title: Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment.
abstract: Some experts recommend eliminating "teaspoon" and "tablespoon" terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, 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.
  
  
  
  Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign.
  
  
  
  Seventy-seven percent 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 (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed "mL"-only labels (adjusted odds ratio [AOR] = 4.4 [95% confidence interval (CI), 3.3-5.8]). Odds varied based on whether "teaspoon" was spelled out or abbreviated ("teaspoon"-alone: AOR = 5.3 [95% CI, 3.8-7.3]); "teaspoon" with mL: AOR = 4.7 [95% CI, 3.3-6.5]; "tsp" with mL: AOR = 3.3 [95% CI, 2.4-4.7]; P < .001). Similar findings were noted across health literacy and language groups.
  
  
  
  Use of teaspoon units ("teaspoon" or "tsp") on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY. Electronic address: yinh02@med.nyu.edu.
authors.forename: H Shonna
authors.initials: HS
authors.lastname: Yin
authors.affiliation: Department of Medicine, Emory University, Atlanta, Ga.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY.
authors.forename: Benard P
authors.initials: BP
authors.lastname: Dreyer
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY.
authors.forename: Alan
authors.initials: A
authors.lastname: Mendelsohn
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC.
authors.forename: Stacy
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Deesha A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Jimenez
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Kwang-Youn A
authors.initials: KA
authors.lastname: Kim
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Ga.
authors.forename: Kara
authors.initials: K
authors.lastname: Jacobson
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Laurie
authors.initials: L
authors.lastname: Hedlund
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Rosa
authors.initials: R
authors.lastname: Landa
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY.
authors.forename: Leslie
authors.initials: L
authors.lastname: Maness
authors.affiliation: Department of Pediatrics, Bellevue Hospital, New York, NY.
authors.forename: Purvi
authors.initials: P
authors.lastname: Tailor Raythatha
authors.affiliation: Department of Pediatrics, School of Medicine, Emory University, Atlanta, Ga.
authors.forename: Terri
authors.initials: T
authors.lastname: McFadden
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D004348:Drug Labeling; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007802:Language; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D010290:Parents; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D044465:White People; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations
keywords: ambulatory care; dosing errors; health communication; health literacy; injury prevention; medication errors