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Drug-related risks among street youth in two neighborhoods in a Canadian setting Werb, Daniel; Kerr, Thomas; Fast, Danya; Qi, Jiezhi; Montaner, Julio; Wood, Evan Sep 1, 2010

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DRUG-RELATED RISKS AMONG STREET YOUTH IN TWONEIGHBORHOODS IN A CANADIAN SETTINGDan Werb1,2, Thomas Kerr1,3, Danya Fast1, Jiezhi Qi1, Julio S. G. Montaner1,3, and EvanWood1,31 British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Avenue, Vancouver, BC,Canada, V6Z 1Y62 School of Population and Public Health, University of British Columbia, Vancouver, Canada3 Division of AIDS, Department of Medicine, Faculty of Medicine, University of British ColumbiaAbstractWe compared drug-related behaviors, including initiation of drug use, among street youth residingin two adjacent neighborhoods in Vancouver. One neighborhood, the Downtown Eastside(DTES), features a large open-air illicit drug market.In multivariate analysis, having a primary illicit income source (Adjusted Odds Ratio [AOR] =2.64, 95% Confidence Interval [CI]: 1.16 – 6.02) and recent injection heroin use (AOR = 4.25,95% CI: 1.26 – 14.29) were positively associated with DTES residence, while recent non-injectioncrystal methamphetamine use (AOR: 0.39, 95% CI: 0.16 – 0.94) was negatively associated withDTES residence. In univariate analysis, dealing drugs (Odds Ratio [OR] = 5.43, 95% CI: 1.24 –23.82) was positively associated with initiating methamphetamine use in the DTS compared to theDTES.These results demonstrate the importance of considering neighborhood variation when developinginterventions aimed at reducing drug related harms among street-involved youth at various levelsof street entrenchment.Keywordsstreet youth; crystal methamphetamine; initiation; injection drug use; drug dealingINTRODUCTIONCities throughout the world are increasingly confronted with diverse health and social harmsrelated to the use of illicit drugs (1–3). Commonly, these harms are most intense in areaswhere illicit drug markets are active (4–6), and studies have reported consistently highincidence of HIV and hepatitis C infection, incarceration, and fatal and non-fatal overdoseamong illicit drug-using individuals in urban centers that contain drug markets (7,8). As aresult, a variety of public health and law enforcement interventions have become clusteredSend correspondence to: Evan Wood, MD, PhD, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C.,V6Z 1Y6, CANADA, Tel: (604) 806-9116, Fax: (604) 806-9044, uhri-ew@cfenet.ubc.ca.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to ourcustomers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review ofthe resulting proof before it is published in its final citable form. Please note that during the production process errors may bediscovered which could affect the content, and all legal disclaimers that apply to the journal pertain.NIH Public AccessAuthor ManuscriptHealth Place. Author manuscript; available in PMC 2011 September 1.Published in final edited form as:Health Place. 2010 September ; 16(5): 1061–1067. doi:10.1016/j.healthplace.2010.06.009.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptin urban illicit drug markets in an attempt to mitigate the negative impacts of illicit drug useand drug market involvement (9,10).Recent efforts to disentangle urban health harms have focused on how environmentalphenomena help to define the risk environments experienced by vulnerable populations inspecific geographic areas (11,12). For example, researchers using spatial analysis inKwazulu-Natal found that in a mixed urban-rural study setting, residency near the NationalRoad, a major regional transit hub, was associated with a significantly higher risk of HIVinfection (13). In the context of illicit drug use, research from Vancouver recently identifiedresidency in the city’s downtown eastside (DTES), a low-income neighborhood that hostsone of North America’s largest open-air illicit drug markets, as independently associatedwith a twofold risk of HIV seroconversion among a cohort of injection drug users, despiteadjustment for a variety of confounders (14). Further, researchers have demonstrated thatgeographic proximity to an illicit drug market, as well as neighborhood-level factors, helpdetermine the severity and scope of drug- and health-related risks that illicit drug users mayface (15–17).