ARCHIVED - Street Youth in Canada

Findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003

March 2006

Table of Contents

Dedication
Preface
Acknowledgements
Executive Summary

1. Introduction
   1.1 Street Youth
   1.2 Street Youth and the General Youth Population: How Different Are They?
   1.3 Canadian Street Youth: A Vulnerable Population
   1.4 Rationale for Enhanced Street Youth Surveillance
   1.5 Enhanced Surveillance of Canadian Street Youth (E-SYS)

   1.5.1 Goal

   1.5.2 Objectives

   1.6 Public Health Benefits
2. Findings
   2.1 Key Findings From 1999 to 2003
   2.2 Socio-demographics Characteristics
   

   2.2.1 Age and gender

   2.2.2 Ethnicity

   2.2.3 Education

   2.3 Life on the Streets
   

   2.3.1 Living on the streets

   2.3.2 Sleeping arrangements

   2.3.3 Amount of Time Spent on the Streets

   2.4 Home Life Situations Reported by Street Youth
   

   2.4.1 Family characteristics

   2.4.2 Reasons for leaving home

   2.4.3 Contact with parents/caregivers

   2.5 Abuse
   2.6 Interaction With the Social Service System
   

   2.6.1 Social workers

   2.6.2 Foster care

   2.6.3 Group homes

   2.7 Correctional Services
   

   2.7.1 Jail

   2.7.2 Probation/parole officer

   2.8 Income
   2.9 Sexual Behaviours
   

   2.9.1 Sexual partnering

   2.9.2 Condom use

   2.9.3 Sex trade

   2.9.4 Obligatory sex

   2.10 STIs and Blood-Borne Infections
   

   2.10.1 Previous STIs

   2.10.2 Prevalence of STIs and blood-borne infections

   2.10.3 Self-perceived risk of STIs

   2.11 Substance Use
   

   2.11.1 Injecting drug use

   2.11.2 Non-injecting drug use

3. Implications for Interventions
4. Conclusions
5. References

Appendix
  Methodology

Design and Recruitment

Laboratory Testing

Statistical Analysis

Analysis Terms

Limitations

List of Tables
Table 1. Overview of socio-demographic characteristics of street youth in the
E-SYS sample population
Table 2. Reasons for leaving home (1999 and 2001)
Table 3. Prevalence rates of STIs and BBIs in street youth
Table 4. Substance use patterns among street youth
Table 5. Injection drugs most commonly used by injecting drug users in the
previous 3 months
Table 6. Drugs most commonly used by non-injecting drug users in the
previous 3 months

List of Figures
Figure 1. Street youth by gender
Figure 2. Street youth by age category
Figure 3. Average age by gender
Figure 4. Ethnic origins reported by street youth
Figure 5. Sleeping arrangements for the night as reported by street youth
(2001 and 2003)
Figure 6. Time spent on the streets in the previous month (2001 and 2003)
Figure 7. Home life situation while growing up as reported by street
youth (2001 and 2003)
Figure 8. Contact with parents in the previous three months (2001 and 2003)
Figure 9. Type of contact with parents in the previous three months (2001 and 2003)
Figure 10. Type of emotional abuse reported by street youth (2003)
Figure 11. Type of neglect reported by street youth (2003)
Figure 12. Proportion of street youth who had left home because of abuse
Figure 13. Type of abuse reported (1999)
Figure 14. Type of abuse reported (2001)
Figure 15. Type of abuse reported (2003)
Figure 16. Social workers, foster care and group homes by gender
Figure 17. Reasons for having a probation or parole officer (2003)
Figure 18. Main source of income reported by street youth
Figure 19. Main source of income reported by male street youth
Figure 20. Main source of income reported by female street youth
Figure 21. Number of sexual partners by partner relationship reported by male
street youth (2001 and 2003)
Figure 22. Number of sexual partners by partner relationship reported by female
street youth (2001 and 2003)
Figure 23. Proportion of street youth who reported not using condoms for
protection at their last sexual encounter by gender of partner
(2001 and 2003)
Figure 24. Sex trade history among street youth
Figure 25. Sex trade in the previous 3 months among street youth who reported
having traded sex in the past
Figure 26. Items most commonly received after trading sex
Figure 27. Obligatory sex among street youth (2003)
Figure 28. Items most commonly received before obligatory sex (2003)
Figure 29. Proportion of street youth reporting a history of STIs
Figure 30. Use of any form of sexual protection after diagnosis of an STI
Figure 31. Prevalence rates of STIs and blood-borne infections
Figure 32. Self-perceived risk of STIs
Figure 33. Injecting drug use among street youth
Figure 34. Use of clean needles or other drug injection equipment in the
previous 3 months
Figure 35. Non-injecting drug use among street youth

This report is dedicated to the nearly 5000 street youth who took part in E-SYS in seven cities across Canada. It is hoped that the information they took the time, energy and courage to give about themselves will find its way back to them in the form of improved and increased health and social service interventions.

The information contained in this report is drawn from data provided by street youth in three separate cycles of data collection between 1999 to 2003 in seven urban centres across Canada.

Core questions were repeated in each data collection cycle and new questions were added as a result of knowledge gained in previous cycles. This affords the opportunity for longitudinal comparisons of prevalence rates of sexually transmitted infections (STIs) and blood-borne infections, in addition to trends in risk behaviours.

This report contains only an overview of the available data. As a complement to this main report, three sub-reports addressing specific issues relating to the street youth population contain more complex and in-depth analyses. These sub-reports detail information from the surveillance data on STIs, substance use and associated sexual risk behaviours as well as hepatitis C and injecting drug use (IDU).

