A controlled study of the impact of a poison prevention education program on parental awareness and behaviors

An estimated one to two million accidental childhood poisonings occur yearly in the United States, primarily in children under five. The National Clearinghouse for Poison Control Centers (NCPCC) reported over 150,000 poisonings in 1978., 71 percent of which occurred in this age group. In the same year, the Intermountain Regional Poison control Center (IRPCC) confirmed that 75 percent of their total reported accidental poisonings occurred in children under age five. Overall, in most studies or reports where statistics have been gathered, 70 to 95 percent of the reported poisonings have occurred in children under five years of age and of this group, the eighteen to three-year old child accounts for over half. The high incidence of accidental poisonings seen and reported in these children under five is the result of the interaction of several factors, namely: the nature of children, presence of a hazardous environment, and easy accessibility to toxic substances. A child tends to react to his environment impulsively, seeking what he wants when he wants it. A six-month old child will put anything in his mouth, and a one-to-two-year old child will taste almost any product stored within his reach at low levels. By the time the child is two and a half to three years of age, agility and mobility become factors, often giving him access to many cabinets of storage areas in the home. Even to age five, most children are naive to the consequences of a poisoning. As a result, most of these children under five must be protected from the toxic products within their environment and their parents educated about the dangers and consequences of accidental poisonings.

A CONTROLLED STUDY OF THE IMPACT OF A P O I S O N P R E V E N T I O N EDUCATION P R O G R A M ON P A R E N T A L AWARENESS A N D BEHAVIORS by L u c i n d a Jo M a r v i n A project submitted to the faculty of the University of Utah in p a r t i a l fulfillment of the requirements for the degree of D o c t o r of P h a r m a c y C o l l e g e of P h a r m a c y U n i v e r s i t y of Utah August 1981 U N I V E R S I T Y OF U T A H COLLEGE OF PHARMACY F I N A L R E A D I N G APPROVAL TO THE DOCTOR OF PHARMACY C O M M I T T E E OF THE UNIVERSITY OF U T A H C O L L E G E OF P H A R M A C Y : I have read the clinical r e s e a r c h p r o j e c t report of LUCINDA JO M A R V I N in its f i n a l form and have found that 1 ) its f o r m a t , c i t a t i o n s , and b i b l i o g r a p h i c style are c o n sistent and acceptable; 2) its i l l u s t r a t i v e m a t e r i a l s including f i g u r e s , t a b l e s , and charts are in place; and 3 ) the f i n a l m a n u s c r i p t is satisfactory to the S u p e r visory Committee and is ready for submission to the Doctor of P h a r m a c y C o m m i t t e e . C h a i r m a n , Supervisory C o m m i t t e e Approved f ~ Practice Chairman Approved for the D o c t o r of Pharmacy C o m m i t t e e Chairmaft, D o c t o r of Pharmacy C o m m i t t e e UNIVERSITY OF UTAH COLLEGE OF PHARMACY SUPERVISORY COMMITTEE APPROVAL of a clinical research project report submitted by L U C I N D A JO MARVIN W e , the undersigned, have read this clinical research p r o j e c t report and have found it to be of satisfactory quality for a Doctor of Pharmacy D e g r e e . M-MCisf / fl, ffr/ •T Date 7 C h a i r m a n , Supervisory Committee U Date 2-i < L C D£t JMImmm : M e m b e r / Supervisory Committee M(™ber, Supervisor ACKNOWLEDGEMENTS If I could extend In w r i t i n g my gratitude to everyone who has g i v e n me their assistance and support over the past three years I'm afraid it would fill a document longer t h a n this o n e . W h i l e I can say c o m p l e t i o n of this project has b e e n the biggest challenge of my l i f e , my f r i e n d , enemy, instructor, and c o m m i t t e e chairman, J o e V e l t r i would probably attest that getting me through it has b e e n the b i g g e s t c h a l l e n g e of his life. In addition to the rest of m y committee and my c l a s s m a t e s , friends and teachers at the University of U t a h , I owe a v e r y special thanks to all my associates at A d v a n c e d H e a l t h S y s t e m s , Inc. D u r i n g this last year they have given me continual s u p p o r t , e n c o u r a g e m e n t , and a s s i s t a n c e when I needed it. Y o u are a terrific group of people! L a s t , and greatest of a l l , thank you mom and d a d . S o m e h o w you managed to instill in me a desire to continually reach for the top and to never give up along t h e w a y . TABLE OF CONTENTS page Acknowledgements List of Illustrations iv vi,vii Introduction 1 Methods 9 Results __ 17 Discussion 30 Conclusion 36 Appendix A: Solicitation L e t t e r 66 Appendix B: Pre-test 68 Appendix C: Consent Form 70 Appendix D: Demographic Data 72 Appendix E : Questionnaire 74 References 78 Curriculum Vitae 80 L I S T OF ILLUSTRATIONS page Tables I. Poisonings among c h i l d r e n under five reported to the N a t i o n a l Clearinghouse for P o i s o n Control Centers from 1968 to 1978 38 II. Response to s o l i c i t a t i o n of 60 physicians for participation in the poison p r e v e n t i o n education program 39 Workshop p a r t i c i p a n t s ' correct responses to each of the pre- and p o s t - t e s t 40 III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV. question Characteristics of s t u d y sites including job title and medical degree of c o o r d i n a t o r s , assigned study s c h e d u l e , and number of p a r t i c i p a n t s per group 41 Distribution of d e m o g r a p h i c variables of marital status and employment s t a t u s o f subjects in study groups 42 Distribution of d e m o g r a p h i c variables of type of d w e l l i n g , length of time at d w e l l i n g , and ownership status of subjects in study g r o u p s 43 Distribution of the d e m o g r a p h i c variable of average number of children per f a m i l y f i v e years of age or less and over five years of age f o r t h e subjects in the study groups 44 Distribution of the d e m o g r a p h i c variable of accidental childhood poisonings o c c u r r i n g i n families of the study groups 45 Distribution of v a r i a b l e s of age and sex of c h i l d r e n involved in p o i s o n i n g i n c i d e n t s in 84 families of the study groups reporting a n a c c i d e n t a l childhood poisoning 46 Measures taken to t r e a t the children involved in poisoning incidents in 84 f a m i l i e s of the study groups reporting a n accidental childhood p o i s o n i n g 47 Questionnaire items a s k i n g the subjects in groups B , C , and D their assessment of t h e educational program 48 Subjects' responses i n g r o u p s receiving education (B, C , D ) to Item 2 - How w o u l d y o u rate the program? 49 Subjects' responses i n g r o u p s receiving e d u c a t i o n (B, C , D ) to Item 3 - W h a t i m p r e s s e d you most about the program? 50 Questionnaire items a s s e s s i n g the s u b j e c t s ' increase in awareness about p o i s o n i n g s and poison prevention 51 List of Illustrations, continued XV. XVI. XVII. XVIII. XIX. XX. XXI. XXX X • XXIX X« XXIV. XXV. XXVI. page Subjects' responses to Item 4 - Have you ever heard of the Poison Control Center? 52 Subjects' responses to Item 5 - Which group is a t the greatest risk of becoming accidentally poisoned? 53 Subjects' responses to Item 6 - Does your home c o n t a i n toxic substances? 54 Subjects' responses to Item 7 - Can you name three potential poisons in y o u r home? 55 Subjects' responses to Item 12 - Do you feel that accidental poisonings in children are a significant problem? 56 Subjects' responses to Item 20 - Do you k n o w what syrup of ipecac is used for? 57 Questionnaire items assessing behavioral changes occurring i n the home since the subjects received the program 58 Subjects' responses to Item 8 - Have you recently examined your home for toxic substances? 59 Subjects' responses to Item 10 - H a v e y o u recently t a k e n any poison prevention m e a s u r e s in y o u r home? 60 Subjects' responses to Item 19 - Have y o u discussed poison prevention techniques w i t h your children? 61 Subjects' responses to Item 21 - Do you s t o r e syrup of ipecac in your home? 62 Subjects' responses to Item 22 - How long h a v e you stored syrup of ipecac in y o u r home? 63 Subjects' responses to Item 9 - W h a t are some steps you can take to poison-proof your home? 64 Subjects' responses to Item 11 - What w e r e the poison prevention measures y o u recently took in your home? 65 Figures 1. 2. INTRODUCTION An estimated one to two n i l l i o n accidental childhood poisonings occur yearly in the United S t a t e s , primarily in c h i l d r e n u n d e r five. 1-9 The National Clearinghouse for Poison Control Centers (NCPCC) reported over 150,000 poisonings in 1 9 7 8 , 71 percent of which occurred i n this age group.1 In the same y e a r , the Intermountain R e g i o n a l P o i s o n C o n t r o l Center (IRPCC) confirmed that 75 percent of their total reported accidental poisonings occurred in children under age five.Overall, in most studies or reports w h e r e statistics have been g a t h e r e d , 70 to 95 percent of the reported poisonings have occurred i n c h i l d r e n u n d e r five years of age and of this g r o u p , the eighteen month to three y e a r old child accounts for over half.* > ,10 The high incidence of a c c i d e n t a l poisonings seen and reported in these children under five is the result of the interaction of several factors; namely, the n a t u r e of c h i l d r e n , presence of a h a z a r d o u s environment, and easy a c c e s s i b i l i t y to toxic s u b s t a n c e s . A child tends to react to his environment i m p u l s i v e l y , seeking w h a t he w a n t s when h e wants it.^ A six-month-old child w i l l put a n y t h i n g i n his m o u t h , and a one- to two-year-old child w i l l taste almost any product stored w i t h i n 4 5 his reach 3 1 low l e v e l s . > > 9 By the time a child is two and a half to three years of a g e , agility and mobility b e c o m e f a c t o r s , o f t e n giving him access to many cabinets or s t o r a g e areas in the h o m e . ^ » ^ Even to age f i v e , most children are n a i v e to the c o n s e q u e n c e s of a p o i s o n i n g . As a result, most of these children u n d e r five m u s t b e protected from the toxic products w i t h i n their environment a n d t h e i r parents educated about the dangers and consequences of accidental poisonings. The second component in any poisoning is the a v a i l a b i l i t y of the hazardous substance. Medications account for over half of the poisoning accidents reported in children under five, followed b y household products, petroleum p r o d u c t s , and pesticides.^ >^>5 One survey of 84 households found that each contained an average of 8.4 c o n t a i n e r s of prescription drugs and 7.8 containers of n o n p r e s c r i p t i o n drugs in the home.11 An estimated 200,000 potentially poisonous c o m m e r c i a l products are available in the United S t a t e s ^ , and each y e a r the average family of four brings approximately 400 containers of these substances into the hone.^ It is obvious from the figures that a tremendous potential for accidental poisonings exists w i t h i n the h o m e . The third factor in a poisoning is ready a c c e s s i b i l i t y to the product by the child. Accessibility can be defined as l a c k of a d e q u a t e protection or supervision, lack of c a u t i o n , and careless h a n d l i n g and storing of materials.^ It w a s noted by J a c o b z i n e r ^ that m o r e than 80 percent of the substances involved in poisonings w e r e placed by adults where they could be easily reached b y c h i l d r e n . In interviewing families who had experienced p o i s o n i n g s , the same author identified 20 percent who did not consider the agent involved as even h a z a r d o u s , and 37 percent who had not stored the agent in the original container.