‘Entrenchment’ in this context refers to individuals that have become highly acculturated tolife on the street, who employ street-based income generation activities (e.g., selling drugs,sex trade involvement, panhandling) as a primary source of income, and who report long-term homelessness or living in unstable housing situations (e.g., single-occupancy hotels orshelters) (18). Preventing illicit drug scene entrenchment is critical to the reduction of avariety of severe health risks, and experts have therefore urged a greater focus on researchinto the prevention of injection drug use initiation (19). Street youth are at particularly highrisk of drug scene entrenchment and related risk behaviors such as the initiation of injectiondrug use (20), and exposure to an adult illicit drug injection scene has previously beenshown to be associated with a variety of health harms among this population (4,21).Recent qualitative and ethnographic research conducted among a cohort of street youth inVancouver suggests that a number of social and structural dynamics play a key role inincreasing young people’s entrenchment in Vancouver’s local drug scene (22–24). Further,these dynamics shape risk differently in the DTES compared with an adjacent area known asthe Downtown South (DTS), which is Vancouver’s primary entertainment and retail district,and also features urban residential and financial zones (25). The DTS is characterized bymixed income housing, including an estimated 1,000 non-market housing units (25), and amore ‘closed’ drug scene than that found in the DTES, featuring younger individuals andthose characterized by less intense involvement in street life (i.e., illicit income generation,long-term homelessness, and drug dependence) (23). The DTS is also adjacent to the WestEnd, an affluent retail and residential district that youth in our setting often consider as anextension of the DTS (see Figure 1) (24). Previous research also suggests that illicit drugusers in the DTS are younger, less-entrenched, and use crystal methamphetamine at higherrates compared with drug users in other neighbourhoods in Vancouver (26). Comparatively,the DTES is well-known as an open-air adult injecting scene, characterized by a largeproportion of individuals that engage in high levels of crack use, injection heroin andcocaine use, illicit income generation, and who report high levels of unstable housing andhomelessness (23). Compared with the British Columbia provincial average, the DTES alsohas a 33% increased mortality rate, and a higher proportion of male and Aboriginalresidents. Further, life expectancy is 3 years lower than the provincial average among femaleDTES residents, and 9 years lower than the provincial average among male DTES residents(5). Drug-related deaths (i.e. overdose mortality) occur at 7 times the provincial rate in theDTES (5), and while rates of drug overdose have decreased in recent years, thisphenomenon still represents one of the major leading causes of death in British Columbia(27,28).Werb et al. Page 2Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptLocally, concern exists that the proximity of the DTS to the DTES, coupled with themobility of the city’s street youth population across these distinct neighborhoods, maycontribute to a process of normalization of more intense drug-related harms (21). Thisprocess of normalization could in turn lead to increased uptake of injection drug use andhigher levels of street entrenchment among youth residing in both areas (in spite of the factthat open injection drug use is far less prevalent in the DTS than in the DTES) (29). Thisconcern is informed by research investigating the association between neighborhood-levelinfluences and drug-related health risks (14,16,24,30,31). In particular, a large body ofliterature has demonstrated that the built environment affects the range of choices availableto vulnerable populations such as street-involved youth (32–36), particularly whenconsidered within the context of the confluence of other social, structural, and policy factorswithin a broader risk environment (2,37). Appropriate and stable housing, for example, isoften not available to street-involved youth and may result in a reliance on social networksfor stability (23). As such, the influence of these social networks may play a primary role inshaping decision-making among this population (22).The scope and density of the illicit drug market in Vancouver’s DTES, as well as thepresence of a large street youth population spread out across multiple neighborhoods,affords a unique opportunity to investigate how exposure to an adult drug market may shaperisk among street youth. We therefore sought to further quantify the health, behavioral anddrug-related risks experienced by street youth residing in the DTES and the DTSneighborhoods in Vancouver, and to investigate geographic correlates of drug use initiation(i.e., crystal methamphetamine use) and drug market involvement among