Children's recognition of dangerous household products: child development and poisoning risk

Unintentional poisoning exposures: how does modeling the opening of child-resistant containers influence children's behaviors?

OBJECTIVE

Unintentional poisoning in the home is a risk for children. Over-the-counter medicinal products in child-resistant containers (CRC) are common causes of pediatric poisoning. The current study examined children's abilities to open three types of CRC mechanisms (twist, flip, and push) and corresponding control containers, comparing their ability to do so spontaneously and after explicit modeling. The study also examined if inhibitory control (IC) was associated with children's overall score for spontaneous openings.

METHOD

Children 5-8 years old were randomly assigned to one of three mechanism conditions (between-participants factor): twist, flip, and push, with each child experiencing both a risk and a control container (within-participants factor) having that mechanism. Children were first left alone with a container (measures: engagement with container, spontaneous opening) for up to 2 min and subsequently observed an adult explicitly model opening the container before the child was asked to do so (measure: opening after modeling).

RESULTS

Children were more engaged with and likely to spontaneously open control containers than CRCs, though some (4%-10%) also opened CRCs. After modeling, significantly more children opened each of the three types of CRCs, with nearly all children opening the push mechanism CRC. IC positively predicted children being more engaged with and spontaneously opening more containers.

CONCLUSIONS

Implications for improving pediatric poison prevention are discussed.

Childhood poisonings: Effects of ambiguous product characteristics on preschool children's categorization of household chemicals

This study investigated preschool children's categorization and risk perception of products with ambiguous product characteristics (e.g., food-like packaging). These characteristics make it difficult for preschool children to categorize household chemicals correctly. This, therefore, increases the risk of unintentional poisoning. We hypothesized that ambiguity arises from different product characteristics, such as the type of packaging, the products' scent, or the packaging's color and transparency. In four behavioral tasks, N = 108 preschool children (M = 43 months, SD = 3) categorized different products and household chemicals with various types of packaging, colors, and scents. Individually wrapped dishwasher tablets were more likely to be categorized as edible than unwrapped ones. Furthermore, children who had interacted with any type of dishwasher tablet in the last 6 months performed better in identifying dishwasher tablets, regardless of packaging type. Household chemicals with a fruity scent were more likely to be categorized as drinkable than those with a chlorine scent. Finally, the children considered black bottles more dangerous and preferred them less than bottles of a different color. In contrast, bottle transparency generally did not seem to affect risk perception and preference. These findings confirm that ambiguous product characteristics influence children's categorization of unknown products and, thus, their risk perception and decision-making. Manufacturers and caregivers are advised to reduce the ambiguity of household chemicals by designing more neutral product packaging and choosing products with more neutral elements, respectively.

Seeing household chemicals through the eyes of children-Investigating influential factors of preschoolers' perception and behavior

INTRODUCTION

Children who encounter household chemicals run the risk of unintentional injury. The aim of this study was to understand which factors heighten children's attention or misguide their decision-making concerning household chemicals. We hypothesized that certain product attributes (i.e., label, packaging, closure types), storage context, and parental beliefs play a role in this setting.

METHOD

We conducted a laboratory study with N = 114 children (M = 45 months, SD = 6.5) and their parents (M = 38 years, SD = 4.92). Children completed a series of behavioral tasks in which they had to choose between products with different attributes, identify products in different storage contexts, and sort household chemicals.

RESULTS

The results confirmed that the children preferred products with cartoon-style labels compared to products without such labels. However, children's decision-making did not differ for products with different closure types (child-resistant vs sprayer-type closures). Regarding the storage context, our results showed that the children particularly struggled to identify dishwashing tabs when they were stored with other food items rather than household chemicals. In terms of parental beliefs, our study found that parents rated more household chemicals as child-safe than their children did.

PRACTICAL APPLICATION

Parents should buy household chemicals with neutral labels and pay attention to how their household chemicals are stored. Manufacturers should consider potential adverse effects when developing new product designs.

