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Helfers RC, Nhan J. A Qualitative Study: An Examination of Police Officers' Lived Experiences During the COVID-19 Pandemic. INTERNATIONAL CRIMINAL JUSTICE REVIEW 2022; 32:308-327. [PMID: 36065417 PMCID: PMC9247632 DOI: 10.1177/10575677211050427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the spring of 2020, the COVID-19 pandemic spread across the globe prompting stay-at-home orders for all but the most essential workers in society. Policing was one of the professions that is essential for community safety, regardless of the circumstances. Officers were on the front-line of the COVID-19 public health crisis and their preparedness was crucial for officer and community health. During the onset of the pandemic little was known about how officers perceived the virus and how police agencies prepared officers to work in a highly contagious environment. This study used semistructured interviews of police officers in two states in the United States that had elevated cases of the virus. The authors explored the lived experiences of police officers to explore officers' perceptions, concerns, implications the pandemic had on patrol activity, and agency preparedness during the onset of the COVID-19 pandemic. The results revealed structural and cultural forces that resulted in officers and their agency leadership not taking the pandemic seriously, ill-preparation and ill-equipping, and disincentives in reporting exposure. Moreover, officers' fears were largely not based on their own well-being, but on the risk of spreading the disease to their family members.
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Affiliation(s)
| | - Johnny Nhan
- Texas Christian University, Fort Worth,
TX, USA
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2
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Simmons J, Elliott L, Bennett AS, Beletsky L, Rajan S, Anders B, Dastparvardeh N. Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response. JMIR Res Protoc 2022; 11:e33451. [PMID: 35212639 PMCID: PMC8917434 DOI: 10.2196/33451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/15/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. OBJECTIVE The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. METHODS This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. RESULTS Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. CONCLUSIONS The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. TRIAL REGISTRATION ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33451.
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Affiliation(s)
- Janie Simmons
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Luther Elliott
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Alex S Bennett
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Leo Beletsky
- School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, United States
| | | | - Nicole Dastparvardeh
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
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3
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Beletsky L, Abramovitz D, Baker P, Arredondo J, Rangel G, Artamonova I, Marotta P, Mittal ML, Rocha-Jimenéz T, Morales M, Clairgue E, Kang S, Banuelos A, Cepeda J, Patterson TA, Strathdee SA. Reducing police occupational needle stick injury risk following an interactive training: the SHIELD cohort study in Mexico. BMJ Open 2021. [PMCID: PMC8039238 DOI: 10.1136/bmjopen-2020-041629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective At a time of unprecedented attention to the public health impact of policing, it is imperative to understand the role of occupational safety in shaping officer behaviours. We assessed the longitudinal impact of police training in a quasi-experimental hybrid type-1 trial to reduce syringe-related occupational risk, while realigning police practices with public health prevention among people who inject drugs (PWID). Setting Tijuana, Mexico. Participants Of 1806 Tijuana municipal police trainees, 771 reporting previous exposure to syringes were randomly selected for follow-up. All participants completed at least one follow-up visit; attrition at 24 months was 8%. Intervention Between 2015 and 2016, officers received a training intervention (Safety and Health Integration in the Enforcement of Laws on Drugs, SHIELD) bundling occupational needle stick injury (NSI) prevention with health promotion among PWID. Outcome measures Longitudinal analysis with generalised linear mixed models to evaluate training impact on occupational NSI risk via NSI incidence and prevalidated Syringe Threat and Injury Correlates (STIC) score. This composite indicator integrates five self-reported risky syringe-handling practices (eg, syringe confiscation, breaking) and was used as a proxy for NSI risk due to reporting bias and concerns about reliability of NSI incidence reports. Results No change in self-reported NSI incidence was observed, but significant reductions in risk (16.2% decrease in STIC score) occurred at 3 months, with a sustained decrease of 17.8% through 24 months, compared with pretraining (p<0.001). Police assignment (patrol vs administration) moderated the training effect (p=0.01). Younger age, male gender, lower rank and previous NSI were independently and significantly associated with higher NSI risk overtime, although all groups demonstrated significant reductions post-training. Conclusions SHIELD is the first intervention to be associated with significant sustained changes in police practices that pose risk for both occupational and the public’s health. Integrating occupational safety and public health education should inform other interventions to mitigate the community health detriments of policing behaviours. Trial registration number NCT02444403.
