1

CHAPTER I THE PROBLEM

Background of the Study Over-the-counter drugs had been utilized by many people nationwide to treat common illnesses/ailments which is/are not serious enough to seek the help of health care providers. In the past, OTC consist only of relatively small number of medication but to dat, OTC medicines are account for the majority of all medicines used in the US including many that were once available only by prescription. Such drugs used by Americans include everything to treat cough, colds and aches.(www.bemedwise.org) Moreover according to FDA, 1999, Americans buy about five billion over-thecounter drug products each year to treat their routine health problems.As cited by Roper Starch,2011, 82 percent of American women and 71 percent of American men have used a nonprescription medicine in the last six months to treat at least one minor health problem. Over four in five U.S. adults who have experienced various illnesses that can be treated or relieved by non-prescription medications (82%) typically self-medicate for those conditions. Colds (56%) and coughs (37%) are the most common conditions for which adults medicate themselves. Adults are less likely to self-medicate for seasonal or year-round allergies than they are for illnesses such as coughs, colds, heartburn, and headaches (http://www.bemedwise.org/survey/ExecutiveSummary.pdf).

On the other hand, according to the consumer poll, a third of Americans say they take more than the recommended dose of a nonprescription medicine, believing that it will increase the effectiveness of the product. Of these consumers, two thirds (69 percent) say they take more than the recommended amount at a single time; three fifths (63 percent) report taking the next dose sooner than directed; and two fifths (44 percent) say they take more than the recommended number of doses in a day.At the same time, a third of Americans (36 percent) say they are likely to combine nonprescription medicines when they have multiple symptoms, like a headache and a sore throat. This practice can increase the risk that consumers take more than one OTC product at a time that contains the same active ingredient (http://www.bemedwise.org/survey/summary_survey.pdf). Cases of drugs abused/misused had been the problem towards OTC drugs all this years.Abuse of OTC medicines is now so prevalent it is normalized among teens. Nearly one in five teens (19 percent, or 4.5 million) report abusing prescription medications to get high and one in 10 (10 percent or 2.4 million) report abusing cough medicine to get high. Far too many teens have a false sense of security about the abuse of OTC medicines. Two in five teens (40 percent or 9.4 million) agree that medicines, even if they are not prescribed by a doctor, are much safer to use than illegal drugs. Nearly one-third of teens (31 percent, or 7.3 million) believe theres nothing wrong with using medicines without a prescription once in a while.

(http://memorials.drugfree.org/Portal/DrugIssue/Features/Key_Findings_on_Teen_Drug_ Abuse). In the Philippines, cases of inappropriate use of drugs has been very common most especially antibiotics. According to Emmanuel Edwin R. Dy, M.D, many people

just take antibiotics with improper administration with respect to drug, dose, interval, duration this is because people are prisoned to their beliefs or misconceptions and likewise to their inability to purchase the prescribed medicine due to financial constraints. Adolescents used of over-the-counter drugs have been uncontrollable. Some just take medicines without background or enough knowledge about these medications. Some takes antibiotics without following the needed time to complete the dose, taking analgesics and even laxatives without knowing enough about its side/adverse effects. According to Leochico et al (2010), while self-medication is prevalent among adolescents, they remain to have significant knowledge deficits, which may predispose them to medication misuse and/or adverse effects. With these findings, the researchers are the motivated to look into the variables that affect the perception of adolescents on OTC drugs. It is hoped that the information generated with this study will help to bridge the gap in knowledge in OTC drugs. Statement of the Problem This study aims to determine the relationship between Socio-demographic characteristics and Perceptions of the Respondents on OTC drugs. More specifically, this study gears towards the resolution of the following problems: 1. What are the Socio-demographic characteristics of the Respondents? A. Demographic Factors A.1. Sex A.2. Monthly Family Income A.3. Educational Attainment

A.4. Common Illnesses A.5. Common Drugs used B. Sociological Factors B.1 Sources of Information B.1.1. Peers B.1.2. Relative B.1.3. Media B.1.3.a. TV B.1.3.b. Radio B.1.3.c. Newspaper 2. What are the perceptions of the respondents on OTC drugs in terms of: 2.1. Effects 2.2. Dosage 2.3. Frequency 2.4. Reasons 3. What is the relationship between Socio-demographic characteristics and Perceptions on OTC drugs? Statement of the Objectives In general, the study will be conducted to identify the relationship between Sociodemographic characteristics and Perceptions of the Respondents on OTC . Specifically it aims: 1. determine the Socio-demographic characteristics of the Respondents as to: A. Demographic Factors

A.1. Sex A.2. Monthly Family Income A.3. Educational Attainment A.4. Common Illnesses A.5. Common Drugs used B. Sociological Factors B.1 Sources of Information B.1.1. Peers B.1.2. Relative B.1.3. Media B.1.3.a. TV B.1.3.b. Radio B.1.3.c. Newspaper

2. determine the perceptions of the respondents on OTC drugs in terms of: 2.1. Effects 2.2. Dosage 2.3. Frequency 2.4. Reasons 3. determine the relationship between Socio-demographic characteristics and Perceptions on OTC drugs.

Significance of the Study Nowadays, the use of Over-the-Counter drugs is already been increasing and somehow the rate of drug abuse or misused of drugs is rising. The health professionals address such problems by giving health education on over-the counter drugs and

controlling the dispensing of drugs throughout the market. Thus this study will benefit the following group along the perception of adolescents in OTC drugs. The results of this study will reveal information on how Adolescents. These adolescents view their use of OTC drugs. This will help them understand their perceptions and modify these views and behaviour for safe use of non prescribed OTC drugs. Nurses. The result of the study will serve as guide by nurses in planning and rendering nursing care and health education to adolescents. Employees of Food and Drug Administration/Bureau of Food and Drugs.This study will increase their awareness on the alarming situation of misused of OTC drugs hence the result will be utilized as their basis in coming up with guidance or policies or laws to control the misuse of OTC drugs. Researcher. The result of the study will be instrumental in conceptualizing research study that will include variables that are not part of this study to broaden the understanding on OTC drugs among adolescent. Scope and Delimitation of the Study This study focused on the Socio-demographic characteristics affecting the perceptions on OTC drugs among Adolescents. It focuses on finding out the perceptions and the socio-demographic characteristics of the respondents. The research undertaken was limited to Adolescents aged 16-18 who are not taking any health related course and who are studying at Mariano Marcos State University. This research will be conducted on Second Semester School Year 20112012.

