The Youth Health Research Program is a qualitative research program co-led by Dr. Danya Fast and Dr. Rod Knight. Their research continues to focus on how contexts and patterns of substance use are influenced by the social and structural conditions in which youth live. Dr. Fast’s ethnographic research focuses on substance use, treatment, and care trajectories among highly marginalized youth. Dr. Knight’s research focuses on identifying how interventions can be implemented and adapted to improve substance use and sexual health outcomes and experiences for youth, including a stream of work involving Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex and other youth (2SLGBTQI+) and a stream with young men and masculine-identified folks.
More information about Danya’s current work can be found here.
For more information, please contact Cathy Chabot, Research Manager, at [email protected]
Current Studies
PI: Danya Fast
Overview
Intervening early to prevent and treat substance use disorders among vulnerable Canadian youth ages 14-18 (a critical period of neurodevelopment) is essential to reducing harms, including the long-term consequences of substance use disorders for development and social functioning. Evidence-informed substance use services are the cornerstone of the response to substance use among youth. Research suggests that the sooner substance use treatment is initiated, the shorter the duration and impact of substance use disorders. However, numerous distinct gaps and barriers exist in the provision of addiction services for youth, which for vulnerable, street-involved youth are often compounded by complex institutional trajectories that include pediatric care, mental health care, foster care, criminal justice and frontline service (e.g., shelter) systems.
The Care Pathways Study focuses on the experiences of younger youth (ages 14-18) as they simultaneously navigate multiple systems of care and supervision, including the substance use service, criminal justice, government care, and mental health care systems. Through interviews and ethnographic fieldwork, we are documenting the evolving experiences of these young people and their service providers over time. As with the Treatment Trajectories Study, our goal is to create new knowledge that can directly inform ongoing efforts to deliver innovative substance use services to youth across Greater Vancouver.
Objectives
The objectives of the study are to:
- Characterize the individual, social, structural and environmental contexts that shape youth’s engagement with various addiction services, including harm reduction services, residential detoxification and treatment, outpatient psychosocial programs, and opioid agonist treatment (OAT);
- Describe how youth’s engagement with addiction services are shaped by responses from the other systems in which they are immersed, including the primary pediatric care, mental health care, foster care, criminal justice and frontline service systems; and
- Identify critical gaps and opportunities for improvement in the delivery of addiction services for vulnerable youth, and their onward impact on key health outcomes (e.g., overdose, remission of substance use disorders).
Partners
This study is co-led by Family Services of Greater Vancouver-Directions Youth Services. Throughout all stages of the research, are working closely with the At-Risk Youth Study (ARYS) Peer Research Team and Youth Advisory Council.
Our other partners include:
- Vancouver Coastal Health Authority
- Urban Native Youth Association (UNYA)
- YouthCO HIV and Hepatitis C Society
Funders
- Canadian Institutes of Health Research
- SickKids Foundation
- Vancouver Foundation
Interested in finding out more about the Care Pathways Study?
Please contact Danya Fast at [email protected].
PI: Danya Fast
Overview
Little is known about what young people who use crystal methamphetamine and other amphetamine-type stimulants (herein, ‘crystal meth’) need and want with regard to their stimulant use, including strategies and interventions that can best support them. Historically, there has been little public health programming targeted at youth who use crystal meth in British Columbia (BC) and Greater Vancouver. However, the intervention landscape has recently evolved to include novel provincial pharmacological treatment guidelines for stimulant use disorder and a dedicated Stimulant Strategy Taskforce at the Vancouver Coastal Health Authority (VCH). The knowledge gaps in this area are particularly salient in the context of overlapping public health crises that disproportionately impact youth who use crystal meth in Greater Vancouver, including the overdose epidemic, the COVID-19 pandemic and the housing crisis.
