merchandising of cigarettes in san francisco pharmacies: 27 years later
by：CAI YI JIE2019-09-29
Abstract objective: to estimate the change in the proportion of cigarettes sold in San Francisco pharmacies since 1976 and to describe the features of cigarette advertising and non-cigarette merchandise sales Prescription of nicotine replacement therapy (NRT) Products from these retail locations. Method and Location: 100 San Francisco pharmacies were randomly selected from 2003. Pharmacies are characterized by the sale of cigarettes, cigarette advertising and sales of non- Prescription NRT products. Results: in 2003, 61% of pharmacies sold cigarettes, a significant decrease from 89% of cigarettes sold in 1976 (p < 0. 001); 84% of the pharmacies that sell cigarettes also display cigarette advertisements. Non- Prescription NRT products are in stock by 78% of pharmacies, in pharmacies where cigarettes are sold at 55%, and inventory of NRT products is close to cigarettes. Conclusion: Since 1976, the overall proportion of pharmacies selling cigarettes in San Francisco, especially traditional chain pharmacies, has decreased, continuing to sell the major death risk factors known in the United States. As we all know, smoking is a major preventable cause of death known in the United States, with an estimated 440 deaths per year, and clinicians can significantly influence the likelihood of smokers quitting smoking. Most medical institutions use tobacco- Free \"policies such as ending tobacco sales in hospitals and promoting smoking The free environment in medical places, community pharmacies in the United States continue to sell tobacco products, although National and National pharmaceutical organizations have put forward many resolutions and suggestions against these practices in the past 30 years. In 1976, we conducted a study to assess the proportion of cigarettes sold at community pharmacies in San Francisco. 100 pharmacies randomly selected 6 and sold 89 cigarettes; Of the 52 institutions (58. 4%) Cigarettes are placed at the pharmacy counter with prescription drugs. To estimate the change in the proportion of pharmacies selling cigarettes, we replicated the study in the same metropolitan area in 2003 and compared our new data with the data we collected 27 years ago. Also in 2003, we checked the display of tobacco ads and the sales location of non-tobacco ads Prescription of nicotine replacement therapy (NRT) Products from these retail locations. The method is similar to our 1976 research methods, and 100 pharmacies in San Francisco were randomly selected; However, these 2003 samples were selected from the full list of licensed retail pharmacies in the California Department of Consumer Affairs (N = total 133) Compared to 1976 studies that selected samples from the San Francisco Yellow Pages. Clinics that list multiple valid pharmacy licenses for the same street address represent only once in the pharmacy population who took random samples. On July/August 2003, a research assistant visited each of the selected pharmacies. Pharmacy decided to be permanently closed after visit (n u200a=u200a 2) Replaced by random selection. Each pharmacy is classified as one or more of the following: an independent traditional chain pharmacy, a clinical affiliate pharmacy, a part of the grocery store and a part of the mass merchant store. Consistent with our 1976 studies, \"traditional chain pharmacies\" are defined as pharmacies clearly identified with other stores or pharmacies of the same name, \"self-owned pharmacy\" is defined as a pharmacy that is not identified with any other pharmacy or clinic, and \"clinical affiliate pharmacy\" is defined as a pharmacy based on a medical building, office or clinic. \"Part of the grocery store\" indicates that the pharmacy is located in a market mainly where the grocery is sold, and \"part of the mass merchant\" indicates that the pharmacy is located in a larger retail organization, it is mainly the place where wholesale goods are sold. As with our previous studies, these appraisals are based on appearance and do not represent legal ownership or whether the institution is owned or operated by a pharmacist. For each pharmacy, we determine whether a cigarette is sold or not, and if so, the location of the cigarette ( Behind the front checkout counter, behind the pharmacy counter and/or separate counter in the store) , Whether the product is in the same store as the pharmacy dispensing area, and whether the cigarette is visible to the customer. If you can\'t see a cigarette, you will be asked if the store staff has a cigarette. Pharmacies are classified as advertising cigarettes ( For example, signs such as display stands, aisle tickers, shopping cart signs, etc) Or no, the location of the ad is described as one or more of the following: next to the cigarette ( For example, as part of a cigarette display) Other places in the store, or can be seen from outside the store. Because we believe that pharmacies that sell tobacco and nicotine replacement therapy at the same time (NRT) The product conveys a complex message to the consumer, and we also determine the proportion of pharmacies that sell NRT products relative to the location of the dispensing pharmacist ( Within the pharmacist\'s line of sight and/or within the pharmacist\'s line of sight) And cigarettes ( Whether adjacent to cigarettes) And whether it is necessary for employees to get help Prescription NRT products. Because pharmacy products are usually stored in multiple locations in the pharmacy, the research assistant asks the pharmacy staff about their location. Use simple summary statistics to describe the measurement variables. The X2 independence test and Fisher precision test were used to compare the sales of cigarettes by pharmacy type and compare our 2003 results with the results of our 1976 studies. Sales of cigarettes at the San Francisco pharmacy 100 (table 1); Among them, cigarettes can be seen by the public for 60 years (98. 