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PubMed1994

Changing asthma mortality and sales of inhaled bronchodilators and anti-asthmatic drugs.

BACKGROUND: Increasing rates of death from asthma in the United States have stabilized somewhat since 1988. Case-control studies have suggested possible adverse effects of inhaled beta-adrenergic agonists that may have contributed to mortality. OBJECTIVE: To examine possible relationships between changing asthma mortality and sales of inhaled antiasthmatic drugs. METHODS: The National Center for Health Statistics supplied numbers and rates of death from asthma (ICD 493) by year. The Bureau of the Census supplied population data. IMS America provided estimates of total hospital and drugstore sales of inhaled beta-adrenergic agonists, cromolyn sodium, and inhaled corticosteroids by year and annual sales of AeroChambers and InspirEase kits. I calculated sales of the antiasthmatic drugs as puffs per person in the general population or doses per person for cromolyn sodium, defining a dose as a 20-mg capsule or vial or 2 mg by metered dose inhaler. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 general population in 1977 and 1978 to 2.0 in 1989, then decreased to 1.9 in 1990 before increasing again to 2.0 in 1991. Rates of death for blacks 5 through 34 years of age increased from 0.9 in 1980 to 1.3 in 1990 and decreased to 1.2 in 1991. Estimated total hospital and drugstore sales of beta-adrenergic metered dose inhalers increased from 10.3 puffs per person in the general population in 1976 to 31.0 in 1991; those for inhaled corticosteroids, from 0.44 puffs per person in 1976 to 5.44 in 1991. Sales of cromolyn increased from 0.047 doses per person in 1978 to 0.91 in 1991. Sales of AeroChambers and InspirEase kits have also increased. CONCLUSIONS: Since 1988 there has been some moderation in increases in rates of death from asthma while progressive increases in sales of inhaled antiasthmatic drugs have continued. These data are consistent with the likelihood that previous increases in rates of death from asthma were partly due to undertreatment.

Aerosols↗
PubMed1993

A baseline assessment of cigarette sales to minors in San Diego, California.

This study reports the sales rate of cigarettes to minors in San Diego County, and investigates factors associated with cigarette sales to minors. Two hundred and ninety-four stores were identified and recruited to participate in a retailer education effort. To assess the baseline illegal sales rate of cigarettes to minors, selected stores were surveyed by 70 volunteer teams of adults and minors. Questionnaires were also administered to participating store owners or managers to assess retailers' knowledge about laws regulating minors' access to tobacco. Survey results indicated that minors were able to successfully purchase cigarettes in 68% of attempts. In addition, teen gender, community sociodemographics and cashier characteristics were associated with sales to minors. Analyses of the retailer questionnaire indicated retailers knew the legal age to purchase cigarettes, but few knew of the specific penalties associated with sales to minors. These findings indicate that minors have easy access to cigarettes and underscore the need for intensive tobacco sales education for retailers and enforcement of sales to minors laws.

Adolescent↗
PubMed1996

Sales of tranquillizers, hypnotics/sedatives and antidepressants and their relationship with underprivileged area score and mortality and suicide rates.

OBJECTIVE: This study analyses the correlation between the Swedish underprivileged area score and sales of tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants, and the correlation between these sales and mortality and suicide rates, with the aim of using sales data to identify areas with poor socioeconomic conditions. SETTING: Southern Sweden, 33 municipalities in Skåne, 1987 and 1994. DESIGN: Ecological study. Determined and undetermined cases of suicide were taken from the local death register for the years 1987-1993. Suicide rates (determined and undetermined cases) were calculated as the ratio between observed and expected number of suicides. Mortality for people aged 20-64 years was calculated from life tables for the decade 1981-1990. The underprivileged area score was calculated for municipalities using the proportion of persons in the following groups: elderly living alone, under 5 years of age, one-parent families, unskilled, unemployed, living in crowded households, those moving house in the previous year, and ethnic groups. After transformation (square root of arc sine) and standardization, each of the eight variables was weighted by the British general practitioners average weighting and added to give the underprivileged area score. The selection of the eight variables was based on general practitioners' perceptions of the effect of the social characteristics of the populations in their respective residential areas on their workload or pressure on services. The total drug sales figures for tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants are expressed in Defined Daily Doses per 1000 inhabitants per day. The relationship between these variables was analysed using Pearson's correlation coefficient. RESULTS: There was a moderate correlation (0.41-0.68) between the sales expressed as in Defined Daily Doses per 1000 inhabitants per day of tranquillizers and hypnotics/sedatives and underprivileged area score. Furthermore, the sales of tranquillizers and hypnotics/sedatives seemed to be moderately correlated with both mortality (0.44-0.67) and suicide (0.47-0.58). CONCLUSION: Sales of tranquillizers or hypnotics/sedatives could be used with caution as markers for socioeconomic conditions on the basis of their moderate ecological correlation with a composite socioeconomic index such as the Swedish underprivileged area score and their moderate correlation with mortality and suicide.