^ In another survey of 84 families, 1 * o n l y 23 percent stated they had their drugs stored in areas inaccessible to c h i l d r e n , while 64 percent admittted they were relatively accessible (i.e., on a h i g h shelf a child could reach on a chair); and 13% indicated their drugs w e r e w i t h i n easy a c c e s s of the children. ^ These data reveal a lack of a w a r e n e s s among parents regarding the need to protect a child from the toxic environment. Because the curious nature of children cannot b e c h a n g e d , the m o s t logical approach to the problem of accidental p o i s o n i n g s is to limit accessibility. One w a y to do this is to use c o n t a i n e r s w i t h child- resistant closures. It became evident in the i960's that a c c i d e n t a l childhood poisonings were becoming an increasing problem* medications responsible for over half of the >^ with incidents.Preliminary studies during this period suggested that the use of c h i l d - r e s i s t a n t closures (CRCs) for medications was feasible and a p p r o p r i a t e . Scherz^ evaluated the effectiveness of CRCs for oral p r e s c r i p t i o n m e d i c a t i o n s dispensed by the pharmacies of M a d i g a n General H o s p i t a l and McChord Air Force Base in T a e o m a , W a s h i n g t o n over a one year p e r i o d . He found a 37 percent decline in the number of poisoning e x p o s u r e s in c h i l d r e n w h e n the data were compared to a similar period prior to the u s e of C R C s . B r e a u l t ^ evaluated the u s e of CRCs in one c o u n t y w h e r e every pharmacy agreed to dispense tablets and capsules in CRCs for a five-year period. At the end of the five y e a r s , the i n c i d e n c e of p o i s o n i n g s w i t h oral prescription medications dropped by 84 percent compared to the years prior to their u s e . He discovered as did S c h e r z ^ 3 of poisonings declined d u r i n g the period of use of C R C s . that all types Both authors suggested that reductions in p o i s o n i n g s for other toxic s u b s t a n c e s not distributed in CRCs could be the result of the s a f e t y packaging a c t i n g as an educational device to m a k e parents m o r e a w a r e of c o n v e n t i o n a l l y packaged products. With increasing evidence that CRCs w e r e u s e f u l i n reducing poisoning accidents, federal a c t i o n was u n d e r t a k e n which r e s u l t e d i n passage of the Poison Prevention Packaging Act of 1970 (Public L a w 9 1 - 6 0 1 ) r e q u i r i n g the use of CRCs for "certain p o i s o n o u s , t o x i c , c o r r o s i v e or other dangerous substances customarily used or stored about the h o m e . A s p i r i n and certain aspirin-containing products were the first products required to be dispensed in CRCs under this regulation in 1972 because the p r o d u c t s were the single most frequently ingested by young c h i l d r e n . In the following year, the number of children's deaths resulting f r o m i n g e s t i o n of aspirin products declined by 43 percent.16)17 Since 1 9 7 3 , fourteen other consumer products have been similarly regulated by the Consumer Product Safety Commission under the authority provided by the P o i s o n Prevention Packaging A c t , possibly correlating with a decrease of 63 percent from 1972 to 1978 in the n u m b e r of deaths to c h i l d r e n u n d e r five due to ingestion of household p r o d u c t s . ^ While these studies and statistics indicate that safety packaging has had a n impact on decreasing the incidence of c h i l d h o o d poisoning in certain situations, the overall incidence of poisonings in children under five has not changed a p p r e c i a b l y during this t i m e . Table I l i s t s the number and rate of p o i s o n i n g s i n children under five reported to the NCPCC during the period of 1 9 6 8 - 1 9 7 8 . The rate of poisonings per one million children under five jumped d r a m a t i c a l l y in 1972 but h a s not dropped significantly i n any of the the years f o l l o w i n g . W h i l e improved reporting methods m a y account for some of the c o n t i n u a l h i g h incidence of childhood poisonings, it w o u l d s e e m evident that a tremendous p r o b l e m exists despite regulation of packaging of many p r o d u c t s b y the P o i s o n Prevention Packaging A c t . Since the novelty of c h i l d - r e s i s t a n t containers has likely w o r n o f f , it is possible that parents and pharmacists have become lax in their use of C R C s , t h u s diminishing effectiveness. their Regardless of the specific r e a s o n s , it Is obvious that regulations alone have not b e e n able to prevent a c c i d e n t a l childhood substances customarily used or stored about the h o m e . A s p i r i n and certain aspirin-containing products were the first p r o d u c t s r e q u i r e d t o be dispensed in CRCs under this regulation in 1972 because the products were the single most frequently ingested by young c h i l d r e n . I n the following year, the number of children's deaths resulting f r o m i n g e s t i o n of aspirin products declined by 43 p e r c e n t . » Since 1 9 7 3 , f o u r t e e n other consumer products have been similarly regulated by the C o n s u m e r Product Safety C o m m i s s i o n u n d e r the authority provided by the P o i s o n Prevention Packaging A c t , possibly c o r r e l a t i n g w i t h a decrease of 63 percent from 1972 to 1978 in the n u m b e r of deaths to c h i l d r e n u n d e r five due to ingestion of household products.^ While these studies and statistics indicate that safety packaging has had an impact o n decreasing the incidence of c h i l d h o o d poisoning In certain situations, the overall incidence of poisonings In c h i l d r e n under five has not changed a p p r e c i a b l y during this t i m e . Table I lists the number and rate of p o i s o n i n g s in children under five reported to the NCPCC during the period of 1 9 6 8 - 1 9 7 8 . The rate of poisonings per one million children under five jumped dramatically in 1972 but has not dropped significantly in any of the the years f o l l o w i n g . W h i l e improved reporting methods may account for some of the c o n t i n u a l h i g h incidence of childhood p o i s o n i n g s , it w o u l d seem evident that a t r e m e n d o u s p r o b l e m exists despite regulation of packaging of many p r o d u c t s by the P o i s o n Prevention Packaging A c t . Since the novelty of c h i l d - r e s i s t a n t containers has likely worn o f f , it is possible that parents and pharmacists have become lax in their use of C R C s , t h u s diminishing effectiveness. their Regardless of the specific r e a s o n s , it is obvious that regulations alone have not b e e n able to prevent a c c i d e n t a l childhood poisonings and must be augmented with additional efforts in order to reduce this problem. Education is a reasonable adjunct to the packaging of products in CRCs and may have two advantages not inherent in safety packaging regulations. E d u c a t i o n can be selectively aimed a t the p o p u l a t i o n m o s t closely involved in accidental childhood poisonings and e d u c a t i o n can encompass a broad range of toxic s u b s t a n c e s , m a n y of which a r e not packaged in safety closured containers. Several studies investigating poison p r e v e n t i o n education have b e e n c o n d u c t e d . 7 , 1 8 , 1 9 Although these authors stated that poison prevention education may be of b e n e f i t in increasing public k n o w l e d g e and awareness, ^»^ in decreasing repeat p o i s o n i n g s , a n d in decreasing the number of hospitalized poisoning v i c t i m s , 7 the studi es were poorly controlled and contained i n t u i t i v e conclusions about the o v e r a l l effectiveness of e d u c a t i o n . Mass public education p r o g r a m s have also b e e n conducted i n p o i s o n p r e v e n t i o n . 7 Several p u b l i c a g e n c i e s cooperated to provide this of program to the public in C h a r l e s t o n C o u n t y , S o u t h Carolina.7 type They reviewed figures of patients under five years of age who w e r e hospitalized one or m o r e days f o r accidental p o i s o n i n g s , b o t h b e f o r e and after the mass educational p r o g r a m . They found a decline in hospitalizations from a b a s e l i n e of 90 patients i n 19 61 to 64 patients in 1964 following the p r o g r a m . The lack of c o n t r o l for total hospitalized patients and t h e type of education received make unreliable the conclusions that the m a s s p r e v e n t i o n program w a s responsible for this d e c l i n e . Another coordinated m a s s e d u c a t i o n p r o g r a m w a s c o n d u c t e d as a controlled study in two cities in M a s s a c h u s e t t s f o r a t h r e e m o n t h p e r i o d of time.^ One city served as the s t u d y p o p u l a t i o n in w h i c h a m a j o r educational effort w a s directed at e l e m e n t a r y and j u n i o r h i g h school students (6-14 y e a r s ) , with the i n t e n t that the i n f o r m a t i o n w o u l d b e passed from the children to t h e i r p a r e n t s . A second city was m a t c h e d demo graphically to t h e first w i t h r e s p e c t to p o p u l a t i o n , d i s t a n c e from B o s t o n , median school years c o m p l e t e d , m e d i a n family i n c o m e , p e r c e n t of population with incomes b e l o w p o v e r t y l e v e l , and u s a g e of the B o s t o n P o i s o n Center. A telephone survey was conducted In both cities before and after the education program w a s l a u n c h e d in the s t u d y c i t y . of the survey indicated that t h e r e w a s a significant increase k n o w l e d g e in families in the s t u d y c i t y . Results in H o w e v e r , this was n o t e d overall in those families w i t h c h i l d r e n b e t w e e n the ages of six and 14 and n o t in families with children u n d e r f i v e . C o n s e q u e n t l y , the a u t h o r s mentioned that educational p r o g r a m s n e e d e d to be s p e c i f i c a l l y to those families w i t h c h i l d r e n u n d e r targeted five. D e s p i t e the lack of e v i d e n c e to s u p p o r t the efficacy of p o i s o n prevention education, data do e x i s t to s u g g e s t that e d u c a t i o n Is effective in inducing p a r e n t s to u t i l i z e safe car restraint s y s t e m s Infant transport. 18-20 in Each of t h e s e s t u d i e s w a s conducted in a physician's clinic or h o s p i t a l . R e c i p i e n t s of the p r o g r a m w e r e e i t h e r parents of young children or p o s t - p a r t u m m o t h e r s . Scherz^l showed in a m u l t i - a p p r o a c h e d u c a t i o n a l p r o g r a m to 500 parents in a well child clinic i n M a d i g a n G e n e r a l H o s p i t a l , l a c o m a , W a s h i n g t o n , that a d i s p l a y card o n l y e d u c a t i o n a l p r o g r a m r e s u l t e d i n 10 percent of the parents s a f e l y t r a n s p o r t i n g their c h i l d r e n . A more intense instructional program w i t h verbal input resulted in a 22 percent response as measured by a questionnaire eight weeks l a t e r . Another group provided the educational program to mothers in the maternity ward at G r o u p H e a l t h Hospital in Seattle, W a s h i n g t o n . 2 2 those in the c o n t r o l group receiving no e d u c a t i o n , 37 percent (20/54) were using appropriate infant restraints as defined by Physicians Automotive Safety. of for This compared to a rate of use of safe restraints of 54 percent (30/56) in the g r o u p g i v e n printed information only and 71 percent (30/42) of those exposed to both information and a f i l m on the subject. The g r o u p differences in both studies w e r e significant. The authors concluded that a more sophisticated type of educational approach utilizing both l i t e r a t u r e and some form of v e r b a l discussion was more effective at increasing parental use of safe car restraint systems for their children than either offering them printed information only o r no education. Utilizing information from these s t u d i e s , a pilot study was designed to evaluate the effects of three different types of poison prevention education and compare them to a c o n t r o l g r o u p . provided in a primary health CcLXGi setfc i The programs w e r e to parents of children at the greatest risk of becoming a c c i d e n t a l l y poisoned. W i t h the intent to disprove the hypothesis that e d u c a t i o n would be of no b e n e f i t , each subject, including those in the c o n t r o l g r o u p , responded to a questionnaire developed to test the effect of education in increasing parental knowledge of the poisoning problem and i n stimulating parents to make their h o m e s a f e r . It w a s assumed that a combination of verbal education supplemented with printed material would be more effective than either alone w h i c h w o u l d all be more effective than no e d u c a t i o n . Though it was not studied in this initial p r o j e c t , the u l t i m a t e goal such education is to provide another means of reducing the o v e r a l l incidence of poisoning. METHODS Development of Materials The educational program was designed for the parents of c h i l d r e n at greatest risk of becoming accidentally p o i s o n e d , i . e . those children between one and five years of a g e . The program consisted of two p a r t s , one dealing with verbal i n s t r u c t i o n , and the other providing printed material. The goal of each was to provide basic information to p a r e n t s about poisonings and their p r e v e n t i o n . S p e c i f i c a l l y , this included discussion of the poisoning incidence and the age at r i s k , the presence of potential poisons in the h o m e , those substances most often implicated in poisonings, and a review of c o m m o n poison p r e v e n t i o n m e a s u r e s . The instrument used in providing the verbal presentation was a visual instructional manual developed in a specially designed three-ring binder containing photographs of poisoning hazards and outlining the basic principles stated a b o v e . A sheet of O f f i c e r U g g s t i c k e r s , a pamphlet on houseplants, and a pamphlet on the use and effectiveness of syrup of ipecac were also included i n the n o t e b o o k . The packet of printed material consisted of e i g h t brochures and pamphlets covering the basic principles governing the cause and prevention of accidental childhood poisonings in greater d e t a i l than that provided In the v e r b a l p r e s e n t a t i o n . Included i n the folder w e r e the following: 1. "Your Home Could be Full of Poisons." (An 11" x 17" fold-out leaflet containing basic information on steps to take to prevent h o m e p o i s o n i n g s . ) U . S . Consumer Product Safety Commission, Superintendent of D o c u m e n t s , U . S . Government Printing O f f i c e , W a s h i n g t o n , D . C . 20402. 10 2. "The Perils of PIP - Preventing Poisoning." (Colorfully illustrated comic book about an elephant w h o teaches poison prevention.) U . S . Consumer Product Safety C o m m i s s i o n , Superintendent of D o c u m e n t s , U . S . Government Printing O f f i c e , Washington, D.C. 3. 20402. "What About Houseplants?" (Pamphlet listing the common houseplants and their toxicity.) Available from the Intermountain Regional Poison Control C e n t e r , 50 North Medical D r i v e , Salt Lake C i t y , Utah 84132. Provided by Blue Cross and Blue Shield of U t a h . 4. "What About Ipecac?" (One p a g e , 3-1/2" x 8-1/2" brochure containing basic information on syrup of ipecac.) Available from the Intermountain Regional Poison Control C e n t e r , 50 North M e d i c a l D r i v e , Salt Lake C i t y , U t a h 84132. Provided by Blue Cross and Blue Shield of U t a h . 