Tears for pears: Influence of children’s neophobia on categorization performance and strategy in the food domain

Preschoolers’ neophobic dispositions mainly target fruits and vegetables. They received a great deal of attention in the past decades as these dispositions represent the main psychological barrier to dietary variety. Recently, children’s food neophobia has been found to be negatively correlated with their categorization performance (i.e., the accuracy to discriminate between food categories). We investigated categorization strategies among neophobic children, tendencies to favor one type of error over the other (misses over false alarms), in order to compensate for their poor categorization performance. To capture children’s categorization strategies, we used the Signal Detection Theory framework. A first experiment assessed 120 3-to-6-years old children’ sensitivity to discriminate between foods and nonfoods as well as their decision criterion (i.e., response strategy). In a second experiment, we manipulated the influence of food processing. The hypothesis was that food processing acts as a sign of human interventions that decreases uncertainty about edibility and thus promotes feelings of safety in the food domain. 137 children were tested on a food versus nonfood categorization task contrasting whole and sliced stimuli. In both experiments, increased levels of food neophobia were significantly associated with poorer categorization sensitivity and with a more conservative decision criterion (i.e., favoring “it is inedible” errors). Additionally, results from Experiment 2 revealed that food processing did not influence neophobic children, whereas their neophilic counterparts adopted a more liberal decision criterion for sliced stimuli than for whole stimuli. These findings are the first demonstration of a relationship between a decision criterion and food neophobia in young children. These results have strong implications for theories of food neophobia and laid the groundwork for designing novel types of food education interventions.

Effective communication with caregivers to prevent unintentional injuries in children under seven years. A systematic review

OBJECTIVE

This review systematically examines the theory base and effectiveness of communication strategies (i.e., message content, message attributes, communication channels, and communicators) of interventions for caregivers to prevent unintentional child injuries.

METHODS

Relevant articles were searched in the databases Communication and Mass Media Complete, PsycInfo, Pubmed, and Google Scholar, the journal Injury Prevention, and the literature of included studies. A total of 71 articles reporting 67 different studies were included and fully coded. Quality was assessed using the Mixed Methods Appraisal Tool. Coded categories and their frequencies are described, and the effectiveness of different communication strategies is explored with crosstabs.

RESULTS

Only 17 studies stated the use of a specific theory base; Precaution Adoption Process-Model, Theory of Planned Behavior, and Health Belief Model were most often used. The message content of most studies aimed at knowledge dissemination; however, addressing behavioral determinants, such as risk perception and self-efficacy, was more effective. About half of the studies did not elaborate on message attributes; calls to action, exemplars, and tailoring were most often used, the latter being most effective. Communication channels ranged from printed products to face-to-face communication and digital media. In addition, studies specifying interpersonal communicators were highly effective.

CONCLUSION

The results of the review suggest that the following aspects can contribute to effective communication in child injury prevention: theory-based communication, addressing broad knowledge and further behavioral determinants, digital tailoring, and health professionals as communicators. However, a conclusive statement on the effectiveness of different communication strategies is hampered by the fact that they are not specified and/or confounded in many studies.

PRACTICE IMPLICATIONS

Communication strategies should be theory based and address, in addition to knowledge, behavioral determinants such as risk perception and self-efficacy. Moreover, digital tailoring is an advanced way of enhancing effectiveness and health professionals, such as pediatricians and clinic staff, are important multipliers.

Consumers' decision-making process when choosing potentially risky, frequently used chemical household products: The case of laundry detergents

Chemical household products are a common cause of accidents in the domestic sphere. Despite such products being associated with certain risks in the event of swallowing or contact with the skin or eyes, they are used in nearly every household worldwide for hygiene purposes. In most European countries, chemical household products feature warnings of the Globally Harmonized System (GHS) as well as other warnings. In this eye-tracking study (N = 147), which was conducted in a virtual environment, we examined (i) whether consumers use such warnings when choosing a laundry detergent, (ii) whether they consider information irrelevant to risk assessment and (iii) whether they make use of this information for their final product choice. For this, the participants were split randomly into three experimental groups (a risk priming group, an effectiveness priming group, and a control group) that each received different tasks while purchasing a laundry detergent. The results indicate that the warnings found on laundry detergents are effective when they are used, although the majority of consumers do not look at the warnings. Therefore, we suggest that the alternative placement of warnings or the use of simplified warnings should be considered to improve consumers' awareness of potential risks.