a street youthsample.METHODSAll data for these analyses were conducted using data from the At-Risk Youth Study(ARYS), a Vancouver-based cohort study of street youth aged 14 to 26 (38). ARYSparticipants are recruited using street outreach and self-referral, and eligible studyparticipants reported using illicit drugs other than marijuana in the last 30 days. Oncerecruited, participants complete an interviewer-administered questionnaire and a physicaland mental health assessment that includes blood samples for diagnostic testing. Thereafter,participants return to complete the interviewer-administered questionnaire semi-annually.Participants are provided with a $20 CND honorarium. The ARYS questionnaire solicitsdetailed demographic data as well as data on drug use behaviors, income sources, housingsituation, experiences with incarceration, involvement in the sex trade and the illicit drugtrade, and perceptions of the efficacy and accessibility of health and social services. Thestudy has been approved by the University of British Columbia/Providence Health CareEthics Review Board, and all study participants provide written consent prior to enrolment.For the present study, data were collected from participant interviews conducted betweenSeptember 1, 2005 and December 31, 2007. Because we were interested in comparing drug-related behaviors and health risks among street youth in two well characterizedneighborhoods (those in the DTES with those in the DTS), we restricted our sample toARYS participants who reported currently residing in either of these two areas, andresidency in the DTES vs. the DTS constituted our dependent dichotomous variable ofinterest. Our selection of independent variables of interest was informed by previousqualitative and quantitative analyses of illicit drug use conducted among vulnerablepopulations in our study setting (23,38–40), and included the following: age, gender,ethnicity (Aboriginal vs. other), homelessness, amount of money spent on drugs per day($50 or less vs. more than $50), having a primarily licit vs. illicit source of income, dealingdrugs, recent crack smoking, recent non-injection crystal methamphetamine use, recentWerb et al. Page 3Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptinjection heroin use, recent injection cocaine use, recent injection crystal methamphetamineuse, preferred location of illicit drug purchases (DTES vs. DTS vs. all other areas), unsafesex (i.e., unprotected vaginal or anal sexual intercourse excluding commercial sex work),involvement in the commercial sex trade, having been assaulted, and being stopped,searched or detained by police. All behavioral variables refer to the 6 months prior to theparticipant interview. The variables selected for inclusion in the model represent commonlyused identifiers of drug-related health harms, unstable housing situations, and involvementin street-based drug market scenes. Our statistical model therefore allows for theinvestigation of levels of health risks and street entrenchment among participants residing ineach neighbourhood of interest.We conducted univariate logistic regression analyses to determine factors associated withcurrent neighborhood of residence (DTES vs. DTS). Categorical and explanatory variableswere analyzed using Pearson’s X2, while continuous variables found to be normallydistributed were analyzed using t-tests for independent samples, and continuous variablesfound to be skewed were analyzed using Mann-Whitney U tests. Variables found to beassociated with the outcome of interest at p ≤ 0.05 were then considered in a fixedmultivariate logistic regression model. Finally, we solicited data on circumstancessurrounding first injection drug use and first crystal methamphetamine use experiencesamong study participants residing in the DTES or the DTS. We then conducted separateunivariate logistic regression subanalyses to determine factors associated with the initiationof crystal methamphetamine among our cohort participants. In this subanalysis, participantswere asked, “the first time you used crystal meth, what neighbourhood were you in?” Allstatistical analyses were performed using SPSS software version 17.0 (SPSS, Chicago, IL).RESULTSOverall, 222 street youth participated in the present study, including 65 (29.3%) women and51 (23.0%) individuals who self-identified as Aboriginal. Median participant age was 23.6years old (Interquartile Range: 20.1 – 27.1). Overall, 155 (69.8%) participants reportedcurrently residing in the DTS, while 67 (30.2%) reported currently residing in the DTES.Further, 26 (38.8%) of those participants residing in the DTES reported injection drug use inthe last 6 months, while 37 (23.8%) of those