Mobilizing Evidence Into Action - “How hot is your tap water?” Health Communication Campaign Joanne Kaashoek Toronto Public Health January 16, 2006

Presentation Overview Why This Issue? NACCARS data The Campaign Components & duration Preliminary Evaluation Data Next Steps – Advocacy Policy Network

Flash / flame (12.5%) Electrical (6.8%) Chemical (4.0%) Contact (30.8%) Scalds (43.5%) CHIRPP, 1999 Database % types of burns

Spilled tea or coffee (34.7%) Hot food (28%) Cooking (15.5%) Tap water (7.1%) CHIRPP, 1999 Database % types of scalds

Tap Water Scalds Data In Canada: 300 children, elderly people and people with disabilities are treated in hospital with tap water injuries every year. Safe Kids Canada, 2003

Children 1- 4 years of age: Fire / Burn / Scald (ICD9 E , 924) 37.9/100,000 (Toronto) 28.3/100,000 (Ontario excluding Toronto) Hospital Inpatient Data Provincial Health Planning Database Local data on burns

Hot Tap Water Burns Children > 6 Six Years In Ontario: 158 visited emergency rooms 17 hospitalized 2003 Ambulatory Visits & Hospital Inpatient Data, MOHLTC.

Who is scalded most frequently? Children under two years of age 59.6% treated with follow-up 27.2% admitted to hospital CHIRPP, 1999 Database

Required hospitalization (28% vs 12%) Prolonged hospitalization (21-35 days) for pain control, fluid balance, and multiple surgeries. Over $ 5 million annually initial treatment costs Hospitalization & costs Safe Kids Canada, 2003

Rationale: Why focus on this issue? Support Ontario Building Code Serious Injury Preventable - Passive Interventions

Developing a Campaign Position Parents’ knowledge and awareness Legislative & education initiatives Hot water heaters & risk of legionellosis

A common cause of serious burn injuries to children is tap water scalds. Health Canada Focus Groups Safe Kids Canada, 2001 Toronto Public Health Focus Groups, 2004 Parental knowledge and awareness

Water heaters in Canada are set at 60C (140F). Legislation

Water temperature <49C Built in anti-scald device Anti-scald device at outlet of water heater Point of use anti-scald devices Ontario Building Code September, 2004

Health Canada’s preferred option Store high, deliver low Oil and gas fired water heaters No evidence to show risk in healthy population Electric water heaters Maintain at 60C Hot Water Heaters & Risk of Legionellosis

Campaign Position Hot Water Heater Recommend anti-scald devices as first option. Turn gas or oil water heaters down only: Single dwelling home Not at risk for Legionnaires’ disease

Campaign Components

Key Messages: “How hot is your tap water?” Hot tap water is a common cause of serious burns to children. Protect your child from a serious injury by controlling the temperature of your hot water.

Key Messages: “How hot is your tap water?” Test the temperature of your hot water. Reduce the temperature of your water to 49C with simple one-time only changes to plumbing systems.

Secondary Messages: “How hot is your tap water?” Do not alter the temperature of your hot water heater if: Electric Certain health conditions Safety tips for bathing children

Campaign Launch Phase 1 November TTC Bus Shelter 385 Internal Subway Ads Brochure Poster 8 Newspaper Ads Phase 2 Sept 2005 – March ,000 Water bill insert 221 TTC bus shelter 660 Internal subway ads Brochure & poster Retail strategy

Campaign Pre-test Item: Measured hot water temperatures Reduced hot water temperatures %Yes % No %DK

How did you reduce the temperature of hot water in your home? Item: Temperature controls at base of water heater Temperature controls in bathroom or kitchen Turned down the water heater %Yes % No % NA

Campaign Pre-test Have you ever: Used tap guards to block your child’s access to the hot water tap? Heard of the “How hot is your tap water?” campaign %Yes % No %DK

Process Evaluation November – Dec visits to hot tap water page 291 PDFs downloaded 4,500 brochures 3 requests to reproduce materials Jan - September ,320 brochures 5,136 posters 470,000 water bills Requests for 6,593 brochures, 187 posters

RRFSS Post Campaign Evaluation Have you heard about the “How hot is your tap water?” campaign? Heard % Not heard %

How helpful was the information? RRFSS Post Campaign Evaluation

Have you used the information? RRFSS Post Campaign Evaluation

How have you used this information? RRFSS Post Campaign Evaluation CountPercent±95% CI Made changes in my home (e.g. turned down water heater, child- proofed) Supervised/watched children more carefully Changed how I do things (e.g. use back burners, spill-proof mugs)

Next Steps - Targeted Dissemination Pre-kindergarten packages Day cares Retail strategy Evaluation of the Campaign RRFSS Internet Panel

Next Steps - Advocacy and Policy Building Codes Cost benefit analysis Enforcement of the Ontario Building Code

Childhood IP Policy Network Draft terms of reference Outreach to ECD-IP contacts Policy development support Identification of other Priority IP issues and policy strategies Provincial body to support