"They try to suppress us, but we should be louder": a qualitative exploration of intimidation in tobacco control

BACKGROUND

Tobacco control advocates and researchers face powerful opponents who go to great lengths to protect their interests. While threats and attacks are documented in the grey literature, research into intimidation remains scarce. Building on previous exploratory research, this study seeks to offer in-depth insights into experiences of intimidation in the global tobacco control community.

METHODS

Using qualitative description, we conducted a focus group and semi-structured interviews with tobacco control advocates and researchers to explore their experiences, including forms of, and responses to, intimidation, and ways forward. Data were analysed using qualitative content analysis.

RESULTS

Twenty-nine individuals from across the globe participated in the study. They reported several forms of intimidation including attacks in the media; online harassment; legal threats; non-legal threats, including death threats; Freedom of Information requests; perceived or actual surveillance; as well as burglary and theft. Responses included non-action (i.e. ignoring attacks); withdrawal (i.e. abandoning a project, area or field); defensive adaptation, for example through self-censorship; and offensive measures, including exposing attacks or filing complaints. Responses were shaped by several factors, including type and level of support from within internal and external networks; as well as an individual's mindset, skills and experiences; and state-civil society relations. Participants suggested several measures that could help address intimidation: 1) report and monitor intimidation; 2) (better) prepare individuals through awareness raising and training (e.g. IT security, legal); 3) support those in need through legal advice, a peer-support network and involvement in response; and 4) look beyond tobacco control to learn and build connections.

CONCLUSION

Intimidation is a significant challenge to tobacco control that needs urgent attention. This study suggests measures to address intimidation that require commitment from, and collaboration amongst, multiple actors including governments, international organisations, funders, researchers and civil society. Moreover, collective action beyond tobacco control is needed to not only manage but move beyond intimidation.

A new approach to prevent, diagnose, and treat hepatitis B in Africa

There are 82 million people living with hepatitis B (PLWHB) in the World Health Organization Africa region, where it is the main cause of liver disease. Effective vaccines have been available for over 40 years, yet there are 990,000 new infections annually, due to limited implementation of hepatitis B birth dose vaccination and antenatal tenofovir prophylaxis for highly viraemic women, which could eliminate mother-to-child transmission. Despite effective and cheap antiviral treatment which can suppress hepatitis B virus replication and reduce the risk of hepatocellular carcinoma (HCC), < 2% of PLWHB are diagnosed, and only 0.1% are treated. As a result, PLWHB are frequently diagnosed only when they have already developed decompensated cirrhosis and late-stage HCC, and consequently 80,000 hepatitis B-associated deaths occur each year. Major barriers include complex treatment guidelines which were derived from high-income settings, lack of affordable diagnostics, lack or insufficient domestic funding for hepatitis care, and limited healthcare infrastructure. Current treatment criteria may overlook patients at risk of cirrhosis and HCC. Therefore, expanded and simplified treatment criteria are needed. We advocate for decentralized community treatment programmes, adapted for low-resource and rural settings with limited laboratory infrastructure. We propose a strategy of treat-all except patients fulfilling criteria that suggest low risk of disease progression. Expanded treatment represents a financial challenge requiring concerted action from policy makers, industry, and international donor agencies. It is crucial to accelerate hepatitis B elimination plans, integrate hepatitis B care into existing healthcare programmes, and prioritize longitudinal and implementation research to improve care for PLWHB.

Response to antimicrobial resistance in South-East Asia Region

Antimicrobial resistance (AMR) inflicts significant mortality, morbidity and economic loss in the 11 countries in the WHO South-East Asia Region (SEAR). With technical assistance and advocacy from WHO, all countries have developed their respective National Action Plans on AMR that are aligned with the Global Action Plan. Historically, the WHO Regional Office has been proactive in advocacy at the highest political level. The past decade has seen an enhancement of the country's capacity to combat AMR through national efforts catalyzed and supported through several WHO initiatives at all levels-global, regional and country levels. Several countries including Bangladesh, India, Indonesia, Nepal, Sri Lanka and Thailand have observed a worrying trend of increasing drug resistance, despite heightened awareness and actions. Recent AMR data generated by the countries are indicative of fragmented progress. Lack of technical capacity, financial resources, weak regulatory apparatus, slow behavioural changes at all levels of the antimicrobial stewardship landscape and the COVID-19 pandemic have prevented the effective application of several interventions to minimize the impact of AMR.

