Validating self reported home safety practices in a culturally diverse non-inner city population

Evaluation of a mobile safety center's impact on pediatric home safety knowledge and device use

Background

A Mobile Safety Center (MSC) is designed to remove financial accessibility barriers to home safety by providing education and safety devices within local communities. The objective of this study was to evaluate the impact of an MSC on pediatric home safety knowledge and device use.

Methods

We conducted a prospective home safety interventional study. Parents and grandparents with children at home were recruited at community events attended by the MSC. Participants completed a pre-test survey assessing demographics and current home safety knowledge, practices, and device use. Participants then attended the MSC’s short home safety educational program. Afterwards, participants completed a knowledge reassessment post-test and were offered free safety devices: a smoke detector, a gun lock, and a childproofing kit comprising outlet covers, doorknob covers, and cabinet latches. We administered two follow-up surveys four weeks and six months after visiting the MSC. Descriptive statistics, Friedman tests, Wilcoxon Sum-Rank tests, and Pearson Chi-Square were used to assess respondent demographic characteristics and changes in home safety knowledge, practices, and device use.

Results

We recruited 50 participants, of whom 29 (58%) completed follow-up 1, 30 (60%) completed follow-up 2, and 26 (52%) completed both. Participants who completed both follow-ups increased total correct answers to safety knowledge questions between the pre-test and post-test (p = 0.005), pre-test and follow-up 1 (p = 0.003), and pre-test and follow-up 2 (p = 0.012) with no significant changes between the post-test, follow-up 1, and follow-up 2. Of the respondents who reported accepting safety products, outlet covers were used most frequently, followed by the smoke detector, doorknob covers, cabinet latches, and the gun lock.

Conclusions

The MSC may be an effective means of increasing home safety among families with children, as participation in the MSC’s home safety educational program significantly increased home safety knowledge and spurred home safety device use. Implementation of MSCs could potentially reduce childhood injury rates within communities through promotion of home safety.

Housing tenure as a focus for reducing inequalities in the home safety environment: evidence from Growing Up in New Zealand

OBJECTIVES

To determine whether specific demographic characteristics are associated with the presence or absence of household safety strategies.

METHODS

This study was conducted within Growing Up in New Zealand, a contemporary longitudinal study of New Zealand (NZ) children. Multivariable analyses were used to examine the maternal (self-prioritised ethnicity, education, age, self-reported health) and household (area-level deprivation, tenure, crowding, residential mobility, dwelling type) determinants of household safety strategies being present in the homes of young children.

RESULTS

In comparison to family-owned homes, privately owned rental homes were less likely (OR=0.78; 95%CI 0.65-0.92), and government-owned rental homes were more likely (OR=1.74, 95%CI 1.25-2.41) to have eight or more household safety strategies present.

CONCLUSIONS

Living in a privately owned rental home in NZ exposes children to an environment where there are fewer household safety strategies in place. Implications for public health: Housing tenure provides a clear target focus for improving the household safety environment for NZ children.

Supporting Family Engagement in Home Visiting with the Family Map Inventories

The purpose of this study was to examine the feasibility and usefulness of a universal screening tool, the Family Map Inventory (F MI), to assess family strengths and needs in a home visiting program. The FMI has been used successfully by center-based early childcare programs to tailor services to family need and build on existing strengths. Home visiting coordinators (N = 39) indicated the FMI would provide useful information, and they had the capacity to implement. In total, 70 families who enrolled in a Home Instruction for Parents of Preschool Youngsters (HIPPY) program were screened by the coordinator. The results of the FMI provided meaningful information about the home and parenting environment. Overall, most caregivers provided high levels of school readiness and parental warmth and low levels of family conflict and parenting stress. On the other hand, many families did not provide adequate food quality, exhibited chaotic home environments, and practiced negative discipline. This study demonstrated that the FMI is a feasible and useful option to assess comprehensive family needs in home visiting programs. It also demonstrated that the FMI provided home visiting coordinators a system to measure family strengths and needs. This could provide an assessment of program effectiveness and changes in the family's environment.

Measuring behaviours for escaping from house fires: use of latent variable models to summarise multiple behaviours

Background

This paper reports the development and testing of a construct measuring parental fire safety behaviours for planning escape from a house fire.

Methods

Latent variable modelling of data on parental-reported fire safety behaviours and plans for escaping from a house fire and multivariable logistic regression to quantify the association between groups defined by the latent variable modelling and parental-report of having a plan for escaping from a house fire. Data comes from 1112 participants in a cluster randomised controlled trial set in children’s centres in 4 study centres in the UK.

