HRSA Poison Control Program 2006 Grantee Meeting Public Education in Poisoning Prevention Angela Mic - PowerPoint PPT Presentation

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HRSA Poison Control Program 2006 Grantee Meeting Public Education in Poisoning Prevention Angela Mic

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Title: HRSA Poison Control Program 2006 Grantee Meeting Public Education in Poisoning Prevention Angela Mic


1
HRSA Poison Control Program 2006 Grantee
MeetingPublic Education in Poisoning
PreventionAngela Mickalide, Ph.D.,
CHESDirector of Education and OutreachFebruary
9, 2006
2
Home Safety Research
Conducted the largest and most comprehensive
study of injuries at home the State of Home
Safety in America
  • Each year, preventable injuries in the home
  • Result in nearly 20,000 deaths
  • Cause nearly 21 million medical visits
  • Are the fifth leading cause of death overall
  • Are 2.5 times more likely to cause injury than
    car crashes
  • Cost our nation up to 380 billion
  • Cost employers up to 38 billion
  • Commissioned by the Home Safety Council and
    conducted by the
  • University of North Carolinas Injury and
    Prevention Research
  • Center

3
Home Safety Research
State of Home Safety in America
  • Leading causes of home injury death
  • Falls
  • Poisoning
  • Fires / Burns
  • Choking
  • Drowning
  • Unintentional poisonings are the second leading
    cause of unintentional home injury death in the
    United States, accounting for more than
    one-fourth of all home injury deaths. An average
    of 4,833 people die each year of an unintentional
    poisoning that occurs at home.

4
Location of Fatal Poisonings
  • More than half (50.6) of fatal poisonings
    occur in the home. Approximately
  • one-third of poisoning deaths (33.6) cannot be
    linked to a location.

5
Nonfatal Poisonings
  • Poisonings are the fifth leading cause of
    nonfatal home injuries and the ninth leading
    cause of home injuries resulting in an emergency
    department visit. Nonfatal rates are highest
    among children less than five years of age.

6
Poisoning-Related Morbidity and Mortality Among
Adults
  • The majority of people who die from unintentional
    poisoning are young and middle age adults with
    the death rate for males three times that for
    females.
  • Overall, death rates are highest for adults
    between 40 and 49 years of age.
  • Most unintentional poisoning deaths in the home
    are due to heroin (23.8), appetite depressants
    (21.9), and local anesthetics like cocaine
    (12.3). Other major sources of unintentional
    poisoning deaths are from amphetamines, caffeine,
    antidepressants,
  • alcohol, and motor vehicle exhaust gas.

7
Poisoning-Related Morbidity and Mortality Among
Children
  • In 2002, more than 1.2 million unintentional
    poisonings among children ages 5 and under were
    reported to U.S. Poison Control Centers.
  • Unlike poisoning deaths where adults have the
    highest rates, nonfatal poisoning rates are
    highest among children younger than 5.
  • Children are most often poisoned by household and
    cleaning products, personal care and beauty
    products, medicines (iron containing medicines
    are among the most dangerous), vitamins, plants,
    lead and carbon monoxide.
  • On average, every 7 seconds a child age 5 and
    under arrives
  • at an emergency room due to a suspected
    poisoning.

8
Where and When Poisoning-Related Deaths and
Injuries Occur
  • Approximately 90 of all poison exposures occur
    in the home.
  • Calls to U.S. Poison Control Centers peak between
    4 pm and 10 pm and during warmer months.
  • Most child poisonings occur when parents
  • are not actively supervising children.

9
Populations at Disproportionate Risk for
Poisoning
  • African American children ages 14 and under have
    a poisoning death rate more than one and a half
    times that of white children.
  • Children ages 1 to 5 are more likely to have
    elevated blood lead levels if they are poor, or
    live in older housing. Children ages 1 to 5
    enrolled in Medicaid have a prevalence of
    elevated blood lead levels three
  • times greater than children not enrolled in
  • Medicaid.

10
Cost and Cost-effectiveness Data
  • For every dollar spent on poison control services
    in 1992, an estimated 7 was saved in medical
    care payments by reducing the number of medically
    treated poisonings.
  • The savings per poisoning call were 175.

11
Cost of Poisoning Injuries
From 1997-2001 poisonings were the third highest
cause of medical care costs from unintentional
home injuries, with an average annual cost of 18
billion.
12
Burden to Employers
  • Home injuries cost employers 38 billion
    annually
  • and poisonings contribute to this economic toll.

