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entitled 'Consumer Product Safety Commission: Better Data Collection 
and Assessment of Consumer Information Efforts Could Help Protect 
Minority Children' which was released on August 5, 2009. 

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Report to Congressional Committees: 

United States Government Accountability Office:
GAO: 

August 2009: 

Consumer Product Safety Commission: 

Better Data Collection and Assessment of Consumer Information Efforts 
Could Help Protect Minority Children: 

GAO-09-731: 

GAO Highlights: 

Highlights of GAO-09-731, a report to congressional committees. 

Why GAO Did This Study: 

In 2004, the U.S. Consumer Product Safety Commission (CPSC) estimated 
that 29,400 deaths in the United States were related to consumer 
products. As required under Section 107 of the Consumer Product Safety 
Improvement Act of 2008, this study reviews what is known about the 
relative incidence of preventable injuries and deaths among minority 
children associated with products intended for children's use and also 
examines what actions CPSC has taken through its public information and 
education initiatives to minimize these injuries and deaths. To address 
these issues, we assessed injury and death data sources used by CPSC, 
compared CPSC’s consumer education efforts with key practices, and 
interviewed federal officials and groups representing the health and 
consumer interests of minority populations. 

What GAO Found: 

Few studies have assessed racial and ethnic differences in child death 
rates from injuries related to consumer products, and CPSC has not 
analyzed whether specific racial or ethnic groups are 
disproportionately affected by product hazards because of data 
limitations. These limitations include incomplete and inconsistent race 
and ethnicity data on emergency room reports and the inconsistent 
presence of product-related information on death certificates. In 2007, 
race and ethnicity data were not coded in about 31 percent of cases in 
CPSC’s National Electronic Injury Surveillance System (NEISS), which 
collects data from a nationally representative sample of hospital 
emergency rooms. In addition, the hospitals that do record race and 
ethnicity information in CPSC’s NEISS system do so inconsistently, in 
part because of limited CPSC guidance. While death certificates may 
include more complete race and ethnicity information compared with 
nonfatal injury data from hospitals, related product information is not 
consistently documented on the certificates. 

Despite this lack of data, CPSC has developed or modified some consumer 
information efforts to reach specific minority populations, but it has 
not assessed the results of these efforts. CPSC provides information in 
Spanish for many of its outreach efforts, including its telephone 
hotline, Web site, television, radio, and print publications. CPSC has 
also identified and established relationships with other organizations 
to help disseminate consumer safety information to minority 
communities. And while CPSC has used some consumer input to develop 
safety information, it has not assessed outreach efforts for specific 
audiences. CPSC has also established goals for its overall consumer 
information efforts, but not for its messages targeted to specific 
populations. In addition, CPSC relies on its Neighborhood Safety 
Network, a group of organizations that have expressed interest in 
receiving product safety information, to share information with 
audiences that can be hard to reach, but the agency has not assessed 
whether these populations are receiving and using the information. 
Organizations we contacted for this report, including Neighborhood 
Safety Network members and children’s safety groups, generally reported 
using safety information provided by CPSC, but some offered suggestions 
for improvement of efforts to reach minority communities, such as 
providing safety information in other languages and additional exposure 
through broadcast media. 

What GAO Recommends: 

GAO recommends that CPSC develop and implement cost-effective means of 
improving data collection on factors that may contribute to any 
differences in the incidence of consumer product-related injury and 
death. GAO also recommends that CPSC develop and implement cost-
effective ways to enhance and assess the likelihood that safety 
messages are received and implemented by all the intended audiences. 
CPSC and the Department of Health and Human Services (HHS) agreed with 
GAO’s recommendations. 

View [hyperlink, http://www.gao.gov/products/GAO-09-731] or key 
components. For more information, contact Cornelia M. Ashby at (202) 
512-7215 or ashbyc@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

Few Studies Assess Racial and Ethnic Differences in Children's Risk of 
Death from Injuries Related to Consumer Products, and Data Limitations 
Constrain CPSC Analysis: 

CPSC Has Developed or Modified Some Consumer Information Efforts to 
Reach Specific Minority Populations, but Has Not Assessed the Results 
of These Efforts: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Objectives, Scope, and Methodology: 

Appendix II: Key Practices for Consumer Education Planning: 

Appendix III: Comments from the Department of Health and Human 
Services: 

Appendix IV: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Table: 

Table 1: Key Practices for Planning Consumer Education Campaigns: 

Figures: 

Figure 1: CPSC Consumer Information Methods: 

Figure 2: Estimated Percentage of NEISS Cases Missing Race and 
Ethnicity Information, 1999-2007: 

Figure 3: Portion of NEISS Hospitals with Various Percentages of Cases 
Not Coded for Race and Ethnicity, 2007: 

Figure 4: Examples of CPSC Consumer Information: 

Abbreviations: 

CDC: Centers for Disease Control and Prevention: 

CPSC: U.S. Consumer Product Safety Commission: 

CPSIA: Consumer Product Safety Improvement Act: 

HHS: Department of Health and Human Services: 

IHS: Indian Health Service: 

MCHB: Maternal and Child Health Bureau: 

NEISS: National Electronic Injury Surveillance System: 

NCHS: National Center for Health Statistics: 

NSN: Neighborhood Safety Network: 

[End of section] 

United States Government Accountability Office: 
Washington, DC 20548: 

August 5, 2009: 

Congressional Committees: 

The U.S. Consumer Product Safety Commission (CPSC), an independent 
federal agency charged with protecting the public from consumer 
products that pose an unreasonable risk of injury and death, estimated 
that 29,400 deaths in the United States related to consumer products 
occurred in 2004.[Footnote 1] CPSC works to fulfill its broad mission 
in part by conducting research into the causes and prevention of 
product-related deaths, illnesses, and injury and assisting consumers 
in evaluating the comparative safety of consumer products. CPSC has 
identified certain populations as vulnerable or hard to reach with 
safety information, including older Americans, urban and rural low- 
income families, new parents, and minority groups. Consumer groups and 
researchers have also suggested that minority children, particularly 
those living in low-income communities, may face an increased risk of 
death from injuries because of factors associated with living in 
poverty, such as poor living conditions and less access to health care, 
quality recreational activities, and safety devices. Similarly, reports 
from the Centers for Disease Control and Prevention (CDC) have 
documented racial disparities in injury-related death rates among 
children. 

The Consumer Product Safety Improvement Act of 2008 (CPSIA) established 
consumer product safety standards and other safety requirements for 
children's products. It also contained a provision requiring GAO to 
study disparities in the risks and incidence of preventable injuries 
and deaths among children of minority populations related to consumer 
products intended for children's use.[Footnote 2] Specifically, GAO is 
to look at preventable injuries and deaths related to suffocation, 
poisoning, and drowning, including those associated with the use of 
swimming pools and spas; toys; cribs, mattresses, and bedding 
materials; and other products intended for children's use. Minority 
populations specified in the mandate include Black, Hispanic, American 
Indian, Alaska Native, Native Hawaiian, and Asian/Pacific Islander. 
[Footnote 3] The mandate also required GAO to provide information about 
ways to minimize risks of preventable injuries and deaths among 
minority children, including through consumer education initiatives. To 
address this mandate, we examined (1) what is known about the relative 
incidence of preventable injuries and deaths related to drowning, 
poisoning, and suffocation associated with products intended for 
children's use among minority children compared with nonminority 
children, and (2) what actions CPSC has taken through its public 
information and education initiatives to minimize child injuries and 
deaths, including those in minority populations, related to products 
intended for children's use. 

