Safely disposing unused and unwanted prescription and over-the-counter medications: a public health, housing, and safety partnership in Framingham, MA.

BACKGROUND: The improper disposal of unused drugs can harm the environment and living beings. Programs such as drug take-back bins encourage people to dispose of unused medication at designated locations have increased. Unfortunately, awareness and participation is low, especially in ethnically and culturally diverse communities. The purpose of this paper is to describe the implementation of the Knock Talk and Toss (KTT), a drug take-back program aimed at taking unused drugs out of circulation and building police-resident connections in the housing authority of Framingham, MA. METHODS: Multi-lingual brochures on the dangers of unused drugs and safe disposal were distributed on residents' doors via the police department and/or listservs to residents living in the housing authority. Awareness efforts were then followed-up by teams of individuals, including the police, going door-to-door to collect any unused drugs, no questions asked. During the visits, one team member observed resident characteristics, whether drugs were disposed, including the estimated quantity and type, and police/resident interactions. Interviews were conducted with key staff and Chi-square analyses were used to assess socio-demographic differences in proportions of individuals willing to toss drug(s). RESULTS: A total of 27 h were spent going door-to-door and 33 pounds of drugs were disposed. Households with observed adults aged 65 years or older and children/teenagers were twice as likely to dispose drugs compared to households, where these populations were not present. CONCLUSION: Initiatives, such as KTT, where police go door-to-door in areas with a higher concentration of families and elderly may help take unused drugs out of circulation while also enabling the police to have a positive presence in the community.

A Volunteer Program in Maine to Transport Community Members to Health Care Appointments.

Transportation to health care appointments is a well-known barrier for many people, especially people living in rural areas. At the Kennebec Valley Community Action Program (KVCAP), 1 of 8 regional transportation centers in Maine, a robust volunteer program consisting of 93 drivers complements a staff of 45 drivers and 23 office staff members. The volunteers drive approximately 5 to 40 hours per week and have served for an average 4.4 years (range, 1-26 y); their ages range from 23 to 88. The volunteer driver program consists of a volunteer coordinator who communicates with volunteers; staff members who schedule rides; a software application (app) that serves as an interface between the agency and the volunteers as they drive clients to and from medical and social service appointments; regular training; recognition events; and incentives. Most clients have no other transportation option and indicated in informal surveys conducted by KVCAP that they would not attend appointments if the volunteer program were not available. In rural settings, volunteer driving networks provide a viable model to help meet the transportation needs of the population. Recruitment and retention of volunteers is an ongoing effort.

Diversion Alert: 1-Year Evaluation Across Northern New England, 2013-2014.

This report describes Diversion Alert, a unique online tool aimed at reducing misuse and diversion of prescription drugs, and reports the results of a 1-year evaluation of Diversion Alert's impact in Maine. We used a quasi-experimental research design to compare survey data in Maine with those of neighboring states (New Hampshire and Vermont, 2013 and 2014). Compared with their counterparts in New Hampshire and Vermont who did not use Diversion Alert, prescribers and pharmacists in Maine who used Diversion Alert increased their communication with patients and other providers involved in their patients' care, became aware of patients arrested for prescription drugs possession or diversion, used best practices associated with prevention or detection of addiction and diversion more frequently, and attributed positive changes in their prescribing practices to Diversion Alert. In combination with other state and federal programs, Diversion Alert may be an effective tool to help prevent the misuse of opioid medications.

Evaluation of urban-rural differences in pharmacy practice needs in Maine with the MaPPNA / Evaluación de las diferencias urbano-rural en las necesidades de la farmacia práctica en Maine con el MaPPNA