13
Implications for Health Education in Poisoning
Prevention
  • Adoption of Haddons matrix to develop
    interventions
  • Multifaceted approaches using Es of injury
    prevention
  • Differentiation of primary and secondary
    prevention messages
  • Addressing risk perceptions and misperceptions
  • Attention to literacy levels of adult audiences
  • Framing messages to meet unique learning styles

14
Haddons Matrix
15
Multifaceted Approach to Injury Prevention the
Es
  • Education
  • Environmental/Engineering Modifications
  • Enactment/Enforcement
  • Economic Incentives
  • Empowerment
  • Evaluation

16
Education
  • Target audiences children, parents, caregivers,
  • health care providers, the media, policymakers
  • Essential to implement educational campaigns
    based on data (children and nonfatal poisonings
    versus adults and fatal poisonings)
  • Examples
  • National Poison Prevention Week (children)
  • Poison Help Campaign (all populations)

17
Environmental/Engineering Modifications
  • Physical environment changes
  • Product labeling
  • Poor storage facilities (e.g., garages)
  • Workplace safety equipment
  • Engineering modifications
  • Blister packaging for single dosing
  • Child-resistant packaging (Poison Prevention
  • Packaging Act of 1970 helped to prevent 460
  • deaths among children under age 5 from 1974
  • through 1992, a 45 reduction in mortality)

18
Enactment/Enforcement
  • Passage, strengthening and enforcement of laws
  • Issuance and enforcement of regulations
  • Development of voluntary standards and guidelines
  • Safety cap regulations
  • Packing and labeling of baby aspirin (led
  • to a 34 reduction in the child death rate)

19
Economic Incentives
  • Working with manufacturers to improve safety
    devices and packaging without increasing consumer
    costs
  • Distribution of safety products at low cost or no
    cost to low-income families
  • Cabinet latches
  • Caps for bottles containing paraffin oil in
  • South Africa

20
Empowerment
  • Activism at the community level to increase
    funding for poison control centers and public
    health agencies
  • Formation of advisory panels and injury
    prevention coalitions to focus on poisoning
    efforts
  • HRSAs Poison Stakeholders Group
  • Institute of Medicine Committee on Poison
  • Prevention and Control

21
Evaluation
  • Research on changes in poison-related knowledge,
    attitudes and behaviors through focus groups and
    polls
  • Evaluation of programmatic and product
    effectiveness through data collection and
    surveillance
  • Toxic Exposure Surveillance System (TESS)
  • National Poison Control Toll-free Hotline
  • (1-800-222-1222)

22
Differentiating Primary and Secondary Prevention
Messages
  • Primary Prevention avoiding the occurrence of a
    poisoning exposure
  • Advising safe storage of household cleaners
    especially in the homes of young children
  • Use of gloves, goggles and protective clothing
    among employees exposed to hazards substances
  • Avoiding medication errors among all age groups
    (Targets new Clear RX program)

23
Accolades for Target
  • Commendation Awards for Product Safety Innovation
    at Salute to Home Safety Awards Dinner, June 8,
    2006, Washington, D.C.
  • The Home Safety Councils Product Innovation for
    Consumer Safety Award is given to manufacturers
    for their contribution in helping consumers
    maintain a safe home environment by reducing home
    injury risks through innovation product design
    and development.

24
Differentiating Primary and Secondary Prevention
Messages
  • Secondary prevention reducing the effect of a
    poisoning exposure through improved access to
    poison control services
  • National Toll-free Hotline availability and
    access to immediate and highly skilled medical
    management
  • Emergency Medical Services and Emergency
    Department proximity
  • Storage of syrup of ipecac and activated
  • charcoal at home (controversial issue)

25
Poisoning Prevention Perceptionsand
Misperceptions
  • Home Safety Council conducted survey of 1,000
    parents to determine knowledge, attitudes, and
    self-reported behaviors related to injury
    prevention
  • 92 reported feeling safest in their homes
  • 60 admitted that there were actions they
  • could take to make their homes safer

26
Primary Reasons for Not Taking Action to Make
Homes Safer
  • Do not know what actions to take 32
  • Do not have enough time 24
  • Home improvements are too expensive 13
  • Have more important safety concerns 9

27
Families Are at Risk for Poisoning
  • More than 80 of parents in homes with young
    children report leaving medicines in unsecured
    locations
  • More than 50 report leaving dangerous household
    chemicals in unsecured locations
  • Only 28 report that the Poison Control
  • Hotline number is posted next to all phones

28
Misplaced Concerns
29
The Importance of Health Literacy
  • Health literacy is the degree to which
    individuals can obtain, process, and understand
    the basic health information and services they
    need to make appropriate health decisions.
  • Health literacy influences poisoning prevention
  • Public education brochures, videos, posters
  • Medication labels and instructions
  • Household cleaner use and misuse

30
National Assessment of Adult Literacy (NAAL)
  • Conducted by U.S. Department of Education,
    National Center for Educational Statistics
  • Released December 2005
  • Interviewed 19,714 participants ages 16 or
  • older in homes and prisons across the
  • United States