The study used the descriptive-correlational research method. This It utilized survey method using a questionnaire with guided interview to follow-up answers. Operational Definition of Terms For better understanding of the research of the research, the following terms are defined as used in the study. Adolescents. Refers to the individuals who will be the respondents of the study aged 15-18 years of age and except those who are taking health related courses offered at MMSU. Over-the-Counter drugs (OTC drugs).Refers to drugs/medicines that can be acquired in pharmacies, market or store with or without the prescription of a physician that include antibiotics, cough remedies,etc. Perception.Refers to the view or opinion of the adolescents on over-the-counter drugs. Socio-demographic.Refers to the characteristics of the Adolescents which includes: Gender.Refers to the sexual category as to either a boy or a girl. Socioeconomic Status.Refers to the financial capability of the adolescents as categorized by NEDA. 5,999 and below Very poor 6,000-10,999 Poor 11,000-15,999 Average 16,000 and below Above average

Family.Refers to the who are with the adolescents in the same house. Friends/peers.Refers to the constant companion of the adolescents outside the house. Media.Refers to the main source of current information/s like television magazines and newspapers. Place of Residence. Refers to the location of the house of the adolescents as to rural or urban. Rural.Refers to an area outside the city/town proper where the adolescents reside. Urban. Refers to an area inside the city/town proper where the adolescents reside. Common Illnesses.Refers to ailments or conditions that the adolescents usually treat with over-the-counter drugs.

CHAPTER II

THEORETICAL FRAMEWORK

Review of Related Literature

This chapter presents a discussion of review of literature, theoretical framework, conceptual framework and the research paradigm. Over-the-counter drugs

As technology advances, drugs where classified as over-the-counter drugs or by prescription. Prescription drugs are those that needs physicians prescription note while over-the counter drugs are those drugs which can be bought in the store, market and pharmacy without any physicians prescription (Microsoft Encarta 2008. 19932007 Microsoft Corporation. All rights reserved).

Over-the-counter (OTC) drugs are the ones that can be purchase at local pharmacies without a doctor's prescription. These are drug substance that affects the function of living cells and are commonly used to relieve pains, aches and itches. According to Alexis Bergen, over-the-counter (OTC) medications currently account for more than 100,000 drug products on the market. More than 700 of these products were still prescription-only drugs 30 years ago.

Over-the-counter self-medicating is prevalent in the United States and other countries. It's widely accepted to go to a local pharmacy and buy the medication to alleviate unwanted conditions. The FDA has approved these medications for over the

10

counter use with just a number of limitations. According the FDA Office of Nonprescription Products, "Over-the-counter (OTC) drugs play an increasingly vital role in America's health care system that have more than 80 therapeutic categories, ranging from acne drug products to weight control drug products.

Within the last few years, several notable drugs have made the switch from prescription to OTC status, including Claritin, Pepcid AC and Zantac, giving consumers immediate access to effective medications. But with increased accessibility also comes an increased risk for drug interactions and side effects, particularly for individuals who require long-term use (Overboard on Over-the-counter drugs, Alexis Bergen).

Due to the unrestricted use of over-the-counter (OTC) drugs among the public, problems involving the use of these drugs have arised like self-medication that often lead to poisonings, allergy, habituation, addiction, and other adverse reactions due to misused or decrease knowledge about the drug (Dangers of Self-medication, 2009). In other words, self-medication had always been accompanying OTC drugs ever since this drug was released to the public.

Classification of OTC Drugs

More than 80 classes (therapeutic categories) of OTC drugs are available in the market that range from acne drug products to weight control drug products (http://fdadrugcompliance.com/resources/otc/). The following are the common classes of OTC medicines that are available currently in the United States:

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Analgesics are a class of drugs used to relieve pain. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals, without producing anesthesia or loss of consciousness. There are basically two kinds of analgesics: non-narcotics and narcotics. Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic. Acetaminophen is a popular pain-reliever because it is both effective for mild to moderate pain relief and relatively inexpensive. It must be emphasized though that the safety of acetaminophen is tied to proper use of the drug (use according to specific prescribing instructions). If acetaminophen is not used according to the directions on the label, serious side effects and possible fatal consequences can occur. For example, taking more than 4000 mg/day or using it long term can increase the risk of liver damage. The risk of liver damage with acetaminophen use is also increased by ingesting alcohol. Many people do not realize that acetaminophen is found in more than 600 overthe-counter drugs. It can be found in combination with other active ingredients in many cold, sinus, and cough medications. The cumulative effect of acetaminophen must be considered if you are talking multiple drugs which contain acetaminophen (http://arthritis.about.com/od/analgesic/a/factsanalgesics.htm). Analgesics are sometimes referred to as painkiller medications. There are many different types of analgesic medications available in both prescription and over-thecounter preparations. Examples of analgesic drugs

include aspirin, acetaminophen (Tylenol), ibuprofen(Motrin, Naprosyn), the COX-2 inhibitor celecoxib, and