The influence of packaging on consumers' risk perception of chemical household products

Chemical household products are found in most households. If consumers are to safely handle such products, they need to be aware of the risks posed by the particular product they are using. Although most countries require that chemical household products feature warning labels (e.g. the Globally Harmonized System of Classification and Labelling of Chemicals), consumers appear to also use other cues to determine the risks associated with a specific product. Thus, we studied the influence of packaging on consumers' risk perception of chemical household products. More specifically, we examined the effect of the colour of the packaging (black or pink packaging versus the original packaging) as well as the presence of images of flowers or food-imitating elements on the packaging. Significant differences with regard to consumer's risk perception were found in terms of all four studied manipulations. Therefore, we conclude that consumers' risk perception can be influenced by the packaging design. In particular, if elements that lower consumer's risk perception (e.g. featuring flowers on the label and food-imitating elements on the packaging) are omitted from the packaging, consumers might be able to more accurately judge the risks associated with a product and so take appropriate safety precautions.

Poisoning-related emergency department visits: the experience of a Saudi high-volume toxicology center

BACKGROUND

Acute poisoning is a major contributing factor to mortality and morbidity. There is a lack of research on the epidemiology of acute poisoning risk factors in Saudi Arabia.

OBJECTIVES

Descriptive overview of poisoning cases at a tertiary care center.

DESIGN

Descriptive, medical record review.

SETTINGS

Tertiary care center in Riyadh.

PATIENTS AND METHODS

From the electronic medical record system, we collected demographic information, medical history, and the poisoning history on all emergency department visits diagnosed as acute poisoning from January 2016 to January 2021. Patients were classed as children (<18 years old) or adults, and further classified by body mass index.

MAIN OUTCOME MEASURES

Intensive care unit (ICU) admission, organ transplantation, and mortality were classified as poor outcomes.

SAMPLE SIZE

492 adults and 1013 children (<18 years old) were identified.

RESULTS

The most frequent agent in poisoning for both groups was acetaminophen (n=52, 10.57% and n=100, 9.87%, respectively). The ICU admission rate was 6.7% and 4.8%, and the mortality rate 0.8% and 0.3%, respectively. The accidental poisoning rate was 57.7% among adults (n=284) and 67.6% among children (n=658). The suicide intention rate was 11.2% (n=55) and 7.4% (n=75) among adults and children, respectively. The management for both populations was nonspecific, involving observation, supportive measures, and symptomatic treatment.

CONCLUSION

Although the ICU admission rates were consistent with reported data, the mortality rate was marginally lower. The pediatric predominance in the population implies a lack of caregiver education in the region regarding the safe storage of drugs and household products, as well as the use of child-resistant packaging. The high rate of accidental poisoning in both age groups should prompt further investment to promote public health education on the rational use and safe storage of toxic agents and self-protection. The high suicide intention rate needs to be investigated to develop multidisciplinary risk prevention strategies.

LIMITATIONS

Single center, retrospective, small population size.

CONFLICT OF INTEREST

None.

Bee stings in Brazil: Epidemiological aspects in humans

Bees are insects of the order Hymenoptera and are involved in human accidents. In Brazil, bees that cause accidents are crosses derived from Europeans with African bees and are known for their aggressive behavior. Despite being considered an important public health concern, epidemiological studies at the national level are scarce. The objective of this study was to verify the epidemiological profile of bee accidents in humans in Brazil, using data from 2009 to 2019 of the Brazilian Ministry of Health. It was found that bee accidents increased by 207.61% from the first to the last year of the present study. The incidence varied according to the geographical region; the southern region had more bee accidents, but the Northern region had more deaths caused by bee accidents. Besides, climatic conditions were associated with susceptibility to bee stings; the incidence was higher during spring and summer. Age was also associated with fatality rate, with the elderly being the group with the highest fatality rate. Our results demonstrate that accidents caused by bees involve factors related to patients, the environment, and the behavior of bees. It is important to know the epidemiological aspects to help prevent apidic accidents.

