Interpretations of a teratogen warning symbol.

BACKGROUND: Warning symbols are used on teratogenic medications to communicate the message that women should (1) not take that medication if they may already be pregnant, and (2) not get pregnant while taking that medication. Communications research indicates that people interpret symbols or pictures in different ways. Other studies have shown that patients do not always receive education materials that are part of prescription protocol. Researchers at the Centers for Disease Control and Prevention (CDC) tested the interpretation of the teratogen warning symbol and its ability to convey the correct information without accompanying education. METHODS: A teratogen warning symbol currently printed on some medication packaging uses graphics and text warning the user not to get pregnant. Researchers interviewed women of childbearing age about their interpretation of the warning symbol and its meaning. Ninety-seven women were interviewed in a variety of locations, including public health clinics, literacy and job training offices, health clubs, and malls. RESULTS: Only 21% of women interpreted correctly without prompting that they should either not take the medication if they are pregnant or not get pregnant while taking the medication. Twenty-seven percent of women first thought the symbol meant the package contained birth control medication, and 24% said it simply indicated the package contained drugs or medicine. An additional 7% said they did not know what the symbol was supposed to mean; 39% of respondents offered circumstances in which prescription medications might be shared. CONCLUSIONS: Misinterpretation of warning symbols can result in serious consequences. This research should serve as an urgent call for mandating education for all patients receiving drugs with teratogenic properties, and careful pretesting and modification of warning symbols before they are used on medications with teratogenic effects. Published 2001 Wiley-Liss, Inc.

The effect of dust lead control on blood lead in toddlers: a randomized trial.

BACKGROUND: Contaminated household dust is believed to be a major source of exposure for most children with elevated blood lead levels. To determine if a vigorous dust clean-up effort would reduce this exposure we conducted a randomized controlled field trial. METHODS: We randomized 113 urban children between the ages of 6 and 36 months: 56 children to a lead dust intervention composed of maternal education and biweekly assistance with household cleaning and 57 children to a control group. Household cleaning was done by two trained lay workers who focused their efforts on wet mopping of floors, damp-sponging of walls and horizontal surfaces, and vacuuming with a high-efficiency particle accumulating vacuum. Household dust lead levels, child blood lead levels, and maternal knowledge of lead poisoning and sources of exposure were measured before and after the intervention. RESULTS: Ninety-nine children were successfully followed for 12 +/- 3 months: 46 children in the lead group and 53 children in the control group. Age and blood lead were similar in the two groups at baseline and averaged 20 months and 12.0 micrograms/dL, respectively. Blood lead fell 17% in the intervention group and did not change among controls. Household dust and dust lead measures also fell significantly in the intervention group. Children in homes cleaned 20 or more times throughout the year had an average blood lead reduction of 34%. CONCLUSIONS: Regular home cleaning, accompanied by maternal education, is a safe and partially effective intervention that should be recommended for the large majority of lead-exposed children for whom, unfortunately, removal to lead-safe housing is not an option.

Childhood lead screening knowledge and practice. Results of a New Jersey physician survey.

CONTEXT: As the nation moves toward targeted childhood lead screening, CDC continues to recommend universal screening in states with no childhood lead poisoning prevalence data. OBJECTIVE: The study was conducted, prior to the new universal screening state law, to determine physician screening practices and their consistency with key CDC recommendations as a basis for future education activities. DESIGN/SETTING/PARTICIPANTS: A statewide cross-sectional self-administered multiple choice survey of 541 randomly selected New Jersey pediatricians and family practitioners. OUTCOME MEASURES: Risk assessment, screening and case management practices and their consistency with CDC recommendations. RESULTS: We obtained 333 usable responses (69.4%). Most respondents reported confirming blood lead level, initiating case management, and identifying medical emergencies at blood lead levels lower than recommended by CDC. More than half reported not assessing the risk of the majority of their patients. At least one third were not screening infants, children between 1 and 2 years, or children between 2 and 6 years of age. Physicians who assessed risk tended to screen high-risk children in all age groups. Only 42% of pediatricians and 24% of family practitioners said they screened the majority of the children in their practice by age 2 years. About 60% of all respondents reported not providing lead exposure education to half their patients. CONCLUSIONS: Passing a universal screening law, as New Jersey has done, is one way to obtain baseline childhood lead poisoning prevalence data. Private practice-targeted physician education led by preventive medicine specialists may also be helpful.