5. "Poison P r e v e n t i o n Packaging Fact Sheet." (Contains facts about the P o i s o n P r e v e n t i o n Packaging Act dealing w i t h safety closures, c u r r e n t l y r e g u l a t e d products, and effectiveness of poison prevention p a c k a g i n g . ) U . S . Consumer Product Safety Commission, Superintendent of D o c u m e n t s , U . S . Government Printing O f f i c e , W a s h i n g t o n , D . C . 6. 20402. "Join Officer U g g ' s P o i s o n Patrol." (An 8" x 9" sheet of sixteen O f f i c e r U g g stickers to attach to toxic household products and 3 t e l e p h o n e s t i c k e r s , all displaying the name and telephone number of the Poison Control C e n t e r . ) Poison F o u n d a t i o n , D e n v e r , C o l o r a d o . Rocky M o u n t a i n 7. "What To Do in Case of a Poisoning?" (Three-fold leaflet, 3-1/2" x 8 - 1 / 2 " , explaining the steps to take if a poisoning occurs.) Available from the Intermountain Regional P o i s o n Center, 50 N o r t h M e d i c a l D r i v e , Salt L a k e C i t y , U t a h 84132. Provided b y Blue Cross and Blue Shield of U t a h . 8. "First Aid for Poisoning." (A 5" x 8" card on first-aid instructions for poisoning emergencies.) Available from American Association of Poison Control C e n t e r s , c/o R e g i o n a l Poison C e n t e r , UCSD M e d i c a l C e n t e r , San D i e g o , C a l i f o r n i a 92103. Provided by P l o u g h , I n c . Site Selection Primary care physician's offices w e r e selected a s the site for the study for several r e a s o n s . Parents w i t h children under five r o u t i n e l y visit a physician's o f f i c e , including both family or general practitioners and p e d i a t r i c i a n s . offices were: Advantages for selecting physician's 1) parents frequently have waiting time in the office which could be utilized c o n s t r u c t i v e l y to provide health-related education, 2) parents are g e n e r a l y concerned with a h e a l t h issue w h e n present in a physician's office a n d possibly more receptive to learning about acccident prevention, and 3 ) other studies have indicated a c c i d e n t prevention is effective w h e n p r o v i d e d in a h e a l t h care setting.20-22 In planning the s t u d y , U t a h served as a n excellent p o p u l a t i o n b a s e . According to 1978 United States Census f i g u r e s , 12 percent of the U t a h population consisted of children under the age of five.28 This compares with a national average of seven percent and is h i g h e r than a n y other state average. Utah County was c h o s e n as the specific site for s e l e c t i o n of physician's offices. It Is a county with a r e l a t i v e l y closed h e a l t h 1 care s y s t e m and is e a s i l y accessible (within 50 m i l e s ) to Salt L a k e C i t y and the Intermountain R e g i o n a l P o i s o n Control Center w h e r e the study w a s coordinated. Utah C o u n t y also has a h i g h ratio of primary care physicians per capita; U t a h County has 2.7 physicians for every 10,000 p e r s o n s , compared with 2.4 in Salt Lake County,28,29 Initially 60 letters w e r e sent to the primary health care practitioners in U t a h County listed in the 1979 Utah M e d i c a l A s s o c i a t i o n Directory. This c o n s i s t e d of 10 pediatricians and 50 family practice physicians or general p r a c t i t i o n e r s , all of w h o m were M.D.'s. In the letter (Appendix A ) the childhood poisoning problem was identified for the U . S . , Utah and Utah C o u n t y . Each p h y s i c i a n w a s asked to offer h i s assistance in conducting a s t u d y of a poison prevention education program for parents of young children which could be presented in the office waiting room. A n u r s e or receptionist would make it available a n d w e w o u l d make follow-up t e l e p h o n e calls to those participating to a s s e s s the i m p a c t . Included in the letter was a s e l f - a d d r e s s e d , stamped postcard asking them to i n d i c a t e their interest in the program b y responding to one of the following: 1) I do wish to participate; 2 ) I may w i s h to participate, but w o u l d like m o r e information; and 3 ) I do not wish to participate. T h r e e weeks after the cards were sent the non-respondents and those p o s s i b l y interested were contacted p e r s o n a l l y by telephone. Then all those definitely interested w e r e contacted and provided further details about the p r o g r a m . Each was asked to send an interested representative, e . g . , n u r s e , t e c h n i c i a n , r e c e p t i o n i s t , f r o m their office to a t h r e e - h o u r w o r k s h o p to p r o v i d e them with the details of the s t u d y and instruct t h e m about accidental childhood poisonings and prevention methods. This I n d i v i d u a l would act as the study c o o r d i n a t o r 1 in the physician's office and b y the end of the w o r k s h o p be able to; 1. Explain the intended purpose of the p r o g r a m . 2. Identify the overall poisoning incidence and population at greatest risk of becoming accidentally 3. poisoned. Describe three factors which result in a c c i d e n t a l poisoning in children. 4. Identify c o m m o n m e t h o d s of poison p r e v e n t i o n . 5. Describe the initial treatment of a p o i s o n i n g . 6. Describe the study d e s i g n and their responsibilities during the study. 7. Provide a 5-10 m i n u t e v e r b a l discussion to p a r e n t s about poisonings and poison prevention utilizing the n o t e b o o k . The workshop was held o n September 12, 1979, a t Utah V a l l e y H o s p i t a l in Provo, Utah. Each individual who attended was given a pre-test (Appendix B) after w h i c h the w o r k s h o p was p r e s e n t e d . The poisoning problem was identified and m e t h o d s of prevention discussed in a slide presentation. The program m a t e r i a l s w e r e then distributed and e x p l a i n e d . The participants received a d e m o n s t r a t i o n of how to present the verbal portion of the study utilizing the n o t e b o o k . They also w e r e given a description of the material c o n t a i n e d in the folder with instructions to read the materials b e f o r e beginning the study. Detailed explanations were provided as to how the s t u d y would be conducted and questions w e r e solicited and answered. At the conclusion of the workshop the participants completed the p o s t - t e s t , which was identical to the pretest. The results of the tests w e r e analyzed for each participant and by each question in order to evaluate the effectiveness of the training session. In the event the scores did not significantly improve overall 1 following the post-test it would have been necessary for the investigator to spend additional training time w i t h the c o o r d i n a t o r s . Study Design The study was designed to evaluate the effect different types of education had on parental knowledge and behaviors concerning poisons and poison prevention. The three types of education consisted of 1) printed material only, 2) verbal instruction o n l y , and 3) a combination of b o t h verbal instruction and printed m a t e r i a l . In order to evaluate the individual and combined impact of the different types of education on awareness and behavior m o d i f i c a t i o n , the study was designed as a counterbalanced, randomized, factorial assessment of printed material and verbal instruction. The study coordinators w e r e instructed to offer the education program to any parent visiting the office who had at least one child between the ages of o n e and five y e a r s . Each subject completed a consent form and was assigned to one of four g r o u p s . Subjects in Group A served as control and received no printed m a t e r i a l or verbal discussion. Subjects in Group B w e r e given only the folder of printed materials and asked to read t h e m . Subjects in Group C received only the verbal presentation, and subjects in Group D received b o t h the printed materials and the v e r b a l p r e s e n t a t i o n . A l l office sites solicited subjects from each of the four groups on a randomly a s s i g n e d , rotating schedule. Each group was studied for a two-week period totaling eight weeks for completion of the e n t i r e s t u d y . The sites w e r e assigned to schedule 1 , 2 , 3 , or 4 indicating the following cycle: 1 | SCHEDULE 1 2 1 1 1 I 1 1 GROUP ASSIGNMENT Week 1 & 2 A 3 1 1 1 1 B c 4 J D I I 1 1 Week 3 & 4 1 I 1 1| I 1 1 Week 5 & 6 I I Week 7 & 8 B 1 1 1 1 c j D c I D 1 A D I A 1 B A I 1 B 1 1 c This design aided in eliminating bias introduced by differences in study coordinator, each physician's o f f i c e , and differences in k n o w l e d g e and experience of the study population b y soliciting participants for each group at each site. Data Collection and Analysis In each study site, parents w i t h children between the ages of one and five were asked to participate i n a poison prevention education program and complete a consent form (Appendix C ) w h i c h explained the program and obtained their consent to make a follow-up telephone c a l l . They were also asked to provide demographic data on the opposite side of the form (Appendix D ) , including n a m e , a d d r e s s , mother's and father's occupation, marital s t a t u s , n u m b e r and ages of c h i l d r e n , type of dwelling, and ownership s t a t u s . A f t e r the consent form was completed and signed, the parent received e d u c a t i o n from Group B , C, or D . Only names were collected from the c o n t r o l group (Group A ) , and they were sent a folder of the printed m a t e r i a l after the follow-up data w e r e obtained. The investigator visited each s i t e prior to commencement of the program and every two w e e k s during t h e study to m a k e the necessary g r o u p 1 assignment changes and r e p l e n i s h required m a t e r i a l s . Completed consent forms which had not b e e n a l r e a d y mailed to the investigator were also collected at this time. A series of 24 questions w a s formulated in a questionnaire designed to ascertain what each s u b j e c t learned from the program and what protective changes, if a n y , w e r e m a d e in the home (Appendix E ) . Within three to four weeks after the parents received the educational program or completed the consent form ( c o n t r o l group o n l y ) , the subjects were contacted by telephone and a s k e d to respond to the questionnaire. Subjects in the control g r o u p w e r e asked the sane questions after providing the same demographic data obtained from subjects in Groups B , C , and D . A maximum of four a t t e m p t s w e r e made to contact each participant. Upon completion of the q u e s t i o n n a i r e s , differences in responses from the four groups were a n a l y z e d b y two standard statistical methods. A cross-tabulation and c h i s q u a r e a n a l y s i s was performed on all variables except those provided as i n t e r v a l d a t a . The exceptions included the rating of the program, the p o t e n t i a l poisons c o r r e c t l y i d e n t i f i e d , and the total number of poison p r e v e n t i o n measures both identified and taken. Rating was evaluated by a o n e - w a y a n a l y s i s of v a r i a n c e , and the other dependent variables were tested a g a i n s t the separate and combined effects of printed and verbal e d u c a t i o n b y a two-way a n a l y s i s of v a r i a n c e . Numerical computations w e r e performed at the U n i v e r s i t y of Utah Computer Center on the Univac 1100-61 computer using the Statistical Package for S octal Sciences (SPSS): N i e , H u l l , J e n k i n s , S t e i n b r e n n e r , B e n t , 1975. Statistical significance w a s d e f i n e d as p<0.05 for a l l analyses performed. 