Chinese pharmacy students' knowledge, attitudes and practice about environmental risks of pharmaceuticals and their source control from the perspective of One Health

Background: Growing concern has raised regarding environmental risks posed by pharmaceuticals, as representative emerging contaminants originating from human and veterinary pharmacotherapies. Given irreplaceable role of source control in the management of emerging contaminants, the active engagement of pharmacy professionals is fundamental to solving environmental issues associated with pharmaceuticals. This study explored the knowledge, attitudes and practice of pharmacy students, future pharmacy professionals, toward environmental risks of pharmaceuticals and their source control from a One Health perspective. Methods: A cross-sectional survey was conducted using an online questionnaire, which was self-developed to assess the knowledge levels, current concerns, practices, and attitudes of undergraduate and graduate pharmacy students at a Chinese university regarding One Health, environmental risks of pharmaceuticals and their source control. Results: A total of 206 valid responses were obtained, with a response rate of 71.8%. Average self-perceived knowledge scores of students on One Health, environmental risks of pharmaceuticals, and their source control ranged from 2.24 to 2.48 on a five-point scale, and actual knowledge score measured via objective assessment was 2.48 out of 10. Only 46.1% respondents reported considering environmental factors during pharmaceutical use, and 18.0% opted to return unused medications to pharmacies or hospitals. Students who integrated environmental considerations into their pharmaceutical use or routinely returned unused drugs to pharmacies/hospitals achieved significantly higher knowledge scores than their counterparts. Average attitude score reached 4.05 on a five-point Likert scale. Pearson's correlation analysis revealed positive correlations between attitude scores and self-perceived knowledge regarding the environmental risks of pharmaceuticals and their source control from the perspective of One Health. Conclusion: Chinese pharmacy students hold positive attitudes toward the environmental risks of pharmaceuticals and their source control from a One Health perspective, but lack relevant knowledge and practical experience, thus highlighting the need to integrate related sustainability content into pharmacy curricula to promote sustainable pharmaceutical and healthcare practices.