Poisoning

Community-based Education Programs

Background

Community-based educational interventions strive for the same goals, but may involve a broader participation among the community in their implementation. Outcomes can be in the form of poisonings from national databases, calls to local poison control centers, changes in the number of "at-risk" areas at home, or some combination of these items.

Review of community-based education studies:

Authors

Johnston, 2000

Study design and target population

Controlled study.

Preschool children.

Intervention

Home visits by nurses as part of Head Start Program.

Provided syrup of Ipecac and instructions for use, information about removal of poisons.

Outcomes

Repeat home visit 3 months later.

Results

Intervention families were 2.2 fold (95% CI 1.3, 3.2) more likely to remove poisonous substances form their homes than control families. Intervention families were 4.7 fold (95% CI 3.0, 7.3) more likely to report presence of ipecac in the home.

Study quality and conclusions

Not an RCT.

Authors

Bablouzian, 1997

Study design and target population

One group pre-test, post-test design.

Boston, low income families (n=72), identified at prenatal care.

Intervention

Home visits by nurses.

Outcomes

Matched pairs analysis, n=72.

Results

There was a 32% increase in the number of households that had the phone number of poison center sticker on the phone and a 40% increase in the number of homes with Ipecac.

Study quality and conclusions

Weak study design.

No data on the effect on poisoning incidents.



Authors

Rey et al., 1993

Study design and target population

Non-equivalent control group design.

Children between 0 and 15 in the town of Chambˇry from Oct 1988, to March 1989.

Intervention

Community-based health education against childhood accidents.

Questionnaire mailed to parents before and after intervention.

Outcomes

Main comparison was change in number of calls made to anti-poison centers between intervention and comparison towns (Annecy and Haute-Savoie, respectively).

Results

Tendency toward a decrease in number of calls made to anti-poison centers among intervention families compared to control families during study period (p=0.03).

Downward trend also seen among intervention families in frequency of home accidents.

Study quality and conclusions

Overall impact of intervention is small at best; no follow-up data collected to check for decay of intervention’s effect.

Study covered wide range of ages among towns’ children; effect of intervention on children less than 5 not analyzed separately.

Study written in French.



Authors

Cooper et al., 1988

Study design and target population

Non-equivalent control group design.

Families of normal infants born at Women and Infants’ Hospital of Rhode Island between March 1985 and December 1985 (n=5264 intervention families) and all other newborns born at other Rhode Island hopsitals during same period (n=4484 control families).

Intervention

Nine-month educational campaign that included (for intervention families) free, 1-ounce bottle of syrup of ipecac, with verbal and written instructions to be followed in the event of a poisoning.

Control families received no such program.

Outcomes

All calls between March 1986 through June 1986 made to Rhode Island Poison Center that involved children between 3 and 16 months of age.

Interviewer-administered questionnaire given to 92% of callers.

Results

No significant difference between intervention families (n=6) and control families (n=2) in calls made to poison control center.

Significant difference in mean time (+ SD) between posioning and call for intervention families (5 + 3 minutes) and control families (12 + 4 minutes), p < 0.01.

Study quality and conclusions

Educational campaign and distribution of syrup of ipecac appear to be somewhat effective in improving response time of calls to poison center.

Difficult to ascertain clinical importance of response time if intervention families were encouraged to report exposures of less severity than control families.

Neither total population nor number of calls for all ages changed during study, thus removing possibility of confounding by these factors.



Authors

Harris et al., 1979

Study design and target population

Before and after design.

Children under 15 treated for poisoning at East Birmingham Hospital

Intervention

3-week educational campaign designed to collect unused medicines.

Outcomes

Incidence of accidental poisoning before and after campaign.

Results

No significant change between number of poisonings before campaign (average of 12 per week) and after campaign (average of 10.5 per week).

Study quality and conclusions

Ability of data presented to determine efficacy of intervention poor.

Yield of medicines returned considered low (11,400 containers from a population of 1.05 million).

Campaign had no immediate effect on childhood poisoning incidence.



Authors

O’Connor, 1982

Study design and target population

Before and after design.

Children 0-14 years admitted to Adelaide Children’s Hospital with accidental poisoning March 1977 to March 1978 (n=267).

Intervention

Poisoning Prevention Week (PPW), held in September 1977, including radio and television coverage, statewide promotion of syrup of ipecac, and poster contests.

Outcomes

Poisonings requiring admission to hospital before and after intervention.

Results

No significant difference between number of poisonings before intervention and after intervention. This trend held for all age groups (0-2 yrs, 2-3, 3-5, and 5-14).

Study quality and conclusions

No effect of intervention on poisonings.

Data for less than half (48%) of poisonings admitted during study period were collected.

Summary of community-based education studies

There has been one randomized controlled study examining the effect of community-based campaigns, although it showed a significant effect only in the use of telephone stickers and cabinet locks (and not in increasing the household prevalence of syrup of ipecac). Also, its results were drawn from families who were aware of and used (and owned a telephone) poison control centers. As such, its results may not be applicable to lower-income families. The remaining studies did not show any effect of the intervention on poisonings. However, these studies had some serious flaws in their designs.

Recommendations on community-based education programs

Although the studies reviewed to date indicate that there may be some benefit to community-based campaigns, the data do not warrant a recommendation for their use.

Recommendations for future research

There is a need for a rigorous randomized controlled trial assessing the effectiveness of a narrowly-focused educational campaign. Such a study might be modeled after the Seattle bicycle helmet education campaign by Rivara and colleagues (see section on bicycle injuries), informing families of ways to reduce the risk of childhood poisoning such as utilizing cabinet locks, ensuring proper closure of child-resistant caps, and knowing what to do in the event of an emergency. The outcomes of interest would be emergency room visits and hospital admissions for poisoning (and depending on the area, calls to poison control centers). Such a campaign could be repeated at regular intervals and should be tailored toward (older) children and adults.