Background: Maine is a rural state with an aging population located in the northeastern United States. Pharmacists play an important role in serving the public’s health as they are often the most available point-of-contact within a community. Objective: To assess the current pharmacy practice needs as viewed by licensed pharmacists across our rural state, and to distinguish issues that are unique to rural pharmacy practice. Methods: An online survey was sent to all licensed pharmacists in the state in the fall of 2014 (n=1,262) to assess their pharmacy practice needs, and specify an rural-specific needs, within the categories of (1) opioid misuse, abuse, and diversion, (2) challenges associated with access to healthcare, (3) poly-pharmacy use, (4) meeting the needs of special populations, (5) lack of antibiotic stewardship, and (6) resources, such as staffing. Results: The response rate was 22.1 % (n=279). We found the most agreed upon issue facing pharmacists’ in Maine is opioid use, misuse and diversion, followed closely by shortages in staffing. We also learned that pharmacists’ view pharmaceutical care for older adults, those with low health literacy, and those with mental disabilities more time-consuming. Some urban-rural differences were discovered in with regard to the pharmacists’ views; such as the magnitude of the distance barrier, and limited transportation options available to rural residents. Issues related to polypharmacy were viewed as more problematic by pharmacists practicing in urban versus rural sites. Conclusions: Pharmaceutical care in Maine must focus on meeting the needs of the elderly, those with disabilities, and those with limited health literacy. As with the rest of the nation, opioids challenge pharmacy practice in a variety of ways. These findings clarify areas that present opportunities for pharmacists to focus more specifically on Maine’s largely rural population (AU)

Antecedentes: Maine es un estado rural con una población envejecida localizado al noreste de los Estados Unidos. Los farmacéuticos desempeñan un papel importante sirviendo la salud del público, ya que a menudo son el punto de contacto más disponible en una comunidad. Objetivo: Evaluar las necesidades de farmacia práctica actuales desde el punto de vista de los farmacéuticos registrados en nuestro estado rural, e identificar problemas que son específicos del ejercicio rural de la farmacia. Métodos: Se envió un cuestionario online a todos los farmacéuticos registrados en el estado en otoño de 2014 (n=1.262) para evaluar sus necesidades de la práctica, y las necesidades específicas del rural, con las categorías de (1) mal uso, abuso y uso recreativo de opiáceos, (2) retos asociados con el acceso a la sanidad, (3) uso de polimedicación, (4) satisfacción de las necesidades de poblaciones especiales, (5) falta de control antibiótico, y (6) recursos, tales como el personal. Resultados: La tasa de respuesta fue del 22,1% (n=279). Encontramos que la mayoría está de acuerdo que el mayor problema a los que se enfrentan los farmacéuticos es el uso, abuso y uso recreativo de opiáceos, seguido de cerca por la escasez de personal. Aprendimos también que los farmacéuticos ven la atención farmacéutica a ancianos, a los de baja literacía en salud y a los que padecen discapacidades mentales como más consumidora de tiempo. Se descubrieron algunas diferencias entre urbano-rural en la visión de los farmacéuticos tales como la magnitud de la barrera distancia, y las limitadas opciones de transporte disponibles para los residentes rurales. Los asuntos relacionados con la polimedicación eran vistos como más problemáticos por los farmacéuticos ejerciendo en ambiente urbano. Conclusiones: La atención farmacéutica en Maine debe centrarse en satisfacer las necesidades de los ancianos, de los que tienen discapacidades y de los que tienen baja literacía en salud. Como en el resto del país, los opiáceos amenazan el ejercicio de la farmacia de varios modos. Estos hallazgos clarifican áreas que representan oportunidades para que los farmacéuticos se centren más específicamente en la población mayoritariamente rual de Maine (AU)

A Pharmacy Student-Facilitated Interprofessional Diabetes Clinic With the Penobscot Nation.

