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Background Inappropriate use of acetaminophen products is a concern due to the severe liver damage associated with intentional or accidental overdose of these products. In 2009, the U.S. Food and Drug Administration (FDA) issued more severe organ-specific warnings for the acetaminophen Drug Facts label to improve protective behavior among patients. However, it is not clear how patients react to such interventions by the FDA. Objective The objective of this study was to evaluate the factors influencing patients' intention to engage in protective behavior while using acetaminophen products after reading the Drug Facts label. The study specifically looked at the relationship between four Protection Motivation Theory-based risk cognition factors and the intention to engage in protective behavior. Methods An experimental, cross-sectional, field study was conducted using self-administered questionnaires at four community pharmacies in Houston, TX. Two hundred surveys were collected from adults visiting the selected pharmacy stores. Participants were exposed to a simulated label (i.e. Drug Facts label) containing organ-specific warnings for over-the-counter (OTC) acetaminophen products. Risk cognition measures (i.e. measures of perceived severity, perceived vulnerability, response efficacy, and self-efficacy) and measures of intention to engage in protective behavior (always reading warnings, using products with more caution, and consulting a pharmacist/physician) were recorded. Pearson correlation and multiple linear regression analyses, controlling for demographic and behavioral characteristics of the participants, were performed. Results Bivariate analyses indicated that an increase in perceived severity, perceived vulnerability and response efficacy were associated with a higher intention to engage in protective behavior. Findings from the multiple regression indicated that increase in perceived severity of liver damage, belonging to a non-healthcare occupation, no history of acetaminophen use and no history of alcohol consumption were associated with a higher intention to engage in protective behavior. Conclusion Higher risk cognition of liver damage associated with inappropriate use of OTC acetaminophen products leads to greater intention to engage in protective behavior while using such products. Developing interventions targeted towards improving reading and adhering to the Drug Facts label could improve risk cognition, and thus improve patients' intention to engage in protective behavior. Regular acetaminophen users, heavy alcohol consumers and healthcare professionals might need other interventions apart from the Drug Facts label to improve their likelihood to engage in protective behavior.

Background Self-medication practices and polypharmacy are common among human immunodeficiency virus (HIV)-infected patients. Inappropriate use of over-the-counter (OTC) medications potentiates the risk for drug misuse and adverse drug events (ADEs). Objectives To investigate use and misuse of OTC medications in HIV-infected patients and determine related ADEs. Methods A nonexperimental cross-sectional field study design was used. Study subjects were HIV-infected patients from a local HIV clinic in Houston, TX. Information on subject demographics, OTC medication use, and ADEs experienced were obtained using combined self-administered questionnaire and personal interview techniques. Misuse was divided into 3 categories: strength/frequency misuse, length misuse, and condition misuse. Data were analyzed using descriptive and Chi-square analyses. Results A total of 215 completed surveys were obtained, with a net response rate of 63.6%. The mean (±SD) age of the respondents was 45 (±8.32) years and 69% were males. Analgesics/antipyretics (64.2%) were the most commonly used OTC medications of which nonsteroidal agents accounted for the greatest proportion (38.4%). Of the respondents, 80 (37.2%) misused OTC medications. The highest incidence occurred in length misuse (46.3%), followed by strength/frequency misuse (45.6%), and condition misuse (8.1%). Categories of misuse overlapped in 30 cases (20.1%). Thirty-six (16.7%) participants experienced at least one or more ADEs related to OTC medication use/misuse. Occurrence of ADEs was significantly higher in patients who misused OTC medications compared with those who did not ( P Conclusions Analgesics/antipyretics were the most commonly used OTC medications by HIV-infected patients. The incidence of misuse and ADEs associated with OTC medications were documented with the sample. Keeping in mind the limitations of study design, our findings suggest that misuse of OTC medications in HIV-infected patients may increase the incidence of ADEs experienced.