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Affiliation(s)
- Leo Beletsky
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Law, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Daniela Abramovitz
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Pieter Baker
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Jaime Arredondo
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Programa de Politica de Drogas, Centro de Investigacion y Docencia Economicas, Mexico, Mexico
| | - Gudelia Rangel
- Mexico Section, U.S.-Mexico Border Health Commission, Tijuana, Mexico
| | - Irina Artamonova
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Phillip Marotta
- School of Medicine, Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Maria Luisa Mittal
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Medicine, Universidad Xochicalco - Campus Tijuana, Tijuana, Mexico
| | - Teresita Rocha-Jimenéz
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Mario Morales
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- School of Government and Public Policy, University of Arizona Health Sciences Center, Tucson, Arizona, USA
| | - Erika Clairgue
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Sunyou Kang
- School of Law, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Arnulfo Banuelos
- Department of Planning and Special Projects, Secretaria de Seguridad Publica Municipal, Tijuana, Mexico
| | - Javier Cepeda
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas A Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Steffanie A Strathdee
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, California, USA
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4
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Scheibe A, Sibeko G, Shelly S, Rossouw T, Zishiri V, Venter WD. Southern African HIV Clinicians Society guidelines for harm reduction. South Afr J HIV Med 2020; 21:1161. [PMID: 33391833 PMCID: PMC7756663 DOI: 10.4102/sajhivmed.v21i1.1161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Andrew Scheibe
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shaun Shelly
- TB HIV Care, Cape Town, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Vincent Zishiri
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D.F. Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Cordeiro TMSC, Ferreira Filho RP, D'Oliveira Júnior A. Factors associated with occupational and non-occupational viral hepatitis infections in Brazil between 2007-2014. Ann Hepatol 2020; 18:751-756. [PMID: 31153910 DOI: 10.1016/j.aohep.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/17/2019] [Accepted: 02/17/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Viral hepatitis is an endemic and epidemic disease of relevance in public health. This study estimated the frequency of viral hepatitis by occupational and non-occupational infections and analyzed the factors associated with case notifications in Brazil from 2007 to 2014. MATERIAL AND METHODS This was an exploratory epidemiological study using the Notifiable Diseases Information System database. Descriptive and multivariate analyses were performed. RESULTS The frequency of viral hepatitis by occupational infections was 0.7%, of which 1.3% were due to hepatitis A virus (HAV), 45.1% hepatitis B virus (HBV), and 45.3% hepatitis C virus (HCV). There was a significant association of the disease with female sex [AOR=1.31; P=0.048], schooling [AOR=1.71; P<0.001], occupation [AOR=2.74; P<0.001], previous contact with an HBV or HCV-infected patient [AOR=5.77; P<0.001], exposure to accidents with biological materials [AOR=99.82; P<0.001], and hepatitis B vaccination [AOR=0.73; P=0.033]. CONCLUSION While there was a low frequency of viral hepatitis by occupational infections in Brazil from 2007 to 2014, these findings might be underreported and have been associated with individual and occupational characteristics. This reinforces the need for the adoption of prevention strategies in the workplace and for completeness of case notifications.