residing in the DTS reported such use in thelast 6 months. Drug dealing among street youth occurred at comparably high levels amongparticipants in both neighborhoods (DTS: 74.8%; DTES: 85.1%; p = 0.091).Tables 1 and 2 present the results of our univariate analyses of sociodemographic,behavioral, and drug use variables associated with current neighborhood of residence. Table3 presents the results of the multivariate analysis and, as can be seen, after intensiveadjustment for potential confounders, reporting an illicit primary income source (AdjustedOdds Ratio [AOR] = 2.64, 95% Confidence Interval [CI]: 1.16 – 6.02, p = 0.021), injectionheroin use (AOR = 4.25, 95% CI: 1.26 – 14.29, p = 0.019), and preferring to buy drugs inthe DTES vs. the DTS (AOR = 6.93, 95% CI: 3.83 – 12.52, p < 0.001) were allindependently associated with residence in the DTES. Further, non-injection crystalmethamphetamine use (AOR = 0.39, 95% CI: 0.16 – 0.94, p = 0.037) was negativelyassociated with residing in the DTES.Overall, 64 (28.8%) participants reported previously initiating injection drug use. Of these,10 (24.4%) participants reported first injecting drugs in the DTES, while 20 (48.8%)reported first injecting drugs in the DTS. Further, among 72 (32.4%) participants whoreported initiating crystal methamphetamine use, 43 (59.7%) reported initiating crystalmethamphetamine use in the DTS, while 12 (16.7%) reported doing so in the DTES.Werb et al. Page 4Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptFinally, in a univariate logistic regression subanalysis, reporting initiating ofmethamphetamine use in the DTS compared with the DTES was significantly associatedwith reporting dealing drugs (OR = 5.43, 95% CI: 1.24 – 23.82, p = 0.030).DISCUSSIONAmong a cohort of street youth, levels of initiation of injection drug use were over twice ashigh in the DTS than levels reported by youth residing in the DTES. We also found thatstudy participants residing in the DTES were significantly more likely to report having anillicit primary income source, report engaging in injection heroin use, and report preferringto buy drugs in the DTES compared with participants residing in the DTS. However, studyparticipants living in the DTS were significantly more likely to engage in non-injectioncrystal methamphetamine use. Of concern, study participants reported initiating injectiondrug use in the DTS at a level twice as high compared with the DTES, and the initiation ofcrystal methamphetamine use was reported among study participants in the DTS at a levelalmost four times as high as the level of initiation reported in the DTES. Finally, inunivariate analysis, individuals reporting initiating methamphetamine use in the DTS weremore likely to report dealing drugs than those that reported initiating methamphetamine usein the DTES.While preliminary, these results are surprising since we expected that residency within theDTES, which includes a large open-air illicit drug market, would be associated withsubstantially greater drug-related health risks. That we observed non-significant risks for avariety of types of drug use as well as for involvement in drug dealing and the sex tradebetween street youth residing in the DTS and the DTES may suggest that interventions toreduce youth entrenchment in an open-air illicit drug market should take into considerationthe role of adjacent neighborhood street scenes in influencing drug use patterns (21).Specifically, while we found that participants residing in the DTES were more likely thanthose in the DTS to report having a primary illicit income source, we found no significantdifferences in risk of drug dealing, as well as comparably high levels of this illicit activity,among individuals residing in both neighborhoods. These reported high levels are consistentwith previous research in our study setting, which found that 79% of a sample of street-involved youth reported selling drugs, while 86% reported that they were involved in thedrug trade in order to generate income for their personal drug use (40). It is also of note thatin univariate analysis, drug dealing was associated with reporting initiating crystalmethamphetamine use in the DTS. While caution is warranted in the interpretation ofunivariate results, these data may suggest that the initiation of crystal methamphetamine byyouth residing in the DTS signals an immersion into a street-based illicit drug scene, andmay therefore represent a potential interventional point for the prevention of streetentrenchment among youth. Taken alongside the findings of our multivariate analysis andprevious qualitative work from our study setting, these results suggest that the DTS may bean introductory