Advil), naproxen (Aleve, drugs including

narcotic

morphine, oxycodone, and hydrocodone (Vicodin). Analgesics may also be combined

12

with other drugs in some types of medications (for example, analgesics are combined with decongestants and/or antihistamine in many over-the-counter cold remedies) (http://www.medterms.com). Antipyretic is a type of medication that will prevent or reduce fever by lowering body temperature from a raised state. They will not affect normal body temperature if the patient does not have a fever. Fever, or pyrexia, occurs when the body reaches a temperature above what is considered "average" (http://www.assistpainrelief.com). Antipyretic is something that reduces fever or quells it. There are 3 classes of antipyretic medications that are sold OTC (over-the-counter) without prescription: Salicylates -- aspirin (acetylsalicylic acid), choline salicylate (Arthropan), magnesium salicylate (Arthriten), and sodium salicylate (Scot-Tussin Original); Acetaminophen (Tylenol); and Nonsteroidal anti-inflammatory drugs (NSAIDs) -- ibuprofen (Advil), naproxen (Naprosyn, Aleve), and ketoprofen (http://www.medterms.com).

Cold and Cough Medicines. This are usually used to treat sneezing, sore throat, a stuffy nose, coughing and other symptoms for common colds. This medicines include nasal decongestants - unclog a stuffy nose, cough suppressants - quiet a cough, expectorants - loosen mucus so you can cough it up, and antihistamines - stop runny noses and sneezing (http://www.nlm.nih.gov).

Antiallergic products. This treat misguided reaction to foreign substances by the immune system, the body system of defense against foreign invaders, particularly pathogens (the agents of infection). The most common allergic conditions that usually address by using anti allergic product include hay fever (allergic rhinitis),asthma, allergic

13

eyes (allergic conjunctivitis), allergic eczema, hives(urticaria), and allergic shock (also called anaphylaxis and anaphylactic shock).

Sleeping pill. A prescription sedative taken for insomnia. This is usually taken to induce sleep. An over-the-counter pill classified pharmaceutically as an aid to sleeping. Commonly used sleeping pills, or "hypnotics", such as temazepam and zolpidem, which is prescribed for short-term insomnia, are associated with more than a fourfold risk of death, according to the study published in the BMJ Open journal

(http://www.guardian.co.uk),

Gastrointestinal Products. Drugs that are used to intra-abdominal ailments like for ulcer, constipation and diarrhea. Laxatives can help relieve and prevent constipation. But not all laxatives are safe for long-term use. Overuse of certain laxatives can lead to dependency and decreased bowel function. Sometimes it can cause cramping, gas, bloating, nausea or diarrhea (http://familydoctor.org). Antidiarrheal medicines include loperamide (1 brand name: Imodium) and bismuth subsalicylate (2 brand names: Kaopectate, Pepto-Bismol). Bismuth subsalicylate can also be used for upset stomach and as an antiemetic (a medicine that treats nausea and vomiting).

Loperamide works by slowing down the speed of fluids moving through your intestines (bowels). Bismuth subsalicylate works by balancing the way fluid moves through your intestines. It also reduces inflammation and keeps certain bacteria and viruses that cause diarrhea from growing in the stomach and intestines

(http://familydoctor.org).

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Antiulcer drugs are a class of drugs, exclusive of the antibacterial agents, used to treat ulcers in the stomach and the upper part of the small intestine. Recurrent gastric and duodenal ulcers are caused by Helicobacter pylori infections, and are treated with combination treatments that incorporate antibiotic therapy with gastric acid suppression. Additionally, bismuth compounds have been used. The primary class of drugs used for gastric acid suppression . are the proton pump inhibitors and omeprazole

(http://www.enotes.com)

Dermatological Products. This are used to treat skin complications or abnormalities like pimples, acne, rashes, and roughness of the skin. One of which is Acne treatments which work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, results cannot be seen for four to eight weeks, and skin may get worse before it gets better (http://www.mayoclinic.com).

Weight Loss Aids. Used to treat obesity should be used as an option for the following individuals: People with a body mass index (BMI) of 30 and above with no obesity-related conditions. A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure

(http://www.webmd.com/diet/guide/weight-loss-prescription-weight-loss-medicine). Most available weight loss drugs approved by the FDA are for short-term use, meaning a few weeks or months.

One type of weight-loss medication is "appetite suppressants." These drugs generally come in the form of tablets or extended-release capsules (pills that release

15

medication over a long period of time). Appetite suppressants can be obtained by a doctor's prescription or purchased over the counter. One common prescription appetite suppressant is phentermine. Another type of prescription weight loss drug is a fat absorption inhibitor. Xenical is the only example of this type of treatment approved for use in the U.S. Xenical works by blocking about 30% of dietary fat from being absorbed. Xenical is now sold over-the-counter as Alli. Xenical is the only weight loss drug approved for longer-term use in significantly obese people, although the safety and effectiveness have not been established for use beyond two years. Newer drugs are being studied as potential treatments for obesity, some of which are showing promise and may be available in the near future (http://www.webmd.com).

Antibiotics. Also known as antibacterials, and they are drugs used to treat infections caused by bacteria. Bacteria are tiny organisms that can sometimes cause illness to humans and animals. The singular word for bacteria is bacterium (http://www.medicalnewstoday.com).

Antibiotics are widely used in the prevention and treatment of infectious diseases (http://www.answers.com). Antibiotics, first used in the 1940s, are certainly one of the great advances in medicine. But overprescribing them has resulted in the development of resistant bacteria, which are bacteria that don't respond to antibiotics that may have worked in the past. Plus, whenever kids take antibiotics they run the risk of side-effects, such as stomach upset and diarrhea or even a possible allergic reaction (http://kidshealth.org). The antibiotics that are commonly used are Amoxicillin, Clindamycin,Cefalexin, Penicillin and Streptomycin (http://en.wikipedia.org).