Building positive respectful midwifery relationships: An analysis of women's experiences of continuity of midwifery care in Aotearoa New Zealand

PROBLEM/BACKGROUND

Respectful woman-centred care is an expectation of the Midwifery Standards of Practice within Aotearoa New Zealand. With both the national and international expectations identifying human rights as a priority in maternity care. Mistreatment can be experienced by women in all socio-political contexts. Identifying women's experiences of their maternity service is vital when assessing the quality of these services.

AIM

To explore women's experiences of continuity of midwifery care in Aotearoa NZ, whether they support the expectations within the Standards of Midwifery Practice and identify the characteristics of care that may contribute to positive or negative experiences of care.

METHODS

A retrospective analysis of women's formal online feedback to their midwife using a mixed method design. Feedback forms received from the 1st January 2019 to the 31st December 2019 were analysed using descriptive statistics with free text thematically analysed.

FINDINGS

A total of 7749 feedback forms were received demonstrating high levels of satisfaction overall. Three overlapping themes were identified as being central to both positive and negative feedback. Building a positive relationship involved three steps. These were the establishment and maintenance of trust, honouring decisions and empowerment. Overall, the existence of these relationship characteristics contributed to a valued woman-midwife relationship. Women who gave negative feedback identified a lack of trust and a failure to honour decisions which led to women feeling disempowered contributing to a lack of being valued in the relationship.

CONCLUSION

Continuity of care in Aotearoa NZ supports the development of a respectful partnership through trust, honouring decisions and empowerment.

Preparing the Allergist/Immunologist for the Next Pandemic

The COVID-19 pandemic had a profound impact on society in general and allergists' practices in particular. The adverse effects included a loss of practice productivity and income, staffing, and in-office procedures due to concerns about the spread of infection and the need for social/physical distancing as well as isolation. Allergy training programs and research activities also suffered. Federal financial assistance, rapid adoption of telehealth with Medicare waivers, and adaptation of practice sites, training programs, and research activities allowed for some return to normal, although still with significant restrictions in staffing and in-office procedures. There were positive aspects to the pandemic in the form of telehealth initiatives, pathways for rapid development and approval of tests and treatments, opportunities for new collaborations, and expertise in vaccines. Preparation for the next pandemic needs to be considered now to avoid the mistakes and missteps that occurred with the COVID-19 pandemic. On a national level, a strategy to overcome the societal divisions, misinformation/disinformation, and distrust of science needs to be developed based on better communication, as well as advocacy for continued improvement in our public health system. Practices and training programs as well as research centers need to institutionalize changes made during the pandemic so they can quickly be reinitiated when necessary.

Immunologist Margaret Baird, a trailblazer in science and empowerment

Emeritus Professor Margaret Baird forged a luminary career for her pioneering research investigating the role of dendritic cells in cancer and infectious diseases, as an inspirational lecturer at the University of Otago and a role model to many. In this article celebrating the 100-year anniversary of ICB, we discuss Margaret's career and life journey through the eyes of her family and coauthors, as we explore her many publications in ICB and beyond.

Future leaders in pharmacy (FLIP): Student perceptions of leadership development within pharmacy school

INTRODUCTION

This study evaluated the perceptions of student pharmacists in their final year regarding leadership development and feelings of preparedness to assume their first leadership role after graduation.

METHODS

This research was conducted using an anonymous, researcher developed, online instrument distributed to 21 institutions across the United States for students in their final semester. Data collected included demographics, the availability/benefit of leadership development activities, and perceptions of leadership skills a pharmacist needs. Student pharmacists' perceptions of their own leadership development and feelings of preparedness to be a leader upon graduation were also analyzed using descriptive statistics.

