Poisoning Interventions
Warning Labels
Background
Warning labels are usually colorful stickers
(with a picture of a scowling face and its protruding tongue) placed on containers
of hazardous substances ostensibly in order to warn children to stay away. In the
United States, these stickers are commonly referred to as Mr. Yuk (  ) and were developed by the National Poison Center in Pittsburgh. The
efficacy of this intervention can be measured by observing changes in poisonings
before and after the introduction of warning labels to a certain population, as
well as observing children’s behavior toward the warning labels.
Review of warning label
studies:
Author | Vernberg et al., 1984 |
Study design and target population | Randomized controlled trial.
Children age 12 to 30 months (n=20). |
Intervention | Mr Yuk warning labels and educational instruction (5
minutes in each of two sessions) for intervention group only. |
Outcomes | Touching containers with Mr. Yuk labels. |
Results | Experimental group showed a significantly increased
preference for Mr. Yuk-labeled containers compared to control group (p=0.02). |
Study quality and conclusions | Small sample size; developmental difference in age
range studied.
Mr. Yuk labels appear to attract children.
No evidence that intervention was understood
by subjects. |
Author | Fergusson et al., 1982 |
Study design and target population | Non-equivalent control group design.
Families with 2-year-olds participating
in the Christchurch Child Development Study, Christchurch, NZ (n=1156). |
Intervention | Mr Yuk warning labels and instructional information
for intervention families only.
No intervention for control group. |
Outcomes | Hospital records of childhood poisonings among the
two groups. |
Results | No significant difference in subsequent poisonings
between intervention and control group.
Poisonings were not affected by compliance
to program. |
Study quality and conclusions | Good study to determine effect of Mr. Yuk stickers.
No evidence supporting reduction in poisonings from
intervention.
Intervention may actually increase
risk of poisoning because of colorful sticker on medicine container. |
Summary of warning label studies
Of the two studies examining the effectiveness
of warning labels, one actually showed an increase in children’s handling of
the labeled medicine. The other study showed no effect of the intervention, but
did hint that the warning labels may increase the risk of poisoning. It is clear
from the studies to date, warning stickers are not a good deterrent for children.
Recommendations on warning label programs
At this time, these colorful warning stickers
cannot be advocated for use as a deterrent for children. This is especially true
for toddlers, who may not understand the meaning of the sticker’s image (even
though older children may benefit from its appearance). The usefulness of the label
appears to be only in the phone number for the local Poison Control Center.
Recommendations for future research
An appropriate approach to examine whether
a different type of warning sticker (say, a black and white design; or perhaps something
not as cartoonish) is effective in deterring children from handling medicine is
a randomized controlled trial. The study by Vernberg and colleagues11
was a good attempt at such a study. Such studies should
examine children of different age categories, keeping in mind the developmental differences
between, for example, a toddler and a 4-year old.
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