8
Prevention and Public Education

A useful framework that helps organize thinking about poison prevention is the Haddon Matrix (Table 8-1), named for William Haddon, an early leader in the injury prevention field, and widely used in injury control to guide the development of strategies for prevention and treatment.

The Haddon Matrix is organized along two dimensions. The first is a categorization of the timing of injury into three levels: “preexposure” factors that influence the likelihood that a poisoning will occur; “exposure” conditions that influence the exposure itself; and “postexposure” conditions that influence the consequences of the exposure once it has taken place. The other dimension is organized according to the classification of host, agent, and environmental factors that influence a poisoning occurrence. Finally, the cells identify risk factors and potential interventions for all three temporal periods. For example, removing the availability of pills from the environment of a young toddler through appropriate storage is an example of a preexposure environmental intervention. Alternatively, immediate action to contact a poison control center and administer the recommended treatment for ingestion is an “exposure”-level intervention strategy based on human host action. Finally, initiating new regulations of a hazardous product that has been newly identified as causing poisoning, after the fact, is an example of a policy-level environmental response at “postexposure” level.

Public education and community outreach can contribute at all temporal levels—it can be used to teach safe product storage practices at the



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Forging a Poison Prevention and Control System 8 Prevention and Public Education A useful framework that helps organize thinking about poison prevention is the Haddon Matrix (Table 8-1), named for William Haddon, an early leader in the injury prevention field, and widely used in injury control to guide the development of strategies for prevention and treatment. The Haddon Matrix is organized along two dimensions. The first is a categorization of the timing of injury into three levels: “preexposure” factors that influence the likelihood that a poisoning will occur; “exposure” conditions that influence the exposure itself; and “postexposure” conditions that influence the consequences of the exposure once it has taken place. The other dimension is organized according to the classification of host, agent, and environmental factors that influence a poisoning occurrence. Finally, the cells identify risk factors and potential interventions for all three temporal periods. For example, removing the availability of pills from the environment of a young toddler through appropriate storage is an example of a preexposure environmental intervention. Alternatively, immediate action to contact a poison control center and administer the recommended treatment for ingestion is an “exposure”-level intervention strategy based on human host action. Finally, initiating new regulations of a hazardous product that has been newly identified as causing poisoning, after the fact, is an example of a policy-level environmental response at “postexposure” level. Public education and community outreach can contribute at all temporal levels—it can be used to teach safe product storage practices at the

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Forging a Poison Prevention and Control System TABLE 8-1 Haddon Matrix for Poison Prevention and Control Timing of Injury Human Host Agent (vector of metabolic injury) Preexposure (preexisting) Developmental aspects: —children: explore —teens: experiment —elderly: mistakes; drug interactions —addicts: overdose —workers: job related Unnecessary use of hazardous agents Toxicity of chemical Availability of agent Unanticipated exposure Eliminate production Eliminate chemicals as weapons Exposure Knowledge of what to do Knowledge of poison control center toll-free number Emergency actions: —antidotes —emetics —correct treatment Access to expert advice Dose of exposure Route of exposure Body’s reaction to agent Immediate use of antidote/ treatment Postexposure Rehabilitation: —lungs —esophagus —neurological Educate public based on cases, experience Postexposure follow-up and monitoring of victims Knowledge about correct care of poisoned host Track exposure to agents Modify hazardous agents based on information Repackaging agents NOTE: Two principles of the Haddon matrix: (1) It is not when you do something, such as eliminating production, but when the action is relevant to the time frame of the injury occurrence or mitigation. (2) An action that prevents an injury is “preevent” even if it is based on after-the-fact knowledge.

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Forging a Poison Prevention and Control System Physical Environment Social-Economic Environment Agents available: —pills —consumer products —illegal substances —terrorism Product labeling Poor storage Too many pills Safety packaging; blister packaging Protective gear for workers Workplace safety equipment Poor storage practices Poor supervision of young and old Drug-taking society Substance abuse Poor children at greater risk Substitute safer products Design homes with childproof storage areas Antidote information available Availability of emergency medical services and emergency departments Health system functioning Available antidotes Availability of telephone and transport Availability of poison control center information Regulate products Invent new products that are less toxic to replace those more toxic Repackage agents Protect workers Political and public support to regulate chemicals and change manufacturing Replace hazards Workers actually use protective gear Public knowledge and perception of poison control system

