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1.
Epidemiology ; 35(4): 447-457, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38912711

RESUMO

BACKGROUND: Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures. METHODS: Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements). RESULTS: Localities that ultimately banned storefront recreational retail cannabis businesses had fewer harmful cannabis exposures for children aged <13 years (rate ratio = 0.82; 95% confidence interval = 0.65, 1.02), but not for people aged >13 years (rate ratio = 0.97; 95% confidence interval = 0.85, 1.11). Of 167 localities ultimately permitting recreational cannabis sales, overall restrictiveness was not associated with harmful cannabis exposures among children aged <13 years, but for people aged >13 years, a 1-standard deviation increase in ultimate restrictiveness was associated with fewer harmful cannabis exposures (rate ratio = 0.93; 95% confidence interval = 0.86, 1.01). For recommended provisions, estimates were generally too imprecise to detect associations with harmful cannabis exposures. CONCLUSION: Bans on storefront retail and other restrictive approaches to regulating recreational cannabis may be associated with fewer harmful cannabis exposures for some age groups following statewide commercialization.


Assuntos
Cannabis , Comércio , Centros de Controle de Intoxicações , Humanos , California/epidemiologia , Centros de Controle de Intoxicações/estatística & dados numéricos , Criança , Adolescente , Comércio/legislação & jurisprudência , Comércio/estatística & dados numéricos , Adulto
2.
BMC Public Health ; 24(1): 2153, 2024 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-39118033

RESUMO

BACKGROUND: More than 263,000 individuals died due to prescription opioid misuse between 1999 and 2020. Between 2013 and 2015 alone, pharmaceutical companies spent over $39 million to market opioids to over 67,000 prescribers. However, there is still limited information about differences in provider responses to promotions for medications. In this study we investigated and evaluated strategies used by opioid manufacturers to encourage overprescribing, specifically focusing on oncology. METHODS: We conducted a retrospective review of opioid industry documents released in litigation between 1999 and 2021. We began with a preliminary search for business plans in a subset of collections that identified key terms and phrases. These search terms were then used to narrow the investigation, which ultimately focused on Insys Therapeutics, and how they targeted oncology providers as well as patients with cancer pain. RESULTS: We found that, overall, Insys sought to market to institutions with fewer resources, to less experienced and high-volume providers, and directly to cancer patients, with the goal of encouraging increased opioid prescribing and use. CONCLUSIONS: Our research revealed gaps in provider training that may make some providers more susceptible to pharmaceutical marketing. Developing and promoting continuing education courses for providers that are free from conflicts of interest, particularly at smaller institutions, may be one step towards reducing opioid overprescribing and its associated harms.


Assuntos
Analgésicos Opioides , Indústria Farmacêutica , Humanos , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Padrões de Prática Médica/estatística & dados numéricos , Prescrição Inadequada/prevenção & controle , Pessoal de Saúde/psicologia
3.
J Am Pharm Assoc (2003) ; : 102201, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39097189

RESUMO

BACKGROUND: Over 1 million people in the US are infected with human immunodeficiency virus (HIV). As of 2021, pharmacists in California can prescribe PrEP and PEP without establishing a collaborative practice agreement in an effort to reduce HIV transmission. However, in 2021 less than 3% of independent pharmacies in the San Francisco Bay Area did so. To our knowledge, there has been no follow-up research assessing potential changes in PrEP/PEP furnishing rates in the region. OBJECTIVE: Assess the extent of PrEP/PEP furnishing in San Francisco Bay Area pharmacies 3 years after policy implementation. METHODS: We conducted an observational, cross-sectional study to identify independent community and mail-order pharmacies furnishing PrEP/PEP in the 9-county San Francisco Bay Area in 2024. Furnishing pharmacies were identified via phone calls and the findings were validated with in-person visits. We also identified the number of retail chain pharmacies furnishing PrEP/PEP in San Francisco County. RESULTS: We contacted 202 independent community and mail order pharmacies in the 9-county San Francisco Bay Area by telephone; of these, 16 reported furnishing PEP/PrEP and all confirmed their ability to furnish when visited in person. We contacted 67 retail chain pharmacies in San Francisco County; of these, 11 pharmacies reported furnishing PrEP/PEP (10 Safeway; 1 Walgreens). CONCLUSIONS: More pharmacies furnished PrEP/PEP in the 9-county San Francisco Bay Area in 2024 (8%) than in 2021 (3%); in addition, one retail chain pharmacy had instituted a furnishing protocol. However, furnishing rates remained low. Past research suggests that advertising and the development of furnishing protocols may help increase furnishing and increase medication access.

