Enhancing fire department home visiting programs: results of a community intervention trial

CHASE (Children's Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children's homes

BACKGROUND

Decades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety.

METHODS

This is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children's Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation.

DISCUSSION

Better data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.

Interventions for Preventing Residential Fires in Vulnerable Neighbourhoods and Indigenous Communities: A Systematic Review of the Literature

Globally, residential fires constitute a substantial public health problem, causing major fire-related injury morbidity and mortality. This review examined the literature on residential fire prevention interventions relevant to Indigenous communities and assessed their effectiveness on mitigating fire incidents and their associated human and economic burden. Electronic databases including MEDLINE, EMBASE, CENTRAL, and Web of Science Core Collection were reviewed for studies on fire prevention interventions published after 1990 and based on the 4E’s of injury prevention approaches (Education, Enforcement, Engineering, and Engagement). The grey literature and sources including indigenous organizational websites were also searched for eligible studies. Two authors independently screened, selected, and extracted data, in consultation with experts in the field. Outcomes measured included enhanced safety knowledge and practices, decreased residential fires incidents, reduced fire-related injuries and deaths, and lowered costs for healthcare needs. After removing duplicates, screening titles and abstracts, and assessing full texts, 81 articles were included in this review. Of the included studies, 29.1% implemented educational interventions within a variety of settings, including schools, community centres and homes, and included healthcare professionals and firefighters to raise awareness and the acquisition of fire safety skills. Engineering and environmental modifications were adopted in 20.2% of the studies with increased smoke alarm installations being the leading effective intervention followed by sprinkler inspections. Moreover, engagement of household members in hands-on safety training proved to be effective in enhancing household knowledge, fire safety decisions and practices. More importantly, effective outcomes were obtained when multi-faceted fire safety interventions were adopted, e.g., environmental modification and educational interventions, which together markedly reduced fire incidents and associated injuries. This review reveals the dearth of fire prevention evidence gathered directly within Indigenous communities. Nonetheless, relevant fire prevention recommendations can be made, calling for the adoption of combined and context-sensitive fire prevention interventions tailored to targeted Indigenous and vulnerable communities through multiple approaches and measures. Follow-ups and longitudinal studies are critical for accurate evaluation of the long-term outcomes and impacts on preventing residential fires.

Working with fire departments to adapt and implement evidence-based programs that increase uptake of smoke alarms: a case-series report

We describe a partnership between an academic injury center and three US fire departments to adapt and implement strategies for promoting smoke alarm programs. Each fire department identified the aims and parameters for a new promotion campaign for their smoke alarm programs. Promotion was directed towards residents in each department’s catchment area who were eligible for the smoke alarm program. All three departments independently elected to use an automated telephone message to promote their smoke alarm programs. Uptake of smoke alarm installation services ranged between .02% and 2% of the calls placed. In Rochester, automated calls were sent to all residential landlines via the city’s non-emergency call center; requests for smoke alarms increased by a factor of 7.5 in the month following the campaign. In Grand Rapids, automated calls were sent to 6% of the households served due to the telecommunications infrastructure; because of the limited reach, the overall number of requests remained unchanged, and the number of callers citing the automated calls was less than the number of requests callers reported were motivated by Grand Rapids’ existing promotion strategies. In Cloquet, the automated calls were broadcast on a rolling basis to geographic clusters of households; although the number of requests remained unchanged, fire district officials were pleased to reduce driving time between appointments which allowed volunteers to offer more home visit appointments. Automated telephone calls can be a valuable tool for promoting smoke alarm programs, but fire departments should carefully identify how dissemination strategies can best complement existing program efforts.

