GAO 

United States Government Accountability Office

Report to Congressional Committees

CONSUMER 

PRODUCT SAFETY 

COMMISSION 

Better Data Collection 

and Assessment of 

Consumer Information 

Efforts Could Help 

Protect Minority 

Children 

August 2009 

GAO-09-731 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

August 2009

CONSUMER PRODUCT SAFETY COMMISSION

Better Data Collection and Assessment of Consumer 

Information Efforts Could Help Protect Minority 

Highlights of GAO-09-731, a report to Children 

congressional committees 

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 Recommends

GAO recommends that CPSC 

develop and implement costeffective means of improving data 

collection on factors that may 

contribute to any differences in the 

incidence of consumer productrelated 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. 

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. 

View GAO-09-731 or key components.

For more information, contact Cornelia M. 

Ashby at (202) 512-7215 or 

ashbyc@gao.gov. 
Page i GAO-09-731 

Contents 

Letter 1

Background 3 

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 7 

CPSC Has Developed or Modified Some Consumer Information 

Efforts to Reach Specific Minority Populations, but Has Not 

Assessed the Results of These Efforts 16 

Conclusions 21 

Recommendations for Executive Action 22 

Agency Comments and Our Evaluation 23 

Appendix I Objectives, Scope, and Methodology 25 

Appendix II Key Practices for Consumer Education Planning 27 

Appendix III Comments from the Department of Health and 

Human Services 28 

Appendix IV GAO Contact and Staff Acknowledgments 30 

Related GAO Products 31 

Table 

Table 1: Key Practices for Planning Consumer Education 

Campaigns 27 

Figures 

Figure 1: CPSC Consumer Information Methods 4 

Figure 2: Estimated Percentage of NEISS Cases Missing Race and 

Ethnicity Information, 1999-2007 12 

 Consumer Product Safety Commission 
Figure 3: Portion of NEISS Hospitals with Various Percentages of 

Cases Not Coded for Race and Ethnicity, 2007 13 

Figure 4: Examples of CPSC Consumer Information 18 

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 

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Page ii GAO-09-731 Consumer Product Safety Commission
Page 1 GAO-09-731 

 

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 2004.1

 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.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 

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. 

 Consumer Product Safety Commission 
 

specified in the mandate include Black, Hispanic, American Indian, Alaska 

Native, Native Hawaiian, and Asian/Pacific Islander.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.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.5

 

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, GAO-08-43 (Washington, 

D.C.: Nov. 19, 2007). 

Page 2 GAO-09-731 Consumer Product Safety Commission
 

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. 

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. 

Background 

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 fig. 

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 

Page 3 GAO-09-731 Consumer Product Safety Commission
 

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 

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).

Page 4 GAO-09-731 Consumer Product Safety Commission
 

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.6

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 

Related Department of Health 

and Human Services Efforts 

 

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. 

Page 5 GAO-09-731 Consumer Product Safety Commission
 

goals to eliminate disparities in injuries, disabilities, and deaths due to 

unintentional injuries and violence. 

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. 

Injury and Death Data Sources 

Used by CPSC 

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 productrelated, 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. 

Page 6 GAO-09-731 Consumer Product Safety Commission
 

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. 

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. 

Drowning 

Page 7 GAO-09-731 Consumer Product Safety Commission
 

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.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.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.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. 

 

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. 

Page 8 GAO-09-731 Consumer Product Safety Commission
 

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).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.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.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. 

Suffocation 

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.13 The study 

concluded that while fatal child poisonings involving drugs and other 

Poisoning 

 

10Carrie 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. 

11See 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). 

12Accidental suffocation and strangulation in bed is a subgroup of sudden, unexpected 

infant deaths, a leading category of injury-related infant deaths. 

13Robert 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. 

Page 9 GAO-09-731 Consumer Product Safety Commission
 

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.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.15

CPSC Has Not Analyzed 

Racial and Ethnic 

Differences in ProductRelated 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.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. 

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 

NEISS System 

 

14Elevated blood lead levels are associated with harmful health effects in children, such as 

impaired mental and physical development. 

15GAO, Consumer Product Safety Commission: Better Data Needed to Help Identify and 

Analyze Potential Hazards, GAO/HEHS-97-147 (Washington, D.C.: September 1997). 

16We 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 GAO/HEHS-97-147. 

Page 10 GAO-09-731 Consumer Product Safety Commission
 

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.17

 

17Developing 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. 

Page 11 GAO-09-731 Consumer Product Safety Commission
 

Figure 2: Estimated Percentage of NEISS Cases Missing Race and Ethnicity 

Information, 1999-2007 

0

10

20

30

40

50

60

70

80

90

100

1999 2000 2001 2002 2003 2004 2005 2006 2007

Percentage

Source: GAO analysis of CPSC’s NEISS data.

Year

36

21

24 24 24 23

26 29 31

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

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. 

Page 12 GAO-09-731 Consumer Product Safety Commission
 

Figure 3: Portion of NEISS Hospitals with Various Percentages of Cases Not Coded 

for Race and Ethnicity, 2007 

14%

24%

62%

Source: GAO analysis of CPSC’s NEISS data.

0 to 10 percent missing

10 to 75 percent missing

75 to 100 percent missing

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 

Page 13 GAO-09-731 Consumer Product Safety Commission
 

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.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.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 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.20 According to CDC, studies have shown that individuals who 

Death Certificates 

 

18Michele Ver Ploeg and Edward Perrin, eds., Eliminating Health Disparities: 

Measurement and Data Needs (Washington, D.C.: The National Academies Press, 2004). 