To answer these questions, we reviewed studies and reports by the 
Institute of Medicine, federal agencies, researchers, and other 
organizations that assessed racial or ethnic differences in injury and 
death among children and related studies that discussed injury 
prevention programs targeted to minority populations.[Footnote 4] We 
reviewed injury and death data sources used by CPSC to estimate product-
related injuries and deaths. We interviewed federal officials at CPSC 
and five Department of Health and Human Services (HHS) organizations to 
learn about their related programs and initiatives. In addition, we 
obtained information about injury data, racial and ethnic disparity 
issues, and injury prevention campaigns from researchers, 
representatives of injury prevention programs, consumer groups, and 
groups representing the health and consumer interests of minority 
populations. Finally, we reviewed CPSC documents and interviewed CPSC 
officials regarding the development, operation, and evaluation of the 
agency's consumer information efforts. We compared the processes used 
by CPSC with key practices identified by experts in GAO's previous work 
on consumer information and education.[Footnote 5] The key practices 
include defining goals and objectives; analyzing the situation; 
identifying stakeholders; identifying resources; researching target 
audiences; developing consistent, clear messages; identifying credible 
messengers; designing media mix; and establishing metrics to measure 
success. Appendix I explains our scope and methodology in more detail. 

We conducted this performance audit from December 2008 through August 
2009 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

Background: 

CPSC was created in 1972 under the Consumer Product Safety Act to 
regulate consumer products that pose an unreasonable risk of injury, 
assist consumers in using products safely, develop uniform safety 
standards for consumer products, minimize conflicting state and local 
regulations, and promote research and investigation into product- 
related deaths, injuries, and illnesses. CPSC oversees about 15,000 
types of consumer products used in the home, in schools, and in sports 
and recreation. In fiscal year 2008, CPSC carried out its mission with 
a budget of about $80 million and 396 full-time employees. Prior to 
2008, CPSC experienced significant budget cuts and a sharp decline in 
its staffing level from a high of 978 employees in 1980. Congress 
appropriated increased funding totaling about $105 million for fiscal 
year 2009. This appropriation funds a staffing level of 483 full-time 
employees, according to CPSC's 2010 budget request. 

CPSC Efforts to Inform Consumers about Product Hazards: 

CPSC uses different methods to inform the public about product recalls 
and safety practices that can help prevent product-related injuries 
(see figure 1). CPSC maintains a National Injury Information 
Clearinghouse that disseminates information to the public related to 
deaths and injuries associated with consumer products under the 
agency's jurisdiction. CPSC also warns the public about product hazards 
by announcing product recalls and providing other safety information 
through print and electronic media, a telephone hotline, electronic 
mail, and the Internet. For example, CPSC works with manufacturers to 
provide public notice of product recalls, in which a defective item is 
to be removed from store shelves and consumers are alerted to return 
the item for repair, replacement, or refund, or otherwise dispose of 
them. To further its reach, CPSC also provides safety information to 
broadcast outlets, such as radio and television stations, and to print 
media outlets. According to CPSC officials, CPSC has allocated 
approximately $1 million annually to support its consumer information 
efforts and has nine employees in the Office of Public Affairs, the 
office responsible for developing and implementing CPSC's consumer 
information efforts in consultation with CPSC's technical experts and 
other CPSC staff. Congress appropriated funding in 2009 to help CPSC 
administer the Virginia Graeme Baker Pool and Spa Safety Act, including 
about $2.4 million for a state grant program and over $4 million for a 
program to inform the public and pool owners of pool and spa hazards to 
prevent children from drowning. 

Figure 1: CPSC Consumer Information Methods: 

[Refer to PDF for image: illustrated table] 

CPSC Consumer Information Methods: 
* Telephone hotline; 
* Web site (Press releases, recall alerts, wireless cell phone access, 
podcast recordings, video news releases,e-publications for download); 
* E-mail notification service; 
* Television (broadcast interviews, video news releases); 
* Radio news releases; 
* Print publications (CPSC posters/safety information, newspaper and 
magazine articles). 

Sources: CPSC and Art Explosion (photos). 

[End of figure] 

Recently passed legislation requires CPSC to improve its consumer 
information activities. For example, the Consumer Product Safety 
Improvement Act (CPSIA) requires CPSC to develop an online database 
that is publicly available and searchable by date, product name, model, 
and manufacturer. The database must contain reports of harm relating to 
the use of consumer products. CPSIA also specifies the information that 
must be included in a mandatory product recall notice, including 
details about related injuries and deaths. The act also authorizes CPSC 
to require manufacturers to give public notice in languages other than 
English, although this provision applies only to mandatory recalls, 
according to CPSC officials.[Footnote 6] 

Related Department of Health and Human Services Efforts: 

While CPSC is charged with protecting the public from unreasonable 
risks of injury and death from the thousands of types of consumer 
products under the agency's jurisdiction, HHS offices and agencies also 
play a role in injury prevention by conducting injury prevention 
research and information campaigns, collecting injury data, and 
promoting the health of minority populations. For example, according to 
agency officials and documents, CDC and the National Institutes of 
Health support research on a variety of topics, including injury 
prevention, and have conducted public information campaigns to reduce 
childhood injury. CDC's National Center for Health Statistics (NCHS) 
collects information about injuries, including race and ethnicity 
characteristics, from death certificates in all 50 states and the 
District of Columbia, as well as from household surveys and health care 
provider surveys. The Maternal and Child Health Bureau (MCHB) and the 
Indian Health Service (IHS) finance public health services, including 
injury prevention programs. HHS offices and agencies also lead efforts 
aimed at understanding and addressing racial and ethnic disparities in 
health care, including rates of unintentional injury among minority 
groups. For example, HHS's Office of Minority Health serves as a focal 
point within HHS to coordinate efforts to improve racial/ethnic 
minority health and eliminate racial/ethnic health disparities. The 
Office of Minority Health is charged with providing leadership and 
coordination for offices of minority health operating in other HHS 
agencies and in states to reduce racial and ethnic health disparities, 
according to agency officials. CDC is the lead agency charged with 
measuring progress toward national HHS goals to eliminate disparities 
in injuries, disabilities, and deaths due to unintentional injuries and 
violence. 

Injury and Death Data Sources Used by CPSC: 

CPSC collects and analyzes data on consumer product-related injuries 
and deaths for products under its jurisdiction to determine where 
hazards exist and how to address them. CPSC obtains most of its 
information on injuries from its National Electronic Injury 
Surveillance System (NEISS), which gathers information from a 
nationally representative sample of about 100 hospital emergency rooms. 
NEISS provides national estimates of the number and severity of 
emergency room-treated injuries associated with, although not 
necessarily caused by, consumer products in the United States. 
Characteristics coded in the NEISS system include the date of 
treatment; the patient's age, gender, race and ethnicity, injury 
diagnosis, body part affected, case disposition; incident location; as 
well as the product involved. In 2000, NEISS was expanded to provide 
data on all trauma-related injuries. The expanded data provide other 
federal agencies, researchers, and the public with more comprehensive 
information on injuries from all sources, not just consumer products. 
CPSC receives approximately $2 million each year from CDC to support 
this effort. 