It Is Not the Batteries! Smoke Alarm Presence and Functionality 5 to 7 Years Postinstallation of Sealed Lithium Battery Alarms

Smoke alarms with lithium batteries have been marketed as long life or "10-Year Alarms." Previous work has drawn into question the actual term of functionality for lithium battery alarms. This article reports on observed smoke alarm presence and functionality in a sample of 158 homes that had participated in a fire department smoke alarm installation program 5 to 7 years prior to the observations. A total of 391 alarms were originally installed in the 158 homes that completed the revisit. At the time of the revisit, 217 of those alarms were working (54%), 28 were nonworking (7%), and 146 were missing (39%). Of the 158 homes that completed the revisit, n = 62 (39%) had all their originally installed project alarms up and working at the revisit. Respondents who reported owning their homes or who reported living in their home for 6 or more years were significantly more likely to maintain all of their project alarms than renters or those living in their homes for 5 or fewer years. Smoke alarm installation programs should consider revisiting homes within 5 to 7 years postinstallation to inspect and replace any missing or nonfunctioning alarms. We recommend programs conducting community risk reduction programs track and plan installations and revisits to improve smoke alarm coverage.

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

Background

By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value.

Objectives

This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence.

Search Methods

We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov).

Selection Criteria

Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps.

Data Collection and Analysis

We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist.

Main Results

After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues.

Authors' Conclusions

There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.

Patterns and risk factors of opioid-suspected EMS overdose in Houston metropolitan area, 2015-2019: A Bayesian spatiotemporal analysis

BACKGROUND

Opioid-related overdose deaths are the top accidental cause of death in the United States, and development of regional strategies to address this epidemic should begin with a better understanding of where and when overdoses are occurring.

METHODS AND FINDINGS

In this study, we relied on emergency medical services data to investigate the geographical and temporal patterns in opioid-suspected overdose incidents in one of the largest and most ethnically diverse metropolitan areas (Houston Texas). Using a cross sectional design and Bayesian spatiotemporal models, we identified zip code areas with excessive opioid-suspected incidents, and assessed how the incidence risks were associated with zip code level socioeconomic characteristics. Our analysis suggested that opioid-suspected overdose incidents were particularly high in multiple zip codes, primarily south and central within the city. Zip codes with high percentage of renters had higher overdose relative risk (RR = 1.03; 95% CI: [1.01, 1.04]), while crowded housing and larger proportion of white citizens had lower relative risks (RR = 0.9; 95% CI: [0.84, 0.96], RR = 0.97, 95% CI: [0.95, 0.99], respectively).

CONCLUSIONS

Our analysis illustrated the utility of Bayesian spatiotemporal models in assisting the development of targeted community strategies for local prevention and harm reduction efforts.

Utilizing Facebook and Automated Telephone Calls to Increase Adoption of a Local Smoke Alarm Installation Program

CONTEXT

Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior.

OBJECTIVE

We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program.

PARTICIPANTS

We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system.

DESIGN

The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system.

RESULTS

By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call.

CONCLUSION

Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.

Association between neighbourhood socioeconomic features and residential fire incidence, related casualties and children: a cross-sectional population-based study in 4 Canadian provinces

BACKGROUND

This study assessed whether socioeconomic factors affect the rates of residential fire incidence and fire-related injuries and deaths, and whether children are affected differently than the general population.

METHODS

We employed a cross-sectional study design using data for British Columbia, Alberta, Manitoba and Ontario from the National Fire Information Database, which includes fire incidents and losses reported by provincial fire marshals across Canada between 2005 and 2015. It also contains 2011 census subdivision social domain data from Statistics Canada based on fire location. Multivariable negative binomial regressions tested the significance of relations between census subdivision socioeconomic factors (average household size, educational attainment, median income and unemployment rate) and the rates of residential fires and casualties per person-year, and casualties per fire incident.

RESULTS

Census subdivisions with higher educational attainment and unemployment rates had higher rates of residential fires (incidence rate ratio [IRR] 1.07, 95% confidence interval [CI] 1.05-1.10, and IRR 1.24, 95% CI 1.18-1.31, respectively) and of residential fire casualties per person-year (IRR 1.09, 95% CI 1.05-1.13, and IRR 1.29, 95% CI 1.20-1.40, respectively). Census subdivisions with smaller average households had higher rates of residential fire casualties per person-year (IRR 0.43, 95% CI 0.22-0.83) and per fire incident (IRR 0.75, 95% CI 0.58-0.97), and the association was even stronger for children (IRR 0.17, 95% CI 0.08-0.36, and IRR 0.41, 95% CI 0.20-0.86, respectively).

