title: Refining teratogen warning symbols for diverse populations.
abstract: BACKGROUND
  The current research reports on efforts to refine the design of recently developed teratogen warning symbols and to examine their interpretation by different populations such as those with low health literacy, adolescents, and individuals who are not fluent in English.
  
  
  METHODS
  Alternative symbols identified as most successful in an earlier study were further refined through the use of multiple focus groups and expert review. Six symbols emerged as potential candidates to replace the current symbol. A nationally distributed field trial (n = 700) examined these six alternate teratogen warnings in addition to the symbol presently in use.
  
  
  RESULTS
  Five of the alternate warning symbols exceeded the level of correct interpretation elicited by the current symbol. No symbol exceeded the ANSI limit of 5% critical confusion. Two symbols consistently elicited the most accurate responses in terms of message interpretation, target audience, intended action, and perceived consequences of ignoring the warning.
  
  
  CONCLUSIONS
  This effort produced at least two viable alternative symbols that appear to be more effective than the current symbol at communicating both the instruction to not take while pregnant and the consequence that exposure could cause birth defects. Several results varied by participant characteristics. Understanding how members of diverse subpopulations might interact with these warnings should be informative to healthcare professionals.
authors.affiliation: North Carolina State University, Raleigh, North Carolina 27695-7650, USA. Chris_Mayhorn@ncsu.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Mayhorn
authors.forename: Richard C
authors.initials: RC
authors.lastname: Goldsworthy
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D002648:Child; D018864:Cultural Diversity; D004348:Drug Labeling; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010353:Patient Education as Topic; D011247:Pregnancy; D011795:Surveys and Questionnaires; D013561:Symbolism; D013723:Teratogens; D014481:United States
chemical_list: D013723:Teratogens