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Forging a Poison Prevention and Control System preexposure level, provide awareness of poison center services and contact information at the exposure level, and provide input to developing a positive public perception of poison control centers and poison control at the postexposure level. An important message that can be drawn from experience with the Haddon Matrix is that injury prevention can only be achieved through a multifaceted approach. Integral components of effective programs incorporate the following elements, known as the “E’s” of injury prevention and control: Education Environmental/Engineering modifications Enactment/Enforcement Economic incentives Empowerment Evaluation Education includes any efforts to reach children, parents, caregivers, the public, practitioners, the media, policy makers, and other target groups to change knowledge, attitudes, and behavior (e.g., National Poison Prevention Week, Spike’s Poison Prevention Adventure). In addition to changes in the physical environment, engineering and environmental modifications include the design, development, and manufacture of safe products (e.g., child-resistant packaging of prescription medications). Enactment and enforcement include the passage, strengthening, and enforcement of laws; the issuance and enforcement of regulations; and the development of voluntary standards and guidelines (e.g., safety cap regulations, packaging and labeling of baby aspirin and medications containing iron). As noted earlier in this report, regulations can be effective in reducing the number of human exposures (a complete listing of regulations is provided in Chapter 4). For example, an estimated 460 deaths among children ages 4 and under were prevented from 1974 through 1992 through the use of child-resistant packaging of prescription medications, a 45 percent reduction in the mortality rate from levels predicted without such packaging (Rodgers, 1996). In particular, the use of child-resistant packaging was associated with a 34 percent reduction in the aspirin-related child death rate (Rodgers, 2002). Several other studies providing evidence for the effectiveness of the Poison Prevention Packaging Act are summarized by the Harborview Injury Prevention and Research Center (http://depts.washington.edu/hiprc/childinjury/topic/poisoning/pcc.htm). Economic incentives influence the socioeconomic environment of communities through the distribution of safety products at no cost or low cost to families in need and working with manufacturers to improve safety

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Forging a Poison Prevention and Control System devices without increasing their costs (e.g., distribution of cabinet latches to prevent access to medications and household cleaners). Empowerment includes activism at the grassroots level as well as the formation of federal and private-sector advisory panels and injury prevention coalitions or partnerships at the national, state, and local levels (e.g., Health Resources and Services Administration Stakeholders Group; Poison Prevention Week Council). Evaluation includes research, data collection, and surveillance, as well as evaluation of program and product effectiveness (e.g., the Toxic Exposure Surveillance System, or TESS). This chapter focuses on public education efforts in poison prevention. These efforts have the potential to influence the health behavior of individuals in positive ways, yet as described above, they constitute only one of many factors to be considered. Public education efforts should be considered a necessary but not sufficient component in preventing and mitigating poisonings. Poison control centers have two relatively distinct education activities—primary and secondary prevention. The goal of primary prevention is to avoid the occurrence of a poisoning exposure. Examples include advising parents to lock up medication and household cleaners to keep them out of reach of young children; requiring employees who could be exposed to hazardous chemicals to wear safety equipment such as gloves, goggles, and protective clothing; and recommending storage techniques to older adults to avoid medication mishaps. Secondary prevention strives to reduce the effect of a poisoning exposure through improved access to poison control services (e.g., raising awareness of the poison control center telephone number as well as urging adults to keep activated charcoal available for use as an antidote on the explicit advice of a physician or the poison control center staff). Educators in centers offer both types of prevention by distributing brochures, refrigerator magnets, and checklists; airing videos and public service announcements; and making presentations in classrooms, at senior centers, and at health and safety fairs. Much of the educational material distributed to the public contains both primary and secondary prevention messages. An example is the widely used Mr. Yuk campaign material, which contains warning labels for poisonous substances and stickers with the poison control center telephone number for rapid access to advice and needed treatment. Although the size, content, and reach of the public education programs vary among the poison control centers, implementation generally includes a variety of cooperative arrangements involving health departments, health care facilities, pediatricians and family care practitioners, pharmacies, local retail outlets, and various private and public organizations (e.g., National SAFE KIDS Campaign, Red Cross, National Fire Prevention Association’s Risk Watch Program). In 2001, 71.3 full-time

