Pharmacists' Perceptions of Tobacco Sales in an Elevated-Risk Population.

Background: Policies by the American Medical Association and the American Pharmacists Association advocate for the discontinuation of tobacco sales in pharmacies, yet tobacco sales remain lucrative for pharmacies in the United States. West Virginia has the highest smoking rate (29%) and the second highest lung cancer incidence in the country. Objective: This study examined pharmacists' perceptions of tobacco sales in pharmacies and awareness of relevant policies. Methods: West Virginia pharmacists (n = 195) were surveyed to understand tobacco sales in West Virginia pharmacy, utilizing Diffusion of Innovations as a theoretical framework. Results: Eighty-one percent were community pharmacists, and 39% practiced at independent pharmacies. Sixty-two percent reported that their pharmacies did not sell tobacco. Pharmacists at independent pharmacies were more likely to be in rural areas/small towns, have decision-making control over tobacco sales, and not currently selling tobacco products. Other community pharmacists (ie, at regional and national chains) were more likely to sell tobacco products, not have decision-making control over tobacco sales, and perceive revenue loss from discontinuing tobacco sales. Other types of pharmacists (eg, hospital) estimated a greater number of patients who were smokers/tobacco users. A logistic regression showed that less perceived revenue loss was associated with greater likelihood of not selling tobacco products (all Ps < .05). Conclusions: Findings indicate a strong movement among community pharmacists to curtail the use of tobacco. Generating support for the elimination of tobacco sales and adoption of tobacco cessation initiatives in community pharmacy could help reduce smoking rates in elevated-risk populations.

Insure Me Cancer Free: An Intervention Utilizing a Dynamic Communication Model.

The purpose of this study was to examine the impact of a pilot insurance company-based intervention guided by a Dynamic Communication Model to increase breast and colorectal cancer screening in Appalachian WV, a medically-underserved population with low screening rates. Our team and key informants developed letters and a website to promote cancer screening, and these were mailed to patients needing screening (breast: n = 232; colorectal: n = 324). After 6 months, a sample of women (n = 22) and men (n = 27) continuing to need screening received telephonic case management counseling. Screening rates were assessed at baseline, 6 months, and 12 months. A final telephone interview was conducted at 12 months with a subset of participants. Key informants (n = 21) provided feedback on the letter/website, resulting in improved readability, organization, and informational content. The letter/website had minimal impact on screening (breast: n = 8; colon: n = 5). The final telephone interview of plan members (n = 12) found they liked the personalized approach and appreciated learning more about cancer, and that you need to "catch it early for good treatment." All understood the counseling and believed the information was correct. Nearly all intended to get screened. Following counseling, screening numbers increased (total breast: n = 39; total colon: n = 18). Our theoretically-driven, case management counseling intervention was well received and has the potential to increase cancer screening rates, particularly in a rural, medically-underserved populations.

Breastfeeding: An Unknown Factor to Reduce Heart Disease Risk Among Breastfeeding Women.

BACKGROUND: Breastfeeding confers many health benefits not only to babies but also to their lactating mothers. Breastfeeding is a notable protective factor in the Gail model for breast cancer and is protective for heart disease. Although individuals in the Appalachian region have lower risk of developing breast cancer, their risk of heart disease is elevated compared with the national value for the United States. SUBJECTS AND METHODS: We surveyed 155 predominantly breastfeeding mothers of toddlers under 3 years old, recruited through parenting groups, daycares, and county extension in Appalachian West Virginia. Participants were asked their perceived comparative risks for breast cancer and heart disease and why they felt their risk was higher, same, or lower than that of the general population. RESULTS: For breast cancer, 29.7% felt their risk was lower than the general population. For heart disease, 26.5% felt their risk was lower than the general population. Although these risks were highly correlated (p=0.006), there was considerable variability in responses (p<0.03). Qualitative responses for breast cancer risk frequently included breastfeeding (30.3%) and family history (30.3%). Qualitative responses for heart disease noted family history (36.1%) but did not include breastfeeding. A regression analysis found that greater family history, shorter duration of breastfeeding, and fewer pregnancies were associated with greater breast cancer risk perceptions. Family history, lower household income, and current smoking were associated with greater heart disease risk perceptions. CONCLUSIONS: These well-educated, predominantly lactating women did not know the protective effects of breastfeeding for heart disease. Increased educational efforts about heart disease may be helpful to encourage more women to breastfeed.

Rapid screening, in vitro study of metal oxide and polymer hybrids as delivery coatings for improved soft-tissue integration of implants.

Metal-organic chemistry allows for molecular mixing and creation of a range of submicron phase-separated structures from normally brittle metal oxides and flexible polymers with improved bioactivity and delivery properties. In this study, we used a high throughput platform to investigate the influence of organic metal oxide doping of polydimethylsiloxane (PDMS) coatings on cellular bioactivity and controlled release of vanadium compared with titanium oxide coatings without additional PDMS. Metal-organic-derived titanium and or vanadium was doped into PDMS and used to form a coating on the bottom of cell culture microplates in the absence of added water, acids, or bases. These hybrid coatings were rapidly screened to establish how titanium and vanadium concentration influences cell proliferation, adhesion, and morphology. We demonstrate that titanium doping of PDMS can be used to improve cell proliferation and adhesion, and that vanadium doping caused a biphasic dose response in proliferation. A 28-day vanadium and titanium elution study indicated that titanium was not released, but the presence of PDMS in coatings increased delivery rates of vanadium compared with titania coatings without polymer. Hybrid coatings of titanium-doped polymers have potential for improving wound healing dynamics, soft-tissue integration of medical implants, and use as controlled delivery vehicles.

Controlled release of vanadium from titanium oxide coatings for improved integration of soft tissue implants.

This study evaluates the potential of titanium oxide coatings for short-term delivery of vanadium for improved wound healing around implants. Titanium and vanadium oxides are bioactive agents that elicit different bioresponses in cells, ranging from implant integration and reduction of inflammation to modulation of cell proliferation and morphology. These oxides were combined in biomaterial coatings using metal-organic precursors and rapidly screened in cell-culture microplates to establish how vanadium-loading influences cell proliferation and morphology. Twenty-eight-day elution studies indicated that there was a controlled release of vanadium from stable titanium oxide matrices. Elution profiles were mathematically modeled for vanadium loading of 20-1.25% up to a period of 28 days. Scanning electron microscopy and energy dispersive spectroscopy of the coatings indicated that the vanadium was present as a nanoscale dispersion and not segregated micron-scale islands. The study confirmed that the observed bioresponse of cells was modulated by the soluble release of vanadium into the surrounding medium. Controlled release of vanadium from titania coatings may be used to influence soft-tissue integration of implants by modulating cell proliferation, attachment, inflammation, and wound healing dynamics.