4.
J Am Pharm Assoc (2003) ; 64(1): 226-234.e2, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37595885

RESUMO

BACKGROUND: In the United States, more than 19 million people of reproductive age need access to publicly funded hormonal contraception or live in areas where it is not readily available. These include rural areas of the country, commonly known as contraception deserts. Pharmacist prescribing has been proposed to increase access, but little is known about its implementation in such areas. OBJECTIVE: This study quantified the extent of pharmacists' furnishing (prescribing) of hormonal contraception in California's Central Valley community pharmacies and identified barriers and facilitators to implementation. METHODS: The researchers conducted a cross-sectional, mixed methods, observational study by (1) contacting all community pharmacies in the 11 counties of the Central Valley to determine furnishing rates and (2) surveying and interviewing pharmacies that indicated they furnished hormonal contraception. RESULTS: Overall, 13% of pharmacies within the Central Valley reported that they furnished hormonal contraception. Pharmacists reported that barriers to furnishing included costs to patients and the pharmacy, lack of time and staff, lack of training and certifications, limited patient awareness of pharmacists' ability to furnish, pharmacists' limited confidence in furnishing, and patient use of emergency contraception as an alternative to hormonal contraception. Pharmacists reported that patients often sought hormonal contraception from pharmacists owing to ease of accessibility to a pharmacist; some other facilitators included advertising, confidentiality, low cost to patients, and referrals from other providers. CONCLUSIONS: Common barriers were identified across pharmacies that furnished hormonal contraception, indicating the need for strategies that reduce these barriers to help expand patient's access to these services and to increase pharmacists' ability and confidence to prescribe.


Assuntos
Contracepção Hormonal , Farmacêuticos , Humanos , Estados Unidos , Estudos Transversais , Prescrições de Medicamentos , Acessibilidade aos Serviços de Saúde , Anticoncepção , California
5.
Tob Control ; 2023 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-37989585

RESUMO

BACKGROUND: Reducing tobacco depictions in media has significant health benefits because tobacco placements in films normalise tobacco use and are linked to youth initiation. Cannabis depictions may have similar effects. Placing restrictions on film incentives has been suggested; however, it remains an unexplored strategy for reducing tobacco depictions. We investigated whether states and localities that offer film incentives have established funding restrictions to deter tobacco or cannabis depictions. METHODS: We conducted a descriptive cross-sectional survey of official state and local government websites in the USA that listed film incentives. We coded policy level (ie, state, local), incentive type (ie, tax credit, rebate), incentive amounts, programme qualifiers and presence and characteristics of tobacco and cannabis restrictions. RESULTS: Quantifiable tax incentives at the state level offered over $1.6 billion to producers. Among 50 US states and Washington, DC, 39 provided film incentives: 4 restricted tobacco and 0 restricted cannabis. Among the 238 local film offices we identified, 24 offered incentives; 5 restricted tobacco and 1 restricted cannabis. All the incentive restrictions excluded tobacco or cannabis purchases from reimbursement; there were no penalties for tobacco or cannabis depictions. CONCLUSIONS: Film incentives are large financial commitments that may undermine public health since they allow depictions of tobacco and cannabis that contribute to initiation and use. Few states or localities limit film incentives related to tobacco or cannabis, and the existing restrictions are unlikely to deter depictions or product placement. Restrictions on incentives are an underused tool for deterring tobacco and cannabis depictions in film.