31
Definitions of Literacy
  • Three types of literacy
  • Prose literacy continuous text arranged in
    sentences and paragraphs (e.g., news stories,
    brochures)
  • Document literacy non-continuous text (e.g.,
    job applications, payroll forms, bus schedules,
    maps, tables, food and drug labels)
  • Quantitative literacy identifying and
  • performing computations (e.g., order
  • forms, checkbooks interest on loans)

32
Literacy Levels
  • Below basicranges from being non-literate in
    English to being able to do only the most simple
    and concrete tasks such as signing a form, adding
    the amounts on a bank deposit slip, or reading a
    short text to find out what a patent is allowed
    to drink before a medical test.
  • Basicability to perform simple and everyday
    literacy activities such as using a TV guide to
    find out what programs are on at a specific time,
    comparing the ticket prices for two events,
    searching a pamphlet for prospective jurors to
    find out how people were selected for the jury
    pool.
  • Intermediateability to perform moderately
    challenging literacy activities such as
    identifying a specific location on a map,
    consulting reference materials to determine which
    foods contain a particular vitamin, or
    calculating the total cost of ordering specific
    office supplies from a catalog.
  • Proficientability to perform more complex and
    challenging literacy
  • activities such as comparing viewpoints in two
    editorials interpreting a
  • table about blood pressure, age, and physical
    activity and computing
  • and comparing the cost per ounce of food items.

33
Key Findings from NAAL
  • 14 of the population (30 million adults)
    function at the lowest or Below Basic level on
    prose tasks
  • 29 of the population (63 million adults)
    function at the second or Basic level on prose
    tasks
  • 55 of the population (118 million adults)
  • have only Basic or Below Basic
  • quantitative skills

34
Why Does Health Literacy Matter?
  • Studies that have investigated the issue report
    that limited literacy skills are a stronger
    predictor of an individual's health status than
    age, income, employment status, education level,
    and racial or ethnic group.
  • Partnership for Clear Health Communications

35
Institute of Medicine Committee on Poison
Prevention and Control
  • 14-member committee (including your speaker
    today!)
  • Met face-to-face 6 times over an 18 month span in
    2003 -2004
  • Final book entitled, Forging a Poison Prevention
    and Control System
  • Guiding premise
  • Alle Ding sind Gift und nichts ohne Gift
    alein die Dosis macht das ein Ding kein Gift
    ist All things are poison and not without
    poison only the dose makes a thing not a
    poison Paracelsus (14931541)

36
Committee Charge
  • The Institute of Medicine was asked by the
    Maternal and Child Health Bureau of the Health
    Resources and Services Administration to assist
    in developing a more systematic approach to
    understanding, stabilizing, and providing
    long-term support for poison prevention and
    control services. Within this context the
    Committee was asked to examine the future of
    poison prevention and control services in the
    United States.

37
Specific Tasks
  • The specific tasks included in the charge were to
    examine
  • The scope of services provided, including
    consumer telephone consultation, technical
    assistance, and/or hospital consultation for the
    care of patients with life-threatening
    poisonings, and education of the public and
    professionals
  • The coordination of poison control centers with
    other public health, emergency medical, and other
    emergency services
  • The strengths and weaknesses of various
    organizational structures for poison control
    centers and services, including a consideration
    of personnel needs
  • Approaches to providing the financial resources
    for poison prevention and control services
  • Methods for assuring consistent, high-quality
    services, including the certification of centers
    and methods of evaluation and
  • Current and future data systems and surveillance
    needs.

38
Conclusions Prevention and Public Education
  • 1. Public education efforts are necessary but not
    sufficient to accomplish primary and secondary
    prevention of poisonings. Education efforts must
    be integrated with other programs in the broader
    public health system at the state and federal
    levels.
  • 2. Public education efforts should separate
  • primary and secondary messages to
  • better measure effectiveness of each.

39
Conclusions Prevention and Public Education
  • 3. Expand poison educational efforts beyond
    children ages 6 and under, such as other age
    groups, drug and alcohol abusers, and workers in
    certain high-risk occupations.
  • 4. Develop a repository of best practices in
  • public education with attention to target
  • audiences, literacy levels, and evaluation
  • (e.g., PIREs Toolbox for Health Educators
  • in Poison Centers under development).

40
Additional Information about Poisoning Prevention
Education
  • Please contact
  • Angela Mickalide, Ph.D., CHES
  • Director of Education and Outreach
  • Home Safety Council
  • 1250 Eye St., NW, Ste. 1000
  • Washington, DC 20005
  • 202-330-4907
  • angela.mickalide_at_homesafetycouncil.org
  • www.homesafetycouncil.org
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