1 RESULTS Study Sites Of the 60 physicians initially contacted about the p o i s o n prevention education program, 47 percent (28/60) returned c a r d s . Of these 16 indicated they wished to p a r t i c i p a t e , five indicated a possible and seven did not wish to p a r t i c i p a t e . The remaining interest, physicians, including those returning cards who were possibly i n t e r e s t e d , w e r e all contacted by telephone. E l e v e n of these 37 also expressed their desire to participate, resulting in a total of 27 of the 6 0 physicians contacted (45 percent) who indicated they wished to be included in the program. Of those who were not interested i n p a r t i c i p a t i n g , 13 had either inadequate time or p e r s o n n e l , 10 gave no r e a s o n , and 10 could not consider participating because they had moved or r e t i r e d . Of the 27 offices desiring to participate in the p r o g r a m , 13 were represented at the w o r k s h o p . T h o s e not in attendance cited scheduling conflicts and lack of time as the primary reasons. Following completion of the w o r k s h o p , two offices elected not to engage in the s t u d y , both stating they felt it would be too time consuming. F i n a l l y , one office w a s dropped from the study for failing to solicit any s u b j e c t s , leaving a total of 10 sites p a r t i c i p a t i n g in the s t u d y . T h e above results are summarized in Table I I . Training Workshop Results were tabulated f o r the pre- and p o s t - t e s t completed by each study coordinator. The tests w e r e given a n o n y m o u s l y , so results are also included for the coordinator from the site dropped from the study. The numbers and percentages of correct responses to the questions are listed in Table III. All p a r t i c i p a n t s improved their o v e r a l l pit6"™tsst score 1 upon taking the post-test except for one participant whose score remained the s a m e . Overall, the m e a n score of the pre-test w a s 9.8 of 18 and on the post-test was 14.2. In describing the p a r t i c i p a n t ' s performance regarding individual test questions, more correct responses were given on the post-test than the pre-test for 10 of 13 a n s w e r s . Q u e s t i o n #1 (number of yearly poisonings) was answered c o r r e c t l y by two on the pre-test and 10 on the post-test. Everyone answered q u e s t i o n #2 (most common age of poisonings) correctly on both the pre- and p o s t - t e s t . Seven individuals named the precipitating factors (question //3) on the pre-test compared w i t h nine on the post-test. Six agreed poisonings were preventable (question #4) on the pre-test compared to eight on the p o s t - t e s t . Only o n e individual initially identified the three most c o m m o n types of poisonings #5). This increased to s e v e n on the p o s t - t e s t . (question T e n of 11 answered question #6 correctly (Must a s p i r i n - c o n t a i n i n g products be packaged in CRCs?) on the pre-test and a l l 11 answered it c o r r e c t l y o n the post-test. Question #7 asked each participant to identify four of six household products requiring CRCs- Six on the pre-test and five on the post—test correctly named automobile a n t i f r e e z e , four on the pre-test and nine on the post-test named oil of w i n t e r g r e e n , six on the p r e - t e s t and seven on the post-test named oven c l e a n e r , and seven on the pre-test and six on the post-test named t u r p e n t i n e . Four correctly identified four steps to poison-proof a home (question # 8 ) , compared w i t h 10 on the post-test. Five of the 11 knew syrup of ipecac w a s not the same as universal antidote (question #9). This improved to six on the p o s t - t e s t . L a s t l y , five answered question #10 (first step to take in a p o i s o n i n g ) correctly o n the pre-test which doubled to 10 o n the p o s t - t e s t . A n a l y s i s of the 1 difference between the two tests was performed by u s i n g the t-test for paired samples. It revealed a significant difference between the overall pre- and post-test scores (p<0.01) for all workshop participants. Study Participants During the eight w e e k c o u r s e of the study, 319 families participated in all groups. Sixteen of these had disconnected or incorrect telephone numbers and could not be r e a c h e d , 16 could not be contacted after four attempts, and two were dropped from the study because of inability to identify the group they were associated with. The remaining 285 families successfully contacted w e r e divided into the four groups as follows: Group A (control) = 87 (30.5 p e r c e n t ) , Group B (printed material) = 121 (42.5 percent), Group C (verbal presentation) = 27 (9.5 percent), and Group D (printed + v e r b a l ) =» 5 0 (17.5 p e r c e n t ) . Table IV illustrates characteristics of the study sites including job title and medical d e g r e e , if a n y , of the study c o o r d i n a t o r s , the assigned study schedule o n w h i c h each group was randomly p l a c e d , and the number of subjects in each g r o u p per s i t e . As previously m e n t i o n e d , one site was excluded because of failure to solicit any participants, leaving 10 sites for data a n a l y s i s . In evaluating t h e results b y examining the study schedule to which each office was a s s i g n e d , 156/285 or 55 percent of the subjects were from Schedule 1 which included only two offices. Fifty of the 285 subjects (17.5 percent) participated on Schedule 2 and 50 on Schedule 4 , with three offices included i n e a c h . Ten percent or 29/285 were assigned to Schedule 3 , r e p r e s e n t i n g two offices. In a d d i t i o n , it can be noted that the largest cell of subjects In each rotation schedule Schedule 1, Group B for Schedule 2 , Group G for Schedule 3 , and Group D for Schedule 4 . In examining the sites by number of subjects selected per group, only five of the 10 sites (50 percent) solicited participants for Group A , every site (100 percent) had subjects in Group B , seven of the sites (70 percent) solicited subjects for Group C, and eight (80 percent) for Group D. Each of the study coordinators represented family practice physicians. Four offices were located in Spanish Fork, two in Payson, two in Orem, one in Provo, and one in Pleasant Grove. The Provo-Orem area is the largest metropolitan vicinity in the county with a combined population of 126,000, and the other cities report populations of between eight and ten thousand.28 Because of insufficient data, no correlations could be drawn between the size of the cities and the responses generated by each s i t e . Demographics of the Study Population Subjects provided the demographic data requested on the form In Appendix D . Of all participants, 97 percent (277/285) were married, one percent (2/285) were separated, and no one indicated they were either single or divorced. There were 84 percent (239/285) of the mothers who stated they were housewives and eight percent (25/285) indicated they were employed. Ninety-one percent (259/285) of the fathers were employed, five percent (16/285) w e r e s t u d e n t s , and two subjects (one percent) w e r e unemployed. These results are illustrated in Table V . The groups did not differ significantly for these variables. When questioned, 83 percent (238/285) of the subjects indicated they lived in a house, seven percent (21/285) in an apartment, three percent (8/285) in duplexes, three percent (8/285) in mobile homes, and the remaining two respondents (one percent) indicated other which was military base housing. (p<0.05). The groups were not uniform for this variable Significantly more subjects in Group C lived in apartments compared to the other three groups. Refer to Table V I . Each subject was asked how long h e / s h e had lived at their present dwelling. Twenty-five percent (72/285) stated it had been one year or l e s s , 19 percent (55/285) had lived i n their present dwelling two y e a r s , 13 percent (37/285) for three y e a r s , and the remainder for four years or more. Fifteen percent (43/285) did not respond to this question for no readily apparent reason. These results are listed in Table V I . By combining the data, it can be seen that the majority (57 percent or 164/285) of the participants had only lived at their present address for three years or less. No significant differences were noted among the four groups. Seventy-five percent (215/285) of the subjects indicated they owned their own residence, 22 percent (62/285) rented, and one percent (3/285) lived with friends or relatives. This is summarized in Table V I . The groups did not differ significantly for this variable. Children. There was a total of 887 children represented by a l l the respondents, of which 598 (67 percent) were five years or younger. The number of children per family ranged from one to nine with an average of 3.1 children per family and 2.1 children five years of age or less. The groups were not significantly different for either total number of children or for children five y e a r s of age and under as illustrated in Table V I I . Prior Poisonings. Each s u b j e c t was asked about their prior experiences with accidental childhood poisonings. This included questions 13-18 from the questionnaire found in A p p e n d i x E . W h e n asked if they had ever experienced a childhood poisoning i n their household (Item 13), 84 respondents (29 p e r c e n t ) stated "yes". significantly among the four g r o u p s . This did not differ Although c h i square analysis did not demonstrate a significant d i f f e r e n c e , when asked how long ago the poisoning incident occurred (Item 1 4 ) , four families in G r o u p A and four families in Group B reported them following their visit to the physician's office. None occurred in G r o u p s C or D following their p a r t i c i p a t i o n . The four groups were significantly different (p<0.05) for age of the children involved in poisonings (Item 15). M o r e children involved in poisonings were less than o n e year of age in Group A compared to the other g r o u p s , and significantly fewer w e r e three years of age in Group A compared to Group D. F i f t y - s i x percent (47/285) of the poisoned children were males and 44 percent (37/285) w e r e females. differ significantly. The groups did not Distribution of ages and sex per group is listed in Table I X . Item 17 asked the subjects to briefly describe the situation in which the poisoning occurred in an attempt to assess the severity of the poisoning. Because no severity criteria w e r e established prior to asking the question, this was not e v a l u a t e d . In Item 18 the subjects stated what measures they took to treat the children involved in poisoning i n c i d e n t s . Sixty-one percent (51/84) called the Poison Control Center and 30 percent (25/84) called their physician. In 38 percent (32/84) of the cases, only simple treatment was g i v e n . This included measures such as d i l u t i o n , administration of a a variety of other more specific items such as the Officer Ugg Stickers or the handout regarding h o u s e h o l d plants. As more than one response was possible to the q u e s t i o n , each answer was analyzed separately. The groups differed only with those w h o responded that the brochures and materials impressed them m o s t . Significantly fewer in Group C (verbal only) named this which is reasonable realizing they only glanced at the brochures that were included i n the binder used as an outline for the verbal presentation, whereas those in the other two groups took them home. This is described in Table X I I I . Item 23 asked the subjects to give additional comments about the program. This question w a s designed only to provide the investigator future study information and was not analyzed. All subjects w h o responded to Item 24 except one thought they would like to see other programs such as this one continued in their physician's o f f i c e . Knowledge of Poison Prevention The subjects were asked s e v e n questions designed to test any increase in awareness about poisonings and poison prevention w h i c h could be related to receiving t h e p r o g r a m . This included Items 4 , 5 , 6 , 7 , 9, 12, and 20 on the questionnaire and are listed in Table X I V . Item 4 (Have you ever heard of the P o i s o n Control Center?) assessed the subjects' knowledge of the Center. Among a l l subjects, 90 percent (256/285) had knowledge of the Poison C o n t r o l Center and there w e r e no significant group differences. This is i l l u s t r a t e d in Table X V . Item #5 asked the respondents to identify the g r o u p at greatest risk of becoming accidentally p o i s o n e d . Ninety-two percent (261/285) w e r e able to correctly name c h i l d r e n aged one to five y e a r s . group differences on this q u e s t i o n as seen in Table X V I . There w e r e no The participants were each questioned as to whether they felt their h o m e contained toxic substances (Item 6 ) . In all four groups, 96 percent (275/285) answered "Yes", h o w e v e r , those in Group A stated significantly more often (p<0.05) that their homes did not contain toxic substances than did those in the groups receiving education. Refer to Table XVII. Those who responded in the affirmative to Item 6 were then asked to name three potential poisons in their home (Item 7). As seen in Table XVIII, 80 percent (221/275) in all groups correctly identified three poisons, 17 percent (47/275) named two, and two percent (6/275) named one potential poison. any. Only one subject from the control group (A) could not identify An analysis of variance performed on this question failed to reveal any significant differences. Item 12 (Do you feel that accidental poisonings in children are a significant problem?) revealed that across the groups, 91 percent (259/ 285) thought accidental childhood poisonings w e r e a problem, three percent (8/285) believed they were n o t , and five percent (14/285) did not know. The distribution among the groups is found in Table XIX and showed no significant differences. Item 20 (Do you know what syrup of ipecac is used for?) was designed to test the subjects' knowledge regarding the proper use of syrup of ipecac. In all four g r o u p s , 84 percent (240/285) knew it was used to induce vomiting. This is illustrated in Table X X and again revealed no differences among the g r o u p s . Identification of Poison P r e v e n t i o n M e a s u r e s . The subjects were asked to identify some steps they could take in poison-proofing their homes (Item 9 ) . Figure 1 illustrates the percentage of responses in each group to nine different poison prevention measures. Originally there w e r e only eight possible responses to the q u e s t i o n , but so many in the "other" category responded w i t h "putting items out of reach" that this w a s then analyzed individually as w e l l . The number of responses to three of the interventions resulted i n significant differences in the groups. For the measures "clean the medicine cabinet" and "cle an under the sink" the subjects in the three educational groups (B, C, D ) stated these significantly more frequently (p<0.005 and p < 0 . 