A large proportion of teenagers regularly and frequently take some form of medication without receiving targeted information about the risks and benefits, according to a review of current research, to be presented at the annual congress of the International Pharmaceutical Federation (FIP).
Dr Priya Bahri will tell delegates that 35% of boys and 45% of girls in Europe and the USA take painkillers for headaches every month. In addition, they take a variety of other medicines for things like stomach aches, sleeping disorders, nervousness, asthma, infectious diseases and for pregnancy prevention. "Most teenagers take their medicines appropriately, but there is evidence of accidental or intentional inappropriate use or misuse," she says.
At a time when young people want to be independent of their parents and make their own decisions about their bodies and medications, they feel misunderstood by healthcare professionals, have concerns over side effects and may be confused by information coming from a variety of sources such as their friends, their family, the internet, the news, and the healthcare professionals they encounter, says Dr Bahri, who is the pharmacovigilance lead for guidelines and risk communication at the European Medicines Agency (London, UK), but who was speaking in a personal capacity.
"Part of teenage life is starting to make your own health choices. The medicines that teenagers use most frequently and largely autonomously include those for asthma, and painkillers such as paracetamol and ibuprofen. Every month in Europe and the USA, about 35% of boys and 45% of girls use painkillers for headaches. Teenagers also use other medicines: every month 32% use them for stomach aches, 6% for sleeping disorders and 6% for nervousness. The prevalence of asthma, one of the most frequent chronic disorders worldwide, is around 10% in teenagers, so most of those with this condition will be taking medication for it, and it is estimated from worldwide data that around a quarter of teenage girls will be taking some form of contraceptive, including hormonal ones. In addition, girls may be invited to receive the human papilloma virus (HPV) vaccine to protect them against cervical cancer. However, public discussions in the media over the usefulness and safety of these measures make some feel anxious and confused," she says.
Dr Bahri is investigating how well information about medications are communicated to teenagers, and has found that not only is there very little research into this area, but what there is indicates that healthcare professionals, including pharmacists, need to improve the way they talk to young people and communicate the risks and benefits of medicines.
"The HPV vaccination programme is a good example of where healthcare professionals could be better prepared for communication with teenagers," she says. "There were several incidents in Europe of HPV vaccination-related anxiety attacks among girls receiving the vaccine. In addition, in many countries in the world, older children and adolescents, rather than young children receive various vaccinations, and may develop concerns over them.
"Research has found that although pharmacists know about the importance of talking to teenagers about their medications, they tend not to. This was shown in The Netherlands with the example of isotretinoin, which is sometimes prescribed for teenage acne. Isotretinoin causes birth defects and so can only be taken in conjunction with effective contraception, requiring the physician and pharmacist to initiate a conversation with teenage girls. The study showed that the pharmacists knew they should talk to the girls, but it didn't reveal why the majority of them did not comply fully with their role in the country's pregnancy prevention programme when dispensing isotretinoin. Obstacles to communication is an area where much more research needs to be done," says Dr Bahri.
"As a pharmacist myself, I know how difficult these conversations can be, but I would advocate that pharmacists should be looking into their communication behaviour and identifying opportunities and successful methods for initiating caring and non-judgemental dialogue. It is vital that pharmacists overcome our own hesitation to talk; we should start the dialogue and listen to questions and concerns. It is important to help teenagers to care for their health, while being aware of their vulnerabilities as well as their capabilities."
She will tell the congress that pharmacists also need to be aware that increasingly medicines are being advertised on the internet to improve school performance, and they need to monitor this and inform teenagers about the risks.
Good communications with teenagers could also be vital for the well-being of the whole family in some circumstances. This can be the case in developing countries and among disadvantaged groups in the developed world, such as those who have migrated and have poor language skills.
"Sometimes, in places where teenagers are the only literate person in the family, they may even bear the responsibility of the health of their siblings and the older members of their families," she says.
Dr Bahri concludes: "Effective communications with teenagers at the individual and population level is vital, and pharmacists should consider investigating the use of text messages, social media and other web-based forms of communication with this age group, in addition to more traditional methods. We need to bear in mind that some research in different regions of the world has shown that teenagers still expect most information to come directly from their healthcare providers, but not necessarily from pharmacists.
"As pharmacists, we should be prepared to handle the needs and feelings of young people in a sensitive manner, taking into account the fact that they are in a vulnerable phase where a bad experience could influence their current and future health behaviour."
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