College of Pharmacy, Howard University, 2300 4
Former Affiliation, Unity Point Health-St. Luke’s Hospital, 2720 Stone Park Boulevard, Sioux City, IA 51104 (Retired), Current Address: 1409 Jackson Rd, Silver Spring, MD 20904, USAUnited States
Also available as PDF (figures and tables appear in the PDF).
Purpose The objective of the survey is to evaluate the knowledge and opinion of Howard University College of Pharmacy first-year pro-fessional pharmacy students regarding the use of the sleep medication melatonin. Methods A survey questionnaire comprising 20 questions on melatonin was developed and response obtained from 42 students. Demo-graphic data and responses were gathered and evaluated. Descriptive statistics were used to analyze the responses. Results Most of the respondents had adequate knowledge about melatonin ranging from 54.8 to 92.6%. There was no statistical differ-ence when responses were analyzed based on the gender of the survey participants. To specific questions whether melatonin is associated with weight gain, can help with signs and symptoms of cancer, recommend sleep hygiene instead of melatonin, and whether melatonin is addictive, the majority (57.1%, 42.9%, 64.3% and 69.0%, respectively) provided the wrong responses. Conclusion More than half of the respondents had good levels of knowledge and opinion about melatonin, with the highest being 92.6% to a specific question on the use of melatonin. The students were only deficient in areas of melatonin being associated with weight gain, melatonin helping with signs and symptoms of cancer, recommending sleep hygiene, and melatonin causing addiction. There are significant differences between the age groups and whether those who worth healthcare area, or not in their response to some of the survey questions.
Keywords: Melatonin; Dietary supplement; Insomnia; Weight gain; Cancer; Light
A survey questionnaire comprising 20 questions on melatonin was developed and response obtained from 42 students. Demo-
graphic data and responses were gathered and evaluated. Descriptive statistics were used to analyze the responses.
Most of the respondents had adequate knowledge about melatonin ranging from 54.8 to 92.6%. There was no statistical differ-
ence when responses were analyzed based on the gender of the
associated with weight gain, can help with signs and symptoms of cancer, recommend sleep hygiene instead of melatonin, and
whether melatonin is addictive, the majority (57.1%, 42.9%, 64.3% and 69.0%, respectively) provided the wrong responses.
More than half of the respondents had good levels of knowledge and opinion about melatonin, with the highest being 92.6% to
a specific question on the use of melatonin. The students were only deficient in areas of melatonin being associated with weight
gain, melatonin helping with signs and symptoms of cancer, recommending sleep hygiene, and melatonin causing addiction.
There are significant differences between the age groups and whether those who worth healthcare area, or not in their response
to some of the survey questions.
Melatonin; Dietary supplement; Insomnia; Weight gain; Cancer; Light.
elatonin, an endogenous hormone produced by the body, is
mainly responsible for regulating sleep cycles. Most exog- M enous melatonin is synthetically produced. It may also be produced
from animal pineal gland. Darkness is thought to stimulate melato-
nin release, whereas light suppresses it. Melatonin is used to treat
insomnia, autism spectrum disorders (ASD), and to prevent jet lag.
Its adverse effects range from nausea, vomiting, headache, tachy-
cardia, irritability, dysthymia, worsening of depressive symptoms
1,2 to morning grogginess. Unlike most other sleep medications
such as benzodiazepines, melatonin does not cause withdrawal or
dependence symptoms. Evidence is conflicting on its use for oc-
1,2 casional insomnia. Associations such as the American Academy
cc Copyright 2022 by Hailemeskel B. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), survey participants. To specific questions whether melatonin is
of Sleep Medicine (AASM) and the American College of Phar-
1 macy state that sufficient evidence is lacking to support the use of
melatonin in the general population for chronic insomnia. A large
Cochrane review of 9 trials reported night shift workers who took
2 3 to 6 mg of melatonin slept 24-minutes longer during daytime.
Side effects did not differ from placebo.4 There is no direct asso-
ciation between melatonin use and weight gain, although low-level
of melatonin in the body may contribute to weight gain.5 Lack of
adequate sleep or inconsistent sleep patterns has been linked to
a higher body mass index (BMI) and thus precipitating obesity.6
The literature on melatonin has also been reviewed extensively as
a possible candidate for adjuvant therapy in various cancer types,
including breast cancer.7
Prior to recommending melatonin, good sleep hygiene
has been encouraged to correct the causes of insomnia.1 For most
cases, a dose of 0.3 mg at bed time is sufficient to produce higher
than normal physiological concentrations.2 Melatonin tablets and/
or capsules ranging from 0.2 mg to 20 mg are available. Smith et al8
reported the use of 1 mg to 10 mg dose for short-term manage-
ment of insomnia in a hospital inpatient setting. Although the au-
thors noted lack of adequate documentation by providers on sleep
quality, they reported adverse events such as daytime drowsiness,
headache, and deliriumin only 6 out of 200 patients.
