Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Degree Program

Nursing, PhD

Committee Chair

Hines-Martin, Vicki

Committee Co-Chair (if applicable)

Shawler, Celeste

Committee Member

Shawler, Celeste

Committee Member

Smith, Rachel, Vickers

Committee Member

Smart, Laura

Author's Keywords

syringe sharing; people who inject drugs; social determinants of health; syringe exchange program


This dissertation contains five chapters, including three manuscripts, covering harm reduction and some of the challenges people who inject drugs (PWID) face in their effort to reduce the risk of injection drug-related harms through sterile injecting supply acquisition and use. Chapter One discusses some background related to PWID and provides an overview of the issues addressed in this dissertation. Chapter Two includes a literature review covering the harm reduction concept, important aspects of syringe exchange programs as a harm reduction tool, and the social determinants of health model as a potential tool for future research. Chapter Three is a two-phase study that examines the problem of syringe and drug injecting equipment sharing and reuse among PWID participating in a syringe exchange program. This study explores the scope of the problem, then uncovers reasons contributing to syringe sharing and reuse behavior. Findings are applied to the social determinants of health model, with results demonstrating a number of social determinants that influence PWID behavior. In Chapter Four the author highlights approaches to sterile drug injecting supply acquisition used by PWID and presents policy alternatives. Finally, there is a discussion of a case study and description of how nurses can ethically support harm reduction strategies for PWID. Chapter Five contains a summary of findings and recommendations for future work.