High-frequency use of over-the-counter analgesics among adolescents: reflections of an emerging difficult life, a cross-sectional study.

AIMS: To examine characteristics of 15- to 16-year-old adolescents who used over-the-counter analgesics daily to weekly (high-frequency users) as compared to those who used less or no analgesics (low-frequency users). Further to analyse the differences in pain experience, lifestyle, self-esteem, school attendance and educational ambition. METHODS: An anonymous cross-sectional questionnaire-based study. The questionnaire covered the use of over-the-counter analgesics, pain experience, sociodemographics, lifestyle factors, self-esteem, school absence and future educational plans. The study took place in the 10th grade in six junior high schools in a medium-sized town in Norway. The local sales data for analgesics and antipyretics were close to the national average. We invited 626 adolescents to participate. Of the 367 adolescents (59%) who responded, 51% were girls. Associations between the frequency of use of over-the-counter analgesic and the mentioned variables were analysed using multiple logistic regression. RESULTS: In total, 26% (42 boys and 48 girls) used over-the-counter analgesics daily to weekly. These high-frequency users experienced more widespread pain, slept less, had more paid spare-time work, drank more caffeinated drinks, participated more often in binge drinking, had lower self-esteem, less ambitious educational plans and more frequent school absence than did the low-frequency users. These associations remained significant when controlling for gender, cultural background and self-evaluated economic status. CONCLUSION: Adolescent, who are high-frequency users of over-the-counter analgesics, suffer more pain and have identifiable characteristics indicative of complex problems. Their ability to handle stress appears to be discordant with the kind of situations to which they are exposed. The wear and tear associated with allostatic mechanisms counteracting stress may heighten their pain experience.

[Self-medication with over-the-counter analgesics among 15-16 year-old teenagers]. / Selvmedisinering med reseptfrie smertestillende legemidler hos 15-16-åringer.

BACKGROUND: OTC analgesics were released for sale outside pharmacies in Norway in 2003. This study assesses indications and frequency of use of these drugs among 15-16 year-old teenagers in Norway after 2003. MATERIAL AND METHOD: We developed a questionnaire, which contained 65 questions with one or more response options. This was given to all pupils in the final grade at six junior high schools in a town with 60,000 inhabitants (Drammen). RESULTS: 367 of 626 (58.6 %) pupils participated. 50 % of the boys and 71 % of the girls had used OTC analgesics during the last four weeks; 26 % of them on a daily or weekly basis. Girls experienced episodes of pain more frequently than boys, but the proportion of episodes treated with analgesics did not differ between the sexes. Headache and muscle pain were common. Half of those with severe headache/migraine used OTC analgesics on a daily or weekly basis. The teenagers reported several reasons for experiencing pain and discomfort, such as long time spent in front of various screens, tight time schedules with physical exercise and friends, drinking too little and much noise in the classroom. INTERPRETATION: Use of OTC analgesics has increased considerably among Norwegian teenagers. Drug-induced headache may occur as an adverse event. If more effort is made to improve life situations that adolescents perceive as painful and a cause of discomfort, the need for OTC analgesics may be reduced.

[Attitudes to over-the-counter analgesics among 15-16 year-old teenagers]. / Holdninger til reseptfrie smertestillende legemidler blant 15-16-åringer.

BACKGROUND: More information is needed on teenagers' attitudes to self-medication with OTC-analgesics, and their access to medicine and information. MATERIAL AND METHOD: An anonymous questionnaire study was performed among all tenth grade students in Drammen, a middle sized city in Norway, in spring 2007. RESULTS: 367 students participated in the study, 55 of them had a non-western background. 24 % of boys and 41 % of girls stated that analgesics could be used whenever they experienced pain. Among these, 91 % had taken analgesics during the previous four weeks, among those who thought that analgesics should not be used 50 % had taken it. The girls reported episodes of pain more often than the boys, but analgesics were used to treat pain to the same extent by all students, irrelevant of sex and cultural background. 77 % of students with a western origin and 62 % of those from non-western countries felt free to use OTC-analgesics at home without asking for permission. 31 % of western girls got analgesics from their friends. 8.5 % bought medicines at the pharmacy and 7.1 % bought them in grocery shops. Information on how to alleviate pain with medicine was usually given by the parents. INTERPRETATION: Teenagers in secondary school have different opinions on self-medication with OTC-analgesics. The parents assist their children in how to manage pain. 15 - 16 year-olds experience much pain, and mainly have free access to analgesics at home.

How adolescents experience and cope with pain in daily life: a qualitative study on ways to cope and the use of over-the-counter analgesics.

