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McAdam E, Hayashi K, Cui Z, Anderson H, Nelson S, Milloy MJ, DeBeck K. Receipt of COVID-19 emergency funds and engagement in sex work during COVID-19 among people who use drugs: evidence from Vancouver, Canada. Harm Reduct J 2024; 21:86. [PMID: 38678228 DOI: 10.1186/s12954-024-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/01/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND During the early period of the COVID-19 pandemic, public health orders disrupted income generation in numerous sectors and many governments provided emergency financial support. Access to government support and changes in engagement in sex work during the early period of the pandemic among people who use drugs (PWUD) are not well described. In the present study, we investigate the prevalence and correlates of engaging in sex work during the COVID-19 pandemic, among PWUD in Vancouver, Canada. METHODS Data derived from three harmonized cohorts of PWUD. Using multivariable logistic regression, we characterized factors associated with engaging in sex work in the last month between July 17 and November 30, 2020. Reports of changes in frequency of engagement in sex work since the pandemic were also collected. RESULTS Of the 864 individuals included in this analysis, 55 (6.4%) reported sex work engagement in the last month. Among these participants, 40.7% reported receiving COVID-19 income support in the past month vs. 52.7% of the rest of the sample, though receipt of income support in the past six months was similar between the two groups (72.2% vs. 75.7%, p = 0.624). In multivariable analysis, receipt of financial support in the last month was negatively associated with engagement in sex work in the last month (adjusted odds ratio [AOR] = 0.44 [95% confidence interval [CI]: 0.24-0.81]). Among 69 participants who responded to a question regarding changes in engagement in sex work, 38 (55.1%) reported a decrease, 11 (15.9%) reported an increase, 19 (27.5%) reported no change, and 1 (1.4%) reported cessation. CONCLUSIONS Findings document that engagement in sex work appears to have declined early in the pandemic. Participants who received income support in the past month were less likely to report recent engagement in sex work. Findings suggest that recent receipt of income support may have contributed to reductions in engagement in sex work. Additional investigation is warranted.
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Affiliation(s)
- Erica McAdam
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, V5A 1S6, Burnaby, BC, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, 608-, V6Z 1Y6, Vancouver, BC, Canada
| | - Haleigh Anderson
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
- Peer Research Associates, At-Risk Youth Study, 1265 Granville St, V6Z 1M5, Vancouver, BC, Canada
| | - Scarlett Nelson
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
- Peer Research Associates, At-Risk Youth Study, 1265 Granville St, V6Z 1M5, Vancouver, BC, Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, 608-, V6Z 1Y6, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Howe St, 400-1045, V6Z 2A9, Vancouver, BC, Canada.
- School of Public Policy, Simon Fraser University, 515 West Hastings St, V6B 5K3, Vancouver, BC, Canada.
- CIHR Applied Public Health Chair, Simon Fraser University, 515 West Hastings St, V6B 5K3, Vancouver, BC, Canada.
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Kipchumba E, Davey C, Marks S, Mugeere A, Chen S, Banks LM, Islam KE, Shakespeare T, Kuper H, Sulaiman M. Evaluation of a disability-inclusive ultra-poor graduation programme in Uganda: study protocol for a cluster-randomised controlled trial with process evaluation. Trials 2024; 25:206. [PMID: 38515150 PMCID: PMC10956226 DOI: 10.1186/s13063-024-08040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/07/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be effective in many contexts but not evaluated for people with disabilities. METHODS The DIG programme works with project participants over a period of 18 months. Participants receive unconditional cash transfers for 6 months, training, access to savings-and-loans groups, and a capital asset that forms the basis of their new livelihood. The programme is also adapted to address specific barriers that people with disabilities face. Eligible households are clustered by geographical proximity in order to deliver the intervention. Eligibility is based on household screening to identify the 'ultra-poor' based on proxy means testing-both households with and without people with disabilities are included in the programme. Clusters are randomly selected prior to implementation, resulting in 96 intervention and 89 control clusters. The primary outcome of the trial is per-capita household consumption. Before the start of the intervention, a baseline household survey is conducted (November 2020) among project participants and those not offered the programme, a similar endline survey is conducted with participants with disabilities at the end of programme implementation in July 2022, and a second endline survey for all participants in October 2023. These activities are complemented by a process evaluation to understand DIG programme implementation, mechanisms, and context using complementary qualitative and quantitative methods. Ethical approval for the research has been received from Mildmay Uganda Research Ethics Committee and London School of Hygiene and Tropical Medicine. DISCUSSION DIG is a promising intervention to evaluate for people with disabilities, adapted to be disability inclusive across programme components through extensive consultations and collaboration, and has proven efficacy at reducing poverty in other marginalised groups. However, evaluating a well-evidenced intervention among a new target group poses ethical considerations. TRIAL REGISTRATION Registry for International Development Impact Evaluations, RIDIE-STUDY-ID-626008898983a (20/04/22). ISRCTN registry, ISRCTN78592382 . Retrospectively registered on 17/08/2023.