INTERPRETATION

The results suggest that efforts to prevent residential fires should be prioritized in neighbourhoods with higher educational attainment and unemployment, whereas house fire safety programs should be intensified in neighbourhoods with smaller households to prevent fire casualties, especially among children, once a fire does occur.

Child Housing Assessment for a Safe Environment (CHASE): a new tool for injury prevention inside the home

OBJECTIVE

To develop a tool to assess the safety of the home environment that could produce valid measures of a child's risk of suffering an injury.

METHODS

Tool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case-control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee's home, and we compared scores on individual and summary items between cases and controls.

RESULTS

Twenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures.

CONCLUSION

Programmes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.

Predictors of Participation in a Fire Department Community Canvassing Program

An urban fire department has been distributing free smoke alarms for more than 30 years. A community-academic partnership was developed to conduct a community intervention trial as part of the fire department's home visiting program. The trial comprised 170 canvassing events held across 12 census tracts; half of the census tracts were assigned to the treatment condition and received prepromotion of the home visit events. The objectives of this analysis were to identify environmental and programmatic predictors of 1) whether someone would be at home at the time of a visit, and 2) if at home, whether the resident would participate. A separate multilevel analysis was conducted to address each objective. The canvassing event served as the first level to account for variation in implementation of the program, with the census tract as the second level. All environmental and program characteristics were included as fixed effects in both models. Throughout 170 events, 8080 eligible residential addresses were visited, of which 3216 had someone at home, and 2197 homes participated in the program. Canvassing events held on weekends and during the evening hours was associated with higher odds of a resident being at home. Canvassing events without rain and held in the treatment census tract areas was associated with higher odds of resident participation. Environmental and programmatic factors can impact the reach of home visiting programs. These findings can contribute to emerging best practices for fire department home visiting programs.

How the science of injury prevention contributes to advancing home fire safety in the USA: successes and opportunities

BACKGROUND

In the decades since the landmark report-America Burning-was published in 1973, the number of home fire deaths has shrunk from >5500 per year to 2650 in 2015. This paper: (1) describes how science and practice in injury prevention and fire and life safety contributed to successful interventions, and (2) identifies emerging strategies and future opportunities to prevent home fire-related deaths.

METHODS

The aims are addressed through the lens of population health research, with a focus on the work of selected Centers for Disease Control and Prevention-funded Injury Control Research Centers. Results are organised using the Haddon Matrix and an ecological model.

RESULTS

We found evidence to support interventions that address all components of both the matrix and the model, including: reduced ignition propensity cigarettes, stop smoking campaigns, housing codes, residential sprinkler systems, smoke alarms, community risk reduction, school-based educational programmes, and fire and burn response systems. Future reductions are likely to come from enhancing residential sprinkler and smoke alarm technology, and increasing their utilisation; expanding the use of community risk reduction methods; and implementing new technological solutions. Despite the successes, substantial disparities in home fire death rates remain, reflecting underlying social determinants of health.

CONCLUSION

Most of the evidence-supported interventions were focused on changing the policy and community environments to prevent home fires and reduce injury when a fire occurs. Future prevention efforts should give high priority to addressing the continued disparities in home fire deaths.