Antidepressive Agents↗
PubMed2006

Sales of systemic anti-infective agents in Cyprus in comparison with four other European countries.

OBJECTIVE: To determine the pattern of systemic antibiotic sales in Cyprus during the years 1990-1993 and 1996 and make a comparison with other four European countries. METHOD: The Anatomical Therapeutic Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology according to the WHO (World Health Organization) guidelines were employed and data in wholesales were used. The results were presented as DDD/1000 inhabitants/day and were compared with similar results from Sweden, Norway, Denmark and Greece. Data from two independent surveys (1990 and 2001/2002), which covered a total sample of 166,979 persons regarding medicine taking in Cyprus were also used. RESULTS: The overall sales of systemic anti-infective agents in Cyprus were 22.1, 20.6, 24.5 and 24.2 DDD/1000 inhabitants/day for 1990, 1991, 1992 and 1993 respectively. The sales number increased to 30.2 by 1996. Penicillins, cephalosporins and tetracyclines had the greatest share. The above numbers were higher than the respective ones in the reference countries. The first independent survey conducted in 1990 showed that 4.2% of the population reported to take antibiotics without prescription. The second survey provided evidence about the kind of antibiotics taken by the sample (mainly amoxicillin and ciprofloxacin). CONCLUSION: These data reveal that the sales of antibiotics in Cyprus are higher than in Sweden, Norway, Denmark and Greece. The broad-spectrum antibiotics in Cyprus have higher sales than the other antibiotics. This study describes for the first time the pattern of systemic anti-infective agent sales in Cyprus. Further investigations are needed in order to determine the possible factors that might be implicated or explain the high antibiotic sales in Cyprus.

Anti-Infective Agents↗
PubMed1995

The relationship of the retail availability of alcohol and alcohol sales to alcohol-related traffic crashes.

The research literature on the relationship of alcohol consumption to motor vehicle crash risk clearly implicates the importance of minimizing the use of alcohol in conjunction with the operation of motor vehicles. However, there has been relatively little documentation of the direct impact of changes in beverage-specific alcohol sales on the most common surrogate for alcohol-involved traffic crashes, single-vehicle nighttime fatalities. Similarly, there have been few studies of the relationship between the physical availability of alcohol and fatal crash rates which have concurrently controlled for differences in alcohol sales. Indeed, the possibility that reduced availability might lead to increases rather than decreases in fatal crashes (due to increased driving after drinking) has not been adequately tested. This paper presents a series of analyses of time-series cross-sectional data from 38 states over 12 years to evaluate the impact of changes in alcohol sales and the physical availability of alcohol upon single-vehicle nighttime fatal crashes. The results of the study showed, first, that independent of a number of economic and demographic covariates, rates of single-vehicle nighttime fatal crashes were most strongly related to sales of beer and less so to sales of spirits and wine. Second, net of beverage-specific alcohol sales, the physical availability of alcohol was not related to measurable changes in fatal crash rates. Thus, reductions in availability intended to reduce alcohol sales and problems would not appear to increase traffic-related crashes through increased driving exposure.

Accidents, Traffic↗
PubMedDate not supplied

The effects of licensing and inspection enforcement to reduce tobacco sales to minors in Greater Philadelphia, 1994-1998.

