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By Michelle Meadows
Medicine use isn't a typical part of the curriculum for middle school students. But a new educational outreach program is changing that.
Medicines in My Home (MIMH) is intended to teach students in sixth through eighth grades about the safe use of over-the-counter (OTC) medicines. The program was launched in June 2006 by the Food and Drug Administration's Center for Drug Evaluation and Research (CDER), in cooperation with Montgomery County Public Schools (MCPS) in Maryland and the National Council on Patient Information and Education (NCPIE).
The 45-minute, interactive lesson is a welcome addition to the classroom, according to Frieda Cooney, a health education teacher at Gaithersburg Middle School, Gaithersburg, Md. Cooney is one of three teachers who helped with the pilot program last year. She also initiated the development of tests, worksheets, and a home activity to reinforce the lesson.
"Medicine and self-treatment are concepts that middle school students encounter on a daily basis," Cooney says. "But the meaning and impact of decisions related to these topics haven't been routinely discussed with them." Through MIMH, Cooney cleared up some common misconceptions with her classes.
For instance, few students knew that medicine bottles had expiration dates. "Many of them thought the bathroom medicine cabinet was specially designed to keep medicine fresh," Cooney says. "Many students also didn't realize that prescription medicine should only be used by the person it's intended for. They thought all of the kids in a family could and should take the same medicine for any and all cold symptoms." Some students thought that they could use a drug which was prescribed for a sibling.
During the early stages of the pilot program, health professionals in the CDER's Office of New Drugs and Office of Training and Communications visited schools and taught the MIMH lesson. In time, teachers in the schools took over and successfully taught the course. Three middle schools in Montgomery County participated in the pilot program during the 2005-2006 school year: Gaithersburg, Lakelands Park, and Briggs Chaney.
Starting this year, MCPS integrated the MIMH lesson into the health education curriculum for all of its sixth-grade health education classes. The suburban D.C. county has 38 middle schools with about 10,000 students in sixth grade.
The FDA encourages other middle schools to adopt the MIMH program. Convenient Web-based resources for the course make it easy to implement the MIMH program. This is the first time that the agency has developed materials to educate school-aged children about medicine use.
Karen Feibus, M.D., joined the FDA's Office of Nonprescription Products in December 2003 when the agency had just kicked off a campaign promoting safe use of OTC pain relievers and fever reducers. The campaign focused on OTC medicines containing acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen, naproxen sodium, and ketoprofen. Taking too much acetaminophen can lead to liver damage and death. NSAIDs can cause stomach bleeding and raise the risk of kidney problems.
"Watching the videotape from focus groups that were done for the OTC medicine campaign really made an impact on me," Feibus says. She recalls that one man in the focus group talked about using a four-ingredient cold medicine when he gets sick. He drank medicine directly from the bottle and sometimes finished a whole bottle in a day. He didn't follow directions on the label or measure the correct dose with a medicine measuring tool.
Then, in June 2004, Feibus heard a speech by a representative from the Medicines and Healthcare Products Regulatory Agency in the United Kingdom (UK). "The speaker discussed incorrect use and overuse of acetaminophen in the UK and complimented FDA on communicating health messages to the public," Feibus says. "She wondered whether the agency had taken its educational campaign into schools." That question sent Feibus' wheels turning. With experience as an obstetrician/gynecologist, she already had a strong interest in empowering consumers to learn more about their health and to make smart health choices.
"Studies suggest that some children in middle school begin to take medicine on their own," Feibus says, "so it makes sense to bring MIMH to this age group." By October 2004, an MIMH working group of 16 physicians and nurses from the Office of New Drugs and educators from the Office of Training and Communications had committed to developing the MIMH lesson plan and to teaching it in the schools.
Barbara Pearlman, coordinator of health education for MCPS, says she was excited about the program because decision-making skills on medicine use align with the county's sixth-grade unit on "Alcohol, Tobacco and Other Drugs."
Feibus says CDER's Office of Training and Communications professionals created the Web site and helped make the program materials as accessible as possible. "The FDA's mission is to protect and promote the public health, and a big part of that involves educating consumers about how to use the products regulated by the agency," she says.
An MIMH teacher's kit, available online, contains an MIMH booklet, a slide presentation, classroom materials, a home activity, and assessment tools. There is also supplemental background information about FDA drug regulation and links to other consumer resources on OTC medicines.
Some of the learning objectives for students are identifying the active ingredients in an OTC drug product and understanding the purposes and uses. Students also practice reading directions on medicine bottles and recognizing the warnings sections on the Drug Facts Label. For example, students learn that two medicines with the same active ingredient should not be used at the same time.
Cooney says that her students manipulated medicine packages and showed that they could find information on the label. "This hands-on experience ensures students can apply the demonstration materials to actual medicine bottles," Cooney says. Students also learned the importance of using measuring tools that are made specifically for medicine. Household spoons vary in volume and may not measure an accurate dose for medicine. Cooney's students measured salt with a teaspoon from the kitchen drawer and also measured salt with medicine measuring tools. They noted the difference in the measured quantities and discussed the potential effects of incorrect measuring and dosing.
In addition to emphasizing the importance of reading labels, the lesson stresses the need for involving a parent or guardian in decisions about medicine use. Students can do activities at home to teach their families what they learned in class.
There are plans for other counties in Maryland to implement the MIMH program in their schools, Feibus says. The MIMH materials are designed to be a national educational resource for schools and community groups interested in teaching students and families about safe medication use.
Additional Web materials are under development and will provide a lesson geared toward adult and caregiver audiences, as well as more interactive activities to reinforce and enhance the MIMH concepts. An MIMH mailbox has been set up online to receive suggestions and feedback from health educators and community leaders who use the program. Since the site is growing and changing, a listserv has been set up so visitors to the site can receive notification when new materials are posted.
The NCPIE is helping to build program awareness and to distribute materials through its coalition members. "Our member health care professional organizations, including physician, pharmacy, and nursing groups, are being urged to encourage their members to reach out in their local communities to get MIMH conducted in middle schools in their area," says Ray Bullman, executive vice president of the NCPIE.
"Better informed consumers of any age can lead to better medicine use and better outcomes," Bullman says. "Reading the OTC Drug Facts Label, and knowing when and how to ask a parent and health care professionals for assistance when it comes to taking medicines the right way, are skills that will serve the MIMH target audience well throughout their lives."
The FDA and the NCPIE have also worked together to organize and conduct the NCPIE's ongoing "Be MedWise" campaign to promote using OTC medicines with care.