Adolescents' Knowledge and Use of Acetaminophen: What You Don't Know Can Hurt You

Rationale: The FDA has identified gaps in evidence about consumer understanding and use of OTC acetaminophen products. The Institute of Medicine (IOM) has documented evidence of adults' errors in prescription medicine use. However, less is known about problems with OTC medicines, and even less is known about OTC use in adolescents. Therefore, we measured understanding of OTC acetaminophen among adolescents and young adults, who are still developing skills for using these products. Methods: We conducted a cross-sectional in-person interview study in a population-based sample of 266 youth (16-23 years) in Monroe County, NY from 11/08-9/09. We recruited throughout the county from outpatient health care (teen clinic and primary care sites) or educational settings (i.e.: high-school, collegiate, vocational, or GED programs). We measured recent use of OTC medicines (any use within past month; names of medicines used), knowledge about acetaminophen, and used validated scenarios to assess participants' skills in selection and use of OTC medicines (for headache, cold with fever, and flu). We measured HL using the Rapid Estimate of Adult Literacy in Medicine (REALM) for participants =>18, and the REALM-Teen (<18). We performed bivariate comparisons and logistic regression using STATA 10.1. Results: Respondent race was white (47.4%), black (32.3%), Hispanic (13.2%) and other (7.1%); mean age was 19 years; and 44% were male. Overall, 31% had inadequate HL per REALM criteria. 73% percent of respondents had used OTC medicines within the past month. 63% of all respondents had never heard of acetaminophen, yet 33% of those (21% of all respondents) had unknowingly used =>1 acetaminophen-containing product within the past month. In both bivariate and multivariate analyses, inadequate HL was significantly associated with misunderstanding of Tylenol (including incorrect: active ingredient, # pills per dose, time between doses, and # doses per day), as well as failure to identify any acetaminophen-containing products from a selection of common OTC medicines [33% (HL inadequate) versus 2% (HL adequate), p<.001]. Overall, only 16% of all participants responded correctly to all knowledge and skill measures. Conclusions and Implications: Misunderstanding and potential misuse of OTC products, including acetaminophen, was common in our sample of young consumers. Teens and young adults increasingly lack access to care, and may manage their health without input from clinicians. Our results can help inform: 1) the design of public health education programs for the safe use of OTC acetaminophen, and 2) policy decisions about maximum dose recommendations and labeling of these products.