Results

A two class model provided the best fit to the data, combining responses to five fire safety planning behaviours. The first group (‘more behaviours for escaping from a house fire’) comprised 86 % of participants who were most likely to have a torch, be aware of how their smoke alarm sounds, to have external door and window keys accessible, and exits clear. The second group (‘fewer behaviours for escaping from a house fire’) comprised 14 % of participants who were less likely to report these five behaviours. After adjusting for potential confounders, participants allocated to the ‘more behaviours for escaping from a house fire group were 2.5 times more likely to report having an escape plan (OR 2.48; 95 % CI 1.59–3.86) than those in the “fewer behaviours for escaping from a house fire” group.

Conclusions

Multiple fire safety behaviour questions can be combined into a single binary summary measure of fire safety behaviours for escaping from a house fire. Our findings will be useful to future studies wishing to use a single measure of fire safety planning behaviour as measures of outcome or exposure.

Trial registration number: NCT 01452191. Date of registration 13/10/2011

Validity of parent's self-reported responses to home safety questions

The aim of the study was to describe the validity of parent's self-reported responses to questions on home safety practices for children of 2-4 years. A cross-sectional validation study compared parent's self-administered responses to items in the Home Injury Prevention Survey with home observations undertaken by trained researchers. The relationship between the questionnaire and observation results was assessed using percentage agreement, sensitivity, specificity, positive predictive value, negative predictive value and intraclass correlation coefficients. Percentage agreements ranged from 44% to 100% with 40 of the total 45 items scoring higher than 70%. Sensitivities ranged from 0% to 100%, with 27 items scoring at least 70%. Specificities also ranged from 0% to 100%, with 33 items scoring at least 70%. As such, the study identified a series of self-administered home safety questions that have sensitivities, specificities and predictive values sufficiently high to allow the information to be useful in research and injury prevention practice.

Validation of a home safety questionnaire used in a series of case-control studies

Objective

To measure the validity of safety behaviours, safety equipment use and hazards reported on a questionnaire by parents/carers with children aged under 5 years participating in a series of home safety case-control studies.

Methods

The questionnaire measured safety behaviours, safety equipment use and hazards being used as exposures in five case-control studies. Responses to questions were compared with observations made during a home visit. The researchers making observations were blind to questionnaire responses.

Results

In total, 162 families participated in the study. Overall agreement between reported and observed values of the safety practices ranged from 48.5% to 97.3%. Only 3 safety practices (stair gate at the top of stairs, stair gate at the bottom of stairs, stairs are carpeted) had substantial agreement based on the κ statistic (k=0.65, 0.72, 0.74, respectively). Sensitivity was high (≥70%) for 19 of the 30 safety practices, and specificity was high (≥70%) for 20 of the 30 practices. Overall for 24 safety practices, a higher proportion of respondents over-reported than under-reported safe practice (negative predictive value>positive predictive value). For six safety practices, a higher proportion of respondents under-reported than over-reported safe practice (negative predictive value<positive predictive value).

Conclusions

This study found that the validity of self-reports varied with safety practice. Questions with a high specificity will be useful for practitioners for identifying households who may benefit from home safety interventions and will be useful for researchers as measures of exposures or outcomes.

Using the pediatric emergency department to deliver tailored safety messages: results of a randomized controlled trial

OBJECTIVE

This study aimed to evaluate the impact of a computer kiosk intervention on parents' self-reported safety knowledge as well as observed child safety seat, smoke alarm use, and safe poison storage and to compare self-reported versus observed behaviors.

METHODS

A randomized controlled trial with 720 parents of young children (4 months to 5 years) was conducted in the pediatric emergency department of a level 1 pediatric trauma center. Enrolled parents received tailored safety information (intervention) or generic information (control) from a computer kiosk after completing a safety assessment. Parents were telephoned 4 to 6 months after the intervention to assess self-reported safety knowledge and behaviors; in-home observations were made 1 week after the telephone interview for a subset of 100 randomly selected participants. Positive and negative predictive values were compared between the intervention and control groups.

RESULTS

The intervention group had significantly higher smoke alarm (82% vs. 78%) and poison storage (83% vs 78%) knowledge scores. The intervention group was more likely to report correct child safety seat use (odds ratio, 1.36; 95% confidence interval, 1.05-1.77; P = 0.02). Observed safety behaviors were lower than self-reported use for both groups. No differences were found between groups for positive or negative predictive values.

CONCLUSIONS

These results add to the limited literature on the impact of computer tailoring home safety information. Knowledge gains were evident 4 months after intervention. Discrepancies between observed and self-reported behavior are concerning because the quality of a tailored intervention depends on the accuracy of participant self-reporting. Improved measures should be developed to encourage accurate reporting of safety behaviors.

