HHS Public Access Author manuscript Author Manuscript
Acad Pediatr. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Acad Pediatr. 2016 ; 16(8): 734–741. doi:10.1016/j.acap.2016.04.012.
Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment
Author Manuscript
H. Shonna Yin, MD, MSa,b, Ruth M. Parker, MDc, Lee M. Sanders, MD, MPHd, Benard P. Dreyer, MDa, Alan Mendelsohn, MDa, Stacy Bailey, PhD, MPHe, Deesha A. Patel, MSf, Jessica J. Jimenez, BAa, Kwang-Youn A. Kim, PhDg, Kara Jacobson, MPHh, Laurie Hedlund, MAf, Rosa Landa, BAd, Leslie Maness, BAa, Purvi Tailor Raythatha, BSca, Terri McFadden, MDi, and Michael S. Wolf, PhD, MPHf H. Shonna Yin: [email protected]; Ruth M. Parker: [email protected]; Lee M. Sanders: [email protected]; Benard P. Dreyer: [email protected]; Alan Mendelsohn: [email protected]; Stacy Bailey: [email protected]; Deesha A. Patel: [email protected]; Jessica J. Jimenez: [email protected]; Kwang-Youn A. Kim: [email protected]; Kara Jacobson: [email protected]; Laurie Hedlund: [email protected]; Rosa Landa: [email protected]; Leslie Maness: [email protected]; Purvi Tailor Raythatha: [email protected]; Terri McFadden: [email protected]; Michael S. Wolf: [email protected] aPediatrics,
NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
bPopulation
Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, United
States cMedicine,
Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, 30322, United
States
Author Manuscript
Corresponding author: H4. Shonna Yin, MD, MS, New York University School of Medicine, Department of Pediatrics, 550 First Avenue, NBV 8S4-11, New York, NY 10016; Telephone: (646) 501-4284, Fax: (212) 263-8172; [email protected]. Conflict of Interest: The authors have no conflicts of interest to report. Preliminary findings from this study were presented in part at the 2015 Pediatric Academic Societies meeting (April 25, 2015 in San Diego, CA), as well as at two meetings of the CDC Prevention of Overdoses & Treatment Errors in Children Taskforce (PROTECT) initiative (November 13, 2014 and November 4, 2015 in Atlanta, GA). Financial Disclosure: Drs. Bailey, Parker, and Wolf, and Ms. Jacobson, have served as a consultant to, and received grant funding, from Merck, Sharp and Dohme for work unrelated to this study.
Author Manuscript
CONTRIBUTOR STATEMENT Dr. Yin and Ms. Patel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors made contributions as delineated below. Study concept and design: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Kim. Acquisition, analysis, or interpretation of data: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Critical revision of the manuscript for important intellectual content: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Statistical analysis: Patel, Kim, Yin, Wolf, Dreyer, Mendelsohn. Obtained funding: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Kim. Administrative, technical, or material support: Yin, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Study supervision: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Jacobson, Patel. All authors have approved the final manuscript as submitted. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Yin et al.
Page 2
dPediatrics,
Author Manuscript
Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
ePharmaceutical
Outcomes and Policy, UNC Eshelman School of Pharmacy, 2204 Kerr Hall, Chapel Hill, NC, 27599, United States
fDivision
of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States gPreventive
Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
hRollins
School of Public Health Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United
States iPediatrics,
Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, USA, 30322
Author Manuscript
Abstract OBJECTIVE—Some experts recommend eliminating “teaspoon” and “tablespoon” terms from pediatric medication dosing instructions, as they may inadvertently encourage use of nonstandard tools (i.e. kitchen spoons), which are associated with dosing errors. We examined whether use of “teaspoon” or “tsp” on prescription labels affects parents’ choice of dosing tools, and the role of health literacy and language.
Author Manuscript
METHODS—Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids study), which randomized English/Spanish-speaking parents (n=2110) of children ≤8 years old to 1 of 5 groups which varied in unit of measurement pairings on medication labels/dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy measured using the Newest Vital Sign. RESULTS—77.0% had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either “tsp” or “teaspoon” units (alone or with “mL”) chose nonstandard dosing tools (i.e. kitchen teaspoon, kitchen tablespoon), compared to 8.3% who viewed “mL”-only labels (AOR=4.4[95%CI: 3.3–5.8]). Odds varied based on whether “teaspoon” was spelled out or abbreviated (“teaspoon”-alone: AOR=5.3[3.8–7.3]); “teaspoon” with mL: AOR=4.7[3.3–6.5]; “tsp” with mL (AOR=3.3[2.4–4.7]); p0.05 for all characteristics). Two thousand and ninety-six parents completed the assessment of dosing tool preference and are included in this study analysis. Characteristics of the study sample are shown in Table 2. Over half of parents were Hispanic, and a third Black, non-Hispanic. Nearly 80% of parents had an annual household
Acad Pediatr. Author manuscript; available in PMC 2017 November 01.
Yin et al.
Page 6
Author Manuscript
income
Acad Pediatr. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Acad Pediatr. 2016 ; 16(8): 734–741. doi:10.1016/j.acap.2016.04.012.
Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment
Author Manuscript
H. Shonna Yin, MD, MSa,b, Ruth M. Parker, MDc, Lee M. Sanders, MD, MPHd, Benard P. Dreyer, MDa, Alan Mendelsohn, MDa, Stacy Bailey, PhD, MPHe, Deesha A. Patel, MSf, Jessica J. Jimenez, BAa, Kwang-Youn A. Kim, PhDg, Kara Jacobson, MPHh, Laurie Hedlund, MAf, Rosa Landa, BAd, Leslie Maness, BAa, Purvi Tailor Raythatha, BSca, Terri McFadden, MDi, and Michael S. Wolf, PhD, MPHf H. Shonna Yin: [email protected]; Ruth M. Parker: [email protected]; Lee M. Sanders: [email protected]; Benard P. Dreyer: [email protected]; Alan Mendelsohn: [email protected]; Stacy Bailey: [email protected]; Deesha A. Patel: [email protected]; Jessica J. Jimenez: [email protected]; Kwang-Youn A. Kim: [email protected]; Kara Jacobson: [email protected]; Laurie Hedlund: [email protected]; Rosa Landa: [email protected]; Leslie Maness: [email protected]; Purvi Tailor Raythatha: [email protected]; Terri McFadden: [email protected]; Michael S. Wolf: [email protected] aPediatrics,
NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
bPopulation
Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, United
States cMedicine,
Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, 30322, United
States
Author Manuscript
Corresponding author: H4. Shonna Yin, MD, MS, New York University School of Medicine, Department of Pediatrics, 550 First Avenue, NBV 8S4-11, New York, NY 10016; Telephone: (646) 501-4284, Fax: (212) 263-8172; [email protected]. Conflict of Interest: The authors have no conflicts of interest to report. Preliminary findings from this study were presented in part at the 2015 Pediatric Academic Societies meeting (April 25, 2015 in San Diego, CA), as well as at two meetings of the CDC Prevention of Overdoses & Treatment Errors in Children Taskforce (PROTECT) initiative (November 13, 2014 and November 4, 2015 in Atlanta, GA). Financial Disclosure: Drs. Bailey, Parker, and Wolf, and Ms. Jacobson, have served as a consultant to, and received grant funding, from Merck, Sharp and Dohme for work unrelated to this study.
Author Manuscript
CONTRIBUTOR STATEMENT Dr. Yin and Ms. Patel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors made contributions as delineated below. Study concept and design: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Kim. Acquisition, analysis, or interpretation of data: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Critical revision of the manuscript for important intellectual content: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Statistical analysis: Patel, Kim, Yin, Wolf, Dreyer, Mendelsohn. Obtained funding: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Kim. Administrative, technical, or material support: Yin, Patel, Jimenez, Kim, Jacobson, Landa, Maness, Tailor Raythatha, Hedlund, McFadden. Study supervision: Yin, Wolf, Parker, Sanders, Dreyer, Mendelsohn, Bailey, Jacobson, Patel. All authors have approved the final manuscript as submitted. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Yin et al.
Page 2
dPediatrics,
Author Manuscript
Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
ePharmaceutical
Outcomes and Policy, UNC Eshelman School of Pharmacy, 2204 Kerr Hall, Chapel Hill, NC, 27599, United States
fDivision
of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States gPreventive
Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
hRollins
School of Public Health Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United
States iPediatrics,
Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, USA, 30322
Author Manuscript
Abstract OBJECTIVE—Some experts recommend eliminating “teaspoon” and “tablespoon” terms from pediatric medication dosing instructions, as they may inadvertently encourage use of nonstandard tools (i.e. kitchen spoons), which are associated with dosing errors. We examined whether use of “teaspoon” or “tsp” on prescription labels affects parents’ choice of dosing tools, and the role of health literacy and language.
Author Manuscript
METHODS—Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids study), which randomized English/Spanish-speaking parents (n=2110) of children ≤8 years old to 1 of 5 groups which varied in unit of measurement pairings on medication labels/dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy measured using the Newest Vital Sign. RESULTS—77.0% had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either “tsp” or “teaspoon” units (alone or with “mL”) chose nonstandard dosing tools (i.e. kitchen teaspoon, kitchen tablespoon), compared to 8.3% who viewed “mL”-only labels (AOR=4.4[95%CI: 3.3–5.8]). Odds varied based on whether “teaspoon” was spelled out or abbreviated (“teaspoon”-alone: AOR=5.3[3.8–7.3]); “teaspoon” with mL: AOR=4.7[3.3–6.5]; “tsp” with mL (AOR=3.3[2.4–4.7]); p0.05 for all characteristics). Two thousand and ninety-six parents completed the assessment of dosing tool preference and are included in this study analysis. Characteristics of the study sample are shown in Table 2. Over half of parents were Hispanic, and a third Black, non-Hispanic. Nearly 80% of parents had an annual household
Acad Pediatr. Author manuscript; available in PMC 2017 November 01.
Yin et al.
Page 6
Author Manuscript
income