CPSC obtains most of its information on fatal injuries from death 
certificates. Information recorded on death certificates includes the 
date and place of death, cause of death, age, gender, race and 
ethnicity, and residence of the deceased. CPSC estimates the number of 
consumer product-related deaths from data collected by NCHS about all 
deaths through the National Vital Statistics System. Because of the 
complexity and volume of collecting information about all deaths, there 
is over a 2 year lag before NCHS mortality data become available. 
According to a CPSC official, to obtain more timely information, CPSC 
annually purchases about 8,000 death certificates directly from states 
for selected causes of death that the agency has determined are likely 
to be product-related, such as bicycle accidents or falls involving 
playground equipment. 

CPSC supplements information from the NEISS system and death 
certificates with reports from individual consumers and with data from 
private organizations such as fire prevention groups and poison control 
centers. CPSC collects approximately 4,600 additional reports from 
participating medical examiners and coroners throughout the country, 
about 7,400 news clips, and 14,300 other reports of product-related 
injuries and deaths from consumers, lawyers, physicians, fire 
departments, and other sources, according to its 2010 performance 
budget request. 

Few Studies Assess Racial and Ethnic Differences in Children's Risk of 
Death from Injuries Related to Consumer Products, and Data Limitations 
Constrain CPSC Analysis: 

Few Studies Assess Racial and Ethnic Differences in Child Death Rates 
from Injuries Related to Consumer Products: 

Although some research suggests racial disparities in child death rates 
resulting from general causes of injury--including drowning, poisoning, 
and suffocation--we identified few studies that assessed racial and 
ethnic differences in child death rates from injuries related to 
consumer products. The studies we identified included two that 
identified racial and ethnic disparities in drownings in swimming pools 
and a study that identified a disparity between black and white infants 
in the risk of suffocation or strangulation in bed. We did not identify 
any studies that compared the incidence of poisoning related to 
consumer products by children's race and ethnicity. While these studies 
identified racial and ethnic differences in death rates related to 
specific products, the researchers were not consistently able to 
consider all factors that may contribute to these differences, such as 
differences in exposure to the consumer products. 

Drowning: 

Mortality data reported by CDC suggest racial disparities in drowning 
rates, although these data do not specify whether the deaths involved 
consumer products. Drownings can occur in a variety of settings, such 
as natural water settings, swimming pools, bathtubs, and buckets. 
According to CDC, between 2000 and 2005, the fatal unintentional 
drowning rate of black children ages 5 to 14 was 3.2 times that of 
white children in the same age range. For American Indian and Alaska 
Native children, the fatal drowning rate was 2.4 times higher than for 
white children. 

One study, conducted by researchers from HHS's National Institutes of 
Health, CPSC, and a research institute, found racial and ethnic 
disparities in swimming pool drowning rates.[Footnote 7] This study 
examined circumstances surrounding 678 swimming pool drownings among 
U.S. residents aged 5 to 24 years that occurred between 1995 and 1998. 
The study used data collected by CPSC about drowning deaths from death 
certificates, medical examiner reports, and newspaper clippings. 
[Footnote 8] The study found that black non-Hispanic males and females 
had higher swimming pool drowning rates compared with white non-
Hispanic males and females of comparable age. Drowning rates were 
highest among black males, often occurring during the day at public 
pools, and this increased risk persisted after controlling for 
differences in neighborhood income. Hispanic males also had higher 
rates of pool drowning compared with white non-Hispanic males, but they 
had lower rates compared with black non-Hispanic males of comparable 
age. The drowning rates among Hispanic females were similar to those of 
white non-Hispanic females. The drowning rates among foreign-born 
victims were higher than among American-born victims. The study 
concluded that targeted interventions are needed to reduce the 
incidence of swimming pool drownings across racial and ethnic groups; 
it particularly recommended adult supervision at public pools and 
swimming instruction to increase children's swimming ability. 

Another study examining racial disparities in drowning rates in 
specific locations found that after the age of 5 years, the risk of 
drowning in a swimming pool was greater among black males compared with 
white males.[Footnote 9] Specifically, this study analyzed death 
certificate data collected by CPSC and NCHS about U.S. drowning deaths 
of children aged up to 19 in 1995. This research found that among black 
males aged 5 to 19 years, about 37 percent of drowning deaths with 
known location of drowning were in swimming pools, while only 10 
percent of similar drownings among white males occurred in pools. 

Suffocation: 

One study conducted by CDC researchers found that black infants were 
disproportionately affected by accidental suffocation and strangulation 
in bed (27.3 versus 8.5 deaths per 100,000 live births for blacks and 
whites, respectively).[Footnote 10] This study analyzed infant deaths 
occurring between 1984 and 2004 using CDC's National Center for Health 
Statistics mortality files containing information from all death 
certificates. Researchers only analyzed differences between black and 
white infants in this study because of concerns about misreporting of 
racial and ethnic identity on death certificates for other racial and 
ethnic groups.[Footnote 11] Although not reported by racial group, 
beds, cribs, and couches were reported overall as the most common sleep 
surfaces where accidental suffocation and strangulation deaths 
occurred.[Footnote 12] In addition, co-sleeping or bed sharing was 
reported in over half of the cases. The study concluded that efforts 
should target those at highest risk and focus on helping parents and 
caregivers provide safer sleep environments. 

Poisoning: 

We did not identify any studies that compared the incidence of 
poisoning related to consumer products by children's race and 
ethnicity. CPSC has assessed differences in the incidence of product- 
related poisonings among children by age group and gender. A recent 
study conducted by CPSC staff found that 70 percent of an estimated 
86,194 child poisoning incidents involving children less than 5 years 
of age treated in hospital emergency rooms that occurred in 2004 
involved children 1 to 2 years of age; slightly more than one-half 
involved boys; and about 60 percent involved oral prescription drugs, 
nonprescription drugs, and supplements.[Footnote 13] The study 
concluded that while fatal child poisonings involving drugs and other 
hazardous household substances have decreased in recent years, nonfatal 
child poisonings treated in hospital emergency rooms have remained at 
high levels. 

Poisoning can also occur when children swallow or put in their mouths 
products that contain excessive levels of lead paint or lead content, 
such as toys or children's costume jewelry; however, CPSC receives 
little information about such incidents through its data systems. 
[Footnote 14] According to CPSC officials, the agency rarely receives 
reports of child lead poisoning through its data systems because lead 
poisoning usually appears as a chronic illness rather than an acute 
injury, and as we have previously reported, CPSC's data systems are not 
set up to capture information about chronic illnesses.[Footnote 15] 

CPSC Has Not Analyzed Racial and Ethnic Differences in Product-Related 
Injury and Death because of Data Limitations: 

CPSC estimates product-related injury and death rates by age group, but 
because neither emergency room nor death certificate data provide 
complete information about both race and ethnicity and related 
products, CPSC has not analyzed product-related injury and death rates 
by race and ethnicity or other characteristics that could identify 
particularly vulnerable populations.[Footnote 16] While other federally 
supported data collection efforts provide more, or more reliable, 
information on the range of factors, including race and ethnicity, that 
may contribute to injury risk, these efforts have not collected data on 
consumer product involvement or CPSC has not been involved with them. 

NEISS System: 

While products related to patients' injuries are coded in the NEISS 
system, limited patient race and ethnicity information has hindered 
analysis of racial and ethnic differences in product-related injuries. 
CPSC's NEISS system specifies the products involved in injuries treated 
in hospital emergency rooms. NEISS coders can choose from approximately 
900 product codes when identifying any products mentioned in hospital 
emergency room records, such as toys, cribs, and swimming pools. 
Consumer products are coded to allow for specificity. For example, a 
baby bathtub seat would be specified differently from a baby bath. In 
its 2008 performance report, CPSC reported conducting annual monitoring 
visits to all of the NEISS hospitals in its sample, concluding that 
data were collected on over 90 percent of product-related cases in 
emergency room records through the NEISS system. 

