Use and Risk Perception of Electronic Nicotine Delivery Systems and Tobacco in Pregnancy.

INTRODUCTION: Given the rapid rise in availability and use, understanding the perception of electronic nicotine delivery systems (ENDS) products in pregnant women is vital. As more women of reproductive age use these products, it is likely that their use during pregnancy is also increasing. This study investigated the use of ENDS and tobacco cigarettes, along with knowledge and perceptions of associated health risks in pregnant women. METHODS: A cross-sectional survey was conducted at a university-based obstetrical clinic. A 32-item self-administered survey was used to collect participants' knowledge, use, and risk perceptions of ENDS and tobacco smoking. Bivariate associations of demographics and ENDS user status were explored using Chi-square or Fisher's exact tests. Average differences in agreement with perception statements across ENDS user status were tested using ANOVA with Tukey's tests for multiple comparisons. RESULTS: Of 382 participants, 57.9% were 21-29 years old and 60.1% had some college or higher education. 30.3% reported using both ENDS and tobacco cigarettes and 11.9% were current ENDS users. The majority of participants had adequate knowledge about the facts and safety of ENDS and there was no difference across three ENDS user status groups. ENDS users perceived significantly lower risk of ENDS and higher benefit of using ENDS to aid quitting tobacco smoking, compared to non-ENDS users. The majority of participants reported that their healthcare providers less frequently assessed ENDS use during their prenatal visits, compared to tobacco cigarette use. CONCLUSIONS: There is critical need for healthcare providers to increase the screening for ENDS use during pregnancy and promote awareness of risks and benefits of ENDS in pregnant women.

Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects.

Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.

Promoting Tdap immunization in pregnancy: Associations between maternal perceptions and vaccination rates.

OBJECTIVE: Tdap vaccine uptake among US pregnant women is low despite current recommendations. This study evaluated if a Tdap vaccine information statement (VIS) affected overall perception, vaccination intention, and components of a health behavior model associated with Tdap vaccination rates. METHODS: A randomized, prospective study was conducted among pregnant women receiving care at two women's clinics in May-August 2014. Verbally consented participants were randomized to receive either the standard CDC Tdap VIS (sVIS) or a modified version (mVIS) before completing the first multi-part survey (T1). After T1, participants read their assigned VIS then completed the second part (T2). A 2015 chart review identified vaccinated participants. A health behavior model was hypothesized using the Reasoned Action Approach and Health Belief Model. Logistic regression, path analysis, and chi-square tests were used in the analysis. RESULTS: 279 surveys were analyzed. Average age of the participants was 26.4 years (SD=5.7) with average gestational age of 25.9 weeks (SD=9.2). 13% self-reported receiving Tdap vaccine prior to the survey. Overall perception scores significantly increased (3.1-3.4, p<0.001) after VIS review. A chart review showed that 131 (47%) received the vaccine post study. There was no significant difference in vaccination rates between the sVIS and mVIS groups (45% vs. 49%). Perceived benefits (B=0.315) and self-efficacy (B=0.197) were positively associated with the overall perception (T1), while perceived barriers (B=-0.191) were negatively associated with the overall perception (T1). Social norms (B=0.230), self-efficacy (B=0.213), and perceived benefits (B=0.117) were positively associated with vaccination intention (T1). The vaccination intention (T2) was positively associated with participants' decision to receive Tdap vaccine (B=0.223). CONCLUSION: A VIS improved overall perception of the Tdap vaccine. Vaccination intention was a predictor of Tdap vaccination. It is crucial to provide information about immunization benefits to promote maternal Tdap vaccination.

Health Literacy in Obstetric Patients: A Pharmacist's Experience with The Newest Vital Sign.

Health literacy can greatly impact patients' self-management of medical conditions and adherence to treatment recommendations. This study aimed to assess the health literacy of obstetric patients at a university-based women's clinic using the Newest Vital Sign (NVS). A clinical pharmacist or student pharmacist utilized the instrument to interview women during a routine clinic visit. This project is a cross-sectional, retrospective study using the de-identified survey data. Descriptive statistics were used to provide a summary of the NVS scores in this population. The average age of the 140 participants was 27 years (SD = 6) with the range from 16 to 49 years old. The majority (78%) of the patients was ≤ 30 years old; 50% were white and 39% were black. The average NVS score was 3 (SD = 2.2). 49% had scores ≤ 3 which indicates limited literacy. This pilot study yielded preliminary data for future investigations of health literacy in this population while identifying a potential role for pharmacists. Due to its ease of use and quick administration, it is feasible to use the NVS instrument to routinely screen health literacy in an obstetric clinic setting.

Family Commitment and Work Characteristics among Pharmacists.