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Affiliation(s)
- Técia Maria S C Cordeiro
- School of Medicine in Bahia, Post-Graduate Program in Health Sciences, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
| | - Raymundo P Ferreira Filho
- School of Medicine in Bahia, Post-Graduate Program in Health Sciences, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Argemiro D'Oliveira Júnior
- School of Medicine in Bahia, Post-Graduate Program in Health Sciences, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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6
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Beletsky L, Abramovitz D, Arredondo J, Baker P, Artamonova I, Marotta P, Mittal ML, Rocha-Jimenez T, Cepeda JA, Morales M, Clairgue E, Patterson TA, Strathdee SA. Addressing Police Occupational Safety During an Opioid Crisis: The Syringe Threat and Injury Correlates (STIC) Score. J Occup Environ Med 2020; 62:46-51. [PMID: 31658223 PMCID: PMC6933083 DOI: 10.1097/jom.0000000000001754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To develop and validate syringe threat and injury correlates (STIC) score to measure police vulnerability to needlestick injury (NSI). METHODS Tijuana police officers (N = 1788) received NSI training (2015 to 2016). STIC score incorporates five self-reported behaviors: syringe confiscation, transportation, breaking, discarding, and arrest for syringe possession. Multivariable logistic regression was used to evaluate the association between STIC score and recent NSI. RESULTS Twenty-three (1.5%) officers reported NSI; higher among women than men (3.8% vs 1.2%; P = 0.007). STIC variables had high internal consistency, a distribution of 4.0, a mode of 1.0, a mean (sd) of 2.0 (0.8), and a median (interquartile range [IQR]) of 2.0 (1.2 to 2.6). STIC was associated with recent NSI; odds of NSI being 2.4 times higher for each point increase (P-value <0.0001). CONCLUSIONS STIC score is a novel tool for assessing NSI risk and prevention program success among police.
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Affiliation(s)
- Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Law & Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave., Massachusetts 02115, United States
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, California. 92182, United States
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Phil Marotta
- School of Social Work, Columbia University, 1255 Amsterdam Ave., New York, NY, 10027, United States
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, Tijuana, Baja California, 22110, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
- School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, California. 92182, United States
| | - Javier A. Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Thomas A. Patterson
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, California. 92093, United States
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Dasgupta S, Broz D, Tanner M, Patel M, Halleck B, Peters PJ, Weidle PJ, O'Donnell J, Amlung J, McAlister C, Chapman E, Bailey A, Burnett J, Duwve J. Changes in Reported Injection Behaviors Following the Public Health Response to an HIV Outbreak Among People Who Inject Drugs: Indiana, 2016. AIDS Behav 2019; 23:3257-3266. [PMID: 31313095 DOI: 10.1007/s10461-019-02600-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A syringe services program (SSP) was established following the Indiana HIV outbreak among persons who inject drugs (PWID) in Scott County. Among Indiana-based PWID, we examined injection behaviors associated with HIV status, SSP use after its establishment, and changes in injection behaviors after the outbreak response. During 2016, we interviewed 200 PWID and assessed injection behaviors before the response by HIV status. We reported injection behaviors prior to the response and used Fisher's exact Chi square tests (P < 0.05) to assess differences by HIV status. Next, among persons who injected both before (July-December 2014) and after (past 30 days) the response, we (1) reported the proportion of persons who used the SSP to obtain sterile syringes, and assessed differences in SSP use by HIV status using Fisher's exact Chi square tests; and (2) compared distributive and receptive sharing of injection equipment and disposal of syringes before and after the outbreak response, and assessed statistical differences using McNemar's test. We also compared injection behaviors before and after the response by HIV status. Injecting extended release oxymorphone (Opana® ER); receptive sharing of syringes and cookers; and distributive sharing of cookers, filters, or water before the response were associated with HIV infection. SSP use was high (86%), particularly among HIV-positive compared with HIV-negative persons (98% vs. 84%). Injection equipment sharing decreased and safe disposal of used syringes increased after the response, especially among HIV-positive persons. Injection equipment sharing contributed to the outbreak. High SSP use following the response, particularly among HIV-positive persons, contributed to decreased high-risk injection practices.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA.