This study examined the changes in tobacco sales to minors after active enforcement of merchant compliance to the Synar regulation and the city of Philadelphia Youth Access to Tobacco Ordinance 732. Data for the present study were obtained through Tobacco-free Education and Action Coalition for Health (TEACH) Program in a 5-year, follow-up retail compliance check survey of 1649 stores in 14 cluster areas of Philadelphia, PA. Trend analysis was conducted ofthe sales of tobacco to minors by type of retail outlet, gender, and age of the buyer, and gender, age, and race of the store clerk, and whether restriction policy signs were posted. Analysis indicates that there was a reduction in tobacco sales to minors after implementation of enforcement; sales dropped from 85% in 1994 to 43% in 1998. There were less sales to minors when signs were posted. There were differences in sales if the buyer was asked his or her age and whether the minor was asked to show identification. In addition, the age of the buyer and the brand of cigarettes were associated with sales. Future research should focus on both commercial and social availability and provision of tobacco to minors.

Adolescent↗
PubMed1996

Reward structure as a moderator of the relationship between extraversion and sales performance.

The proposition that the relationship between extraversion and sales performance is moderated by reward structure was investigated. Specific hypotheses were tested with data obtained from 152 sales representatives. One group of sales representatives was rewarded primarily for obtaining new sales and another primarily for retaining customers. Data pooled across the 2 groups showed that extraversion did not correlate significantly with either new sales or customer retention. However, moderator analysis revealed that extraversion was positively associated with the dimension of performance that was explicitly rewarded but not with the nonrewarded dimension. A significant correlation between conscientiousness and new sales, but not between conscientiousness and customer retention, was found with the pooled data. As expected, relationships between conscientiousness and sales performance were not moderated by reward structure.

Employee Performance Appraisal↗
PubMed1998

How easy is it for young people to obtain cigarettes, and do test sales by trading standards have any effect? A survey of two schools in Gateshead.

Smoking prevalence among young people continues to rise and cigarettes are easily available from many shops. Test sales are used by trading standards departments to try to reduce under-age sales, but it is not known whether this has any real impact on cigarette purchase and consumption. This study aims to evaluate the impact of test sales on purchase and consumption of cigarettes by young people. A survey of two schools in Gateshead, one in the intervention area and one acting as a control was carried out. A series of test sales were targeted to shops within 1.5 km of the intervention school. A questionnaire was administered in both schools among year 10 pupils, age 14-15 years, prior to the intervention and again 1 year later. The outcomes measured were number of successful test sales, reported availability of cigarettes and change in smoking prevalence following the intervention. Some 224 pupils from both schools were surveyed in 1995 and 163 pupils from the new cohort of year 10 pupils in 1996. Prior to the intervention, the levels of regular smoking in the intervention school were 39% for girls and 26% for boys. In the control school these levels were 24% and 14%, respectively. The intervention by trading standards resulted in no purchases and hence no prosecutions, but children reported being able to buy cigarettes with ease from the nearby shops; only three (2.5%) reported sales refused in 1995 and five (5.8%) in 1996. Not surprisingly there was no significant change in smoking prevalence in either school in 1996. This study suggests that test sales may not be effective in modifying cigarette availability to young people and that they are not a reliable measure of access to cigarettes by children.

Adolescent↗
PubMed2004

Usage of antifungal drugs for therapy of genital Candida infections, purchased as over-the-counter products or by prescription: 2. Factors that may have influenced the marked changes in sales volumes during the 1990s.

