Table 2 Bivariate relationship between safer smoking supplies implementation and SSP characteristics in the United States, November–December 2023 (n = 118)
From: Implementation determinants of safer smoking supplies in U.S. syringe services programs
|  | Has not implemented smoking supplies (n = 39; 33.1%) | Has implemented smoking supplies (n = 79; 66.9%) | Total (n = 118)a | P-valueb | Unadjusted Prevalence Ratio (95% CI)c |
|---|---|---|---|---|---|
Organizational Characteristics | |||||
Region | |||||
 Midwestd | 7 (17.9%) | 12 (15.2%) | 19 (16.1%) | 0.006* | 1.11 (0.93, 1.34) |
 Northeaste | 3 (7.7%) | 18 (22.8%) | 21 (17.8%) |  | 1.27 (1.09, 1.47) |
 Westf | 12 (30.8%) | 36 (45.6%) | 48 (40.7%) |  | 1.20 (1.03, 1.38) |
 Southg | 15 (38.5%) | 13 (16.5%) | 28 (23.7%) |  | Ref |
Urbanicity of areas served$ | |||||
 Urban& | 22 (56.4%) | 51 (64.6%) | 73 (61.9%) | 0.693 | – |
 Suburban& | 10 (25.6%) | 27 (34.2%) | 37 (31.4%) | 0.643 | – |
 Exurban/Semi-rural& | 5 (12.8%) | 25 (31.6%) | 30 (25.4%) | 0.042* | 1.14 (1.03, 1.25) |
 Rural& | 13 (33.3%) | 33 (41.8%) | 46 (39.0%) | 0.676 | – |
Type of Organization$ | |||||
 Community-based Organization/Non-profit& | 22 (56.4%) | 65 (82.3%) | 87 (73.7%) | 0.011 | 1.20 (1.06, 1.37) |
 City, County, or State Health Department& | 15 (38.5%) | 16 (20.3%) | 31 (26.3%) | 0.107 | – |
 Otherh,& | 3 (7.7%) | 3 (3.8%) | 6 (5.1%) | 0.395* | – |
Funding sources$ | |||||
 Federal& | 24 (61.5%) | 31 (39.2%) | 55 (46.6%) | 0.074 | 0.89 (0.80, 0.98) |
 State& | 32 (82.1%) | 66 (83.5%) | 98 (83.1%) | 0.980 | – |
 Foundation& | 11 (28.2%) | 42 (53.2%) | 53 (44.9%) | 0.037 | 1.14 (1.04, 1.26) |
 Private donations from fundraising& | 13 (33.3%) | 43 (54.4%) | 56 (47.5%) | 0.097 | 1.12 (1.01, 1.24) |
 Otheri,& | 11 (28.2%) | 22 (27.8%) | 33 (28.0%) | 0.929 | – |
Duration of operation | |||||
 Less than one year | 0 (0%) | 2 (2.5%) | 2 (1.7%) | 0.816* | – |
 1–2 years | 1 (2.6%) | 5 (6.3%) | 6 (5.1%) |  |  |
 3–5 years | 8 (20.5%) | 16 (20.3%) | 24 (20.3%) |  |  |
 Greater than 5 years | 30 (76.9%) | 55 (69.6%) | 85 (72.0%) |  |  |
Number of unique clients (past month) | |||||
 Median [IQR] | 165 [288] | 300 [551] | 300 [499] | 0.175 | – |
 Unsure or missing | 16 (41.0%) | 20 (25.3%) | 36 (30.5%) |  |  |
Services offered$ | |||||
 Naloxone& | 38 (97.4%) | 79 (100%) | 117 (99.2%) | 0.360 | – |
 Syringes& | 32 (82.1%) | 77 (97.5%) | 109 (92.4%) | 0.012 | 1.40 (1.11, 1.75) |
 Safer snorting supplies& | 4 (10.3%) | 60 (75.9%) | 64 (54.2%) |  < 0.001* | 1.43 (1.30, 1.58) |
 Anal administration supplies& | 10 (25.6%) | 52 (65.8%) | 62 (52.5%) |  < 0.001 | 1.24 (1.12, 1.37) |
 Basic first aid& | 35 (89.7%) | 74 (93.7%) | 109 (92.4%) | 0.751 | – |
 Food& | 18 (46.2%) | 52 (65.8%) | 70 (59.3%) | 0.123 | – |