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Mary Tanner
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Monita Patel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | | | - Philip J Peters
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Paul J Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Julie O'Donnell
- Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Amlung
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Cameron McAlister
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Erika Chapman
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Ayriane Bailey
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Janet Burnett
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA
| | - Joan Duwve
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Moazen B, Deckert A, Saeedi Moghaddam S, Owusu PN, Mehdipour P, Shokoohi M, Noori A, Lotfizadeh M, Bosworth R, Neuhann F, Farzadfar F, Stöver H, Dolan K. National and sub-national HIV/AIDS-related mortality in Iran, 1990-2015: a population-based modeling study. Int J STD AIDS 2019; 30:1362-1372. [PMID: 31739749 DOI: 10.1177/0956462419869520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveillance of HIV/AIDS mortality is crucial to evaluate a country’s response to the disease. With a modified estimation approach, this study aimed to provide more accurate estimates on deaths due to HIV/AIDS in Iran from 1990 to 2015 at national and sub-national levels. Using a comprehensive data set, death registration incompleteness and misclassification were addressed by demographical and statistical methods. Trends of mortality due to HIV/AIDS at national and sub-national levels were estimated by applying a set of models. A total of 474 men (95% uncertainty interval [UI]: 175–1332) and 256 women (95% UI: 36–1871) died due to HIV/AIDS in 2015 in Iran. Peaked in 1995, HIV/AIDS-related mortality has steadily declined among both genders. Mortality rates were remarkably higher among men than women during the period studied. At the sub-national level, the highest and the lowest annual percent change were found at 10.97 and −1.36% for women, and 4.04 and −3.47% for men, respectively. The findings of our study (731 deaths) were remarkably lower than the Joint United Nations Programme on HIV and AIDS (4000) but higher than Global Burden of Disease (339) estimates in 2015. The overall decrease in mortality due to HIV/AIDS may be attributed to the increasing burden of noncommunicable diseases; however, the role of the national and international organizations to fight HIV/AIDS should not be overlooked. To decrease HIV/AIDS mortality and to achieve international goals, evidence-based action is required. To fast-track targets, the priority must be to prevent infection, promote early diagnosis, provide access to treatment, and to ensure treatment adherence among patients.
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Affiliation(s)
- Babak Moazen
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Health and Social Work, Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Priscilla N Owusu
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
| | - Atefeh Noori
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Masoud Lotfizadeh
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.,Department of Community Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rebecca Bosworth
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Florian Neuhann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Heino Stöver
- Department of Health and Social Work, Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt/Main, Germany
| | - Kate Dolan
- Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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9
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Khorasheh T, Naraine R, Watson TM, Wright A, Kallio N, Strike C. A scoping review of harm reduction training for police officers. Drug Alcohol Rev 2019; 38:131-150. [PMID: 30785229 DOI: 10.1111/dar.12904] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/20/2018] [Accepted: 01/01/2019] [Indexed: 01/18/2023]
Abstract
ISSUES Preventable overdose deaths, especially due to opioids, have increasingly been reported worldwide. Expansion of life-saving harm reduction services is underway with increasing public support in some jurisdictions. However, such services often fall short of reaching people who use drugs (PWUD), in part, due to law enforcement practices that are aligned with punitive drug laws and incongruent with harm reduction principles. One suggested strategy to facilitate police understanding and uptake of practices that are more congruent with harm reduction is to provide police with relevant training. APPROACH This scoping review synthesises English-language peer-reviewed and grey literature on harm reduction training programs for police. KEY FINDINGS We reviewed 31 sources and found that most trainings covered topics related to harm reduction objectives, overdose recognition and response, occupational safety and policing practices. Information was often presented via single-session, 1-hour long, slide-assisted presentations that were integrated into in-service trainings. Inconsistent throughout the literature was the career stage or position/rank of training audience (e.g. cadets, senior officers, street-level officers), when and how much training should be provided, and the occupational background of the training facilitator. IMPLICATIONS The available literature contains significant gaps pertaining to descriptions of training development, design and content specific to facilitating positive police-PWUD interactions, and formal evaluations. These gaps limit our understanding of what well-designed trainings may look like, if and how training alters policing practices, and to what extent training completion may lead to improved outcomes. CONCLUSION Greater research and formal evaluations of harm reduction training for police is recommended.