4%). Generally put cigarettes behind the front desk cashier (n u200a=u200a 48; 78. 61 pharmacies selling cigarettes 7%) But they are also stored behind the pharmacy counter (n u200a=u200a 1; 1. 6%) Or at a separate counter (n u200a=u200a 12; 19. 7%). Of the 61 pharmacies that sell cigarettes, 10 (16. 4%) , The product is located in the same half of the agency as the prescription distribution area. View this table: View inline View pop-up table 1 cigarettes cigarette merchandise sales by year (1976 or 2003) 51 and Pharmacy (83. 6%) Of the 61 pharmacies that sell cigarettes, advertisements for these products are also shown. All 51 stores position tobacco advertising as part of a cigarette display; three (5. 9%) Place ads elsewhere in the pharmacy, two (3. 9%) Display ads that can be seen from outside the pharmacy. Nicotine replacement therapy is available in 78 pharmacies (78%; 95. 1% of people selling cigarettes)stocked non- Prescription products (table 2). In 64. Of the 78 pharmacies, 1% of the pharmacies products are stored in places invisible to pharmacists, 47. 4% of the products in these pharmacies are stored in places not visible to pharmacists ( Categories that are not mutually exclusive). In 66 pharmacies (84. 6% of sales NRT) , It is necessary for the customer to get help to get some or all of the non- Prescription The NRT product because the product is either stored in a locked box (n u200a=u200a 9; 11. 5%) , In the case of unlocking behind the counter (n u200a=u200a 53; 67. 9%) Or in a locked box behind the counter (n u200a=u200a 4; 5. 1%). Sell non at the same time in 58 homes Prescription NRT and cigarettes, 32 (55. 2%) Store NRT products next to cigarettes. Sales of traditional chain pharmacies Prescription NRT products than independent pharmacies (p < 0. 001). View this table: View the inline View pop-up table Prescription of nicotine replacement therapy (NRT) The products in 2003 were compared with 1976 data by pharmacy type, 1976 (table 1) The overall proportion of pharmacies selling cigarettes decreased significantly ( 89% per cent in 1976 and 61% per cent in 2003; p < 0. 001). No obvious change (p u200a=u200a 0. 55) Proportion of cigarettes sold in traditional chain pharmacies ( 100% v. 93, 1976. 8% in 2003) But a sharp decrease (p < 0. 001) Observed in independent owned and clinical affiliated pharmacies: 1976, 90. There are 64 independent, accounting for 6% and 58. Of the 12 clinical affiliated pharmacies, 3% sold cigarettes, while in 2003, 24% sold cigarettes independently and none of the clinical affiliated pharmacies. There were no grocery stores and mass merchant pharmacies in 1976 samples; Therefore, the comparison data is not applicable. We also observed a decrease in the proportion of pharmacies where cigarettes are located at the drug distribution counter (58. In 1976, there were 4% V-1 in 89 pharmacies selling cigarettes. 6% pharmacies in 2003; p < 0. 001). Non-comparative data Prescription NRT products are not available because they were not sold at the counter until 1996. During the discussion over the past 30 years, as people became more aware of the health impact of tobacco use, we observed a significant decrease in the proportion of cigarettes sold at San Francisco pharmacies by 28 percent, compared to our 1976 study. The main reason for this change is the independent possession and clinical affiliate pharmacies. Not the proportion. The number of clinical affiliate pharmacies selling tobacco has also decreased, compared to a small change. The observed chain has several possible explanations with independent differential. The size of chain pharmacies is often larger, so there are more types of goods in stock. Another possibility is that unlike independent pharmacies, the sales decisions of traditional chain pharmacies are usually made at a higher level, usually right and wrong. These decisions are influenced by the shareholders of the company. Cigarettes are products that are frequently purchased and may attract customers who buy other products, thereby increasing overall sales and revenue. It is worth noting that only 1. In a survey of 6% licensed pharmacists in four northern California counties, 1168 of respondents ( Conducted on 1999)and 2. In a survey of 0% students from the California School of Pharmacy, 1518 of respondents ( Between 2003 and 2000) It is conducive to tobacco sales in pharmacies. However, these California data may not represent the United States- For example, in a survey of 476 pharmacists in Indiana ( Conducted on 2001), 11. 3% of pharmacists favor tobacco sales at pharmacies, down from 18. 5% in 1996. Although traditional chain pharmacies accounted for only 24% of the random sampling in 1976, they now account for 48%. Since 1991, the proportion of independent pharmacies in the national community retail pharmacies has dropped from 53% to 36%, and the proportion of chain, supermarket and mass merchants has increased. This trend is particularly significant because as chain pharmacies continue to occupy the market, we expect an increase in the overall proportion of pharmacies selling tobacco. All types of pharmacies visited in 2003 were consistent with the removal of cigarettes from the prescription dispensing area. In addition, in 84% of pharmacies selling cigarettes, these products are not in the same half of the store as the prescription dispensing area. This shows that the separation between licensed pharmacists and the actual sale of cigarettes is going on. Our 2003 study also recorded Prescription NRT, 78% of pharmacies store these products. However, in many pharmacies, these products are provided without help. Although ease of use removes potential barriers to product use ( That is, seeking assistance in obtaining products) , The opportunity for clinicians to intervene to ensure proper product selection, dosage and consultation for drug use is reduced. Failure to comply with the medical program or incorrect use of the NRT will result in failure to quit smoking; As a matter of fact, in the recent 103 29% of preempusers users did not read the packaging insert material, 19% viewed the material, 14% read most of the material, and only 38% read all the material. 