Knowledge and Opinion of First-Year Pharmacy Students About Herbal/Dietary Supplements

Background: Herbal and dietary supplements have been the cornerstone of historic pharmaceutical therapy. Cultural attributes and holistic or plant-based modifications have restructured the method in which we supplement our diets. The fact that herbal and dietary supplements are underrepresented in research, downplays the miraculous progression in medicine by way of our natural environment. For this reason, underrepresented groups in research, such as minorities, have undefined knowledge of herbal and dietary supplemental benefits, promoting reliance on prescription medications to self-treat and recommend. Objective : The objectives of this study are to asses first professional year pharmacy school students, of their knowledge, familiarity, and opinions of dietary and herbal supplements; to explore if participants support more dietary and herbal supplement medical research to incorporate them as first-line therapy; and to learn if students on a budget, would self-medicate more often with herbal supplements for minor illnesses due to proven results. Methods : Electronic surveys with six questions, were given to 44 first year pharmacy students at a college of pharmacy. The first 2 questions were specific to the quality of medical research toward herbal and dietary supplements and a providers’ ability to prescribe said supplements for stress-related issues. The last 4 questions focused on personal approach to finances and preference of prescription medication over herbal supplements. Results : Most students agreed (88.7%) that there are not enough medical research supports the quality of herbal and dietary supplements. On the other hand, most students agreed (80.6%) that providers should be able to prescribe medicinal marijuana as a first-line treatment for anxiety and stress-related


Introduction
The purpose of this study is to evaluate the knowledge and opinions of first-year pharmacy students on herbal and dietary supplements. Dietary supplements include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet. Herbal supplements are a type of dietary supplement regulated by the Food and Drug Administration (FDA) [1]. Even though herbal supplements are readily available both in stores and on the internet, pharmacists do not routinely recommend herbal supplements as a first-line defense for temporary relief of symptoms instead of OTC prescription medications. A study done in 2017 to compare dietary supplement use between 179 student pharmacists and the general population, and assess knowledge, attitudes toward use, and dietary supplement effectiveness; and to explore how student pharmacists view their education on dietary supplements found that 52% had used at least one dietary supplement in their lifetime versus 25% in the general population [2]. Students perceived supplement label information as unhelpful, research into supplements inadequate, and supplements non-essential to health. Students thought supplement knowledge was important, but their education was inadequate. In another study published on Complementary Therapies in Medicine, positive attitudes, and willingness to recommend dietary supplements to patients were evaluated among 506 students from Pharmacy, Dental, and Medical schools from a single university [2].
Pharmacy students scored highest in both areas [2]. As with over the counter (OTC) and prescription medications, pharmacy students should have a firm working knowledge of common dietary and herbal supplements. The study revealed that the knowledge disadvantage impacted the willingness to recommend rather than personal usage of dietary supplements [2]. The study did not further evaluate the pharmacy students' opinion on replacing prescription medication with dietary supplements for minor illnesses even if there were better research. A similar study done with 355 pharmacy students, 168 were reposted to using at least one dietary supplement, mainly to treat health problems [3]. A review of studies among U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic reported they were not possible to draw a conclusion with respect to pharmacists' general attitudes toward dietary supplements. However, they reported that approximately equal numbers of pharmacists report positive as well as negative attitudes about the safety and efficacy of dietary supplements. They for a wide range of reasons including to compensate for diets, medical conditions, or eating habits that limit the intake of essential vitamins and nutrients; and postmenopausal women often times using dietary/herbal supplements to regulate estrogen levels [4]. Furthermore, according to a study done by Lakhan, herbal supplementation is an effective treatment option for treating anxiety without the risk of serious adverse effect [3]. Seeing that there is an array of uses for herbal supplements, the goal of this study is to find out whether pharmacy students would self-medicate more often with herbal supplements for minor illnesses if there were better research to prove results, and also to identify their opinion on the overall use of dietary supplements. The results of this study will help improve the education and training of pharmacy students on the knowledge of herbal/dietary supplements.

Methods
A survey was distributed to 44 first-year professional pharmacy students. The survey consisted of six questions plus 8 demographics related questions. The first two questions focused on the quality of medical research and a provider's ability to prescribe herbal supplements for stress-related issues. The last four questions revealed the cognizance of a "students' finances and overall deliberation prior to selecting an herbal or dietary supplement over a prescription [4]. The survey questions were constructed by the research team using Qualtrics and distributed via email to the class of 2024. This study was conducted as a part of a drug informatics course, which is a mandatory course for firstyear pharmacy students. The survey was sent to 44 students and 44 students responded (100 percent response rate). The data was rated on a 4-point Likert Scale (strongly agree to strongly disagree).
A descriptive analysis was completed using SPSS software.

Results
A total of 44 first-year pharmacy students completed Of the demographic survey questions, pharmacy students were asked about information regarding their highest level of education prior to pharmacy school enrollment. Most first-year pharmacy students at Howard University completed a 4-year degree program prior to pharmacy school (59.09%). Other students completed some college (27.27%), few students had a 2-year college degree (4.55%), and 9.09% of students completed a professional degree before entering pharmacy school. Prior to admission into the Howard University College of Pharmacy program, most students had been employed (95.45%) as opposed to unemployed (4.55%).
The annual income of the pharmacy students who had prior employment range from less than $10,000 (39.53%) to greater than $49,999 (11.63%) with the rest in between [5]. Of the pharmacy students who had previous work experience, most of the students had pharmacy-related work experience (62.79%).
The other previously employed pharmacy students either had non-pharmacy but healthcare-related work experience (20.93%) or non-pharmacy or non-healthcare-related work experience (16.28%). The years of work experience among previously employed students ranged from less than 1 year (16.28%) to greater than 5 years of employment (25.58%) ( Table 1). In addition to demographic-based survey questions, the survey participants also answered a total of six knowledge-based questions about herbal and dietary supplements. More than half of the pharmacy students surveyed somewhat agree or strongly agree (59.09%) that enough medical research has been done to prove the efficacy and quality of herbal supplements. In addition, the majority of students strongly agree or somewhat agree (79.55%) that providers should

Discussion
The data collected from the study survey questions has revealed  Our study suggests that their knowledge does impact their opinions and willingness to both personal use and recommendations of herbal and dietary supplements to their future patients.