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Analysis of taxable sales receipts: was New York City's Smoke-Free Air Act bad for restaurant business?

This article examines the results of a study to determine if the New York City Smoke-Free Air Act has had an adverse economic impact on the taxable sales receipts from the city's restaurant and hotel industries. The study found that real taxable sales from eating and drinking places and hotels in New York City increased by 2.1 percent and 36.9 percent, respectively, compared with levels two years before the smoke-free law took effect. During the same period, real taxable sales for eating and drinking establishments and hotels in the rest of the state experienced a 3.8 percent decrease and a modest 2.4 percent increase in sales, respectively.

Health Policy↗

Endogenous versus exogenous shocks in complex networks: an empirical test using book sale rankings.

We study the precursory and recovery signatures accompanying shocks in complex networks, that we test on a unique database of the Amazon.com ranking of book sales. We find clear distinguishing signatures classifying two types of sales peaks. Exogenous peaks occur abruptly and are followed by a power law relaxation, while endogenous peaks occur after a progressively accelerating power law growth followed by an approximately symmetrical power law relaxation which is slower than for exogenous peaks. These results are rationalized quantitatively by a simple model of epidemic propagation of interactions with long memory within a network of acquaintances. The observed relaxation of sales implies that the sales dynamics is dominated by cascades rather than by the direct effects of news or advertisements, indicating that the social network is close to critical.

Bookselling↗

The influence of Rx-to-OTC changes on drug sales. Experiences from Sweden 1980-1994.

OBJECTIVE: A descriptive study of national sales data from Sweden to find out the effect of over-the-counter (OTC) switches on total sales of a number of drugs. During the period 1980-94, 16 drugs were changed from prescription only (Rx) status to the Swedish OTC market. Total sales increased for 14 out of these 16 drugs. The increase was seen soon after the change to OTC status. Two years after the change an average increase of 36% was seen. In the following 2 years, the increase was typically very modest (average 1%). Large differences in the changes were seen for the individual drugs. The prescription of OTC packs decreased on average by 26% during the first 2 years after the switch. Converting this decrease in sales in terms of number of packs no longer prescribed led to an estimated yearly saving of SEK 200 million ($US 30 million) for the national drug budget. Taking account of the total increase in defined daily doses (DDDs) 2 years after the change for those 16 drugs led to an estimated yearly saving of SEK 2.5 billion ($US 400 million).

Cost Savings↗

Can nutrition information increase sales of healthful vended snacks?

Snack selections from unrefrigerated vending machines were studied in relation to increasing availability of nutrient-dense snack options and providing nutrient information at four selected vending sites on a large university campus. Only four of 133 different snacks available for unrefrigerated vending met the criterion for nutrient-dense snacks. When snack proportion was changed to increase availability of nutrient-dense snacks, sales dropped. When nutrition information in bar graph form was posted on the machines, sales increased but not back to the original level. Although snack sales increased after graphic nutrition information was posted, sales were primarily for the least nutrient-dense, perhaps because few well-liked, nutrient-dense snacks were available for unrefrigerated vending. Schools concerned about providing a selection of vended snacks in agreement with the U.S. Dietary Guidelines might be advised to maintain refrigerated vending or to pursue a "healthy snack" machine concept.

Adolescent↗

People and guns involved in denied and completed handgun sales.

OBJECTIVE: Denial of handgun purchases by prohibited people and knowledge of the structure of gun commerce have helped to deter and prevent firearm violence. The authors hypothesize that handguns involved in a denied purchase would more closely resemble those used in crime compared with handguns sold. DESIGN: Cross sectional. SETTING: Denied and completed handgun sales in California, 1998-2000. MAIN OUTCOME MEASURES: Handgun and purchaser characteristics of denied and completed sales were compared. In particular, handgun characteristics most closely associated with crime guns (type, caliber, barrel length, price) were examined. RESULTS: Compared with handguns sold, handguns in denied sales were somewhat more likely to be semiautomatic pistols (74.6% v 69.4%), to have short barrels (25.9% v 22.2%), and be of medium caliber (48.9% v 37.3%). Ten percent of the handguns in denied sales and 3.4% of handguns sold were identified as inexpensive. CONCLUSIONS: The characteristics of denied handguns are similar to those seen among crime guns. Both groups of guns may reflect the desirability for criminal purposes of pistols, which have larger ammunition capacities than other handguns, and short barrels, which increase their ability to be concealed.

