In the present study, 86.4% of the total students reported self-medicating. This result is similar to that reported in studies conducted with university students in the Palestine (98%) [11
] and Slovenia (92.3%) [16
]. It is interesting to note that a Brazilian study conducted with university healthcare and non-healthcare students in the city of Recife [8
] showed that 57.7% declared not to self-medicate. As shown in a previous study, healthcare-related education in students led to more responsible self-medication [16
Previous studies comparing university healthcare to non-healthcare programs include a small number of healthcare students [10
]. In the present study, in which the multivariate analysis revealed a relationship between self-medication and several protection and predisposing factors, a larger number of healthcare students (56.5%) was included, as was also the case with the study by Klemenc-Ketis et al. [16
Several aspects influence self-medication, such as education, family, advertising, legislation, having previous experience with a symptom or disease, importance attributed to a disease, and economic issues [9
]. Also, self-medication, as well as seeking advice from friends and relatives, might be a way of overcoming the obstacles to medical care, or else result from dissatisfaction with medical care [18
]. The World Health Organization (WHO) supports self-medication as a means to reduce costs for the healthcare system and the individual citizens. However, the WHO stresses that self-medication can only be used in countries that are able to provide adequate healthcare and education, and thus empower citizens to self-medicate responsibly [19
As previously reported [10
], we did not observe any significant differences in prevalence of self-medication by healthcare and non-healthcare students. This contrasts with the results obtained by Sawalha [11
] and Sapkota et al. [21
], who showed low prevalence of self-medication among healthcare students.
Being a first or last-year student did not affect the outcome. We hypothesized that after a few years in university, students would be more aware of the risks of self-medication, as reported by Sapkota et al. [21
]. In that study, being a last-year student was a protection factor for self-medication.
According to Gama et al.
], the structure of questionnaires may affect prevalence estimates. Those authors found that longer questionnaires, including more questions, with specific indications and pharmacological groups resulted in higher prevalence of self-reported self-medication, whereas a shorter questionnaire with open questions resulted in a lower prevalence of self-reported self-medication in the same population. The fact that we employed a long questionnaire, with 62 questions, could explain the higher prevalence of self-reported self-medication we observed. Concerning the demographic and socioeconomic profile, the present sample is similar to those of other studies on self-medication among university students [8
]. Previous results regarding the influence of factors such as sex, age, and socioeconomic status on self-medication are controversial [7
In the present study, having children, being male, being employed and having a partner, were significantly associated with self-medication, but the two former factors lost significance after adjustment. Having children and being male were identified as protection factors against self-medication.
In Croatia, Alijinović-Vucić et al. [23
] reported the existence of a home pharmacy in 68.3% of the households surveyed in a study about self-medication in medical students. The fact that 87% of our students also mentioned having a home pharmacy suggests that this factor is a risk factor for self-medication. The home pharmacy was significantly associated with self-medication in the bivariate and multivariate analyses. It might also be associated with the reasons cited for self-medication, of which the first one was “I have already experienced the symptom and know what to take” (57.2%). It may reflect a usual behavior and the repeated use of an old prescription. The storage of medication at home with free access and easy visualization of the products is a risk factor for self-medication [24
]. Receiving advice about self-medication mainly from the family (53.1%) and the reuse of an old prescription (40.4%) contribute to the risk posed by home pharmacies. This suggests easy access to medication and a culturally inherited acceptance of self-medication, as pointed out by Abahussain et al. [7
]. In the present study, additional explanations for self-medication were cited by the students, including “There is no need to see a doctor because of a simple disease” and “Quick relief,” among others. These explanations could also be supported by the existence of a home pharmacy.
As to life style, illicit drug use was found to be a risk factor for self-medication. An association between self-medication and illicit drug use has not been previously reported. Marijuana was the drug most frequently used by students (96%), and was associated with use of other illicit drugs in 32.8% of the cases.
Healthcare students had significantly more knowledge about medication than non-healthcare students. Similar results were obtained by Sawalha [11
]. Medication knowledge was significantly associated with the outcome in both the bivariate and multivariate analyses. The lack of adequate medication knowledge seems to have made the students more cautious, leading to less self-medication. In a study conducted with medical students from Bahrein, those who had more knowledge about medication reported self-medicating more [9
As to the type of medication used, as mentioned in the literature [7
], acetaminophen was the most common active ingredient. This could be justified by the reasons cited for self-medication, including headache, colds, and sore throat, as reported by other investigators [8
]. Interestingly, for specific conditions such as menstrual cramps, nausea, and vomit, the percentage of healthcare students self-medicating was significantly higher, as also observed by Sawalha [11
] using multiple logistic regression.
Most students who answered the questionnaire (81.9%) declared having discouraged friends and relatives from self-medicating. In the comparison between areas, we observed a significantly higher percentage of reported discouragement among healthcare students. This result contradicts the high prevalence of self-medication in this sample. Another study conducted with medical students shows that self-medication was used by most the students; those authors suggest that healthcare students feel more confident self-prescribing [9
The present study has limitations that need to be addressed. First of all, because the sample refers to a specific university and a specific geographic area, it cannot be generalized. Also, chronic diseases, which are more often associated with self-medication, were not assessed. Nevertheless, we believe that the present results will be useful for other investigators as well as healthcare programs designing interventions relating to self-medication. Knowledge of the advantages, disadvantages and consequences of self-medication is important to raise awareness about the seriousness of prescribing. The behavior of students may influence his or her attitude towards the patient in professional practice.