• Cindy Feng, Kora DeBeck, Thomas Kerr, Steve Mathias, Julio Montaner, and Evan Wood.
• British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
• J Adolesc Health. 2013 Apr 1;52(4):499-501.

PurposeThis longitudinal study examines the association between homelessness and injection drug use initiation among a cohort of street-involved youth in a setting of high-prevalence crystal methamphetamine use.MethodsWe derived data from the At-Risk Youth Study, a prospective cohort of street-involved youth aged 14-26 years, recruited between September 2005 and November 2011. We used Cox proportional hazards regression to identify factors independently associated with time to injection initiation.ResultsAmong 422 street-youth who had never injected at baseline, we observed 77 injection initiation events during follow-up. Homelessness was independently associated with injection initiation in multivariate Cox regression (relative hazard, 1.80 [95% confidence interval, 1.13-2.87]) after adjusting for crystal methamphetamine use and other potential confounders.ConclusionsThese findings highlight that homelessness is a key risk factor for injection initiation among street-involved youth. Supportive housing interventions for street youth may help prevent injection drug use initiation within this high-risk population.Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

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