RESULTS

Seventy-two percent of respondents agreed or strongly agreed that they felt prepared to assume their first leadership role after graduation. Students agreed (91.4%) that their school/college of pharmacy (S/COP) offered enough leadership development opportunities; however, common opportunities were not always identified as the most beneficial. Those most beneficial to student pharmacists' growth were in extracurriculars and experiential learning. Least beneficial were advocacy related activities and self-reflection.

CONCLUSIONS

The majority of respondents felt they were prepared to be a leader in their first professional role. Student pharmacists did not perceive certain common activities related to advocacy and self-reflection as beneficial to their growth. S/COPs should explore strategies to improve such leadership development opportunities.

Population Health Projects: An Innovative Teaching Strategy for Baccalaureate Nursing Education

The American Association of Colleges of Nursing (AACN) Core Competencies for Professional Nursing Education (2021) include a Population Health domain. Future nurses well-versed in the social determinants of health are poised to be leaders, creating change to improve the lives of vulnerable populations. The Population Health Project (PHP) is an innovative learning experience, immersing student nurses in authentic interactions that impact the communities they partner with. Baccalaureate nursing students, during their Population Health course, work in groups to produce innovative, community-focused PHPs, successfully incorporating the AACN competencies. Students identify issues impacting the wellbeing of their assigned population; these issues become the focus of their PHP. They engage with community stakeholders, including their patients, policy makers, and community partners to develop evidence-based and sustainable projects. PHPs focus on reducing health disparities and address priorities important to communities, including concepts of diversity, inclusion, and equity. Examples of long-term impacts of PHPs include: legislative change - a new law mandating pharmacies provide prescription labels in a language the patient can understand; innovative policies - initiating efforts to create a hospice for unhoused patients; and new service provision programs - teaming with a fire department to co-develop a home-visiting program to reduce non-emergent 911 calls.

A Pediatric Resident Advocacy in Complex Care Curriculum

Introduction

Children and youth with special health care needs (CYSHCN) are a special, vulnerable population. Children with medical complexity (CMC) represent a smaller, medically fragile sliver (6%) of the US child population. Several professional pediatric entities direct (or require) pediatric educators to instruct residents in advocacy for all children, explicitly including CYSHCN/CMC populations. While many existing curricula address pediatric advocacy education, a gap remains in curricula specifically designed to aid learners in advocacy of CYSHCN/CMC.

Methods

Using Kolb's experiential learning cycle as a framework, we designed and delivered a comprehensive outpatient complex care curriculum, including several didactic video lectures (total: 60:04 minutes, median: 6:25 minutes) and experiential site visits devoted to advocacy topics for CMC, as one portion of a 4-week elective complex care rotation. Residents completed pre- and posttests of knowledge and pre- and postsurveys to self-assess attitudes, comfort, and behavior; viewed didactic video lectures; and engaged in experiential site visits. Reflective statements captured attitudes regarding advocacy for CMC.

Results

Between July 2016 and June 2020, 47 trainees completed the rotation; data were available for 30 trainees. Residents demonstrated a statistically significant improvement in knowledge (p < .001), as well as improved attitudes, diversity sensitivity, and comfort in advocating for CMC postrotation. Qualitative comments showed overwhelmingly positive learner reaction.

Discussion

This curriculum, which can be offered as a stand-alone resource or a supplement to a comprehensive complex care curriculum, incorporates didactic and experiential teaching methods and addresses a significant competency in advocacy education.

