Abstracts on Nutrition and Cancer

Objectives: Our first objective was to determine the accuracy of information provided to customers in health food stores (HFS) in Canada. The second objective was to compare the accuracy of this information with that provided to customers in pharmacies.

Methods: Undergraduate students visited 192 HFS and 56 pharmacies, located across Canada. In approximately half of the stores, they asked whether a specific supplement would help to prevent a particular condition or enhance health in a particular way. In the rest of the stores, they asked for advice on particular health concerns.

Results: On 88% of times that questions were asked in HFS, the recommendations made were either unscientific (6%) or were poorly supported by the scientific literature (82%). By contrast, this occurred for only 27% of visits to pharmacies (p < 0.01). Conversely, on two thirds of visits to pharmacies, staff gave advice considered to be fairly accurate or accurate, but this seldom occurred in HFS (68% vs. 7%, p < 0.01).

Conclusions: The vast majority of information provided in HFS in response to questions has little scientific support. Pharmacies are a far more reliable source of information, although they still have significant scope for improvement.     

Pharmacists' Concerns and Suggestions Related to the Sale of Tobacco and Alcohol in Pharmacies

A random sample of Pharmacists in Indiana was selected and surveyed regarding their thoughts and comments on the sale of tobacco and alcoholic products by pharmacies. A total of 212 pharmacists provided written responses to an open-ended question. The replies were then synthesized into major themes. The majority of comments categorized revealed strong opposition to pharmacies selling tobacco and alcohol products. The most frequently occurring message regarding the sale of these products by pharmacies was that it goes against the pharmacist's role as a professional health care provider and may harm their image. For some pharmacists, this issue posed a moral dilemma between caring for patient safety and the economic incentives provided by the sale of tobacco and alcohol. Based on these findings, a follow-up phone survey was conducted to solicit suggestions from pharmacists on how to advocate against the sale of tobacco and alcohol by pharmacies. The majority of pharmacists strongly recommended that they need to do more among themselves and within their store environment, rather than have regulations imposed on pharmacies when it comes to limiting the sale of these products.     

Selecting pharmacies for COVID-19 testing to ensure access

Rapid diagnostic testing for COVID-19 is key to guiding social distancing orders and containing emerging disease clusters by contact tracing and isolation. However, communities throughout the US do not yet have adequate access to tests. Pharmacies are already engaged in testing, but there is capacity to greatly increase coverage. Using a facility location optimization model and willingness-to-travel estimates from US National Household Travel Survey data, we find that if COVID-19 testing became available in all US pharmacies, an estimated 94% of the US population would be willing to travel to obtain a test, if warranted. Whereas the largest chain provides high coverage in densely populated states, like Massachusetts, Rhode Island, New Jersey, and Connecticut, independent pharmacies would be required for sufficient coverage in Montana, South Dakota, and Wyoming. If only 1,000 ZIP code areas for pharmacies in the US are selected to provide testing, judicious selection, using our optimization model, provides estimated access to 29 million more people than selecting pharmacies simply based on population density.

     

A review of tobacco abuse and its epidemiological consequences

Aim

The economic burden caused by death and disease in the world is credited mainly to tobacco use—currently linked to approximately 8,000,000 deaths per year with approximately 80% of these faralities reported in low and middle income economies. The World Health Organization (WHO) estimates that nearly 7,000,000 deaths are attributed to direct tobacco use, while approximately 1,200,000 non-smokers exposed to second hand cigarette smoke die every year. Accordingly, tobacco use is a major threat to the public health infrastructure; therefore, proper cessation interventions must be put in place to curb tobacco abuse and ease economic and social burdens caused by the tobacco epidemic.

Methods

A systematic review was conducted to investigate how scientific efforts have been advanced towards harm reduction among smokers and non-smokers. Relevant articles published during the period 2010–2020 in PubMed, Crossref, Google scholar, and Web of Science were used in this study. The articles were selected based on health impacts of cigarette smoking, tobacco cessation and emerging diseases, including Covid?19. Various cessation strategies have been identified although their efficiency is yet to match the desired results.

Results

A series of carcinogenic chemicals are generated during cigarette smoking resulting in serious health complications such as cancer and mutagenesis. The precursors for tobacco induced diseases are toxic and carcinogenic chemicals of the nitrosamine type, aldehydes, polonium-210 and benzo[a]pyrene, which bio-accumulate in the body system during cigarette smoking to cause disease. Rehabilitation facilities, use of drugs to diminish the desire to smoke, heavy taxation of tobacco products and warning labels on cigarettes are some of the cessation strategies employed towards curbing tobacco abuse.