0 5 , respectively) than those in the control g r o u p indicating a positive impact of all types of education. In a s i m i l a r manner significantly more subjects in G r o u p I) (p<0.05) identified "disposing of toxic substances" as a poisonproofing step than those in the control group indicating a positive impact of the combination of printed and verbal education. There were no group differences for a n y of the other six poison prevention measures mentioned which included "cleaning the garage", "locking up toxic substances", "installing s p e c i a l l o c k s " , "using Officer Ugg Stickers", "putting items out of r e a c h " , o r "other" measures. However, a n analysis of variance performed on the total number of intervention steps mentioned demonstrated that a significant m a i n effect occurred (p<0.05) for education utilizing the printed m a t e r i a l o n l y . Behavioral Changes in the Home The subjects w e r e asked s i x questions designed to identify what behavioral changes had occurred in the home since the subjects had received the program. This included Items 8, 10, 11, 19, 21, and 22 from the questionnaire and are listed in Table X X I . Item 8 (Have you recently examined your h o m e for the presence of toxic substances?) asked if the subjects had examined their home for toxic substances in the last t h r e e weeks or since receiving the program. Fifty percent (142/285) indicated they had. Significant differences could not be demonstrated between those receiving e d u c a t i o n and the control group (Table X X I I ) . Poison Prevention M e a s u r e s T a k e n . The subjects were asked if they had recently taken any poison p r e v e n t i o n measures in their home (Item 10). Fifty-nine percent (169/285) stated they had instituted poison prevention measures and no significant differences w e r e revealed among the groups (Table X X I I I ) . Those subjects who had answered in the affirmative to Item 10 w e r e asked to identify which measures they had Implemented (Item 11). These data are presented in Figure 2 and indicate the percentage of responses in each group to the same nine poison prevention measures mentioned In Item 9 . (This differs from Figure 1 in that it illustrates the p o i s o n prevention measures which were actually implemented in the home r a t h e r than those identified.) In five instances the m e a s u r e s taken demonstrated a significant difference between the four g r o u p s . The subjects in the three educational groups "cleaned the m e d i c i n e cabinet" (p<0.005) and "cleaned under the sink" (p<0.005) significantly more frequently than those subjects in the control group, suggesting that education had a n impact on causing parents to implement poison prevention m e a s u r e s . Additionally, significantly m o r e subjects in Groups B and D "used Officer Ugg stickers" i n their h o m e compared to those in Groups A and C (p<0.001). Though the stickers w e r e not available from t h e p r o g r a m to the subjects in Groups A and C , the differences noted indicate a much higher rate of use than expected i n Groups B and D . Significant differences in the groups were also noted for the measures taken to "install s p e c i a l locks" (p<0.05) and "to put items out of reach" (p<0.05). For "installation of special l o c k s " , subjects in Group A (control) responded significantly more often that they had implemented this m e a s u r e than did those receiving education. Analysis of the measure "putting items out of reach" revealed that subjects in Groups A and D did this significantly more often than subjects in Groups B and C . There were no significant differences in the remaining four measures taken which included "cleaning t h e garage", "disposing of toxic substances", "locking up t o x i c s " , or "other measures". In evaluating the total number of poison p r e v e n t i o n measures recently instituted, analysis of variance demonstrated that a significant interaction occurred (p<0.05) for use of the c o m b i n a t i o n of printed materials and verbal instruction. Discussing Poison P r e v e n t i o n . W h e n asked if they had discussed poison prevention w i t h their children (Item 19), 51 percent (146/285) indicated they had since v i s i t i n g the physician's o f f i c e . Though the groups did n o t differ s i g n i f i c a n t l y as seen in Table X X I V , 64 percent (32/50) in Group D discussed p r e v e n t i o n w i t h their children compared with 34 percent (9/27) in Group C , 50 percent (60/121) in group B , and 52 percent (45/87) in Group A , p o s s i b l y indicating that verbal instruction alone was less effective In causing this change. This may have been affected by the availability of a children's comic book about poisonings to those subjects in Groups B a n d D receiving the packet of printed material. Syrup of Ipecac. Items 21 (Do you store syrup of ipecac in your home?) and 22 (How l o n g h a v e you stored syrup of ipecac in your home?) were designed to determine the presence of syrup of ipecac in the homes and assess the effect of the educational program on the storage of syrup of ipecac. Across the g r o u p s , 44 percent (125/285) of the population indicated they had s y r u p of ipecac in their home at the time of the survey, which is illustrated in Table X X V . Of these 125 subjects 21 (17 percent) had purchased it a f t e r receiving the program. The smallest percentage of those responding to this occurred in the control group, h o w e v e r , the differences w e r e not significant. Refer to Table X X V I for the group distributions. Relationship to P o i s o n i n g Incident The variables studied in the questionnaire were each evaluated in terms of the subjects' prior experiences with accidental childhood poisonings. A chi square a n a l y s i s was performed on each variable and whether the subject had a previous poisoning incident. Occurrence of a poisoning significantly affected responses to three variables. For Item 4 (Have you heard of the P o i s o n Control Center before?), 100 percent (84/84) of those experiencing a poisoning had heard of the Center compared with 86 percent (172/201) of those not reporting a childhood poisoning (p<0.05). When asked if they knew what syrup of ipecac was used for (Item 2 0 ) , correct responses came from 98 percent (82/84) who h a d a prior childhood p o i s o n i n g , and 79 percent (159/201) who had never experienced a poisoning ( p < 0 . 0 0 5 ) . Similarly, 73 percent (61/84) of the subjects reporting a childhood poisoning had syrup of ipecac in their h o m e s , whereas only 32 percent (64/201) of those having no experience w i t h a poisoning stored s y r u p of ipecac in the home (p<0.001). Other than for those items m e n t i o n e d a b o v e , prior experience with a childhood poisoning did not s i g n i f i c a n t l y affect the subjects' awareness or behaviors. DISCUSSION Study Sites When initially c o n t a c t e d , almost half of the physicians expressed a desire to participate in the p r o g r a m . T h e only limiting factor for those who did not engage in the study but had a n interest, was the time or opportunity to attend the o r i e n t a t i o n workshop. However, only 17 percent (10/60) of those originally contacted completed the study. By eliminating those 10 physicians who had moved or r e t i r e d , the participation rate increased to 20 percent ( 1 0 / 5 0 ) of those available, which is favorable considering the fact that the only contact they had with the study investigator was through l e t t e r or telephone. Because 87 percent (52/60) of the physicians originally contacted w e r e family practice p h y s i c i a n s , it is logical that most of the study participants would represent f a m i l y practitioners, and in fact, they all did. Since the reason m o s t did not participate was because of inadequate time or personnel, these two f a c t o r s may pose a greater problem with pediatricians than with family p r a c t i t i o n e r s . The educational p r o g r a m w a s a relatively simple program to develop and organize, and the study coordinators w e r e enthusiastic and interested d u r i n g their training session o r i e n t i n g t h e m to the program. Even though the pre- and post-test was the same test and was given only three hours a p a r t , the coordinators performed very well as noted by the significant difference in the two scores ( p < 0 . 0 1 ) . Consequently, it was somewhat discouraging to terminate the study with a rather low response and with such an uneven distribution of subjects in the four study groups. a r e a number of explanations for t h i s . There F i r s t , though each site was visited every two weeks during the s t u d y , no requirement was placed on the study coordinators to solicit a m i n i m u m number of subjects In order to remain in the study. M a n y e x p l a n a t i o n s were given by the coordinators including lack of time, particularly to present the v e r b a l program (Group C). Others cited lack of a d e q u a t e office personnel because of employees leaving unexpectedly and a w a n i n g in their interest in providing i t . One study coordinator moved away during the final two weeks of the study. T h e control group would have helped balance these difficulties, but unfortunately 90 percent of the control subjects came from only two study sites. This may have been the study problem most significantly affecting the results of many of the analyzed variables in which the education p r o g r a m had no effect on a w a r e n e s s or b e h a v i o r s . It is possible that the individuals In the c o n t r o l groups from these two geographical sites possessed more inherent k n o w l e d g e and experience with childhood poisonings t h a n those at some of the o t h e r sites who had none or very few subjects participating in the control g r o u p . Each study coordinator solicited t h e greatest number of participants d u r i n g the first two weeks of the s t u d y . This reflects a high level of interest and recruitment of s u b j e c t s by the study coordinators during the first two weeks of the s t u d y , b u t the enthusiasm diminished thereafter. C o n s e q u e n t l y , this or similar p r o g r a m s may not be carried out well in a physician's office on a l o n g - t e r m b a s i s . It is also interesting to evaluate the differences in numbers of subjects within each g r o u p , is m e n t i o n e d in the results, 100 percent of the sites solicited participants f o r Group B , with less for G r o u p D , C, and A , respectively. This difference m a y have been related to ease of providing the various types of education since Group B required only completing the consent form and handing the parents the packet. No e x p l a n a t i o n can be given for the relatively small number of subjects In the control group from such few sites. The advantage of not strictly controlling each site is that it represents more accurately how the education program would be conducted if it was made generally available. A consideration for future studies would be to provide the verbal education through a self-contained audio-visual presentation. This would ensure all the presentations were consistent and response would possibly b e greater because the coordinators would not have to devote so much time to presentation of the program. Demographics of the Study Population The four groups within the study sample were uniform for marital status and employment status of both the mothers and fathers. They were n o t , however, representative of the general United States population or that of Utah. Characteristics of the population from the 1970 U.S. Census indicate that only 58 percent of the families with children under six years of age are composed of married couples. In addition, statistics for Utah indicate that in families with children under six, 91 percent are married, four percent are divorced, one percent are single and one percent are s e p a r a t e d . 2 8 Compared to our study demographics, 97 percent were married and none were divorced or single, indicating more of our population was stable with respect to marital status than the average population in Utah, and certainly than the United States population. In examining the employment characteristics of the population, eight percent of the mothers and 91 percent of the fathers were active in the labor force. In U t a h , women w i t h children under six represent 28 percent of the labor force, and 87 percent of the married men 16-44 years of age are employed. This is also not representative of the U . S . population in which 41 percent of the women are employed and 77 percent of the m e n . 