The current study was initiated to learn about the knowl-
edge level and opinion of first year pharmacy students at Howard
University (HU), Washington, D.C., USA regarding melatonin and
its use. Compiling and analyzing the survey data is thought to help
identify the strengths and needs of students in this area of knowl-
edge.
A total of 45 professional first year pharmacy students at How-
ard University College of Pharmacy for the year 2021 participated
in the survey. Forty-two (response rate of 93.3%) completed the
questionnaire. The following demographic data were gathered:
age, gender, education, residence, work-related items, and annual
income. Twenty items were included in the questionnaire to collect
the opinion and the knowledge level of the study enrollees about
melatonin. A 4-point Likert scale (1=strongly agree; 2=agree;
3=disagree; 4=strongly disagree) was used to rate responses. The
strongly agree and agree responses were aggregated as “agree”
or “yes” responses, while the disagree and strongly disagree were
lumped together as “disagree” or “no”. Mean Likert scores were
calculated to place the levels of the responses. A two-tailed Fisher’s
exact test was used to determine p values by comparing gender-
based responses. The study was approved by Howard University
institutional review board.
A total of 42 students (15 male, 27 female) participated in the
survey. About 41% are in the age range 24-26-years. Thirty-four
of the participants (81%) had a bachelor’s degree before joining
pharmacy school. In addition to attending pharmacy education at
HU College of Pharmacy, most of the respondents (n=33, 78.6%)
Figure 1. Gender Breakdown of Survey Respondents
Table 1. Demographic Characteristics of Respondents
21-23 14 (33.3) 19.1-47.6
24-26 17 (40.5) 25.6-55.3
27-29 5 (11.9) 2.1-21.7
>29 6 (14.3) 3.7-24.9
Male 15 (35.7) 21.2-50.2
Female 27 (64.3) 49.8-78.8
Some college 1 (2.4) 0.0-7.0
Associate Degree 1 (2.4) 0.0-7.0
BA/BSc 34 (81) 69.1-92.8
MSc 4 (9.5) 2.7-22.6
PhD/Professional 2 (4.8) 0.0-11.2
Washington, D.C. 4 (9.5) 0.7-18.4
Maryland 13 (31) 16.9-44.9
Virginia 7 (16.7) 5.4-27.9
Other States 18 (42.9) 27.9-57.2
Yes 9 (21.4) 9.0-33.8
No 33 (78.6) 66.2-90.9
Never worked 2 (4.8) 0.0-11.2
Short-term 3 (7.1) 0.0-14.9
Part-time 16 (38.1) 23.4-52.8
Full-time 21 (50) 34.9-65.1
Pharmacy related 16 (38.1) 23.4-52.8
Other healthcare 12 (28.6) 14.9-42.2
Non-health related 13 (31) 16.9-44.9
Not applicable 1 (2.4) 0.0-7.0
< USD 10,000 13 (31) 16.9-44.9
10,001-20,000 7 (16.7) 5.4-27.9
20,001-30,000 6 (14.3) 3.7-24.9
30,001-40,000 5 (11.9) 2.1-21.7
>40,000 11 (26.2) 12-9-39.5
None 1 (2.4) 0.0-7.0
1-2 19 (45.2) 30.2-60.3
3-4 11 (26.2) 12.9-39.5
>4 11 (26.2) 12.9-39.6
* CI=Confidence Interval; normal approximations of binomial exact values.
held jobs at the time of this survey. Many (n=18, 42.9%) of the
students’ home states are outside of the Washington DC-Mary-
land-Virginia (DMV) metro area, while the rest are spread in these
areas (Table 1 and Chart 1).
Thirty-nine respondents (92.6%) agreed melatonin is
taken by consumers for sleep; 35 (83.3%) agreed melatonin is a
dietary supplement used for insomnia. Twenty-seven participants
(64.3%) responded that melatonin also decreases depression. Thir-
ty-two students (76.2%) agreed that melatonin causes headache,
dizziness, sleepiness, and nausea as side effects. In an answer to a
specific question whether melatonin is associated with weight gain,
24 (57.1%) agreed it is associated (Table 2).