Objectives
The objectives of this study are to:
- Document and inventory the state of existing and evolving interventions in Greater Vancouver that seek to address the health and social needs of youth who use crystal meth;
- Explore longitudinally the care strategies, pathways and trajectories of youth who use crystal meth within the evolving intervention landscape in this setting; and;
- Use community- and participatory-based approaches to identify how new care interventions and pathways can be optimized (e.g., adapted, integrated) to best support youth who use crystal meth.
This longitudinal study design allows us to track changes in care strategies, pathways and trajectories across time, as youth move across different facets of rapidly evolving treatment and care systems.
Funders
Canadian Institutes of Health Research – Project Grant
Vancouver Foundation – Participatory Action Research Investigate Grant
PI: Rod Knight
Identifying the impact of cannabis use on mental health outcomes among sexual and gender minority youth: A mixed methods study
About the study
This study explores how young Sexual and Gender Minority (SGM) youths’ experiences with cannabis and mental health challenges influence their lives. We are also interested in understanding how the COVID-19 pandemic has impacted youth experiences. This photovoice project gives SGM youth the opportunity to tell your story and help us improve the provision of substance use and mental health policy, programming, and prevention strategies.
Recruitment
We are currently not participants for this study.
Interested in finding out more?
If you would like to find out more about this study, please contact the Research Coordinator, Cameron Schwartz at [email protected].
Completed Studies
Addiction treatment trajectories among street-involved young people who use opioids: Responding to a public health emergency in Vancouver, funded by Canadian Institutes of Health Research – Project Grant
Substance use and addiction services engagement among vulnerable youth, funded by Vancouver Foundation – Participatory Action Research Investigate Grant
Substance use and addiction services engagement among vulnerable youth: an ethno-epidemiological study, funded by SickKids Foundation – New Investigators Research Grant
CRISM emerging health threat implementation science program on opioid interventions and services: At-risk youth/newer users project – Canadian Institutes of Health Research
Mobilizing knowledge to inform improved recovery-oriented youth substance use services, funded by the BC Ministry of Health Research Seed Grant Program – Priority Research Projects
Mobilizing knowledge with young people who use drugs, caregivers, and providers: Informing improved youth mental health and substance use services, funded by Canadian Institutes of Health Research – Catalyst Grant
Between homelessness and care (and back again): Navigating complex institutional trajectories among young people who use drugs in Greater Vancouver, funded by Making the Shift, Inc.
Telling stories together: translating research into action with YPWUD, funded by Frayme – Learning Through Living Applied Research Program
To learn more about Danya’s work, please click on these links:
- The Best Place: Addiction, Intervention, and Living and Dying Young in Vancouver. 2024. Rutgers University Press.
- Academic articles
- Youth Voices Reports
- Living On films series
- Crackdown podcasts
- “Control,” Crackdown podcast. 28 December 2020. https://crackdownpod.com/podcast/episode-21-control/
- “Cop Baked In,” Crackdown podcast. 29 September 2021. https://crackdownpod.com/2021/09/29/episode-27-cop-baked-in/
- “After the Flood,” Crackdown podcast. 12 January 2022. https://crackdownpod.com/podcast/episode-28-after-the-flood/
- “Kids on the Block Part 1 – Bones,” Crackdown podcast. 28 November 2023. https://www.crackdownpod.com/episodes/episode-42-kids-on-the-block-part-1-bones
- Kids on the Block Part 2 – Jade,” Crackdown podcast. 16 February 2024. https://www.crackdownpod.com/episodes/episode-43-kids-on-the-block-part-2-jade
- “Kids on the Block Part 3 – Danny,” Crackdown podcast. 22 March 2024. https://www.crackdownpod.com/episodes/episode-44-kids-on-the-block-part-3-danny
- “The Best Place,” Crackdown podcast. 05 December 2024. https://www.crackdownpod.com/episodes/episode-49-the-best-place
- “The Man in the High Castle,” Crackdown podcast. 30 June, 2025. https://www.crackdownpod.com/episodes/episode-55-the-man-in-the-high-castle
- Living in the Best Place on Earth photovoice project website
PI: Rod Knight
Overview
Sexually transmitted and blood-borne infections (STBBIs) rates continue to increase, especially among sub-groups of young men. New STBBI interventions are being designed and launched regularly; however, little data exists on how features of socio-cultural contexts, including shifting patterns, contexts and motivations of substance use, impact young men’s uptake of STBBI interventions. The ‘Context Study’ examines the socio-cultural contexts that affect young men’s sexual decision-making, including if and how they uptake STBBI interventions.