Conclusion

The need for further research to develop better methods and research based policies for safe cigarette smoking and workable cessation strategies must be a priority in order to deal with the tobacco epidemic. Campaigns to promote tobacco cessation and abstinence are recommended in this review as a sure measure to mitigate against the deleterious impacts caused by cigarette smoking and tobacco abuse.

     

A comparison of three policy approaches for tobacco retailer reduction

BackgroundThe Institute of Medicine recommends that public health agencies restrict the number and regulate the location of tobacco retailers as a means of reducing tobacco use. However, the best policy strategy for tobacco retailer reduction is unknown.PurposeThe purpose of this study is to test the percent reduction in the number and density of tobacco retailers in North Carolina resulting from three policies: (1) prohibiting sales of tobacco products in pharmacies or stores with a pharmacy counter, (2) restricting sales of tobacco products within 1000 ft of schools, and (3) regulating to 500 ft the minimum allowable distance between tobacco outlets.MethodsThis study uses data from two lists of tobacco retailers gathered in 2012, one at the statewide level, and another “gold standard” three-county list. Retailers near schools were identified using point and parcel boundaries in ArcMap. Python programming language generated a random lottery system to remove retailers within 500 ft of each other. Analyses were conducted in 2014.ResultsA minimum allowable distance policy had the single greatest impact and would reduce density by 22.1% at the state level, or 20.8% at the county level (range 16.6% to 27.9%). Both a pharmacy and near-schools ban together would reduce density by 29.3% at the state level, or 29.7% at the county level (range 26.3 to 35.6%).ConclusionsThe implementation of policies restricting tobacco sales in pharmacies, near schools, and/or in close proximity to another tobacco retailer would substantially reduce the number and density of tobacco retail outlets.     

A Qualitative Exploration of Low-Income Women's Experiences Accessing Abortion in Massachusetts

BackgroundAt a time when most states are working to restrict abortion, Massachusetts stands out as one of the few states with multiple state-level policies in place that support abortion access for low-income women. In 2006, Massachusetts passed health care reform, which resulted in almost all residents having insurance. Also, almost all state-level public and subsidized insurance programs cover abortion and there are fewer restrictions on abortion in Massachusetts compared with other states.MethodsWe explored low-income women's experiences accessing abortion in Massachusetts through 27 in-depth telephone interviews with a racially diverse sample of low-income women who obtained abortions. Interviews were digitally recorded, transcribed, coded, and analyzed thematically.ResultsMost women described having access to timely, conveniently located, affordable, and highly acceptable abortion care. However, a sizable minority of women had difficulty enrolling in or staying on insurance, making abortion expensive. A small minority of women said their abortion care could be improved by increasing emotional support and privacy, and decreasing appointment times. Some limited data also suggest that young women and immigrant women face specific barriers to care.ConclusionThis study provides important, novel information about the need for state-level policies that support access to health insurance and comprehensive abortion coverage. Such policies, along with a well-functioning health care environment, help to ensure that low-income women have access to abortion. However, not all abortion access challenges have been resolved in Massachusetts. More work is needed to ensure that all women can access affordable, confidential care that is responsive to their specific needs and preferences.     

Women and Health Reform: How National Health Care Can Enhance Coverage,Affordability, and Access for Women (Examples From Massachusetts)

BackgroundMassachusetts women have the highest rates of health insurance coverage in the nation and women's access to care has improved across all demographic groups. However, important challenges persist. As national health reform implementation moves forward under the Affordable Care Act (ACA), states will likely encounter many of the same women's health challenges experienced in Massachusetts over the past 7 years.MethodsA review of the literature and data analyses comparing health care services access, utilization, and cost, and health outcomes from Massachusetts pre- and post-2006 health care reform identified two key challenges in women's continuity of coverage and affordability.ConclusionThese areas are crucial for state and national policymakers to consider in improving women's health as they work to implement health care reform at the state and federal levels.     

The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing

Objectives. Exposure to tobacco marketing has been associated with an increased likelihood that youth start smoking and may interfere with tobacco cessation. We aimed to describe the prevalence, placement, and features of tobacco advertising at the point of sale by race, ethnicity, and other neighborhood demographics, as well as by store type.

Design. A cross-sectional assessment of the advertising environment in establishments that held tobacco licenses in our study region (a metropolitan area in the Midwest USA) was conducted in 2007. Stores were geocoded and linked with block group demographic data taken from the Year 2000 US census. We calculated associations between our hypothesized predictors, race, ethnicity, and other neighborhood demographics, and two types of outcomes (1) amount and (2) characteristics of the advertising.

