Influence of nativity on cancer mortality among black New Yorkers

BACKGROUND: Cancer is the second leading cause of death in U.S., and blacks have higher cancer death rates than whites. The authors conducted an analysis to determine the influence of birthplace on cancer mortality among blacks in New York City. METHODS: Death records for New York City from 1988 through 1992 were linked to the 1990 U.S. Census data. Age-adjusted cancer death rates by race and birthplace were computed. The experience of black residents born in the South and Northeast of the U.S. and in Caribbean countries were compared with that of New York City whites. RESULTS: The cancer mortality rate of blacks exceeded that of whites for males (512.6 vs 385.6 per 100,000 per year), but was similar for females (270.8 vs 270.6). However, cancer death rates of Southern-born black males (615.7) were substantially higher than those of black males born in the Northeast (419.1) or the Caribbean (352.4). Carcinomas of the lung, prostate, breast, and colon/rectum accounted for >50 percent of all cancer deaths. Lung carcinoma mortality varied greatly by birthplace, with Caribbean-born blacks (63.5 and 19.2 for males and females, respectively) having approximately one-third the death rates of Southern-born blacks (187.8 and 52.5 for males and females, respectively), and <50 percent that of New York City whites (108.7 and 53.2 for males and females, respectively). These differences were present in each age category, but were most pronounced among those age 45-64 years. In striking contrast, death rates from prostate carcinoma were highest in Caribbean-born black men, and this were especially apparent in persons age > or = 65 years. CONCLUSIONS: The generally higher cancer mortality of blacks compared with whites masks even greater intraracial heterogeneity revealed through stratification by birthplace. In general, Caribbean-born blacks are at lower risk of cancer mortality than other blacks, and whites, but their advantage does not hold for prostate carcinoma, for which Caribbean-born men had the highest mortality rate.(AU)

Factors influencing pharmacists' preference for the legal classification of Rx-to-OTC switched drug products.

The United States is one of the few developed countries that has only two legal classifications of drug products, prescription (or legend) and non-prescription. U.S. pharmacy associations, however, are lobbying for legislation that will classify drugs which are switched from prescription to non-prescription (Rx-to-OTC) status as a third class of pharmacist-legend or pharmacy-only drug products. Pharmacists have indicated that their demand for a third class of drugs is to enable safer use of switched drug products by consumers through pharmacist supervision. Critics of the third class concept, however, have attributed the pharmacists' demand to a desire to gain economic control of the products. In order to assess empirically pharmacists' motivations, data collected from 389 randomly selected U.S. pharmacists, forming part of a larger study, were used to assess: (i) pharmacists' preferences for five selected conditions of sale for drug products switched from prescription to non-prescription status and (ii) the role of selected demographic and practice characteristics on pharmacists' preferences. Analyses of the data indicated that 'permanent pharmacist supervised sale (or a third class status)' and 'general unsupervised' sale were pharmacists' most and least preferred conditions of sale for switched products, respectively. Overall, pharmacists preferred conditions of sale that involved pharmacist supervision over those that did not. Pharmacists' preferences differed significantly when compared on the basis of their employment status. Owner or partner pharmacists indicated a greater preference for the pharmacist-supervised third class status for switched drug products and a lesser preference for unsupervised sale of switched drug products than staff, employee, director, or manager pharmacists. Pharmacists' preferences for the conditions of sale also differed by the nature of the professional association in which they were members. Pharmacists who were members of the American Society of Hospital Pharmacists (ASHP) indicated a greater preference for 'unsupervised sale after initial diagnosis and prescription from a physician', than pharmacists who were not members of the association. Pharmacists who were members of the National Association of Retail Druggists (NARD) viewed unsupervised sale of switched products with greater disfavour than the non-members of that association. Overall, it appears that some pharmacists may be governed by safety concerns and some by economic concerns in their demand for a third class or pharmacy-only status for Rx-to-OTC switched drug products.