For example, for today’s young men, the availability of effective treatment for HIV infection is a potential ‘game changer’ and the socio-cultural contexts in which they launch their sexual lives are profoundly different from those experienced by previous generations, including shifting substance use landscapes (e.g., legalization of cannabis, online-mediated markets and information sources). Today’s young men are exposed to evolving gender stereotypes, a proliferation of online dating or ‘hook-up’ platforms, and other factors that shape their sexual lives. Providing more information to young men might help them engage in risk-reduction practices and biotechnical interventions (e.g., antiretroviral-based prevention strategies, such as Pre-Exposure Prophylaxis) may help reduce risk, but successful and sustainable interventions need to account for evolving implementation contexts. Thus, the study is timely and important because it can help intervention planners understand the sociocultural contexts and their influence on STBBI-related risks experienced by today’s young men.
Objectives
The aims of this study were to:
- Analyze the descriptions of young men regarding the connections between their socio-cultural contexts, substance use patterns, their sexual lives and STBBI-related risks.
- Examine young men’s evolving perceptions of sex, gender and gendered stereotypes and the influence those conceptions have on their experiences with STBBI and substance use interventions.
- Depict the insights of key stakeholders, including policy makers and service providers, regarding the influence of contemporary socio-cultural contexts on evolving STBBI and substance use interventions for young men.
- Inform the implementation and scaling up of the three identified STBBI interventions and the ways they adapt to young men’s contemporary socio-cultural contexts.
Partners
- Health Initiative for Men (HiM)
- BC Centre for Disease Control’s GetCheckedOnline
- YouthCO HIV and Hepatitis C Society
- BC Ministry of Health’s Provincial Strategy for STI Prevention, Testing and Treatment
Funders
Canadian Institutes for Health Research
PI: Rod Knight
Overview
The Drug-Checking sub-study is focused on the design and implementation of a drug-checking intervention in a community-based setting (Health Initiative for Men) for gay, bisexual and other men who have sex with men (gbMSM). The aim of the drug-checking intervention is to provide information on the chemical composition of substances, including the presence of harmful adulterants such as fentanyl. This is achieved through the use of a Fourier Transform Infrared (FTIR) spectrometer and supplemented with fentanyl test strips, which can detect the presence of fentanyl below 5% (the minimum concentration a FTIR spectrometer can detect).
Major research questions
- What are the factors (e.g., micro, meso, macro) that led to the development of HiM’s drug-checking intervention located within a service that is focused on the health needs of gbMSM?
- What were the challenges that arose in developing and implementing HiM’s drug-checking intervention for gbMSM, and how were those challenges overcome?
- What are the lessons learned for other community-based organizations that have had the opportunity to implement a drug-checking intervention?
Objectives
The objectives of the sub-study were to:
- Describe the implementation process of a drug-checking intervention for gbMSM;
- Identify ‘lessons-learned’ from HiM’s drug-checking intervention; and
- Inform other community-based settings on setting up drug-checking interventions using HiM’s experience as an example.
Partners
- Community-Based Research Centre
- Health Initiative for Men (HiM)
Funders
Canadian Institutes of Health Research
PI: Rod Knight
Overview
The Heads Together online survey was a Canada-wide survey that aimed to better understand the needs of LGBTQ2S+ people related to mental health and substance use within the context of the coronavirus COVID-19 pandemic. It was administered by the BC Centre on Substance Use and the University of British Columbia. The survey covered a wide range of topics concerning substance use and mental health among sexual and gender minorities, as well as experiences with health care services. Some questions were about experiences of self-isolation to better understand the impact of the coronavirus COVID-19 pandemic on sexual and gender minority health. The survey data were used to inform substance use and mental health services for sexual and gender minorities in Canada.