Factors associated with family commitment among pharmacists in the south central U.S. are explored. In 2010, a cross-sectional mailed self-administered 70 item survey of 363 active licensed pharmacists was conducted. This analysis includes only 269 (74%) participants who reported being married. Outcome measures were family commitment (need for family commitment, spouse's family commitment), work-related characteristics (work challenge, stress, workload, flexibility of work schedule), and job and career satisfaction. Married participants' mean age was 48 (SD = 18) years; the male to female ratio was 1:1; 73% worked in retail settings and 199 (74%) completed the family commitment questions. Females reported a higher need for family commitment than males (p = 0.02) but there was no significant difference in satisfaction with the commitment. Work challenge and work load were significantly associated with higher need for family commitment (p < 0.01), when controlled for age, gender, number of dependents, work status, and practice setting. Higher work challenge was associated with higher career satisfaction. Higher job related stress was associated with lower job satisfaction. High work challenge and work load may negatively impact family function since married pharmacists would need higher family commitment from their counterparts. The impact of work-family interactions on pharmacy career satisfaction should be further investigated.

Consumer attitudes towards and satisfaction with emergency contraception counselling: experience from clinic and retail pharmacy settings.

OBJECTIVE: To collectively assess consumer attitudes towards and satisfaction with emergency contraception (EC) counselling by student pharmacists in two different locations: an academic healthcare clinic and a retail pharmacy. METHODS: EC counselling was provided by trained student pharmacists utilizing a standardized education toolkit. Participants were asked to rate the counselling at the end of the knowledge survey. In addition to descriptive statistics, we compared the self-reported attitudes and satisfaction with the counselling between the two sites. KEY FINDINGS: The majority of participants from both settings rated 'strongly agree' on the attitude and satisfaction statements for the EC counselling. Participants from the clinic setting rated higher in two of the four statements than the participants from the retail setting. CONCLUSIONS: Participants had positive attitudes towards and were highly satisfied with the EC counselling in both settings. EC counselling should be encouraged in practice settings.

Emergency contraception counseling in a retail pharmacy setting: a pilot study.

INTRODUCTION: Nonprescription emergency contraception (EC) is now available for purchase without age restrictions. This is a great opportunity for pharmacists to provide counseling to ensure that customers use EC correctly. OBJECTIVE: This pilot study explored the impact of student pharmacist counseling on customer knowledge of EC in a retail pharmacy setting and assessed customer satisfaction with the counseling. METHODS: Counseling was performed at 2 retail pharmacies during June and July 2012. Participants completed a 12-question pretest that measured baseline knowledge of EC prior to a 5- to 10-minute education session, followed by the same 12-question posttest. A follow-up test was conducted via telephone within 1 to 3 months after the counseling. RESULTS: Eighty-seven women participated with a mean age of 30.2 (standard deviation = 7.2) years. The average posttest score was significantly higher than the pretest score (11.5 ± 1.0 vs 8.5 ± 2.5; P < .001). The mean follow-up score (9.9 ± 1.1) was significantly higher than the pretest score (P = .014), which indicated retained knowledge. Participants reported being highly satisfied with the counseling session and strongly agreed that the counseling would help them use EC correctly. CONCLUSION: Student pharmacist-provided EC counseling increased participants' EC knowledge both immediate and long term. This study suggests that EC counseling is feasible and valued by customers.

Factors associated with health-related quality of life of student pharmacists.

OBJECTIVE: To assess the health-related quality of life (HRQoL) of student pharmacists and explore factors related to HRQoL outcomes of student pharmacists in a doctor of pharmacy (PharmD) program at a public university. METHODS: A survey instrument was administered to all student pharmacists in a PharmD program at a public university to evaluate differences and factors related to the HRQoL outcomes of first-year (P1), second-year (P2), third-year (P3), and fourth-year (P4) student pharmacists in the college. The survey instrument included attitudes and academic-related self-perception, a 12-item short form health survey, and personal information components. RESULTS: There were 304 students (68.6%) who completed the survey instrument. The average health state classification measure and mental health component scale (MCS-12) scores were significantly higher for P4 students when compared with the P1through P3 students. There was no difference observed in the physical component scale (PCS-12) scores among each of the 4 class years. Significant negative impact on HRQoL outcomes was observed in students with higher levels of confusion about how they should study (scale lack of regulation) and concern about not being negatively perceived by others (self-defeating ego orientation), while school satisfaction increased HRQoL outcomes (SF-6D, p<0.001; MCS-12, p=0.013). A greater desire to be judged capable (self-enhancing ego-orientation) and career satisfaction were positively associated with the PCS-12 scores (p<0.05). CONCLUSION: Factors associated with the HRQoL of student pharmacists were confusion regarding how to study, ego orientation, satisfaction with the chosen college of pharmacy, and career satisfaction. First-year through third-year student pharmacists had lower HRQoL as compared with P4 students and the US general population. Support programs may be helpful for students to maintain or improve their mental and overall health.