Experiences of Minority Frontline Healthcare Workers During the COVID-19 Pandemic

Minority healthcare worker (MHW) experiences during the COVID-19 pandemic has received little attention in the published literature compared to their majority counterparts. This study describes healthcare systems, mental health, and advocacy challenges that MHWs experienced during the pandemic in the United States. A descriptive cross-sectional design was used to gather data from a convenience sample (n = 74) of MHWs who identified as registered nurses, advanced nurse practitioners, physicians, pharmacists, nursing assistants, dentists, and respiratory therapists. Data were imported into SAS Version 9.4 (Cary, NC) for analysis. Responses to each survey question were tabulated, and percentages of participants responding in the affirmative to each health system, mental health, and advocacy question were displayed. Findings indicate the pandemic both exacerbated old and imposed new challenges. Health systems should offer both tangible and intangible or emotional resources that support resilience; build an inclusive work environment that would consider the experiences and knowledge of MHWs; implement and sustain workplace changes that support and promote self-advocacy without fear of retribution; and increase research on MHWs to inform effective and culturally relevant interventions for challenges experienced by MHWs.

A framework of NGO inside and outside strategies in the commercial determinants of health: findings from a narrative review

BACKGROUND

Public health scholarship has uncovered a wide range of strategies used by industry actors to promote their products and influence government regulation. Less is known about the strategies used by non-government organisations to attempt to influence commercial practices. This narrative review applies a political science typology to identify a suite of 'inside' and 'outside' strategies used by NGOs to attempt to influence the commercial determinants of health.

METHODS

We conducted a systematic search in Web of Science, ProQuest and Scopus. Articles were eligible for inclusion if they comprised an empirical study, explicitly sought to examine 'NGOs', were in English, and identified at least one NGO strategy aimed at commercial and/or government policy and practice.

RESULTS

One hundred forty-four studies met the inclusion criteria. Eight industry sectors were identified: extractive, tobacco, food, alcohol, pharmaceuticals, weapons, textiles and asbestos, and a small number of general studies. We identified 18 types of NGO strategies, categorised according to the target (i.e. commercial actor or government actor) and type of interaction with the target (i.e. inside or outside). Of these, five NGO 'inside' strategies targeted commercial actors directly: 1) participation in partnerships and multistakeholder initiatives; 2) private meetings and roundtables; 3) engaging with company AGMs and shareholders; 4) collaborations other than partnerships; and 5) litigation. 'Outside' strategies targeting commercial actors through the mobilisation of public opinion included 1) monitoring and reporting; 2) protests at industry sites; 3) boycotts; 4) directly engaging the public; and 5) creative use of alternative spaces. Four NGO 'inside' strategies directly targeting government actors included: 1) lobbying; 2) drafting legislation, policies and standards; 3) providing technical support and training; and 4) litigation. NGO 'outside' strategies targeting government included 1) protests and public campaigns; 2) monitoring and reporting; 3) forum shifting; and 4) proposing and initiating alternative solutions. We identified three types of NGO impact: substantive, procedural, and normative.

CONCLUSION

The analysis presents a matrix of NGO strategies used to target commercial and government actors across a range of industry sectors. This framework can be used to guide examination of which NGO strategies are effective and appropriate, and which conditions enable NGO influence.

Political Activism and the Dermatologist

The practice of medicine is governed by legislation and regulation at the state and national level. It is crucial, therefore, that dermatologists become and remain involved in the process to advocate for their patients, their practices, and the specialty itself. Maintaining a relationship with one's state and federal senators and representatives is critical for physicians to have a voice in the shaping of health care policy. Local, state, and national medical and specialty societies are a tremendous resource for physicians to remain abreast of policies affecting the practice of medicine.

Developing a partnership to improve health care delivery to children <18 years with cancer and blood disorders in the English-speaking Caribbean: lessons from the SickKids-Caribbean Initiative (SCI)

In 2013, the SickKids-Caribbean Initiative (SCI) was formalised among The Hospital for Sick Children in Toronto, Canada, the University of the West Indies, and Ministries of Health in six Caribbean countries (Barbados, The Bahamas, Jamaica, St. Lucia, St. Vincent and the Grenadines, and Trinidad and Tobago). The aim was to improve the outcomes and quality of life of children (<18 years) with cancer and blood disorders in the partner countries. Core activities included filling a human resource gap by training paediatric haematologists/oncologists and specialised registered nurses; improving capacity to diagnose and treat diverse haematology/oncology cases; developing and maintaining paediatric oncology databases; creating ongoing advocacy activities with international agencies, decision makers, and civil society; and establishing an integrated administration, management, and funding structure. We describe core program components, successes, and challenges to inform others seeking to improve health service delivery in a multidisciplinary and complex partnership.