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The availability of new and more effective drugs, such as antibiotics, which fight bacterial infections, and vaccines, which prevent diseases caused by bacteria and viruses, helped increase the average Americans life span from about 60 years in 1900 to about 78 years in 2005. Drugs have vastly improved the quality of life (Microsoft Encarta 2008. 1993-2007 Microsoft Corporation. All rights reserved).

Consumer perspectives

OTC medicines are generally priced much lower than prescription products. An analysis published in 2005 reported that the average retail price of an OTC medicine in America was $7, whereas the average price of a name-brand prescription medicine was $96, and the price of a generic prescription medicine was $28 USD. At the time of their introduction to the OTC market, Alli (orlistat), Zantac (ranitidine), and Miralax (polyethylene glycol), were all priced between 50% and 90% lower than the original branded prescription medicines. Similarly, the cost of a 30-day supply of Claritin (loratadine) was $96 when the drug was available by prescription and $22 following the switch to OTC availability. Due to the economic advantage of OTC medicines, physicians are likely to recommend the use of an OTC medicine as a substitute for an prescription medicine to assist patients who are burdened with out-of-pocket prescription costs. By using OTC medications, consumers not only save on drug costs, they also save the out-of-pocket costs for doctor visits (including insured consumers copayments) and transportation, as well as the cost of time spent traveling and waiting at the doctors office. Using the U.S. June 2010 average hourly wage rate of $22.53, the 2 to 4 hours that a patient saves from avoiding a doctors visit would result in an average savings of $45 to

17

$90. According to Temin there are three factors used to assess the economic implications of the OTC availability of topical hydrocortisone: price of the drug, cost of the doctor visit to get the prescription, and value of the time used to go to the doctor. He estimated that consumers saved more than $200 million the first year after topical hydrocortisone was switched from prescription (Rx) to OTC status and more than $400 million the second year after the switch. In a study concerning the switch of heartburn medications from Rx to OTC status, Mansfield et al. found that consumers saved approximately $160 in out-of-pocket drug costs and $14 in physician visit costs annually

(www.pharmacytoday.org).

In the Philippines, according to Dr. Robles, people tend to use over-the counter drugs because of the advice coming from their relatives, friends and neighbours. The basis of utilization of drug/s is based on the effectiveness experienced after using these drugs to treat common illnesses. On the other hand, according to Dr. Dy, the use of overthe-counter drugs most especially antibiotics is influence by financial constraints. According to him, due to financial instability, drugs are inappropriately. The right dose, interval and duration of intake of the drugs are not accurately followed causing the development of drug resistance.

Reasons of using OTC Drugs

Self-medication has always been a part of normal living. One who suffers from any minor disease like flu, fever or headache goes to a medical store, purchases his required medicine and takes it (Self-medication a Dangerous Practice,Zameeruddin Shakeel, Pindi Bhattian).

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It is a common practice among our people to use a medicine when experiencing discomfort such as headache, runny nose, cough, fatigue and stomach ache. The fact that these symptoms seem to disturb people from time to time makes it easier for them to decide what to buy from a nearby drug outlet. Self-medication, as a practice, is defined by International Pharmaceutical Federation (FIP) and the World Self-Medication Industry (1999) as, the use of nonprescription medicines by people on their own initiatives. It is expected that individuals may resort to self-medication (The Dangers of Self-Medication, Yolanda R. Robles, PhD).

According to Dangers of Self-medication (2009), a large number of people, when they fall sick, do not consult the physician. They either consult a chemist and obtain a medicine from his shelf, or may consult a neighbour who may be having some tablets left over from his previous illness, and readily spares them. May be most of the times nothing untoward happens on following such advice, but it can be dangerous. OTC medications save the consumer time and money because they dont have to go to the doctor every time they are sick. But, it is important to understand that nonprescription drugs should be used with the same amount of caution as prescription drugs, says Kathy Johnson, Pharm.D., Ph.D., associate professor of clinical pharmacy and pharmaceutical economics and policy at the USC School of Pharmacy (Overboard on Over-the-counter drugs, Alexis Bergen). Today self-medication is already common to everybody in both developed and developing countries. This may be due to different factors like individuals satisfaction with the healthcare provider (which is the cause of a major reason in developing countries). Other includes interactions between prescribed drugs and the drugs taken for

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self-medication, educational level, socioeconomic factors, age and gender, distance from the health care facilities/services. And based on some studies, the greater prevalence of self-medication among the younger generation could be due to the better educational level. Obtaining OTC medication is much cheaper and easier than seeing a doctor and going through the process of obtaining a prescription drug. As a result, there is a high potential for inappropriate used and side effects, especially if people are unaware of the risks. In US, adults who self-medicate do so primarily because they are familiar with how to treat their illness due to past experience (90%). In addition, nearly four of five say they self-medicate because it saves them a trip to the doctors office (78%), their illness isnt serious enough to warrant a doctors visit (78%), non-prescription medication are just as effective as prescription drugs (63%) and it saves time (77%) (Self-medication and Allergies Survey-executive Summary. US Adults experiences with Self-Medicating). Due to its cheap cost, OTC drugs are commonly used by the public to treat common illnesses like the ones mentioned a while ago, and this include proprietary drugs which are sold over-the-counter include pain relievers, cough remedies, anti-allergics, laxatives, vitamins, tonics, antacids and many others. (Dangers of Self-medication, 2009). Common ailments treated with OTC Drugs According to Self-medication and Allergies Survey-executive Summary. US Adults experiences with Self-Medicating, the common illness that the American experience and commonly treated with OTC drugs are chest congestion (38%), coughing

