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 (

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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