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Affiliation(s)
- Elijah Kipchumba
- Independent Evaluation and Research Cell (IERC), BRAC International, Kampala, Uganda
- Trinity College Dublin, Dublin, Ireland
| | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Marks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony Mugeere
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Munshi Sulaiman
- BRAC Institute of Governance and Development, BRAC University, Dhaka, Bangladesh
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Han J, Wang J, Zhang W. Digital Adoption levels and income generation in rural households in China. Heliyon 2023; 9:e21045. [PMID: 37885717 PMCID: PMC10598482 DOI: 10.1016/j.heliyon.2023.e21045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
With the increasing digital transformation of rural industries, the digital economy is considered a new driving force for consolidating the achievements of eradicating poverty and comprehensively promoting rural revitalization. This study constructs a multidimensional index to measure the digital application level of rural households based on microsurvey data and empirically investigates the economic returns and mechanism of its effects. The results show that digital application significantly improves the economic situation of households. For every 1 unit increase in the level of digital application, per capita net income of households will increase by 0.427 units, and the relative poverty incidence will decrease by 0.421 units. Mechanism analysis shows that the level of digital application in rural households can significantly improve the technical abilities of household members, promote non-agricultural employment, and increase the share of agricultural and sideline business operations, thus improving the economic situation of households. Further research shows that the economic returns obtained from digitization in rural households exhibit significant regional differences. This study provides research support on how to better examine the role of the digital economy for rural households to generate wealth and increase income.
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Affiliation(s)
- Jiaqi Han
- Party School of Lianyungang Municipal Committee of C.P.C, Lianyungang, 222006, China
| | - Jiayin Wang
- School of business, Nanjing University, Nangjing, 210093, China
| | - Wenwu Zhang
- College of Economics and Management, Nanjing Forestry University, Nangjing, 210037, China
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Jaffe K, Nosova E, Maher L, Hayashi K, Milloy MJ, Richardson L. Income generation and the patterning of substance use: A gender-based analysis. Drug Alcohol Depend 2021; 226:108862. [PMID: 34198138 DOI: 10.1016/j.drugalcdep.2021.108862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous research has demonstrated how income-generating activities among marginalized people who use drugs (PWUD)-including employment, income assistance, street-based activities, sex work, and illegal activities-can provide both benefit (e.g., additional income) and harm (e.g., violence, criminalization). However, little is known about gender differences in factors such as drug use patterns that are associated with income-generating activities among PWUD. METHODS Using data from prospective cohorts of HIV-positive and HIV-negative PWUD in Vancouver, Canada, we conducted exploratory gender-stratified analyses of associations between substance use patterns and income-generating activities, using generalized linear mixed-models. RESULTS Participants reported income sources as employment (23.4 %), income assistance (88.1 %), street-based activities (24.9 %), sex work (15.2 %), drug dealing (31.5 %), or other illegal activities (13.9 %). GLMM results showed gendered patterns of engagement in specific income-generating activities and some diverging patterns of substance use. For instance, men receiving income assistance were less likely to use opioids (Adjusted odds ratio(AOR) = 0.64; 95 % confidence interval(CI) = 0.50-0.82) and women engaged in sex work were more likely to use crack-cocaine (AOR = 2.74, 95 % CI = 2.22-3.37). However, results reflected primarily converging patterns of substance use between women and men across income-generating activities, particularly for drug dealing and other illegal activities. CONCLUSIONS Our results suggest that substance use patterns may be more closely associated with income generation context than gender. Given potential harms associated with some income generation activities, results highlight the need for further investigation of the social and structural context of income generation, its intersections with gender and substance use, and the expansion of low-threshold work opportunities.
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Abstract
The COVID-19 pandemic has pushed the world into an unprecedented crisis and uncertainty, calling to expedite the implementation of the Centenary Declaration. It called upon constituents to pursue 'with unrelenting vigour its [ILO] constitutional mandate for social justice by further developing its human centred approach to the future of work'. It called for putting workers' rights and the needs, aspirations and rights of all people at the heart of economic, social and environmental policies. The international community and ILO's constituents have engaged in a collective endeavour to tackle the devastating human impact of the pandemic, but more is needed.
