Richard C. Goldsworthy

Beyond abuse and exposure: framing the impact of prescription-medication sharing.

OBJECTIVES We sought to document the frequency, circumstances, and consequences of prescription medication-sharing behaviors and to use a medication-sharing impact framework to organize the resulting data regarding medication-loaning and -borrowing practices. METHODS One-on-one interviews were conducted in 2006, and participants indicated (1) prescription medicine taken in the past year, (2) whether they had previously loaned or borrowed prescription medicine, (3) scenarios in which they would consider loaning or borrowing prescription medicine, and (4) the types of prescription medicines they had loaned or borrowed. RESULTS Of the 700 participants, 22.9% reported having loaned their medications to someone else and 26.9% reported having borrowed someone elses prescription. An even greater proportion of participants reported situations in which medication sharing was acceptable to them. CONCLUSIONS Sharing prescription medication places individuals at risk for diverse consequences, and further research regarding medication loaning and borrowing behaviors and their associated consequences is merited.

Prescription Medication Sharing Among Adolescents: Prevalence, Risks, and Outcomes

We interviewed 594 adolescents throughout the United States. One in five reported sharing prescription medication. Of these, less than half received instructions, many delayed professional care, few informed providers, and a third reported experiencing side effects. Efforts to reduce medication sharing prevalence and risks among adolescents may be justified.

Evaluation of an Intervention Among Adolescents to Reduce Preventive Misconception in HIV Vaccine Clinical Trials

PURPOSE Placebo and randomization are important concepts that must be understood before youth can safely participate in HIV vaccine studies or other biomedical trials for HIV prevention. These concepts are central to the phenomenon of preventive misconception that may be associated with an increase in risk behavior among study participants related to mistaken beliefs. Persuasive messaging, traditionally used in the field of marketing, could enhance educational efforts associated with randomized clinical trials. METHODS Two educational brochures were designed to increase knowledge about HIV vaccine clinical trials via one- and two-sided persuasive messaging. Through the Adolescent Medicine Trials Network, 120 youth were enrolled, administered a mock HIV vaccine trial consent, and then randomized to receive either no supplemental information or one of the two brochures. RESULTS The two-sided brochure group in which common clinical trial misconceptions were acknowledged and then refuted had significantly higher scores on knowledge of randomization and interpretation of side effects than the consent-only control group, and the willingness to participate in an HIV vaccine trial was not decreased with the use of this brochure. CONCLUSION Two-sided persuasive messaging improves understanding of the concepts of randomization and placebo among youth who would consider participating in an HIV vaccine trial. Further evaluation of this approach should be considered for at-risk youth participating in an actual trial of a biomedical intervention for HIV prevention.

Patient and Partner Perspectives on Patient-Delivered Partner Screening: Acceptability, Benefits, and Barriers

The study examined willingness to engage in patient-delivered partner screening (PDPS) and preferences for expedited partner services (EPS). Forty urban U.S. sexually transmitted infection (STI) clinic patients participated in individual mixed-methods interviews exploring EPS preferences and PDPS willingness. Most participants selected PDPS and PDPT together and uptake varied by patient–partner relationship closeness. For PDPS, several potentially important barriers and benefits were identified. Perceived benefits included improved sexual health for patients and their sexual partner(s) as well as convenience, privacy, and the potential to enhance trust between sexual partners. Perceived barriers included concerns about PDPS processes (e.g., time it would take to receive the result, risk of sample contamination), the accuracy of results, STI stigma and associated blame, lack of trust for a sexual partner, and the packaging/appearance of the screening kit. PDPS affords benefits and may overcome treatment barriers in some situations; however, it shares common PDPT barriers and has its own unique challenges. There are also concerns regarding how the offer of PDPS may interact with PDPT utilization.

