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This dissertation examined the impact of Medicare Plan D on medication compliance in Medicare beneficiaries at University of Texas Health Center at Tyler, TX. Data were collected before and after the implementation of Plan D. The impacts of various types of benefits, such as private insurance, employer insurance and pharmacy assistance programs were evaluated in terms of impact on drug compliance. Medication compliance was found to increase in those respondents without Plan D. Plan D was found to be a predictor of those who spent less on basics in order to buy medications. Although compliance increased in general, these increases could not be attributed to the acquisition of a Plan D policy.

Background: Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities. Methods: Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18 years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership. Results: Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P valueThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

The thesis addresses the analysis of the marketing mix in the pharmaceutical industry with a detailed focus on the promotion and communication channels of the prescription drug. The aim is to help a company with a control and optimization of the communication strategy so that it is adapted to the new trends. The differences between the prescription drug and the over-the-counter drug in the aspects of communication, promotion and the role of branding is drawn. Several methods such as analysis, description and marketing research are used. The thesis is divided into five main chapters.

Background: Community pharmacists are legally required to evaluate and confirm the legitimacy of prescription opioids (POs) prior to dispensing. Yet, previous research has indicated community pharmacists perceive nearly 50% of dispensed POs to be issued lacking a legitimate medical purpose. Objective: To analyze correlates of PO legitimacy judgments across pharmacist and pharmacy setting characteristics. Methods: A cross-sectional study of 2000 Tennessee pharmacists was conducted during October and November of 2012. Community pharmacists' self-reported attitudes, beliefs, and behaviors specific to PO legitimacy were elicited. Step-wise multinomial logistic regression techniques were used to model correlates of PO legitimacy across low, moderate and high PO legitimacy estimations. Results: Being female, practicing in a chain or independent practice setting, fear of employer disciplinary action if PO legitimacy is questioned, and self-confidence in one's ability to detect PO abuse increased the odds of low (vs. high) PO legitimacy estimation (p < 0.05). Employment in chain and independent pharmacies, having POs as a greater percent of total prescriptions filled, and having the perception of PO abuse as a problem in the practice setting were significant positive correlates of moderate (vs high) PO legitimacy estimation (p < 0.05). Conclusions: Both modifiable and non-modifiable correlates were statistically significantly associated with PO legitimacy judgments. Distinct correlates were noted across low and moderate as compared to high estimations of PO legitimacy. Legitimacy judgments can inform theoretical exploration of PO dispensing behaviors and inform intervention development targeted at reducing and preventing prescription drug abuse.

In an age of biomedicine, technologies, drugs, and treatments are expanding in new and diverse ways. Especially relevant to biomedicalization and this research is how such information is conveyed to the public through the media. Medical information is omnipresent in the media through direct-to-consumer (DTC) advertising and regular coverage of health topics in the news. The accessibility and proliferation of medical information provides an important opportunity to examine the ways in which these topics are framed in the media. This research specifically examines the framing of the HPV vaccine, Gardasil in the mass media. In this study, I explore how Gardasil was framed, how gender and sexuality were utilized within such frames, and what groups influenced these frames. I employ frame analysis to examine the presentation of Gardasil in the mass media. Due to the vaccine's intricate connection to gender and sexuality, I examine how these dimensions are utilized and reproduced in such frames. Gardasil was originally approved only for women, making gender a salient aspect of the vaccine. The current body of research examining Gardasil in the media presents data from the time the vaccine was only available to women. Now that the HPV vaccine is approved for men, this research seeks to contribute to a more comprehensive understanding of how Gardasil was framed in the media now that it is available to men and women. And given that Gardasil prevents a sexually transmitted infection (STI) in men and women, it is uniquely tied to issues of sexuality. To analyze Gardasil in the media, I examine newspaper articles, magazine articles, and media representations from stakeholder groups, including DTC advertising, official statements, and group websites. Analysis of key sources indicates that Merck dominated the framing of the vaccine in DTC advertisements and the news media, illustrating the power of the pharmaceutical industry. Findings indicate that the initial marketing of Gardasil constructed the vaccine as uniquely tied to femininity and later, women's empowerment. However, once the drug was approved for men, messages were reframed to appeal to a wider audience. Overall, the media continued to frame the vaccine specifically for women, further constructing HPV as a "woman's disease." The dominant focus on women concomitantly silenced the sexual health of men and sexual minorities. In conclusion, the marketing, discourse, and structural elements of Gardasil make it less accessible to those most in need, therefore contributing to the ongoing problem of cervical cancer and HPV.

Syftet med detta projekt var att identifiera om en implementering av en standardisering för receptbelagda läkemedelsförpackningar, skulle kunna bidra till en minskad risk gällande feldosering eller felmedicinering av patient. Resultatet av studien konstaterar att en standardisering för ordinationer har större effekt. / The purpose of this project was to identify if an implementation of a standardization for prescription drugs packaging, could contribute to a reduced risk of error when medicating a patient with prescription drugs and dosage. The outcome of the study states that a standardization for prescriptions has a bigger impact.