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Affiliation(s)
- Dagmar Walter
- ILO Decent Work Team for South Asia and Country Office for India, New Delhi, India
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Jaffe K, Dong H, Godefroy A, Boutang D, Hayashi K, Milloy MJS, Kerr T, Richardson L. Informal recycling, income generation and risk: Health and social harms among people who use drugs. Int J Drug Policy 2018; 60:40-46. [PMID: 30098498 DOI: 10.1016/j.drugpo.2018.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/28/2018] [Accepted: 07/15/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Informal recycling refers to the street-based collection of discarded materials for reuse, resale, or return to a recycling facility for money. While qualitative research has explored experiences and perceptions of informal recycling, little is known about the scope and exposures associated with informal recycling among people who use drugs (PWUD). METHODS Using data from two prospective longitudinal cohorts of PWUD, we examined the prevalence of informal recycling and its association with social, structural and health risks, including criminal justice system involvement. RESULTS Between June 2010 and May 2015, of 1664 participants, 557 (33.5%) reported engaging in informal recycling during the study period. In multivariable generalised estimating equations (GEE) analyses, informal recycling was positively associated with injection drug use (Adjusted Odds Ratio (AOR) = 1.43, 95% Confidence Interval (CI) 1.21-1.68), public injection (AOR = 1.27, 95% CI 1.09-1.49), methamphetamine use (AOR = 1.35, 95% CI 1.05-1.72), difficulty finding harm reduction equipment (AOR = 1.16, 95% CI 1.02-1.32), and police interactions (AOR = 1.35, 95% CI 1.18-1.55). Sub-analyses revealed PWUD engaged in informal recycling were more likely to be told to move on, ticketed, stopped for jaywalking, and directed to services by police. CONCLUSIONS These findings suggest informal recycling as a situated practice for PWUD, with potential indications for higher-risk drug use, experiencing greater surveillance, and difficulty accessing health and addiction treatment services. This research highlights the significance of the broader risk environment and the need for health-promoting policies for socioeconomically marginalised PWUD engaged in informal recycling.
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Affiliation(s)
- Kaitlyn Jaffe
- BC Centre on Substance Use, Vancouver, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada.
| | - Huiru Dong
- BC Centre on Substance Use, Vancouver, Canada.
| | | | | | - Kanna Hayashi
- BC Centre on Substance Use, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
| | - M-J S Milloy
- BC Centre on Substance Use, Vancouver, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Thomas Kerr
- BC Centre on Substance Use, Vancouver, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - Lindsey Richardson
- BC Centre on Substance Use, Vancouver, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada.
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Boyd J, Richardson L, Anderson S, Kerr T, Small W, McNeil R. Transitions in income generation among marginalized people who use drugs: A qualitative study on recycling and vulnerability to violence. Int J Drug Policy 2018; 59:36-43. [PMID: 29986270 DOI: 10.1016/j.drugpo.2018.06.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/23/2018] [Accepted: 06/11/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Income is an important determinant of health among people who use drugs (PWUD). However, understanding transitions between differing types of income generation within the formal and informal economy and how they can be shaped by vulnerability to risk and harm remain poorly understood. This study examines how transitions in income-generating activities are shaped by and influence exposure to violence among marginalised PWUD, in Vancouver, Canada's, Downtown Eastside (DTES) neighbourhood. METHODS Qualitative interviews were conducted with twenty-six individuals engaged in informal and illegal income-generating activities in the DTES. Interview transcripts were analyzed thematically, focusing on relationships between income generation and violence during the study period between January 2014 to April 2015 and drew upon concepts of social violence when interpreting these themes. RESULTS Participants' engagement in informal and illegal income-generating activities represented a means to negotiate survival given multiple barriers to formal employment and inadequate economic supports. Our findings highlight how informal and illegal income-generating activities in the DTES are characterized by structural, symbolic and everyday violence, while transitions from 'high risk' (e.g., sex work, drug dealing) to perceived 'low risk' (e.g., recycling) activities represent attempts to reduce exposure to violence. However, participants emphasized how informal income generation was nonetheless shaped by structural violence (e.g., gendered hierarchies and police harassment), experienced as everyday violence, and introduced exposure to alternate risks. CONCLUSION Our findings underscore the critical role of income generation in shaping exposure to violence, highlighting the need for low-threshold employment interventions targeting PWUD as a central component of harm reduction strategies.