6.
Subst Use Misuse ; 58(12): 1519-1527, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37401115

RESUMO

Background: Interventions are needed to increase access to tobacco treatment for people experiencing homelessness. We developed a community pharmacist-linked cessation program for adults experiencing homelessness that included one-time, pharmacist-delivered counseling and furnishing nicotine replacement therapy (NRT) for 3 months. Methods: We conducted a single-arm, uncontrolled trial of the pharmacist-linked intervention among adults experiencing homelessness recruited from three homeless shelters in San Francisco, CA. We asked participants to complete questionnaires at baseline and during 12 weekly follow-up visits. We obtained information on cigarette consumption, use of NRT, and quit attempts at each visit, and reported cumulative proportions during the study interval. We used Poisson regression and logistic regression, respectively, to examine factors associated with weekly cigarette consumption and quit attempts. We conducted in-depth interviews with residents to understand barriers to and facilitators of engagement. Results: Among 51 participants, average daily cigarette consumption reduced 55% from 10 cigarettes per day at baseline to 4.5 cigarettes at 13 wk follow-up, and 56.3% had CO-verified abstinence. Use of medications in the past week was associated with a 29% reduction in weekly consumption (IRR 0.71, 95% CI 0.67-0.74), and increased the odds of a quit attempt (adjusted odds ratio (AOR), 2.37, 95% CI 1.13-4.99). While residents benefited from engaging in the pharmacist-linked program to increase quit attempts, they felt that to sustain abstinence, longitudinal tobacco treatment was needed. Conclusions: A pharmacist-linked smoking cessation program at transitional homeless shelters can reduce structural barriers to cessation care and reduce tobacco use among people experiencing homelessness.


Assuntos
Alcoolismo , Pessoas Mal Alojadas , Abandono do Hábito de Fumar , Produtos do Tabaco , Adulto , Humanos , Farmacêuticos , Dispositivos para o Abandono do Uso de Tabaco
7.
J Am Pharm Assoc (2003) ; 63(2): 566-573, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36476261

RESUMO

BACKGROUND: California has sought to expand medication access and improve public health by authorizing pharmacists in California to prescribe certain medications since 2014. Medications with pharmacist-initiated prescribing, or furnishing, include naloxone, hormonal contraception, postexposure prophylaxis/preexposure prophylaxis, and nicotine replacement therapy. In light of the United States' opioid epidemic, naloxone, an opioid antagonist, this study considered furnishing rates in urban areas of California. Research from 2020 found 42.5% of pharmacies furnished naloxone. However, there has been limited study of furnishing outside of urban areas. OBJECTIVE: This study assessed pharmacist furnishing rates of naloxone in California's Central Valley and identified barriers and facilitators to implementation. METHODS: From April to May 2022, the researchers first conducted a cross-sectional, observational study of community and mail-order pharmacies in California's largely rural Central Valley, then collected interview data from a subset of pharmacists in stores that indicated they furnished naloxone. RESULTS: Forty-three percent of Central Valley pharmacies reported that they furnished naloxone. Interview respondents reported that barriers to furnishing included time restrictions, cost to patients, stigma, and language barriers. CONCLUSIONS: Furnishing rates in the Central Valley were slightly higher (43.4%) than those reported in previous research focusing on urban areas of California (42.5%). Identified barriers to furnishing were consistent with those identified in previous research. These findings suggest that further policy interventions may be needed to reduce out-of-pocket costs, establish stronger pharmacist-provider relationships, and provide education combatting stigma against opioid users to increase naloxone furnishing.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Farmácias , Abandono do Hábito de Fumar , Humanos , Naloxona , Estudos Transversais , Dispositivos para o Abandono do Uso de Tabaco , Antagonistas de Entorpecentes , California , Farmacêuticos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Overdose de Drogas/prevenção & controle
8.
Epidemiology ; 33(5): 715-725, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35944153