Academic help-seeking behavior among student pharmacists.

Objectives. To identify factors associated with academic help-seeking behavior among student pharmacists at a public university.Methods. Semi-structured focus group interviews were conducted to explore in depth perceptions of facilitators of and barriers to the help-seeking behavior and academic achievement of student pharmacists who had received a D or F grade in any year. A 4-part survey instrument was developed and administered to all student pharmacists and included sections for (1) attitudes and academic help-seeking behavior, (2) health status, (3) demographics, and (4) open comments. A structural equation modeling approach was used to assess relationships among domains of interest.Results. Three student focus groups noted that helpfulness of faculty members and school administrators were 2 prominent facilitators of help-seeking behavior and academic achievement. Diminished quality of life caused by stress and depression was the primary barrier to help-seeking and achievement. Three hundred four (68.6%) student pharmacists completed the survey instrument. Academic help-seeking behavior was influenced mostly by perceived academic competence and perceived faculty helpfulness. In contrast, ambivalence and perception of help-seeking as threatening were 2 factors that were negatively associated with academic help-seeking behavior.Conclusions. Academic help-seeking behavior was positively related to greater perceived academic competence and positive relationships among student pharmacists and faculty members.

Obstetrical opportunities: will pharmacy ever realize them?

Based on a survey of the American College of Clinical Pharmacy Women's Health Practice and Research Network and our own experience, the pharmacy profession has limited involvement in obstetric pharmacotherapy. We believe that such involvement in pregnancies with complicated conditions can result in significant improvement of pregnancy outcomes. Moreover, we believe this involvement would be welcomed by the physicians caring for these patients. This commentary documents current obstetrical pharmacy practices and proposes changes for the profession of pharmacy to consider.

Emergency contraception counseling: an opportunity for pharmacists.

OBJECTIVE: To determine the impact of pharmacist counseling on patients' knowledge of emergency contraception (EC). DESIGN: Single-group, repeated-measures analysis. SETTING: Academic medical center women's clinic in Little Rock, AR, between January and July 2010. PARTICIPANTS: 116 women 18 years or older. INTERVENTION: 10-minute education session provided by a pharmacist or trained student pharmacist. MAIN OUTCOME MEASURES: Change in participants' test scores (range 0 [lowest possible] to 13 [highest possible]) at three assessment periods (pretest, posttest, and follow-up) using 12 knowledge questions. RESULTS: 116 participants with a mean (±SD) age of 25 ± 5.9 years participated in this study. Mean knowledge scores were 5.3 ± 4.1 for the pretest and 10.7 ± 1.4 for the posttest (P < 0.001). The least-squares mean EC knowledge test score (adjusted for demographics) was 5.86 at pretest, 10.75 at posttest, and 10.75 at follow-up. A nonsignificant small change in scores from posttest to follow-up was detected after the Tukey-Kramer adjustment. A higher education level was associated with higher knowledge scores in this population. CONCLUSION: Brief pharmacist-driven counseling sessions provided in a clinic setting are feasible and have a positive impact on immediate EC knowledge and long-term knowledge retention.

Job and career satisfaction among pharmacy preceptors.

OBJECTIVES: To examine the perceived benefit of job and career satisfaction among pharmacist preceptors and to explore other factors that might influence satisfaction. METHODS: A cross-sectional self-administered survey instrument was mailed to pharmacists in the South Central region of the United States who had active 2010 licenses to investigate whether being a pharmacist preceptor increases job and career satisfaction. RESULTS: Twenty-three percent of the 363 respondents were active preceptors and 62% of these reported that they had been preceptors at some point in the past. Being an active preceptor was significantly related to increased job satisfaction (p = 0.01) but not to career satisfaction. Having a perceived benefit of continuing education and being professionally challenged at work also were associated with increased job and career satisfaction (p < 0.001). CONCLUSIONS: Pharmacist preceptors have higher levels of self-reported job satisfaction.

Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice / Impacto del estado de los contraceptivos de emergencia en el embarazo indeseado: datos observacionales de una clínica de medicina de mujer

Objective: This study aimed to determine if non-prescription emergency contraception (EC) availability impacted self-reported unintended pregnancy rates and to assess women's knowledge and awareness of EC prior to and after non-prescription availability. Methods: A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women's clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market) in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC. Results: The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172). The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%). There was no significant difference in the participants' awareness of EC between the two groups (BA-46.8% vs. AA-43.0%) nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%). However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410) and education (P = 0.0021). Conclusion: The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use (AU)

