Elevated risk of incarceration among street-involved youth who initiate drug dealing

Abstract

BackgroundStreet-involved youth are known to be an economically vulnerable population that commonly resorts to risky activities such as drug dealing to generate income. While incarceration is common among people who use illicit drugs and associated with increased economic vulnerability, interventions among this population remain inadequate. Although previous research has documented the role of incarceration in further entrenching youth in both the criminal justice system and street life, less is known whether recent incarceration predicts initiating drug dealing among vulnerable youth. This study examines the relationship between incarceration and drug dealing initiation among street-involved youth.MethodsBetween September 2005 and November 2014, data were collected through the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs, in Vancouver, Canada. An extended Cox model with time-dependent variables was used to examine the relationship between recent incarceration and initiation into drug dealing, controlling for relevant confounders.ResultsAmong 1172 youth enrolled, only 194 (16.6%) were drug dealing naïve at baseline and completed at least one additional study visit to facilitate the assessment of drug dealing initiation. Among this sample, 56 (29%) subsequently initiated drug dealing. In final multivariable Cox regression analysis, recent incarceration was significantly associated with initiating drug dealing (adjusted hazard ratio = 2.31; 95% confidence interval (CI) 1.21–4.42), after adjusting for potential confounders. Measures of recent incarceration lagged to the prior study follow-up were not found to predict initiation of drug dealing (hazard ratio = 1.50; 95% CI 0.66–3.42).ConclusionsThese findings suggest that among this study sample, incarceration does not appear to significantly propel youth to initiate drug dealing. However, the initiation of drug dealing among youth coincides with an increased risk of incarceration and their consequent vulnerability to the significant harms associated therein. Given that existing services tailored to street-involved youth are inadequate, evidence-based interventions should be invested and scaled up as a public health priority.

Socioeconomic factors associated with cessation of injection drug use among street-involved youth

“…We also used an extended Cox proportional hazards regression model with time-updated variables to examine bivariate associations between each of the sociodemographic and socioeconomic factors, and time to cessation of injection drug use. The extended Cox model has been validated [ 15 ] and widely used in previous studies [ 7 , 16 , 17 ]. The inclusion of time-updated covariates in an extended Cox model negates the requirement of the proportional hazards assumption [ 15 ].…”

Situating the Continuum of Overdose Risk in the Social Determinants of Health: A New Conceptual Framework

“…Although there has been relatively less attention paid to the epidemic's social roots, several social determinants that drive drug initiation have been identified: (1) microsocial factors, including trauma, social exposure/access to prescription opioids and illicit drugs; 34 and (2) macrosocial factors such as structural racism, income inequality, and affordable housing 10,51‐54 . For example, although NMPO initiation and use is often a response to physical pain and injury, it can also be a response to life stressors like unemployment or untreated mental illness 36 .…”

“…Although there has been relatively less attention paid to the epidemic's social roots, several social determinants that drive drug initiation have been identified: (1) microsocial factors, including trauma, social exposure/access to prescription opioids and illicit drugs; 34 and (2) macrosocial factors such as structural racism, income inequality, and affordable housing. 10,[51][52][53][54] For example, although NMPO initiation and use is often a response to physical pain and injury, it can also be a response to life stressors like unemployment or untreated mental illness. 36 Placebased factors have been well-documented as critical to shaping the risk of drug initiation, with neighborhood-level measures of disadvantage such as income inequality, low educational attainment, and racial segregation associated with an earlier initiation of overall substance use and administration via injection.…”

Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada

“…The final extended Cox model was assessed for collinearity by calculating a variance inflation factor, and no such relationship was identified. This technique has been used and described previously [31][32][33][34].…”