RESUMO

BACKGROUND: Cannabis outlets may affect health and health disparities. Local governments can regulate outlets, but little is known about the effectiveness of local policies in limiting outlet densities and discouraging disproportionate placement of outlets in vulnerable neighborhoods. METHODS: For 241 localities in California, we measured seven policies pertaining to density or location of recreational cannabis outlets. We geocoded outlets using web-scraped data from the online finder Weedmaps between 2018 and 2020. We applied Bayesian spatiotemporal models to evaluate associations of local cannabis policies with Census block group-level outlet counts, accounting for confounders and spatial autocorrelation. We assessed whether associations differed by block group median income or racial-ethnic composition. RESULTS: Seventy-six percent of localities banned recreational cannabis outlets. Bans were associated with fewer outlets, particularly in block groups with higher median income, fewer Hispanic residents, and more White and Asian residents. Outlets were disproportionately located in block groups with lower median income [posterior RR (95% credible interval): 0.76 (0.70, 0.82) per $10,000], more Hispanic residents [1.05 (1.02, 1.09) per 5%], and fewer Black residents [0.91 (0.83, 0.98) per 5%]. For the six policies in jurisdictions permitting outlets, two policies were associated with fewer outlets and two with more; two policy associations were uninformative. For these policies, we observed no consistent heterogeneity in associations by median income or racial-ethnic composition. CONCLUSIONS: Some local cannabis policies in California are associated with lower cannabis outlet densities, but are unlikely to deter disproportionate placement of outlets in racial-ethnic minority and low-income neighborhoods.


Assuntos
Cannabis , Etnicidade , Teorema de Bayes , California/epidemiologia , Comércio , Humanos , Grupos Minoritários , Políticas , Características de Residência , Análise Espaço-Temporal
9.
Am J Public Health ; 112(11): 1640-1650, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36075009

RESUMO

Objectives. To assess whether cannabis control policies that may protect public health were adopted evenly across California localities with differing sociodemographic compositions. Methods. From November 2020 to January 2021, we measured cannabis control policies for 241 localities across California and linked them to data on the characteristics of the communities affected by these policies. We evaluated whether disadvantaged communities were more likely to allow cannabis businesses and less likely to be covered by policies designed to protect public health. Results. Localities with all-out bans on cannabis businesses (65% of localities) were disproportionately high-education (55.8% vs 50.5% with any college) and low-poverty (24.3% vs 34.2%), with fewer Black (4.4% vs 6.9%) and Latinx (45.6% vs 50.3%) residents. Among localities that allowed retail cannabis businesses (28%), there were more cannabis control policies in localities with more high-income and Black residents, although the specific policies varied. Conclusions. Cannabis control policies are unequally distributed across California localities. If these policies protect health, inequities may be exacerbated. Public Health Implications. Uniform adoption of recommended cannabis control policies may help limit any inequitable health impacts of cannabis legalization. (Am J Public Health. 2022;112(11):1640-1650. https://doi.org/10.2105/AJPH.2022.307041).


Assuntos
Cannabis , California , Comércio , Humanos , Legislação de Medicamentos , Políticas , Saúde Pública
10.
J Am Pharm Assoc (2003) ; 62(1): 370-377.e3, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34429253

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). In 2019, California authorized pharmacists to furnish PrEP and PEP under Senate Bill 159 (SB-159). OBJECTIVE: Assess implementation of SB159 in San Francisco Bay Area community and mail-order pharmacies. METHODS: We conducted an observational, cross-sectional survey of independent community and mail-order pharmacies in the 9-county San Francisco Bay Area to identify those that were in the process of furnishing, actively furnished, or furnished under a collaborative practice agreement (CPA). We conducted interviews with furnishing pharmacies in April 2021, focusing on the barriers to and successes of implementation, as well as the impact of coronavirus disease 2019 (COVID-19), and qualitatively analyzed them. RESULTS: Of the 209 pharmacies contacted, 6 furnished under SB-159 (2.9%), 2 were in the process of furnishing under SB-159, and 1 furnished under a CPA. Six pharmacies and 7 pharmacists were interviewed. Barriers to implementation and furnishing included COVID-19, laboratory tests, lack of time and staff, cost to pharmacy, refill limitation, lack of patient awareness, difficulty arranging follow-up care, and vague wording of the policy. Facilitators to implementation included collaborations with clinics and health centers, privacy, increased accessibility, increased need in the patient population, and the pharmacy culture. CONCLUSION: Barriers and facilitators to PrEP and PEP furnishing were consistent across pharmacies, suggesting strategies that could be replicated and potential improvements to SB-159.