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Affiliation(s)
- Triti Khorasheh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Renuka Naraine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tara Marie Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amy Wright
- The Works, Toronto Public Health, Toronto, Canada
| | - Natalie Kallio
- keepSIX Supervised Consumption Services, South Riverdale Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Arredondo J, Beletsky L, Baker P, Abramovitz D, Artamonova I, Clairgue E, Morales M, Mittal ML, Rocha-Jimenez T, Kerr T, Banuelos A, Strathdee SA, Cepeda J. Interactive Versus Video-Based Training of Police to Communicate Syringe Legality to People Who Inject Drugs: The SHIELD Study, Mexico, 2015-2016. Am J Public Health 2019; 109:921-926. [PMID: 30998406 PMCID: PMC6507990 DOI: 10.2105/ajph.2019.305030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To assess how instructional techniques affect officers' intent to communicate syringe legality during searches in Tijuana, Mexico, where pervasive syringe confiscation potentiates risk of HIV and HCV among people who inject drugs (PWID) and of occupational needle-stick injury among police. Methods. Using the SHIELD (Safety and Health Integration in the Enforcement of Laws on Drugs) model, Tijuana police underwent training to encourage communication of syringe possession legality to PWID. Trainees received either passive video or interactive role-play exercise on safer search techniques. We used logistic regression to assess the training's impact on self-reported intent to communicate syringe legality by training type and gender. Results. Officers (n = 1749) were mostly men (86%) assigned to patrol (84%). After the training, intent to communicate the law improved markedly: from 20% to 39% (video group) and 20% to 58% (interactive group). Gender and training type significantly predicted intent to communicate syringe legality. Male and female officers' adjusted odds ratios in the interactive group were 5.37 (95% confidence interval [CI] = 4.56, 6.33) and 9.16 (95% CI = 5.88, 14.28), respectively, after the training. Conclusions. To more effectively persuade police to endorse harm reduction and occupational safety practices, police trainings should include interactive elements.
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Affiliation(s)
- Jaime Arredondo
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Leo Beletsky
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Pieter Baker
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Daniela Abramovitz
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Irina Artamonova
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Erika Clairgue
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Mario Morales
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Maria Luisa Mittal
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Teresita Rocha-Jimenez
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Thomas Kerr
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Arnulfo Banuelos
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Steffanie A Strathdee
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Javier Cepeda
- Jaime Arredondo, Leo Beletsky, Pieter Baker, Daniela Abramovitz, Irina Artamonova, Erika Clairgue, Mario Morales, Maria Luisa Mittal, Teresita Rocha-Jimenez, Steffanie A. Strathdee, and Javier A. Cepeda are with the Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego. Thomas Kerr is with the Department of Medicine, University of British Columbia, Vancouver, Canada. Arnulfo Banuelos is with the Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
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11
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Rocha-Jiménez T, Mittal ML, Artamonova I, Baker P, Cepeda J, Morales M, Abramovitz D, Clairgue E, Bañuelos A, Patterson T, Strathdee S, Beletsky L. The Role of Gender in the Health and Human Rights Practices of Police: The SHIELD Study in Tijuana, Mexico. Health Hum Rights 2019; 21:227-238. [PMID: 31239629 PMCID: PMC6586956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Globally, punitive drug law enforcement drives human rights violations. Drug control tactics, such as syringe confiscation and drug-related arrests, also cascade into health harms among people who use drugs. The role of police officer characteristics in shaping such enforcement and measures to reform police practices remains underexamined. We evaluated gender differences in syringe confiscation and syringe-related arrest behaviors among municipal police officers in Tijuana, Mexico, where syringe possession is legal. In the context of the SHIELD Study focusing on aligning policing with harm reduction measures, our baseline sample covered municipal police officers who reported having occupational contact with syringes. We used multivariable logistic regression with robust variance estimation via a generalized estimating equation to identify correlates of syringe-related policing behaviors. Among respondent officers (n=1,555), 12% were female. After considering possible confounding variables, such as district of service and work experience, female officers were significantly less likely to report confiscating syringes or arresting individuals for syringe possession. Consideration of officer gender is important in the design of interventions to improve the health and human rights of people who inject drugs and other highly policed groups, as well as measures to safeguard officer occupational safety. The feminization of law enforcement deserves special consideration as an imperative in reducing the public health harms of policing.
