The distribution of poison prevention and education literature represents a significant part of poison center outreach programs. Yet the effectiveness, in terms of cost and impact, of mailing this material in an unsolicited fashion has not been investigated. We questioned the effectiveness of poison education literature through mass mailing to increase poison center awareness and improve one's ability to comprehend and retain appropriate first aid response in the event of a poisoning emergency. Two poison education brochures, in English and Spanish translation, and 2 telephone stickers were mailed third class to all 8,948 households in 1 rural county at a total cost of $3,420. A total of 397 (4.4%) households were randomly selected and successfully completed a 23-question telephone survey 6 mo after the mailing. The primary language spoken by the respondents were English, 311 (78%) and Spanish, 86 (22%). Children under the age of 6 y were present in 101 (25%) households. Only 50 (13%) respondents remembered having received any poison education brochures. Although 147 (37%) responded that they had heard of the regional poison center, only 63 (16%) said they would call the poison center first in the event of a poisoning. Forty-four percent indicated they would call 911 first. Only a small increase in penetrance rate was found when comparing 6 mo periods before and after the mailing. We conclude that mass mailing of poison education brochures made little impact in improving poison center awareness and first aid response and was not a cost effective method of poison education.