Behaviors and Advocacy Related to COVID-19 among Cancer Patients: The Health Belief Model and Opportunities for Messaging and Education

Cancer patients have an increased risk of severe COVID-19 outcomes and were recommended to be vaccinated, wear a mask, practice social distancing, and increase hand hygiene. We used the Health Belief Model (HBM) to identify constructs that were associated with the likelihood of adhering to and advocating for CDC COVID-19 prevention recommendations. We surveyed adult cancer patients who had an onsite appointment at the Penn State Cancer Institute or at the Hematology and Oncology Associates of Northeastern Pennsylvania. Survey measures included adherence to and informing others of COVID-19 recommendations as well as HBM constructs. Relationships between HBM constructs and outcomes were assessed with Spearman's correlation and multivariable ordinal logistic regression. Of the 106 participants who completed the survey for our objectives of interest, 76% always wore a mask, 29% always practiced social distancing, and 24% washed their hands at least 10 times a day. Limited advocacy behaviors were captured for the COVID-19 vaccine (30%), social distancing (36%), and wearing masks (27%). Perceived benefits, perceived barriers, and cues-to-action were positively associated with the likelihood of adherence or advocacy of COVID-19 recommendations among cancer patients, whereas perceived susceptibility and self-efficacy were negatively associated with the likelihood of adherence or advocacy of COVID-19 recommendations among cancer patients. Perceived benefits may be the strongest predictor for adherence and advocacy for specific COVID-19 guidelines. Future messaging and educational campaigns focused on improving adherence to or advocacy of specific health behaviors should be informed by the HBM and originate from multiple outlets.

Zebras Among Us: Advocating for the 30 Million Americans Living with Rare Disease

Nearly 30 million (about 1 in 10) Americans have a rare disease. On average, rare disease patients wait 6 years for an accurate and definitive diagnosis and see as many as 12 specialists along their diagnostic journey. In this brief article, we highlight some of what is being done across patient care, medical education, policy, and innovation in order to improve the diagnostic and treatment journeys of rare disease patients. We hope that members of the medical education community will appreciate this call to action and engage in the rare disease space.

Health Advocacy for Undocumented Immigrant Pregnant Patients

The challenges of providing prenatal care for undocumented immigrants require patience. Pregnant undocumented immigrant women should receive routine prenatal care tailored to their specific needs, with an emphasis on basic needs (eg, housing, safety, food, transportation to appointment). Financial, cultural, and language barriers can impede undocumented immigrants from receiving adequate or optimal prenatal care. Adverse maternal and fetal outcomes may be more common but have not been well-quantified and cannot be compared with outcomes if care had been provided in their country of origin. An example of a community-funded clinic is described in minimizing cost and optimizing outcomes.

Assessing the impact of a leadership and advocacy elective course in a college of pharmacy curriculum

INTRODUCTION AND LEADERSHIP FRAMEWORK

While the scope of a pharmacist's work has grown, continued advocacy is needed to ensure that their skillset is used to the best advantage of the patient. To accomplish this aim, the University of Utah College of Pharmacy created an elective advocacy and leadership class to train students in leadership and advocacy methods, with a focus on enabling students to practice advocacy within the state of Utah throughout the class.

EDUCATIONAL CONTEXT AND METHODS

In addition to traditional lectures, this class asked students to apply the knowledge learned in class to projects within their sphere of influence. Activities included drafting their own bill, writing to a legislator, attending state legislative and board of pharmacy meetings, and a longitudinal quality improvement project. Students answered a pre- and post-class survey to assess their attitudes towards advocacy efforts and how those attitudes were affected by participation in the class.

FINDINGS AND DISCUSSION

As expected, a positive change in attitude towards advocacy was observed, and students indicated that they were more likely to engage in advocacy activities in the future after participating in the course. Moreover, a real legislative outcome has been observed as the result of class projects.

