The Association Between Residential Eviction and Syringe Sharing

The Association Between Residential Eviction and Syringe Sharing among Street. Involved Youth in Vancouver, Canada Andreas Pilarinos Ph. D Student Interdisciplinary Studies Graduate Program University of British Columbia Research Trainee British Columbia Centre on Substance Use

Conflicts of Interest • None to declare

Background • Street-based injection drug use constitutes significant public health concern • Particularly among injection drug users (IDU) who share syringes • Significant reductions in syringe sharing among adult populations in Vancouver – Needle exchange(s) – Supervised Injection Facilities - Insite UNAIDS, 2006; Kerr et al. , 2010

Background • Syringe sharing remains a prevalent practice among street-involved youth • Identified risk factors include: homelessness, difficulty accessing needles, binge drug use, and injection cocaine use • Less is known about the association between residential eviction and syringe sharing Des Jarlais et al. , 2007; Wood et al. , 2002; Bozinoff et al. , 2017

Objective • to longitudinally examine the association between residential eviction and syringe sharing among a cohort of street-involved youth in Vancouver, Canada

Methods • At Risk Youth Study (ARYS), an ongoing prospective cohort study of street-involved youth ages 14 -26 • Recruited through self-referral and streetbased outreach from the Greater Vancouver region • At baseline and semi-annually, participants complete an interviewer-administered questionnaire

Sample Selection • Restricted to 2007 – 2014 – When question on residential eviction was asked • Youth who reported injection drug use over the study period

Analysis • Key explanatory variable of interest: residential eviction in the last six months • “Have you been evicted in the last 6 months? ” • Primary outcome: Syringe sharing in the last six months • Borrowing: “Have you used a syringe that was already used by someone else? ” • Lending: “Have you lent your used syringe to someone else? ”

Analysis • Model controlled for the following covariates: üAge, gender, ethnicity üBinge drug use üDaily illicit drug use üDifficulty accessing syringes üPublic injection üIncarceration üAccessing drug treatment • Multivariable generalized estimating equation (GEE) was used

Sample characteristics • Total of 405 youth reported injection drug use • Contributed to 1, 131 observations • Median number of follow-ups: 2 (IQR 1 -3) • Baseline characteristics: • • Median age 22. 7 years (IQR 21 – 24) 142 (35. 1%) female 114 (28. 1%) reported experiencing residential eviction 149 (36. 8%) youth reported syringe sharing

Results • Of 114 (28. 1%) who reported experiencing residential eviction – 25% reported more than one eviction event 75% 17% One Two 6% 2% Three Four Eviction events

Results GEE analysis of residential eviction and syringe sharing among street-involved youth (n=405)* Characteristic Residential eviction yes vs. no Adjusted Odds Ratio (95% CI) 1. 72 (1. 16 – 2. 57) *Model adjusted for: age, ethnicity, binge drug use, daily illicit drug use, difficulty accessing syringes, public injecting, incarceration, and accessing drug treatment

Discussion • Findings are supported by existing literature that report: – a high prevalence of syringe sharing among streetinvolved youth – youth who are unstably house or who experience homelessness are more likely to share syringes

Discussion • Eviction may displace youth to other neighborhoods, reducing access to harm reduction services • Once homeless, youth more likely to: – Come into contact with police – Experience violence – Use drugs in public settings

Discussion • Stable housing is critical to reducing risky substance use among street-involved populations • Housing supports are associated with housing stability and reduced risky substance use among adult populations • Expanding such services for street-involved youth may produce similar improvements

Limitations • Participants were not recruited at random • Relied on self-report and social desirability bias may occur • Observational study: – Temporality cannot be inferred

Conclusions • Youth in this setting reported experiencing residential eviction, which was independently associated with syringe sharing.

Implications • Policy interventions that provide street-involved youth with access to a continuum of housing options may mitigate residential eviction and high-risk substance use among this population

Acknowledgements ü All study participants who generously gave their time ü Study Co-Authors (Mary Clare Kennedy, Ryan Mc. Neil, Huiru Dong, Thomas Kerr, Kora De. Beck) ü BCCSU Staff, Graduate Students, and Administrative Support ü Community groups and others who support this work