Objetivo: Este estudio trató de determinar si la disponibilidad sin receta de la contracepción de emergencia (CE) impactó en la proporción auto-reportada de embarazos no deseados y evaluar el conocimiento y consciencia de las mujeres sobre la CE antes y después de la disponibilidad sin receta. Métodos: Se administró verbalmente un cuestionario sobre uso y conocimiento a una muestra transversa de conveniencia de 272 mujeres embarazadas que recibían atención prenatal en una gran clínica urbana de mujeres entre agosto 2003 y octubre 2008. Los análisis estadísticos determinaban las diferencias entre dos grupos (antes [BA] y después [AA] de la disponibilidad de la CE sin receta en el mercado de medicamentos de Estados Unidos) en términos de tasas reportadas de embarazo no deseado, conocimiento y consciencia de la CE. Resultados: El grupo AA reportó mayor incidencia de embarazo no deseado en comparación con el grupo BA (90,7% vs. 72.7%, P=0,0172). La mayoría en ambos grupos informó que no estaban utilizando ningún contraceptivo en el momento de la concepción (BA-84,4%; AA-83,3%). No había diferencia significativa en la consciencia de los participantes sobre la CE entre ambos grupos (BA-46,8% vs. AA-43,0%) ni había diferencia significativa en la voluntad auto-.reportada de utilizar CE en el futuro (BA-53,1% vs. AA-63,4%). Sin embargo, entre los participantes que no eran conocedores de la CE, el 61% reportó que considerarían utilizarla en el futuro después de haber recibido un breve consejo de un farmacéutico o un estudiante de farmacia. Ni la edad, ni la intención de embarazo estaba asociada con la consciencia auto-reportada de la CE, pero había asociación con los ingresos (P=0,0410) y la educación (P=0,0021). Conclusión: El cambio del estado de prescripción a sin receta de la CE en el mercado de medicamentos de los Estados Unidos no impactó en la tasa de embarazos indeseados en esta población de pacientes. La falta de conocimiento y consciencia de la CE es la mayor barrera para la diseminación del uso de CE (AU)

Depression and diabetes: Establishing the pharmacist's role in detecting comorbidity in pregnant women.

OBJECTIVES: To determine the prevalence of depression in women with diabetes receiving prenatal care and to determine whether pregnant women with comorbid depression and diabetes are receiving adequate care for depression. SETTING: Little Rock, AR, between June and August 2007. PRACTICE DESCRIPTION: At a women's health clinic providing obstetrical services to local and statewide patients, the clinical pharmacist functions as a diabetes educator, provides treatment recommendations for the OB/GYN medical residents, and precepts fourth-year student pharmacists. PRACTICE INNOVATION: The pharmacist and student pharmacists screened patients with diabetes for depression using the Beck Depression Inventory, 2nd ed. (BDI-II). MAIN OUTCOME MEASURES: Patient demographics, including obstetrical history, type of diabetes, depression history, and current treatments. RESULTS: 50 patients were screened in this pilot study. Of participants, 42% reported scores that indicated clinical depression. Among patients with clinical depression, only 19% were receiving treatment for depression. Obstetrical history (number of pregnancies) showed a positive correlation with the BDI-II total scores (P = 0.0078). CONCLUSION: This population had a high prevalence of depressive symptoms, but very few women were receiving treatment for depression. Depression screenings should be integrated into routine prenatal care, offering adequate treatment when needed. This study implies that pharmacists can assist with screening for depression in diabetes and thus ensure that at-risk patients receive the attention needed to better manage their illnesses.

Impact of emergency contraception status on unintended pregnancy: observational data from a women's health practice.

OBJECTIVE: This study aimed to determine if nonprescription emergency contraception (EC) availability impacted self-reported unintended pregnancy rates and to assess women's knowledge and awareness of EC prior to and after nonprescription availability. METHODS: A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women's clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market) in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC. RESULTS: The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172). The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%). There was no significant difference in the participants' awareness of EC between the two groups (BA-46.8% vs. AA-43.0%) nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%). However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410) and education (P = 0.0021). CONCLUSION: The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use.

Pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception.

OBJECTIVES: To determine pharmacy students' knowledge, attitudes, and behaviors regarding emergency contraception. METHODS: A cross-sectional survey was conducted among a convenience sample of students prior to a regular class period. The 16-item survey instrument included both multiple-choice and true/false questions to assess knowledge and Likert-type scale questions regarding attitudes and behaviors. Frequency and descriptive statistics were calculated for all variables. RESULTS: Three hundred one pharmacy students were surveyed. Eighty-seven percent knew that Plan B had been approved by the Food and Drug Administration (FDA) for nonprescription use, yet 33% believed that it worked by disrupting a newly implanted ovum. On a scale from 1-5 on which 5 = strongly agree, the mean item score was 1.5 for whether nonprescription emergency contraception should be available without counseling by a pharmacist, yet only 26.7% believed they were competent instructing patients on the use of emergency contraception. CONCLUSIONS: Additional education is needed to prepare pharmacy students to provide informed pharmaceutical care to patients seeking emergency contraception, especially given the passage of legislation making the pharmacy the point of access for some emergency contraception products.