Sharing prescription medication is a concern among adolescent girls not only for potential health effects to the girls taking the medications but also because of the potential for teratogenic effects (causing birth defects) on an unplanned or unrecognized pregnancy. A number of factors contribute to this latter concern, including the relatively common use of prescription drugs among children and adolescents; in 1 study, children and adolescents 9 through 17 years of age received 2 to 3 prescriptions per year. (1) Another factor is that the practice of marketing drugs directly to the consumer through advertising has increased dramatically during the past 15 years and has led to increased requests for specific prescriptions from health care providers. (2) This marketing can influence consumer perceptions of and knowledge about the safety of highly advertised medications. Attitudes and behaviors concerning medication sharing that are formulated during childhood or adolescence might influence the potential for such risk behaviors throughout a woman's reproductive years.
Two recent studies reported circumstances related to prescription medication sharing among adult women. The first study documented women who had obtained a teratogenic medication outside of a clinical setting, including from friends or colleagues. (3) The second reported reasons that women gave for sharing medications; among the reasons cited were: common practice, medication costs, sharing with friends and family, helping others, and already having a prescription for the same medication. (4) A search of published medical, psychological, and drug abuse literature yielded few studies of prescription medication borrowing or sharing. (5,6) Illicit use of prescription drugs, often in place of illegal drugs, has received some attention. (7-11) In contrast, very little is known about well-intended prescription medication sharing, despite the risks associated with this inappropriate practice. No studies were found on prescription medication sharing among adolescents. In reporting this study, we identify some of the factors that influence medication sharing among children and adolescents, and we encourage pediatricians to integrate this knowledge into patient education and counseling on proper medication use.
METHODS
We analyzed data from Youthstyles, a mail survey of boys and girls 9 through 18 years of age about their attitudes and reported behaviors related to prescription medications. Results from the survey, a supplement to the American Healthstyles Audience Segmentation Project (Healthstyles survey), provide an outline of reported beliefs and behaviors related to prescription medication sharing and other health issues among US adolescents and pre-adolescents. Youthstyles is a survey questionnaire mailed to a stratified sample of the US population as a follow-up survey to the DDB Needham Lifestyles Survey on demographics and media use. (12) The Youthstyles survey, intended for the parents, children, and adolescents in each household, was mailed to 3050 households that had already completed the Lifestyle survey; 1583 responses were received (52% response rate). Parents were offered a small incentive (the choice of a travel mug or a road atlas) to encourage the family to respond; children and adolescents were not offered additional incentives to fill out their part of the questionnaire.
Youthstyles data were stratified by factors, including household income, race, ethnicity, education, age, gender, geographic region, marital status of parents, household size, and population density of area of residence (demographics were reported by parents). Data weighting was based on census figures to address any discrepancies between the US population and the sample? The margin of error for estimates based on 1568 valid respondents (804 boys and 764 girls) 9 through 18 years of age was [+ or -] 3%. For analysis of subgroups, the margin of error was larger.
Prescription medication was defined in the survey for the respondents as follows: "A `prescription' means the doctor has signed a paper so that you can get a medicine. It usually has your name on it. It does not mean medicines like Tylenol or aspirin that you can just buy at any grocery or drug store." This description was pilot-tested with children and adolescents of the relevant ages to assess their understanding. Questions in Youthstyles were intended to elicit respondents' behaviors and frequency of prescription medication sharing, including both sharing one's own prescription medications with others and borrowing other people's medications for oneself. Children and adolescents 9 through 18 years of age were asked, "Have you ever shared your prescription medication with others?" and, "Have you ever borrowed prescription medication from others?"
Social cognitive theory (13) recognizes an interdependence of cognitive/emotional, behavioral, and social/environmental factors and was used to design the attitudinal questions for Youthstyles. Respondents were asked to respond to hypothetical reasons that they would share prescription medications (or they could respond that they would not). This hypothetical question was asked only of respondents who were 12 years of age or older because of concern that younger children would not be able to interpret the question appropriately.
Categorical variables related to respondent demographics were analyzed using [chi square] tests. Responses were compared by gender and among age groups (9 through 11, 12 through 14, and 15 through 18 years) and other variables, including household income and size, geographic area, population density, type of dwelling unit, residence ownership, marital status of parents, and multivitamin use (as a proxy for pill-taking behavior). A multivariate analysis was performed using SPSS 10.0 (SPSS Inc, Chicago, IL) to test the significance of these variables on reported medication sharing.
RESULTS
Among all respondents (9 through 18 years of age), 10.9% reported having ever shared their prescription medications with someone else, and 13.5% reported having ever borrowed someone else's medication. The combined rate of any sharing and borrowing behaviors (Table 1) was higher among girls (20.1%) than boys (13.4%) and was most common among girls 15 through 18 years of age (22.9%). Other variables significantly associated with increased medication sharing were rural population density, lower income, and larger household size (P < .01).
When respondents were asked about their actual medication borrowing or sharing practices in the past year, 16.9% of girls and 10.4% of boys reported this behavior (Table 2). Medication sharing or borrowing in the past year was most common among respondents 15 through 18 years of age. Among girls in that age group, 18.5% reported sharing medications (either borrowing from others or sharing theirs) 1 or 2 times in the past year, and 7.3% reported doing so 3 or more times in the past year.
Among respondents 12 through 18 years of age, 58% provided at least 1 reason that they would share prescription medications (Table 3). These adolescents considered that family members, someone who "knows something" about medicines, and someone who "has the same problem" were acceptable sources of prescription medications. Medication sharing was also deemed to be more acceptable if the person with whom the medication was being shared 1) already had a prescription but had run out or did not have it with them, 2) had an emergency, or 3) could not afford the medication but needed it. Medications would also be shared if the person were experiencing specific medical conditions such as headache or pain, had sleep needs, or had "pimples or oily skin." This dermatologic reason was given by significantly more girls than boys: 10.5% of girls 12 through 18 years of age said they would share medication for that reason. Significantly fewer girls than boys (35.2% vs 48.5%) 12 through 18 years of age stated that they would not share medications at all.
There was some overlap between those who borrowed and those who shared medications: of the 1568 respondents, 206 had borrowed medications from others, 165 had shared their medications with others, and 115 had done both. Respondents who reported having previously shared medications offered many more reasons for sharing medications than did those who did not report sharing, but the types of reasons provided did not differ qualitatively between the 2 groups.
DISCUSSION
