title: Prevalence and correlates of needle-stick injuries among active duty police officers in Tijuana, Mexico.
abstract: Police officers are at an elevated risk for needle-stick injuries (NSI), which pose a serious and costly occupational health risk for HIV and viral hepatitis. However, research on NSIs among police officers is limited, especially in low- and middle-income countries. Despite the legality of syringe possession in Mexico, half of people who inject drugs (PWID) in Tijuana report extrajudicial syringe-related arrests and confiscation by police, which has been associated with needle-sharing and HIV infection. We assessed the prevalence and correlates of NSIs among Tijuana police officers to inform efforts to improve occupational safety and simultaneously reduce HIV risks among police and PWID.
  
  
  
  Tijuana's Department of Municipal Public Safety (SSPM) is among Mexico's largest. Our binational, multi-sectoral team analyzed de-identified data from SSPM's 2014 anonymous self-administered occupational health survey. The prevalence of NSI and syringe disposal practices was determined. Logistic regression with robust variance estimation via generalized estimating equations identified factors associated with ever having an occupational NSI.
  
  
  
  Approximately one-quarter of the Tijuana police force was given the occupational health survey (N=503). Respondents were predominantly male (86.5%) and ≤35 years old (42.6%). Nearly one in six officers reported ever having a NSI while working at SSPM (15.3%), of whom 14.3% reported a NSI within the past year. Most participants reported encountering needles/syringes while on duty (n=473, 94%); factors independently associated with elevated odds of NSIs included frequently finding syringes that contain drugs (adjusted odds ratio (AOR): 2.98; 95% confidence interval (CI): 1.56-5.67) and breaking used needles (AOR: 2.25; 95% CI: 1.29-3.91), while protective factors included being willing to contact emergency services in case of NSIs (AOR: 0.39; 95% CI: 0.22-0.69), and wearing needle-stick resistant gloves (AOR: 0.43; 95% CI: 0.19-0.91).
  
  
  
  Tijuana police face an elevated and unaddressed occupational NSI burden associated with unsafe syringe-handling practices, exposing them to substantial risk of HIV and other blood-borne infections. These findings spurred the development and tailoring of training to reduce NSI by modifying officer knowledge, attitudes and enforcement practices (e.g. syringe confiscation) - factors that also impact HIV transmission among PWID and other members of the community.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.|School of Medicine, Universidad Xochicalco, Tijuana, México.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Mittal
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.|School of Law & Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Beletsky
authors.affiliation: School of Medicine, Universidad Xochicalco, Tijuana, México.|Public Safety Support Department, Dirección Municipal de Salud, Tijuana, México.
authors.forename: Efraín
authors.initials: E
authors.lastname: Patiño
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Abramovitz
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Teresita
authors.initials: T
authors.lastname: Rocha
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Arredondo
authors.affiliation: Department of Planning and Special Projects, Secretaría de Seguridad Pública Municipal, Tijuana, México.
authors.forename: Arnulfo
authors.initials: A
authors.lastname: Bañuelos
authors.affiliation: Comisión de Salud Fronteriza México-EEUU, Sección México, Tijuana, México.|Department of Migrant Health, Secretaría de Salud, México DF, México.
authors.forename: Gudelia
authors.initials: G
authors.lastname: Rangel
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA; sstrathdee@ucsd.edu.
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D035846:Law Enforcement; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D016485:Needle Sharing / Q000009:adverse effects; D009339:Needles / Q000009:adverse effects; D016602:Needlestick Injuries / Q000453:epidemiology* / Q000209:etiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D016495:Police / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013594:Syringes; D000078329:Workforce
keywords: HIV; harm reduction; law enforcement; occupational accidents; policing; syringe confiscation; syringe disposal; viral hepatitis