Assuntos
COVID-19 , Infecções por HIV , Farmácias , Profilaxia Pré-Exposição , Estudos Transversais , Humanos , Farmacêuticos , SARS-CoV-2 , São Francisco , Estados Unidos
11.
J Health Polit Policy Law ; 47(4): 453-472, 2022 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-35044464

RESUMO

CONTEXT: From 1999 to 2018 the opioid epidemic claimed more than 500,000 lives in the United States. Military veterans and older adults were particularly affected; veterans' deaths attributed to opioid use increased by 65% from 2010 to 2016, while opioid prescriptions for older adults increased ninefold between 1995 and 2010. METHODS: We reviewed internal pharmaceutical industry documents released in legal discovery to determine how companies targeted these groups to increase prescribing and sales. This review included an analysis of corporate goals and plans identified through internal emails, sales pitches, and presentations. FINDINGS: These policy and advertising campaigns focused on (a) lobbying policy makers, (b) undertaking unbranded campaigns promoting opioid use, and (c) promoting opioid use in research and the popular media. Opioid manufacturers claimed that opioids could resolve preexisting concerns identified among military veterans and older adults and that the use of opioids would improve quality of life. These campaigns were positioned as public health initiatives and efforts to increase disease awareness. CONCLUSIONS: The findings suggest a need for regulatory reform and transparency related to lobbying, advocacy group relationships with industry, and pharmaceutical advertising.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Veteranos , Idoso , Analgésicos Opioides/uso terapêutico , Humanos , Marketing , Oklahoma , Qualidade de Vida , Estados Unidos
12.
Nicotine Tob Res ; 22(6): 967-974, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-31058282

RESUMO

BACKGROUND: Increasing tobacco taxes, and through them, prices, is an effective public health strategy to decrease tobacco use. The tobacco industry has developed multiple promotional strategies to undercut these effects; this study assessed promotions directed to wholesalers and retailers and manufacturer price changes that blunt the effects of tax and price increases. METHODS: We reviewed tobacco industry documents and contemporaneous research literature dated 1987 to 2016 to identify the nature, extent, and effectiveness of tobacco industry promotions and price changes used after state-level tobacco tax increases. RESULTS: Tobacco companies have created promotions to reduce the effectiveness of tobacco tax increases by encouraging established users to purchase tobacco in lower-tax jurisdictions and sometimes lowering manufacturer pricing to "undershift" smaller tax increases, so that tobacco prices increased by less than the amount of the tax. CONCLUSIONS: Policymakers should address industry efforts to undercut an effective public health intervention through regulating minimum prices, limiting tobacco industry promotions, and by enacting tax increases that are large, immediate, and result in price increases. IMPLICATIONS: Tobacco companies view excise tax increases on tobacco products as a critical business threat. To keep users from quitting or reducing tobacco use in response to tax increases, they have shifted manufacturer pricing and developed specific promotions that encourage customers to shop for lower-taxed products. Health authorities should address tobacco industry efforts to undercut the effects of taxes by regulating prices and promotions and passing large and immediate tax increases.


Assuntos
Comércio/legislação & jurisprudência , Custos e Análise de Custo/normas , Impostos/legislação & jurisprudência , Indústria do Tabaco/legislação & jurisprudência , Produtos do Tabaco/economia , Uso de Tabaco/economia , Comércio/economia , Comportamento do Consumidor , Humanos , Saúde Pública , Impostos/economia , Indústria do Tabaco/economia
13.
Tob Control ; 29(e1): e10-e17, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31969381

RESUMO

BACKGROUND: Increasing the price of tobacco products has the potential to reduce tobacco consumption. As other forms of promotion have been increasingly restricted over time, tobacco manufacturers have relied more on trade discounts. Minimum price laws that prevented the use of manufacturer promotions were once common; however in most US jurisdictions these discounts are now legally protected. METHODS: We collected tobacco industry documents, state legislation and court cases between 1987 and 2016 to review tobacco manufacturer strategies to change minimum price laws in the USA. RESULTS: Beginning in 2000, tobacco manufacturers lobbied to amend minimum price legislation after state regulators indicated that manufacturer promotions were illegal under existing laws. Companies viewed changing these laws as critical to maintaining tobacco sales, and after the initiation of an industry lobbying campaign, at least 20 states changed the way they calculated tobacco prices. CONCLUSIONS: Modifying existing minimum price laws so that manufacturer discounts are no longer protected, and implementing new minimum price policies with comparable scope, would likely increase prices and reduce tobacco use.