Table 2. Response Pattern of Survey Respondents (n=42) Based on Gender
Melatonin is mostly taken by people who
want to sleep 21 18
Melatonin is used as a dietary supplement
for insomnia 25 10
Melatonin when taken as a sleep aid is
known to decrease depression in patients 13 14
Melatonin causes headache, dizziness,
sleepiness, and nausea as side effects 12 20
Melatonin is associated with weight gain
Abbreviation: SA=Strongly agree; A=Agree; DA=Disagree; SDA=Strongly disagree;TA=Total agree;TD=Total disagree; M=Male;
F=Female; LK=Likert score; m±SD=mean±standard deviation.
*p values ≥ are considered not significant.
Table 3. Additional Questionnaire Items Used in the Survey 1. I feel confident in recommending melatonin to patients who have trouble sleeping. 2. I believe getting used to melatonin as a sleep aid may lead to the development of tolerance and may not be a good idea. 3. I believe melatonin, although a natural product, may cause problems if taken long term. 4. I believe in sleep hygiene and do not recommend melatonin or any other sleep aid. 5. I believe melatonin is a natural substance and can cause adverse effects if taken as a sleep aid.
6. Do you agree that melatonin can help alleviate signs and symptoms of breast cancer?
7. Do you agree that light can block the mechanism of melatonin when used in the management of breast cancer?
8. Do you agree that the body naturally produces melatonin?
9. Besides its use in breast cancer patients, melatonin improves jet lag symptoms.
10. Melatonin, since it is produced in the body, should generally be a safe medication
11. I believe that melatonin should have no known side effects since our body makes it.
12. Natural substances such as melatonin should be safe in children.
13. I believe taking additional supplements of melatonin may decrease the body’s ability to crat more.
14. Although natural, melatonin may have an addictive property if it is taken for a long time.
15. I do not mind purchasing melatonin over the counter for myself or my family if the need arises.
In response to a further 15 questionnaire items on mela-
tonin (Table 3), the majority agreed to each statement or ques-
tion, except for four statements: to melatonin being associated
with weight gain (n=18; 42.9% disagreeing vs n=24; 57.1% agree-
ing); the belief in sleep hygiene and not recommending melatonin
(n=15; 35.7% agreeing vs n= 27; 64.3 disagreeing); to melatonin
helping with signs and symptoms of cancer (n=18; 42.9% agreeing
M 6 8 1 0 14 1
F 1510 20 252
1.57±0.63 1.000 30 393
(50) (42.9) (7.1) (0.0) (92.9) (7.1)
M 9 2 4 0 11 4
F 168 21 243
1.60±0.83 0.2252 61 35 7
(59.5) (23.8) (14.3) (2.4) (83.3) (16.7)
M 7 1 5 2 8 7
F 613 71 198
2.12±0.94 0.3252 12 3 27 15
(31.0) (33.3) (28.6) (7.1) (64.3) (59.5)
M 4 6 5 0 10 5
F 814 41 225
1.98±0.78 0.4508 9 1 32 10
(28.6) (47.6) (21.4) (2.4) (76.2) (23.8)
M 2 8 5 0 10 5
F 59 121 1413
1.57±0.63 1.000 7 17 17 1 24 18
(16.7) (40.5) (40.5) (2.4) (57.1) (52.9)
vs n=24; 57.1% disagreeing) and to melatonin having no known
side effects, since the body makes it (n=16; 38.1% disagreeing vs
n=26; 61.9% agreeing) (Table 4). Analysis of the survey data re-
vealed no statistical differences between male and female respon-
dents across all 20 questionnaire items (p>0.05) (Tables 2 and 4).
Various reports have appeared in the literature evaluating drug
knowledge of junior pharmacy students regarding selection of
generic medicines,9 and others in their later years of training on
topics, such as pharmacovigilance and drug-drug interactions.
However, studies are lacking that evaluate in-coming first-year
pharmacy students on their knowledge. To gauge the knowledge
level of pharmacy students early on helps to identify the deficits
in various knowledge areas. Thus, our survey took melatonin as an
example to test the knowledge of students through administration
of a survey questionnaire.