28 Again, these data indicate a fairly conservative population in which the mothers are commonly a t home and consequently may be more available to implement poison prevention measures than the average United States population. This possibly lead to a decrease in the effect of the educational program. Our study population was homogeneous for previous experiences with accidental childhood ingestions w i t h respect to sex of the child involved and measures taken to treat the c h i l d . Though a slight variability occurred for all the ages of poisoning vleitims, the groups were uniform when age of the victims w a s measured as five years and under and over five. Respondent Assessment of the P r o g r a m Response to the p o i s o n prevention education program was positive from the subjects. or excellent. The m a j o r i t y of them (92 percent) felt it was good A significantly greater number of subjects receiving the combination of verbal education and printed material rated the program good to excellent. It seems reasonable that providing both forms of the education had a greater impact on the subjects' rating of the program than offering either method a l o n e . W h e n asked what impressed them most, no one stated it was the person providing the program. However, this was a more likely response from those receiving only the verbal component which constituted the smallest number of subjects. As was expected, significantly more subjects in the groups receiving the printed material to take home were impressed m o s t b y the brochures and materials. The groups did not differ in their responses to other impressive portions of the program, and no other conclusions can be drawn from this question. Change in Awareness a n d Behaviors O v e r a l l , the study demonstrated few effects attributable to education on either increasing the parent's awareness of poisons and poison prevention or in causing them to make protective changes in the child's h o m e environment. The areas i n w h i c h education was of benefit dealt primarily with knowledge of the toxic environment and poison-proofing methods. Education w a s shown to have a positive effect in teaching parents their homes c o n t a i n toxic substances. education provided did not affect this. The specific type of The most notable effect was in parental ability to identify and implement potential poison prevention measures. Education was s u c c e s s f u l in causing parents to identify "cleaning out the m e d i c i n e c a b i n e t " , "cleaning under the sink", and "disposing of toxic substances." Though not significant, Figure 1 demonstrates an increasing trend by group in the knowledge obtained for these three measures, with printed material only < verbal instruction only < printed + verbal e d u c a t i o n . W h e n responses from all nine measures were combined and analyzed together there was a main effect overall for the subjects receiving printed m a t e r i a l only. This may be due to greater knowledge retention b e c a u s e subjects receiving the printed material had the information at h o m e for several weeks prior to completing the survey. For the poison p r e v e n t i o n m e a s u r e s actually implemented, education was successful in stimulating parents to "clean the medicine cabinet" and "clean under the s i n k " . N o significant differences were noted between the three types of e d u c a t i o n , but a trend similar to that noted above was evident in Figure 2 (printed material only < verbal instruction only < printed + verbal e d u c a t i o n ) f o r the measures "cleaning the medicine cabinet" and "cleaning under the s i n k " . Subjects from the two groups in which printed materials were provided showed a significant "use of Officer Ugg stickers." Education had a negative effect on causing parents to "install special locks" in the home. The reasons are unclear, hut possibilities are that the locks were readily available in the community or that education had an effect in making this prevention measure appear more difficult to implement. Lack of education also resulted in more subjects "putting items out of reach." This seems logical because this is a broad statement most individuals could think of and does not require a definite action to be taken in a specific area of the home. For the total number of measures implemented by a family, the combination of printed and verbal education was most successful. For purposes of future teaching of families about poison prevention measures, it may be worthwhile to emphasize those areas in which our subjects responded m o s t frequently. "Cleaning out the medicine cabinet" and "cleaning under the sink" w e r e the two responses in which education was of benefit in both increasing our subjects' knowledge and in changing their behaviors. CONCLUSION This study was designed to e v a l u a t e whether different types of poison p r e v e n t i o n education w e r e effective at increasing parental awareness and knowledge as it relates to accidental childhood poisonings. Subjects receiving printed and v e r b a l education rated the program higher than those receiving either form of e d u c a t i o n a l o n e , but this was the only instance in which there was a difference in the type of education provided. Education overall was effective at increasing parental knowledge in two areas. The parents w e r e successfully made aware that their homes contained toxic s u b s t a n c e s . Those receiving education were also able to identify "cleaning the m e d i c i n e cabinet," "cleaning under the sink," and "disposing of toxic s u b s t a n c e s " as specific poison-proofing measures. Subjects receiving education significantly changed their behaviors by actually "cleaning the m e d i c i n e cabinet" and "cleaning under the sink." Providing families with Officer Ugg stickers also resulted in t h e m using the stickers around the h o m e . Although education had some e f f e c t on increasing parental awareness and behaviors, these study results a r e not conclusive and indicate a need for continued study of methods of effective education. Several p o i n t s discovered in conducting this study should be considered in designing others. F i r s t , a study such as this is difficult to accurately c o n t r o l because of so many variables in the population, study sites, and study coordinators. The specific study design controlled for most of this variation but p e r h a p s was too complex to enable the study sites to uniformly solicit s u b j e c t s . C o n s e q u e n t l y , the uneven and somewhat small distribution of subjects in the g r o u p s studied added to the difficulty in attempting to demonstrate significant effectiveness of education. Ways in which this could be improved u p o n would be to more closely m o n i t o r and control each s i t e , carefully select the study coordinators a n d train them thoroughly on a group and individual basis, or provide the verbal portion of the program as an audio-visual presentation to alleviate some of the time spent by the coordinator. For purposes of evaluating the effects of an education program similar to this, the testing instrument m a y well be the most important tool of the study. It is conceivable that more significant effects of t h e different types of education could have been noted in this study had the questionnaire been designed in m o r e detail and thoroughly tested on a small sample representative of the study sample prior to implementation. Another significant factor in this study was the study population selected. The study was appropriately targeted at parents of children at greatest risk of becoming a c c i d e n t a l l y poisoned and the physician's o f f i c e was a suitable location in which to solicit these parents. Also, e v e n though the particular geographical a r e a chosen consisted of a large n u m b e r of young children, the population w a s not representative of the general United States p o p u l a t i o n . In o r d e r to extrapolate results to a larger sample, a more representative s t u d y population would need to be selected. Finally, a worthwhile consideration i n designing a n y type of study evaluating poison prevention education w o u l d be to measure the actual childhood poisoning incident in the s u b j e c t s participating before receiving the education and then follow-up on this a year l a t e r . Including that evaluation in this study may have made it possible to further sustantiate the conclusions reached. Table It Poisonings among children under five reported to the National Clearinghouse for Poison Control Centers from 1968 to 1978 Year Children < 5 years of age in the U.S. (1,000,000) Number of Poisonings Rate per 1,000,000 1968 17.9 71,563 3999 1969 17.4 76,155 4377 1970 17.1 70,897 4146 1971 17.2 84,370 4905 1972 17.0 105,018 6178 1973 16.7 101,676 6088 1974 16.3 94,575 5802 1975 15.8 102,709 6500 1976 15.3 89,755 5866 1977 jL5 • 2 94,949 6247 1978 15.3 93,325 6100 Sources-. National Center for Health Statistics and United States Bureau of Census. Population estimates and projections, Current Population Reports. Series P-25, N o s . 519, 643. National Clearinghouse for Poison Control Centers. Poison control case report summary, Washington, D.C.: FDA Bureau of Drugs, 1980. (Division of Poison Control, HFD240). Table_II: - Response to solicitation of 60 physicians for participati the poison prevention education program i n P o s t c a r d Return a. Number Huniuei | I Percent rercent 1 27% Definite interest 1 16 b. Possible interest 1 1 5 8Z c. Not interested 1 ? 12% d. Card not returned I 1 1 1 1 32 Total T e l e p h o n e Call Response^ 60 1 1 i 1 i 53% 100% 1 a. Definite interest 1 11 1 18% | b. Not interested 1 1 1 1 1 i 1 1 1 I 1 26 | 1 1 | 1 "1 | ! 1 I 1 43% | 1 61% ! 45% | 22% | Total T o t a l Wishing to Participate T o t a l Attending Workshop 1 I I 37 27 13 T o t a l Participating 11 1 18% [ T o t a l Study Sites Participating (excluding dropouts) 10 1 j 17% | j T e l e p h o n e solicitation calls were made to the five indicating a p o s s i b l e Interest and the 32 not returning cards. T a b l e III: Workshop participants' correct responses to each question of the pre- and post-test I I I Question | 1 Number I Subject 1 1 1 I Number of yearly poisonings 1 I Most common age of poisonings 1| 2 | 11(100%) I 1 11(100%) I 1 1 I 7 (64%) I 9 (82%) 6 (55%) 1 1 I I 1 I 8 (73%) 4 I 1 I 1 Poisonings are preventable? 1 5 1 Most common types poisonings (3) 1 1 6 Aspirin in CRCs? 1 7 1 1 1 I 1 I I I I 1 1 Household products requiring CRCs1 1. automobile a n t i f r e e z e I 2 . oil of w i n t e r g r e e n 1 3 . oven cleaner I 4 . turpentine 1 I 1 I I I | I I Steps to poison-proof h o m e (4) 1 3 j1 1 1 i 1 8 9 1 10 Precipitating factors I Number of Correct | I Responses (n**ll) | f~ " ~~ | | Pre-test 1 Post-test I 1 1 2 (18%) I 10 (91%) I Syrup of ipecac same as universal antidote? First step to take in poisoning t ( 1 0 ) = 4 . 1 6 , p<0.01 I 1 i I 1 1 I I 1 (9%) 10 (91%) 6 4 6 7 (55%) (36%) (55%) (64%) 4 (36%) 5 (45%) 5 (45%) 7 (64%) 11(100%) iI 5 (45%) |1 9 (82%) 1 7 (64%) 1 6 (55%) j [ | 10 (91%) 1 i 11 6 (55%) | | 1 10 (91%) i I Table IV: Characteristics of s t u d y sites including job title and medical degree of c o o r d i n a t o r s , assigned study s c h e d u l e , and number of participants per group GROUPS 1 I S t u d y Coordinator: | Study 1 Job Title & (Degree) I S c h e d u l e 1 (Office Manager 1 1 | 1 I 1 | 1 I Office Nurse (RN) 1 I 1 1 11 I Office Nurse (LPN) j I I I Medical Assistant I 1 I (Laboratory Technician I I(MLT) j A 1 I 24 | 1 1 54 1i 78 1 ! 1 | B ! 1 1 26 | | 37 t | I 63 | 1 1 | 1 2 c 1 1 1 " 2 |I 1 13 2 |I 1I 13 - 12 2 3 20 2 D 4 I 1 I Total 50 1 106 I 1 ( 156(55%) 1 I I 12 2 1 10 4 I | 28 50(17.5%)| 37 ( (Receptionist I I Medical Assistant I Office Nurse (RN) I I Receptionist I Office Manager 3 3 2 3 4 3 4 I 7 I 2 7 ( 1 4 8 17 2 I 12 121 29(10%) I I I I I I 6 16 87 | 11 | 4 OVERALL T O T A L 4 27 7 I | I | 17 16 | I | I t 25 | 50(17.5%)| 50 | 285(100%)! 2 3 30 T a b l e V: Distribution of d e m o g r a p h i c v a r i a b l e s of m a r i t a l status and employment status of s u b j e c t s in s t u d y groups 1 1 GROUPS I 1 I M a r i t a l Status* 1 A 1 B I n=87 I n=121 1 1 1 1 1 1 1 1 | 85(98%) 1116(96%) j I 1 l 1 Married Separated I | 1 No Response 1 I Mo t hers 2 I Status I 1 Employment 1 (1%) ! 1 1 (1%) j 1 1 I 1 c n=27 " 1 | | 1 D n=50 i I I 1 1 1 | 1 1 [| 27(100%)|| 49(98%) jI 2 7 7 ( 9 7 % ) i (i%) 1j o f| 0 I 2 (1%) 4 (3%) 1 1 0 i 1 1 (2%) 1 6 (2%) I I I I I I I ! I I I I | 9 5 ( 7 9 % ) I 22(82%) | 44(88%) | 2 3 9 ( 8 4 % ) • I I I 1 Housewife I 78(891) I I Employed | I 4 (5%) I 1 5 ( 1 2 % ) | I I 2 (7%) | I 4 (8%) | I I Student | 1 (1%) | 0 0 I No Response I 4 (5%) | 11 (9%) I I Fathers I Status^ I I I 1 0 Employed [ 8 0 ( 9 2 % ) |109(90%) I I Unemployed | 0 I 1 I I I 4 (5%) | I 3 (31) | No Response = 0 , 8 | | 3(11%) | 25 (8%) | 1 (1%) 2 (4%) | 20 (7%) Employtnent Student 17 Total n=285 | 2 (2%) 6 (5%) 4 (3%) 24(89%) I 46(92%) I 0 I 0 I 3(11%) | 3 (6%) I 0 ] 1 (2%) o(3) > P > 0 . 0 5 , the g r o u p s do n o t differ significantly 2 / g \ = 6 . 5 , p > 0 . 0 5 , the g r o u p s d o n o t d i f f e r significantly X ^ = 4 . 4 , p > 0 . 0 5 , the g r o u p s d o n o t d i f f e r significantly 259(91%) 2 (1%) 16 (5%) 8 (3%) 43 Table VI; 1 Distribution of demographic variables of type of dwelling, length of time at d w e l l i n g , and ownership status of subjects in study groups GROUPS 1 1 A n=87 1 B I n-121 j I 101(84%) | I j I C n=27 1 D I n=50 1 1 19(70%) I| 38(76%) I Type of Dwelling^ I| House 1 1 Apartment 1 i I Duplex 1 1 80(92%) 1 1 1j 5 (6%) 1| 6 (5%) |j 5(19%) 1 | 1| 1 (1%) 1| 5 (4%) || 0 1 Mobile Home 1 1 (1%) I| 3 (2%) || 1 Other 1 o I| 1 (1%) I| j o 1 I L e n g t h of Time at 1 Present Dwelling- 1 1 1 Year or less 1 14(16%) I 1 1 2 Years I| 17(20%) 1 l 1 I| 15(17%) 1 3 Years 1 1 1 1 1 ! 5 (4%) | 1 1 1 1 39(32%) | I | 1 I| 1 4 Years 8 (9%) 1 I 5 Years 1 6 Years I 1 1 1 Total n=285 1 238(83%) l l 5(10%) 1 21 (7%) | 8 (3%) 2 (4%) 1 |1 1 j 0 1 1 1 1 (4%) i1| 4 (8%) | | 1 o Ij1 2 (7%) 11 1 1 (2%) i 8 (3%) I 1 1 1 1 1 8(30%) i1| 11(22%) || 72(25%) 22(18%) | | 1 14(121) f| 2 (7%) I1| 14(28%) j| 55(19%) 6(12%) j| 37(13%) 1j 6 (5%) j| 2 (7%) |1| i l (4%) :1j 1 (2%) jI 16 (6%) 4 (5%) 1| 2 (2%) [| 3(11%) 1| 2 (4%) || 11 (4%) 1j 14(12%) || 1 (4%) 1| 6(12%) [| 32(11%) Over 6 Years I! 11(12%) I1 1 I 5 (6%) | 13(15%) 9 (7%) | | 15(12%) | 4(15%) 1 I 6(22%) |1 1 (2%) I 1 9(18%) | 19 (7%) No Response 1 1 | No Response I Ownership Status^ I Own I I Rent I I Live w i t h 1 friends or I relatives I 1 1 1 No response i1 1 1 1 69(79%) 17(20%) 0 1 (1%) | I | I I I 1 I 1 [ 8 (3%) 2 (1%) | 43(15%) 95(79%) 17(63%) 34(68%) 215(75%) 22(18%) 10(37%) 13(26%) 62(22%) 2 (4%) 3 (1%) 1 (2%) 5 (2%) 1 (1%) 3 (2%) 0 X / l g )== 2 1 . 6 , p<0.05, more subjects in Group C lived in apartments XY ^ Q 2 ) 2 7 . 2 , p>0.05, the g r o u p s did not differ s i g n i f i c a n t l y ~ • - =10.6, p>0.05, the g r o u p s did not differ s i g n i f i c a n t l y (6) T a b l e VII: Distribution of the demographic variable of average number of children per f a m i l y five years of age or less and over five years of age for the subjects in the study groups GROUPS Five years of age or younger O v e r five years TOTAL 1 2 1 | I A n=87 I B | n=121 I j C n=27 I I D n=50 | j Total n=285 | I I I I I I I I 2.27 I I 1 I 1 I I I I | 1.74 I I I | 0.82 I I I I 2.56 | I I I I I I 1 I 2.08 j I I I I ! I I I 2.10 1.39 3.67 2.05 0.91 2.97 1.39 2.80 1.01 3.11 "> P^O-05, the groups do not differ significantly for number = of children five years of age or younger X ( 2 4 ) 2 8 . 4 , p>0.05, the groups do not differ significantly for total number of children T a b l e VIII: 1 1 1 GROUPS 1 Poisoning Distribution of t h e demographic variable of accidental childhood poisonings occurring in families of the s t u d y groups 1 A I n=87 1 1 | 26(301) No Poisoning 1 61(70%) No R e s p o n s e 1 1 0 1 1 I B n=121 1 I 37(31%) 1 1 I 80(66%) 1 1 1 4 (3%) 1 c I n=27 1 1 1 5(19%) 1 1 I 22(81%) 1 1 D I n=50 1 1 I 16(32%) 1 1 J 33(66%) 1 1 1 1 o 1 (2%) I I 1 1 1 I 1 1 i1 1i Total n=285 84(29%) 196(69%) 2 X £ 3 ^ 2 . 