area for those youth drawn towards street-involvement and may uniquelyfacilitate transitions to the development of more intense risk behaviors as observed amongyouth in the DTES (21). This phenomenon may also be a product of the socio-historicalcontext of drug use, illicit drug culture, and policy responses in the city of Vancouver.Beginning in the 1950s, the DTES began to transform from Vancouver’s premier retail,administration, and entertainment district into an area now better known as a low-incomesetting marked by high levels of injection drug use (41). This characterization has continuedfor decades, and has resulted in a commonly held perception of the DTES as a ‘closed’space (23). While the results of our study are limited, it is possible that this perception of theDTES may discourage novice street-involved youth from initially residing in that area (23).For example, previous research in our study setting has hypothesized that non-injectioncrystal methamphetamine use may be predictive of the initiation of injection drug use amongWerb et al. Page 5Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptstreet youth (38), and as noted above we found that study participants initiated crystalmethamphetamine use at much higher levels in the DTS compared with the DTES. Whilethe DTES is the site of a variety of programs servicing that neighborhood’s large polydrug-using community, the street youth population in the DTS may contain a high number ofindividuals who are newly-recruited to street involvement and highly vulnerable to streetentrenchment and initiation of injection drug use (21). This is particularly pertinent giventhat public health experts have suggested prioritizing the prevention of injection drug useamong vulnerable populations (19).These preliminary results build on previous research on geographic factors associated withdrug market entrenchment and suggest areas of future research. Observers have noted theways in which geographic migration can modify health risks among vulnerable populationsin a variety of settings (42–44). While this research is often focused regionally, our findingssuggest that considering micro-setting and intra-city migration may also be useful inidentifying key opportunities for the reduction of risk for HIV and other blood-borne diseaseinfection, the initiation of injection drug use, and street entrenchment. For example, thesexual transmission of HIV infection in southern Africa has been linked to the migration oflaborers and the expansion of commercial sex trade work along the transit routes connectingSouth Africa to its neighboring countries (44,45). As a result, policymakers have thereforetargeted these particular transit routes for preventive campaigns to reduce sexualtransmission of HIV (46).While little data exist regarding migration patterns among street-involved youth inVancouver, a previous qualitative study reported that the majority of youth participantsmigrated from other Canadian cities in order to escape negative situations with lawenforcement, while a minority indicated that they grew up ‘on the streets’ of Vancouver’sdowntown (23). In our study setting, like many other urban communities, street involvementappears to facilitate a range of high-risk behaviors among youth. Perhaps most relevant isour finding that participants report initiating crystal methamphetamine use at much higherlevels in the DTS compared with the DTES. In this context, it is important to note that theDTS’ geographic proximity to the DTES and the mobility of street youth across these twoareas appears to create a permeability that may facilitate further street entrenchment amongyouth in our study. While age-appropriate outreach and treatment services are available foryouth in both the DTS and the DTES (47), the utility of these services to newly-recruitedstreet-involved youth may be limited, given that research suggests that such populationshave minimal uptake of treatment services (48). Further, both the DTS and the DTES sufferfrom a dearth of youth-targeted structural interventions such as assisted housing and harmreduction shelters (22). For example, qualitative research from our study setting hasdemonstrated that street-involved youth residing in downtown Vancouver reported thatinflexible shelter rules and the stigma and lack of safety associated with single-roomoccupancy hotels outweighed the benefits of sleeping indoors. In turn, this lack ofappropriate housing greatly increases the risk of further entrenchment within a street-basedillicit drug scene (22). Given that public health experts have suggested prioritizing theprevention of injection drug use among vulnerable populations (19), the implementation