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Forging a Poison Prevention and Control System equivalent poison control center personnel across all centers were devoted to public education. During that same year, approximately 16.8 million materials were distributed at a cost of $2.4 million, and more than 287,000 individuals attended poison education sessions organized and delivered by poison control center staff or by individuals trained by them to be trainers in their service area (American Association of Poison Control Centers, 2001, 2002a). Additional information on prevention and poison recognition is provided to the public through follow-up to exposure calls and by answering information calls. PROGRAM DEVELOPMENT AND EVALUATION: THEORIES AND MODELS As noted earlier, the purpose of public education is to change health behavior related to poisonings; that is, to influence people to (1) take the recommended actions to avoid poisonings; and (2) contact a poison control center should a poisoning occur. There is evidence from surveys and focus groups suggesting that, although a large percentage of people say they are knowledgeable about poisons, most do not take appropriate actions. According to a survey conducted by the Home Safety Council (2002), more than half of homes with children ages 6 and younger have household chemicals (e.g., cleaners, bleach, kerosene) stored in unlocked locations. The question remains: How do we provide people with the necessary knowledge and also influence them to take positive actions based on that information? According to theories of communication and behavior change, a number of variables influence the intention of an individual to perform a behavior (Institute of Medicine, 2002a). The most central of these include attitudes (how favorable a person is toward the behavior), perceived norms (the degree to which a person perceives that a given behavior is viewed as appropriate or inappropriate by members of the individual’s social network), and personal agency (the belief that one has the necessary skills and abilities to perform the behavior). In addition, there are positive and negative influences associated with the individual’s environment (e.g., lack of a telephone). Figure 8-1 provides a general model of the determinants of behavior change. The variables shown are also central in the Theory of Reasoned Action (Fishbein et al., 1991), Social Cognitive Theory (Bandura, 1977, 1986, 1991, 1994), the Theory of Planned Behavior (Ajzen, 1985, 1991; Ajzen and Madden, 1986), and the Health Belief Model (Becker, 1974; Rosenstock et al., 1994). The PRECEDE model, developed by Green in 1968 and later elaborated on by Green and Krueter in the late 1980s, provides a framework for the systematic development and evaluation of health education programs

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Forging a Poison Prevention and Control System FIGURE 8-1 Determinants of behavior. SOURCE: Institute of Medicine (2002b). that takes into account the variables discussed previously (Green and Krueter, 1991). The elaborated model, PRECEDE/PROCEED, relies on the premise that effective health education is dependent on the voluntary participation of the client in both identifying current behavioral practices and changing those practices. Furthermore, it is based on the notion that the degree of change in knowledge and practice is directly related to the degree of active participation by the client. The model specifies nine phases. The first five phases focus on program development, and the last four phases involve implementation and evaluation activities. This model has been used for a variety of applications, including developing collaborative partnerships in community health (Fawcett, 1995), promoting breast cancer screening (Taylor, 1994), and assisting in the development of public health campaigns by the Centers for Disease Control and Prevention (CDC) (Donovan, 1995). Another model used in health education-related program development and evaluation is the Program Evaluation Logic Model. It is orga-

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Forging a Poison Prevention and Control System nized in terms of program inputs (e.g., the problem being addressed, characteristics of the client’s circumstances, resources needed, and content of the program); the activities or outputs of the program; and the outcome objectives (including increases in knowledge and skills, modified behavior). The evaluation portion of this model focuses on establishing quantitative performance standards (e.g., how many individuals will change their behavior in the required direction and over what time period). This model is currently being used in Arizona to develop, implement, and evaluate the “Tell a Friend Campaign.” This campaign, discussed later in the chapter, is designed to increase poison control center access across the state through community partnerships and the distribution of multilingual educational materials. A third communication model entitled “A Su Salud” aims to change behavior by using positive role models and volunteers from the community to provide positive social support. This model has been implemented by the Texas Department of Health to encourage the use of screening for breast and cervical cancer in diverse communities (Suarez et al., 1993) and is currently being employed by the South Texas Poison Center in an attempt to increase awareness of poison center services in the Hispanic community. THE CHALLENGE OF ETHNIC DIVERSITY Current demographic trends show that the U.S. population is growing larger, older, and more ethnically diverse. Hispanics are now the largest minority and are projected to grow to 23 percent of the population by 2045. In some states, such as California, many cultures and languages are represented in the population. What are the challenges these trends pose for poison control center educators? Penetrance data available from the American Association of Poison Control Centers (AAPCC) show different levels of poison control center use in ethnically diverse and low-income communities (American Association of Poison Control Centers, 2003b). One study that illustrates different poison control center use patterns by different population segments was conducted at a Texas medical center by Kelly et al. (1997). The purpose of the study was to characterize and compare caretakers of children who failed to contact the poison control center about unintentional poisonings prior to visiting an emergency department with those who used the center first and were then referred to the emergency department. Comparisons were made by age, gender, relationship to the child, ethnicity, language preference, education, and marital status. The results showed that whites were most likely to call a poison control center, followed by Hispanics and then blacks. Also, caretakers schooled in Mexico

