A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs.
BACKGROUND
The United States (U.S.) approved use of federal funds for needle and syringe programs (NSPs) in December 2009. This study compares syringe disposal practices in a U.S. city with NSPs to a U.S. city without NSPs by examining the prevalence of improperly discarded syringes in public places and the self-reported syringe disposal practices of injection drug users (IDUs) in the two cities.


METHODS
We conducted visual inspection walkthroughs in a random sample of the top-quartile of drug-affected neighborhoods in San Francisco, California (a city with NSPs) and Miami, Florida (a city without NSPs). We also conducted quantitative interviews with adult IDUs in San Francisco (N=602) and Miami (N=448).


RESULTS
In the visual inspections, we found 44 syringes/1000 census blocks in San Francisco, and 371 syringes/1000 census blocks in Miami. Survey results showed that in San Francisco 13% of syringes IDUs reported using in the 30 days preceding the study interviews were disposed of improperly versus 95% of syringes by IDUs in Miami. In multivariable logistic regression analysis, IDUs in Miami had over 34 times the adjusted odds of public syringe disposal relative to IDUs in San Francisco (adjusted odds ratio=34.2, 95% CI=21.92, 53.47).


CONCLUSIONS
We found eight-fold more improperly disposed syringes on walkthroughs in the city without NSPs compared to the city with NSPs, which was corroborated by survey data. NSPs may help IDUs dispose of their syringes safely in cities with large numbers of IDUs.
Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida, USA.
Hansel E
HE
Tookes
Alex H
AH
Kral
Lynn D
LD
Wenger
Gabriel A
GA
Cardenas
Alexis N
AN
Martinez
Recinda L
RL
Sherman
Margaret
M
Pereyra
David W
DW
Forrest
Marlene
M
LaLota
Lisa R
LR
Metsch
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D003625:Data Collection; D005260:Female; D005431:Florida / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012111:Residence Characteristics; D012495:San Francisco / Q000453:epidemiology; D012737:Sex Factors; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology; D013594:Syringes; D055815:Young Adult