Adult↗

Tobacco availability and point of sale marketing in demographically contrasting districts of Massachusetts.

OBJECTIVE: To assess the prevalence and characteristics of tobacco sales and point-of-sale promotions and advertising in predominantly Latino business districts, and in comparison districts; and the economic importance of tobacco sales and marketing to Latino owned small businesses. DESIGN: Observational surveys of retail establishments and interviews with store managers. SETTING: Demographically contrasting business districts of eastern Massachusetts. MAIN OUTCOME MEASURES: Percentage of businesses selling tobacco, numbers and characteristics of exterior and interior tobacco advertisements per store, merchant reports of promotional allowances received from tobacco distributors. RESULTS: The proportion of businesses selling tobacco, and hence having storefront tobacco advertising, is strongly negatively correlated with per capita income in the census tracts where businesses are located (Spearman's rho = -0.794, p = 0.006). Mentholated brands are marketed disproportionately in low income, urban communities. Latino merchants are highly dependent on tobacco sales, but would require relatively modest compensation to forego tobacco promotional allowances. CONCLUSIONS: Storefront tobacco advertising is far more prevalent in predominantly minority, low income communities than in non-minority, higher income communities, principally because of the differing mix of kinds of businesses in the two types of communities, and the greater prevalence of tobacco vendors in lower income neighbourhoods. Tobacco companies obtain this advertising at little cost.

Advertising↗

Features of sales promotion in cigarette magazine advertisements, 1980-1993: an analysis of youth exposure in the United States.

OBJECTIVE: To examine the presence of features of sales promotion in cigarette advertising in United States magazines, and to describe trends in youth (ages 12-17) exposure to such advertising (termed "promotional advertising"). DESIGN: Analysis of 1980-1993 annual data on: (a) total pages and expenditures for "promotional advertising" (advertising that contains features of sales promotion) in 36 popular magazines (all magazines for which data were available), by cigarette brand; and (b) readership characteristics for each magazine. We defined promotional advertising as advertisements that go beyond the simple advertising of the product and its features to include one or more features of sales promotion, such as coupons, "retail value added" promotions, contests, sweepstakes, catalogues, specialty item distribution, and sponsorship of public entertainment or sporting events. MAIN OUTCOME MEASURES: Total pages of, and expenditures for promotional advertising in magazines; and gross impressions (number of readers multiplied by the number of pages of promotional advertising) among youth and total readership. RESULTS: During the period 1980-1993, tobacco companies spent $90.2 million on promotional advertising in the 36 magazines. The proportion of promotional advertising appearing in "youth" magazines (defined as magazines with a greater than average proportion of youth readers) increased from 7% in 1980 to nearly 100% in 1987. Although youth readers represented only 19% of magazine readers, the proportion of youth gross impressions to total gross impressions of tobacco promotional advertising exceeded this value throughout the entire period 1985-1993, peaking at 33% in 1987. The five "youth" cigarette brands (defined as brands smoked by at least 2.5% of smokers aged 10-15 years in 1993) accounted for 59% of promotional advertising in all magazines, but for 83% of promotional advertising in youth magazines during the study period. CONCLUSIONS: In their magazine advertising, cigarette companies are preferentially exposing young people to advertisements that contain sales promotional features.

Adolescent↗

A state-wide survey of hospital policy and practice concerning cigarette sales.

This study was conducted to determine the current practices and problems with regard to the sale of cigarettes in the approved hospitals of Indiana. A questionnaire was sent to all approved hospitals within the state asking each hospital administrator to respond to specific questions concerning cigarette sales policy and practice. After an initial waiting period, a follow-up letter was sent to each nonresponder. Finally, a response rate of 99 per cent was achieved. It was found that approximately 58 per cent of respondents sold cigarettes, with the majority selling cigarettes both over the counter and through vending machines. However, among the 42 per cent of the sample not selling cigarettes, the vast majority (82 per cent) indicated that no problems were encountered with their no-sales policy and practice. On the basis of both a review of literature pertaining to the potential dangers of ambient cigarette smoke and the findings of this study, the writers concluded that a no-cigarette-sales policy in hospitals is reasonable, feasible, and desirable.