New and improved: The role of text augmentation and the application of response interpretation standards (coding schemes) in a final iteration of birth defects warnings development

BACKGROUND Several birth defects warning symbols identified as most successful in an earlier study (Mayhorn and Goldsworthy, 2007) were further modified and then evaluated within a nationally distributed field trial (n = 2773). The purpose for the current research was to determine whether symbol warning components could be improved further, whether the addition of text enhanced comprehension uniformly across symbols, and whether results varied by the application of different interpretation standards (coding schemes). METHOD A total of 11 warning labels were examined: four new symbols plus the existing baseline symbol, each in versions with and without text, plus a text-only condition. Participant interpretation accuracy and preferences were assessed during face-to-face interview sessions. RESULTS For symbol-only conditions, several candidate symbols outperformed the existing symbol, one substantially so. The effect of adding text to symbols varied significantly by symbol. Symbol plus text and text-only conditions performed equivalently, generally exceeded symbol-only conditions, and often surpassed the American National Standards Institute benchmark of 85% accurate interpretation. CONCLUSIONS The research effort has identified a teratogen symbol and warning that outperforms the one currently in use. The effort has also identified important pragmatic and conceptual issues that should inform future work to improve medication labeling and other hazard communication.

Discovering Sexual Health Conversations between Adolescents and Youth Development Professionals.

Youth development professionals (YDPs) working at community-based organizations are in a unique position to interact with the adolescents because they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the framework of the Sexuality Information and Education Council of the United States (SIECUS) comprehensive sexuality education guidelines. YDPs reported conversations with adolescents that included topics related to the SIECUS key concepts of human development, relationships, personal skills, sexual behavior, and sexual health.

On Warning Symbols, Text, and ‘getting it right’: The Iterative Refinement of a Teratogenic Pharmaceutical Label

Several birth defects warning symbols identified as most successful in an earlier study (Mayhorn & Goldsworthy, 2007) were further modified and then evaluated within a nationally distributed field trial (n = 2773). A total of 11 warning labels were examined: 4 new symbols plus the existing baseline symbol, each in versions with and without text, plus a text-only condition. Participant interpretation accuracy and preferences were assessed. For symbol-only conditions, several candidate symbols outperformed the existing symbol, one substantially so. The effect of adding text to symbols varied significantly by symbol. Symbol+text and text-only conditions performed equivalently, generally exceeded symbol-only conditions, and often surpassed the ANSI benchmark of 85% accurate interpretation. Implications are drawn from the process and outcomes in relation to warning design, warning evaluation, and future research.

A Qualitative Exploration of Community-Based Organization Programs, Resources, and Training to Promote Adolescent Sexual Health

Youth development professionals (YDPs) working at community-based organizations (CBOs) can promote adolescent sexual health through programs. This study explored the programs and resources that youth access at CBOs and training YDPs receive. Twenty-one semi-structured interviews were conducted with YDPs. Qualitative content analyses were conducted using NVivo. The study found that most YDPs described sexuality-related programs for youth. Many YDPs provided informal information and/or referrals for youth. Few YDPs were trained to address adolescent sexuality, but many sought outside resources. Also, YDPs have a unique opportunity to improve adolescent sexual health and sexuality. Five considerations for organizations that develop programs and training for CBOs are suggested.

Messages and Medical Behaviors: DTCA's Influence on Healthcare Consumer Thinking and Doing, and How We Can Help

Pharmaceutical direct-to-consumer advertising (DTCA) has grown exponentially and is suggested to increase perceived medication needs and patient drug requests. However, its impact on healthcare consumer safety is not well-understood. This effort sought to examine DTCA healthcare consumer effects and their public health and practical implications. During spring 2008, 2767 individuals were asked, through public intercept interviews, about pharmaceutical DTCA: recalled products, exposure frequency, exposure medium, and impact on a range of health-related behaviors and beliefs. Consumers report inundation with DTCA, with 8 of 10 respondents indicating exposure to messaging within the past 30 days. Television was the medium with the most noted impressions; direct mail, the least (although still >35%). Most impressions reported were for Viagra and Claritin. One of four participants reported cognitive or behavioral changes as a result of viewing DTCA: advertisements prompted people to believe they had an illness/condition, to seek more information, to schedule provider visits, and to ask providers about symptoms or medications during regular visits. Moreover, almost 1 in 5 reported an increased willingness to share their prescription medication with others if they saw it in DTCA, indicating that DTCA exposure may increase this risky behavior. DTCA are nearly ubiquitous yet consumers remained attuned to the message content. The effects of DTCA are complex and range from beneficial (e.g., information-seeking) to detrimental (e.g. medication-sharing). Interestingly, participants do not readily differentiate prescription versus over-the-counter DTCA. Increased attention to understanding DTCA appears worthwhile, perhaps targeting provider awareness of message effect, further regulation and modification of DTCA messaging, and enhancing DTCA media literacy as a component of health literacy. Human factors professionals have the right toolset to play an active role in these efforts.