Nonprescription Drug Use Research Articles

Clustering and Consistency of Use of Medicines Among Mid-Aged Women

This paper describes the use of drugs among middle-aged Massachusetts women from 1982 to 1986. Data were obtained from follow-up interviews of women (n = 2565) who were premenopausal in a baseline survey of a representative sample of women with an age range of 45-55. In the first follow-up interview, 92% of women had used nonprescribed drugs ("current use"), but most only sporadically, while 47% had used prescribed drugs. The use of different types of drugs was concentrated in the same women, and women who had used prescribed drugs had also used nonprescribed drugs more often than the other women. In the first follow-up, women were classified as nonusers (includes sporadic nonprescribed drug use), nonprescribed medicine users, prescribed drug users, and mixed users; 43% of the women were in a different class three years later. Comparison of individual drug groups also showed changes in the user status between the two surveys. With the exception of poorer health, users of nonprescribed and prescribed drugs were similar to nonusers. Because use of drugs is common, further research on both its determinants and appropriateness is needed.

Health Professionals' Perceptions of Drug Use Problems of the Elderly

ABSTRACTMany elderly in Canada are living independently and managing their own medication use. Since the elderly are more susceptible to the ill-effects of drugs, non-prescription drug use may pose a hazard. In order to conduct a survey to determine the extent of hazardous self-medication with non-prescription analgesics and the factors that contribute to such use, a valid measurement of hazardous use was needed. To determine items for this measurement, a survey was conducted with health professionals in a position to detect problems with drug use by the elderly. Nurses and physicians were asked their perceptions of drug use problems and of their elderly clients' concerns about their health and drug use. Results indicated that eight items should be included in a measurement to reflect hazardous drug use seen in practice by more than 50% of the health professionals surveyed. Nurses and physicians differed in their perceptions of certain problems and of their elderly clients' concerns.

Relationship between drug use and urinary incontinence in elderly women.

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

An outcome study comparing refusers and acceptors of treatment for alcoholism.

Fifteen matched pairs of alcoholics who had either refused or completed day treatment were reassessed sixteen months after the initial assessment. The treated group had improved significantly more than the untreated group on measures related directly to alcohol abuse, in their utilization of inpatient psychiatric services, and the use of family physician's services. The treated group had also used disulfiram for significantly longer periods of time. The treatment refusers had nonetheless achieved statistically significant, albeit modest, reduction in their consumption of alcohol compared to their pre-assessment levels. Both groups showed equal amount of change on a number of psychosocial measures, such as employment, use of minor tranquilizers and non-prescription drugs, legal problems and symptoms of depression. These findings are discussed in the context of the effectiveness of a day program, the use of disulfiram and certain pretreatment characteristics of the patient.

The Relation Between Vaginal Spermicides and Congenital Disorders-Reply

In Reply.— Currently available data 1,2 on spermicides and malformations argue against a causal association between the two. In commenting on our study, 3 however, Dr Shapiro has been drawn into areas about which he is not well informed. We chose as our exposure variable the acquisition of a vaginal spermicide, as recorded in an automated pharmacy file, within 600 days of delivery. After some discussion we specifically chose not to abstract spermicide exposure data from clinical records. Medical charts are limited and frequently misleading with regard to important details of nonprescription drug use. (We did of course arrange for expert review of all available clinical and laboratory data to decide on the nature of the congenital anomalies.) As we stated in our letter last year in JAMA , 4 4 and as we suggested in our original publication, 3 we consider use of spermicides prior to conception to be a

Exploring the Iceberg

Despite the importance of daily symptoms for people's quality of living, they are seldom studied (thus, the "iceberg of morbidity"). We begin by reviewing United States and British studies that have information on daily symptoms experienced by adults. The most common ones are respiratory (largely from colds) and musculoskeletal (largely from arthritis, injury, overexertion). Using health diaries kept for 6 weeks by a population-based sample of adults, we report the frequency of respiratory and musculoskeletal symptoms, their specific types and causes, and what factor urge people to take therapeutic actions for them. The most popular action for both is prescription or nonprescription drugs, followed by lay consultation, then restricted activity, and lastly seeking medical care. On Respiratory Days, how miserable a person feels is the main stimulus to action; other morbidity aspects of the day also rank high. Sociodemographic groups scarcely differ in their responses to respiratory symptoms. The situation is similar for Musculoskeletal Nondisease Days (injury/overexertion). But for Musculoskeletal Disease Days (arthritis), sociodemographic characteristics figure more strongly in care, and the day's degree of morbidity less. These results signal basic differences in how people approach chronic and acute health problems: For chronic ones, they devise strategies of care (determined partly by their roles, attitudes, and resources) over months and years, and apply them during flare-ups. For acute problems, decisions about care are made in the short run and hinge mostly on symptoms. Our analysis also considers how actions complement or substitute for each other: Self-care actions (nonprescription drug use and restricted activity) tend to co-occur, and so do actions based on medical care (prescription drug use and medical contact). The two domains substitute in one way (nonprescription drug use greatly reduces chances of prescription drug use) and join in another (restricted activity increases chances of medical contact).