OBJECTIVE: The aim of this study was to describe how different adolescents experience and manage pain in their daily life, with a focus on their use of over-the-counter analgesics. More specifically, the aim was to explore different patterns among the adolescents in pain descriptions, in the management of pain, in relationships with others, and in their daily life. DESIGN: Qualitative semistructured interviews on experiences with pain, pain management and involvement of family and friends during pain. Pain and stress management strategies and attachment theory will be in focus for interpretations. PARTICIPANTS AND SETTING: 25 participants aged 15-16-years from six different junior high schools, both genders, with and without immigrant background were interviewed at their local schools in Norway. RESULTS: We identified 4 groups of adolescents with similarities in attitudes and management strategies to pain: 'pain is manageable', 'pain is communicable', 'pain is inevitable' and 'pain is all over'. The participants within each group differed in how they engaged their parents in pain; how they perceived, communicated and managed pain; and how they involved emotions and used over-the-counter analgesics. CONCLUSIONS: The adolescents' different involvement with the family during pain related to their pain perception and management. Knowledge of the different ways of approaching pain is important when supporting adolescents and may be a subject for further research on the use of over-the-counter analgesics in the family.

[The use of paracetamol and antibiotics among preschool children]. / Bruk av paracetamol og antibiotika blant førskolebarn.

BACKGROUND: Sales of paracetamol in paediatric formulations are increasing and antibiotics are frequently prescribed to children. Our aim was to study the use of paracetamol and antibiotics in different age groups among preschool children. MATERIAL AND METHODS: Parents of 1312 children (99% response rate) visiting public health centres were asked to state how often their child had been sick, used paracetamol, seen a doctor, or used antibiotics during the previous three months. If the child had used antibiotics, parents were asked to give the reason for treatment, the name of the drug used, and the duration of treatment. RESULTS: 71% of the children had been sick, 46% had received paracetamol, 36% had seen a doctor, and 12% had used antibiotics. The highest frequency of illness and paracetamol use was seen among children one to two years of age. Otitis was the main reason for using antibiotics in children of one to four years of age, and the duration of treatment was often longer than recommended. INTERPRETATION: Use of paracetamol is widespread among preschool children. Parents going back to work after maternity leave and more frequent fever resulting from exposure to infections may contribute to an increased use of paracetamol. Restrictive use of antibiotics for otitis and shorter treatment duration continue to be emphasised.

[Paracetamol to preschool children--indications and cultural background]. / Paracetamol til førskolebarn--indikasjoner og kulturbakgrunn.

BACKGROUND: Immigrants may have a different attitude to the use of paracetamol (acetaminophen) than parents of western European or North American origin. The aim of this study was to examine under what conditions parents find treatment with paracetamol appropriate. MATERIAL AND METHOD: Parents at six public health centres were asked to select one or more among 26 indications for paracetamol treatment and to state the body temperature at which fever medication should be used. The indications were independently evaluated as appropriate, uncertain or inappropriate by the staff of the public health centres. RESULTS: 1563 (99%) parents participated in the study. 79% chose a fever threshold of 39 degrees C or above as appropriate for treatment with paracetamol. Fever, earache, influenza and headache were frequently chosen as appropriate indications by both parents and staff. On average, parents from non-western countries more frequently chose indications considered by the staff as uncertain or inappropriate and seemed to use paracetamol more frequently (odds ratio 2.35; 95% CI 1.26-4.40) and in larger doses than other parents did. INTERPRETATION: This study indicates that parents from non-western countries use paracetamol for their children on wider indications, to more of their children, and in larger doses than other parents do.

Childhood illnesses and the use of paracetamol (acetaminophen): a qualitative study of parents' management of common childhood illnesses.

OBJECTIVES: Parents frequently give over-the-counter paracetamol (acetaminophen) during childhood illness. This study aims at exploring parents' use of this medicine in relation to their management of common childhood illnesses and the impact on the family. METHODS: Parents of pre-school aged children were asked open-ended questions about their perceptions of illness, its impact on the family, the use of paracetamol and sources of medical information. The interviews were audiotaped. The transcribed text was condensed and different views and opinions were identified for each question. The parents were recruited from six Norwegian public health centres during a questionnaire study on the use of paracetamol among their children. Volunteering parents supplied their name and telephone number for further contact. A strategic sample of 24 parents was selected for interviews according to their responses to the questionnaire and family characteristics. RESULTS: Parents recognized illness among their children either intuitively or by taking notice of specific signs or symptoms. Fever was considered a definite sign of illness, almost congruent with the disease itself. Some parents acknowledged that low or moderate fever reflected a battle between the body and the disease-causing organism. High or rapidly increasing fever, however, was frequently looked upon as dangerous. Mothers preferred to stay close to their child during illness and postponed other duties. Inexperienced parents felt particularly anxious and helpless since they often found the severity of the illness difficult to judge. Administration of paracetamol gave parents the feeling of mastery. The medicine was also used to calm down the child enabling sleep and rest for the whole family. Some parents were generally interested in information about child diseases, others were only eager to know more about it during periods of illness, and some parents were not interested as they felt information only caused more anxiety. CONCLUSIONS: Fever was often judged to cause discomfort and danger. Thus antipyretics like paracetamol were regarded as a medicine counteracting disease. Paracetamol constituted an important tool for parents in managing different upsets during childhood illnesses. Information was not always wanted. Better knowledge about the significance of fever and how to handle children during common illnesses might need to be presented in a context familiar to parents, for instance, in relation to general information on childcare.