Objectives
The purpose of the Heads Together online survey was to examine alcohol use, cannabis use, and mental health among sexual and gender minorities living in Canada within the context of the coronavirus COVID-19 pandemic. Our aim was to use the new information gathered to improve substance use and mental health care for Canadian sexual and gender minorities.
Funders
- Canadian Institutes of Health Research
PI: Rod Knight
Overview
This three-year longitudinal qualitative study examined the experiences of people who inject drugs (PWID) with utilizing Direct-Acting Antivirals (DAA) HCV treatment. Through in-depth semi-structured interviews with PWID and key stakeholders (including care providers, policy makers, and community organization representatives) in Vancouver, this study aimed to inform the development of DAA HCV treatment policies and service delivery practices (including clinical and provincial guidelines) by identifying implementation issues, to optimize treatment outcomes and prevent reinfection over the long term.
Objectives
- Document the perspectives and experiences of PWID and key stakeholders (care providers, policy makers, and community organization representatives) regarding DAA treatment initiation and uptake patterns (e.g., treatment readiness, treatment-related decision-making, understandings of DAA treatment efficacy, social and structural barriers/facilitators);
- Describe the perspectives and experiences of PWID and stakeholders with DAA treatment regimens (e.g., adherence, completion/discontinuation);
- Identify the health, social and behavioral trajectories of PWID post-treatment (e.g., patterns of drug and/or alcohol use; experiences with HCV prevention practices, including HCV testing, use of sterile syringes and sexual practices);
- Examine the feasibility of HCV ‘Treatment as Prevention’ among PWID (e.g., implementation challenges, system needs, PWID’s needs);
- Inform DAA policy and care guidelines to optimize PWID’s treatment outcomes and prevent reinfection over the long term.
Partners
- BC Ministry of Health
- BC Centre for Disease Control
- Vancouver Coastal Health
- YouthCO HIV and Hepatitis C Society
Funders
Canadian Institutes of Health Research
PI: Rod Knight
Overview
Two-Spirit, lesbian, gay, bisexual, transgender, queer, intersex and other youth (2SLGBTQI+) youth experience disproportionately high rates of opioid use and opioid-related substance use disorders. While specialized sexual health services for 2SLGBTQI+ young adults exist, specialized substance use and harm reduction programs that are tailored for these youth are scarce and focus primarily on stimulants, not opioids. This sub-study of our CIHR-funded Implementation Science Team Grant employed a photovoice research methodology to examine the social and cultural context of opioid use among 2SLGBTQI+ youth and their experiences accessing harm reduction and substance use services.
Photovoice is a participatory action research approach in which participants are invited to take photographs that illustrate their experiences and perspectives. These images are used as reference points for participants to represent aspects of their everyday experiences to researchers, and as a source for initiating conversations that document and reflect their reality. Selected photographs and accompanying narratives were featured in online and in-person exhibitions.
Objectives
The objectives of the sub-study were to:
- Examine the social and cultural context of opioid use among 2SLGBTQI+, including the evolving landscape of harm reduction and substance use interventions.
- Identify the socio-cultural risk factors that shape drug-related harm among 2SLGBTQI+ youth who use opioids.
- Identify potential solutions to drug-related harms that are grounded in the lived experiences of 2SLGBTQI+ youth who use opioids.
- Inform the implementation and adaptation of harm reduction and substance use interventions for 2SLGBTQI+ youth who use opioids.
Funders
Canadian Institutes of Health Research
PI: Rod Knight
Overview
This sub-study of our CIHR-funded Implementation Science Team Grant is in response to the BC government’s January 2018 announcement that Pre-Exposure Prophylaxis (PrEP) is now included in the provincial Medical Services Plan (MSP) for eligible individuals. This study examined young gay and bisexual men who have sex with men’s (gbMSM) experiences with accessing PrEP in BC. Through in-depth, qualitative interviews, co-conducted with our community partners at the Community-Based Research Centre for Gay Men’s Health, we examined implementation and adaptation issues, including accessibility, ease of use and identifying actionable strategies to improve access. This included identifying how access to PrEP can be more fully integrated into family practice, as well as sexual health and mental health services, in an effective, ethical and evidence-informed manner.