Home safety practices in an urban low-income population: level of agreement between parental self-report and observed behaviors

Home-related injuries are overrepresented in children from low-income households. The objectives of this study were to determine frequencies of home safety behaviors and the level of agreement between parental self-report and observed safety practices in low-income homes. In a prospective, interventional home injury prevention study of 49 low-income families with children <5 years old, a trained home visitor administered baseline parental home safety behavior questionnaires and assessments. There was high agreement between caregiver self-report and home visitor observation for lack of cabinet latch (99%, 95% confidence interval [CI] = 88%-99%) and stair gate use (100%, 95% CI = 88-100%). There was lower agreement for the safe storage of cleaning supplies (62%, 95% CI = 46%-75%), sharps (74%, 95% CI = 59%-85%), and medicines/vitamins (83%, 95% CI = 69%-92%) because of the overreporting of safe practices. Self-reports of some home safety behaviors are relatively accurate, but certain practices may need to be verified by direct assessment.

Association between smokefree laws and voluntary smokefree-home rules

BACKGROUND

More states and localities are passing restrictions on smoking in public places and workplaces.

PURPOSE

To determine what, if any, association exists between enactment of strong laws making public places or workplaces smokefree on adoption of voluntary smokefree-home policies, particularly whether such laws are associated with increased smoking at home.

METHODS

Logistic regressions were used to estimate the OR of a person living with a 100% smokefree-home rule as a function of individual characteristics, household composition, and whether or not the residential region is covered by clean indoor air laws. The data came from successive waves of the Tobacco Use Supplement to Current Population Survey (TUS-CPS) for the years 1992-2007, and the American Nonsmokers' Rights Foundation database of state and local government clean indoor air laws. Analysis was conducted in 2010 and 2011.

RESULTS

Living in a county fully covered by a 100% clean indoor air law in workplaces or restaurants or bars is associated with an increased likelihood of having a voluntary 100% smokefree-home rule both for people living with smokers (OR=7.76, 95% CI=5.27, 11.43) and not living with smokers (OR=4.12, 95% CI=3.28, 5.16).

CONCLUSIONS

Strong clean indoor air laws are associated with large increases in voluntary smokefree-home policies both in the homes with and without smokers. These results support the hypothesis of norm spreading of clean indoor air laws.

Validation of a HOME Injury Survey

BACKGROUND

There are no validated observational surveys to assess injury hazards in the home environment.

OBJECTIVE

To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children.

METHODS

A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child's bathroom and child's bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland-Altman analysis of agreement, analysis of variance and kappa statistics.

RESULTS

There were 163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r = 0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r = 0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child's bathroom. Inter-rater reliability between research assistants, as measured by the kappa statistic, was excellent with a mean of 0.81.

CONCLUSIONS

The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.

Association between the number of home injury hazards and home injury

Although the home is a major setting for injury morbidity and mortality, there are few proven effective interventions for reducing home injury risk. To inform future research or interventions, this study measures associations between home injury hazards and home injury from a sample of New Zealand households. Logistic regression was used to assess the association between injury hazards identified by a building inspection and injuries requiring medical or associated services that occurred to household members prior to the inspection. There was an estimated increase of 22% in the odds of injury occurrence associated with each additional injury hazard found in the home (with 95% CI: 6-41%). This research suggests that addressing injury hazards in the home may be effective in reducing home injury. There are a number of potentially confounding factors that may affect relationships found between the existence of home hazards and injury occurrence. These need to be taken into account when future evaluations are planned.

Preventing product-related injuries: a randomized controlled trial of poster alerts

BACKGROUND

The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.

METHODS

15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.

RESULTS

We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.

CONCLUSION

Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety.

Preventing product-related injuries: a randomized controlled trial of poster alerts

BACKGROUND

The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.

METHODS

15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.

RESULTS

We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.

CONCLUSION

Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety.

Interventions for promoting smoke alarm ownership and function

BACKGROUND

Residential fires caused at least 67 deaths and 2,500 non-fatal injuries to children aged 0-16 in the United Kingdom in 1998. Smoke alarm ownership is associated with a reduced risk of residential fire death.

OBJECTIVES

We evaluated interventions to promote residential smoke alarms, to assess their effect on smoke alarm ownership, smoke alarm function, fires and burns and other fire-related injuries.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register, Cochrane Injuries Group database, MEDLINE, EMBASE, PsycLIT, CINAHL, ERIC, Dissertation Abstracts, International Bibliography of Social Sciences, ISTP, FIREDOC and LRC. Conference proceedings, published case studies, and bibliographies were systematically searched, and investigators and relevant organisations were contacted, to identify trials.

SELECTION CRITERIA

Randomised, quasi-randomised or nonrandomised controlled trials completed or published after 1969 evaluating an intervention to promote residential smoke alarms.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality.

MAIN RESULTS

We identified 26 trials, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR=1.26; 95% CI: 0.87 to 1.82) or having a functional alarm (OR=1.19; 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR=1.96; 1.03 to 3.72) and function (OR=1.72; 0.78 to 3.80). Results were sensitive to trial quality, however, and effects on fire-related injuries were not reported. In two non randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire-related injuries. Media and community education showed little benefit in non randomised trials.

REVIEWER'S CONCLUSIONS

Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give-away programmes apparently reduce fire-related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give-away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.