Karen K. Gerlach

Consumer Understanding of Prescription Drug Information: An Illustration Using an Antidepressant Medication

Background Patient education and warnings have emerged as prominent interventions for improving drug safety. As part of the provision of information and guidance on safe use of drugs, patients often receive multiple pieces of written information when they obtain a prescription medication, including a Food and Drug Administration (FDA)–mandated medication guide (MG), consumer medication information (CMI), and patient package insert (PPI). Objective: To determine whether patients understand the materials providing drug information and whether the materials convey the intended information. Methods: Fifty-two adults with a high school education or less were shown an actual (blinded) MG, CMI, and PPI for a marketed antidepressant medication. Comprehension was tested with methods used by the FDA to assess label comprehension for nonprescription products. Results: The majority of participants (88.2%) looked at all 3 pieces of information provided. The mean (SD) time spent reviewing the CMI was 5.2 (4.8) minutes (range 0-21.9). 16.5(13.3) minutes for the PPI (range 0-43.0), and 2.5 (1.6) minutes for the MG (range 0-7.6). Less than 20% of participants were able to identify the symptoms of a rare but potentially life-threatening situation that can occur with this medication and only 61.5% recalled the risk of teen suicide, which is the sole focus of the MG. Respondents with lower literacy scores performed more poorly than those with higher literacy scores. Conclusions: Information provided with at least some prescription drugs is not adequately understood by less-educated consumers and does not effectively communicate critical safety messages or directions.

Understanding the Association Between Authoritative Parenting and Adolescent Smoking

Background: Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent–child relationship, such as parenting style. Methods: The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style—authoritative, permissive, autocratic, and unengaged—experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking. Results: Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents’ opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents’ opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents’ opinions about smoking are important. Discussion: Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.

Tobacco Use and Cessation Behavior Among Adolescents Participating in Organized Sports.

OBJECTIVES To examine the difference in tobacco use between adolescents who participate in organized sports and those who do not. METHODS Using a cross-sectional study design, this study uses data from a nationally representative sample of adolescents enrolled in public high schools in the United States. RESULTS Those participating in organized sports were 25% less likely to be current cigarette smokers. However, smokeless tobacco use was found to be associated with participation in organized sports. CONCLUSIONS Given the large proportion of students involved in organized sports, intervening through this venue to address tobacco use has the potential to reach significant numbers of adolescents.

Use of nicotine replacement therapy among never smokers in the 1999-2006 National Health and Nutrition Examination Surveys

Nicotine replacement therapies (NRT) have been available without a prescription in the United States since 1996. Given that nicotine, at least as it is delivered through tobacco products, is addictive, we examined whether NRT was being used by individuals who have never smoked cigarettes. Adults (n=18,986) and adolescents (n=9187) who participated in the in-home survey and physical examination components of the 1999-2006 National Health and Nutrition Examination Surveys were assessed for cigarette smoking status, other tobacco use or exposure, and use of NRT. Among the 8415 adults (ages 20 and older) who reported never having smoked 100 cigarettes and who provided a blood sample during their physical exam, 3 (0.08%; 95% CI=0.02-0.28%) reported using NRT within the 5 days prior to being examined. Among the 5510 adolescents (aged 12-19 years) who reported never smoking and who provided a blood sample, 5 (0.12%; 95% CI=0.04%-0.36%) reported using NRT. Analyses of cotinine (a metabolite of nicotine) from their blood samples, along with analysis of their other survey responses regarding additional nicotine exposures suggest that it is unlikely that any of the adults were never smokers using NRT and perhaps 2 adolescents may have been never smokers who used NRT. Based on these assessments, the re-estimated prevalence of NRT use by never smokers would be 0% among adults and 0.05% (95% CI=0.01-0.27%) among adolescents.

Changes in Adolescent Cigarette-Brand Preference, 1989 to 1996.

OBJECTIVE To understand changes in cigarette-brand choice by adolescents in the context of demographic differences and advertising. METHODS Data from 3 nationally representative cross-sectional surveys of adolescents were analyzed. RESULTS Marlboro, Camel, and Newport brand cigarettes accounted for over 80% of the cigarettes usually bought by adolescents in 1989, 1993, and 1996. Between 1989 and 1996, Marlboro and Camel market shares changed little, whereas preference for Newport doubled among white and Hispanic adolescents. CONCLUSIONS Brand preference among adolescents has been steadily concentrated among 3 brands. More attention may need to be focused on mentholated brands given the increase in Newports market share.

On the threshold of a dream.

2504 www.ccmjournal.org November 2015 • Volume 43 • Number 11 key organizational characteristics that may influence outcomes; and third, we should be more skeptical about our own beliefs. Remember, the conclusions about night intensivists come from six ICUs with no daytime intensivists that chose to have a night intensivist. The role of the intensivist in United States ICUs may indeed be a moving target. We will need to explore all of the interactions among the organizational factors—the ones we believe and the ones we would rather not believe.

Investing in substance abuse research: The Robert Wood Johnson Foundation story

3. 1991–1999: Working toward the substance abuse goal . . . . . . . . . . . . . . . . . . . . . . . S6 3.1. Healthy Nations: Reducing Substance Abuse among Native Americans (1991) . . . . . . S6 3.2. SmokeLess States: Statewide Tobacco Prevention and Control Initiatives (1993) . . . . . S6 3.3. Tobacco Policy Research Program (1993)/Substance Abuse Policy Research Program (1996). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S6 3.4. A Matter of Degree: Reducing High-risk Drinking among College Students (1996). . . . S7 3.5. The Center for Tobacco-Free Kids (1996). . . . . . . . . . . . . . . . . . . . . . . . . . . . S7 3.6. Addressing Tobacco in Managed Care (1997) . . . . . . . . . . . . . . . . . . . . . . . . . S7 3.7. Reducing Underage Drinking through Community and State Coalitions (1997) . . . . . . S7