adults in three cities. Soc Sci Med 2015;135:47–55. (46) Maher L, Daly K. Women in the Street-Level Drug Economy: Continuity or Change?*. Criminology 1996;34:465–92. (47) Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women’s experiences in North America’s first supervised injection facility. Soc Sci Med 2008;67:817–23. (48) Darke S. Self-report among injecting drug users: A review. Drug Alcohol Depend 1998;51:253–63. (49) Brener ND, Billy JOG, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health 2003;33:436–57.  Table 1: Characteristics of street-involved youth in Vancouver, Canada with no history of drug dealing at baseline (n= 194). Characteristic n, (%) Age at baseline (median, IQRa) 22 (20 – 23) Age at first hard drug use (median, IQR) 16 (15 – 18) Hard drug use durationb (median, IQR) 7 (5 – 10) Female Gender 91 (46.9) Caucasian Ethnicity 127 (65.5) High School Incompletion  111 (57.2) Homelessnessc 166 (85.6) Incarcerationc 55 (28.4) Heavy alcohol usec 41 (21.1) Crystal methamphetamine usec  Any use 125 (64.4) ≥Daily use (injection and/or non-injection) 48 (24.7) Injection 55 (28.4) Cocaine usec  Any use 118 (60.8) ≥Daily use (injection and/or non-injection) 12 (6.2) Injection 27 (13.9) Heroin usec  Any use 81 (41.8) ≥Daily use (injection and/or non-injection) 30 (15.5) Injection 56 (28.9) Crack usec  Any use 121 (62.4) ≥Daily use (injection and/or non-injection) 35 (18.0) Injection 11 (5.7) Marijuana usec  Any use 177 (91.2) ≥Daily use  116 (59.8) Note: a IQR = Interquartile range; b Calculated as years since first hard drug use at last study visit; c Refers to having engaged in behavior or experienced characteristic at baseline or some point over the study period  Table 2: Multivariable Cox regression analyses of factors associated with initiating drug dealing among street-involved youth in Vancouver (n=194).    Unadjusted Hazard Ratio     Adjusted Hazard Ratio  HR  (95% CI) p-value AHR (95% CI) p-value Age (Per year older) 0.95 (0.86-1.04) 0.252   Gender (Male vs. Female) 1.89 (1.08-3.29) 0.025 1.90 (1.06-3.42) 0.031 Ethnicity (Caucasian vs. other) 0.95 (0.56-1.62) 0.857   Homelessa (Yes vs. No) 2.35 (1.33-4.16) 0.003 1.88 (1.05-3.35) 0.033 Heavy alcohol usea (Yes vs. No) 0.83 (0.26-2.65) 0.751   Crystal meth usea (Yes vs. No) 2.78 (1.63-4.76) <0.001 2.48 (1.47-4.20) <0.001 Cocaine usea (Yes vs. No) 2.06 (1.18-3.58) 0.011   Heroin usea (Yes vs. No) 2.19 (1.26-3.79) 0.006 1.55 (0.89-2.71) 0.125 Crack smokinga (Yes vs. No) 2.87 (1.67-4.93) <0.001 2.35 (1.38-4.00) 0.002 Note: a Denotes activities in the previous six months   


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