As shown in figure 2, our analysis of CPSC's NEISS data found that race 
and ethnicity data were not coded in about 31 percent of cases in 2007. 
The percentage of NEISS cases missing race and ethnicity information 
has prevented CPSC and CDC from assessing racial and ethnic differences 
in nonfatal injury rates, according to agency officials. According to a 
CPSC official, the agency has been aware of the missing race and 
ethnicity data and considered ways of statistically estimating race and 
ethnicity information using existing data, but has not pursued such 
analysis because of competing agency priorities.[Footnote 17] 

Figure 2: Estimated Percentage of NEISS Cases Missing Race and 
Ethnicity Information, 1999-2007: 

[Refer to PDF for image: vertical bar graph] 

Year: 1999; 
Cases Missing Race and Ethnicity Information: 36%. 

Year: 2000; 
Cases Missing Race and Ethnicity Information: 21%. 

Year: 2001; 
Cases Missing Race and Ethnicity Information: 24%. 

Year: 2002; 
Cases Missing Race and Ethnicity Information: 24%. 

Year: 2003; 
Cases Missing Race and Ethnicity Information: 24%. 

Year: 2004; 
Cases Missing Race and Ethnicity Information: 23%. 

Year: 2005; 
Cases Missing Race and Ethnicity Information: 26%. 

Year: 2006; 
Cases Missing Race and Ethnicity Information: 29%. 

Year: 2007; 
Cases Missing Race and Ethnicity Information: 31%. 

Source: GAO analysis of CPSC’s NEISS data. 

Note: Ninety-five percent confidence intervals are all less than or 
equal to plus or minus 0.2 percent. 

[End of figure] 

Our analysis of CPSC's NEISS data found that some hospitals have a high 
percentage of cases missing race and ethnicity information. As shown in 
figure 3, about one-quarter of NEISS hospitals had more than 75 percent 
of cases missing race and ethnicity information in 2007. 

Figure 3: Portion of NEISS Hospitals with Various Percentages of Cases 
Not Coded for Race and Ethnicity, 2007: 

[Refer to PDF for image: pie-chart] 

0 to 10 percent missing: 62%; 
10 to 75 percent missing: 14%; 
75 to 100 percent missing: 24%. 

Source: GAO analysis of CPSC’s NEISS data. 

[End of figure] 

In addition, NEISS hospitals that have recorded race and ethnicity 
information do so inconsistently, in part because of limited CPSC 
guidance. For example, a NEISS coder in one NEISS hospital we visited 
reported that the hospital registrar would generally record the 
patient's race and ethnicity using visual observation and rarely verify 
this information with the patient. Staff at other NEISS hospitals 
reported that the admitting staff may ask for race or ethnicity data 
along with other information when the patient is checking into the 
emergency room. In its manual, CPSC does not specify how hospital staff 
should obtain the information about patient race and ethnicity, 
although some researchers suggest that information reported by patients 
or patient representatives is more accurate than visual observation by 
hospital staff. In addition, CPSC's coding system for race and 
ethnicity is limited to white, black, and a narrative field for "other" 
categories, resulting in inconsistent coding and making data on other 
categories challenging to analyze. Our review of NEISS data found that 
NEISS hospitals use different terminology to code the same racial or 
ethnic categories in the "other" category. 

According to a few organizations we interviewed, hospital-based 
collection of data on the race and ethnicity of patients is a challenge 
for several reasons. A hospital staff member from one NEISS hospital we 
visited said that these data are missing because hospital staff are 
uncomfortable asking patients about race and ethnicity. CDC officials 
and a researcher we interviewed said that hospital staff may not be 
trained to collect race and ethnicity information or may not understand 
that it is being used for purposes other than providing medical care. 

Other studies have found incomplete and inconsistent collection of 
information about patient race and ethnicity from hospitals. A panel 
convened by the National Academy of Sciences conducted a survey of 
hospitals and found that many hospitals report collecting race and 
ethnicity information, but these data are not reported to state and 
federal programs in a standardized format, and the information reported 
for racial and ethnic groups other than white and black may be 
unreliable.[Footnote 18] The panel recommended that HHS require health 
insurers, hospitals, and private medical groups to collect data on 
race, ethnicity, socioeconomic position, and acculturation and language 
and provide leadership in developing standards for collecting these 
data. Another qualitative study, funded by the California Endowment, 
reviewed hospital efforts to provide culturally and linguistically 
appropriate health care in 60 hospitals nationwide.[Footnote 19] The 
majority of hospitals reviewed in this study had inconsistent methods 
for collecting data on patient race, ethnicity, and primary language. 
In some hospitals, systems were in place but not used; in others, staff 
appeared not to have been trained on methods to accurately collect data 
from patients. 

Death Certificates: 

Death certificates may include more complete and accurate race and 
ethnicity information compared with nonfatal injury data from 
hospitals, according to CDC officials, but concerns remain about the 
accuracy of this information for some groups. The accuracy of race and 
ethnicity information recorded on death certificates has been studied 
over time. A recent evaluation conducted by CDC found that race and 
ethnicity reporting on death certificates has been excellent for white 
and black populations, poor for the American Indian or Alaska Native 
populations, and reasonably good for the Hispanic and Asian or Pacific 
Islander populations.[Footnote 20] According to CDC, studies have shown 
that individuals who self-reported as American Indian, Asian, or 
Hispanic on census and survey records were sometimes reported as white 
or non-Hispanic on the death certificate, resulting in an 
underestimation of deaths and death rates for the American Indian, 
Asian, and Hispanic groups. 

While death certificates may contain more complete and accurate race 
and ethnicity data than the NEISS system, according to CPSC and CDC 
officials, related product information is not consistently documented 
on the certificates. Unlike coders who enter data into CPSC's NEISS 
system, individuals who complete death certificates are not prompted or 
required to record information identifying specific consumer products 
related to the death. Information about product involvement may be 
found in the narrative recorded on the certificate; however, this 
information is not consistently recorded, according to both CPSC and 
CDC officials. CPSC has developed national estimates of consumer 
product-related death rates by age group using HHS data containing 
information about all deaths; but CPSC has not analyzed these deaths by 
race and ethnicity, according to CPSC officials. A CPSC official told 
us that CPSC staff could analyze consumer product-related deaths by 
race and ethnicity, although the agency has not done so to date. CDC 
officials said that given the limited information about product 
involvement found on death certificates, estimating product-related 
death rates by race and ethnicity could produce underestimates. 

Some states are collecting information about product-related deaths as 
part of investigations to understand the causes of child deaths; 
however, CPSC has not been involved in this effort. HHS's Maternal and 
Child Health Bureau funds a Web-based system and technical assistance 
center to support state collection of data from child death reviews, 
including race and ethnicity, type of injury, and details on product 
involvement. Child death reviews involve state and local officials from 
multiple disciplines sharing information to better understand child 
deaths and prevent future deaths. Since 2002, HHS's Maternal and Child 
Health Bureau has funded the National Maternal Child Health Center for 
Child Death Review, a technical assistance center that developed the 
Child Death Review Case Reporting System. As of February 2009, 28 
states have used the system, and states vary in the types of deaths 
reviewed, the timing of entry into the system, and the amount of detail 
entered into the system, according to officials. The system prompts the 
user to record whether the death was a consequence of a problem with a 
consumer product and, if so, collects information about the product and 
whether the incident was reported to CPSC. However, according to 
officials, CPSC has not been involved in the development and 
implementation of this system. CPSC does not currently receive updates 
from HHS or the states directly through the Child Death Review Case 
Reporting System. 