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Forging a Poison Prevention and Control System were significantly less likely to call a poison control center than those schooled in the United States. Although knowledge about poisonings and the availability of a poison control center differed between those who called and those who did not, 68 percent of those who did not call indicated that they knew about the center. Thus, having knowledge of the existence of the poison control center does not guarantee that an individual will call the center. Kelly et al. (2003) found that lower utilization of poison control centers by Spanish-speaking parents was attributable to a lack of confidence in center staff, greater trust in their own family physicians, and a lack of knowledge about the severity of different poisons. In this study, videotapes were used successfully to both increase knowledge and encourage changes in behavior of women attending classes at a Special Supplemental Nutrition Program for Women, Infants, and Children clinic. Conclusions were based on pre-post questions administered to matched control and treatment samples. Significant differences between the groups were found in knowledge, attitudes, and behavioral intentions following the videotape intervention. It was suggested by the authors that this intervention might prove useful in other low-income, ethnically diverse areas. CURRENT PRACTICES IN POISON PREVENTION EDUCATION Although several populations are at disproportionate risk for poisoning (e.g., the elderly, alcohol and drug abusers, workers in certain high-risk occupations), the majority of public education materials focus on preventing unintentional childhood injuries. Although poison control center education efforts cover the United States, there is substantial variability among centers in the amount of material distributed (under 7,000 pieces to more than 2 million) and the number of offsite activities (6 to more than 1,500). Some centers rely heavily on materials produced by AAPCC, while others develop their own. The focus of these efforts has been on unintentional, minor poisonings in children under 6 years of age; little effort has been directed toward prevention activities for the broader population, for serious poisonings, or for individuals intentionally poisoning themselves. A few programs have been developed based on a careful analysis of target audience characteristics such as age, ethnicity, and socioeconomic status, and have attempted to follow models in developing and evaluating their campaigns. The following sections briefly discuss the education activities of AAPCC; describe the education staff at the poison control centers; provide examples of model-based educational programs developed by centers; and describe collaborative efforts, including activities involved in National Poison Prevention Week.

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Forging a Poison Prevention and Control System Poison Prevention Education Activities of the American Association of Poison Control Centers According to a cooperative agreement with CDC, APPCC is currently working on the following tasks in the public education arena: Maintain a national toll-free telephone number for poison control services. Develop and implement a public service media campaign to familiarize health care professionals, public health professionals, and the public with poison control services. Establish a media campaign stakeholder committee composed of poison control center health educators, state health department injury prevention professionals, and representatives from relevant national organizations to guide this effort. Promote the broad use of the toll-free number by poison control centers, professionals, and the public by using materials developed by AAPCC in 2002. Conduct an independent evaluation of materials developed in 2002, such as English- or Spanish-language promotional brochures or preschool educational materials. Use formative research methods to test the effectiveness in target audiences. In positioning the national toll-free number, and in deciding on appropriate poison messages and logos, AAPCC worked with KRC Research and Consulting. The approach was to use focus groups representing senior citizens, parents (who had completed college or high school), teenagers, and preteens. These groups discussed attitudes and behaviors in poison situations, perceptions of poison control centers, messages regarding poison prevention and the use of poison control centers, various logos, and the desirability of a national toll-free number (KRC Research and Consulting, 2001). The results were used to design campaign materials in consultation with experts in public education and poisoning prevention. The primary public education messages from AAPCC are: Read the label each and every time you take a medicine or use a product or chemical. Prevent poisoning by using child-resistant packaging; locking cabinets containing medications, cleaning supplies, and other toxic substances; and putting potentially harmful products out of reach. Put your poison control center’s emergency phone number on or near every phone: 1-800-222-1222. Call the poison control center immediately in case of possible poisoning.

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Forging a Poison Prevention and Control System Call your poison control center for educational materials and for assistance with planning poison prevention education programs in your community. The national toll-free telephone number has been in effect since January 2002, and all poison control centers have been provided with stickers, brochures, and posters advertising it. KRC Research conducted a tracking survey to evaluate the usage and effects of this number (KRC Research, 2003). The results are based on a comparison of responses from random samples drawn prior to the introduction of the toll-free number and then 14 months later. The samples consisted of adults 18 years and older living in private households and representing the demographic and geographic distributions present in the population. The results showed that over the 14 months of operation, the percentage of respondents who would call the poison control center first increased from 19 to 30 percent, while the percentage who would call 911 first decreased from 63 to 49 percent. Examining the results across age groups shows that adults aged 25 to 34 were most likely to call a poison control center (45 percent) while adults aged 65 and older were least likely (14 percent). With the new national toll-free telephone number, total call volume at the Pittsburgh Poison Center increased by 11.2 percent. Comparing 2001 and 2002 trend analysis data revealed a 10 percent increase in exposure volume. Information calls dramatically increased in volume as well, probably because of toll-free access (Krenzelok and Mvros, 2003). Monthly data tracking of the number of calls to the national toll-free number shows an increase from approximately 40,000 per month in January 2002 to approximately 140,000 per month in April 2003. During the same time period, data from TESS show a fairly constant level of exposure plus information calls to poison control centers (250,000 to 300,000 per month). The cooperative agreement with CDC has been used to fund the development of a prevention program for preschoolers and their parents. The package (containing a teacher’s guide and video along with music and take-home materials) is free to schools and is distributed through the poison control centers. The Head Start program has ordered kits for its own internal distribution. This child-based program was developed though the use of focus groups to test key messages. A similar program for adults is under development. It is anticipated that the adult program will be provided in venues such as senior centers, parent/teacher association and parent/teacher organization meetings, and workplace safety meetings. The AAPCC website offers information to various audience segments. For example, poisoning fact sheets are available for specific target groups:

