Title: HRSA Poison Control Program 2006 Grantee Meeting Public Education in Poisoning Prevention Angela Mic
1HRSA Poison Control Program 2006 Grantee
MeetingPublic Education in Poisoning
PreventionAngela Mickalide, Ph.D.,
CHESDirector of Education and OutreachFebruary
9, 2006
2Home 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
3Home 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.
4Location 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.
5Nonfatal 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.
6Poisoning-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.
7Poisoning-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.
8Where 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.
9Populations 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.
10Cost 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.
11Cost 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.
12Burden to Employers
- Home injuries cost employers 38 billion
annually - and poisonings contribute to this economic toll.
13Implications 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
14Haddons Matrix
15Multifaceted Approach to Injury Prevention the
Es
- Education
- Environmental/Engineering Modifications
- Enactment/Enforcement
- Economic Incentives
- Empowerment
- Evaluation
16Education
- 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)
17Environmental/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)
18Enactment/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)
-
19Economic 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
20Empowerment
- 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
21Evaluation
- 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)
-
22Differentiating 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)
23Accolades 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.
24Differentiating 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)
25Poisoning 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
26Primary 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
27Families 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
28Misplaced Concerns
29The 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
30National 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
31Definitions 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)
32Literacy 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.
33Key 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
34Why 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
35Institute 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)
36Committee 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.
37Specific 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.
38Conclusions 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.
39Conclusions 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).
40Additional 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