The Cedar Project: Residential transience and HIV vulnerability among young Aboriginal people who use drugs

Jongbloed, Kate; Thomas, Vicky; Pearce, Margo; Christian, Kukpi Wunuxtsin; Zhang, Hongbin; Oviedo‐Joekes, Eugenia; Schechter, Martin T.; Spittal, Patricia M.

doi:10.1016/j.healthplace.2015.02.008

Cited by 16 publications

(23 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some have turned to substance use as a way to cope with the effects of these historical and lifetime traumas [ 40 - 42 ]. Intersections of substance use and poverty can create barriers to connectedness, for example, by contributing to incarceration and housing transitions [ 43 ]. Lack of phone ownership must be understood within the context of colonization, which continues to impact the well-being of Indigenous people across Canada and is a key consideration for future mHealth programs [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study

Jongbloed

Pearce

Thomas

et al. 2020

JMIR Mhealth Uhealth

Self Cite

View full text Add to dashboard Cite

Background Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study

Jongbloed

Pearce

Thomas

et al. 2020

JMIR Mhealth Uhealth

Self Cite

View full text Add to dashboard Cite

show abstract

“…A largely quantitative body of research from settings across North America has highlighted various barriers to accessing care among vulnerable youth, including long wait times, age restrictions, a lack of trained providers and access to pharmacotherapies, and experiences of discrimination on the basis of gender, race and sexuality [ 15 – 19 ]. For young people experiencing street entrenchment, barriers to services are often compounded for those experiencing the concurrent disorders of substance use and mental health issues [ 20 ], and residential instability and mobility across institutional (e.g., government care homes, correctional facilities) and non-institutional (e.g., ‘flop houses’) settings over time [ 21 , 22 ]. Moreover, among vulnerable youth, negative experiences with various forms of institutionalization and care stretching back to their childhoods can lead them to the conclusion that reducing or eliminating drug use are things best accomplished independently, without professional help [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“Something that actually works”: Cannabis use among young people in the context of street entrenchment

et al. 2020

View full text Add to dashboard Cite

Background Cannabis is one of the most widely used substances among vulnerable young people (<26 years of age) experiencing street entrenchment. Although previous research has documented the role cannabis can play in harm reduction, substance use and mental health treatment and pain management, this research has predominantly been quantitative and focused on adult drug-using populations. Little qualitative work has examined how young people who use drugs understand, experience, and engage with cannabis in the context of street entrenchment and drug use trajectories that include the use of other substances such as alcohol, opioids and crystal methamphetamine (meth).

show abstract

“…In addition, loss to follow-up may be higher in the comparison group than the intervention group. Cedar Project participants are highly transient and often difficult to track down [ 41 ]. Having a mobile phone and consistent airtime will likely make it easier to reach participants receiving the intervention for follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

“…Cedar Project participants represent many of the diverse First Nations, Inuit and Métis communities across Canada and are often living far away from their home communities. Participants are highly transient, moving frequently between cities and reserves, making continuity of care a tremendous challenge [ 41 ]. Indigenous interviewers and nurses support both sites and are encouraged to provide referrals to cultural supports, health care, substance use services, food programs, housing, and counseling for participants who seek them.…”

Section: Methods and Designmentioning

confidence: 99%

The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial

Jongbloed

Friedman

Pearce

et al. 2016

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundDespite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers.MethodsThe Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat.DiscussionCulturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population.Trial registrationClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.

show abstract

The Cedar Project: Residential transience and HIV vulnerability among young Aboriginal people who use drugs

Cited by 16 publications

References 38 publications

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study

The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study

“Something that actually works”: Cannabis use among young people in the context of street entrenchment

The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial

Contact Info

Product

Resources

About