Nearly 80% of the survey items (16 out of 20) were an-
swered correctly by more than 50% of the surveyed students for
each item). There is no adequate evidence that melatonin is associ-
ated with weight gain; the reverse may be true considering melato-
nin indirectly my help with weight reduction if it is associated with
lack of sleep.5 However, the majority respondents (n=24; 57.1%)
agreed melatonin is associated with weight gain). Most sleep medi-
Table 4. Gender Based Response Pattern to Items 1-15 from Table 3
* Agree (strongly agree+agree); disagree (disagree+strongly
cations such as benzodiazepines cause some level of addiction,3
so it is possible that the students had the impression that mela-
tonin, as a sleep aid, may have similar addictive properties. Stud-
ies indicate that melatonin can help with signs and symptoms of
cancer types such as breast cancer, prostate cancer, gastric cancer,
and colorectal cancer.7 Less than half of the respondents (n=18;
42.9%) agreed with the statement This study also found out a simi-
lar response pattern between the genders. Analysis of the survey
data revealed no statistical differences between male and female
respondents across all 20 questionnaire items (p>0.05).
10,11 Fisher’s Exact test was done to determine if there were
any significant differences among the various groups in their re-
sponse to the questionnaires. We found that age of the participants
matters in their belief that melatonin, although a natural substance,
can cause adverse effects when it is taken as a sleep aid (26-years or
younger vs. older than 26; p=-0.05). We also found a significant dif-
ference in participants’ response, whether melatonin is associated
with headache, dizziness, sleepiness, and nausea as a side effect,
when the responses were evaluated on the basis of the type of
work the participants had (those who work at healthcare related
jobs vs. those in non-health related jobs: p=0.0085). The partici-
pants who are confident in their knowledge significantly rated their
agreement with melatonin as a naturally produced hormone com-
pared to their counterparts (p=0.0281).
Agree (A)* 35(83.3) 11(26.2) 24(57.1) 1.90±0.79 0.2252 Disagree (DA)* 7(16.6) 4(9.5) 3(7.1)
A 33(78.6) 10(23.8) 23(54.8) 1.93±0.89 0.2417 DA 9(21.4) 5(11.9) 4(9.5)
A 33(78.6) 12(28.6) 21(50) 2.00±0.80 1.0000 DA 9(21.4) 3(7.1) 6(14.3)
A 15(35.7) 4(9.5) 11(26.2) 2.69±0.78 0.5055 DA 27(64.3) 11(26.2) 16(38.1)
A 30(71.4) 12(28.6) 18(42.8) 2.12±0.80 0.4848 DA 12(28.6) 3(7.1) 9(21.4)
A 18(42.9) 6(14.3) 12(28.6) 2.52±0.97 0.7674 DA 15(57.1) 9(21.4) 15(35.7)
A 29(69.0) 11(26.2) 18(42.8) 2.14±0.87 0.7387 DA 13(31.0) 4(9.5) 9(21.4)
A 32(76.2) 10(23.8) 22(52.4) 1.95±0.85 0.4508 DA 11(33.8) 5(11.9) 5(11.9)
A 23(54.8) 7(16.7) 18(42.9) 2.38±0.88 0.5249 DA 19(45.2) 8(19.0) 11(26.2)
A 27(64.3) 11(26.2) 16(38.1) 2.21±0.92 0.5055 DA 15(35.7) 4(9.5) 11(26.2)
A 16(38.1) 4(9.5) 12(28.6) 2.67±1.00 0.3302 DA 26(61.9) 11(26.2) 15(35.7)
A 26(61.9) 9(21.4) 17(40.5) 2.26±0.91 1.0000 DA 16(38.1) 6(14.3) 10 (23.8)
A 25(59.6) 9(21.4) 16(38.1) 2.21±0.81 1.0000 DA 17(40.4) 6(14.3) 11(26.2)
A 29(69.0) 8(19.0) 21(50.0) 2.07±0.92 0.1635 DA 13(31.0) 7(16.7) 6(14.3)
A 36(85.7) 13(30.9) 23(54.8) 1.86±0.84 1.0000 DA 6(14.3) 2(4.8) 4(9.5)
disagree), LKS=Likert Score; p≥0.05 are not significant
A survey carried out among the HU College of Pharmacy first-
year professional pharmacy students revealed that more than half
of the respondents had good levels of knowledge and opinion
about melatonin, with the highest being 92.6% to a specific ques-
tion on the use of melatonin. The students were deficient only in
areas of melatonin being associated with weight gain, melatonin
helping with signs and symptoms of cancer, recommending sleep
hygiene, and melatonin causing addiction. There were significant
differences between the age groups and among those who work in
the healthcare area versus in other areas in their response to some
of the survey questions.
The authors declare that they have no conflicts of interest.