The moral foundations of needle exchange attitudes

Abstract

Needle exchange services reduce the spread of disease. However, these services lack public support, in part because of moral misgivings. Research suggests that moral attitudes are grounded in at least five “foundations”: (1) Care, (2) Fairness, (3) Loyalty, (4) Authority, and (5) Purity. Understanding the moral basis of needle exchange attitudes could inform public health messaging. Participants in the study (n = 5,369) completed a questionnaire on needle exchange attitudes (NEA) and also completed the Moral Foundations Questionnaire (MFQ). The NEA had high internal reliability. NEA was most strongly predicted (in the negative direction) by individual level of Purity concerns, followed by (in the positive direction) Care concerns. Moral Foundations Theory provides a framework for understanding moral attitudes towards needle exchange. Moral misgivings about needle exchange are associated with Purity concerns. If this association is causal, it may offer insight into how to build wider support for needle exchange programs.