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(36%), nasal congestion (35%), sinus headache (31%). Adults are less likely to selfmedicate for seasonal or year-round allergies than they are for illnesses such as coughs and colds, heartburn and headache. In India, the most common ailments for which self-medication are resort are headaches, colds, fevers, digestive problems diarrhea, constipation or acidity ( 2011 Window2India.com). Self-medicating not only can be for all the wrong reasons, but it may have started innocently as a way to alleviate an unwanted condition such as sleeplessness, pain, anxiety, allergies, etc. Without proper professional guidance (and sometimes even with it), abuse can ensue creating an even bigger problem for the user. Some people go to great lengths to self-medicate starting with mild remedies and graduate to stronger and sometimes even illegal substances (Self Medicating - Drug Rehabilitation - Help for those who self medicate - Drug rehabs2010 SelfMedicating.info. All Rights Reserved). The common ailments that the public commonly treated with OTC drugs are fever, headache, cough and colds, digestive problems, muscle ache and pains. And paracetamol, analgesics (NSAIDs) and antimicrobials are the most commonly used class of drugs. Herbs were also used for self-medication (Journal of Public Health Medicine.Vol). 18,No. 4,pp. 437-442). Misused of OTC Drugs

Common over-the-counter drugs that among college students includes laxatives, pain reliever, cold remedies and antacids. According to the Journal of American College Health (Vol. 56, No. 5), about 75% of students reported self-administering OTC pain medication when they experienced pain symptoms including headache, ear and throat

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pain, stomach pain, menstrual pain, and musculoskeletal pain. And the most common medication used is acetaminophen. In addition, the used of sleeping aids like OTC night time cold medications were noted since 80% of 278 students had difficulty falling asleep for 1-4 per month.

In recent years there has been an increasing trend in self-medication with nonprescription drugs [sometimes referred to as over-the-counter (OTC) medicines] available in pharmacies and in retail outlets. According Waszaifya et al (2004), more than half of their respondents take OTC drugs on regular basis, though females has higher frequency in taking than OTC drugs males. They said that what mostly influences them is the pharmacist recommendation and that majority of them claimed that they read the package insert of the drug that they usually buy in the pharmacy or market though some reported of not reading the package insert before using the drugs because they claimed that they already read this from previous occasion.

On the other hand, some even reported encountering cases of inappropriate OTC drug use that they had classified as abuse. Some participants reported cases of mixing OTC products with alcohol. Wills (1997) described the use of soluble aspirin tablets along with fizzy cola drinks or beer in order to produce a high, despite the lack of pharmacological evidence. The use of laxatives to lose weight especially by young women with eating disorders has been often cited (Waszaifya et al 2004).

On the other hand, in the Philippines setting, there are lots of cases wherein misused of OTC drugs is very evident most especially antibiotics. According to Dr. Emmanuel Dy (Inappropriate antibiotic use in the Philippines), Filipinos are fond of

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taking medications without proper administration with respect to drug, dose, interval, duration. Like what mostly observe in the community, some would just take antibiotic just for one day not knowing that this may lead to the development of resistance to specific bacteria causing now the decrease effectiveness of the drug to some strains of bacteria.

Furthermore, there are self-medication can be harmful to people with the wrong choice of drugs. According to a local survey, many people ask advice on medicines from their relatives, friends and neighbours. The latter judge effectiveness of drugs from their own experience then uses it as a basis for giving advice. The problem with that practice is, while there is commonality in symptoms of diseases, the extent and nature of a disease may not be the same. Thus, rather than helping solve the problem, the chosen drug may contribute to the problem or aggravate the condition. Let us take asthma, for example. It is characterized by wheezing, cough and difficulty of breathing. For cough, a friend may recommend an antitussive (anti-cough). When such drug is given, the sick person may find it more difficult to breathe due to accumulated pleghm. A bronchodilator and an expectorant could have been used instead. Second is the problem of contra-indications. What is good for Juan may not be good for Juana because the latter is allergic or hypersensitive to the medicine of Juan even when they have the same condition. Also, the cause of the medical condition may be different. In hypertension, for example, a doctor may give a patient a beta-blocker but to another he will prescribe a diuretic. Because the nature of hypertension in these two patients is not the same and will require different drug treatment. Third, the problem of adverse drug interactions. Even OTC medications are not harmless if used improperly. They are notorious for producing undesirable effects

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like reduced effectiveness, reduced absorption of another drug and also of increasing the possibility of toxicity from another drug. This problem is common among people who use many drugs for various ailments. It is not safe to add a drug to a therapeutic regimen without the knowledge of the prescriber. This problem is also encountered with herbal supplements which can be bought from groceries and health shops. They were implicated in many adverse drug interactions with prescription and non-prescription medications. Again, their concomitant use with maintenance drugs must be communicated with prescribers (Robles 2006).

All of these problems carry a cost, not just in terms of pesos but also in terms of health and well-being of a person. While self-medication is more economical, wrong selfmedication may be even more costly and dangerous. It is a virtue to seek advice from well-informed health professionals who have access to scientific information before they give advice to laymen on the use of OTC medications (Robles 2006).

Factors that Affects the Utilization of OTC Drugs

The following are the factors that affect the utilization of OTC Drugs among Adolescents:

Age. According to Erik Erickson, development mostly depends upon what is done to us. From here on out, development depends primarily upon what we do. And while adolescence is a stage at which we are neither a child nor an adult, life is definitely getting more complex as we attempt to find our own identity, struggle with social interactions, and grapple with moral issues. Our task is to discover who we are as

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individuals separate from our family of origin and as members of a wider society. Unfortunately for those around us, in this process many of us go into a period of withdrawing from responsibilities, which Erikson called a "moratorium." And if we are unsuccessful in navigating this stage, we will experience role confusion and upheaval. A significant task for us is to establish a philosophy of life and in this process we tend to think in terms of ideals, which are conflict free, rather than reality, which is not. The problem is that we don't have much experience and find it easy to substitute ideals for experience. However, we can also develop strong devotion to friends and causes. It is no surprise that our most significant relationships are with peer groups

(http://www.learningplaceonline.com).