IMPLICATIONS

Enabling students to engage in advocacy activities and guiding them to effect real change is a valuable technique in pharmacy education. Similar efforts can be replicated in other institutions, and similar training should be expanded to required portions of the pharmacy curriculum.

Exploring Vaccine Hesitancy and Uptake during COVID-19: A Review of PM's Mann Ki Baat Dialogue

Public health programmes are interlinked and intertwined with communication, advocacy and social mobilisation for their success. The unprecedented situation created by COVID-19 brought a medical emergency all over the world, the like of which was probably not seen after the Spanish Flu outbreak, a century ago. First there seemed no solution in sight when tens of thousands of people lost their lives to the coronavirus in various countries, but when the vaccine arrived, there were, in general, doubts about its efficacy and safety. Indian scenario was not any different. When the government launched the vaccine in a campaign mode in January 2021, it was also battling with misperceptions and vaccine hesitancy. Prime Minister Narendra Modi took it upon himself to address the issue through his various addresses to the nation and his signature programme Mann ki Baat (MKB) on the radio. This review paper examines the empirical research on MKB coverage of the COVID-19 pandemic, the media multiplier impact of the MKB, people's voices through their engagement with various social media platforms, and what is the impact on vaccine uptake.

Holding the Space: Individual- and Group-level Factors Predicting Member Retention in Gender-Sexuality Alliances

Involvement in extracurricular groups is associated with positive outcomes for youth. Gender-Sexuality Alliances (GSAs) are school-based clubs that may provide benefits to sexual and gender minority (SGM) youth and their allies, yet little is known about what factors predict member retention. The current study explores individual- and group-level predictors of youth's sustained or discontinued membership in GSAs during a school year. Participants were 410 youth (Mage = 15.56; 83% sexual minority; 57% cisgender female; 70% White) and 50 advisors in 32 GSAs purposively sampled across Massachusetts who completed surveys at the beginning and end of the school year. Sexual minority youth and youth who took on more leadership roles at the beginning of the year were less likely to have left their GSA by the end of the school year. Youth who perceived higher levels of social support from their GSA trended less likely to leave their GSA as well, although the association was not significant. Youth who engaged in more advocacy were more likely to have left. Youth in GSAs with greater structure to their meetings were less likely to discontinue their membership; specifically, having a meeting agenda was uniquely predictive of member retention. Implications for GSA inclusivity and practices to promote retention within GSAs and similar social justice-oriented clubs are discussed.

Policy Advocacy Workshop Tools for Training Medical Students to Act on Climate Change

Introduction

Doctors are trusted voices for communities and can influence lawmakers on climate change. Effective climate policy advocacy requires awareness, knowledge, and skills not typically taught in medical schools. Such curriculum additions could help students describe reasons for physicians to engage in climate policy advocacy and compose advocacy presentations.

Methods

To empower engagement in climate policies and develop advocacy skills, we deployed three 90-minute workshops at three institutions for first-, second-, and fourth-year students. The workshops included background on various climate policies of concern to health care professionals, advocacy guidance, scripts and factsheets from physicians' meetings illustrating advocacy opportunities for students and physicians, and active learning exercises. The exercises utilized advocacy templates and actual proposed actions on climate change. Students worked in small groups on advocacy presentations' content and format. Each group shared its work, and facilitators provided feedback.

Results

Out of 102 participants, 29 completed a survey (28% response rate). Using a Likert scale and narratives, students reported significant improvements in readiness to advocate for legislation or policies to mitigate the health effects of climate change, awareness of advocacy opportunities, and capability to prepare advocacy documents.

Discussion

Workshops on climate policy advocacy can equip medical students with important perspectives on their responsibilities and opportunities, as well as skills to be effective. The physician's voice is critical to promoting policies related to the health impacts of climate change. Targeted workshops with actual examples and exercises on climate advocacy are feasible and important additions to the curriculum.