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations   • Seasonal Information: Test Your Poison Summer Safety IQ; Winter, Spring, and Fall sites under construction   Northern New England Poison Center (Portland, ME) • General Information • Website: http://www.fahc.org/ER/Services/Sub/vtpoison.html Oklahoma Poison Control Center (Oklahoma City) • Poison Prevention Information: Poison Prevention Week, Prevention Tips, Home Check List, What if a Poisoning Happens to You?, Is Your Purse or Diaper Bag a Deadly Weapon?, Arsine Fact Sheet, Carbon Monoxide Fact Sheet, Food Poisoning Fact Sheet, Head Lice Fact Sheet, Look-a-Like Products, Nicotine Fact Sheet, Information to Leave with the Babysitter, Poison Control Center Audio Jingle • National Poison Prevention Week • First Aid • Education Resources: Teacher’s Guides/Handouts, Games, National Poison Prevention Week Activities • Free Resources: stickers and magnets, brochures, fact sheets, teaching resources for elementary school levels • Poison-Related Links: poisonous plants, insects, mushrooms, pesticides • News Archives • Medical Professional Development: 2002 Antidote Survey, Antidote Chart • Website: http://www.Oklahomapoison.org • Links to websites of the American Association of Poison Control Centers (http://www.1-800-222-1222.org) and software (MDS Index, MSDS Search, TOXNET Web Search) • Useful links to websites of the American Academy of Pediatrics, American Association of Poison Control Centers, Animal Poison Control Center, Federal Emergency Management Agency, Hazardous Materials/Waste Disposal, National Library of Medicine Toxicology and Environmental Health and Safety, National Inhalant Prevention Coalition, N.Y.-Arts, Crafts and Theater Safety, Occupational Safety and Health Administration, SAFE KIDS Coalition, Southwest Center for Pediatric Environmental Health

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Forging a Poison Prevention and Control System Oregon Poison Center (Portland)   • Website: http://www.oregonpoison.org is no longer active Palmetto Poison Center (Columbia, SC) • Be Prepared • Epidemiology of Poisonings • Home Poison Safety Check List • First Aid Measures • An Ounce of Prevention • Order Form (not free; mostly small charge) • Website: http://www.pharm.sc.edu/pps/pps.htm • Numerous links to best sites, medical textbooks online, medical dictionary, journals, MEDLINE® access, medical search engines, and links to medical sites, searches, and links Pittsburgh Poison Center (PA) • Mr. Yuk (with audio song) • Ordering poison prevention materials • Fighting the Poisons of Terror: Understanding the Threat of Biological and Chemical Weapons • Poison Education Information with link to poison prevention materials • Website: http://www.chp.edu/clinical/03a_poison.php • Link to website of Children’s Community Pediatrics (http://www.cc-peds.net/main/index.shtm) The Poison Center (Omaha, NE) • Antidote Poster: Emergency Antidotal Management of Poisonings • 2003 Poison Prevention Week: National Poison Prevention Week • First Aid for Poisoning: What to Do if… • Poison Prevention: Steps to Prevent Poisonings, Safety Checklist • Know Your Plants: Poisonous Plants, Non-Poisonous Plants • Brochures: Steps to Prevention Poisonings, Holiday Hazards • Coloring Book: Poison Proof with Pinky • Seasonal Hazards: Spring and Summer Hazards, Autumn Hazards, Hints for Halloween, Winter Hazards • Website: http://www.Poison-Center.org • Links to websites of the American Association of Poison Control Centers, Centers for Disease Control and Prevention, Consumer Product Safety Commission, Food and Drug Administration, National Animal Poison Control Center, National Capital Poison Center, National Clearinghouse for Alcohol and Drug Information, Safety and Health Council

