Mary L. Aquilino

Smoking-Cessation Services in Iowa Community Pharmacies

Study Objective. To examine community pharmacy practice with regard to providing smoking‐cessation counseling.

Adolescent Pregnancy, teen perspectives on prevention

PURPOSE To elicit the views of teens concerning effective strategies to prevent pregnancy. DESIGN Qualitative methods and a focus group approach were used. METHOD The sample consisted of male and female adolescents, 14 to 19 years of age, in grades 9 to 12, who volunteered to participate in the study. Seven groups of teens met with the investigator twice over 2 consecutive weeks. Instruments included a Screening Questionnaire and Focus Group Discussion Guidelines. RESULTS Teens were concerned about teen pregnancy, and supported a comprehensive approach to sex education beginning in the early elementary grades, with age and developmentally appropriate content and reinforcement from late grade school through high school. Generally, teens thought that teaching abstinence in grade school followed by contraception education in junior high and high school was a realistic strategy for pregnancy prevention. They wanted to discuss sexual feelings as well as the mechanical aspects of sex. Finally, they did not want to be told not to have sex, but rather wanted to be guided in their own decision making. Teens wanted parents and other adults to be involved in helping them understand sexuality and make decisions about sexual behavior. CLINICAL IMPLICATIONS Nurses who work with families need to understand why teens are becoming pregnant, provide opportunities for teens to discuss sexual behavior, and educate parents on sexual development and parent-child communication. Nurses also need to let parents and teens know that they are a resource for information, guidance, and health services related to sexual development and behavior.

Predicting Tobacco Sales in Community Pharmacies Using Population Demographics and Pharmacy Type

OBJECTIVE To determine whether the population demographics of the location of pharmacies were associated with tobacco sales in pharmacies, when controlling for pharmacy type. DESIGN Retrospective analysis. SETTING Iowa. PARTICIPANTS All retailers in Iowa that obtained tobacco licenses and all pharmacies registered with the Iowa Board of Pharmacy in 2003. MAIN OUTCOME MEASURE AND INTERVENTIONS: Percentage of pharmacies selling tobacco (examined by pharmacy type using chi-square analysis); median income and distribution of race/ethnicity in the county for pharmacies that did or did not sell tobacco (t tests); predictors of whether a pharmacy sold tobacco (logistic regression using the independent variables county-level demographic variables and pharmacy characteristics). RESULTS County gender composition, race/ethnicity make-up, and income levels were different for tobacco-selling and -nonselling pharmacies. Logistic regression showed that whether a pharmacy sold tobacco was strongly dependent on the type of pharmacy; compared with independent pharmacies (of which only 5% sold tobacco products), chain pharmacies were 34 times more likely to sell tobacco products, mass merchandiser outlets were 47 times more likely to stock these goods, and grocery stores were 378 times more likely to do so. Pharmacies selling tobacco were more likely to be located in counties with significantly higher numbers of multiracial groups. CONCLUSION The best predictor of whether an Iowa pharmacy sells tobacco products is type of pharmacy. In multivariable analyses, population demographics of the county in which pharmacies were located were generally not predictive of whether a pharmacy sold tobacco.

Across the fertility lifespan: desire for pregnancy at conception.

Purpose:To illustrate trends in unintended pregnancy over a 5-year period and to describe variations in desire for pregnancy at conception in relation to maternal age, race/ethnicity, income, and education. Study Design and Methods:Data were collected as part of the Iowa Barriers to Prenatal Care Project, a large, multiyear study of new mothers. A brief questionnaire eliciting maternal experiences and behaviors during pregnancy was administered to new mothers in all Iowa hospitals providing maternity care following the birth of their baby. Sample sizes ranged from 16,714 to 19,421 over the 5 years included in this analysis (1997 to 2001), and response rates ranged from 44% to 53%. Results:The study sample closely matched the overall statewide profile of women in this age group. In each of the 5 years, about one third of the mothers giving birth indicated that they did not intend to become pregnant at that time, and another 4% to 5% indicated that they did not want to be pregnant at that time or in the future. There were no substantive variations across years. Maternal age, race/ethnicity, income, and education were significantly related to intendedness of pregnancy. Clinical Implications:The findings underscore the continuing challenge of unintended pregnancy, despite recent national attention to this issue. All women of childbearing age should be considered at risk for unintended pregnancy. Additional work is needed to examine reasons, attitudes, and behaviors associated with unintended pregnancies and to determine the relative predictive strength of key demographic variables to improve interventions aimed at decreasing unintended pregnancy rates.