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Affiliation(s)
- Teresita Rocha-Jiménez
- Research associate at the University of California San Diego’s Division of Infectious Diseases and Global Public Health and a fellow at the Center for U.S.-Mexican Studies, University of California San Diego, USA
| | - Maria Luisa Mittal
- Project scientist at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | | | - Pieter Baker
- PhD student and research associate at the University of California San Diego and San Diego State University, USA
| | - Javier Cepeda
- Assistant professor at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Mario Morales
- Research assistant at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Daniela Abramovitz
- Principal statistician at the Division of Infectious Diseases and Global Public Health, University of California San Diego, USA
| | - Erika Clairgue
- Research program manager at the University of California San Diego, USA
| | - Arnulfo Bañuelos
- Research liaison at the Secretaría de Seguridad Pública Municipal, department of special planning and projects, Tijuana, Mexico
| | - Thomas Patterson
- Distinguished professor of psychiatry at the University of California San Diego, USA
| | - Steffanie Strathdee
- Associate dean of global health sciences, Harold Simon Professor at the University of California San Diego Department of Medicine, and principal investigator at Project ESCUDO
| | - Leo Beletsky
- Professor at the School of Law and Bouvé College of�Health Sciences, Northeastern University, and an associate adjunct professor at the University of California San Diego, USA
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12
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Mona GG, Chimbari MJ, Hongoro C. A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service. J Occup Med Toxicol 2019; 14:2. [PMID: 30679940 PMCID: PMC6341669 DOI: 10.1186/s12995-018-0221-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Background Occupational hazards, injuries and diseases are a major concern among police officers, including in Sub-Saharan Africa. However, there is limited locally relevant literature for guiding policy for the South African Police Service (SAPS). The purpose of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark policy implications for the SAPS. Methods We conducted a systematic review of studies using Google Scholar, PubMed and Scopus. Results A total of 36 studies were included in this review. Six revealed that police officers’ exposure to accident hazards may lead to acute or chronic injuries such as sprains, fractures or even fatalities. These hazards may occur during driving, patrol or riot control. There were two studies, which confirmed physical hazards such as noise induced hearing loss (NIHL), due to exposure to high levels of noise. Three studies on chemical hazards revealed that exposure to high concentrations of carbon dioxide and general air pollution was associated with cancer, while physical exposure to other chemical substances was linked to dermatitis. Four studies on biological hazards demonstrated potential exposure to blood borne diseases from needle stick injuries (NSIs) or cuts from contaminated objects. One study on ergonomic hazards showed that musculoskeletal disorders can result from driving long distances and lifting heavy objects. There were 15 studies that indicated psychological hazards such as post-traumatic stress disorder (PTSD) as well as stress. Moreover, four studies were conducted on organizational hazards including burnout, negative workplace exposure and other factors. Conclusions This review outlined the global impact of occupational hazards, injuries and diseases in the police force. It served as a benchmark for understanding the policy implications for South Africa, where there is paucity of studies on occupational health and safety.
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Affiliation(s)
- Gift Gugu Mona
- 1College of Health Sciences, George Campbell Building, Mazisi Kunene Road, Howard College Campus, University of KwaZulu-Natal, P.O Box X7, Congella, Durban, KwaZulu-Natal 4013 South Africa
| | - Moses John Chimbari
- 1College of Health Sciences, George Campbell Building, Mazisi Kunene Road, Howard College Campus, University of KwaZulu-Natal, P.O Box X7, Congella, Durban, KwaZulu-Natal 4013 South Africa
| | - Charles Hongoro
- Research Use and Impact Assessment, Human Sciences Research Council Building, 134 Pretorius Street, Pretoria, 0083 South Africa
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13
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Morales M, Rafful C, Gaines TL, Cepeda JA, Abramovitz D, Artamonova I, Baker P, Clairgue E, Mittal ML, Rocha-Jimenez T, Arredondo J, Kerr T, Bañuelos A, Strathdee SA, Beletsky L. Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2018; 18:36. [PMID: 30219105 PMCID: PMC6139125 DOI: 10.1186/s12914-018-0175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/29/2018] [Indexed: 12/04/2022]
Abstract