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations   • Teacher’s Packet: Parents Letter, Primary Program, Intermediate Program, Program and Materials Evaluation, Inhalant Fact Sheet, coloring pages • Speakers Packet: Speaker’s Manual • Videos: Primary Poison Video, Intermediate Poison Video, Adult Poison Video   PROSAR International Poison Control Center (St. Paul, MN) • Health and Safety Call Center: “PROSAR manages medical and veterinary inquiries regarding product related adverse incidents from your consumers or end users 25 hours per day, 365 days a year.” • Animal Poison Hotline • Consumer products, industrial and institutional, agricultural • Website: http://www.prosarcorp.com • Link to website of Animal Poison Hotline The Poison Control Center (Philadelphia, PA) • Children’s Education Program • Poison Prevention Tips (listing from A–Z): animal poisonings, berries and seeds, calling the poison control center, caustics, Children Act Fast…So Do Poisons, cough and cold medicines, the elderly, eye exposures, food safety, foreign bodies, glow jewelry, holiday hazards, home safety, hydrocarbons, inhalant exposure, insect repellents, mushrooms, personal care products, plants, poison facts and fiction, poison ivy, poison oak, poison sumac, rodenticides (rat poison), safer alternatives, spider bites, sting things, summertime skin irritants, syrup of ipecac, vitamins and pills • Publications: brochures, manuals, books, poster, poison pen notes • Resources for professionals • Website: http://poisoncontrol.chop.edu/ • Link to the website of The Children’s Hospital of Philadelphia (Emergency Medicine, Toxicology) • Links to website of the American Association of Poison Control Centers, National SAFE KIDS Campaign, SAFE KIDS Coalition of Southeastern Pennsylvania

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Forging a Poison Prevention and Control System Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island • The Education Program description • Prevention Tips • Basic Information About Poisons • Health and Beauty Products: perfumes and colognes, nail products, toothpaste and mouthwash, thermometers • Over-the-Counter and Prescription Medicines • Plants: Safe Plants, Poisonous Plants, How to Prevent Plant Poisonings, What to Do if You Suspect Someone Has Swallowed a Plant • Carbon Monoxide • Pesticides • Clinical Toxicology Review (alphabetical list and by month) • Annual Statistics • Website: http://www.maripoisoncenter.com • Numerous links to websites: toxicology resources, environmental health resources, pharmaceutical information resources, injury prevention resources, prevention resources in Massachusetts Rocky Mountain Poison and Drug Center (RMPDC) (Denver, CO) • Information in both English and Spanish • Educational Materials and Presentations (to be added as available) • Developments in Medical Toxicology and RMPDC News • Environmental and Public Health Projects • Poison Prevention Information News and Topics of Interest • Web-Based BT (bioterrorism) Training Available • Para Halloween (Spanish) and Halloween Poison Prevention Safety Tips (English) • What You Need to Know About Carbon Monoxide As Colder Weather Approaches (English–Spanish) • Guía de Plantas and Plant Guide (Spanish and English) • Holiday Poison Prevention Safety Tips (English and Spanish) • Information on Severe Acute Respiratory Syndrome (SARS) (multiple languages at linked website) • Emergency Action Cards—For Parents (English and Spanish) • Website: http://www.RMPDC.org • Link to website of the Metropolitan Medical Response System, Rocky Mountain Arsenal Medical Monitoring Program, Denver Center for Public Health Preparedness • Link to Colorado Department of Public Health and Environment website for SARS information • Links to websites: Proterics and Acetaminophen • Links to websites of the American Association of Poison Control Centers, Health Alert Network (HAN) Training Modules, U.S. Department of Health and Human Services, ASPCA Animal Poison Control Center

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations   • Poison Prevention Tips—Pets (English) • Plants and Children—How to Choose Plants for Your Home • Poison Safety Tips   San Jorge Children’s Hospital Poison Center (Santurce, Puerto Rico) • Information in both Spanish and English • Prevention • Website: http://www.poisoncenter.net • Links to websites of the American Association of Poison Control Centers, American Academy of Clinical Toxicology, American College of Clinical Toxicology, Texas Poison Control Network at Galveston Center, North Texas Poison Center, Arizona Poison and Drug Information Center, California Poison Control System, Central Texas Poison Center, Central Pennsylvania Poison Center, Fingerlakes Regional Poison Center, Florida Poison Information Center/Jacksonville, Kentucky Regional Poison Center, Maryland Poison Center, New Jersey Poison Information and Education System Sioux Valley Poison Control Education Center (Sioux Falls, SD) • This center provides poison prevention education and does not manage exposure cases • Website: http://www.siouxvalley.org; however, “page cannot be displayed” for the poison control center webpage on the main hospital site South Texas Poison Center (San Antonio) • Short summary page with information about poisons and prevention • Website: http://www.uthscsa.edu/surgery/poisoncenter • Website: http:////sthrc.uthscsa.edu/STIPRC/poison.htm