19A. 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). 

20E. 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). 

Page 14 GAO-09-731 Consumer Product Safety Commission
 

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 

Page 15 GAO-09-731 Consumer Product Safety Commission
 

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 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 app. II for further detail on the key 

practices). 

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 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 

Page 16 GAO-09-731 Consumer Product Safety Commission
 

hotline, and maintain a language bank to provide assistance for calls in 

other languages.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. 

 

21 According to CPSC officials, CPSC’s language bank is a working list of CPSC staff 

members who have proficiency in other languages. 

Page 17 GAO-09-731 Consumer Product Safety Commission
 

Consumer Product Safety Commission

 

Page 18 GAO-09-731 

Figure 4: Examples of CPSC Consumer Information 

NSN poster on safe sleep (in English)

NSN poster on drowning prevention (in English)

NSN poster on safe sleep (in Spanish)

NSN poster on drowning prevention (in Spanish)

Source: CPSC Web site.

Page 18 GAO-09-731 
 

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 

Page 19 GAO-09-731 Consumer Product Safety Commission
 

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. 

Page 20 GAO-09-731 Consumer Product Safety Commission
 

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.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. 

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 

Conclusions 

 

22GAO, Program Evaluation: Strategies for Assessing How Information Dissemination 

Contributes to Agency Goals, GAO-02-923 (Washington, D.C.: Sept. 30, 2002). 

Page 21 GAO-09-731 Consumer Product Safety Commission
 

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 productrelated 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. 

To better understand the relative risk of product-related injury among 

minority and nonminority children, we recommend that the Commission, 

in consultation with HHS, 

Recommendations for 

Executive Action 

• 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 

Page 22 GAO-09-731 Consumer Product Safety Commission
 

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. 

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. 

Agency Comments 

and Our Evaluation 

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 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 

Cornelia M. Ashby 

report are listed in appendix IV. 

Director, Education, Workforce, 

 and Income Security Issues 

Page 23 GAO-09-731 Consumer Product Safety Commission
 

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 

Page 24 GAO-09-731 Consumer Product Safety Commission
Appendix I: Objectives, Scope, and 

Methodology 

Page 25 GAO-09-731 

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.1

 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 

 

1

The Injury or Potential Injury Incidents and In-Depth Investigations files include 

information about related consumer products, but not race and ethnicity information. 

 Consumer Product Safety Commission 
Appendix I: Objectives, Scope, and 

Methodology 

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 app. 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. 

Page 26 GAO-09-731 Consumer Product Safety Commission
Appendix II: Key Practices for Consumer Appendix II: Key Practices for Consumer Education Planning 

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 Description 

Define goals and 

objectives 

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. 

Analyze the situation 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. 

Identify stakeholders 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. 

Identify resources Identify available short- and long-term budgetary and other 

resources. 

Research target 

audiences 

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. 

Develop consistent, 

clear messages 

Determine what messages to develop based on budget, 

goals, and audience research findings. Develop clear and 

consistent audience messages; test and refine them. 

Identify credible 

messengers 

Identify who will be delivering the messages and ensure that 

the source is credible with audiences. 

Design media mix 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. 

Establish metrics to 

measure success 

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. 

Page 27 GAO-09-731 Consumer Product Safety Commission 
Appendix III: Comments from the Department Appendix III: Comments from the of Health and Human Services 

Department of Health and Human Services 

Page 28 GAO-09-731 Consumer Product Safety Commission
Appendix III: Comments from the Department 

of Health and Human Services 

Page 29 GAO-09-731 Consumer Product Safety Commission
Appendix IV: 

A

GAO Contact and Staff 

cknowledgments 

Page 30 GAO-09-731 

Appendix IV: GAO Contact and Staff 

Acknowledgments 

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

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. 

GAO Contact 

Staff 

Acknowledgments 

 Consumer Product Safety Commission 
Related GAO Products Related GAO Products 

Feasibility of Requiring Financial Assurances for the Recall or 

Destruction of Unsafe Consumer Products. GAO-09-512R. Washington, 

D.C.: April 22, 2009. 

Traffic Safety: Improved Reporting and Performance Measures Would 

Enhance Evaluation of High-Visibility Campaigns. GAO-08-477. 

Washington, D.C.: April 25, 2008. 

Digital Television Transition: Increased Federal Planning and Risk 

Management Could Further Facilitate the DTV Transition. GAO-08-43. 

Washington, D.C.: November 19, 2007. 

Health Care: Approaches to Address Racial and Ethnic Disparities. 

GAO-03-862R. Washington, D.C.: July 8, 2003. 

Program Evaluation: Strategies for Assessing How Information 

Dissemination Contributes to Agency Goals. GAO-02-923. Washington, 

D.C.: September 30, 2002. 

Internet: Federal Web-based Complaint Handling. 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. 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. GAO/HEHS-98-169R. Washington, D.C.: May 18, 1998. 

Consumer Product Safety Commission: Better Data Needed to Help 

Identify and Analyze Potential Hazards. GAO/HEHS-97-147. Washington, 

D.C.: September 29, 1997. 

(130909) Page 31 GAO-09-731 Consumer Product Safety Commission
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U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, DC 20548 

Public Affairs 

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