Objectives
The objectives of this sub-study were to:
- Identify the experiences of gbMSM who are interested in or currently accessing PrEP;
- Examine how the introduction of the HIV Incidence Risk Index (HIRI)-MSM Screening Tool might impact clinical encounters (e.g., discussing substance use with a health care provider for the first time); and
- Identify the factors that influence young gbMSM’s decisions related to where they choose to access PrEP (e.g., through a HiM Health Centre or through their family doctor).
Partners
- The InvestiGAYtors at the Community-Based Research Centre
- Health Initiative for Men (HiM)
Funders
Canadian Institutes for Health Research
PI: Rod Knight
Overview
This sub-study of our CIHR-funded Implementation Science Team Grant examined the views and experiences of key stakeholders who work with young gay, bisexual and other men who have sex with men (gbMSM) in the fields of substance use, mental health and/or sexual health. While services are often helpful at addressing either substance use, mental health or sexual health issues, there is a growing need to identify strategies to integrate these services in ways that can address often co-occurring conditions and needs. This interview series sought to better understand how key stakeholders are already practicing across these fields, as well as what is needed in order to improve interventions to ensure that young gbMSM are better able to access the various kinds of care they need.
Objectives
The objectives of this sub-study were to:
- Identify how key stakeholders’ experiences can inform how interventions can be designed, adapted and scaled up in order to better meet the needs of young gbMSM;
- Map the ‘information worlds’ of key stakeholders to better understand existing links between services as well as key gaps; and
- Inform the implementation and adaptation of key interventions for addressing young gbMSM’s health needs across the fields of substance use, mental health and sexual health.
Partners
- YouthCO HIV and Hepatitis C Society
- Health Initiative for Men (HiM)
Funders
Canadian Institutes for Health Research
PI: Rod Knight
Overview
This study examines the co-occurring rates of HIV and other sexually transmitted and blood-borneinfections (STBBIs) and substance use among young Two-Spirit, lesbian, gay, bisexual, transgender, queer,intersex and other youth (2SLGBTQI+) youth through a lens of implementation science. Through the intensive study of interventions from within the clinical and policy domains, this study aims to inform theadaptation and scale-up of key interventions. Interventions that concurrently address substance use and sexual harms (e.g., STBBIs, HIV-related outcomes) and other known co-morbidities (e.g., psychiatric comorbidities) are of particular interest.
Objectives
This five-year team grant aimed to identify implementation factors that promote the ethical, effectiveand evidence-informed scale-up of interventions across different contexts and sub-groups of young2SLGBTQI+ in BC. The team also worked to identify and respond to intervention implementation gaps, including instances where interventions differentially affect outcomes within and across sub-groups of young 2SLGBTQI+in BC.
With the aim of reducing sexual- and drug-related HIV risk among young people, this program also worked to develop and use harmonized data systems to monitor and inform key intervention implementation decisions. Our work will provide opportunities to characterize and prospectively monitor both patterns and contexts of substance use, sexual behaviour and resultant HIV risk among 2SLGBTQI+ youth.
Furthermore, we worked to identify actionable strategies for adapting and scaling-up interventions to reduce sexual- and drug-related HIV risk among young 2SLGBTQI+ in BC. The final overarching goal of this study was to launch new training and mentoring opportunities while building multi-sectoral capacity to inform better intervention implementation.
Partners
YouthCO HIV and Hepatitis C Society
Community-Based Research Centre
Health Initiative for Men (HiM)
Interested in finding out more about the IS Team Study?
Contact details: Please contact Research Coordinator Cameron Schwartz at [email protected].