2 9 * p>0*05, the groups do n o t differ significantly for o c c u r r e n c e of poisonings 5 (2%) T a b l e IX: Distribution of v a r i a b l e s of age and sex of children involved in poisoning i n c i d e n t s in 84 families of the study groups reporting an a c c i d e n t a l childhood poisoning 1 | GROUPS A n=26 1 1 I B n=37 1 | | c n=5 1 »e of the C h i l d L„. C n 1 I 1 ! 1 1| 1 1| 5 ( 1 9 % ) I1 1 (3%) | I | 1 i 5 ( 1 9 % ) iI 11(30%) | i j 8 ( 3 1 % ) !1 16(43%) | 1 1 I 1 D n-16 1 I I Total n=84 i 1 | 0 1 1 i i 1 (6%) | 7 (8%) 2(13%) |j 18(22%) 5(31%) | 32(38%) 7(44%) || 17(20%) 1 (6%) || 5 (6%) 1 year | 2 years I 3 years 4 years | 1 (4%) |!| I 1 || 3 ( 1 1 % ) | 1 1 3(602) | '1 1 8 ( 2 1 % ) j| 1(20%) || i 0 |j 1(20%) I] 5 years 1 I 2 (8%) || 1 (3%) j| 0 1[ 0 1 3 (4%) Over 5 years | 0 1 o 1 2 (2%) 1 2 1 S e x of the C h i l d 1 1 2 (8%) | 1 1 1 1 1 1 1 I 1 5 ( 5 8 % ) I| 2 3 ( 6 2 % ) I 0 0 1 1 1 1 1 | 1 || 3(60%) 1j 1 1 1 Male 6(38%) j| 47(56%) 1 i j 1 1 ( 4 2 % ) I 14(38%) I 2(40%) |I 10(62%) | 37(44%) 1 Female 1 1 1 j1 1 I 1 1 1 ? X ~ q q ^ = 2 9 * 6 , p<0.05, G r o u p A reported more children than expected u n d e r 1 y e a r , Group A reported f e w e r than expected and G r o u p D m o r e than expected for children 3 years of age X /3%= 2 . 8 , p>0.05, the g r o u p s did not differ significantly for age of c h i l d r e n experiencing a poisoning Table X: Measures taken to treat the children involved in poisoning incidents in 84 families of the study groups reporting a n acc idental childhood poisoning* [ 1 1 1 A. I n=26 1 1 c 1 D | 1 GROUPS I n=5 I n-16 I i "" 1 1 1 Called P o i s o n Center^ 120(77%) |22(59%) I 3(60%) 1 6(38%) | j No response 1 6(23%) [15(41%) 1 2(40%) 110(62%) f 1 1 1 1 1 1 Called p h y s i c i a n ^ I 8(31%) 111(30%) 1 o I 6(38%) I 118(69%) 126(70%) 1 5(100%) (10(62%) I No response 1 1 1 ! 1 1 1 Simple treatment^ 1 1 1 1 administered-dilution 1 1 1 1 demulcent, irrigation 1 8(31%) 114(38%) I 2(40%) I 8 ( 5 0 % ) | No response j18(69%) |23(62%) I 3(60%) I 8 ( 5 0 % ) 1 ! 1 1I 1 1 1 ( 1 I 1 1 Induced vomiting^ I 7(27%) 112(32%) | 1(20%) 1 5 ( 3 1 % ) | No response 119(73%) 125(68%) I 4(80%) |11(69%) | 1 1 i1 1 1 1 1 1 Taken to emergency^ |! 1 1 1 room | 4(15%) I 8 ( 2 2 % ) 1 2(40%) I 3(19%) | No response | 22(85%) j29(78%) I 3(60%) j13(81%) [ 1 i1 1 11 1 i 1 1 1 1 Hospitalized® j 0 | 1 (3%) 1 o 1 o | No response I 26(100%) 136(97%) I 5(100%) |16(100%)| 1 1 i 1 1 I 1 1 7 Other | 3(12%) 1 3 (8%) |I 1(20%) |1 1 (6%) 1 No response 1 23(88%) |34(92%) iI 4(80%) ||15(94%) ( 1 1 1 1 1 B I n=37 *The groups do not differ significantly for any measure t a k e n . J x : f 3 x = 3 . 5 7 , p>0.05 V 3 = 3 . 2 8 , p>0.05 V ( 3 J = 1 . 9 1 , p>0.05 - X o f 3 r l . 2 2 , p>0. 05 X 6 2(3)=0*48 - xX 9 30 6 38 , s or - * P >0 ' 05 p>0.05 P>°- 05 Total n=84 51(61%) 33(39%) 25(30%) 59(70%) 32(38%) 52(62%) 25(30%) 59(70%) 1 17(20%) 67(80%) 1 (1%) 83(99%) 8(10%) 76(90%) T a b l e XI: Item Questionnaire items a s k i n g the subjects i n groups B , C , and D their assessment of the e d u c a t i o n a l p r o g r a m Question 1 Do you r e c a l l r e c e n t l y receiving a p o i s o n p r e v e n t i o n education p r o g r a m i n y o u r p h y s i c i a n * s office? 2 From the f o l l o w i n g , h o w w o u l d you r a t e the program? Excellent Good Average Fair Poor 3 What i m p r e s s e d you m o s t about the program? The p e r s o n providing it f o r you The b r o c h u r e s and m a t e r i a l s used New i n f o r m a t i o n y o u r e c e i v e d w h i c h w a s helpful Other Nothing i n p a r t i c u l a r 23 Do you h a v e additional c o m m e n t s about the program? 24 Would you l i k e to see o t h e r programs such as t h i s one c o n t i n u e d i n y o u r p h y s i c i a n ' s office? Table XII: Subjects' responses i n g r o u p s r e c e i v i n g education ( B , C , D ) to Item 2 - How w o u l d y o u rate t h e program? GROUPS F n-121 C n=27 D n=50 Total n=198 Excellent 40(33%) 12(44%) 32(64%) 84(42%) Good 70(58%) 12(44%) 18(36%) 100(50%) Average 3 (2%) 2 (8%) 0 5 (3%) Fair 0 1 0 1 (1%) Poor 0 0 0 0 No Response 8 (7%) 0 0 8 (4%) =6, (4%) (2,137) , p<0.01, group D r a t e d the p r o g r a m significantly h i g h e r than groups B and C TableXIII: 1 ! 1 t 1 1 i 1[ S u b j e c t s ' responses i n g r o u p s r e c e i v i n g e d u c a t i o n (B, C t D ) to Item 3 - W h a t i m p r e s s e d you m o s t about the program? i B C 1 i n=27 I n== 121 1I i 1 P e r s o n providing I o 1 0 11 I Did not respond Ii2i(ioo%) ;1 2 7 ( 1 0 0 % ) 1 i . _ _ 1 B r o c h u r e s and materials* 1 42 ( 3 5 % ) I 1 (4%) j GROUPS 1 1 D I n= 50 i 1 0 1 1 50(100%) 1 1 | | 1 I 1 1 I 1 I| 15 (30%) || Total n=198 0 198(100%) i 1 58 (29%) 1 79 ( 6 5 % ) |I 26 (96%) I 35 (70%) | 140 I 1 1 1 1f N e w i n f o r m a t i o n l e a r n e d ^ 1 41 ( 3 4 % ) I 13 (48%) I 26 (52%) | 80 1 1 i 1 1 1 Did not respond I 80 ( 6 6 % ) i| 14 (52%) | 24 (48%) | 118 I 1 i 1 1 1 [ Nothing In p a r t i c u l a r ^ 36 I 23 ( 1 9 % ) i1j 8 ( 3 0 % ) 1 5 ( 1 0 % ) 1 I 1 1 162 1 Did not respond I 98 ( 8 1 % ) |I 19 (70%) I 45 (90%) I 1 1 1 1 1 1 1 1 4 30 1 Other 1 18 ( 1 5 % ) 1 5 (19%) 1 r ( 1 4 % ) I 1 j 1 j Did not respond 103 ( 8 5 % ) I 22 (81%) j 43 (86%) | 168 i 1 1 2 X ^ 2 ^ = 1 0 . 6 7 P < 0 . 0 5 , s i g n i f i c a n t l y f e w e r i n G r o u p C ( v e r b a l only) impressed m o s t b y the b r o c h u r e s a n d m a t e r i a l s X / 2 s ^ 6 . 4 l t p>0« 0 5 3 the groups d i d n o t d i f f e r s i g n i f i c a n t l y p > 0 . 0 5 , the groups did n o t d i f f e r s i g n i f i c a n t l y X p > 0 . 0 5 , the g r o u p s d i d n o t d i f f e r s i g n i f i c a n t l y I Did not i respond | (71%) (40%) (60%) (18%) (82%) (15%) (85%) were T a b l e XIV: Item Questionnaire items a s s e s s i n g the subject's increase in awareness about p o i s o n i n g s and p o i s o n prevention Question 4 Have you ever h e a r d of the P o i s o n Control Center before? 5 Can you tell me w h i c h group is at the greatest risk of becoming a c c i d e n t a l l y poisoned? Children u n d e r 1 year Children b e t w e e n 1 and 5 years Adolescents Adults o v e r a g e 18 Do not k n o w Does your home c o n t a i n toxic substances? Can you name t h r e e of these p o t e n t i a l poisons in your home? What are some s t e p s y o u c a n take to poison-proof your home? Clean out m e d i c i n e cabinet Clean u n d e r the s i n k Clean out t h e g a r a g e Dispose of a t o x i c s u b s t a n c e Lock up t o x i c s u b s t a n c e s Put special locks o n doors or cabinets Use Officer Ugg Other 12 Do y o u feel that a c c i d e n t a l poisonings in children are a significant p r o b l e m ? 20 Do you know what s y r u p of ipecac is used for? T a b l e XV: 1 1 I 1 1 Subjects' responses t o Item 4 - H a v e y o u ever heard of the P o i s o n Control Center? 1 1 I GROUPS 1 A | n=87 | c B I n=27 n-121 I 1 84(97%)| 1 0 3 ( 8 5 % ) | 25(92%) 1 1 Yes I 1 No 1 1 1 1 3 (3%)| 1 1 o I 1 1 I o Did Not Know No R e s p o n s e 1 1 1 16(13%)| 1 1 1 I :1 1 1 (4%) 1 1 j 2 (2%)| 1 0 0 1 (4%) |1 1 1 1 D n=50 I 1I 44(88%) I 256(90%) 6(12%) j 26 (9%) 0 1 I 2 (1%) 0 I 1 1 (1%) 2 X Tot a.! n=285 p>0.05» the groups did n o t d i f f e r significantly Table XVI: j Subjects' responses to Item 5 - Which group is a t t h e greatest risk of b e c o m i n g accidentally poisoned? GROUPS 1 C h i l d r e n Between 1 1 and 5 Years 1 1 I C h i l d r e n Under 1 1 Y e a r , Adolescent, 1 o r O v e r 18 1 1 1 1 D o Not K n o w 1X 2 ^ £ ^ = 5 . 3 5 , 1 A I n=87 1 1 1 B n=121 1 I c n=27 1 1 | 79(91%) | 1 0 8 ( 8 9 % ) ' 25(93%) 1 1 1 1 1 1 | 2 (7%) 1 5 (6%) f 7 (6%) 1 I 1 j 1 1 I 0 1 6 ( 5 % ) | I 3 (3%) j 1 i |I 1 d n=50 1 jI Total n=285 II 9 (3%) I 49(98%) I !1 1 (2%) ! 0 1 1 1 1 p>0.05, the g r o u p s did n o t differ s i g n i f i c a n t l y 1 1 | 261(92%) 1 1 1 I 15 (5%) 1 1 1 T a b l e XVII: Subjects' r e s p o n s e s to Item 6 - Does your home contain toxic substances? GROUP j | A n=87 I | B n= 1.21 I j C n=27 | j D n-50 I Total | n=285 I H o m e does contain I 80(92%) I t o x i c substances I I 1 1 8 ( 9 8 % ) | 27(100%) j 50(1001) j 275(96%) I 1 I I (Home does not I c o n t a i n toxic I substances | I 1 | 7 (8%) I I 3 (2%) I 0 I I | 0 I I I I I 10 (4%) 2 X £ 3 j = 8 . 4 7 , pCQ.05, group A a n s w e r e d significantly more often that their h o m e s did not contain toxic s u b s t a n c e s Table XVIII: Subjects' r e s p o n s e s to Item 7 - Can you n a m e three potential poisons in y o u r home?* GROUPS Number Identified Correctly A n=80 I B n=l 18 C n=27 Total n=275 D n=50 1 (1Z) 1 (1%) I 0 2 (3%) | 2 (2%) I 0 26(22%) | 5(19%) | 4 (8%) | 47(17%) | 22(81%) | 44(88%) | 221(80%) 12(151) j 65(81%) | 90(76%) 6 (2%) 2 (4%) *0nly those answering "Yes" to I t e m 6 r e s p o n d e d to this question 1,274) ^ * P > 0 . 0 5 , the g r o u p s d i d not differ significantly Table XIX: Subjects' responses to Item 12 - Do you f e e l that accidental poisonings in c h i l d r e n a r e a significant problem? GROUPS A n=87 Yes I No I Do Not K n o w No Response n=121 j C n=27 I 24(89%) j 4 (5%) | 2 (2%) | 2 (7%) | 3 (3%) 9 (7%) 80(92%) | 1 0 8 ( 8 9 % ) I 2 (2%) | 1 (4%) | D n=50 47(94%) I 0 Total n=285 259(91%) (3%) 2 (4%) 14 (5%) 1 (2%) 4 (1%) 2 X ^ ^ = 5 . 3 5 , p > 0 . 0 5 , the groups did n o t differ significantly T a b l e XX: Subjects' responses to Item 20 - Do you know what syrup of ipecac is used for? 1 1 I GROUPS Yes I 1 I 1 1 1 1 Mo No Response 1 1 1 1 | B I n-121 1 73(84%) I 1 0 2 ( 8 4 % ) 1 1 1 1 14(16%) I 1 8 ( 1 5 % ) I | 1 1 o |' 1 (1%) 11 1 A n=87 1 | I 1 | 1 | 1 1 | 1 1 1 1 1 1 1 1 1 I 1 19(70%) | | c n=27 1 1 8(30%) | 1 0 1 1 I 1 1 1 | 1 46(92%) | 1 I 1 I 4 (8%) | 1 D n=50 o 2 X p > 0 . 0 5 , the groups d i d n o t differ significantly ! i i Total n=285 240(84%) 44(15%) 1 (1%) Table XXI: Item 8 Questionnaire items a s s s e s s i n g behavioral changes occurring in the home since the s u b j e c t s received t h e program Question Have you recently e x a m i n e d your h o m e for the p r e s e n c e of toxic substances? 10 Have you r e c e n t l y t a k e n a n y poison prevention m e a s u r e s in, your home? 11 What w e r e they? Clean out m e d i c i n e cabinet Clean under the s i n k Clean out t h e g a r a g e Dispose of a t o x i c substance Lock up t o x i c s u b s t a n c e s Put s p e c i a l l o c k s on doors or cabinets Use Officer U g g Other 19 Have you d i s c u s s e d a n y p o i s o n p r e v e n t i o n techniques with your children? 21 Do you store s y r u p of i p e c a c in your home? 22 How long have y o u k e p t it in your home? Table XXII: GROUPS Yes No Do Not Know Subjects' responses to Item 8 - H a v e you recently examined your home for toxic s u b s t a n c e s ? 1 1 I 1 9 1 | | 1 1 41(47%) | 1 1 1 1 1 1 41(47%) | 1 I 2 (2%) j 1 1 3 (4%) | 1 1 No Response X A n=87 1 I I 1 1 55(46%) | 1 1 63(52%) | 1 B n-121 o 1 1 1 3 (2%) j c n=27 Total n=285 1 | 1 1 14(52%) | 1 32(64%) j 142(50%) 13(48%) 1 16(32%) j 133(47%) 0 I 1 1 (2%) | 3 (1%) 0 j 1 1 (2%) j 7 (2%) D n=50 I j 9 3 , p > 0 . 0 5 , the groups d i d not differ significantly Table XXIII: GROUPS Subjects' responses to I t e m 10 - H a v e y o u r e c e n t l y taken any poison p r e v e n t i o n m e a s u r e s in y o u r home? I I A n=87 I j B n=121 I | C n=27 | | D n=50 Total n=285 Yes I 49(56%) | 71(58%) 1 [ I I 13(48%) | 36(72%) | 169(59%) No 37(43%) | 48(40%) j 14(52%) j 110(39%) Do Not K n o w I 1 (1%) i No Response 1 (1%) | 1 (1%) 0 11(22%) | 1 (2%) 2 (1%) 2 (4%) 4 (1%) p X ^2^=9.36, p > 0 . 0 5 , the groups did n o t d i f f e r significantly Subjects' responses to Item 19 - Have you discussed poison prevention techniques with your children? T a b l e XXIV: i | j 1 1 I j 1 i i ' i r | A I B | | n=87 | n=121 j I 1 I I I I | 45(52%) | 60(50%) | I I j GROUPS Yes No | 1 1 I I I I No Response X2/3n=6.74, I I I | i i | Total I I n=285 I 1 ' I ' I I 1 I 9(34%) | 32(64%) I 146(51%) I I I j C n=27 r | j D n-50 42(48%) I 58(48%) ! 16(59%) I 16(32%) ! 132(47%) I 1 i i i ! ! ! ! 1I I I 0 I 3 (2%) I 2 (7%) | 2 (4%) I 7 (2%) I I I I I I I I I I I p > 0 . 0 5 , the groups did not differ significantly Table XXV: Subjects' responses to I t e m 2 1 - Do you s t o r e syrup of ipecac in your home? GROUPS Store in Home | Do Not Store ( No Response 1 I | I 1 38(43%) I A n=87 45(52%) | 1 4 (5%) | 1 B n-121 1 I 53(44%) j 1 68(56%) | 1 1 l 1 0 1 1 1 C n=27 1 1 | D n=50 Total n=285 1 j | 11(41%) j 23(46%) 125(44%) | 16(59%) | 26(52%) 155(54%) i 1 (2%) 1 1 1 5 (2%) | 1 1 o 2 X ^ = 0 . 4 6 , p > 0 . 0 5 , the g r o u p s d i d n o t d i f f e r I 1 1 1 significantly Table XXVI: j Subjects' responses to I t e m 22 - H o w long have you stored syrup of ipecac i n y o u r h o m e ? GROUPS j A n=38 I After visiting the I 1 I physician office I 2 (5%) 1 1 1 1 1 Prior to visiting the I I physician's office 1 36(95%) 1 1 | I 1 I 1 1 I Could not recall I 0 [ I 1 1 B n=53 1 I c n-ll 1 1 I D n=23 I I Total n=125 1 I 1 0 ( 1 9 % ) 1 1 (9%) 1 1 1 I 4 2 ( 7 9 % ) I 10(91%) 1 1 I 1 I I 1 j ! 1 (2%) f o 8(35%) ! 21(17%) 1 1 I 15(65%) 1103(82%) 1 0 ! i 2 X ^ = 1 1 . 0 , p > 0 . 0 5 , the groups d i d n o t d i f f e r significantly i (i%) t 80 - 70 I | Group A , control 0 c. 62 87 Group B , printed + verbal 33 60 50 . 40 - A 30 - 19 20 10 Clean Garage (p<0.05) Figure 1: Dispose of Toxic Substances (p<0.05) Lock Up Poisons CSS} • / Jagg * //Hi i'./i v / J . •/Ja 10 , 16 t • I P 1 1 */ • r• / I i * / Install Special Locks <HS) Use Officer Ufig (KB) Subject's response co Xcea 9 - What are some Bteps you can take to poison- proof your hone? " (Chi square analysis, above the bars Indicate actual number of responses per group. Putting Items Out of Reach' (US) DS-not significant) The numbers •e- y 80 - • 70 - Group A., control 1**1 Group B , printed \/\ Group C , verbal ••I Group D , printed + verbal 60 50 " 40. . 