Monthly Family Income. This involves certain factors which influence utilization of OTC Drugs. Underlying the process of utilization of over-the-counter drugs, it may constitute a crucial situation to Adolescents. Most adolescents submit to selfutilization/medication as needed. This means that when the family income is increased, the frequency of consultation to health facilities or duration of medical visit, before an individual is prompted to utilize OTC drugs, increases. It was also noted that Over-thecounter drug utilization is determined in a significant manner by the financial status of the family (Oano, 2004).

Educational Attainment. The higher the educational background of on individual, the higher the knowledge with regards to a certain thing. Like in the utilization of OTC drugs, the more the individual expose to higher education, the higher/advance he/she is in understanding the uses, effects and complications brought

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about by drug used. Several studies also shows that many are ill informed on the use and side effects of drugs like pain medications. And that more education is still needed (http://www.ncbi.nlm.nih.gov).

Peers. A recent study suggests that adolescents with a large network of friendships on such social cause them to be more apt to drink alcohol. Parents dont deny the influence their childrens peers have on them, but they do wonder just how far their influence stretches. A recent article also suggests that there are other factors that increase the risk of alcohol onset among teens such as age, race, team sports and their position in the social network arena. The study further found that being in close proximity to the most popular peers was a definite factor in the onset of drinking. The study showed that the density of the networks magnified the spread of influence among the adolescents and also amplified the dynamics. The findings also suggest that limiting the size of these social peer groupings may have a positive influence on delaying the onset of alcohol usage. If adolescents are easily influence by their peers in drinking alcohol, how much more in just taking OTC drugs (http://www.addictiontreatmentmagazine.com).

Relatives. Family and peer relationships are important for adolescent drug use because both are primary groups where attitudes and behaviors are learned. According to social learning theory, an individual learns to take drugs in small, informal groups (Akers & Sellers, 2004; Bahr, Maughan, Marcos, & Li, 1998; Petraitis, Flay, & Miller, 1995). It is in these intimate settings that people are taught, through imitation and reinforcement, to hold attitudes that are favorable or unfavorable to drug use (Reed & Rountree, 1997). Within families where alcohol is used, adolescents may observe alcohol use, acquire

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favorable attitudes toward alcohol use, and begin using alcohol themselves (Wills, Mariani, & Filer, 1996). Similarly, if their friends drink alcohol, adolescents are likely to receive positive social reinforcement from their friends for drinking (Petraitis, Flay, & Miller, 1995). Many social learning theorists focus on peers because of the signicance adolescents place on friends as adolescents mature and gain autonomy from their parents. However, families also appear to be important for learning attitudes and behaviors about alcohol and other drug (Bahr et al 2005).

Media. The large proportion of OTC advertising does have serious effects in that there is a possibility these ads can help further a trend for todays youth to find a pill for any type of pain that they might have possibly inducing an overmedicated population which can have serious long-term health effects (http://www.utexas.edu/nursing/).

Theoretical Framework Imogene King defined perception as an individuals representation or image of reality, each one view of what is going on in the world. What we see and perceive is influenced by what we know, what we look for and what is familiar to us. Perception is a process in which data is obtained through the senses and from memory are organized, interpreted and transformed. Kings Conceptual System or the Open System Model includes goal, structure, function, resources and decision making. The Conceptual System has health as a goal in nursing. Structure is represented by the three open systems. Functions are demonstrated in reciprocal relations of individuals in interactions and transactions. Resources include

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both people (health professionals and their clients) and money, goods, and services for items needed to carry out specific activities. Decision making occurs when choices are made resource allocation to support attaining system goals. Kings presents assumptions that human being are open systems in constant interactions with the environment.

The Conceptual System is composed of three interacting systems: the personal systems, the interpersonal systems and the social systems.

Personal systems. Represents an individual/person who values their perceptions, self, growth and development, body image, time and space.

Interpersonal systems. Represents interaction of the individual to others. It includes communicating, transaction, role and stress.

Social systems. Represents group interaction with one another. It is always an important role in goal attainment which includes organization, authority, power status and decision making.

The used of over-the counter drugs will be dependent on the interaction of the person/individual. He uses OTC drugs if he recognizes it as beneficial to his health or may be due to his transaction, interaction and communication within his environment which includes his family, friends, health care provider and the society.

The Open System Model is being used because human being is categorized as an open system because its perception, belief and understanding changes upon experience

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and the environment. It is used as the framework of the study because it states that a lot of factors always affect the persons perceptions and behaviour. With this, the Open System Model will be employ to determine if the environment, together with the experiences and the different factors that will be identified affects the perception of the adolescents on utilization of over-the-counter drugs.

Conceptual Framework

Figure 1 shows the research paradigm of the study which indicates that sociodemographic profile of the respondents which are considered as factors that could affect the perception of adolescents on over-the-counter drugs.

The research paradigm of this study consists of 2 boxes. The first box encloses the socio-demographic profile of the respondents as to sex, monthly family income, educational attainment, and sources of information which includes peers, relatives and media. This profile represents the independent variable. The second box encloses the perception of the respondents on OTC drugs as to effects, dosage, frequency and reason/s. This box represents the dependent variable.

The arrow between the first and second box indicates the possible relationship between the 2 variables: the socio-demographic profile and the perception of the respondents on OTC drugs. The origin of the arrow represents the independent variable while the point of the arrow represents the dependent variable.

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Research Hypothesis

This section will try to determine the possible outcome of this study with regards to the relationship between the independent (socio-demographic profile) and dependent variables (perceptions on OTC drugs).