BACKGROUND: The epidemiology of vulvovaginal candidiasis (VVC) and such recurrent infections (RVVC) has been difficult to study as the majority of episodes of these conditions are self-treated by the women affected. In Sweden, all pharmacies are owned by the state and all prescriptions and over-the-counter (OTC) products, such as antifungals, are registered in a database, which offers unique possibilities to study the epidemiology of VVC/RVVC. OBJECTIVES: To analyze all prescriptions and OTC products purchased for therapy of VVC/RVVC and to establish reasons for any observed variation in the sales figures. METHODS: Sales figures in the Swedish county of Skåne of antifungal drugs for therapy of VVC/RVVC were analyzed by the aid of the 'ACS' database of the National Corporation of Swedish Pharmacies for the years 1990--1999. The size of the female population in the county is approximately half a million. RESULTS: The study showed that 93% of all antifungal drugs for VVC/RVVC were sold as OTC products. An increase in sales of the drugs occurred until mid- 1993/94, followed by a decrease until end of the study period in 1999. Demographic factors (e.g. the number of female inhabitants in the county, pharmacies and health-care units), the pregnancy rate and pharmacy-dependent factors (such as the introduction of shelves for self-selection of antifungal products) did not explain the observed variations in sales. Distinct short-term variations in the number of prescriptions of fluconazole and itraconazole could be explained by drugs company sales campaigns and logistics factors in drug distribution. The sales volumes in the 33 municipalities in the county correlated with the density of the population, which was not the case for the total number of prescriptions made in the county during the 1990s. The variation in antifungal drug sales was similar to that of hormonal intrauterine devices, but this was not the case for oral contraceptives. The total Swedish usage of antibiotics showed a similar variation to that of the antifungal drugs analyzed. CONCLUSION: The study stresses the limited impact on the treatment of VVC/RVVC by the medical community. Behavior-related factors in the female population are the most likely explanation for the marked variations found in the usage of drugs for the two conditions.

Adolescent↗
PubMed1998

Pharmacists' attitudes about pharmacy sale of needles/syringes and needle exchange programs in a city without needle/syringe prescription laws.

We assessed pharmacists' practices for needle and syringe (NS) sales and their attitudes toward a needle exchange program through a telephone survey of 75 randomly selected pharmacies in Baltimore, Maryland, where possession of drug paraphernalia is illegal but where NS can be purchased without a prescription. Pharmacists' (n=46) procedures for NS sales included asking for picture identification (54%), requiring a prescription (34%), or requiring a diabetic identification (DID, 34%) for NS purchase; multiple responses were allowed. The median number of prescription and nonprescription NS sold per month was 950. Most (86.6%) pharmacists reported selling NS without prescriptions at their discretion. Pharmacists sold a median of 16 nonprescription NS per month. Pharmacists who required prescriptions or DID (56.5%) sold nonprescription NS significantly less often than those who did not require prescriptions or DID (p=.007). Most pharmacists (87%) were aware of the needle exchange program, 78.3% supported the program, and 67.4% supported selling nonprescription NS in pharmacies. Although there was no difference in anticipated effects of needle exchange or in support for needle exchange between pharmacists who did or did not require prescriptions, DID, or both, pharmacists who did require these items were significantly less likely to support pharmacy sales of nonprescription NS than pharmacists with less restrictive sales policies (p=.04). Although most pharmacists surveyed supported access to sterile NS by injection drug users through a needle exchange program, there was a diversity of approaches to nonprescription NS sales among pharmacists in a city that does not require prescriptions for access to sterile NS. Most supported nonpharmacy needle exchange programs, and more than one half limited injection drug users' access to NS through restrictive sales practices. To reduce injection drug users' exposure to HIV, pharmacists should be educated about HIV prevention and injection drug use and be included in development of HIV prevention programs, including legal pharmacy NS sales.

Attitude of Health Personnel↗
PubMed2005

Dynamics of book sales: endogenous versus exogenous shocks in complex networks.

We present an extensive study of the foreshock and aftershock signatures accompanying peaks of book sales. The time series of book sales are derived from the ranking system of Amazon.com. We present two independent ways of classifying peaks, one based on the acceleration pattern of sales and the other based on the exponent of the relaxation. They are found to be consistent and reveal the coexistence of two types of sales peaks: exogenous peaks occur abruptly and are followed by a power law relaxation, while endogenous sale peaks occur after a progressively accelerating power law growth followed by an approximately symmetrical power law relaxation which is slower than for exogenous peaks. We develop a simple epidemic model of buyers connected within a network of acquaintances which propagates rumors and opinions on books. The comparison between the predictions of the model and the empirical data confirms the validity of the model and suggests in addition that social networks have evolved to converge very close to criticality (here in the sense of critical branching processes of opinion spreading). We test in detail the evidence for a power law distribution of book sales and confirm a previous indirect study suggesting that the fraction of books (density distribution) P (S) of sales S is a power law P(S) approximately 1/ S(1+mu) with mu approximately equal to 2 .