Both the main report and the sub-reports use data from all three cycles; they consistently identify which cycle of data is being referenced. Each cycle of data was analyzed separately; overall averages are occasionally used when the differences observed between cycles are small.

Attempts have been made to make information contained in this report easier to understand, by providing minimal statistical details in order to present the findings as clearly as possible for non-researchers.

For more information on survey design, data collection and analysis, please contact Olayemi Agboola, Principal Investigator for E-SYS, Surveillance and Epidemiology Section, Community Acquired Infections Division, PHAC.

This report was prepared by the Surveillance and Epidemiology Section, Community Acquired Infections Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada.

We would like to thank all of the street youth who participated in the surveys for giving their time. We are also grateful to all of the principal investigators and coordinators from the sites, for their commitment from the beginning of the pilot project in 1998 to phase IV in 2003. They include:

• Dr. Baldwin Toye, Jacques Neron, Caroline Millar, and Tom Quintero in Ottawa;
• Dr. Miriam Rossi, Ruth Ewert and Dr. Karen Leslie in Toronto;
• Dr. David Haase, Pat Hazell and Janet Walsh in Halifax;
• Dr. Ameeta Singh, Barbara Anderson, Jennifer Gratrix, Vicki Pilling and Dr. Gerry Predy in Edmonton;
• Dr. Cordell Neudorf, Karen Grauer, Suzanne Mahaffey and Jocelyn Andrews in Saskatoon;
• Dr. Gina Ogilvie, Darlene Taylor, Dr. Michael Rekart, Dr. David Patrick, Juanita Maginley, Elsie Wong and Elaine Jones in Vancouver; and
• Dr. Carole Beaudoin, Dr. Stephen Moses, Dr. Greg Hammond, Michelyn Wood and Margaret Ormond in Winnipeg.

Many thanks to our colleagues from the National HIV and Retrovirology Laboratories, especially Dr. John Kim and Laurie Malloch. The National Microbiology Laboratory (Dr. Lai King Ng and formerly, Dr. Rosanna Peeling), and all the participating local and provincial laboratories.

We are especially grateful to Robert Hanson, Stéphane Racine and Jillian Flight from the Office of Research and Surveillance, Drug Strategy and Controlled Substances Program, Health Canada, for their valuable input into the analysis, writing and review of the substance use sub-report.

We would like to express our appreciation for the input of numerous staff, past and present, of the Public Health Agency of Canada (PHAC) who offered their expertise for the successful completion of the main report and sub-reports, including:

• Susanne Shields, who was the former principal investigator instrumental in conceptualizing, creating and designing E-SYS in the first place. Without Ms. Shields' dedication, E-SYS would not be a reality today.
• Jennifer Phelan and Cara Bowman for their analytic and data management contribution;
• Tracey Donaldson, Katherine Dinner, Rhonda Kropp and Yogesh Choudri, for taking the time to review the sub-reports and for the practical feedback they provided;
• Hany Bishay and the information technology (IT) team for their help in developing and building the database;
• Barbara Jones, Jeff Dodds, Robert Lerch and Allison Ringrose, and the entire CAID staff for the various support they provided; and
• Dr. Donald Sutherland, Dr. Ann Jolly and Sandra Burton for their previous work on this project.

We would also like to thank all other staff and contractors who have been involved over the years and have contributed to the overall success of E-SYS.

Many thanks to Surveillance and Risk Assessment Division, PHAC and Drug Strategy and Controlled Substances Programme, Health Canada for their financial contributions.

Surveillance and Epidemiology Section
Olayemi Agboola, Epidemiologist
Maritia Gully, Surveillance Analyst
Lisa Hansen, Field Epidemiologist
Jennifer Siushansian, Interim Coordinator
Dr. Tom Wong, Director, Community Acquired Infections Division

Contact Information
Surveillance and Epidemiology Section
Community Acquired Infections Division (CAID)
Centre for Infectious Disease Prevention and Control (CIDPC)
Public Health Agency of Canada (PHAC)
Jeanne Mance Building, AL 1906B.
Ottawa, ON K1A 0K9

Tel. 613-941-8422
Fax. 613-941-9813

Enhanced Surveillance of Canadian Street Youth (E-SYS) was initiated in 1998. The surveillance system was launched in direct response to recommendations made by provincial and territorial directors of sexually transmitted infections (STIs), at their 1997 national meeting. This system is the result of strong collaboration between local, provincial and federal public health stakeholders in addition to universities. The surveillance system has provided prevalence and risk behaviour data for a population not represented in school or in population-based study designs.

Findings from the analyses show that street youth have high rates of STIs and blood-borne infections. Examination of subgroups within the street youth sample, such as injection drug users, reveals a particularly disturbing prevalence of some infectious agents, for example the hepatitis C virus. High-risk sexual behaviours such as infrequent condom use, and high numbers of sexual partners were also found within this population, as were concerning levels of substance use.

Effective prevention strategies for STIs and blood-borne infections for the street youth population cannot be developed if data on this population are limited to sexual risk behaviour elements. Knowledge of social dynamics - such as reasons for leaving home, interactions with social services, exposure to abuse and risk behaviours of sexual partners - is needed for us to understand how STI and blood-borne infection prevention fits into street youth's lives. Therefore, this report extends beyond the simple prevalence of adverse health outcomes in this population; it provides information on risk taking and on the social context of risk behaviours. Finally, the report provides longitudinal comparisons of data collected in all surveillance cycles.

Information collected from E-SYS is intended to assist with enhancing social and public health programs aimed at improving the emotional, physical and psychological well-being of Canadian street youth.