History of being in government care associated with younger age at injection initiation among a cohort of street-involved youth

Introduction and Aims. 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. Design and Methods. 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. Results. 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). Discussion and Conclusions. 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.