WIC providers' perspectives on offering smoking cessation interventions.

Purpose To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. Study Design and Methods Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. Results Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. Clinical Implications WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.

Barriers to children having a medical home in Johnson County, Iowa: notes from the field.

Background In Iowa 70.7% of children who qualify for Title XIX and/or Title V services have a medical home, but in Johnson County, Iowa only 54.0% of such children have one. Objectives Identify barriers to access to a medical home for children who use Johnson County Public Health (JCPH) services and recommend strategies to overcome these barriers. Methods Families with children attending JCPH well-child and WIC clinics were randomly selected to be interviewed using a semi-structured, 38-item questionnaire. Data analysis used qualitative and quantitative methodologies. Results Among 71 families interviewed, 41 had children without a medical home and 85% of these families cited financial barriers. Lack of U.S. citizenship accounted for 59% without health insurance. A recent move contributed to 29% not having medical homes. Nine different languages were spoken among the 41 families without a medical home. Forty-one percent of all parents interviewed had never had a medical home themselves. Many parents perceived emergency departments as more convenient than doctors’ offices. Conclusions Lack of health insurance, due primarily to citizenship status, is the greatest barrier to access to a medical home in this population. The migratory nature of the U.S. population, marked cultural diversity, and parental attitudes were additional barriers to children’s access to a medical home. Strategies to overcome these barriers are discussed.

Unlocking the condoms: The effect on sales and theft

Community pharmacies may place condoms in locked displays or behind glass, thereby reducing access and consequent use. Objective Quantify sales and theft of condoms when condoms were unlocked and removed from behind glass in grocery pharmacies Methods Design. In this pilot study, condom displays were unlocked in selected pharmacies for three months. Participants. Eight grocery pharmacies in central Iowa agreed to participate. Intervention. Stores provided inventory at baseline, sales/theft thereafter in three monthly reports and sales for the same period one-year earlier. Outcome measures. Descriptive statistics quantified condom theft and sales. Number of pharmacies leaving condoms unlocked after the intervention was determined. Results Theft varied by pharmacy and ranged from an average of 1.33 boxes (units) per month to 27.33 per month. All stores experienced some increase in sales during the intervention. Two locations decided to re-lock their displays, only one indicated theft as the reason. Conclusion After removing condoms from locked displays, more condoms were purchased and stolen from the study pharmacies. Sales outweighed theft in all pharmacies.

Impact of a passive social marketing intervention in community pharmacies on oral contraceptive and condom sales: a quasi-experimental study.

BackgroundAlmost 50% of pregnancies in the United States are unwanted or mistimed. Notably, just over one-half of unintended pregnancies occurred when birth control was being used, suggesting inappropriate or poor use or contraceptive failure. About two-thirds of all women who are of reproductive age use contraceptives, and oral hormonal contraceptives remain the most common contraceptive method. Often, contraceptive products are obtained in community pharmacies. The purpose of this study was to determine whether a pharmacy-based intervention would impact sales of contraceptive products in pharmacies.MethodsThis study was conducted in Iowa and used a quasi-experimental design including 55 community pharmacies (independent and grocery) in 12 counties as the intervention and 32 grocery pharmacies in 10 counties as a comparison group. The passive intervention was focused towards 18–30 year old women who visited community pharmacies and prompted those of childbearing age to “plan your pregnancy” and “consider using birth control”. The intervention was delivered via educational tri-fold brochures, posters and ‘shelf talkers.’ Data sources for evaluation were contraceptive sales from intervention and comparison pharmacies, and a mixed negative binomial regression was used with study group*time interactions to examine the impact of the intervention on oral contraceptive and condom sales. Data from 2009 were considered baseline sales.ResultsFrom 2009 to 2011, condom sales decreased over time and oral contraceptives sales showed no change. Overall, the units sold were significantly higher in grocery pharmacies than in independent pharmacies for both contraceptive types. In the negative binomial regression for condoms, there was an overall significant interaction between the study group and time variables (p = 0.003), indicating an effect of the intervention, and there was a significant slowing in the drop of sales at time 3 in comparison with time 1 (p < 0.001). There was a statistically significant association between pharmacy type and study group, where the independent intervention pharmacies had a higher proportion of stores with increases in condom sales compared to grocery pharmacies in the intervention or comparison group.ConclusionsA passive community pharmacy-based public health intervention appeared to reduce the decrease in condom sales from baseline, particularly in independent pharmacies, but it did not impact oral contraceptive sales.