Background Mexican law permits syringe purchase and possession without prescription. Nonetheless, people who inject drugs (PWID) frequently report arrest for syringe possession. Extrajudicial arrests not only violate human rights, but also significantly increase the risk of blood-borne infection transmission and other health harms among PWID and police personnel. To better understand how police practices contribute to the PWID risk environment, prior research has primarily examined drug user perspectives and experiences. This study focuses on municipal police officers (MPOs) in Tijuana, Mexico to identify factors associated with self-reported arrests for syringe possession. Methods Participants were active police officers aged ≥18 years, who completed a self-administered questionnaire on knowledge, attitudes and behaviors related to occupational safety, drug laws, and harm reduction strategies. Univariable and multivariable logistic regression was used to identify correlates of recent syringe possession arrest. Results Among 1044 MPOs, nearly half (47.9%) reported always/sometimes making arrests for syringe possession (previous 6mo). Factors independently associated with more frequent arrest included being male (Adjusted Odds Ratio [AOR] = 1.62; 95% Confidence Interval [95% CI] =1.04–2.52; working in a district along Tijuana River Canal (where PWID congregate) (AOR = 2.85; 95%CI = 2.16–3.77); having recently experienced a physical altercation with PWID (AOR = 2.83; 95% CI = 2.15–3.74); and having recently referred PWID to social and health services (AOR = 1.97; 95% CI = 1.48–2.61). Conversely, odds were significantly lower among officers reporting knowing that syringe possession is legal (AOR = 0.61; 95% CI = 0.46–0.82). Conclusions Police and related criminal justice stakeholders (e.g., municipal judges, prosecutors) play a key role in shaping PWID risk environment. Findings highlight the urgent need for structural interventions to reduce extra-judicial syringe possession arrests. Police training, increasing gender and other forms of diversity, and policy reforms at various governmental and institutional levels are necessary to reduce police occupational risks, improve knowledge of drug laws, and facilitate harm reduction strategies that promote human rights and community health.
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Affiliation(s)
- Mario Morales
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Claudia Rafful
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Daniela Abramovitz
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Irina Artamonova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Pieter Baker
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Erika Clairgue
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Maria Luisa Mittal
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Medicine, Universidad Xochicalco, 4850 Calle Rampa Yumalinda, Chapultepec Alamar, 22110, Tijuana, Baja California, Mexico
| | - Teresita Rocha-Jimenez
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Jaime Arredondo
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA.,School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, California, 92182, USA
| | - Thomas Kerr
- Center of Excellence in HIV/AIDS, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, 2141 Blvd Cuauhtémoc Sur y Río Suchiate, 22015, Tijuana, Mexico
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, San Diego, California, 92093, USA. .,Health in Justice Action Lab, School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, 02115, USA.
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14
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Cepeda JA, Strathdee SA, Arredondo J, Mittal ML, Rocha T, Morales M, Clairgue E, Bustamante E, Abramovitz D, Artamonova I, Bañuelos A, Kerr T, Magis-Rodriguez CL, Beletsky L. Assessing police officers' attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 50:56-63. [PMID: 29028564 PMCID: PMC5705567 DOI: 10.1016/j.drugpo.2017.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/24/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Policing practices such as syringe confiscation and arrest can act as important social-structural drivers of HIV risk among people who inject drugs (PWID). However, police referral to treatment and other services may improve the health of PWID. Little is known about the role of modifiable attitudinal and knowledge factors in shaping officer behavior. Using baseline findings from a police education program (PEP), we assessed relationships between drug policy knowledge and attitudes towards public health interventions with self-reported syringe confiscation, drug arrest, and service referral among street-level police in Tijuana, Mexico. METHODS Between February, 2015 and May, 2016 we surveyed 1319 police officers who reported syringe contact. The self-administered survey focused on attitudes, knowledge, and behaviors related to drug policy, public health, and occupational safety. We used ordinal logistic regression to model the odds of syringe confiscation, arrest for heroin possession, and referring PWID to health/social programs. RESULTS The sample was mostly male (87%) and had at least a high school education (80%). In the last six months, a minority reported always/sometimes confiscating syringes (49%), arresting someone for heroin possession (43%), and referring PWID to health and social programs (37%). Those reporting needlestick injuries (NSI) had 1.38 (95% CI: 1.02-1.87) higher odds of reporting syringe confiscation. Officers who had favorable views on laws that treat addiction as a public health issue had lower odds (aOR=0.78; 95% CI: 0.59-1.03) of arresting PWID. Those agreeing that it was their role to refer PWID to health and social programs had higher odds of reporting such referrals (aOR: 3.32, 95% CI: 2.52-4.37). Legal knowledge was not associated with these practices. CONCLUSION Changing drug policy and knowledge may be insufficient in shifting police behavior. Modifying officers' occupational risks and attitudes towards harm reduction interventions can facilitate efforts to align police practices with PWID health.