According to CDC, injury data collected from household interviews 
through its National Health Interview Survey may include more accurate 
data on race and ethnicity compared with medical records-based data 
collection efforts because the information is self-reported or reported 
by a knowledgeable representative. The National Health Interview Survey 
also contains information about other factors that could account for 
health conditions, such as socioeconomic status, but lacks consistently 
reported information about product involvement, according to CDC 
officials. A CPSC official said the agency has not pursued working with 
CDC to augment its data collection efforts by modifying this survey, 
citing doubts that the data collected could include sufficient detail 
about product involvement even if the survey were modified. 

CPSC Has Developed or Modified Some Consumer Information Efforts to 
Reach Specific Minority Populations, but Has Not Assessed the Results 
of These Efforts:
CPSC has incorporated some elements of key consumer education practices 
to provide consumer product safety information to minority populations, 
such as periodically using consumer and other stakeholder input to 
inform its outreach efforts, but it has not specifically defined goals 
or developed measures to assess whether these efforts are effectively 
reaching minority populations (see appendix II for further detail on 
the key practices). 

CPSC Has Tailored Some Outreach for Hispanic Communities and 
Established Relationships to Assist in Reaching Other Minority 
Populations: 

CPSC's consumer information efforts are intended to provide notice of 
product recalls and guidance on safely using products to the general 
public, although some of its safety information regarding children's 
products has also been targeted to minority populations, particularly 
the Hispanic community. CPSC provides information in Spanish for many 
of its outreach efforts, and according to CPSC officials, has hired a 
Hispanic media consumer outreach specialist to assist with translations 
and to work with the Hispanic media, and has established practices to 
develop and disseminate safety information to this community. CPSC 
officials also told us that they provide information to Spanish-
language television and radio stations, use Spanish-speaking telephone 
operators for CPSC's toll-free hotline, and maintain a language bank to 
provide assistance for calls in other languages.[Footnote 21] During 
fiscal year 2008, CPSC records indicate that CPSC hotline staff 
answered 1,570 calls in Spanish. The main CPSC Web site also includes a 
section called El Mundo Hispano de la CPSC with recall notices and 
other product safety information in Spanish. See figure 4 for examples 
of CPSC consumer information in Spanish and English. 

Figure 28: Examples of CPSC Consumer Information: 

[Refer to PDF for image: 4 illustrations] 

The four examples are: 
NSN poster on safe sleep (in English); 
NSN poster on safe sleep (in Spanish); 
NSN poster on drowning prevention (in English); 
NSN poster on drowning prevention (in Spanish). 

Source: CPSC Web site. 

CPSC has also identified and established relationships with other 
organizations to help disseminate consumer safety information to 
additional minority communities through electronic, broadcast, and 
print media. For example, CPSC officials noted that in 2000, CPSC 
worked with the Bureau of Primary Health Care, Gerber, and Black 
Entertainment Television (BET) to launch a safe sleep campaign to help 
lower sudden infant death syndrome (SIDS) rates, especially among 
African-Americans. The campaign included a nationwide television public 
service announcement about placing babies to sleep on their backs to 
prevent SIDS, and special programming to be televised on BET. CPSC has 
also worked on media outreach campaigns with other organizations such 
as public health agencies, industry groups, and child safety 
organizations. In 2004, CPSC launched the Neighborhood Safety Network 
(NSN), to enlist support from community-based organizations in 
extending its messages to communities it designated as hard to reach, 
including older Americans, urban and rural low-income families, new 
parents, and minority groups. According to CPSC officials, CPSC uses 
NSN, now numbering about 5,600 member organizations, to deliver 
information to minority populations. Membership in NSN is free and 
enrollment is voluntary. Some of the member organizations include HHS, 
hospitals and health clinics, day care centers, fire stations, parent 
organizations, and American Indian reservations. CPSC has developed a 
Web page offering online safety materials that NSN members can modify 
for use with specific groups. NSN member organizations receive CPSC's e-
mail updates with product safety information on topics such as drowning 
prevention, crib and toy safety, and poison prevention and may elect to 
employ these in their own outreach efforts. 

Organizations we contacted for this report, including NSN members, 
consumer groups, and organizations that conduct injury prevention 
research or implement injury prevention programs in diverse communities 
generally reported using safety information provided by CPSC, and some 
offered suggestions for improving efforts to reach minority 
communities. Some of the organizations said that they receive 
information from CPSC via e-mail notifications, and some mentioned 
distributing flyers or posters provided by CPSC and incorporating 
information from CPSC into their own pamphlets and brochures. Some 
suggestions to improve consumer information efforts for minority 
populations included additional exposure through broadcast media 
because access to electronic information via computers may be limited. 
Some NSN members also said it would be useful if safety information 
were provided in additional languages. According to CPSC officials, the 
agency does not have the resources to translate information into 
additional languages, but one NSN member we interviewed mentioned that 
their organization had translated some CPSC materials for its 
audiences. Some organizations also expressed interest in collaborating 
more closely with CPSC on its consumer information efforts. 

CPSC Has Used Some Consumer Input to Develop Safety Information, but 
Has Not Assessed Outreach Efforts to Specific Audiences: 

CPSC has periodically conducted audience research to strengthen its 
consumer information efforts. In 2003, the agency funded a literature 
review to examine the factors influencing consumers' understanding of 
and responses to recall notices and other safety information. The study 
findings suggested ways product recall communications could be improved 
to help consumers eliminate or reduce product hazards, such as using 
pictures and signal language like "warning" or "danger" to help 
consumers attend to and understand safety messages. CPSC also created 
an online Consumer Opinion Forum that consumers can join to provide 
feedback on product safety issues, such as how a recall notice could be 
written more clearly; however, consumers must have Internet access to 
participate in this forum. In addition, CPSC recognizes that to 
understand the culture and diversity within the Hispanic community, it 
must take certain steps such as interviewing members of the community, 
reviewing related research, and consulting with colleagues from other 
federal agencies. For example, to translate and adapt materials for one 
of its outreach campaigns for different segments of the Spanish-
speaking audience, CPSC conducted interviews with members of the 
Hispanic community from varying educational backgrounds. Although CPSC 
has periodically conducted audience research, agency officials told us 
they do not have the resources to regularly pretest safety messages. 
However, officials from a few organizations we interviewed noted that 
CPSC could conduct focus groups with members of the target audience or 
include representatives of organizations that work with the target 
audience on an advisory committee to help design and implement safety 
campaigns. 

CPSC has also established goals for its overall consumer information 
efforts, but not for its messages targeted to specific populations. In 
its 2008 performance and accountability report, CPSC stated that its 
goal for using consumer information was to alert the public to 
children's and other hazards through consumer outreach, press releases, 
and conducting nine public information efforts that included topics 
such as drowning and poisoning prevention. CPSC sets annual performance 
goals that measure the success for each of these consumer information 
methods according to the total number of items issued, viewed, or 
conducted during that fiscal year. For example, CPSC set a fiscal year 
2008 goal to receive 450 million views of its safety messages through 
television appearances, video news releases, and downloads of e-
publications. 

