Principal Investigator: Susan C. Jones, Ph.D.
Head lice (Pediculus humanus capitis De Geer) are tiny parasitic insects that can infest humans of any age, but they most commonly occur among children who have close contact with each other at school and at play. Approximately 5 to 10% of all school-age children contract head lice at one time or another (Chunge et al., 1991). Each year in the United States, head lice infect approximately 6 to 12 million persons (Atkinson et al., 1986). Head lice have afflicted humans for millennia (reviewed by Mumcuoglu, 1996).
Head lice are an important community issue, causing disruptions to families, schools, and the workplace. Many school systems in the U.S. advocate a "no-nit" policy, which requires the removal of all head lice and nits (eggs) before a child can return to class. The associated costs to families and to society include: school absenteeism, lost wages, workplace disruptions, and unwarranted ridicule, embarrassment, or blame. The monetary cost to treat head lice infestations is conservatively estimated at $100 million annually (Carson, 1997).
The social stigma that surrounds head lice outbreaks can result in embarrassment and a secretive "home remedy" approach to treatment. Instead of asking for assistance from reliable sources, people who need to know how to control head lice often resort to seeking anecdotal advice from friends and family. Unfortunately, most "home remedies" used by well-meaning parents and caregivers are ineffective; many also are unsafe and directly cause other health problems.
Historically, and even today, chemical treatments have been the preferred method of head lice control. However, there is increasing evidence that head lice have developed resistance to many insecticides (Carson, 1997). Sadly, uninformed consumers risk unnecessary chemical exposure as they misuse over-the-counter insecticidal products or repeatedly use ineffective "home remedies."
During March 2002, the Ohio School IPM Program in conjunction with an EPA grant allowed for distribution of head lice prevention materials to approximately 2,700 elementary schools throughout Ohio. The head lice information packet contained a sheet of four awareness stickers conveying the message, "Be Aware, Please Don't Share" head lice, a cover letter to the school nurse to gauge interest in distributing awareness stickers to students, a quiz to assess children's awareness of head lice, and a public information sheet regarding the safe use of pesticides. The packet also included a complimentary copy of Ohio State University's Extension Bulletin 893 (Head Lice) that described how to safely deal with head lice.
Based on this initial mailing, 95 schools requested sufficient numbers of awareness stickers for approximately 15,000 students. These schools were located in 40 of Ohio's 88 counties. The purpose of the awareness stickers was to increase children's knowledge of head lice, how these parasites are spread, and how to avoid becoming infected. The results of the quiz given to children pre- and post-receipt of the awareness stickers indicated that these stickers are an effective method to increase children's awareness of head lice. The children's awareness stickers are large, colorful stickers that are designed to teach children, in a fun way, some things that they can do to help stop the spread of head lice.
An IPM Block Grant of $3,500 was awarded in March 2003 to sponsor age-appropriate demonstration projects for students and staff at elementary schools in Ohio. The project was implemented with the assistance of an independent contractor, Judy Bozick, who is an R.N. with considerable knowledge of head lice and "nitpicking".
In late April 2003, a letter was sent to school nurses announcing the availability of IPM demonstration projects for students and staff at elementary schools in Ohio. An announcement also was sent to the Ohio Department of Education for inclusion in their May newsletter. In addition, the 95 schools that participated in the awareness sticker program during FY 2002 were contacted to provide follow-up data on the number of children contracting head lice and the total number of days that children were absent due to the presence of nits or lice. These school nurses also were queried as to their general impressions or comments regarding the usefulness of the awareness stickers.
School nurses indicated that they were interested in this IPM demonstration project, but they were unable to participate because of the timing of the grant. When this grant was announced in late April and early May, school activities already had been scheduled until the end of the school year (typically early June) and classes were not in session during the summer. Furthermore, the grant monies had to be spent by 30 September, but schools had difficulty implementing training sessions at the beginning of the school year (late August into September). The demonstration project was conducted in one school, Hilliard Elementary, in September 2003. In the future, increased participation is anticipated with outreach efforts that can be announced at the beginning of the school year and that are available from fall through spring.
In order to facilitate demonstration projects in schools, several pieces of educational artwork were created and a detailed notebook was prepared describing IPM procedures for managing head lice. These materials are available on loan from OSU Extension Entomology for teaching efforts pertaining to head lice. Thus, demonstration projects can be readily conducted in schools in the future.
Of the 95 schools that participated in the awareness sticker program during FY 2002, 25 (26.3%) responded to the request for follow-up information. Comments regarding the usefulness of the awareness stickers included such positive responses as: "Great."; "Kids loved them!"; "The children liked them, and they were useful to teach the basic facts they need to know."; "Easy to understand message due to picture format."; "Reinforces information regarding transmission."; "Were well received and good reminders."; "Stickers and parent sheets used as a follow-up and parent education. Thanks."; "The kids liked them."; "The stickers were received gladly by the students-it gave me a prompt to do the 'lice' lesson and hopefully was a reminder to parents."; "The younger students enjoyed the stickers and felt rewarded for knowing about head lice.". There were only two negative responses: "Don't think stickers are of value. I think a book or a story about lice would be more appropriate."; "Do not seem to be effective; however, effective to some individuals." Overall, positive feedback was received regarding the children's awareness stickers. Additional stickers were mailed to three schools per their request.
Some schools provided detailed data regarding the numbers of children contracting head lice and days absent due to the presence of nits or lice. However, most did not provide necessary information on the timing of educational efforts. Too few data are available to interpret time trends.
Continuing efforts are needed to reinforce IPM approaches to head lice control. It is particularly important to further educate children and families as to the basics of head lice transmission and prevention. Prevention of head lice is the foundation for management efforts. Children that know the basic facts about head lice can become the first line of defense in the on-going battle to prevent head lice infestations. Successful prevention efforts also are expected to decrease the use of pesticides for head lice control. Head lice awareness and the concomitant decrease in insecticides and their misuse will benefit society's children, families, and communities.
| Back |