10. Prescription NRT products are usually located in the pharmacy area that is not easy to see by dispensing pharmacists, and it is not surprising that pharmacists report the main barriers to consulting patients with the use of OTC drugs The prescription NRT is that they don\'t know when to buy the product. 11. although placing NRT near the cigarette display may become a visual reminder for some smokers to quit smoking Prescription NRT products to the pharmacy dispensing area, or very close, will be more conducive to the interaction between pharmacists and potential smokers. In addition, the product is stored in locked cases or behind the counter and can be used as an intervention point, and the store staff can advise patients to be guided by pharmacists. This is particularly important because pharmacists may be the only clinicians who have the opportunity to consult patients who choose to use non-drugs Prescription NRT products as an aid to stop. Paradoxically, the proportion of pharmacies selling NRT is not much larger than the proportion of pharmacies selling tobacco. Our study was limited, including 1976 studies sampled from pharmacies listed in the San Francisco Yellow Pages catalogue and 2003 differences in sampling methods, take samples from the pharmacy from the list provided by the consumer affairs department. While we expect that the pharmacies listed on the Yellow Pages will not differ in the status of tobacco sales compared to those not listed, we cannot address this potential source of bias. However, this potential deviation is unlikely to weaken the observed significant changes. It is also worth noting that although the overall proportion of pharmacies selling tobacco varies significantly, the risk of the public selling tobacco in pharmacies is still high, because the number of traditional chain pharmacies is much larger than that of independent pharmacies, they serve more patients. For example, in a survey of licensed pharmacists in Northern California in 1999, pharmacists (n u200a=u200a 279) Working in traditional chain pharmacies, the median number of prescriptions per day is 210, while the pharmacist has 135 prescriptions per day (n u200a=u200a 106) Working in an independent pharmacy ( Unpublished data). While pharmacists are ideally placed within the community to help all patients quit smoking -- Including patients from underserved populations, otherwise they may have limited access to tobacco interventions facilitated by clinicians -- Pharmacies sell tobacco to send \"mixed messages\" to consumers, especially when many of the same pharmacies also sell NRT products, which are usually placed next to cigarettes. When most medical institutions adopt \"tobacco- Free \"policies such as ending tobacco sales in hospitals and promoting smoking The free environment in medical places, community pharmacies in the United States continue to sell tobacco products, although National and National pharmaceutical organizations have put forward many resolutions and suggestions against these practices in the past 30 years. Some organizations have been working at the grass-roots level to put pressure on pharmacies, especially chain pharmacies, to remove tobacco from stores. Although some research on this topic has been published over the years, no research has been conducted to investigate trends in tobacco sales in pharmacies ( Using the parallel method, at two points in time) In nearly 30 years In 1976, we identified 89% of people selling cigarettes at the San Francisco community pharmacy. We repeated the study in 2003 and reported a significant decrease (to 61%) Proportion of cigarettes sold. The main reason for this decline is the change in cigarette sales in independent pharmacies; In contrast, a non- Chain pharmacies decreased significantly. In addition, we describe the advertising of tobacco products and the sales of non-tobacco products Prescription nicotine replacement therapy in these retail locations. At present, the school of pharmacy across the country is passing a tobacco education program \"Rx of change: Pharmacist- Help quit smoking \". As part of this program, pharmacy students face the moral challenge of providing pharmacy services in an environment where tobacco is sold. By raising awareness in the health community and thus reducing tolerance for tobacco sales in pharmacies, we expect that the owners and employees of pharmacies that actively provide tobacco products will re-examine the promotion of health through a major goal. In the past year, nearly 2 out of 3 pharmacy schools in the United States have adopted the \"transformative Rx: clinicians- Training program for \"assisting in smoking cessation. 12,13 as part of the programme funded by the National Cancer Institute ( Grant R25 CA 90720) \"communication of tobacco courses for the School of Pharmacy\" The challenge for pharmaceutical students is to consider the ethics of providing pharmaceutical services in an environment where tobacco is sold. By raising the awareness of the health community and thus reducing tolerance for tobacco sales in pharmacies, we hope that, the owners and employees of pharmacies that actively provide tobacco products will re-examine the promotion of health through a major target environment that continuously uses the ethics of the major known death risk factors. 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