CPSC relies on the Neighborhood Safety Network to share product safety 
information with audiences that can be hard to reach, but the agency 
has not formally assessed whether these populations are receiving and 
using the information. And while CPSC tracks the number of views its 
safety messages receive, CPSC officials stated that they do not collect 
information on audience demographics, which could indicate the target 
audiences being reached. Likewise, CPSC has conducted surveys to assess 
customer satisfaction with its toll-free hotline, Web site, and 
partnerships with state government agencies, and these surveys indicate 
a high level of satisfaction with CPSC services; however, these surveys 
do not collect information about the demographic characteristics of the 
consumers using CPSC's services to determine the extent to which they 
are representative of the general population. According to CPSC 
officials, CPSC has also not identified outcome measures to evaluate 
how well its campaigns affected the attitudes and behaviors of the 
target audiences it set out to influence. We previously identified 
strategies used by other federal agencies to evaluate the effectiveness 
of information campaigns, including analyzing findings from previous 
research, collaborating with program partners to help meet the 
information needs of diverse audiences and expand the usefulness of 
evaluations, and surveying the intended audience to ask about program 
exposure, knowledge, and attitude change.[Footnote 22] CPSC officials 
have also cited a lack of resources as a challenge to establishing 
evaluation programs to measure results; however, CPSC has recently 
received more resources from the fiscal year 2009 appropriation for the 
Virginia Graeme Baker Pool and Spa Safety Act. In the course of our 
review, CPSC officials stated that with this new funding for the act, 
they planned to include an evaluation component, but as of the writing 
of this report, it was not yet known how CPSC planned to implement this 
component. 

Conclusions: 

Protecting children from dangerous consumer products is a critical part 
of CPSC's mission. Some research suggests that there are racial and 
ethnic disparities in child death rates due to injuries related to 
particular consumer products; however, CPSC does not routinely assess 
whether such disparities exist, primarily because data limitations make 
it challenging to conduct such analyses. In addition, the lack of 
information about other characteristics of individuals who are injured 
or die from involvement with a consumer product, such as socioeconomic 
status, prevents CPSC from identifying potential underlying causes of 
racial and ethnic differences in injury and death rates. Without 
efforts to augment or improve existing data, CPSC may not know which 
groups are most vulnerable to product-related injury or death. If 
available data are improved, CPSC may be better able to identify 
hazards that disproportionately affect certain communities and develop 
ways to reduce those hazards. 

Despite limited information on racial and ethnic differences in product-
related injury and death, CPSC has made some special efforts to deliver 
some of its consumer information to audiences the agency identified as 
hard to reach, including minority groups. However, CPSC has not 
collected information on whether these targeted groups are receiving 
and acting on the safety information. Without fully assessing its 
consumer education and public outreach campaigns, CPSC cannot know how 
effective these initiatives are at reaching intended audiences, some of 
which may be at an elevated risk of injury or death. 

Recommendations for Executive Action: 

To better understand the relative risk of product-related injury among 
minority and nonminority children, we recommend that the Commission, in 
consultation with HHS, 

* Develop and implement cost-effective means of improving CPSC's data 
collection on factors that may contribute to differences in the 
incidence of injury and death related to specific types of consumer 
products, including race, ethnicity, and other patient characteristics. 
For example, steps CPSC could consider include improving the NEISS 
racial and ethnic classification system; working with NEISS hospitals 
to improve collection of data on patient race and ethnicity; and 
leveraging related data collection efforts, such as those sponsored by 
the Maternal and Child Health Bureau, the National Center for Health 
Statistics, or the National Institutes of Health. 

To improve the effectiveness of consumer information efforts, we 
recommend that the Commission, 

* Develop and implement cost-effective ways to enhance and assess the 
likelihood that CPSC's safety messages are received and implemented by 
all the intended audiences. For example, CPSC could consider convening 
groups of consumers or Neighborhood Safety Network members to advise on 
the design and implementation of campaigns targeted to specific 
communities, surveying NSN members, establishing metrics to measure 
NSN's success, and evaluating the effectiveness of information 
campaigns targeted to the racial and ethnic groups at highest risk of 
drowning as part of its implementation of the Virginia Graeme Baker 
Pool and Spa Safety Act. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to CPSC and HHS for review and 
comment. CPSC and HHS concurred with our recommendations and provided 
technical comments, which we incorporated as appropriate. A letter 
conveying HHS's comments is reproduced in appendix III. 

We are sending copies of this report to the appropriate congressional 
committees, the Chairman of the U.S. Consumer Product Safety 
Commission, the Secretary of Health and Human Services, and other 
interested parties. In addition, the report will be available at no 
charge on GAO's Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff have any questions regarding this report, please 
contact me at (202) 512-7215 or ashbyc@gao.gov. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this report. GAO staff who made major contributors to 
this report are listed in appendix IV. 

Signed by: 

Cornelia M. Ashby: 
Director, Education, Workforce, and Income Security Issues: 

List of Committees: 

The Honorable John D. Rockefeller, IV:
Chairman:
The Honorable Kay Bailey Hutchison:
Ranking Member:
Committee on Commerce, Science and Transportation:
United States Senate: 

The Honorable Henry A. Waxman:
Chairman:
The Honorable Joe Barton:
Ranking Member:
Committee on Energy and Commerce:
House of Representatives: 

The Honorable Mark Pryor:
Chairman:
The Honorable Roger Wicker:
Ranking Member:
Subcommittee on Consumer Protection, Product Safety, and Insurance:
Committee on Commerce, Science and Transportation:
United States Senate: 

The Honorable Bobby L. Rush:
Chairman:
The Honorable George Radanovich:
Ranking Member:
Subcommittee on Commerce, Trade and Consumer Protection:
Committee on Energy and Commerce:
House of Representatives: 

[End of section] 

Appendix I: Objectives, Scope, and Methodology: 

The objectives of this report were to examine (1) what is known about 
the relative incidence of preventable injuries and deaths related to 
drowning, poisoning, and suffocation associated with products intended 
for children's use among minority children compared with nonminority 
children, and (2) what actions the Consumer Product Safety Commission 
(CPSC) has taken through its public information and education 
initiatives to minimize child injuries and deaths, including those in 
minority populations, related to products intended for children's use. 

To address the first objective, we reviewed injury and death data 
sources used by CPSC to estimate product-related injuries and deaths. 
We reviewed data and documentation obtained from CPSC concerning its 
databases that contain injury and death data, including the Death 
Certificates database, National Electronic Injury Surveillance System 
(NEISS), Injury or Potential Injury Incidents file, and In-Depth 
Investigations file.[Footnote 23] We reviewed information describing 
Department of Health and Human Services (HHS) mortality data, which 
includes information from death certificates filed in the United States 
collected through the National Vital Statistics System. We also 
reviewed HHS household and health care provider surveys that include 
injury data, such as the National Health Interview Survey and the 
National Hospital Discharge Survey. We also interviewed CPSC officials, 
HHS officials, and researchers to gather information about the 
strengths and weaknesses of available data sources. 

We assessed the completeness and reliability of the NEISS data set by 
(1) reviewing NEISS's technical documentation and methodological 
reports, (2) interviewing CPSC officials, (3) examining these data for 
obvious inconsistencies, and (4) visiting three NEISS hospitals to 
better understand how the data are coded. We determined that these data 
were sufficiently reliable to use as sources of summary statistics 
about the extent of missing race and ethnicity information in the NEISS 
system. To determine the extent of missing race and ethnicity 
information in CPSC's NEISS system, we analyzed NEISS data obtained 
from CPSC for the years 1999-2007. 