Hospital Administration↗

Smoking habits, sales of fat and antihypertensives fail to explain the high coronary mortality in cold regions of Sweden.

A previous study has shown a strong regional association between cold climate and coronary mortality in Sweden. The present study intended to elucidate further this association, in particular whether or not it could be attributed to smoking, hypertension and fat consumption. The 284 Swedish municipalities were used as units. The outcome was mortality (SMR) from acute myocardial infarction in men aged 40-64. Prevalence of smoking and use of snuff was estimated by interviews. Sales of antihypertensive drugs were used to estimate prevalence of hypertension. Sales of butter and estimates of consumption of saturated fat by interviews were used to estimate the consumption of fat. Weighted determination coefficients (D) were calculated. Apart from the strong association between cold climate and coronary mortality (D = 0.39), an association was shown between fat consumption and coronary mortality (D = 0.22). A weaker association was found between prevalency of snuffing and coronary mortality (D = 0.15) and between sales of butter and coronary mortality (D = 0.10) and the weakest between sales of antihypertensives and coronary mortality (D = 0.06). No association was found between prevalence of smoking and coronary mortality. When the other explanatory factors were added to cold climate in the model no substantial enhancement of the association was achieved. Cold exposure was correlated to the other explanatory factors. To conclude, this study showed that the strong association between cold exposure and coronary mortality was not affected by the regional variation in the estimates of fat consumption, hypertension or tobacco use.

Antihypertensive Agents↗

Long-term findings from Woodridge in reducing illegal cigarette sales to older minors.

The purpose of the present study is to assess the effectiveness of an enforcement program in reducing cigarette sales to older minors in a community that had been successful in reducing illegal sales of cigarettes to younger minors. Cigarette sales rates were monitored over a 3-year period with quarterly compliance testing in Woodridge, Illinois. Sales rates for older minors were found to be only slightly higher than those of younger minors with one exception. These findings suggest that the enforcement of cigarette control laws is an effective means by which access to cigarettes can be reduced for both younger and older minors.

Adolescent↗

Project ARM: alcohol risk management to prevent sales to underage and intoxicated patrons.

Clear policies and expectations are key to increasing responsible service of alcohol in licensed establishments. Few training programs focus exclusively on owners and managers of alcohol establishments to reduce the risk of alcohol service. Project ARM: Alcohol Risk Management is a one-on-one consultation program for owners and managers. Participants received information on risk level, policies to prevent illegal sales, legal issues, and staff communication. This nonrandomized demonstration project was implemented in five diverse bars. Two waves of underage and pseudo-intoxicated purchase attempts were conducted pre- and postintervention in the five intervention bars and nine matched control bars. Underage sales decreased by 11.5%, and sales to pseudo-intoxicated buyers decreased by 46%. Results were in the hypothesized direction but not statistically significant. A one-on-one, outlet-specific training program for owners and managers is a promising way to reduce illegal alcohol sales, particularly to obviously intoxicated individuals.

Administrative Personnel↗

Paracetamol sales and atopic disease in children and adults: an ecological analysis.

The authors recently observed that frequent paracetamol use was positively associated with asthma and rhinitis in young adults. Therefore, an ecological analysis was performed to measure international associations between paracetamol sales and atopic disease prevalences in children and adults. Published data from the International Study of Asthma and Allergies in Childhood (ISAAC) on the prevalence of four atopic symptoms in 13-14-yr-olds (112 centres) and 67-yr-olds (66 centres) in 1994/1995, and European Community Respiratory Health Survey (ECRHS) data on the prevalence of asthma symptoms, diagnosed asthma and rhinitis (44 centres), prevalence of atopy, mean bronchial responsiveness and mean total immunoglobulin E levels (34 centres) in young adults in 1991/1992, were used. Their associations with national 1994/1995 per capita paracetamol sales were measured using linear regression. Paracetamol sales were high in English-speaking countries, and were positively associated with asthma symptoms, eczema and allergic rhinoconjunctivitis in 13-14-yr-olds, and with wheeze, diagnosed asthma, rhinitis and bronchial responsiveness in adults. The prevalence of wheeze increased by 0.52% in 13-14-yr-olds and by 0.26% in adults (p<0.0005) for each gram increase in per capita paracetamol sales. These ecological findings require cautious interpretation, but raise the possibility that variation in paracetamol usage may explain some of the variation in atopic disease prevalence between countries.