Journal Article↗
PubMed1990

Effects of the elimination of a state monopoly on distilled spirits' retail sales: a time-series analysis of Iowa.

Since the end of prohibition in the USA, only one state, Iowa, has eliminated its state retail monopoly of distilled spirits sales for off-premise consumption. In March 1987 all state retail stores were closed, and private establishments were licensed to sell distilled spirits. Interrupted time-series analyses of apparent spirits consumption in Iowa, controlling for nationwide sales trends over the past two decades, identified a statistically significant 9.5% increase in spirits sales following the policy change. While there was a corresponding 13.7% decline in wine sales, and no change in beer sales, privatization of spirits retail sales yielded a net increase in total alcohol consumption in Iowa. No changes were found in spirits sales in states bordering Iowa.

Alcohol Drinking↗
PubMed1984

Trends in sales of drugs for asthma in New Zealand, Australia, and the United Kingdom, 1975-81.

As part of an investigation into the recent epidemic of deaths from asthma in New Zealand, trends in the sales of drugs for asthma in New Zealand, Australia, and the United Kingdom during 1975-81 were examined. Data on sales of drugs were obtained from an international pharmaceutical market research organisation. A striking increase in sales of sympathomimetic aerosols, steroid aerosols, and theophylline per caput occurred in all three countries, with the greatest increase occurring in New Zealand. Sales of sodium cromoglycate also increased in New Zealand and the UK but fell in Australia. By 1981 New Zealand had the highest sales of all these drugs per caput. Explanations for the rising mortality from asthma in New Zealand despite large increases in drug sales need to be explored. Although the temporal association between mortality and sales of drugs suggests that direct drug toxicity is unlikely, there may be more subtle adverse effects of drug use.

Adolescent↗
PubMed2000

Cigarette consumption and sales of nicotine replacement products.

BACKGROUND: The first nicotine replacement product, Nicorette Gum, was marketed in 1984 as an adjuvant to help smokers quit smoking. In 1992, sales of nicotine patches were begun. Before 1996, nicotine gums and nicotine patches were prescribed by physicians and supplemented with behavioural counselling. Since 1996, nicotine gums and patches became available over the counter. OBJECTIVES: To examine the effect of sales of nicotine replacement products on national cigarette consumption. DESIGN: National time series quarterly cigarette consumption, sales of nicotine gums and patches data between 1976 and 1998 are used to estimate a time series autoregressive moving average intervention model. PARTICIPANTS: National reported statistics. MAIN OUTCOME MEASURES: Per capita cigarette sales. RESULTS: A 10% increase in sales of nicotine replacement products will lead to a 0.04% reduction in cigarette sales. The model indicates that a 0.076% reduction in cigarette consumption is associated with the availability of nicotine patches after 1992. The over the counter dummy variable (after 1996) has a negative sign, but is not significant, perhaps due to only a few quarters of data in the study period. CONCLUSIONS: Nicotine replacement products (nicotine gums and nicotine patches) play a significant role in reducing cigarette consumption, in addition to the negative effect of increasing cigarette price and the overall trend of declining cigarette consumption (as reflected by the time trend variable). The findings of this study suggest that additional efforts for promoting sales of nicotine replacement products will be another effective alternative to discouraging cigarette consumption.

Adolescent↗
PubMed2006

Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries.

BACKGROUND: The effect of recent increases in antidepressant prescribing on population suicide rates is uncertain. AIMS: To investigate the relationship between antidepressant sales and trends in suicide rates. METHOD: Graphical and quantitative assessment of trends in suicide and antidepressant sales in Norway, Sweden, Denmark and Finland. RESULTS: Suicide rates declined in all four countries during the 1990 s, whereas antidepressant sales increased by 3- to 4-fold. Decreasing suicide rates in Sweden and Denmark preceded the rise in antidepressant sales by over 10 years, although the reductions accelerated between 1988 and 1990. In Norway, a modest but short-lived decline in suicide rates began around the time of the increase in antidepressant sales. In Finland, decreases in male suicide rates and to a lesser extent in female suicide rates began around the time of increased antidepressant sales. In all four countries decreases in suicide rates appeared to precede the widespread use of SSRIs. CONCLUSIONS: We found mixed evidence that increases in antidepressant sales have coincided with a reduction in the number of suicides in Nordic countries.