To explore available data published in related studies, we searched 
relevant databases, including PubMed, ProQuest, PsycFirst, and 
ScienceDirect. We also consulted with CPSC and HHS staff to identify 
related studies. We limited the scope of our work by looking at studies 
published since 1999. Through this process, our literature search 
identified about 70 studies, but only 3 studies published data on 
racial and/or ethnic differences in child injury or death rates related 
to specific consumer products, and we conducted detailed reviews of 
these studies. Our reviews entailed an assessment of each study's 
research methodology, including its data quality, research design, and 
analytic techniques, as well as a summary of each study's major 
findings and conclusions. We also assessed the extent to which each 
study's data and methods supported its findings and conclusions. 

To address the second objective, we reviewed CPSC documents and 
interviewed CPSC officials regarding the development, operation, and 
evaluation of the agency's consumer information efforts. Specifically, 
we reviewed CPSC's Web site, and documents such as CPSC customer 
satisfaction surveys, press releases, strategic plans, and performance 
and accountability reports. We compared the processes used by CPSC with 
key practices identified by experts in GAO's previous work as important 
to planning a consumer education campaign, motivating a target 
audience, and alleviating challenges in a campaign (see appendix II for 
a description of these practices). We interviewed federal officials at 
CPSC and five HHS organizations--Centers for Disease Control and 
Prevention, Indian Health Service, Maternal and Child Health Bureau, 
National Institutes of Health, and the Office of Minority Health--to 
learn about their related programs and initiatives. In addition, we 
interviewed representatives of injury prevention programs, consumer 
groups, and members of CPSC's Neighborhood Safety Network to obtain 
their views on CPSC's efforts to provide product safety information to 
minority communities. 

We conducted this performance audit from December 2008 through August 
2009 in accordance with generally accepted government auditing 
standards. Those standards require that we plan and perform the audit 
to obtain sufficient, appropriate evidence to provide a reasonable 
basis for our findings and conclusions based on our audit objectives. 
We believe that the evidence obtained provides a reasonable basis for 
our findings and conclusions based on our audit objectives. 

[End of section] 

Appendix II: Key Practices for Consumer Education Planning: 

In a 2007 GAO report on consumer issues pertaining to the digital 
television transition, a panel of 14 senior management-level experts in 
strategic communications identified and came to consensus on key 
planning components for consumer education and outreach (see table 1). 

Table 1: Key Practices for Planning Consumer Education Campaigns: 

Key practice: Define goals and objectives; 
Description: Define the goals of the communications campaign, e.g., to 
increase awareness or motivate a change in behavior. Define the 
objectives that will help the campaign meet those goals. 

Key practice: Analyze the situation; 
Description: Analyze the situation, including any competing voices or 
messages, related market conditions, and key dates or timing 
constraints. Review relevant past experiences and examples to identify 
applicable "lessons learned" that may help to guide efforts. 

Key practice: Identify stakeholders; 
Description: Identify and engage all the key stakeholders who will be 
involved in communications efforts. Clarify the roles and 
responsibilities of each stakeholder, including which entity or 
entities will lead overall efforts. 

Key practice: Identify resources; 
Description: Identify available short-and long-term budgetary and other 
resources. 

Key practice: Research target audiences; 
Description: Conduct audience research, such as dividing the audience 
into smaller groups of people who have relevant needs, preferences and 
characteristics, as well as measuring awareness, beliefs, competing 
behaviors, and motivators. Also, identify any potential audience-
specific obstacles, such as access to information. 

Key practice: Develop consistent, clear messages; 
Description: Determine what messages to develop based on budget, goals, 
and audience research findings. Develop clear and consistent audience 
messages; test and refine them. 

Key practice: Identify credible messengers; 
Description: Identify who will be delivering the messages and ensure 
that the source is credible with audiences. 

Key practice: Design media mix; 
Description: Plan the media mix to optimize different types of media 
such as news stories, opinion editorials, and broadcast, print, and 
Internet advertising. Identify through which methods (e.g., advertising 
in newsprint ads), how often (e.g., weekly or monthly) and over what 
duration (e.g., 1 year) messages will reach audiences. 

Key practice: Establish metrics to measure success; 
Description: Establish both process and outcome metrics to measure 
success in achieving objectives of the outreach campaign. Process 
metrics ensure the quality, quantity, and timeliness of the 
contractor's work. Outcome metrics evaluate how well the campaign 
influenced the attitudes and behaviors of the target audience(s) that 
it set out to influence. 

Source: GAO-08-43. 

[End of table] 

[End of section] 

Appendix III: Comments from the Department of Health and Human 
Services: 

Department Of Health& Human Services: 
Office Of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

July 14, 2009: 

Cornelia M. Ashby: 
Director, Education, Workforce and Income Security: 
U.S. Government Accountability Office: 
441 G Street N.W. 
Washington, DC 20548: 

Dear Ms. Ashby: 

Enclosed are comments on the U.S. Government Accountability Office's 
(GAO) report entitled: "Consumer Product Safety Commission: Better Data 
Collection and Assessment of Consumer Information Efforts Could Help 
Protect Minority Children" (GAO-09-731). 

The Department appreciates the opportunity to review this report before 
its publication. 

Sincerely, 

Signed by: 

Barbara Pisaro Clark: 
Acting Assistant Secretary for Legislation: 

Attachment: 

[End of letter] 

General Comments Of The Department Of Health And Human Services (HHS) 
On The Government Accountability Office's (GAO) Draft Report Entitled: 
Better Data Collection And Assessment Of Consumer Information Efforts 
Could Help Protect Minority Children (GAO-09-731): 

The Centers for Disease Control and Prevention (CDC) wishes to thank 
the GAO for the opportunity to review and comment on this Draft Report. 
CDC concurs with the GAO's recommendations and respectfully submits the 
following general comments. 

The National Center for Health Statistics (NCHS) has a history of 
working with the Consumer Product Safety Commission (CPSC) to provide 
death certificate information to assist the CPSC in its mission. 
Mortality data from NCHS are a fundamental source of demographic, 
geographic, and cause of death information including the 
characteristics of individuals dying in the United States. The death 
certificate is not intended, however, to provide detailed information 
about consumer products that may contribute to death. NCHS will 
continue to assist the CPSC in using death certificate data to monitor 
the safety of consumer products. 

[End of section] 

Appendix IV: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Cornelia M. Ashby, (202) 512-7215, ashbyc@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, individuals making key 
contributions to this report include Betty Ward-Zukerman (Assistant 
Director), Carl Barden, Mitch Karpman, Kristy Kennedy, Jim Rebbe, Cathy 
Roark, Jay Smale, Gabriele Tonsil, and Kate van Gelder. 

[End of section] 

Related GAO Products: 

Feasibility of Requiring Financial Assurances for the Recall or 
Destruction of Unsafe Consumer Products. [hyperlink, 
http://www.gao.gov/products/GAO-09-512R]. Washington, D.C.: April 22, 
2009. 

Traffic Safety: Improved Reporting and Performance Measures Would 
Enhance Evaluation of High-Visibility Campaigns. [hyperlink, 
http://www.gao.gov/products/GAO-08-477]. Washington, D.C.: April 25, 
2008. 

Digital Television Transition: Increased Federal Planning and Risk 
Management Could Further Facilitate the DTV Transition. [hyperlink, 
http://www.gao.gov/products/GAO-08-43]. Washington, D.C.: November 19, 
2007. 

