Article: Rod Knight, Danya Fast, Kora DeBeck, Jean Shoveller and Will Small. (2017). “Getting out of downtown”: a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene. BMC Public Health, 17: 376. doi: 10.1186/s12889-017-4313-9.


Toronto reading group – June meeting: Carol Strike; Katherine Rudzinski; Andrea Bowra; Julia Edgar; Gillian Kolla; Melissa Perri; Rose Schmidt; Jessica Xavier (Dalla Lana School of Public Health, University of Toronto)

Meeting summary:

In June 2020, members of Qualitative Methods Journal Club reviewed Knight et al.’s paper, Getting out of downtown”: a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene. The authors of this paper examine the individual, social, and structural factors that shape the experiences of street-entrenched youth in Vancouver, Canada who envision and/or attempt to leave the inner-city drug scene. The study draws on 150 semi-structured interviews with 75 youth gathered in several waves between 2008 and 2016, and include data generated through ethnographic fieldwork with a smaller subgroup of 25 youth. Knight et al. found that most youth communicated a clear desire to exit the urban drug scene on their own, without relying on services/other assistance. The authors describe three inter-related factors that youth expressed needing to achieve in order to leave Vancouver’s drug scene successfully: 1) to engage in educational/occupational training and/or secure legitimate employment; 2) to obtain distance, both physical (e.g., move out of the neighbourhood) and social (e.g., leave behind friends who use drugs) from the drug scene; 3) to decrease their drug use.

Knight et al. examine the significant barriers that many youth face in attempting to leave the urban drug scene. These include dealing with complex health issues as well as social and structural barriers, such as experiencing repeated jail time or interactions with the criminal justice system, and/or having to access services in the downtown core – a place that was key for them to avoid. The authors also highlighted some of the factors that assisted youth in exiting the scene, including supportive friends/family and access to addiction treatment services. The authors believe that there is a critical need for new policy and programming interventions not only help reduce youths’ drug scene involvement and related health risks, but that can also assist youth in their efforts to leave the scene on their own terms. The authors note that these interventions should include opportunities for meaningful educational and/or occupational training, ‘low threshold’ addiction treatment services, and access to supportive housing outside of the urban drug scene.

The journal club appreciated that this paper investigated youth experiences with planning to leave and/or exiting from a street drug scene since in the literature the focus is so often on initiation into drug use and how people become entrenched in drug environment(s). We thought that the viewpoint provided in this paper was interesting and tackled a very important issue for street-entrenched youth.

We were impressed with the manner in which the authors presented a comprehensive yet concise review of the literature and introduced the health and other risks faced by youth in an urban drug scene. We really valued the broad definition of “urban drug scenes” provided by the authors as: “inner city areas featuring large drug-using populations and high levels of street-based drug dealing (and often homelessness or unstable housing)” (p.1). This concise definition is useful to introduce the concept to an audience not familiar with drug use environments and something which we foresee citing in our own work in the future. We felt that descriptions of key neighbourhoods in Vancouver where youth frequent and explanations of the different patterns of drug use/sales occurring in each neighbourhood added depth to the manuscript. While most research from Vancouver focusses on the Downtown Eastside, this manuscript broadened its focus to also encompass the Downtown South.

In comparison with many other qualitative studies of any subject, this manuscript included a very large sample size (150 interviews with 75 youth and ethnographic fieldwork) and involved longitudinal data collection. We were interested in how this amount of data would be managed, analyzed and presented and what the unique aspect of longitudinal data could tell us about youths’ attempts of leaving the drug scene over time. Given the amount of data that the authors were dealing with, the results section was concise, easy to follow, and especially well synthesized.

We discussed how given that this paper was published in journal that does not focus on qualitative research, perhaps the authors took extra care in clearly and explicitly laying out the data analysis process in  a way that would appeal to a broader audience, including those readers not familiar with qualitative methods. The data analysis approach was very thorough; this section was much longer and more detailed than what we are used to seeing in other qualitative papers. The authors set out their analytical questions up front, allowing readers to understand the direction and focus of the analysis. Moreover, the authors provided an in-depth explanation of how the coding and the analyses were conducted. Journal club members particularly appreciated that the authors acknowledged and took the time to discuss how they used both a deductive and an inductive approach to analysis, since this combination more accurately reflects the reality of much qualitative data analysis.

The analysis of the large dataset was condensed into a gripping and profoundly sad/difficult story. Knight et al. took a highly contextual approach to presenting their results, “by providing both a data point (i.e., quote from an in-depth interview) along with a descriptive narrative to illustrate to the reader how these changes have transpired over time” (p. 4), which allowed them to show across- and within-person variations in their longitudinal data. We really liked how the quotes were set up in the results section in this thoughtful and consistent manner. The paper really captures the challenges that the participants faced in getting out of this environment over time. Participants were deeply entrenched in the drug scene and leaving was incredibly difficult because it was contingent on simultaneous changes across several interrelated factors in their lives. The authors did a particularly good job of showcasing the “synergistic set of barriers” to exiting the drug scene facing youth, where the negative impacts were often compounded.  There was an interesting discussion about how social, cultural, and symbolic capital that works for participants in the context of the drug scene is very difficult to transfer into other scenarios (e.g., the legitimate job market). Given that qualitative data analyses can be approached from varied perspectives, the journal club, some of whom have expertise in Bourdieusian analysis, mused about how we might re-analyze data from that perspective focussing on, for example, lack of legitimate cultural capital, challenges in changing deeply ingrained aspects of the street-entrenched youth habitus.

Knight et al. proposed key policy and program changes that could assist youth in their efforts to leave the drug scene and stressed youth affinity for exiting independently. The prospects of this really excited the journal club. We valued that the authors showed just how hard youth were trying to make changes in spite of their extremely challenging circumstances. There is a presumption that youth are dependent on services and research does not often talk about them wanting to do things independently. A re-analysis of the data using a strengths-based approach might add new insights for future service and policy design. For instance, we discussed how the types of income generation youth engage in in the drug scene (e.g., drug selling, boosting) give them a huge amount of autonomy – whereas often the employment opportunities open to them legally are structured, highly regulated, and monotonous. This really brought home the point for the journal club that services for youth do not just have to be accessible but we have to make them desirable. We wondered how to make programs easier to navigate for youth, but also give them opportunities to exercise their autonomy? The work of Knight at al. encouraged us to consider how to provide services for youth that recognize their strong desire for autonomy while also providing them with the skills/tools that they need to maximize their growth/development towards independence.

Additional reading:

  • Bozinoff, Nikki, Will Small, Cathy Long, Kora DeBeck, and Danya Fast. “Still ‘At Risk’: An Examination of How Street-Involved Young People Understand, Experience, and Engage with ‘Harm Reduction’ in Vancouver’s Inner City.” International Journal of Drug Policy 45 (July 2017): 33-39.
  • Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. International journal of drug policy. 2002 Jun 30;13(2):85–94.
  • Spencer L, Ritchie J, O’Connor W. (2003). Analysis: practices, principles and processes, 199–218. In: qualitative research practice: a guide for social science students and researchers. Edited by Jane Ritchie and Jane Lewis. London: SAGE Publications; 2003.

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