In relation to this research study, the following hypothesis will be proposed:

1. There is a relationship between the socio-demographic profile and the perceptions on OTC drugs among the respondents.

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CHAPTER III

METHODOLOGY

This chapter presents the methods that will be utilized by the researcher. This includes the research design, locale of the study, samples and sampling procedures, instrument/tool, data gathering procedure, and statistical treatment of data. Research Design The study will employ a descriptive-correlational design. Descriptive will be used to determine the profile of the respondents as to sex, monthly family income, educational attainment, and sources of information. It also tries to determine the common illnesses experience by the respondents and the common drugs they used to treat these illnesses. It is likewise correlational because it will work into the relationship of the independent and dependent variables. The independent variable is considered to be the socio-demographic profile/characteristics of adolescents while the dependent is the adolescents perception on over-the-counter (OTC) drugs. Locale of the Study This study will be conducted at Mariano Marcos State University, Batac Campus, except the College of Health Sciences. Mariano Marcos State University is the largest tertiary school in the province. It is a state-funded institution of higher learning that serves the Ilocos region and its surrounding regions. It is covers a vast of land of

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approximately 300 hectares (though the land is separated). It is has different campuses, mainly located at Batac, Laoag, Paoay, Currimao and Dingras. It has approximately has 18,000 officially enrolled students and about 10,000 students are studying at Batac campus. The university has 9 colleges and under these colleges several courses are being offered. At Batac campus, there are 5 colleges that offer different courses. At College of Health Sciences in offers BS in Pharmacy, BS in Nursing, BS in Physical Therapy; College of Business and Accountancy the following courses are being offered - BS in Accountancy, BS in Economics, BS in Business Administration (Management Accounting, Marketing Management, Human Resources Development Management), BS in Tourism Management, BS in Cooperative Management, BS in Entrepreneurship, BS in Hospitality Management. The College of Agriculture, Food and Sustainable Development - BS in Agriculture, BS in Forestry, BS in Development Communication, BS in Home Technology, BS in Agricultural Technology, Bachelor of Agricultural Technology, Diploma of Agricultural Technology, Forest Ranger, Technical

Homemaking, Associate in Home Technology, Associate in Technical Homemaking. College of Arts and Sciences offers the following - BS in Mathematics, BS in Computer Science, BS in Biology, BS in Environmental Science, AB in Sociology, AB in English Studies, BS in Chemistry. College of Engineering- BS in Agricultural Engineering, BS in Ceramic Engineering, BS in Chemical Engineering, BS in Civil Engineering, BS in Computer Engineering, BS in Electrical Engineering, BS in Electronics Engineering, BS in Mechanical Engineering; College of Law that offers only Bachelor of Law. Outside Batac Campus includes College of Industrial Technology that offers the following courses- BS in Industrial Education, BS in Industrial Technology (ladderized), BS of

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Automotive Technology; College of Teacher Education - Bachelor in Secondary Education, Bachelor in Elementary Education, Short-Term Programs; and College Aquatic Science and Applied Technology- BS in Marine Biology and BS in Fisheries. Samples and Sampling Procedures The target population of the study includes adolescents aged 15-18 and are currently studying at Mariano Marcos State University, Batac Campus. Data will be gathered through a tool where list of names of students will be taken. Multi-Stage Sampling will be used wherein the researchers use two sampling method. First, the Cluster Sampling, wherein the researchers will divide the population of MMSU, Batac Campus per course to group the samples and then used the Systematic Sampling Method to select the elements to be included in the sample. In this case, the researchers list all the different courses at MMSU, Batac Campus and get the samples by using an interval in between the list of subjects (courses). The interval is determined by getting the quotient of the total population over the 20% of the total population (k=N/n, wherein k is the interval, N is the total population and n is the sample that will represent the total population, it is the 20% of the N). The Instrument or Tool The research instrument that will be used in gathering data is a SurveyQuestionnaire. This research questionnaire will be submitted to the research adviser for improvement and approval and upon this, questionnaires will be revised. It has 3 parts: Part 1 of the questionnaire deals about the socio-demographic profile of the respondents.

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Part 2 determines the common illnesses experience and the common drugs used by the respondents. Part 3 will determine the respondents perception on OTC drugs as to its effect, dosage, frequency and the reason of taking these drugs. Data Gathering Procedures Before the distribution of the survey-questionnaires, a letter will be presented to the dean to obtain a permission to conduct the study. After which, a letter will be forwarded to the dean of different colleges, where the samples are located, to have their approval to conduct the study to their college. After obtaining an approval from the different deans of the colleges where the study will be conducted, the researchers will distribute the survey-questionnaire to the respondents with guided instructions. After which, the data will be collected, arranged and interpreted according to the appropriate statistical treatment. Statistical Treatment The data that will be gathered on the profile of the respondents will be tabulated and will be analyzed using a distribution and percentage. Frequency counts and percentage will be used to present the profile of the respondents. The mean will be used to describe the perceptions of the respondents on OTC drugs. Pearsons r to determine the degree and test the relationship between the respondents profile and to the perceptions on OTC drugs.

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Point Biserial correlation will also be used to determine and test the relationship of the respondents socio-demographic data/profile and their perceptions on OTC drugs.

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QUESTIONNAIRE

SOCIODEMOGRAPHIC FACTORS AFFECTING THE PERCEPTION OF OTC DRUGS OF ADOLESCENTS

General Direction: Please provide the necessary answers to the questions.