Supporting legislative action: Urinary levels of phthalates and phenols among influencers in the 'Plastics in the spotlight' advocacy initiative

BACKGROUND

Society-wide initiatives to prevent human exposure to plastic residues include laws and policies. Such measures require citizens' support, which can be increased by honest advocacy and pedagogic projects. These efforts must have a scientific basis.

OBJECTIVE

To assist the 'Plastics in the spotlight' advocacy initiative raise awareness among the general public of the presence of plastic residues in the human body, and to increase citizens' support for legislation on plastic control in the European Union.

METHODS

Spot urine samples of 69 volunteers with cultural and political influence from Spain, Portugal, Latvia, Slovenia, Belgium, and Bulgaria were collected. Concentrations of 30 phthalate metabolites and phenols were determined through a high-performance liquid chromatography with tandem mass spectrometry and ultra-high-performance liquid chromatography with tandem mass spectrometry, respectively.

RESULTS

At least 18 compounds were detected in all urine samples. The maximum number of compounds detected per participant was 23, and the mean, 20.5. Phthalates were detected more frequently than phenols. Median concentrations were highest for monoethyl phthalate (41.6 ng/mL, adjusted for specific gravity), and maximum concentrations were highest for mono-iso-butyl phthalate (1345.1 ng/mL), oxybenzone (1915.1 ng/mL), and triclosan (949.6 ng/mL). Most reference values were not exceeded. Women had higher concentrations of the 14 phthalate metabolites and oxybenzone than men. Urinary concentrations were not correlated with age.

DISCUSSION

The study had three main limitations: method of subject selection (volunteers), small sample size, and limited data on determinants of exposure. Studies on volunteers do not pretend to be representative of the general population and are no substitute for biomonitoring studies in representative samples of the populations of interest. Studies as ours can only illustrate the existence and some aspects of the problem, and can raise awareness among citizens concerned by the evidence that the studies provide in a group of subjects who are humanly appealing.

CONCLUSIONS

The results illustrate that human exposure to phthalates and phenols is widespread. All countries appeared to be similarly exposed to these contaminants, with higher levels in females. Most concentrations did not exceed reference values. The effects of this study on the objectives of the 'Plastics in the spotlight' advocacy initiative deserve a specific analysis from policy science.

Healthcare lobbying and campaign finance activities of vision-related professional societies, 2015 to 2022

Purpose

To compare the lobbying expenditures and political action committee (PAC) campaign finance activities of the American Academy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), and American Optometric Association (AOA) from 2015 to 2022.

Methods

Financial data were collected from the Federal Election Commission and OpenSecrets database. Analysis was performed to characterize and compare financial activity among the organizations. P < 0.05 was considered significant and all analyses were two-sided.

Results

From 2015 to 2022, the AAO, ASCRS, and AOA spent $6,745,000, $5,354,406, and $13,335,000 on lobbying, respectively. The AOA's annual lobbying expenditure (median, $1,725,000) was significantly greater than AAO's ($842,500, P = 0.03) and ASCRS's ($694,289, P < 0.001). In PAC donations, OPHTHPAC, affiliated with AAO, received $3,221,737 from 2079 donors (median, $900); eyePAC, affiliated with ASCRS, received $506,255 from 349 donors ($500); and AOA-PAC received $6,642,588 from 3641 donors ($825). Compared to eyePAC, median donations to OPHTHPAC (P = 0.01) and AOA-PAC (P = 0.04) were significantly higher. In campaign spending, OPHTHPAC contributed $2,728,500 to 326 campaigns (median, $5000), eyePAC contributed $293,500 to 58 campaigns ($3000), and AOA-PAC contributed $5,128,673 to 617 campaigns ($5500). eyePAC's median campaign contribution was significantly lower than the AOA's (P < 0.001) and AAO's (P = 0.007). Every PAC directed most of its contributions toward Republican campaigns; eyePAC donated the highest proportion (64.9%).

Conclusions

AOA was more assertive in shaping policy by increasing lobbying expenditures, fundraising, and donating to a greater number of election campaigns.