Adolescents, Young Adults Lack Knowledge of Acetaminophen's Toxicity

Brian Hoyle

May 07, 2010

May 7, 2010 (Vancouver, British Columbia) — A study of more than 250 teenagers and young adults by researchers at the University of Rochester, in New York, has found that more than 60% do not know what acetaminophen is, even though a third are users of acetaminophen-containing over-the-counter (OTC) pain-relieving products. Nearly 25% misuse the medications, researchers announced here at the Pediatric Academic Societies 2010 Annual Meeting.

"Acetaminophen toxicity is a big deal, but we know a lot more [about its effects] in adults than we do in adolescents. The adolescent age group is what is new about this work," said study presenter Laura Shone, DrPH, MSW, associate professor of pediatrics and clinical nursing, Department of Pediatrics, University of Rochester Medical Center, in an interview with Medscape Pediatrics.

The problem is huge, Dr. Shone said. Published studies have documented that overdoses of acetaminophen are the cause of more acute liver failure in the United States than viral hepatitis. Furthermore, one half to two thirds of these overdoses are unintentional and result from taking excessive doses of OTC medication.

At the heart of this problem is a lack of awareness about medications being consumed (health literacy). Agencies such as the National Academy of Sciences (NAS) have weighed in on the issue. Estimates are that up to half of American adults have problems with health literacy, which, according to a 2004 NAS report, is "the ability to find, understand, and use health information to communicate and make health decisions and function successfully as a patient."

The situation for adolescents is far less clear, particularly concerning the understanding of OTC medications and label instructions for their use, explained Dr. Shone.

"Health literacy in regard to OTC meds is truly lacking in the adolescent age group, because the medication managers prior to these years were the adults in the home. Now, there is capability and access without knowledge, in combination with teenage behavior and thoughts — a combination of [the attitude that] nothing is going to hurt me, impulsive thinking, and risk-taking behaviors — that are all in play," Germaine Defendi, MD, associate clinical professor, Department of Paediatrics, Olive View/UCLA Medical Center, Los Angeles, told Medscape Pediatrics.

In the study, conducted in 2008 and 2009, 266 youth (age range, 16 to 23 years; mean age, 18.6 ± 2 years; 56% female) from Monroe County, New York, were anonymously recruited, passively during visits to clinics or more actively during health information sessions at schools and elsewhere. The health literacy of the participants was determined using the Rapid Estimate of Adult Literacy (REALM) or REALM-Teen surveys. Limited health literacy was a REALM score of 60 or below, or a REALM-Teen score of 62 or below.

Of the 266 participants, 96 (36%) had limited health literacy and 170 (64%) had adequate health literacy.

A survey solicited information about knowledge of acetaminophen as the active ingredient in OTC pain relief medications, the ability to identify acetaminophen-containing OTC products, and the ability to identify the one-time and daily dosage limits of acetaminophen.

Fully 63% of the participants had no knowledge of acetaminophen, even though 33% of them had used an acetaminophen-containing OTC product within the previous month. The majority displayed limited health literacy.

Multivariate analysis pegged inadequate health literacy as the main reason for taking too few or too many pills per dose, for incorrect frequency of use, and for incorrect maximum daily dose. Even 77% of those identified as health literate did not know the maximum daily dose of acetaminophen.

"I truly think that this is a worthwhile study addressing the lack of knowledge in teens about OTC medication. Kids know that there are things that they can easily purchase OTC that are medicines. But a true understanding of the medications and what they are used for and what they do is lacking," Dr. Germaine told Medscape Pediatrics.

Dr. Shone and the other study authors suggest that providers of OTC drugs have "a critical role" to play in conveying information in a way that is meaningful and relevant to adults and adolescents alike.

"Label information . . . is not as simple as it may seem. Providers can help prepare adolescents to safely self-administer," Dr. Shone told Medscape Pediatrics.

The study was funded by the National Institute for Child Health and Human Development and the Centers for Disease Control and Prevention, Office of the Director. The authors have disclosed no relevant financial relationships.

Pediatric Academic Societies (PAS) 2010 Annual Meeting: Poster session 1476.250. Presented May 1, 2010.