Pilot Study of a Novel Partnership for Installing Smoke Alarms

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1-3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses' relationships with clients made it easier for them to gain access to families who are often described as "hard-to-reach". Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

Using photographic interpretation to evaluate the safety of home environments

In the US there were 400,000 home fires resulting in 2755 deaths, 12,450 injuries, and $6.9B lost. The purpose of this study was to evaluate the content-validity of photographs taken in the home for use as an educational instrument to teach about "safe" and "unsafe" fire safety practice for adults and older adults. A total of 73 home fire safety experts were provided 27 photographs to evaluate home fire safety practice. Initially, a Krippendorff's alpha was calculated for the first 24 questions to evaluate inter-rater reliability, and differences in demographics were evaluated. Unique codes and themes for the last three questions were identified and inter-rater reliability examined. A majority of respondents were female (n = 43, 60.6%), college educated (n = 61, 83.6%), nurses (n = 25, 33.8%), or worked for a fire department (n = 21, 29.6%). Their mean age was 45.5 years and they had 11.05 years of experience. The first 24 questions had high inter-rater reliability (Krippendorff α = 0.831). No significant differences existed between the strata of the demographic variables (all p-values > 0.05). Similarly, based on the codes and themes identified, the last three questions had moderate-to-good inter-rater reliability (Krippendorff α = 0.764). Providing photographs as a 'seek-and-find' or 'What's wrong with this picture?' tools and simplified visual images is an excellent way to aid recognition of unsafe home fire safety environments. Education through non-traditional visual methods increases the possibility of change for diverse low-literacy populations.

Six-month follow-up of lithium-battery smoke alarms and self-reported reasons for disabling

Although smoke alarms with lithium batteries are often marketed as '10-year alarms', on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6-9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.

Unintentional home injuries across the life span: problems and solutions

Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors. The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals-such as architects, home builders, home visitors, and fire and emergency medical services providers-who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.

Changes in smoke alarm coverage following two fire department home visiting programs: what predicts success?

Background

Door-to-door canvassing and installation of smoke alarms have been found to be effective at increasing the number of homes protected. This analysis reports on how smoke alarm coverage changes six months after a home visiting program in a large urban sample, and how this change varies by characteristics of the residents and characteristics of the services delivered during the home visit.

Methods

Fire department Standard and Enhanced home visiting programs were compared. During the home visit, fire fighters installed lithium battery smoke alarms. Residents in the Enhanced program received tailored education about fire safety. Six months after the home visit, participating residences were visited to complete a follow-up survey and to have the installed alarms checked.

Results

81% of the 672 homes that had a working smoke alarm on every level of the home at the end of the home visit remained safe at follow-up, and 87% of the residents found the home visit was very useful, and these rates did not differ between the Enhanced and Standard programs. The degree to which firefighters delivered their services varied, although households in which the resident’s engagement with the fire department team was rated as excellent were 3.96 times as likely to be safe at follow-up compared to those with poor or fair resident engagement (p=0.03).

Conclusions

There is a need to better understand how to maximize the time spent with residents during smoke alarm home visiting programs. This study helps with the development of methods needed for implementing and evaluating such programs in real-world settings.

Electronic supplementary material

The online version of this article (doi:10.1186/s40621-014-0030-3) contains supplementary material, which is available to authorized users.

Utilizing GIS Technology to Improve Fire Prevention Activities in an Urban Fire Department

The Baltimore City Fire Department (BCFD) has been installing smoke alarms city wide for more than three decades. Though data on each visit are entered into a database, no system existed for using these data for planning or evaluation. The objective of this study is to use Geographic Information System (GIS) technology and existing databases to 1) determine the number of residences in need of a home visit; 2) determine total visits, visits per household, and number of homes entered for eligible households; and 3) demonstrate integration of various data via GIS for use in prevention planning. The tax assessment database was queried to determine the number of eligible (as determined by BCFD policy) residences in need of a visit. Each attempted BCFD home visit was coded to identify, if the BCFD personnel interacted with residents ("pass door") and installed alarms. Home visits were geocoded and compared to the tax assessment database to determine city wide pass door rates. Frequency of visits was run by individual residences to measure efficiency. A total of 206,850 residences met BCFD eligibility for a home visit. In 2007, the BCFD attempted 181,757 home visits and 177,213 were successfully geocoded to 122,118 addresses. A total of 122,118 eligible residences (59%) received a home visit. A total of 35,317 residences (29%) received a repeat visit attempt. The pass door rate was 22% (46,429) of all residences. GIS technology offers a promising means for fire departments to plan and evaluate the fire prevention services they provide.

