The Authors reply

Abstract

The letter from Shu-yi Zhou highlights some important issues for adolescents and young adults (AYA) taking medication that resonate with our clinical experience and research, and we thank her for these thoughtful insights from a student's perspective. Taking nonprescription medication for acute illness is an important area of health literacy development and skill mastery. AYA living at home usually rely on the medication chosen and stored by parents, and on administration by them. A move away from home means that each individual must start to make their own medication choices. Research has found that AYA develop their own “health repertories” or schemas in which parental choices are still influential, but that are also impacted by information sources such as television advertisements and the Internet [1Gray N.J. Cantrill J.A. Noyce P.R. Health repertories; An understanding of lay management of minor ailments.Patient Educ Couns. 2002; 47: 237-244Crossref PubMed Scopus (19) Google Scholar, 2Jain A.V. Bickham D. Adolescent health literacy and the Internet: challenges and opportunities.Curr Opin Pediatr. 2014; 26: 435-439Crossref PubMed Scopus (25) Google Scholar]. Shu-yi contacted her pharmacist parent; even without this professional background, many AYA will contact a parent for reassurance and advice. It is usually the responsibility of the AYA living on campus, however, to obtain medication. In this example, fortunately Shu-yi already had the health literacy capacity to know that taking nonprescription analgesics together could result in an overdose of acetaminophen. Combination products heighten this risk when their acetaminophen content is not immediately obvious. The advice of her parent (a pharmacist) and the doctor differed; Shu-yi reflected that when these health professionals are in practice together, there are extra safety checks in place. The conclusion of a study of the self-medication practices of 15- to 17-year-old high school students in Germany for minor illness was that “adolescents gain drug knowledge through drug consumption and not before taking drugs. This leads to a potential risk particularly in the case of self-medication” [[3]Stoelben S. Krappweis J. Rössler G. Kirch W. Adolescents' drug use and drug knowledge.Eur J Pediatr. 2000; 159: 608-614Crossref PubMed Scopus (83) Google Scholar]. Authors of a study in Bahrain of the self-medication practices of first-year medical students concluded that “knowledge about appropriate self-medication was poor, attitude towards self-medication was positive, and the practice of self-medication was common and often inappropriate” [[4]James H. Handu S.S. Al Khaja K.A. et al.Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students.Med Princ Pract. 2006; 15: 270-275Crossref PubMed Scopus (145) Google Scholar]. In both studies, analgesics were the most frequently used nonprescription medications reported. This real-life narrative highlights at least two issues that are reflected in the recent Society for Adolescent Health and Medicine position paper about AYA use of medication [[5]Gray N.J. Christie D. Coyne I. et al.The use of medication by adolescents and young adults: A position paper of the Society for Adolescent Health and Medicine.J Adolesc Health. 2017; 61: 396-399Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar]. It underlines the value of including pharmacists in the multidisciplinary health-care team supporting AYA medication use, to complement the expertise of physicians and nurses. It also supports health literacy capacity development among AYA so that their use of medication for acute or chronic illness is informed by basic safety information and that they have the confidence to engage confidently with prescribers. Parents, doctors, nurses, and pharmacists all have a role to play. We also concur with Shu-Yi Zhou that health literacy programs within education settings may help equip AYA with the skills for independent living, including self-medication practices. Anticipating inevitable independent self-medication, school and college health services could make information available to students in the form of bookmarks on institutional computers for reputable health websites, and provide basic factsheets for a range of common illnesses. Moreover, a generic factsheet about the safe purchase, administration, storage, and disposal of medication, including common interactions, would help students to use nonprescription medication safely and effectively.