Health Care: Approaches to Address Racial and Ethnic Disparities. 
[hyperlink, http://www.gao.gov/products/GAO-03-862R]. Washington, D.C.: 
July 8, 2003. 

Program Evaluation: Strategies for Assessing How Information 
Dissemination Contributes to Agency Goals. [hyperlink, 
http://www.gao.gov/products/GAO-02-923]. Washington, D.C.: September 
30, 2002. 

Internet: Federal Web-based Complaint Handling. [hyperlink, 
http://www.gao.gov/products/GAO/AIMD-00-238R]. Washington, D.C.: July 
7, 2000. 

Consumer Product Safety Commission: Injury Data Insufficient to Assess 
the Effect of the Changes to the Children's Sleepwear Safety Standard. 
[hyperlink, http://www.gao.gov/products/GAO/HEHS-99-64]. Washington, 
D.C.: April 1, 1999. 

Lead Poisoning: Federal Health Care Programs Are Not Effectively 
Reaching At-Risk Children. GAO/HEHS-99-18. Washington, D.C.: January 
15, 1999. 

Children's Health: Elevated Blood Lead Levels in Medicaid and Hispanic 
Children. [hyperlink, http://www.gao.gov/products/GAO/HEHS-98-169R]. 
Washington, D.C.: May 18, 1998. 

Consumer Product Safety Commission: Better Data Needed to Help Identify 
and Analyze Potential Hazards. [hyperlink, 
http://www.gao.gov/products/GAO/HEHS-97-147]. Washington, D.C.: 
September 29, 1997. 

[End of section] 

Footnotes: 

[1] CPSC has jurisdiction over consumer products used in and around the 
home and in sports, recreation, and schools, including many products 
intended for children's use, such as toys, swimming pools, cribs, and 
beds. However, CPSC does not have jurisdiction over all consumer 
products, such as car seats protecting children in on-road vehicles, 
automobiles, foods, drugs, cosmetics, and boats. 

[2] Pub. L. No. 110-314, § 107. 

[3] Racial and ethnic categories defined in Office of Management and 
Budget standards for maintaining, collecting, and presenting federal 
data on race include American Indian or Alaska Native, Asian, Black or 
African-American, Native Hawaiian or Other Pacific Islander, and White. 
There are two categories for data on ethnicity: Hispanic or Latino, and 
Not Hispanic or Latino. Hispanic or Latino refers to a person of 
Spanish culture or origin, regardless of race. 

[4] The Institute of Medicine is a branch of the National Academy of 
Sciences, a private nonprofit organization made up of subject matter 
experts that advises the federal government on scientific and 
technological matters. 

[5] For details, see GAO, Digital Television Transition: Increased 
Federal Planning and Risk Management Could Further Facilitate the DTV 
Transition, [hyperlink, http://www.gao.gov/products/GAO-08-43] 
(Washington, D.C.: Nov. 19, 2007). 

[6] CPSC rarely uses its authority to seek a mandatory recall. All of 
the 563 product recalls conducted in 2008 were voluntary, with CPSC 
negotiating a corrective action plan with the responsible companies. 

[7] Gitanjali Saluja, Ruth A. Brenner, Ann C. Trumble, Gordon S. Smith, 
Tom Schroeder, and Christopher Cox, "Swimming Pool Drownings Among US 
Residents Aged 5-24 Years: Understanding Racial/Ethnic Disparities," 
American Journal of Public Health (2006), 96(4):728-733. 

[8] Although the race of the victim was included as a precoded field on 
death certificates, researchers used data on death certificates about 
place of birth, nationality, and country of origin to more specifically 
code ethnicity. 

[9] Ruth A. Brenner, Ann C. Trumble, Gordon S. Smith, Eileen P. 
Kessler, and Mary D. Overpeck, "Where Children Drown, United States, 
1995,"Pediatrics, (2001), 108: 85-89. 

[10] Carrie K. Shapiro-Mendoza, Melissa Kimball, Kay M. Tomashek, 
Robert N. Anderson, and Sarah Blanding, "US Infant Mortality Trends 
Attributable to Accidental Suffocation and Strangulation in Bed From 
1984 Through 2004: Are Rates Increasing?" Pediatrics (2009), No. 2, 
123: 533-539. 

[11] See also E. Arias, W. Schauman, K. Eschbach, P. Sorlie, and E. 
Backlund, "The Validity of Race and Hispanic Origin Reporting on Death 
Certificates in the United States," Centers for Disease Control and 
Prevention, National Center for Health Statistics, Vital and Health 
Statistics (2008), 2(148). 

[12] Accidental suffocation and strangulation in bed is a subgroup of 
sudden, unexpected infant deaths, a leading category of injury-related 
infant deaths. 

[13] Robert L. Franklin, MS, and Gregory B. Rodgers, PhD, Directorate 
for Economic Analysis, US Consumer Product Safety Commission, Bethesda, 
Maryland, "Unintentional Child Poisonings Treated in United States 
Hospital Emergency Departments: National Estimates of Incident Cases, 
Population-Based Poisoning Rates, and Product Involvement," Pediatrics 
(2008), Vol. 122 No. 6. 

[14] Elevated blood lead levels are associated with harmful health 
effects in children, such as impaired mental and physical development. 

[15] GAO, Consumer Product Safety Commission: Better Data Needed to 
Help Identify and Analyze Potential Hazards, [hyperlink, 
http://www.gao.gov/products/GAO/HEHS-97-147] (Washington, D.C.: 
September 1997). 

[16] We previously found that CPSC uses its data to identify rates of 
injury and death by age group, but not other characteristics, to assess 
which consumer product hazards have a disproportionate effect on 
vulnerable populations, such as persons with disabilities. For details, 
see [hyperlink, http://www.gao.gov/products/GAO/HEHS-97-147]. 

[17] Developing accurate estimates of product-related injury rates by 
racial and ethnic group could be challenging given existing CPSC data 
and data collection methods. Adequate numbers of cases from each racial 
and ethnic group are needed to develop accurate rates of product- 
related injury, and developing such rates could be a challenge in 
smaller minority groups. In addition, CPSC data systems do not collect 
other information that could explain differential rates of injuries 
treated in hospital emergency rooms, such as access to health 
insurance. 

[18] Michele Ver Ploeg and Edward Perrin, eds., Eliminating Health 
Disparities: Measurement and Data Needs (Washington, D.C.: The National 
Academies Press, 2004). 

[19] A. Wilson-Stronks and E. Galvez, Exploring Cultural and Linguistic 
Services in the Nation's Hospitals: A Report of Findings. (Oakbrook 
Terrace, Ill.: Joint Commission, 2007). 

[20] E. Arias, W. Schauman, K. Eschbach, P. Sorlie, and E. Backlund, 
"The Validity of Race and Hispanic Origin Reporting on Death 
Certificates in the United States," Centers for Disease Control and 
Prevention, National Center for Health Statistics, Vital and Health 
Statistics (2008), 2(148). 

[21] According to CPSC officials, CPSC's language bank is a working 
list of CPSC staff members who have proficiency in other languages. 

[22] GAO, Program Evaluation: Strategies for Assessing How Information 
Dissemination Contributes to Agency Goals, [hyperlink, 
http://www.gao.gov/products/GAO-02-923] (Washington, D.C.: Sept. 30, 
2002). 

[23] The Injury or Potential Injury Incidents and In-Depth 
Investigations files include information about related consumer 
products, but not race and ethnicity information. 

[End of section] 

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