30 . 20 - 10 3 r ytt Clean . Under Sink (p<0.005) Figure 2: Clean Dispose of Toxic Subs tances Garage <NS) (NS) Lock Up Poisons (NS) EL Install Special Locks (p<0.05) Subject's response to Item 11 - What were the poison prevention measures you recently took in your home? ; The numbers above the bars indicate actual number. .o£. responses per group. Use Officer Ugg (pcO.OOl) Put Items Out of Reach (p<U.05) Other (NS) (Chi square analysis, NS=not significant) APPENDIX A Solicitation "Letter to 60 P r i m a r y Health Care P h y s i c i a n s in U t a h County the intermountain regiona center Building 428 50 No. Medico! Drive Salt lake City, Utah 84132 [801] 581—2151 (emergency] (80]) 581—7504 [admin,] A u g u s t 1 3 , 1979 As you are a w a r e , accidental p o i s o n i n g is a frequent occurrence among small c h i l d r e n . Over one m i l l i o n toxic ingestions occur y e a r l y in the U . S . , and most of these i n the 18-60 month a g e g r o u p . L a s t year the Intermountain R e g i o n a l P o i s o n Control Center received 28,122 calls. Of these cases, 2488 i n v o l v e d children from Utah C o u n t y . Because m o s t of these i n g e s t i o n s a r e p r e v e n t a b l e , the IRPCC is becoming increasingly c o n c e r n e d w i t h establishing effective educational programs dealing w i t h p o i s o n p r e v e n t i o n . T h e purpose of this letter is to a s k y o u r h e l p in c o n d u c t i n g a study (within Utah County) of an e d u c a t i o n p r o g r a m for parents o f young children which could be easily a n d c o n v e n i e n t l y p r e s e n t e d i n your o f f i c e waiting r o o m . It would c o n s i s t of a packet of p r i n t e d materials f o r parents with a brief presentation a b o u t the importance of p o i s o n prevention m e a s u r e s . Minimal time w o u l d be required of one of your nurses or receptionists to make this a v a i l a b l e to y o u r p a t i e n t s . W i t h patient c o n s e n t , we would then m a k e f o l l o w - u p phone calls to each family participating to assess the impact of t h e p r o g r a m . The IRPCC w i l l be involved in supervising the p r o j e c t , training Individuals w h e r e a p p r o p r i a t e , and conducting the e v a l u a t i o n of the o u t c o m e . P l e a s e consider this offer and r e t u r n the enclosed post card indicating w h e t h e r you desire to p a r t i c i p a t e . T h a n k you. Sincerely Joseph C. Veltri, Pharm.D. Administrator JCV:sb encl. APPENDIX B Pre-Test PRE-TEST Approximately the U.S. _(number) poisonings occur yearly in T h e majority of poisonings i n v o l v e : a . children under 1 year b . children between 1 and 5 c. d. children over 5 none of the above Under which of the following c i r c u m s t a n c e s is a childhood poisoning l e a s t likely to occur? a . when the family is m o v i n g b. when a parent is ill c . when there is a guest i n the h o m e d . when dinner is being c o o k e d e. none of the above T P All poisoning accidents a r e p r e v e n t a b l e . L i s t the three most common types of poisoning. a. b. c. T F All aspirin-containing p r o d u c t s must be packaged in childresistant containers. C i r c l e each of the following h o u s e h o l d products w h i c h must have childr e s i s t a n t safety c a p s . a . Liquid bleaches d. O v e n cleaner b . Automobile antifreeze e. Rubbing alcohol c . Oil of wintergreen f. Turpentine L i s t four steps that can be taken to poison-proof a h o m e . a. b. c._ _ d. T F Syrup of ipecac is the same as universal a n t i d o t e . I n case of a poisoning you should first a . give the child milk to d r i n k b . give the child syrup of ipecac c. d. call the P o i s o n Center take the child to the hospital APPENDIX C Consent Form POISON PREVENTION EDUCATIONAL OPPORTUNITY T h i s physician's office in cooperation w i t h the Intermountain R e g i o n a l Poison Control Center i s making available a program to inform you about accidental poisonings in children and prevention of their occurrence i n your h o m e . This p r o g r a m will increase your awareness of poisonings and instruct you how to poison-proof your h o m e . W i t h your consent a brief educational p r o g r a m dealing with poison prevention will be g i v e n to you while w a i t i n g to see the physician. should only take 10-15 m i n u t e s of y o u r time. This program We will make a telephone call to you within two or three w e e k s asking you a few questions about the program. This opportunity poses no risks whatsoever to you. You may a s k questions of the p r o g r a m and may withdraw from it at any time should you so c h o o s e . Please indicate w h e t h e r y o u a r e interested in participating and complete the following i n f o r m a t i o n f o r u s . I I Y E S , I would like to p a r t i c i p a t e in the poison prevention education I I Thank y o u . program. N O , I do not w i s h to p a r t i c i p a t e at this time. SIGNATURE WITNESS (Please c o m p l e t e r e v e r s e side) APPENDIX D Demographic Data (Reverse side of Consent Form) T E L E P H O N E NUMBER NAME (please print) OCCUPATION ADDRESS M A R I T A L STATUS_ OCCUPATION SPOUSE'S NAME HOW LONG HAVE YOU L I V E D AT THE ABOVE ADDRESS? CHILDREN: DO YOU: AGES I I SEX DO YOU LIVE IN: M F |~| HOUSE M F |~| APARTMENT M F |~l DUPLEX M F |~l MOBILE HOME M F I | OTHER (Specify) OWN Y O U R RESIDENCE |~l RENT |~l LIVE WITH FRIENDS OR R E L A T I V E S I | O T H E R (Specify) APPENDIX E Telephone Survey Questionnaire P O I S O N PREVENTION PROGRAM QUESTIONNAIRE H e l l o , I'm calling from t h e Poison Control Center at the University of U t a h (Medical C e n t e r ) . C O N T R O L GROUP SKIP TO QUESTION 4 A F T E R PROVIDING D E M O G R A P H I C DATA 1. D o you recall recently receiving a poison prevention e d u c a t i o n p r o g r a m in your physician's office? 2. From t h e f o l l o w i n g , h o w would you rate the program? Excellent Good Average Fair Poor 3. W h a t impressed you the most about the program? T h e p e r s o n providing i t for you T h e b r o c h u r e s and materials used N e w i n f o r m a t i o n you received which w a s helpful Other Nothing i n particular 4. H a v e y o u ever heard of the Poison C o n t r o l Center before? 5. C a n y o u tell m e which age g r o u p Is at the greatest risk of becoming a c c i d e n t a l l y poisoned? C h i l d r e n under 1 year Children between 1 and 5 years Adolescents A d u l t s over age 18 D o not know 6. D o e s . y o u r home contain toxic substances? IF NO O R DO N O T K N O W , SKIP T O QUESTION 9 . 7. C a n y o u name three of these potential poisons in your home? 8. Have y o u r e c e n t l y examined your home for the presence of toxic substances? 9. W h a t are some steps y o u c a n take to poison-proof your home? Clean out m e d i c i n e cabinet Clean under the sink Clean out the g a r a g e Dispose of a toxic s u b s t a n c e L o c k up toxic substances Put special locks on doors or cabinets Use O f f i c e r Ugg stickers Other 10. H a v e y o u recently taken any p o i s o n prevention measures in your home? IF N O , SKIP T O Q U E S T I O N 12 11. W h a t were they? Clean out m e d i c i n e cabinet Clean under the sink Clean out the g a r a g e Dispose of a toxic s u b s t a n c e L o c k up toxic s u b s t a n c e s Put special locks o n doors or c a b i n e t s Use Officer U g g stickers Other 12. D o you feel that a c c i d e n t a l poisonings in children are a significant problem? 13. H a v e you ever e x p e r i e n c e d a c h i l d h o o d poisoning in your household? IF N O , SKIP TO Q U E S T I O N 19 14. H o w long ago did it occur? Within the l a s t three weeks More than t h r e e weeks ago Cannot r e m e m b e r 15. H o w old was your child? Under 1 year 1 year 2 years 3 yesxs 4 years 5 years Over 5 y e a r s 16. Did i t involve a boy or girl? 17. Gould you briefly describe the situation i n which it occurred? 18. W h a t was done to treat your child? Called the Poison Control Center Called the physician Gave m i l k , w a t e r , f o o d , c l e a n s e d , i r r i g a t e d , etc. Induced vomiting Taken to emergency room Hospitalized Other 19. Have you discussed p o i s o n prevention techniques with your children? 20. Do y o u know what syrup of ipecac is used for? 21. D o y o u store syrup of ipecac in your home? IF N O , SKIP T O Q U E S T I O N 23 OR CONTROL GROUP (A) GO TO THE END 22. H o w long have y o u kept it in your home? Less than t h r e e weeks (since the program) M o r e than three weeks (prior to the program) Cannot remember CONTROL GROUP (A) GO TO THE END 23. D o y o u have a d d i t i o n a l comments about the program? 24. W o u l d you like to see other programs such as this one continued in your physician's office? T h a n k you very m u c h for your cooperation and willingness to r e s p o n d . REFERENCES 1. N a t i o n a l C l e a r i n g h o u s e for Poison Control Centers. Poison c o n t r o l case r e p o r t s u m m a r y , United States 1971-1978. Washington, D . C . ; FDA B u r e a u of D r u g s , 1980. (Division of P o i s o n Control, H F D 2 4 0 ) . 2. L a c o u t u r e P , M i n i s c i M , Goveia WA et a l . Evaluation of a c o m m u n i t y based p o i s o n e d u c a t i o n program. Clin T o x i c o l . 1978; 1 3 : 6 2 3 - 9 . 3. T r u d e a u T W , Braden F M . The development of a unique, p h a r m a c y b a s e d , p o i s o n p r e v e n t i o n education p r o g r a m . Hosp T o p . 1978; 5 6 : 3 2 - 6 . 4. N o r w o o d G J , Rotello N D . An accidental poisoning prevention p r o g r a m . J Am Pharm A s s o c . 1973; IIS 13:131—8- v 5. S c h e r z R G . P r e v e n t i o n of childhood p o i s o n i n g . 1970; 17:713-27. Ped Clin N o r t h A m . 6. Scherz R G . Childhood poisonings from medications: p r o g r a m s that w o r k e d . Milit M e d . 1968; 133:911-3. 7. M a i s e l G , L a n g d o c BA, Jenkins M Q e t a l . Analysis of two surveys e v a l u a t i n g a project to reduce a c c i d e n t a l poisoning among c h i l d r e n . P u b l i c H e a l t h R e p . 1967; 8 2 : 5 5 5 - 6 0 . 8. Craig J O , Fraser M S . Accidental poisoning in childhood. In: H a d d o n , S u c h m a n , K l e i n , e d s . Accident R e s e a r c h . N e w York: Harper and Row; 1964:111-7. 9. J a c o b z i n e r H . C a u s a t i o n , p r e v e n t i o n , and control of a c c i d e n t a l p o i s o n i n g . In: H a d d o n , Suchman, K l e i n , e d s . Accident R e s e a r c h . New Y o r k : Harper and Row; 1964: 118-25. Three p r e v e n t i o n 10. I n t e r m o u n t a i n R e g i o n a l Poison Control C e n t e r . Statistics. U t a h 1 9 7 8 . Salt Lake C i t y , U t a h : University of Utah Health Sciences C e n t e r , 1979. 11. H a y e s P , Hickey K , L o v e l l S et a l . Med J A u s t . 1976; 1 : 2 3 5 - 6 . 12. T e m p l e A R . Testing of child resistant containers. 1978; 12:357-65. 13. S c h e r z R G , L a t h a m G R , Stracener C E . Child resistant containers c a n p r e v e n t p o i s o n i n g . P e d i a t r . 1969; 4 3 : 8 4 . 14. B r e a u l t H J . Five y e a r s with five m i l l i o n child resistant Clin T o x i c o l . 1974; 7 : 9 1 - 5 . 15. The P o i s o n P r e v e n t i o n Packaging Act of 1 9 7 0 , Public L a w . 9 1 - 6 0 1 , 91st C o n g r e s s , S . 2 1 6 2 , D e c e m b e r 3 0 , 1970. The storage of drugs in h o m e s . Clin T o x i c o l . containers. 16. Clarke A , W a l t o n W W . The effect of safety packaging on children's a s p i r i n i n g e s t i o n s . Consumer Product Safety C o m m i s s i o n . 1978 (August). 17. Consumer Product Safety Commission, Poison prevention packaging, W a s h i n g t o n D.C.: Food and Drug Administration, 1976. (Fact Sheet No. 46), 18. M c l n t i r e M S , Simmons D L . An e v a l u a t i o n of home v i s i t s in poison c o n t r o l . Neb Med J . 1960; 45:580. 19. lozgay D E . Prevention of accidental pediatric p o i s o n i n g . M e d . 1966; 6 5 : 8 4 3 - 4 . 20. Allen D B , Bergman A B . Social learning approaches to h e a l t h education: U t i l i z a t i o n of infant restraint devices. Pediatr. 1976; 58:323. 21. Scherz R G . Restraint systems for the prevention of i n j u r y to children in a u t o m o b i l e a c c i d e n t s . Am J Public H e a l t h . 1976; 6 6 : 4 5 1 . 22. Kanthor HA. counseling. 23. Jacobziner H , R a y b i n H . Accidental poisonings in c h i l d h o o d and their p r e v e n t i o n . J P e d i a t r . 1956; 4 9 : 5 9 2 - 6 0 6 . 24. Bain K . D e a t h due to accidental poisoning i n young J P e d i a t r . 1954; 44:616-23. 25. Ingelfinger F J . A n ounce of h i n d r a n c e (editorial). 1968; 2 7 8 : 6 2 0 - 1 . 26. Pless B I . Accident prevention and h e a l t h education: B a c k to the drawing board? P e d i a t r . 1978; 6 2 : 4 3 1 - 5 . 27. N a t i o n a l Center f o r Health Statistics. Advance d a t a , United States 1976. W a s h i n g t o n , D.C.: Department of H e a l t h , E d u c a t i o n and Welfare, 1977. (Vital and h e a l t h statistics. Public Health S e r v i c e 15:1). 28. B u r e a u of Census Population. U t a h general population characteristics, 1978. W a s h i n g t o n , D . C . : Department of Commerce, 1980. (Government Printing O f f i c e ) . 29. Physician's Directory. 30. R e h d e r T L , McCoy L K , Blackwell B et a l . Improving medication c o m p l i a n c e b y counseling and special prescription c o n t a i n e r . A m J H o s p P h a r m . 1980; 37:379-85. 31. C o l t o n T . Statistics in m e d i c i n e . Boston: L i t t l e , B r o w n , and Company; 1974. 32. K o h o u t F J , Norwood GJ: Interpretation of research data: Analysis of v a r i a n c e . A m J H o s p Pharm. 1981; 3 8 : 9 6 - 1 0 4 . Northwest Car safety for infants: Effectiveness of prenatal P e d i a t r . 1976; 58:320. children. N Engl J Med. Utah State Medical A s s o c i a t i o n , 1979.