Adolescent↗
PubMed1995

The relationship of alcohol sales to cirrhosis mortality.

OBJECTIVE: The goal of the current study was to evaluate the extent to which beverage specific alcohol sales (beer, wine and distilled spirits) are associated with cirrhosis mortality rates. METHOD: Cirrhosis mortality rates were related to measures of beverage specific alcohol sales data from 50 states in the United States taken over 12 years. Cirrhosis mortality rates were regressed over beverage specific alcohol sales in a time series cross-sectional analysis that included age compositions of state populations, measures of the availability of health care, population density, proscriptions on alcohol use, income, tourism and nighttime traffic fatality crash rates as covariates. RESULTS: Controlling for empirically observed first order autocorrelated errors in estimation, and the effects of other related covariates, the analyses showed that there was a beverage specific effect of distilled spirits sales on cirrhosis mortality rates. One percent increases in spirits sales were reflected in .282% increases in cirrhosis mortality rates. There were no significant effects for either beer or wine sales. CONCLUSIONS: The relationship of spirits sales to cirrhosis mortality rates may be explained most reasonably by the association of chronic heavy drinking with the consumption of spirits.

Adolescent↗
PubMed1989

Stereotypical beliefs about overweight and smoking and decision-making in assignments to sales territories.

This study examined job bias associated with business students' role-playing as sales managers who assigned trainees to sales territories. Personal characteristics of being extremely overweight and being a heavy smoker were studied. Research participants were given a personnel record (training record) of a sales trainee and asked to make a sales territory assignment decision; three vacant territories were also described. The participants were told to assign the trainee to one of the territories or to indicate a preference to not have the recruit assigned to any territory within the role-playing manager's region. Analysis indicates that a sales recruit described as extremely overweight was less likely to be assigned to an important or desirable sales territory and more likely to be assigned to an undesirable territory or not selected at all for an assignment within a sales region. Those described as heavy smokers were similarly treated but to a lesser degree. Overweight saleswomen were discriminated against more than overweight salesmen.

Decision Making↗
PubMed2005

Experimental surveillance using data on sales of over-the-counter medications--Japan, November 2003-April 2004.

OBJECTIVES: This report describes a study to explore the possibility of using data on sales of over-the- counter (OTC) medications as part of a routine syndromic surveillance system aimed at early detection of infections of public health concern. A retrospective evaluation was conducted of sales of OTC medications used to treat the common cold. This report discusses the correlation of these data to influenza activity in Japan during the 2003-04 influenza season and evaluates the potential of using such data to predict influenza epidemics. METHODS: Data from approximately 1,100 pharmacies throughout Japan collected during November 2003-April 2004 were analyzed. OTC sales data were compared with influenza incidence data (one weekly and two daily data sets) to determine correlations and predictability. Adjusted R-square was used as an index of goodness of-fit in the estimation. Data reflecting daily influenza activity were obtained from the National Surveillance of Daily Influenza Outpatients and the Mailing List-Based Influenza Epidemic Database. National sentinel surveillance data for influenza from approximately 5,000 sites nationwide also were analyzed. RESULTS: Although a correlation was demonstrated between sales of OTC medications used to treat the common cold and concurrent influenza activity, analysis of sales data alone was not sufficient to determine influenza activity in advance even when sales promotion effects were excluded from the analysis. CONCLUSION: Because visiting a health-care provider costs more than purchasing OTC medications, the hypothesis was formed that an ill person will purchase OTC medications first and visit a physician only if the condition does not resolve or worsens. The results of this study do not provide any clear evidence to support this hypothesis. For this reason, OTC sales do not appear to be a good candidate for a national real-time detection system for influenza epidemics in Japan.

Commerce↗