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Forging a Poison Prevention and Control System Southeast Texas Poison Center (Galveston) • Poison Primer: Is Your Home Poison Proof?, Syrup of Ipecac, Mr. Yuk and Children, Things to Do to Prevent Accidental Poisonings • Website: http://www.utmb.edu/setpc • Link to website of the University of Texas Medical Branch Campus in Galveston • Links to websites of the American Association of Poison Control Centers, Central Texas Poison Center, South Texas Poison Center, Texas Poison Control Network at Amarillo, West Texas Regional Poison Center Southern Poison Center (Memphis, TN)   • Website is under construction Texas Department of Health (Austin) • This department administers the funding to the six poison control centers of the Texas Poison Control Network and conducts epidemiological analyses of poison data; it does not manage exposure cases • Links can provide educational information • Website: http://www.tdh.state.tx.us/epidemiology • Link to Texas Poison Center Network • Links to websites of the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, National Institutes of Health, Texas Department of Health, State of Texas Public Health Information, World Health Organization Texas Panhandle Poison Center (Amarillo)   • Website: http://www.panhandlepoison.org

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations University of Wisconsin Hospital and Clinics (Madison) • This center provides poison prevention education and does not manage exposure cases • Poison Prevention in the Home • Poison Ivy, Poison Oak, Poison Sumac • Lead Poisoning • Heavy Metal Poisoning • Metal Toxicity: Your Brain Under Siege • Resource Materials: Pediatric Poison Prevention, Poisonous Plants Booklet, Poison Prevention for Seniors, Poison Through the Seasons, Home Poison Checklist • Poison Prevention Tips • Website: http://www.uwhospital.org • Search results for poisoning—links to related topics provided • Links to websites of the American Association of Poison Control Centers, Environmental Protection Agency National Lead Information Center and Office of Pollution Prevention and Toxics, Centers for Disease Control and Prevention, American Academy of Dermatology, National Center for Environmental Health (CDC), Occupational Safety and Health Administration, Consumer Product Safety Commission, CDC Childhood Lead Poisoning Prevention Program, Agency for Toxic Substances and Disease Registry, National SAFE KIDS Campaign Utah Poison Control Center (UPCC) (Salt Lake City) • Information in both English and Spanish; also Vietnamese and Russian • Prevention Tips • Education Materials: Order Form (materials free of charge to Utah residents), Babysitters Brochure, Poisonous Plants, Emergency Action for Poisoning, Emergency Action—Vietnamese, Emergency Action—Russian, Poison Smart Utah—A Newsletter of UPCC • More for Educators: Train-the-Trainer Program, Preventing Poisonings: Lesson Plan for Adults, Poison Safety: Lesson Plan for Elementary School Children • More for Parents and Kids: Poisonous Plants, Test Your • Website: http://uuhsc.utah.edu/poison • Links to websites of University of Utah College of Pharmacy, University of Utah Health Sciences Center, Utah Department of Health • Links to websites of the American Association of Poison Control Centers, Environmental Protection Agency, American Academy of Clinical Toxicology, American College of Medical Toxicology, Centers for Disease Control and Prevention, National Animal Poison Control Center, National Poison Prevention Week Council, Occupational Safety and Health Administration, Pregnancy Riskline,

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Forging a Poison Prevention and Control System   Poison Summer Safety IQ, activity sheets, Virtual Interactive Tour, Games for Kids • Health Information and Resources: search adult, pediatric; also in Spanish • Fact Sheets: Parents/Health Care Providers, Children, Teens/Babysitters • Health Information and Resources (searchable database of health information including, but not limited to, “poison” topics) • UPCC in the News Consumer Product Safety Commission, Utah Safety Council, Utah Department of Health Virginia Poison Center (Richmond) • Educational programs on a variety of poison prevention topics can be requested by businesses, schools, child care centers, and community groups • The Virginia Poison Center at MCV Hospitals: An Introduction for Health Care Professionals • First Aid for Poisoning • Poisoning: Don’t Let It Happen to Your Child • Poison Prevention Fact Sheet for Teen Babysitters • The Poisons of Summer • Plants: Many Are Pretty, But Some Are Poisonous • Educational Materials Order Form • Poison Prevention Videotapes • Website: http://www.vcu.edu/mcved/; links to the center Washington State Poison Center Information (Seattle) • Mr. Yuk stickers • Bioterrorism/Disaster Information • Website: http://www.doh.wa.gov.hsqa/emtp/poison.htm • Link to website of the Injury Control Resource Information Network