Drug use in an ambulatory elderly population: a five-year update.

Drug usage was studied in an ambulatory elderly population in Dunedin, Florida. Prescription and nonprescription drug use in these 2834 participants was compared with use during a period five years earlier. The average number of medications increased from 3.2 in 1978-80 to 3.7 in 1983-85. The most commonly prescribed medications in this population were hydrochlorothiazide-triamterene (13.5 percent), digoxin (9.6 percent), and hydrochlorothiazide (8.4 percent). There was a large increase in the use of nutritional supplements in the past five years, with 18.0 percent of these subjects reporting the use of vitamin E and 15.7 percent taking vitamin C. The general philosophy in geriatrics is to use the fewest drugs possible; however, it appears that the elderly are, in fact, receiving an increasing number of medications.

Medication use characteristics in the elderly: the Iowa 65+ Rural Health Study.

Medication use was studied in a rural, elderly population. Household interviews were conducted of 3,467 individuals aged 65 years or older. A total of 9,955 prescription or nonprescription drugs were reported by the respondents. The overall mean number of drugs per respondent was 2.87, while 12% of all respondents were not taking any drugs. Mean prescription and overall drug use increased significantly with increasing age (P less than .001), while mean nonprescription drug use was relatively constant across age groups. Significantly more women were prescription and nonprescription drug users. Directions for scheduled daily dosing accounted for 75% of all directions. The majority of prescription and nonprescription drugs had been taken on the previous day. General practitioners accounted for more prescription drugs (39.7%) than any other medical specialty. The most frequently stated purpose was cardiovascular for prescription drugs and musculoskeletal for nonprescription drugs. The three most frequent prescription drug therapeutic categories were cardiovascular (54.7%), central nervous system (CNS) agents (11.4%), and analgesics (9.4%). For nonprescription drugs, the three most frequent therapeutic categories were analgesics (39.6%), vitamins and minerals (32.9%), and laxatives (14.1%). Implications of these findings are discussed.

Coping with the Stress of Medical Problems among Black and White Elderly

This is a preliminary study looking at the coping responses of a group of black and white urban elderly women to the stressful event of a medical problem. Cognitive and active coping responses, as well as social support, were explored. Findings revealed these women were similar in many of the ways in which they responded to the stress of medical problems. However, there were some definite racial differences. These included level of social support, use of prayer in coping, and use of nonprescription drugs; the black elderly engaged in these latter behaviors more frequently.

Counseling clients regarding over-the-counter drug use.

Few, if any, nurses have conducted a career in health care without being asked for advice about self-treatment of minor health problems and the use of nonprescription drugs. However, nursing education curricula rarely specifically address the issue of self-medication with over-the-counter (OTC) drugs. How well are nurses meeting the needs of the public in this regard? The use of prescription drugs appears to be declining and the practice of selfmedication to be increasing (Dolusio, 1983; OTC Update, 1982). This may be the result of polarization and compartmentalization of attitudes toward the use of drugs. Following the popularization of psychoactive drugs (medicinal and nonmedicinal) in the 50s and 60s, concern arose that society was relying unduly on the use of chemical agents. In overreaction to the pill for every ill philosophy, many people began to oppose the use of any drugs. The issue has become charged with emotion and highly polarized, making objective judgments very difficult. In addition, a given individual may express conflicting opinions, such as opposition to the use of certain substances (illegal drugs, psychotropic medications), while relying heavily on the use of others (vitamins, caffeine, alcohol). There is a tendency for consumers to discount the use of over-the-counter medications because they do not consider them to be drugs. Few studies have been conducted to investigate the use of nonprescription (overthe-counter) drugs. One retrospective study carried out in the United States in 1983 indicated that most people report that they experience self-treatable health problems and that a majority of these are treated with nonprescription drugs (Robinson, 1984). Because the study was sponsored by the Proprietary Association, the national organization of OTC drug manufacturers, these data may be slanted. However, it is undeniable that OTC drugs sell well and are presumably widely used. What can nurses do to make use of these medications safer and more effective?