Assuntos
Indústria do Tabaco , Produtos do Tabaco , Comércio , Humanos , Manobras Políticas , Nicotiana , Uso de Tabaco
14.
J Am Pharm Assoc (2003) ; 60(6): 1050-1057.e1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32948461

RESUMO

OBJECTIVES: In 2017, the Centers for Disease Control and Prevention reported more than 47,600 deaths as a result of opioid overdose in the United States. In an effort to reduce these deaths, California passed legislation providing pharmacists with the ability to furnish naloxone without a prescription. Our study examined pharmacies in San Francisco that furnished naloxone and provided guidance for pharmacies seeking to develop similar programs. The study aims were to (1) identify the legal, structural, social-environmental, and financial components of a pharmacy model that allows for successful naloxone distribution, (2) evaluate the attitudes and beliefs of pharmacy staff members toward patients receiving or requesting naloxone, and (3) assess relationships between these attitudes and beliefs and naloxone furnishing at the pharmacy. METHODS: This cross-sectional study used a series of semistructured interviews of pharmacy staff in San Francisco conducted April-October 2019. Through a thematic, inductive analysis of collected data, emerging themes were mapped to the primary study aims. RESULTS: We interviewed 14 pharmacists and pharmacy technicians at 4 community pharmacies. We identified 4 factors for success in implementing a naloxone furnishing protocol: administrative-led efforts, pharmacist-led efforts, increasing pharmacist engagement, and increasing patient engagement. The respondents also discussed the approaches they used to overcome previously identified barriers: cost, time, expectations of unwanted clientele, and patients' feelings of stigma. CONCLUSION: Pharmacists' approaches to implementing naloxone furnishing had common features across locations, suggesting many of these strategies could be replicated in other community pharmacies.


Assuntos
Serviços Comunitários de Farmácia , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Farmácias , Estudos Transversais , Overdose de Drogas/tratamento farmacológico , Humanos , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Farmacêuticos , São Francisco , Estados Unidos
15.
J Am Pharm Assoc (2003) ; 60(6): 963-968.e2, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32800456

RESUMO

BACKGROUND: In 2013, California passed Senate Bill 493, which allowed pharmacists to furnish hormonal contraceptives without a physician's prescription. Despite this expanded scope of practice, only 11% of the pharmacies reported furnishing hormonal contraception over the following 6 years. OBJECTIVES: Our study objectives were to determine the extent of hormonal contraceptive furnishing and identify the factors that led to successful implementation in San Francisco community pharmacies. METHODS: Backspace we conducted a cross-sectional survey to identify community pharmacies furnishing hormonal contraception in San Francisco. Interviews were coded inductively to identify consistent themes. Semistructured interviews with pharmacists at the locations that furnished contraception identified the factors that had led to successful implementation in local community pharmacies, as well as assessing changes in practice during the coronavirus disease (COVID-19) pandemic. RESULTS: San Francisco had 113 operational community pharmacies in April 2020. Of these, 21 locations reported that they furnished hormonal contraception (19%), and we interviewed pharmacists at 12 of those locations. We identified 3 key factors that drove implementation at the pharmacy level: administrative support, advertising, and pharmacist engagement. Additional drivers of implementation involved the nature of the community. The respondents also reported on barriers that continued to slow adoption, including consultation fees, time constraints, and patient privacy. Changes in demand for services owing to COVID-19 risks were inconsistent. CONCLUSION: Our findings suggest strategies that community pharmacies can use to expand their scope of practice and improve quality and continuity of care for patients.