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations West Texas Regional Poison Center (El Paso) • Information in both English and Spanish • Community Activities: Poison Jungle Safari, Poison Prevention Poster Contest, Community Presentations and Special Events • National Poison Prevention Week and Poison Prevention Poster Contest • Virtual Field Trip • Emergency Action for Poisoning • Potentially Poisonous Products in Your Home • Poison Prevention Materials (ordering) • Bites and Stings: fire ants, tarantulas, black widow, scorpions, centipede/millipede, rattlesnakes, bees and wasps, brown recluse spider, sun spider/wind scorpion, coral snakes, nino de la tierra, first aid for bites and stings • Seasonal Information: Test Your Poison Summer Safety IQ; other sites • Website: http://www.poison.org • Links to websites of the American Association of Poison Control Centers, Thomason Hospital, Texas Poison Center Network, Southwest Center for Pediatric Environmental Health, Animal Poison Control Center, Consumer Product Safety Commission West Virginia Poison Center (Charleston) • Hotline Newsletters • Electronic School Newsletter • Order forms • Stickers • Pamphlets • Audio-Visual Materials List • Information about speakers and health fairs • Plants: Toxic Plants, Non-Toxic Plants, West Virginia Summer Wildflowers, Poisonous Plants of the Southern United States, Living With Holiday Plants • Website: http://www.hsc.wvu.edu/charleston/wvpc/ • Link to West Virginia Chemical Emergency Procedures website • Links for kids to Sparky the Fire Dog, Agency for Toxic Substances and Disease Registry, Child Health Programs, Carbon Monoxide Information, EPA Explorers Club, EPA Student Center, Kidd Safety, Internet Public Library—Poison Prevention Site • Links for teachers to Join Hands Educational

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Forging a Poison Prevention and Control System   • Hazardous Materials • Inhalant Abuse • Kids Corner: Product Safety, Career Rap: Toxicologist, Rap Sheet: How to Use Consumer Products Safely, How Many?, Riddles, Word Search, Where Does Mr. Yuk Go?, Poison Prevention Game • “Prevention Central”: Your Community Bulletin Board (listing of events, photographs) • Media Topics: Party Mix—Alcohol, Holiday Safety, Jimson Weed, What’s Your Resolution, Hobby Safety, Halloween, Poison Ivy, Poison Oak, Poison Sumac, Poisoning Myths, National Childhood Lead Prevention Week, Poison Prevention Week, New Nationwide Telephone Number • Pesticides: Understanding a Pesticide Label, Pesticide Regulations • Your Home: Prevention Tips, Unintentional Poisoning of Children: The Statistics, Protect Children from Iron Poisoning, Senseless Poisoning from Carbon Monoxide • Bites and Stings: bees and wasps, spiders, caterpillars, snakes • Lead Poisoning • Poisoning and Pets • National Poison Prevention Week Foundation publications page and National SAFE KIDS Teachers’ Desk • Media links to local television stations and newspapers • Link to websites of the American Association of Poison Control Centers, National Pesticide Information Center, Food and Drug Administration, National Lead Information Center, National Animal Poison Control Center, American Veterinary Medical Association, West Virginia Animal Shelter, Cornell University—Poisonous Plants Webpages, Dr. C. Everett Koop, Healthtouch Online, KidsHealth.org, National Safety Council, National Fire Protection Association, Partners in Health Network, West Virginia Medical Institute, West Virginia State Fire Marshal, RxFactStat, Marshall University’s West Virginia Websites Index, West Virginia’ Public Employees Insurance Agency “Pathways to Wellness” Program, State of West Virginia, University of Charleston, West Liberty State College, West Virginia Department of Health and Human Resources, West Virginia Kids Count Fund, West Virginia University, West Virginia Division of Natural Resources, Agency for Toxic Substances and Disease Registry, American Red Cross, Chemical Emergency Preparedness and Prevention Office, National Safety Council: Guides to Chemical Risk Management, Kanawha Putnam Emergency Planning Committee, South Charleston West Virginia Community Advisory Panel

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Forging a Poison Prevention and Control System Name Accessible on Web Page Website Links to Other Organizations Western New York Poison Center (Buffalo) • What is a Poison? • What Substances Are Most Commonly Involved in Poisoning? • How Can Poisonings be Prevented? • What is carbon monoxide poisoning? • Information About Lead Poisoning • Information for Childcare Providers, Teachers, and Educators—presentations can be requested and teaching packets with guidelines, statistical data, examples for displays, activity sheets, and handouts for parents are available on request as well; videos that teach children about household dangers are available on loan • Website: http://www.chob.edu/poison