Survey of consumer users of a statewide drug information service

A survey of consumers who had used a state-supported drug information center (DIC) was conducted to determine reasons for and frequency of use of the DIC and opinions about the services of the DIC. The Arizona Poison and Drug Information Center (APDIC) mailed questionnaires to 281 lay persons who had requested information about use of prescription or nonprescription drugs. The questionnaires were sent only to callers who responded affirmatively when asked to participate in the survey. Of 154 (54.8%) respondents (83.8% women), 40.9% were using no prescription drugs at the time of the survey and 83.8% purchased fewer than two nonprescription drugs per month. Approximately 44% said they tried to obtain drug information at least once per month. Pharmacists were named as the most frequent source of drug information for nonprescription drugs, but information about prescription drugs was sought more frequently from physicians and reference books. APDIC was mentioned most frequently as a source of information about all drugs (both prescription and nonprescription). Nearly all respondents said the information from APDIC was helpful and the service should be continued. Drug information consumers looked to this DIC to meet a demand not being met by pharmacists or physicians in the community. Consumers viewed the information as valuable and used this service because it was available and accessible.

Nonprescription Drug Use among the Elderly

We investigated the extent of the use of nonprescription drugs among an elderly population and the health and social characteristics most related to their use (nonprescription drugs referring to "medicines that don't require a prescription for slight illnesses"). The study data derive from an interview survey of a random sample of adult members of a large health maintenance organization (HMO). While most of the members we interviewed used nonprescription drugs, only one in eight were categorized as using them "very often," the category of most frequent use. Nonprescription drug use was more often associated with reports of common, largely self-limiting conditions than with less common symptoms that could be indicative of serious underlying disease. Such drugs appeared to be used in conjunction with, rather than instead of, physician services. The most frequent users also more frequently asked pharmacists for advice, had unfilled prescriptions, and did not follow physician's instructions. Emotional and mental health were the most important factors accounting for nonprescription drug use among the elderly, particularly among the most frequent users. The profile of the "most frequent" elderly user is one of having emotional health problems; engaging in self-care, but also receiving professional physician services; and engaging in some questionable health behaviors, but not skeptical of medicine in general. Our findings suggest that more attention should be paid to the emotional needs of the elderly.

Nonprescription Drug Use among Hospitalized Pediatric Patients

The parents of pediatric patients were questioned regarding the use and selection of nonprescription drugs for their children. A questionnaire was distributed to the parents of 200 hospitalized pediatric patients. It gathered information on nonprescription drug use during the six-month and one-week periods before hospitalization, the importance of various sources of advice regarding the need to self-medicate, and the sources of product information and the factors influencing product selection. One hundred sixty questionnaires were returned. Almost all of the children (97.5%) were self-medicated by their parents within the six-month period before hospital admission. Only 21% of the parents usually sought advice before deciding to self-medicate their children. Physician recommendations were noted as an important factor in the selection of a nonprescription product, followed an importance by pharmacists and then other health-care professionals. Professional recommendations all ranked higher than other recommendation sources, such as television, radio, or printed advertisements. Pharmacists should take a more active role in aiding parents in their decision to self-medicate their children.

Health Status and Social Factors in Nonprescribed Drug Use

This article examines the relationship between a set of demographic, socioeconomic, sociopsychologic, and health status characteristics of a heterogeneous adult population and their use of nonprescribed drugs. The objective is to determine whether nonprescribed drug use is best accounted for by demographic and socioeconomic factors, by health and medical beliefs, by health status, or by some combination of these. The data are derived from a personal interview survey of 2603 adult members of the Kaiser-Permanente Medical Care Program, Oregon Region. The results indicated that a combination of characteristics from among these three sets were the best predictors. Sex, income, education, mental health status, tendency toward self-treatment, and level of concern with health matters were the most important variables, although they account for only a small amount of the variation in nonprescribed drug use. A portrait of the most frequent users of nonprescribed drugs raised the question as to whether these are the classic neurotics, the "worried-well," or persons whose medical care needs have not been adequately recognized or met.

Intake of drugs among elderly people in a Danish municipality, Rødovre.

Drug intake has been studied among a random group of persons, aged 75 or over, in Rødovre Municipality. Two hundred and eight-three elderly persons living in their own homes have been visited and interviewed about their daily intake of prescribed and nonprescribed drugs (including so-called natural drugs). Similar information was gathered from 146 elderly persons living in nursing homes. Thirty-one per cent of the elderly living in their own homes and 3% of those living in nursing homes did not use prescribed drugs daily. The median daily amount of different types of drugs used was 1.8 (range 0-10) for elderly persons living in their own homes and 4.5 (range 0-11) (p less than 0.001) for those living in nursing homes. Women living at home had a higher intake of drugs than men, especially diuretics. The most frequently used drugs were diuretics, sedatives/hypnotics, analgesics, digitalis and electrolytes. For all types of drugs a higher consumption, especially of phenothiazines, was found among elderly persons living in nursing homes. Drug consumption was independent of age and social stratification in both groups. The use of non-prescribed drugs ranges from 0 to 9 different types in the group living in their own homes, and from 0 to 5 in the group living in nursing homes--laxatives being the type most frequently used.

