A Proposed Policy Agenda For Electronic Cigarettes In The US: Product, Price, Place, And Promotion.

Growth in the market for electronic cigarettes (e-cigarettes) raises complex questions about the devices' public health implications and, hence, challenging policy issues. We propose a policy agenda addressing concerns about preventing youth uptake of e-cigarettes and the desire to realize the potential of e-cigarettes to increase adult cigarette smoking cessation. We organize interventions according to the "four Ps" of marketing: product, price, place, and promotion. Policies include decreasing the addictiveness of combusted tobacco products while ensuring the availability of consumer-acceptable reduced-risk nicotine products, imposing large taxes on combustible products and smaller taxes on e-cigarettes, limiting the sale of all tobacco and (nonmedicinal) nicotine products to adult-only retailers, and developing communications that accurately portray e-cigarettes' risks to youth and benefits for inveterate adult smokers. All members of the public health community should unite to pursue a shared commitment to the principle that both youth and adults deserve a future free of tobacco-related disease.

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want.

Objective: To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development. Materials and Methods: We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes. Results: Providers lacked access to information about: patients' ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information's quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges. Discussion: These findings can inform the next generation of informatics tools for minimizing patients' out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources. Conclusion: Results identified opportunities to fill multidisciplinary providers' information gaps and ways in which new tools could better support medication affordability for patients.

Funding Community Health Activities: An Experiment Comparing Health Foundation's Priorities to Those of Public Health Agencies, Hospitals, and Nonprofit Organizations.

CONTEXT: Health foundations provide significant financial resources for community health. Foundation priorities, therefore, can play a key role in setting community agenda, but little is known about the criteria foundations use to prioritize projects. OBJECTIVE: To understand the priorities that guide decision makers in health foundations and compare those priorities with what is known about nonprofit hospitals, public health, and community-based nonprofits. DESIGN: An online survey with a discrete choice experiment and open-ended questions, asking respondents to choose between different types of community health projects based on project characteristics. SETTING: Survey respondents were employed by health foundations located in the United States. PARTICIPANTS: Respondents were leaders at health foundations (n = 173), the majority of which (56.2%) worked at foundations with assets greater than $50 million. These respondents were compared with an earlier survey (n = 561) from nonprofit hospitals, public health, and community-based nonprofits. MAIN OUTCOME MEASURES: A conditional logit model was used to estimate how various project characteristics led to greater or lesser support of a given health project. Open-ended questions aided interpretation. A two sample t test was used to compare groups. RESULTS: Foundation decision makers placed the greatest value on programs with coalitions of community partners, programs with a growing or existing base of evidence for effectiveness, and programs that focus on social determinants of health. These priorities are similar to those of community nonprofits, public health departments, and health systems. However, foundation leaders are more willing to fund interventions with longer time horizons and interventions that are not yet fully evidence-based. Foundations are also less interested in clinical care and more interested in advocacy programs. CONCLUSION: Cooperation in funding and implementation is essential to community health improvement, and major organizations could benefit from everyone clearly articulating their priorities. There are good reasons to intentionally foster both similarities and differences in priorities across organizations.