Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial.

BackgroundIn recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described.ObjectiveTo compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation.MethodsTwenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training.ResultsOver the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10).ConclusionIn both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies

The Power of the Weak: How Informal Power-Sharing Shapes the Work of the UN Security Council

To what extent is the work of international organizations shaped by their most powerful members? Can minor powers influence the decisions taken by these organizations? This dissertation presents the argument that great powers engage in power-sharing in order to attain unanimity inside international organizations, which enhances compliance and increases the effect of the signals these organizations convey to the public. The pursuit of unanimity lends weight even to votes that are not needed for the adoption of a proposal under the formal rules. It enables minor powers to exert more influence inside international organizations than they could if the formal rules and/or the balance of material power between member states determined the outcome of decision-making in international organizations. An analysis of the UN Security Council tests this argument. The dissertation identifies a series of informal power-sharing practices in the Security Council, which systematically depart from the organization's formal rules, and which promote consensus and augment minor powers' influence far beyond what one would expect on the basis of the material capabilities and voting power of these states. In turn, these informal power-sharing practices are motivated by great powers' desire to attain unanimous support for the policies enacted in the Security Council, irrespective of the body's formal voting rules. Survey experiments demonstrate the rationale behind great powers' pursuit of unanimity. They show that a policy's endorsement by a united Security Council has a much larger signaling effect on public opinion than the policy's approval by a divided Council. Qualitative case studies and novel design-based causal inference that exploits natural experiments show that minor powers strongly influence the deployment of UN peace operations and UN counter-terrorism sanctions, and that minor powers also use their influence in the Council to attain side-payments. Minor powers' influence is particularly strong during crises, when great powers are most eager to secure small states' votes through power-sharing. Interviews with diplomats in seven countries and quantitative analyses of exogenous variation in minor powers' representation on the Security Council under pre-determined rotation rules trace minor powers' influence to informal power-sharing practices in the Council