Assuntos
COVID-19/epidemiologia , Serviços Comunitários de Farmácia/organização & administração , Anticoncepcionais Orais Hormonais/provisão & distribuição , Prescrições de Medicamentos/estatística & dados numéricos , Farmacêuticos/normas , Papel Profissional , Serviços Comunitários de Farmácia/normas , Estudos Transversais , Feminino , Humanos , SARS-CoV-2 , São Francisco/epidemiologia
16.
Tob Control ; 28(3): 274-281, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29954860

RESUMO

BACKGROUND: Cigarette packs are a form of advertising that distributes brand information wherever smokers go. In the 21st century, tobacco companies began using onserts on cigarette packs to communicate new advertising messages to smokers. METHODS: We reviewed tobacco industry documents dated 1926 to 2017 to identify how the tobacco industry developed and used onserts in marketing and to serve the industry's political and legal objectives. RESULTS: Onserts added to cigarette packs became a more cost-effective way for brands to market in the year 2000. Manufacturers then began studying them, finding that new messages were appealing, while repeated messages were ignored. By 2005, tobacco companies were using onserts to effectively communicate about new tobacco products and packaging changes. They also used repeated 'corporate responsibility' messages that were, according to the industry's own research, likely to be ignored. CONCLUSIONS: Tobacco companies have expanded on cigarette pack-based advertising. Twenty-first century onserts simultaneously seek to increase sales using materials that are novel, attractive and provide independent value, while undercutting public health messages about the risks of tobacco use using materials that repeat over time and are comparatively unattractive. Health authorities can use this industry research to mandate onserts to communicate effective health messages.


Assuntos
Marketing/métodos , Embalagem de Produtos/métodos , Indústria do Tabaco/economia , Produtos do Tabaco/economia , Publicidade/métodos , Publicidade/tendências , Comércio/economia , Humanos , Marketing/tendências , Embalagem de Produtos/tendências , Fumantes/psicologia , Indústria do Tabaco/tendências
17.
BMC Public Health ; 19(1): 1150, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438900

RESUMO

BACKGROUND: In 1976, the U.S. Sugar Association (SA), a globally networked trade organization representing the cane and beet sugar industry, won the Public Relations Society of America's (PRSA) Silver Anvil Award for a crisis communication campaign. Their campaign successfully limited the diffusion of sugar restriction policies to control obesity, heart disease, diabetes, and dental caries, and marked the beginning of the modern-day SA. The sugar industry continues to resist measures to reduce sugar consumption, therefore understanding and addressing industry opposition is crucial to achieving global targets to reduce non-communicable disease. METHODS: We critically analyze common crisis management rhetorical strategies used by SA to defend itself from perceived wrongdoing, and sugar from perceptions of harm using a thematic content analysis based on Hearit's Corporate Apologia theory. Data sources were internal SA documents related to the 1976 Silver Anvil Award in 1) PRSA records, 2) Great Western Sugar Company records, and 3) William Jefferson Darby Papers. RESULTS: SA, using prototypical apologia stances (counterattack, differentiation, apology, and corrective action) and rhetorical dissociation strategies (appearance/reality, opinion/knowledge, and act/essence) constructed a persuasive narrative to successfully defend sugar from a product safety crisis, and the sugar industry from a social legitimacy crisis. SA's overarching narrative was that restricting sugar, which it claimed was a valuable food that makes healthy foods more palatable, would cause harm and that claims to the contrary were made by opportunists, pseudoscientists, food-faddists, lay nutritionists or those who had been misled by them. SA's apologia does not meet criteria for truthfulness or sincerity. CONCLUSION: Corporate apologia theory provides an accessible way of understanding sugar industry crisis communication strategies. It enables public health actors to recognize and predict industry corporate apologia in response to ongoing product safety and social legitimacy challenges. Industry counterarguments can be examined for truthfulness and sincerity (or the lack thereof), and explained to policymakers considering sugar restriction policies, and to the public, thereby decreasing the effectiveness of illegitimate industry communication efforts to oppose regulation and legislation.


Assuntos
Distinções e Prêmios , Açúcares da Dieta , Indústria Alimentícia , Relações Públicas , Açúcares da Dieta/efeitos adversos , Humanos , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , Política Nutricional , Comunicação Persuasiva , Estados Unidos/epidemiologia
18.
Subst Use Misuse ; 54(10): 1627-1632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973038