Economic evaluation of smoke alarm distribution methods in Baltimore, Maryland

OBJECTIVE

This paper analyses costs and potential lives saved from a door-to-door smoke alarm distribution programme using data from a programme run by the Baltimore City Fire Department in 2010-2011.

DESIGN

We evaluate the impact of a standard home visit programme and an enhanced home visit programme that includes having community health workers provide advance notice, promote the programme, and accompany fire department personnel on the day of the home visit, compared with each other and with an option of not having a home visit programme (control).

RESULTS

Study data show that the home visit programme increased by 10% the number of homes that went from having no working alarm to having any working alarm, and the enhanced programme added an additional 1% to the number of homes protected. We use published reports on the relative risk of death in homes with and without a working smoke alarm to show that the standard programme would save an additional 0.24 lives per 10,000 homes over 10 years, compared with control areas and the enhanced home visit programme saved an additional 0.07 lives compared with the standard programme. The incremental cost of each life saved for the standard programme compared with control was $28,252 per death averted and $284,501per additional death averted for the enhanced compared with the standard.

CONCLUSIONS

Following the US guidelines for the value of a life, both programmes are cost effective, however, the standard programme may offer a better value in terms of dollars per death averted. The study also highlights the need for better data on the benefits of current smoke alarm recommendations and their impact on injury, death and property damage.

Still too hot: examination of water temperature and water heater characteristics 24 years after manufacturers adopt voluntary temperature setting

Although water heater manufacturers adopted a voluntary standard in the 1980s to preset thermostats on new water heaters to 120°F, tap water scald burns cause an estimated 1500 hospital admissions and 100 deaths per year in the United States. This study reports on water temperatures in 976 urban homes and identifies water heater and household characteristics associated with having safe temperatures. The temperature of the hot water, type and size of water heater, date of manufacture, and the setting of the temperature gauge were recorded. Demographic data, including number of people living in the home and home ownership, were also recorded. Hot water temperature was unsafe in 41% of homes. Homeowners were more likely to have safer hot water temperature (<120°F) than renters (63 vs 54%; P < .01). For 11% of gas water heaters, the water temperature was >130°F, although the gauge was set at less than 75% of its maximum setting. In a multivariate logistic regression, electric water heaters were more likely to have safe hot water temperatures than gas water heaters (odds ratio R=4.99; P < .01). Water heaters with more gallons per person in the household were more likely to be at or below the recommended 120°F. Our results suggest that hot water temperatures remain dangerously high for a substantial proportion of urban homes despite the adoption of voluntary standards to preset temperature settings by manufacturers. This research highlights the need for improved prevention strategies, such as installing thermostatic mixing valves, to ensure a safer temperature.

Fire and scald burn risks in urban communities: who is at risk and what do they believe about home safety?

While largely preventable, fire and hot water-related injuries are common in the United States. Measures recommended to reduce these injuries are smoke alarms (SAs) and lowered hot water temperatures. This study aims to: (i) describe the prevalence of working SAs and safe water temperatures among low-income, urban communities and (ii) explore the relationship between these behaviors and individuals' knowledge and beliefs about them. In this cross-sectional study, the Health Belief Model was used as a guide for understanding the safety behaviors. A total of 603 households had their SAs and hot tap water temperatures tested and were surveyed about their knowledge and beliefs related to these safety behaviors. We found that 40% of households had working SAs on every level and 57% had safe hot water temperatures. Perceived severity and self-efficacy were significantly associated with SA coverage, whereas perceived susceptibility and beliefs about benefits were significantly associated with safe hot water temperatures. This study demonstrates the need to increase the number of homes with working SAs and safe hot water temperatures. Messages focused on a safe home environment could communicate the ease and harm reduction features of SAs and benefits and risk reduction features of safe hot water temperatures.