Results. Tobacco advertising at the point of sale was most common in gas stations/convenience stores, liquor stores, and tobacco stores. A 10% difference in a block group's African-American/Black population was associated with 9% (95% confidence interval [CI]=3%, 16%) more ads as well as a greater likelihood that ads would be close to the ground (prevalence ratio [PR]=1.15 [95% CI=1.04, 1.28]). Block groups with greater African-American/Black, Asian, people on public assistance or below 150% of the poverty threshold, or people under the age of 18 years had more ads for menthol brands. Block groups with greater proportions of Whites were more likely to have ads that used health words, such as ‘light’ or ‘natural’ (PR for 10% difference in White population=1.41 [95% CI=1.17–1.70]). Chain stores were more likely to have greater amounts of advertising, ads close to the ground, ads for price deals, or ads that use words that imply health.

Conclusion. Tobacco advertising targets communities with various racial and ethnic profiles in different ways. Now that US Food and Drug Administration has the authority to regulate the marketing and sale of tobacco products, there is new opportunity to reduce the harmful impact of tobacco advertising.     

Facilitators and barriers to implementing pharmacist-prescribed hormonal contraception in California independent pharmacies

ABSTRACT

In 2013, California passed legislation to expand the scope of pharmacist practice, including authorizing pharmacists to prescribe hormonal contraception. Pharmacist-prescribed contraception was largely unavailable across the state in 2017. This study aimed to identify barriers and facilitators to offering this service in California independent pharmacies. To do so, we thematically analyzed qualitative data from structured interviews with 36 pharmacists working in independent pharmacies in 2016–17. We found that pharmacists anticipated general benefits from expanding their roles to prescribe contraception, including increasing health care access and decreasing costs. In contrast, described barriers were concrete, including lack of financial incentives and business risks for independent pharmacies. Specific barriers to prescribing hormonal contraception included time required to screen and counsel women about contraception and concerns that pharmacist-prescribed contraception would increase liability and lead to patients seeking health care less frequently. This study suggests that incentives and barriers identified by the respondents are likely to have varied and unequal impacts, with immediate barriers being potentially prohibitive for pharmacists to prescribe contraception. For independent pharmacies, perceived business risks and lack of insurance reimbursement may outweigh professional support for prescribing contraception, limiting the public health impact of legislation that should increase contraceptive access.     

Competition among pharmacies and the typology of services delivered: The Portuguese case

ObjectiveTo analyze the impact of individual and market characteristics (such as competition) on the typology of services delivered by a community pharmacy after a recent Portuguese pro-competitive regulatory change.MethodsIn this paper, market concentration indices are used to identify market competition groups in the sample. These competition groups are then described with regard to the typology of services on offer by pharmacies within the group. Finally, a system of structural equations is estimated to verify if the decision of a pharmacy to offer or not to offer each of the studied pharmaceutical services is affected by local market regulated competition.ResultsIn some cases, pharmacies belonging to different competition groups do not present significant differences in terms of the typology of services on offer, but according to our regressions, it seems that vaccines and medicines administration services, pharmaceutical care programmes and medicines management programmes are more likely to be offered in pharmacies located in higher competitive markets. These are also urban areas, in which there is already easy access to products sold in pharmacies, and to health services in general.ConclusionsAccess to additional pharmacy services may in some cases increase as market competition increases. Thus, pro-competitive regulatory measures may have led to an asymmetric distribution of pharmacy services across the country, favouring more competitive urban marketplaces. If policy-makers are interested in a more symmetrical distribution of pharmacies services all over the country, they are recommended to take action to ensure equitable access to these services.     

Self-reported health problems of tobacco farmers in south-eastern Bangladesh

Aim

Poor farmers are cultivating tobacco because they can obtain great profit and support from tobacco companies. However, they overlook tobacco-related health problems and consequences. In this study, we explored the impact of tobacco farming on farmers’ health, drawing on an empirical study in seven villages of Ruposhipara union, Bandarban district in Bangladesh.

Subjects and methods

Following a mixed research method, data were collected by administering 200 pre-tested structured questionnaires, five group discussions and five in-depth interviews. We also reviewed existing and proposed policies related to tobacco control in Bangladesh. We followed grounded theory for analysing qualitative data and conducted a Chi-square test to observe any significant associations for selected quantitative data.

Results

Farmers’ self-reported tobacco-related sicknesses were nausea, vomiting, dizziness, headache, weakness, cough, dyspnoea and hypersalivation. Children, women and older people were equally affected. They experienced diverse tobacco-related health problems at different stages of tobacco farming. Continuous contact with tobacco leaves and not using any safety measures had put the farmers at greater risk of tobacco sickness.