RESUMO

Background: There is limited information on separate use and simultaneous use of tobacco and cannabis products, particularly for new electronic nicotine delivery systems (ENDS). This study presents detailed information about the prevalence and correlates of individual use, separate use, and simultaneous use of tobacco and cannabis in California, the first state to allow medical marijuana in the US. It specifically distinguishes between simultaneous use (both substances used in the same occasion) and separate use (both products used, but not simultaneously). Objectives: Participants in the 2016 California Adult Tobacco Survey (N = 3,058; age range 18-64 years) completed online surveys between February and March 2016 that assessed tobacco and cannabis use in the past 30 days. Results: Participants' use of tobacco (15% cigarettes) was higher than use of ENDS (6%) or cannabis (10%); the overall rate of separate use was 6% and the overall rate of simultaneous use was 3%. Correlates of tobacco use included lower levels of education and income. Correlates of simultaneous tobacco and cannabis use included being unemployed or having a disability. Conclusions/Importance: This survey of California residents suggests how use patterns change in states that legalize medical marijuana prior to recreational cannabis, although it may underestimate prevalence due to reliance on self-reported use. Persons who were unemployed and persons with disabilities were at higher risk for simultaneous use of tobacco and cannabis. These findings suggest that prevention and cessation interventions intended to target simultaneous use should address these populations, as well as adolescents and young adults.


Assuntos
Fumar Maconha/epidemiologia , Uso de Tabaco/epidemiologia , Adolescente , Adulto , California/epidemiologia , Comorbidade , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
19.
Health Promot Pract ; 20(3): 325-327, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30845844

RESUMO

Cigarette smoking contributes substantially to the increased financial- and health-related burdens among adults experiencing homelessness. We describe findings from a case study of a model to increase access to cessation services among adults experiencing homelessness. In partnership with Project Homeless Connect (PHC), we piloted a unique service delivery model that involved providing brief cessation counseling and pharmacotherapy to smokers from this population attending large-scale service events in San Francisco, with the goal of connecting them to long-term smoking cessation care. We participated in three service events between October 2017 and March 2018. We offered brief smoking cessation counseling to 45 individuals, and smoking cessation counseling and pharmacotherapy to 7 individuals experiencing homelessness. This model could improve public health if expanded to other cities, particularly the 200 other cities in the United States offering PHC service events.


Assuntos
Pessoas Mal Alojadas/estatística & dados numéricos , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar/métodos , Fumar/epidemiologia , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Humanos , Masculino , São Francisco , Abandono do Hábito de Fumar/psicologia , Seguridade Social , Estados Unidos
20.
BMC Public Health ; 18(1): 1129, 2018 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-30223799

RESUMO

BACKGROUND: In the late 20th century, US localities began increasing the minimum age of legal access (MLA) for tobacco from 18 to 21 years by enacting "Tobacco 21" ordinances. Although these policies have a strong evidence base and broad popular support, popular media coverage of tobacco control laws has not always been accurate. This study sought to determine if contemporaneous popular media reporting accurately reflected the scientific findings regarding increased tobacco MLAs. METHODS: We searched LexisNexis for popular media reports that (1) addressed proposed or enacted Tobacco 21 ordinances and were (2) published in English, (3) drawn from a US news source, and (4) written after January 2004. We conducted a content analysis for quality based on a validated measure of accuracy of reporting, the Index of Scientific Quality (ISQ), which allows assessment of articles by assigning scores ranging from 1 (lowest) to 5 (highest). RESULTS: Searches yielded 378 articles; after screening for relevance and duplicates, 98 were included in the review. All studies identified through the keyword searches addressed Tobacco 21 policies. The average global score identifying the scientific quality of the articles was 2.98 of 5. Over three-quarters of the popular media articles addressing Tobacco 21 laws were written after a systematic review of these policies was released by the Institute of Medicine and approximately 4 in 10 cited findings from that review. CONCLUSIONS: Popular media reports on Tobacco 21 laws demonstrated average overall quality and relied on both anecdotal and scientific evidence, in contrast to previous studies found that popular media reports on tobacco issues demonstrated low overall quality and relied primarily on anecdotal evidence. The systematic review of increased MLAs for tobacco written by the Institute of Medicine diffused quickly into popular reporting, suggesting that this type of evidence might improve research translation.


Assuntos
Meios de Comunicação de Massa/estatística & dados numéricos , Política Pública , Produtos do Tabaco/legislação & jurisprudência , Adolescente , Humanos , Estados Unidos , Adulto Jovem
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