BACKGROUND: American Indians/Alaska Natives have a greater increased risk for diabetes than non-Hispanic whites. Lifestyle interventions are effective in preventing and treating diabetes, and an interprofessional approach is important in diabetes management. COMMUNITY CONTEXT: The Penobscot Nation has a health center with a wide range of services. Our goal with the Nation was to 1) establish an interprofessional, student-facilitated diabetes clinic in the health center; 2) assess the clinic's preliminary impact. METHODS: Relationship building and problem solving was instrumental in working toward the first goal. A survey was developed to assess satisfaction with the clinic. The clinical outcomes, mean and median values of HbA1c, were calculated at baseline (spring 2013) and were used to establish 2 groups of patients: those with controlled levels (<7%) and those with uncontrolled levels (≥ 7%). HbA1c was reassessed in fall 2013. Changes in HbA1c were calculated and compared using the Wilcoxon signed-rank test. OUTCOMES: The student-facilitated, interprofessional diabetes clinic has operated for 2 years, and changes are under way. More than 90% of participants reported being well satisfied with the clinic in the first year. Among the group with uncontrolled HbA1c (n = 18), mean HbA1c values declined from 9.3% to 7.6% (P = .004). Among the group with controlled HbA1c (n = 30), 83% were controlled at follow-up. INTERPRETATION: The Penobscot diabetes clinic is evolving to meet the needs of community members, and pharmacy students have an interprofessional practice site well suited for experiential learning.

Notes from the field: the evaluation of Maine Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) experience.

More than half of all children in the United States aged 3 to 6 years are enrolled in child care centers. Maine received funds from the U.S. Department of Health and Human Services' Communities Putting Prevention to Work to promote the adoption of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC), an evidence-based program for the child care setting. We evaluated the rollout and adoption of NAP SACC in Maine using multiple methods. Our findings suggest that the NAP SACC program has been successfully adopted in Maine. Nutrition and physical activity policies and offerings have improved, especially with regard to purchasing healthier options in the child care setting.

Trek across Maine 25th anniversary: a public health strategy to increase physical activity.

Could an annual event be an effective strategy to improve physical activity? Based on 25 years of data, we argue that it could be. Although there are eight recommended strategies to promote physical activity in the Community Guide, there is insufficient evidence for six others. Qualitative data collected from Trek Across Maine participants and other cause-specific events suggests that goal setting (i.e., individually adapted health behavior change) and family-based social support may be key factors in helping individuals become more physically active.

Healthy Maine Partnerships: policy and environmental changes.

BACKGROUND: Tobacco settlement funds were used to establish the Healthy Maine Partnerships (HMPs) to reduce tobacco use, increase physical activity, and improve nutrition through local policy and environmental change. CONTEXT: The HMP model is a progressive approach to public health. It provides for coordinated efforts between state and local partners for health promotion and disease prevention. Community coalitions, supported with funding and guidance by the state, are the basis for policy and environmental change. METHODS: The state awarded contracts and provided program guidance to foster policy and environmental change at the local level. The partnerships' efforts were assessed with a retrospective evaluation that consisted of 2 data collection periods conducted using the same tool. A survey booklet containing lists of possible environmental and policy changes was developed and mailed - once in 2005 and once in 2006 - to all 31 local partnership directors and school health coordinators who completed it. Additional data were collected from the local partnerships in the form of narrative reports required by their funder (Maine Center for Disease Control and Prevention). CONSEQUENCES: All local partnerships implemented policy or environmental interventions to address tobacco use, physical activity, and nutrition during the period covered by the surveys (July 2002-June 2005 [fiscal years 2003-2005]). Cumulatively, more than 4,600 policy or environmental changes were reported; tobacco use policies represent most changes implemented. A second round of HMP funding has since been secured. INTERPRETATION: Although the survey methodology had limitations, results suggest that much work has been accomplished by the local partnerships. Plans are to share success stories among partnerships, provide training, and continue to improve the public health infrastructure in Maine.

The surveys are in! The role of local government in supporting active community design.

BACKGROUND: Recent studies detailing how the built environment affects health have found that land use and community design may have an impact on reducing sedentary lifestyles and increasing physical activity. METHOD: However, there is little information available about the attitudes of local officials and professional staff who often are directly responsible for making decisions about land use and community design. RESULTS: This opportunistic study reports findings across five major surveys that investigated healthy community design knowledge, attitudes, and practice among local officials and professional staff. When possible, comparisons and contrasts of survey responses and policy implications are discussed. CONCLUSIONS: The sharing of these data across professions is an important step toward enhancing collaboration in the fields and in better understanding the needs of local leaders related to active living and healthy community design.

The feasibility and utility of grocery receipt analyses for dietary assessment.

