Reducing police occupational needle stick injury risk following an interactive training: the SHIELD cohort study in Mexico

Abstract

ObjectiveAt 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).SettingTijuana, Mexico.ParticipantsOf 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%.InterventionBetween 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 measuresLongitudinal 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.ResultsNo 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.ConclusionsSHIELD 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 numberNCT02444403.

Cost-effectiveness of a police education program on HIV and overdose among people who inject drugs in Tijuana, Mexico

“…Overall, the intervention significantly improved and sustained police-reported attitudes, knowledge, and behaviours regarding their interactions with PWID. 13 , 14 …”

Estimating the impact of a police education program on hepatitis C virus transmission and disease burden among people who inject drugs in Tijuana, Mexico: A dynamic modeling analysis

“…Punitive drug laws and their enforcement have been identified as key structural drivers of HCV and HIV transmission among PWID [3][4][5][6][7][8]. For example, fear of arrest because of syringe possession may disrupt safe injecting practices [9][10][11][12].…”

“…Previous modeling found that the drug laws had minimal impact on averting HIV, likely because of poor implementation from police [24]. To improve implementation of the Narcomendeo reforms, US-based investigators collaborated with the Tijuana Police Department to deliver a police education program (PEP), "Proyecto Escudo" ("Project Shield"), which aimed at reducing police occupational needlestick injury and concomitantly, reducing police encounters as a driver of blood borne infections (BBI) among PWID [5,6,26,27]. Earlier work found a promising impact of Escudo in improvements in officer knowledge and attitudes toward addiction and PWID [26,28] including reductions in selfreported arrests of individuals for drug-related crimes [5,29].…”

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

“…Although some overdose education and naloxone distribution (OEND) training initiatives with law enforcement have had mixed results [ 48 , 52 , 53 ], police education programs, including our own online curricula [ 54 , 55 ], have shown promise in precipitating procedural and attitudinal changes related to substance use. Previous research using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model developed by another member of our team (author LB) demonstrated that police officers are especially receptive to education on working with at-risk groups when bundled with occupational safety messages that highlight their own risk of acquiring HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) from a needle stick and other harms [ 14 , 22 , 30 , 56 ]. Police education programs also can address pervasive misconceptions about addiction, and medication for the treatment of opioid use disorder (OUD), as well as the efficacy of harm reduction programming [ 57 ] and accurate information about the risks of fentanyl exposure [ 57 , 58 ].…”