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Luongo NM, Dong H, Kerr TH, Milloy MJS, Hayashi K, Richardson LA. Income generation and attitudes towards addiction treatment among people who use illicit drugs in a Canadian setting. Addict Behav 2017; 64:159-164. [PMID: 27614055 PMCID: PMC5143201 DOI: 10.1016/j.addbeh.2016.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/16/2016] [Accepted: 08/30/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Socioeconomically marginalized people who use illicit drugs (PWUD) often engage in alternative income generating activities to meet their basic needs. These activities commonly carry a number of health and social risks, which may prompt some PWUD to consider addiction treatment to reduce their drug use or drug-related expenses. We sought to determine whether engaging in certain forms of income generation was independently associated with self-reported need for addiction treatment among a cohort of PWUD in Vancouver, Canada. METHODS Data from two prospective cohorts of PWUD in Vancouver were used in generalized estimating equations to identify factors associated with self-reported need for addiction treatment, with a focus on income generating activities. RESULTS Between June 2013 and May 2014, 1285 respondents participated in the study of whom 483 (34.1%) were female and 396 (30.8%) indicated that they needed addiction treatment. In final multivariate analyses, key factors significantly and positively associated with self-reported need for addiction treatment included engaging in illegal income generating activities (adjusted odds ratio [AOR]=1.96, 95% confidence interval [CI}: 1.11-3.46); sex work (AOR=1.61, 95% CI: 1.05-2.47), homelessness (AOR=1.65, 95% CI: 1.22-2.25); and recent engagement in counselling (AOR=1.85, 95% CI: 1.40-2.44). DISCUSSION Our results suggest that key markers of socioeconomic marginalization are strongly linked with a stated need for addiction treatment. These findings underscore the need to provide appropriate and accessible addiction treatment access to marginalized PWUD and to consider alternative approaches to reduce socioeconomic disadvantage.
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Affiliation(s)
- Nicole M Luongo
- Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas H Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - M-J S Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Lindsey A Richardson
- Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Ferguson KM, Bender K, Thompson SJ. Gender, coping strategies, homelessness stressors, and income generation among homeless young adults in three cities. Soc Sci Med 2015; 135:47-55. [PMID: 25942470 DOI: 10.1016/j.socscimed.2015.04.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined gender differences among homeless young adults' coping strategies and homelessness stressors as they relate to legal (e.g., full-time employment, selling personal possessions, selling blood/plasma) and illegal economic activity (e.g., selling drugs, theft, prostitution). A sample of 601 homeless young adults was recruited from 3 cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews from March 2010 to July 2011. Risk and resilience correlates of legal and illegal economic activity were analyzed using six Ordinary Least Squares regression models with the full sample and with the female and male sub-samples. In the full sample, three variables (i.e., avoidant coping, problem-focused coping, and mania) were associated with legal income generation whereas eight variables (i.e., social coping, age, arrest history, transience, peer substance use, antisocial personality disorder [ASPD], substance use disorder [SUD], and major depressive episode [MDE]) were associated with illegal economic activity. In the female sub-sample, three variables (i.e., problem-focused coping, race/ethnicity, and transience) were correlated with legal income generation whereas six variables (i.e., problem-focused coping, social coping, age, arrest history, peer substance use, and ASPD) were correlated with illegal economic activity. Among males, the model depicting legal income generation was not significant yet seven variables (i.e., social coping, age, transience, peer substance use, ASPD, SUD, and MDE) were associated with illegal economic activity. Understanding gender differences in coping strategies and economic activity might help customize interventions aimed at safe and legal income generation for this population.
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Affiliation(s)
- Kristin M Ferguson
- Silberman School of Social Work at Hunter College, 2180 Third Avenue, New York, NY 10035, USA.
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Long C, DeBeck K, Feng C, Montaner J, Wood E, Kerr T. Income level and drug related harm among people who use injection drugs in a Canadian setting. Int J Drug Policy 2013; 25:458-64. [PMID: 24380808 DOI: 10.1016/j.drugpo.2013.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/12/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Higher income is generally associated with better health outcomes; however, among people who inject drugs (IDU) income generation frequently involves activities, such as sex work and drug dealing, which pose significant health risks. Therefore, we sought to examine the relationship between level of income and specific drug use patterns and related health risks. METHODS This study involved IDU participating in a prospective cohort study in Vancouver, Canada. Monthly income was categorized based on non-fixed quartiles at each follow-up with the lowest level serving as the reference category in generalized linear mixed-effects regression. RESULTS Among our sample of 1032 IDU, the median average monthly income over the study follow-up was $1050 [interquartile range=785-2000]. In multivariate analysis, the highest income category was significantly associated with sex work (adjusted odds ratio [AOR]=7.65), drug dealing (AOR=5.06), daily heroin injection (AOR=2.97), daily cocaine injection (AOR=1.65), daily crack smoking (AOR=2.48), binge drug use (AOR=1.57) and unstable housing (AOR=1.67). The high income category was negatively associated with being female (AOR=0.61) and accessing addiction treatment (AOR=0.64), (all p<0.05). In addition, higher income was strongly associated with higher monthly expenditure on drugs (>$400) (OR=97.8). CONCLUSION Among IDU in Vancouver, average monthly income levels were low and higher total monthly income was linked to high-risk income generation strategies as well as a range of drug use patterns characteristic of higher intensity addiction and HIV risk. These findings underscore the need for interventions that provide economic empowerment and address high intensity addiction, especially for female IDU.
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Affiliation(s)
- Cathy Long
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada.
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