OBJECTIVE: To establish the feasibility and utility of a simple data collection methodology for dietary assessment. DESIGN: Using a cross-sectional design, trained data collectors approached adults (approximately 20 - 40 years of age) at local grocery stores and asked whether they would volunteer their grocery receipts and answer a few questions for a small stipend (dollar 1). METHODS: The grocery data were divided into 3 categories: "fats, oils, and sweets," "processed foods," and "low-fat/low-calorie substitutions" as a percentage of the total food purchase price. The questions assessed the shopper's general eating habits (eg, fast-food consumption) and a few demographic characteristics and health aspects (eg, perception of body size). Statistical Analyses Performed. Descriptive and analytic analyses using non-parametric tests were conducted in SAS. RESULTS: Forty-eight receipts and questionnaires were collected. Nearly every respondent reported eating fast food at least once per month; 27% ate out once or twice a day. Frequency of fast-food consumption was positively related to perceived body size of the respondent (p = 0.02). Overall, 30% of the food purchase price was for fats, oils, sweets, 10% was for processed foods, and almost 6% was for low-fat/low-calorie substitutions. Households where no one was perceived to be overweight spent a smaller proportion of their food budget on fats, oils, and sweets than did households where at least one person was perceived to be overweight (p = 0.10); household where the spouse was not perceived to be overweight spent less on fats, oils, and sweets (p = 0.02) and more on low-fat/low-calorie substitutions (p = 0.09) than did households where the spouse was perceived to be overweight; and, respondents who perceived themselves to be overweight spent more on processed foods than did respondents who did not perceive themselves to be overweight (p = 0.06). CONCLUSION: This simple dietary assessment method, although global in nature, may be a useful indicator of dietary practices as evidenced by its association with perceived weight status.

Correlates of physical activity in a national sample of children aged 9-13 years.

BACKGROUND: Physical activity (PA) is critical for children's normal growth and development. The purpose of this study was to assess potential correlates of physical activity in a US national sample of youth aged 9-13 years. METHODS: A nationally representative telephone survey of parent-child pairs was conducted from April through June 2002. The questions assessed organized and free-time physical activity behavior and psychosocial and environmental variables that are potentially related to youth physical activity. RESULTS: Children's positive outcome expectations or beliefs about the benefits of participating in physical activity and parent's beliefs that participating in physical activity is important were related to participation in both organized and free-time physical activity. Children's perception of parental support and parent's reports of direct support were strongly related to organized physical activity. Feeling safe, having lots of places to be active, and parental participation with their child were strongly related to free-time physical activity. CONCLUSIONS: Messages and interventions aiming to increase children and adolescent's participation in organized and free-time physical activity should continue to focus on promoting the benefits that are associated with being active, the importance of parental support, and the provision of safe and enjoyable opportunities to be active.

Urban, rural, and regional variations in physical activity.

PURPOSE: There is some speculation about geographic differences in physical activity (PA) levels. We examined the prevalence of physical inactivity (PIA) and whether U.S. citizens met the recommended levels of PA across the United States. In addition, the association between PIA/PA and degree of urbanization in the 4 main U.S. regions (Northeast, Midwest, South, and West) was determined. METHODS: Participants were 178,161 respondents to the 2000 Behavioral Risk Factor Surveillance System (BRFSS). Data from 49 states and the District of Columbia were included (excluding Alaska). States were categorized by urban status according to the U.S. Department of Agriculture. Physical activity variables were those commonly used in national surveillance systems (PIA = no leisure-time PA; and PA = meeting a PA recommendation). RESULTS: Nationally, PA levels were higher in urban areas than in rural areas; correspondingly, PIA levels were higher in rural areas than in urban areas. Regionally, the urban-rural differences were most striking in the South and were, in fact, often absent in other regions. Demographic factors appeared to modify the association. CONCLUSION: The association between PA and degree of urbanization is evident and robust in the South but cannot be generalized to all regions of the United States. For the most part, the Midwest and the Northeast do not experience any relationship between PA and urbanization, whereas, in the West, the trend appears to be opposite of that observed in the South.