Maternal depression and childhood injury risk: A population-based cohort study in Denmark

AIMS

To assess the association between different stages of maternal depression and injury risk in offspring aged 0-10 years.

METHODS

Population-based cohort study of all live-born children in Denmark from 1 January 1997 until 31 December 2013 (n = 1,064,387). Main outcome measure was emergency department contacts with a main diagnosis of injury coded as DS00-DT98 (chapter XIX) according to the ICD-10. All information was obtained from Danish national registries.

RESULTS

Maternal depression was associated with higher injury hazard in the offspring throughout childhood compared to offspring of mothers with no history of depression. The strongest association was seen for the first year of life. First-time maternal depression was most strongly associated with injury in the child, especially in the first year of life (aHR = 1.70, 95% CI: 1.48-1.96). Children of mothers with relapse depression had 1.57 higher hazard of injury in the first year of life (aHR: 1.57, 95% CI: 1.44-1.70). Children of mothers with previously treated depression (postdepression) had 1.13 higher hazard of injury in the first year of life (aHR: 1.13, 95% CI: 1.09-1.17). Continuous treatment for depression was associated with a nonsignificant higher hazard of injuries in the first year of life (aHR: 1.06, 95% CI: 0.91-1.23).

CONCLUSIONS

Maternal depression was associated with higher injury risk in the offspring, particularly in early childhood. The association persisted in children of mothers with relapse depression. Our results suggest that children of mothers with depression are vulnerable several years after depression onset and treatment cessation.

The exploration of size and toddler interaction with liquid laundry detergent capsules

Liquid laundry capsules have been involved in multiple poisoning incidents with young children in the home. There are a range of contributing factors for these incidents, including influences from industry, culture, home environments, and parenting/supervision. There also are influences from children’s behaviour and decisions in reaction to potential hazards. Previous research examined the influence of capsule product appearance and colour on children’s behaviour around hazardous household items, but little research examines the influence of product size. This research explored if differences in the size of liquid laundry capsules result in different levels of toddler interaction. We compared two commercially available capsule designs that are identical in physical appearance but differ in physical size. Our research was conducted using three studies: Study 1, forced-choice test in an out-of-context laboratory setting; Study 2, an ecologically-valid, simulated real-world setting replicating a home laundry cabinet with a container of capsules left open; and Study 3, a second ecologically-valid study replicating a home laundry cabinet, this time with a capsule left outside its container. Capsule interaction was measured by grasping choice among samples of 156 toddlers ages 9–36 months. The same sample was used for Studies 1 and 2, and a second identically sized sample recruited for Study 3. Results from Study 1 indicated toddlers selected the small (49.8% selection) and large (50.2%) capsule with nearly identical frequency. Study 2 largely replicated Study 1: Toddlers selected the small capsule or container of small capsules 26.8% of the time and the large capsule or container of large capsules 22.3% of the time. Study 3 also replicated previous findings: Toddlers selected the smaller capsule 18.0% of the time and the larger 19.2%. We discuss study results, which suggest no appreciable difference in toddler’s grasping choice to smaller versus larger laundry capsules.

Consumers' perceptions of chemical household products and the associated risks

Accidents with chemical household products are prevalent worldwide and often involve young children. Previous research has shown that consumers use both analytical factors (e.g., warning symbols) and potentially misleading heuristics to evaluate the riskiness. However, it remains unclear whether consumers intuitively think of the specific risks of these products when handling them. We conducted an online survey with Swiss consumers (N = 1109) aiming to investigate consumer's spontaneous and prompted risk perception of chemical household products. First, we asked them about their free associations to laundry detergent, descaler, mold remover and essential oils. While participants were aware of the risks when prompted about them, they did not name them intuitively, but mainly thought of the possible uses and attributes of the product. Next, we examined prerequisites to safe handling of chemical household products. This included applied knowledge about the products, but also factors like perceived barriers to safe use. Finally, we assessed the predictors of perceived severity of accidents in order to estimate the potential behavioral changes that these predictors might elicit. For interventions, particular attention should be accorded to personal risk awareness and the perception of potential barriers, which were significantly related to the perceived severity of accidents.

Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India

Extensive use of different chemicals in various fields and their easy availability has led to an increased incidence of accidental and intentional poisoning in developing countries including India. A diverse range of household products commonly used for domestic purposes comprise pesticides, household cleaners, thermometer mercury, antiseptics, kerosene, paint thinners etc. Any of these products, if misused or mishandled can cause poisoning. In India, the National Poisons Centre (NPIC) at the All India Institute of Medical Sciences, New Delhi, provides information on management of poisoning to treating physicians. Analysis of data based on telephone calls received by the NPIC (April 2006-March 2016) has highlighted a high incidence of poisoning due to household products, followed by pharmaceuticals, agricultural pesticides and industrial chemicals. The objective of the present retrospective study was to determine the incidence of poisoning due to various household products as reported to the NPIC during the ten years period. The total number of calls received by the Centre was 16,420. There were 7114 calls (45.5%) due to household products with adults (>18yrs.) and children (<1-18yrs.) constituting 38.7% and 61.2% calls respectively. Males outnumbered females (M = 62.4%, F = 37.5%). The mode of poisoning was mainly unintentional (66.8%) followed by intentional mode (33.2%). The commonest route of exposure was oral (95.6%). Household pesticides were commonly implicated (43.7%) followed by household cleaners (21.8%), thermometer mercury (5.2%) naphthalene balls (5%), antiseptics (3%), kerosene (2%) and paint thinner (2%). Miscellaneous products comprising of camphor, silica gel, hair dye, nail polish remover, cosmetics, adhesives etc were also involved in poisoning (17.1%). The trend and pattern of poisoning varies in different parts of the country, because all calls on poisoning are not reported to the Centre. So the data as such may not be a true reflection of the scenario in India. However, the results do indicate an increasing incidence of poisoning due to household products especially in children. The probable reasons for high incidence could be careless storage, ignorance, non compliance with prescribed instructions for use and negligible parental supervision in case of children. The results of the study highlight, an urgent need to identify high risk circumstances, common toxic products involved and implementation of prevention and awareness programmes, to achieve poisons control at home.

Assessing the Role of Shape and Label in the Misleading Packaging of Food Imitating Products: From Empirical Evidence to Policy Recommendation

Food imitating products are chemical consumer items used frequently in the household for cleaning and personal hygiene (e.g., bleach, soap, and shampoo), which resemble food products. Their containers replicate elements of food package design such as possessing a shape close in style to drinking product containers or bearing labels that depict colorful fruits. In marketing, these incongruent forms are designed to increase the appeal of functional products, leading to chemical consumer product embellishment. However, due to the resulting visual ambiguity, food imitating products may expose consumers to the risk of being poisoned from ingestion. Thus, from a public health perspective, food imitating products are considered dangerous chemical products that should not be sold, and may merit being recalled for the safety of consumers. To help policymakers address the hazardous presence of food imitating products, the purpose of this article is to identify the specific design features that generate most ambiguity for the consumer, and therefore increase the likelihood of confusion with foodstuffs. Among the visual elements of food packaging, the two most important features (shape and label) are manipulated in a series of three lab studies combining six Implicit Association Tests (IATs) and two explicit measures on products' drinkability and safety. IATs were administered to assess consumers' implicit association of liquid products with tastiness in a within-subject design in which the participants (N = 122) were presented with two kinds of food imitating products with a drink shape or drink label compared with drinks (experiential products with congruent form) and classic chemical products (hygiene products) (functional products with congruent form). Results show that chemical consumer products with incongruent drink shapes (but not drink labels) as an element of food package design are both implicitly associated with tastiness and explicitly judged as safe and drinkable. These results require confirmation in other studies involving different shapes and labels. Notwithstanding, due to the misleading effect of this ambiguity, public health authorities are thus well advised to focus their market surveillance on chemical products emulating a food or drink shape.