I. Personal Profile

Name (Optional) : __________________________________________________ Address : _________________________________________________________ Age : _____ 15 _____ 16 Sex : _____ Male Year Level : _____ 1st _____ 2nd _____ 17 _____ 18 _____ Female _____ 3rd _____ 4th

Course : ____________________________ Family Income (Monthly) : __________ below 1000 __________ 1001-3000 __________ 3001-5000 __________ 5001-10000 __________ Others (please specify)

Sources of Information Regarding OTC Drugs:

_____ peers _____ relatives _____ media _____ Others (please specify)

II. You are allowed to answer the following questions freely in a relatively unrestricted manner.

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1. Put a check on the space provided before each of the following common illnesses which you had experienced. _____ fever _____ headache _____ flu _____ dizziness _____ diarrhea _____ cough _____ constipation _____ wounds _____ toothache _____ stomach ache _____ others (please specify)

2. Put a check on the space provided before each of the following over-the-counter drugs which you usually use in treating common illnesses as indicated below:

Fever _____ Paracetamol (Biogesic) (Robitussin) _____ Ibuprofen (Alaxan) (Solmux) _____ Aspirin (Tylenol) _____ Others (please specify)

Cough _____ Guiafenesin

_____ Carbocisteine

_____ Lagundi (Ascof) _____ Others (please specify)

Flu _____ Paracetamol (Biogesic) _____ Ibuprofen (Alaxan) (Dolfenal) _____ Aspirin (Tylenol) _____ Others (please specify)

Headache _____ Aspirin (Tylenol) _____ Mefenamic acid

_____ Ibufropen (Advil) _____ Others (please specify)

Stomach ache _____ Aspirin (Tylenol) _____ Ibufropen (Advil) _____ Mefenamic acid (Dolfenal)

Dizziness _____ Diphenhydramine ( _____ Meclozine (Bonamine)

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_____ Others (please specify)

_____ Others (please specify)

Diarrhea

Constipation _____ Diphenylmethane

_____ Diphenoxylate/Atropine (Lomotil) (Bisacodyl) _____ Loperamide (Diatabs)

_____ Others (please specify)

_____ Others (please specify)

Wounds _____ Amoxicillin _____ Clindamycin (Dolfenal) _____ Others (please specify)

Toothache _____ Aspirin (Tylenol) _____ Mefenamic acid

_____ Ibufropen (Advil) _____ Others (please specify)

3.a. Direction: Please answer the following questions by putting on check mark to the response that is true to you. A. OTC drugs used for Fever 1. Effect of the drug: ___ this drug decreases my temperature ___this drug relieves pain when I have fever ___ this drug will restores my energy quickly ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) B. OTC Drugs used for headache

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1. Effect of the drug: ___ this drug relieve my headache ___ this drug relieves the pain that I felt and help me resume my activities immediately ___ this drug relieve dizziness when I have headache ___ others (please specify)___________________________________

2. Dosage: _____250 mg ______500mg

________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) C. OTC Drugs used for Flu 1. Effect of the drug: ___ this drug relieves body pain ___ this drug relieves all of my symptoms ___ this drug lowers down my elevated temperature ___ others (please specify)___________________________________

2. Dosage: _____250 mg ______500mg

________750 mg _______others(Please Specify) ________twice

3. Frequency per day: _______once

________thrice _________ Others( please specify) D. OTC Drugs used for Dizziness 1. Effect of the drug: ___ this drug relieves my dizziness ___ this drug prevents nausea and vomiting ___ this drug relieves the pain that I felt when I feel dizzy

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___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify)

E. OTC Drugs used for Diarrhea 1. Effect of the drug: ___ this drug hardened my stool ___ this drug decreases peristaltic movement ___ this drug decrease the frequency of defecating ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) F. OTC Drugs used for Cough 1. Effect of the drug: ___ this drug loosen my phlegm, thus it will easily come out ___ this drug decreases the frequency of coughing ___ this drug relieve the itchiness that I felt on my throat when I have cough ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice

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________thrice _________ Others( please specify) G. OTC Drugs used for Constipation 1. Effect of the drug: ___ this drug softens my stool ___ this drug help me defecate easily ___ this drug helps me attain normal defecation ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify)

H. OTC Drugs used for Wound 1. Effect of the drug: ___ this drug prevent infection ___ this drug promote faster wound healing ___ this drug treat the wound ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) I. OTC Drugs used for Toothache 1. Effect of the drug: ___ this drug relieves toothache

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___ this drug kill the bacteria that causing toothache ___ this drug treats toothache ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others (Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) J. OTC Drugs used for Stomach ache 1. Effect of the drug: ___ this drug relieves stomach ache ___ this drug treats stomach ache ___ this drug prevent complications ___ others (please specify)___________________________________ 2. Dosage: _____250 mg ______500mg ________750 mg _______others(Please Specify)

3. Frequency per day: _______once ________twice ________thrice _________ Others( please specify) 3.b Please put a check to the response that is true for you: Stomach ache Constipation

I take this drug because my friends told me that it is effective for them in curing this illness

Wound

Cough

Reasons Fever

Toothache

Headache

Dizziness

Diarrhea

Flu

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I take this drug because my friends told me so I take this drug because my friend/s use it I take this drug because my mother and my family members told me that this drug is effective in curing this illness I take this drug because my mother and my family told me so I take this drug because my because my mother and my family use it I take this drug because I saw in television that it was effective in curing this illness I take this drug because I heard from the radio that it was effective in curing this illness I take this drug because I read it from the newspaper I take this drug to save time and effort in going to the physician

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I take this drug because I believe that it is cheaper than the one that is prescribed by the physician I take this drug because whenever I experience this illness, this drug always effective in curing my condition I take this drug because it brings me happiness. I take this drug because I dont want to miss my class I take this drug because it is not serious that it need medical consultation I take this drug because I have no confidence on my doctors Others(Please Specify):____________ ______________

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3.c. Please answer the following by putting a check mark to the response that is true for you. You can check more than one of the responses: Stomach ache Constipation

if I take more tablets, it will increase the effectiveness of the drug. If I take the tablet one after the other, it will take effect immediately I can take any medication even without the prescription of the physician I can take two drugs at the same time so that my illness will easily be cured I can stop taking my medications when the symptoms had already disappeared

Wound

Cough

Reasons Fever

Toothache

Headache

Dizziness

Diarrhea

Flu

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There are no side effects if I take more tablet than what is needed I should seek consultation before taking any medications I should follow the recommended dose and frequency to avoid harmful effects I should complete the specified duration for taking the medication to prevent complication

Others (please specify)_________

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