Conclusion

The proposed “Tobacco Cultivation Control Policy, 2017” emphasised to provide necessary supports to farmers for growing alternative crops. Implementation of this policy would encourage farmers to give up harmful tobacco farming and lessen their health problems.

     

Nativity and language preference as drivers of health information seeking: examining differences and trends from a U.S. population-based survey

Objective: To examine differences in health information seeking between U.S.-born and foreign-born populations in the U.S.

Design: Data from 2008 to 2014 from the Health Information National Trends Survey were used in this study (n?=?15,249). Bivariate analyses, logistic regression, and predicted probabilities were used to examine health information seeking and sources of health information.

Results: Findings demonstrate that 59.3% of the Hispanic foreign-born population reported looking for health information, fewer than other racial/ethnic groups in the sample. Compared with non-Hispanic White, non-Hispanic Black (OR?=?0.62) and Hispanic foreign-born individuals (OR?=?0.31) were the least likely to use the internet as a first source for health information. Adjustment for language preference explains much of the disparity in health information seeking between the Hispanic foreign-born population and Whites; controlling for nativity, respondents who prefer Spanish have 0.25 the odds of using the internet as a first source of health information compared to those who prefer English.

Conclusion: Foreign-born nativity and language preference are significant determinants of health information seeking. Further research is needed to better understand how information seeking patterns can influence health care use, and ultimately health outcomes. To best serve diverse racial and ethnic minority populations, health care systems, health care providers, and public health professionals must provide culturally competent health information resources to strengthen access and use by vulnerable populations, and to ensure that all populations are able to benefit from evolving health information sources in the digital age.     

Epidemiologic and economic impact of pharmacies as vaccination locations during an influenza epidemic

IntroductionDuring an influenza epidemic, where early vaccination is crucial, pharmacies may be a resource to increase vaccine distribution reach and capacity.MethodsWe utilized an agent-based model of the US and a clinical and economics outcomes model to simulate the impact of different influenza epidemics and the impact of utilizing pharmacies in addition to traditional (hospitals, clinic/physician offices, and urgent care centers) locations for vaccination for the year 2017.ResultsFor an epidemic with a reproductive rate (R0) of 1.30, adding pharmacies with typical business hours averted 11.9 million symptomatic influenza cases, 23,577 to 94,307 deaths, $1.0 billion in direct (vaccine administration and healthcare) costs, $4.2–44.4 billion in productivity losses, and $5.2–45.3 billion in overall costs (varying with mortality rate). Increasing the epidemic severity (R0 of 1.63), averted 16.0 million symptomatic influenza cases, 35,407 to 141,625 deaths, $1.9 billion in direct costs, $6.0–65.5 billion in productivity losses, and $7.8–67.3 billion in overall costs (varying with mortality rate). Extending pharmacy hours averted up to 16.5 million symptomatic influenza cases, 145,278 deaths, $1.9 billion direct costs, $4.1 billion in productivity loss, and $69.5 billion in overall costs. Adding pharmacies resulted in a cost-benefit of $4.1 to $11.5 billion, varying epidemic severity, mortality rate, pharmacy hours, location vaccination rate, and delay in the availability of the vaccine.ConclusionsAdministering vaccines through pharmacies in addition to traditional locations in the event of an epidemic can increase vaccination coverage, mitigating up to 23.7 million symptomatic influenza cases, providing cost-savings up to $2.8 billion to third-party payers and $99.8 billion to society. Pharmacies should be considered as points of dispensing epidemic vaccines in addition to traditional settings as soon as vaccines become available.     

Public support for tobacco control policies: The role of the protection of children against tobacco

IntroductionIn many countries, health advocates aim to increase public support for tobacco control policies by framing these policies in terms of child protection. We examined whether support for the protection of children is indeed associated with support for tobacco control policies, even among smokers, opponents of state intervention and opponents of a governmental role in tobacco control.MethodsWe used a survey on a representative sample of Dutch adults of 18 years and older (n = 1631). The survey measured respondents’ support for banning tobacco displays, raising the age of sale for tobacco to 21 years and limiting tobacco sales to specialized shops. Regression analyses were done to assess the association with respondents’ support for the protection of children against tobacco. In further analyses, subgroup interactions were added.ResultsRespondents’ support for the protection of children against tobacco with legislation was positively related to support for all three policies. Associations were weaker for smokers (except for raising the age of sale) but similar for opponents of state intervention and opponents of a governmental role in tobacco control.ConclusionThis is the first paper to empirically support the idea that emphasizing the need to protect children against tobacco enhances support for tobacco control policies. This ‘child effect’ is effective in all segments of the population, albeit somewhat weaker among smokers.