{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:20:21Z","timestamp":1763011221826,"version":"3.45.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unsafe household sharps disposal and needle reuse among insulin-treated adults pose clinical and public health risks; however, population-based data from China are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional survey of consecutive insulin-treated outpatients at a tertiary hospital in Enshi, Hubei (February 2023\u2013December 2024). A cross-culturally adapted questionnaire captured 30-day disposal and reuse practices, community-safety incidents, and access determinants. Primary outcomes were unsafe disposal (household trash, public bins, or toilets\/sinks) and any needle reuse. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,810 insulin-treated adults, unsafe sharps disposal was widespread (59.0%; 95% CI: 56.7\u201361.2%). Disposal methods included loose trash at 43.5%, public bins at 15.9%, and approved containers at 24.7%. Needle reuse was reported by 32.5% (95% CI: 30.4\u201334.7%); among reusers (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f588), the primary reason was cost (47.1%). In adjusted models, unsafe disposal was associated with younger age (&amp;lt;30\u202fyears, aOR: 2.31; 95% CI: 1.42\u20133.76; 30\u201344\u202fyears: aOR: 1.67; 95% CI: 1.28\u20132.18), male sex (aOR: 1.38; 95% CI: 1.14\u20131.67), lower education attainment (no formal\/primary education: aOR: 2.84; 95% CI: 2.02\u20133.99), low income (aOR: 3.42; 95% CI: 2.31\u20135.07), travel time &amp;gt;30\u202fmin (aOR: 1.94; 95% CI: 1.51\u20132.49), lack of awareness about take-back programs (aOR: 2.12; 1.75\u20132.57), and limited availability of containers (aOR: 2.45; 95% CI: 2.01\u20132.98), pump usage (aOR: 0.45; 95% CI: 0.27\u20130.75), and counseling (aOR: 0.35; 95% CI: 0.29\u20130.43). Needle reuse showed similar patterns: younger age (aOR: 1.89; 95% CI: 1.18\u20133.03), male sex (aOR: 1.29; 95% CI: 1.07\u20131.55), lower education (aOR: 2.16; 95% CI: 1.56\u20132.99), low income (aOR: 2.87; 95% CI: 1.95\u20134.24), diabetes duration \u226510\u202fyears (aOR: 1.34; 95% CI: 1.11\u20131.61), travel time &amp;gt;30\u202fmin (aOR: 1.78; 95% CI: 1.39\u20132.28), lack of awareness (aOR: 1.87; 95% CI: 1.55\u20132.26), limited availability of containers (aOR: 3.21; 95% CI: 2.64\u20133.90), pump usage (aOR: 0.31; 95% CI: 0.15\u20130.64), and counseling (aOR: 0.42; 95% CI: 0.35\u20130.51). Community safety risks increased: unsafe disposal raised the odds of household needlestick (aOR: 3.47; 95% CI: 2.01\u20135.99) and observed the presence of needles in the community (aOR: 2.89; 95% CI: 1.85\u20134.52). Additionally, the reuse of needles has also increased, impacting both household needlestick incidents and community needle observations (aOR: 2.23; 95% CI: 1.42\u20133.50; aOR: 1.67; 95% CI: 1.13\u20132.47).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Unsafe disposal and needle reuse are prevalent and exhibit strong socioeconomic gradients. Targeted education, container provision, and accessible take-back programs may improve patient and community safety in China.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1698224","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T05:17:20Z","timestamp":1763011040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Access, awareness, and risk: drivers of unsafe sharps disposal and needle reuse in insulin-treated adults in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Shaoping","family":"Wu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1177\/19322968211059851","article-title":"Unsafe sharps disposal among insulin-using patients with diabetes mellitus: An emerging global crisis","volume":"16","author":"Thompson","year":"2022","journal-title":"J Diabetes Sci Technol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/1932296819882926","article-title":"Patterns of sharps handling and disposal among insulin-using patients with diabetes mellitus","volume":"15","author":"Montoya","year":"2021","journal-title":"J Diabetes Sci 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diabetic patients in Pakistan","volume":"5","author":"Ishtiaq","year":"2012","journal-title":"J Infect Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/j.ijnurstu.2016.04.010","article-title":"Safety of the reuse of needles for subcutaneous insulin injection: a systematic review and meta-analysis","volume":"60","author":"Zabaleta-Del-Olmo","year":"2016","journal-title":"Int J Nurs Stud"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1177\/19322968231187661","article-title":"Lipohypertrophy and insulin: An update from the diabetes technology society","volume":"17","author":"Tian","year":"2023","journal-title":"J Diabetes Sci Technol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2146","DOI":"10.2337\/dc24-0157","article-title":"Impact of syringe and needle reuse on the clinical outcomes of patients with type 2 diabetes: a 12-week randomized clinical 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healthcare professionals in Southwest Ethiopia","volume":"2025","author":"Yosef","year":"2025","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"ref17","first-page":"99","article-title":"Health hazards of medical waste and its disposal","volume-title":"Energy from toxic organic waste for heat and power generation","author":"Padmanabhan","year":"2019"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s13300-018-0525-y","article-title":"Insulin injection technique in China compared with the rest of the world","volume":"9","author":"Song","year":"2018","journal-title":"Diabetes Ther"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1185\/03007995.2014.895711","article-title":"Insulin pen injection technique survey in patients with type 2 diabetes in mainland China in 2010","volume":"30","author":"Ji","year":"2014","journal-title":"Curr Med Res 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