Prescribed and nonprescribed drug use in an ambulatory elderly population.

Drug usage was studied in an ambulatory geriatric population. Prescription and nonprescription drug use is described for 3,192 participants in a geriatric screening program (the Dunedin Program). Average drug use by these participants was found to be 3.2 medications. The use of both prescription and nonprescription drugs was higher for the women than for the men. In this population, drug use by both men and women increased with age, and this increase was mainly due to an increased use of prescription drugs. Participants were found to be taking numerous multiple-ingredient drug products.

Aircraft noise and mental health: II. Use of medicines and health care services.

A domiciliary survey (sample size circa 6000) was conducted in areas of different aircraft noise exposure affected by London (Heathrow) Airport. Respondents were urban dwellers aged 16+. Their use of medicines, general practitioner services, hospital facilities and community services were investigated in relation both to the level of aircraft noise and to the degree of annoyance it causes. None of the indicators showed higher uptake in the high noise areas. The relationships between health indicators, noise and annoyance were not uniform. In areas exposed to high noise the use of non-prescribed drugs was significantly higher among 'very annoyed' than among 'less annoyed' respondents. The uptake of psychotropic drugs, and the use of general practice and out-patient services, tended to increase with increasing annoyance both in high- and low-noise areas, but the differences were not in all cases statistically significant. Parallels were drawn between these results and those of earlier analyses of the same survey related to the prevalence of acute and chronic symptoms. Suggestions for the analysis and interpretation of health effects of noise are put forward.

Use of over-the-counter and home remedies by college students.

Abstract This study was designed to understand the prevalence, factors in selection, and appropriateness and safety of the use of nonprescription drugs and home remedies by a population served by a prepaid health program. The aim was to develop baseline data on self-medication and indicators of need for health education programs. Two surveys were conducted, the first among a random sample of students at a primarily residential university (N = 302), and the second among all the professional staff responsible for their care. The student questionnaire asked what brands of nonprescription drugs were used for 27 symptoms and what factors influenced the selection of a recently adopted over-the-counter (OTC) drug. All medications used by consumers for 17 symptoms were evaluated by University Health Service (UHS) staff. The pattern of student use of OTC drugs reflects patterns observed in other populations. Analgesics and cough and cold remedies were the most widely used internally administered drugs, while tooth...

Attitudinal correlates of employees' deviance: theft, alcohol use, and nonprescribed drug use.

Employees' on-the-job theft, alcohol use, and nonprescribed drug use cost businesses billions of dollars yearly due to shrinkage, lowered productivity, absenteeism, law suits related to accidents, etc. Sampling 39 employees from three different workplaces, statistically significant relationships between attitudes toward socially unacceptable deviant behavior, as measured by the Personnel Security Inventory, and employee on-the-job behavior in the areas of theft, alcohol use, and illicit drug use were found. Practical implications of these findings in relation to the pre-employment screening of job applicants and the Occupational Safety and Health Act of 1970 are discussed.

A review of over-the-counter drug therapy.

The authors review the extent of the use of nonprescription drugs as well as possible variables influencing such consumption. Various studies indicate that age, sex, personality characteristics, perceptions of health status, socioeconomic factors, parental example, and pharmacists all play parts in determining over-the-counter (OTC) drug utilization. Several sources express concern about the inaccessibility of accurate OTC drug information to the consumer. Indeed, even the FDA has occasional difficulty obtaining reliable facts on both the numbers and formulae of such products. Several studies indicate that consumers acquire information about their home remedies through advertising, friends and relatives, physicians, pharmacists, and product labels. By far the most influential of these is advertising, and much concern has been voiced over consumers' unquestioning faith in drug ads. Examples are cited of deceptive, inaccurate, and unfair advertising practices used by some OTC drug manufacturers. The pros and cons of the "drug-oriented society" theory are discussed, including an analysis of its underlying origins. Testing of the safety and efficacy of nonrescription remedies has proved to be controversial, especially when considering the ramifications of the placebo effect. Different surveys report widespread misuse of OTC's by consumers through overuse, taking several drugs concurrently, and using home remedies to treat potentially serious diseases.