Acetaminophen↗

Explaining inconsistencies between data on condom use and condom sales.

BACKGROUND: Several HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups. METHODS: We use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution. RESULTS: Analysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate. CONCLUSIONS: Condom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used.

Adolescent↗

The pharmaceutical sales rep/physician relationship in Turkey: ethical issues in an international context.

In many developed countries, the physician/pharmaceutical sales representative relationship has increasingly become the focus of ethical questions. Given this context, the purpose of the present study was to determine the ethical dilemmas faced by pharmaceutical sales representatives in Turkey in their relations with physicians, and to identify possible solutions. Through an investigator-designed questionnaire, the ethical problems perceived by 215 pharmaceutical sales representatives were quantitatively analyzed. Nearly all of the participants (96.7%) reported that they had faced ethical dilemmas in marketing drugs to physicians. The most commonly reported problems included paramedical requests (for free lab test kits, etc.) and the necessity of bargaining with physicians over the use of their firm's drugs by offering gifts and sponsorships. The participants in the study felt that physicians were the primary source of ethical problems in the marketing of drugs, and the participants' most highly ranked potential solution to these ethical problems was a better understanding, on the part of physicians, of the role of pharmaceutical sales representatives. At the end of this study, suggestions are given with a view to helping health policy makers understand and address the current controversies involving drug company representatives and physicians.

Adult↗

Internet pharmaceutical sales: attributes, concerns, and future forecast.

Internet pharmaceutical sales continue to skyrocket as healthcare providers and consumers are increasingly relying on the efficiencies and convenience that is available via such transactions. Managed care companies, increasing demands to reduce healthcare inefficiencies while maximizing the quality of patient care is a significant contributing factor to the expanding utilization and success of online pharmaceutical sales. However, with the expansion of Internet pharmaceutical sales, healthcare providers, pharmacy benefit management and insurance companies, and consumers realize new opportunities and risks. This paper will review the attributes and concerns associated with online pharmaceutical sales, discussing current and pending legislation intended to more effectively manage these parameters.

Commerce↗

Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.

OBJECTIVE: To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. DESIGN: Pre-post comparison. SETTING: In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. MAIN OUTCOME MEASURES: Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. RESULTS: Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began. CONCLUSION: To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

Humans↗

Public policy and the sale of human organs.

Gill and Sade, in the preceding article in this issue of the Kennedy Institute of Ethics Journal, argue that living individuals should be free from legal constraints against selling their organs. The present commentary responds to several of their claims. It explains why an analogy between kidneys and blood fails; why, as a matter of public policy, we prohibit the sale of human solid organs, yet allow the sale of blood; and why their attack on Kant's putative argument against the sale of human body parts is misplaced. Finally, it rejects the claim that the state is entitled to interfere with the actions of individuals only if such actions would harm others. We draw certain lines grounded in what Rawls has termed "public reason" beyond which we do not give effect to the autonomous self-regarding decisions of individuals. Public resistance to the sale of human body parts, no matter how voluntary or well informed, is grounded in the conviction that such a practice would diminish human dignity and our sense of solidarity. A system of organ donation, in contrast, conveys our respect for persons and honors our common humanity.

Blood Donors↗

Does allowing the sale of wine in Quebec grocery stores increase consumption?

OBJECTIVE: To determine if allowing wine sales in corner grocery stores, beginning in 1978 for domestic Quebec wines and then in 1983 for imported wines, in addition to sales in government monopoly stores, led to an increase in alcohol consumption. METHOD: Aggregate retail sales data for the period 1953 to 1990 were analyzed using econometric regression techniques. Time series (unit root) analysis and structural modeling were used to take into account the effect of price, income and other social, economic and demographic factors in order to determine the effect of factors underlying consumption behavior in both the long and short term. RESULTS: In the post-intervention period, wine consumption continued along the rising trend established in the pre-intervention period, with an apparent shift in favor of domestic wine consumption. The increase in wine consumption was highest in the period immediately following privatization, but the increase eventually dampened down within a few years. There was no fundamental change in the responsiveness of wine consumption to price. CONCLUSION: Our findings suggest that the level of wine consumption can be controlled through price changes when alcohol availability increases through increased sales outlets.

Adolescent↗