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Affiliation(s)
- Javier A Cepeda
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States.
| | - Steffanie A Strathdee
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Jaime Arredondo
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Maria L Mittal
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States; Universidad Xochicalco, School of Medicine, Tijuana, Mexico
| | - Teresita Rocha
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Mario Morales
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Erika Clairgue
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Eliane Bustamante
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States; Universidad Xochicalco, School of Medicine, Tijuana, Mexico
| | - Daniela Abramovitz
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Irina Artamonova
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States
| | - Arnulfo Bañuelos
- Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, Mexico
| | - Thomas Kerr
- University of British Columbia, Center of Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Carlos L Magis-Rodriguez
- Centro Nacional para la Prevención y Control del VIH/SIDA, Ciudad de Mexico, Distrito Federal, Mexico
| | - Leo Beletsky
- University of California, San Diego, Department of Medicine, Division of Global Public Health, La Jolla, CA, United States; School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
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15
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Arredondo J, Strathdee SA, Cepeda J, Abramovitz D, Artamonova I, Clairgue E, Bustamante E, Mittal ML, Rocha T, Bañuelos A, Olivarria HO, Morales M, Rangel G, Magis C, Beletsky L. Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico. Harm Reduct J 2017; 14:72. [PMID: 29117858 PMCID: PMC5678566 DOI: 10.1186/s12954-017-0198-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background Mexico’s 2009 “narcomenudeo reform” decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers’ drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. Methods Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar’s tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers’ ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. Results Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4–3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3–4.3), methamphetamine (aOR 2.2, 95% CI 1.4–3.2), and marijuana (aOR 2.5, 95% CI 1.6–4). Conclusions Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.
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Affiliation(s)
- J Arredondo
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA. .,San Diego State University, San Diego, CA, USA.
| | - S A Strathdee
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - J Cepeda
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - D Abramovitz
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - I Artamonova
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - E Clairgue
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - E Bustamante
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA
| | - M L Mittal
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
| | - T Rocha
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,San Diego State University, San Diego, CA, USA
| | - A Bañuelos
- Secretaría de Seguridad Pública Municipal, Dirección de Planeación y Proyectos Estratégicos, Tijuana, Mexico
| | - H O Olivarria
- Secretaría de Seguridad Pública Municipal, Instituto de Capacitación y Adiestramiento Profesional (ICAP), Tijuana, Mexico
| | - M Morales
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,San Diego State University, San Diego, CA, USA
| | - G Rangel
- Comisión de Salud Fronteriza, México-Estados Unidos, Tijuana, Mexico
| | - C Magis
- Centro Nacional para la Prevención y el Control del VIH y el SIDA (Censida), Mexico City, Mexico
| | - L Beletsky
- Division of Global Public Health, UC San Diego - School of Medicine, Third Floor, CRSF, La Jolla, San Diego, USA.,School of Law and Bouvé College of Health Sciences, Northeastern University, Boston, USA
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16
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Police must join the fast track to end AIDS by 2030. J Int AIDS Soc 2016; 19:21153. [PMID: 27435719 PMCID: PMC4951534 DOI: 10.7448/ias.19.4.21153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/09/2016] [Indexed: 01/23/2023] Open
Abstract
World leaders have committed to ending AIDS by 2030, but stigma and discrimination remain significant obstacles. In particular, police are critical, front-line determinants of risk for many people living with HIV (PLHIV) and members of other key affected populations (KAPs). The negative impact of adverse police behaviours and practices on HIV risk is well documented, and these risks undermine global efforts to end AIDS. Far less well documented, and less common, are attempts to ameliorate this impact by working to change police behaviours. This Special Issue seeks to help redress this imbalance by presenting a selection of original, provocative and important interventions from academics, police officers and other stakeholders concerned with documenting the potential for constructive, progressive and evidence-based approaches to the reduction of HIV risk. We recommend urgent boosting of efforts and funding to engage police in the HIV response. Among other strategies, this needs sustainable funding of programmes and their evaluation, and increased and continuing advocacy and education at all levels to match policy and law reform.
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