 Safer sex supplies& | 37 (94.9%) | 77 (97.5%) | 114 (96.6%) | 0.764 | – |
 HIV testing& | 28 (71.8%) | 56 (70.9%) | 84 (71.2%) | 0.995 | – |
 Hepatitis C testing& | 26 (66.7%) | 51 (64.6%) | 77 (65.3%) | 0.975 | – |
 PrEP or PEP for HIV& | 14 (35.9%) | 27 (34.2%) | 41 (34.7%) | 0.983 | – |
 HIV treatment& | 7 (17.9%) | 17 (21.5%) | 24 (20.3%) | 0.902 | – |
 Hepatitis C treatment& | 8 (20.5%1.) | 19 (24.1%) | 27 (22.9%) | 0.912 | – |
 STI testing& | 17 (43.6%) | 41 (51.9%) | 58 (49.2%) | 0.697 | – |
 STI treatment& | 15 (38.5%) | 23 (29.1%) | 38 (32.2%) | 0.593 | – |
 Basic clinical services& | 15 (38.5%) | 27 (34.2%) | 42 (35.6%) | 0.901 | – |
 Mental health services& | 15 (38.5%) | 20 (25.3%) | 35 (29.7%) | 0.339 | – |
 Referrals& | 35 (89.7%) | 71 (89.9%) | 106 (89.8%) | 1.000 | – |
 Case management/housing coordination services& | 18 (46.2%) | 41 (51.9%) | 59 (50.0%) | 0.842 | – |
 MOUD coordination& | 23 (59.0%) | 44 (55.7%) | 67 (56.8%) | 0.944 | – |
Duration of providing syringesj |  |  |  | 0.951* | – |
 Less than one year | 2 (5.1%) | 3 (3.8%) | 5 (4.2%) |  |  |
 1–2 years | 3 (7.7%) | 8 (10.1%) | 11 (9.3%) |  |  |
 3–5 years | 9 (23.1%) | 18 (22.8%) | 27 (22.9%) |  |  |
 Greater than 5 years | 18 (46.2%) | 44 (55.7%) | 62 (52.5%) |  |  |
 Unsure or missing | 7 (17.9%) | 6 (7.6%) | 13 (11.0%) |  |  |
Implementation Determinants | |||||
Perceived change in demand for smoking supplies (past 6 months) |  |  |  |  < 0.001* |  |
 Increased | 19 (48.7%) | 59 (74.7%) | 78 (66.1%) |  | 1.06 (0.93, 1.21) |
 Decreased | 0 (0.00%) | 0 (0.00%) | 0 (0.00%) |  | N/A |
 Unsure | 12 (30.8%) | 1 (1.3%) | 13 (11.0%) |  | 0.65 (0.55, 0.78) |
 Remained the same | 8 (20.5%) | 15 (19.0%) | 23 (19.5%) |  | Ref |
Barriers to implementation$ | |||||
Outer context | |||||
 Local policies& | 21 (53.8%) | 27 (34.2%) | 48 (40.7%) | 0.123 | – |
 Federal policies& | 13 (33.3%) | 24 (30.4%) | 37 (31.4%) | 0.948 | – |
 External opposition& | 15 (38.5%) | 14 (17.7%) | 29 (24.6%) | 0.048 | 0.86 (0.75, 0.98) |
 Fear of external pushback& | 17 (43.6%) | 18 (22.8%) | 35 (29.7%) | 0.067 | 0.87 (0.77, 0.99) |
 Insufficient funding& | 22 (56.4%) | 46 (58.2%) | 68 (57.6%) | 0.982 | – |
Inner context | |||||
 Unsure of the evidence& | 6 (15.4%) | 2 (2.5%) | 8 (6.8%) | 0.155* | – |
 Internal leadership opposition& | 11 (28.2%) | 6 (7.6%) | 17 (14.4%) | 0.011 | 0.79 (0.66, 0.94) |
 Limited awareness of need from staff/leadership& | 8 (20.5%) | 9 (11.4%) | 17 (14.4%) | 0.415 | – |
 Limited interest from SSP clients& | 1 (2.6%) | 0 (0%) | 1 (0.8%) | 0.331* | – |
 Unsure of best practices for implementation& | 4 (10.3%) | 5 (6.3%) | 9 (7.6%) | 0.476* | – |
 Missing | 0 (0.0%) | 5 (6.3%) | 5 (4.2%) | 0.169* | – |