ofinterventions to address the built environment, particularly among newly-recruited street-involved youth in the DTS, is needed.Our study has a number of important limitations. First, we are unable to infer causalassociations between reported neighborhood of residence and the risk behaviors that weanalyzed as a result of the cross sectional nature of our analyses. Specifically, we wereunable to elucidate the mechanisms by which neighborhood of residence modifies risk,though it is noteworthy that previous qualitative investigations of such mechanisms areconsistent with our current findings (23,24). Further, we are unable to determine the causalWerb et al. Page 6Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptdirection between reported residence in each neighbourhood of interest and the drug usepatterns reported by study participants. It is noteworthy, however, that previous researchconducted in our study setting suggests that drug use behaviours may be the result ofimmersion within social networks and illicit drug scenes unique to each neighbourhood ofinterest (23). Second, ARYS is not a random sample and its generalizability to other samplesof street youth may therefore be limited. Third, because we relied primarily on self-report,risk behaviors among study participants may have been underreported as a result of socialstigma (49). Fourth, while we based our analyses on previous research conducted amongstreet-involved youth in our study setting and were therefore able to confirm that our currentfindings were consistent with previous analyses, it is possible that we were still unable toadjust for all variables that may have contributed to the differences that we observedbetween participants residing in the neighborhoods of interest. In this regard, it is importantto note that the low power in our sample excluded the possibility of controlling for factors inour subanalysis of crystal methamphetamine initiation, and these results in particular shouldtherefore be interpreted with caution. Finally, while youth participating in the study reportedon neighbourhood of residence, it is possible given the transient nature of this populationthat some youth may have migrated between areas. This may have resulted in anunderestimate of the risk factors reported by each neighbourhood subsample.Our findings suggest that while the DTES remains the epicenter of drug market activityamong our sample, the adjacent DTS neighborhood may play a key role in the transitionamong street youth from lower-risk street involvement to high-risk street entrenchment, andmay also be an important site of initiation into crystal methamphetamine. As well, on anumber of indicators of drug-related behaviors, no differences existed between street youthresiding in the DTES and those residing in the more affluent DTS. These results suggest thatfuture research is needed to investigate whether neighborhoods peripheral to illicit drugmarkets are sites of increased risk for drug use initiation and entrenchment within adult druginjecting scenes.References1. Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR. Heroin overdose amongyoung injection drug users in San Francisco. 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Risk, shame and the public injector: A qualitative study of druginjecting in South Wales. Soc Sci Med 2007;65(3):572–85. [PubMed: 17475383]38. Wood E, Stolz J-A, Montaner JiSG, Kerr T. Evaluating methamphetamine use and risks ofinjection initiation among street youth: The ARYS study. Harm Reduction Journal 2006;3(18):1.[PubMed: 16403229]39. Fairbairn N, Kerr T, Buxton JA, Li K, Montaner JS, Wood E. Increasing use and associated harmsof crystal methamphetamine injection in a Canadian setting. Drug Alc Depend 2007;88(2/3):313.40. Werb D, Kerr T, Li K, Montaner J, Wood E. Risks surrounding drug trade involvement amongstreet-involved youth. Am J Drug Alc Abuse 2008;34(6):810–20.41. Campbell, L.; Boyd, N.; Culbert, L. A thousand dreams: Vancouver’s downtown eastside and thefight for its future. Vancouver: Greystone/D&M Publishers; 2009.42. Rachlis BS, Wood E, Li K, Hogg RS, Kerr T. Drug and HIV-related risk behaviors aftergeographic migration among a cohort of injection drug users. AIDS and Behavior 2009:1–8.43. Deren S, Kang SY, Colon HM, et al. Migration and HIV risk behaviors: Puerto Rican druginjectors in New York City and Puerto Rico. Am J Pub Health 2003;93:812–6. [PubMed:12721149]44. Lurie MN, Williams BG, Zuma K, et al. The impact of migration on HIV-1 transmission in SouthAfrica: A study of migrant and nonmigrant men and their partners. Sexually Transmitted Diseases2003;30(2):149. [PubMed: 12567174]45. Ramjee G, Gouws E. Prevalence of HIV among truck drivers visiting sex workers in KwaZulu-Natal, South Africa. Sexually Transmitted Diseases 2002;29(1):44. [PubMed: 11773878]46. Riedner G, Hoffmann O, Rusizoka M, et al. Decline in sexually transmitted infection prevalenceand HIV incidence in female barworkers attending prevention and care services in Mbeya Region,Tanzania. AIDS 2006;20(4):609. [PubMed: 16470126]47. The McCreary Centre Society. Between the cracks: Homeless youth in Vancouver. Vancouver:The McCreary Centre Society; 2002.48. The McCreary Centre Society. Against the odds: A profile of marginalized and street-involvedyouth in BC. Vancouver: The McCreary Centre Society; 2007.49. Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audiocomputer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drugusers. AIDS Educ Prev 2002;14(5):367. [PubMed: 12413183]Werb et al. Page 9Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptFig. 1.Map of neighbourhoods.Werb et al. Page 10Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptWerb et al. Page 11Table IUnivariate analysis of sociodemographic and behavioural factors associated with neighbourhood of residenceamong street youth in Vancouver (n = 222)CharacteristicDowntown South Downtown EastsideOdds Ratio (95% CI) p-valuen = 155 n = 67Age Median (and IQR) 23.2 (19.6–26.8) 24.1 (21.3–27.0) 1.25 (1.10 – 1.42) 0.001Gender Male 114 (73.5) 43 (64.2) Female 41 (26.5) 24 (35.8) 1.55 (0.84 – 2.87) 0.161Ethnicity Other 128 (82.6) 43 (64.2) Aboriginal 27 (17.4) 24 (35.8) 2.65 (1.38 – 5.07) 0.003Homelessness No 21 (13.5) 16 (23.9) Yes 134 (86.5) 51 (76.1) 0.50 (0.24 – 1.03) 0.061Income source Primarily licit 82 (52.9) 22 (32.8) Primarily illicit 73 (47.1) 45 (67.2) 2.30 (1.26 – 4.19) 0.007Unsafe sex No 33 (21.3) 16 (23.9) Yes 122 (78.7) 51 (76.1) 0.86 (0.44 – 1.70) 0.669Involvement in the sex trade No 139 (89.7) 62 (92.5) Yes 16 (10.3) 5 (7.5) 0.70 (0.25 – 2.00) 0.506Having been assaulted No 83 (53.5) 40 (59.7) Yes 72 (46.5) 27 (40.3) 0.79 (0.44 – 1.39) 0.398Jacked up by Police* No 107 (69.0) 39 (58.2) Yes 48 (31.0) 28 (41.8) 1.60 (0.89 – 2.90) 0.120Note: CI = Confidence Interval; IQR = interquartile range.Note: All behaviours refer to the previous six months.*‘Jacked up by police’ is defined as being stopped, searched or detained by police.Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptWerb et al. Page 12Table IIUnivariate analysis of drug use behaviors associated with neighborhood of residence among street youth inVancouver (n = 222)CharacteristicDowntown South Downtown EastsideOdds Ratio (95% CI) p-valuen = 155 n = 67Amount spent on drugs ≤ $50 per day 76 (49.0) 23 (34.3) > $50 per day 79 (51.0) 44 (65.7) 1.84 (1.02 – 3.34) 0.044Dealing Drugs No 39 (25.2) 10 (14.9) Yes 116 (74.8) 57 (85.1) 1.92 (0.89 – 4.11) 0.095Crack Use No 66 (42.6) 19 (28.4) Yes 89 (57.4) 48 (71.6) 1.87 (1.01 – 3.48) 0.047Non-injection CM use No 81 (52.3) 52 (77.6) Yes 74 (47.7) 15 (22.4) 0.32 (0.16 – 0.61) 0.001Injection heroin use No 135 (87.1) 47 (70.1) Yes 20 (12.9) 20 (29.9) 2.87 (1.42 – 5.80) 0.003Injection cocaine use No 143 (92.3) 55 (82.1) Yes 12 (7.7) 12 (17.9) 2.60 (1.10 – 6.14) 0.029Injection CM use No 129 (83.2) 58 (86.6) Yes 26 (16.8) 9 13.4) 0.77 (0.34 – 1.75) 0.531Location of drug purchase DTS 23 (14.8) 48 (48) DTES 80 (51.6) 3 (4.5) 7.20 (4.24 – 12.25) < 0.001 Other 52 (33.5) 16 (23.9)Note: CI = Confidence Interval; CM = crystal methamphetamine.Note: All behaviors refer to the previous six months.Health Place. Author manuscript; available in PMC 2011 September 1.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptWerb et al. Page 13Table IIIMultivariate logistic regression analysis of factors associated with residence in the DTES vs. the DTSneighborhood among a cohort of street youth in Vancouver (n = 222)Characteristic Adjusted Odds Ratio 95% CI p-valueAge Per year older 1.17 (0.98 – 1.40) 0.080Ethnicity Other 1.00 ---- ---- Aboriginal 2.06 (0.80 – 5.29) 0.132Amount spent on drugs ≤ $50 per day 1.00 ---- ---- > $50 per day 0.77 (0.33 – 1.79) 0.546Income source Primarily licit 1.00 ---- ---- Primarily illicit 2.64 (1.16 – 6.02) 0.021Crack smoking No 1.00 ---- ---- Yes 1.05 (0.43 – 2.57) 0.923Non-injection CM use No 1.00 ---- ---- Yes 0.39 (0.16 – 0.94) 0.037Injection heroin use No 1.00 ---- ---- Yes 4.25 (1.26 – 14.29) 0.019Injection cocaine use No 1.00 ---- ---- Yes 0.95 (0.23 – 4.03) 0.948Preferred location of drug purchase DTS 1.00 ---- ---- DTES 6.93 (3.83 – 12.52) < 0.001Note: DTES = downtown eastside; DTS = downtown south; CI = Confidence IntervalNote: All behaviors refer to the previous 6 monthsHealth Place. Author manuscript; available in PMC 2011 September 1.

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