Katherine Lyon Daniel

Prescription Medication Borrowing and Sharing among Women of Reproductive Age

OBJECTIVE The purpose of this study was to describe the patterns of prescription medication borrowing and sharing among adults, particularly women of reproductive age. METHODS Data were collected from the 2001-2006 HealthStyles surveys, an annual mail survey conducted in the United States concerning trends in health behavior. The total responses received were 26,566 of 36,420 surveys mailed (response rate 73%). Of these total responses, there were 7,456 women of reproductive age (18-44 years). Survey questions included whether participants had ever shared or borrowed a prescription medication, how often participants shared or borrowed medications in the past year, and types of medications shared or borrowed. Data were weighted by matching sex, age, income, race, and household size variables to annual U.S. census data. Associations between demographic factors and borrowing and sharing were studied. RESULTS Overall, 28.8% of women and 26.5% of men reported ever borrowing or sharing prescription medications. Women of reproductive age were more likely to report prescription medication borrowing or sharing (36.5%) than women of nonreproductive age (>or=45 years) (19.5%) (rate ratio [RR] 1.87, 95% confidence interval [CI] 1.77-1.99). Of reproductive-aged women who borrowed or shared prescription medication, the most common medications borrowed or shared were allergy medications (43.8%) and pain medications (42.6%). CONCLUSIONS Prescription medication borrowing and sharing is a common behavior among adults and is more common among reproductive-aged women than among women in other age groups.

The return of thalidomide: can birth defects be prevented?

Thalidomide, the drug that caused a worldwide epidemic of serious birth defects in the late 1950s and early 1960s, was recently approved by the US Food and Drug Administration (FDA) for use in treating the skin disease erythema nodosum leprosum, a complication of leprosy. The drug has also shown promise in the treatment of other serious diseases. If thalidomide is eventually approved for use in the US and other countries for treatment of diseases more prevalent than erythema nodosum leprosum, or if use of the drug for non-approved indications becomes widespread, hundreds of thousands of women with childbearing ability could be treated. If this should happen, can we prevent another epidemic of birth defects?In an effort to prevent fetal exposures to thalidomide, the FDA mandated a comprehensive programme to regulate prescription, dispensing and use of the drug. The programme is designed to require registration of all participating pre-scribers, pharmacies and patients. It also requires use of effective methods of contraception and periodic pregnancy testing of all patients with childbearing ability during treatment. Prescribers are directed to counsel both female and male patients on the risks, benefits and proper use of the drug, as well as on the proper use of contraceptives during treatment. The patient is required to sign an informed consent form before beginning treatment. Prescription and dispensing of thalidomide will be tightly controlled. A thalidomide registry will monitor prescription, dispensing and use of the drug, and will investigate all reported fetal exposures.This mandatory, but untested, programme promises to be effective at preventing fetal exposures to thalidomide, provided that patients, prescribers and pharmacists comply with all of its provisions. However, even if the programme proves to be successful in the US, there is concern that thalidomide may eventually be widely used in countries that may not require such stringent controls. In Brazil, where thalidomide is commercially available for treatment of leprosy patients, 33 cases of thalidomide embryopathy have already been reported in the literature. Even in countries that may tightly regulate the distribution and use of thalidomide, some patients may obtain the drug through black market sources. Should these events occur, many cases of thalidomide-induced birth defects could appear. Therefore, there is a need to develop nonteratogenic analogues of thalidomide that can provide effective treatment for erythema nodosum leprosum and other serious conditions without increasing the potential for another epidemic of thalidomide-related birth defects.

Social Marketing and Health Communication: From People to Places

The author reflects on the role social marketing can play in helping health providers and public health experts communicate health information to the public. The author suggests that social ecological theory combined with social marketing can help public health experts identify environmental, interpersonal and demographic barriers to improving public health. Disease prevention information can utilize market segmentation strategies to provide information based on the social norms of communities.

Social marketing: planning before conceiving preconception care.

Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P’s, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence.

Broadcasting Behavior Change A Comparison of the Effectiveness of Paid and Unpaid Media to Increase Folic Acid Awareness, Knowledge, and Consumption Among Hispanic Women of Childbearing Age

Awareness about folic acids effectiveness in reducing the risk of certain birth defects has increased among women in the United States; however, few Hispanic women are consuming enough folic acid daily. A 1998 survey conducted by the Gallup Organization for the National March of Dimes Birth Defects Foundation found that English-speaking Hispanic women had lower folic acid awareness (53% vs. 72%) and lower daily consumption (29% vs. 33%) than non-Hispanic White women. In 1999, the Centers for Disease Control and Prevention (CDC) conducted baseline surveys with Spanish-speaking Hispanic women in selected U.S. markets to measure folic acid awareness, knowledge, and consumption. A Spanish-language public service announcement (PSA) volunteer campaign and a paid Spanish-language media and community education campaign were conducted in 2000 and 2002, respectively. Comparisons of postcampaign surveys indicate that the paid media campaign was significantly more effective than the PSA campaign in increasing folic acid awareness, knowledge, and consumption among Spanish-speaking Hispanic women.

New Communication Channels: Changing the Nature of Customer Engagement

Health communication and marketing professionals represent an exceptionally diverse field in their backgrounds and professional interests. A common factor among those who develop and implement health communication and marketing programs is the tactic of customer engagement. The widespread growth of new communication channels, however, has made it critical that health marketing professionals consider both new and traditional channels in developing health marketing programs to engage customers and deliver health information. Whereas there has been substantial progress in efforts to engage customers through these new channels, future work is needed to examine how these new channels can be integrated with traditional channels in health programs and to incorporate existing marketing knowledge into health promotion and disease prevention efforts.

Folic acid and preconceptional care.

If all women capable of becoming pregnant consumed 400 µg (0.4 mg) of the B vitamin folic acid daily before conception and during the first trimester, the annual number of neural-tube birth defect (NTD)-affected pregnancies in this country could be reduced by 50% to 70%. Despite this important relationship, most women are not aware that folic acid prevents NTDs, and folic acid supplementation rates remain low. If folic acid consumption is to succeed as a public health intervention on a societal scale, physicians who care for reproductive-age women must become informed about the folic acid-NTD prevention linkage. Next, they must be encouraged to counsel patients about the need to consume sufficient folic acid before conception. Studies reveal that few physicians have adequate knowledge of the appropriate timing and dosage of folic acid supplementation. Studies also show that women are more likely to get important folic acid information not from their physicians but from other sources. This article provides information about ways in which physicians can improve their folic acid knowledge and education practices.

The Power of Mom in Communicating Health

The author reflects on her views about how public health agencies can communicate better with members of the community. She notes that public health information for families should be easy for people to obtain and presented in a manner which makes it simple and enjoyable to understand. The author suggests that public health agencies should involve key public health stakeholders such as parents in research and intervention designs, create health information which is simple to understand and support policies such as school nutrition.