High quit ratio among Asian immigrants in California: implications for population tobacco cessation.

Asian immigrants to the U.S. are participants in a natural experiment on the effects of social norms on tobacco cessation. Smoking is socially acceptable in most Asian countries. When Asian smokers move to U.S. states such as California, they experience a radically different social norm toward smoking. This study examines ever smokers among two groups of Asian immigrants in California, Chinese and Koreans, and finds that most have quit smoking. The quit ratios (percent of ever smokers who have quit) for Chinese (52.5%) and Korean immigrants (51.1%) have quit ratios for ever smokers in California in general (53.3%), which is among the highest in the U.S. These high quit ratios contrast sharply with much lower quit ratios for Chinese in China (11.5%) and for Koreans in Korea (22.3%). Such large differences in quit ratios are the results of accumulated differences over the years, because of dramatic differences in annual cessation rates: Chinese in California quit at roughly seven times the rate of Chinese in China, and Koreans in California three times that of Koreans in Korea. Analyses further show that these large differences in annual cessation rates come mainly from the fact that these immigrants in California made quit attempts at a much higher rate than their counterparts in their home countries. These results suggest that creating an impetus to drive up quit attempts, which often results from a significant change in social norms toward smoking, is the most important strategy to improve cessation on the population level.

The debate about over-the-counter emergency contraceptive pills.

Many prescription drugs have been converted to over-the-counter (OTC) status in recent years. Another drug that has been proposed for OTC status is a levonorgestrel-only emergency contraceptive pill. The debate surrounding OTC access to emergency contraceptive pills echoes issues encountered in previous reclassification processes and raises new challenges. This article discusses the emergency contraceptive pill, the evolution of its access options, and the context and implications of changing its status from a prescription to an OTC medication.

Consumer knowledge of over-the-counter phenazopyridine.

BACKGROUND: Effective use of over-the-counter (OTC) medications depends on purchasers' knowledge of their indications. This study examines consumer knowledge regarding the urinary tract analgesic phenazopyridine, which recently became available without prescription. METHOD: We conducted a cross-sectional survey of a stratified cluster random sample of purchasers of OTC phenazopyridine (N = 434) in 31 Los Angeles retail pharmacies. RESULTS: The response rate was 58%. Only 42% correctly characterized the likely cause of their symptoms, and only 57% correctly characterized the action of the drug. Worse consumer knowledge was associated with nonwhite race, first-time use, and less contact with health providers. CONCLUSION: Many consumers possess poor knowledge about phenazopyridine, potentially leading to undertreatment, especially in groups with worse access to care.

Consumer usage patterns of nonprescription histamine2-receptor antagonists.

OBJECTIVE: Prescription to over-the-counter (OTC) drug switches are increasingly common. Yet little is known about how the public uses these reclassified products. Histamine2-receptor antagonists (H2RAs) are popular examples, although they may be supplanted by OTC proton pump inhibitors (PPIs). We examined the extent to which consumers substitute OTC H2RAs for physician care and/or engage in off-label use of these medications. METHODS: Self-administered anonymous survey of 1,116 adult OTC H2RA consumers in a random sample of 20 Los Angeles pharmacies from a major retail chain. Off-label use was defined by FDA warning label (e.g., bloody stools, dysphagia). Substitution was defined by intent to use H2RA instead of going to a physician. RESULTS: Forty-six percent engaged in off-label use of OTC H2RAs. Off-label use was independently associated with lower income, substitution for physician care, prior gastrointestinal disease, and past prescription H2RA use. Thirty-four percent substituted OTC H2RA use for physician care, and 54% of these met the criteria for off-label use. Substitution was associated with lack of health insurance, lack of time to see a physician, the belief that OTC H2RA was cheaper than clinic visits, and nonwhite race. CONCLUSION: Almost one-half of adult consumers reported using OTC H2RAs in a manner inconsistent with FDA labeling, and this off-label use was associated with substitution for physician care. Traditionally vulnerable populations were more prone to off-label use and to substituting H2RAs for physician care. Further studies are needed to assess patient outcomes, identify remedies, and explore implications for the reclassification of PPIs.

Usage patterns of over-the-counter phenazopyridine (pyridium).

OBJECTIVES: Little is known about how the public uses formerly prescription medications that are available over-the-counter (OTC). This study examines whether consumers inappropriately use and substitute a recently widely distributed OTC urinary analgesic, phenazopyridine, for provider care. DESIGN/SETTING: We conducted a cross-sectional survey of a stratified cluster random sample of OTC phenazopyridine purchasers (N = 434) in 31 Los Angeles retail pharmacies over 5 months. Recruited by shelf advertisements, participants were 18 years or older who purchased a phenazopyridine product. Each completed a 25-item self-administered anonymous questionnaire. Inappropriate use was defined as 1) having medical contraindications to phenazopyridine, or 2) not having concurrent antibiotic and/or provider evaluation for the urinary symptoms. RESULTS: The survey response rate was 58%. Fifty-one percent of the respondents used OTC phenazopyridine inappropriately, and 38% substituted it for medical care. Multiple logistic regression analyses revealed that inappropriate use was correlated with having little time to see a provider (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.26 to 1.96), receiving friend's or family's advice (OR, 1.25; 95% CI, 1.05 to 1.47), having prior urinary tract infections (OR, 0.49; 95% CI, 0.30 to 0.80), having used prescription phenazopyridine, (OR, 0.40; 95% CI, 0.25 to 0.63), and having back pain (OR, 0.34; 95% CI, 0.16 to 0.74). Similar correlates were found in those who substituted OTC phenazopyridine for provider care. Respondents with incorrect knowledge about phenazopyridine's mode of action had 1.9 times greater odds of inappropriate use and 2.2 times greater odds of substitution than those who had correct knowledge about this drug. CONCLUSION: Inappropriate use of OTC phenazopyridine appears common. Increasing the public's knowledge about reclassified drugs may help to mitigate this problem.