For Submission to the Journal of Community Health: Carbon Monoxide Awareness and Detector Use in the State of Wisconsin

Carbon monoxide (CO) is a leading cause of poisoning. CO detectors are a known-effective prevention strategy, however, little is known about use of detectors or knowledge of risk. This study assessed awareness of CO poisoning risk, detector laws, and detector use among a statewide sample. Data collected from the Survey of the Health of Wisconsin (SHOW) included a CO Monitoring module added to the in-home interview for 466 participants representing unique households across Wisconsin in 2018-2019. Univariate and multivariable logistic regression models examined associations between demographic characteristics, awareness of CO laws and detector use. Less than half of households had a verified CO detector. Under 46% were aware of the detector law. Those aware had 2.82 greater odds of having a detector in the home compared to those unaware of the law. Lack of CO law awareness may lead to less frequent detector use and result in higher risk of CO poisoning. This highlights the need for CO risk and detector education to decrease poisonings.

Impact of Mandatory Carbon Monoxide Alarms: An Investigation of the Effects on Detection and Poisoning Rates in New York City

OBJECTIVES

We sought to evaluate the impact of New York City's (NYC's) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates.

METHODS

We compared CO poisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey.

RESULTS

Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related CO poisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law's effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries.

CONCLUSIONS

Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms.

A comparison of carbon monoxide exposures after snowstorms and power outages

BACKGROUND

Unintentional carbon monoxide poisoning occurs frequently after natural disasters. Although the epidemiology of carbon monoxide exposures that occur after power loss storms has been reported, few publications detail the characteristics of carbon monoxide exposures after massive snowstorms.

PURPOSE

To compare the differences in patient characteristics of carbon monoxide exposures after a snowstorm and power loss storm.

METHODS

In 2013, a retrospective review was conducted of patient characteristics and exposure data from all carbon monoxide cases reported to the Connecticut Poison Control Center in the days following both a major snowstorm in 2013 and a winter storm that caused extensive power outages in 2011.

RESULTS

Portable generators were the most common source of carbon monoxide exposure after a storm that resulted in power losses; car exhaust was the most frequent source of exposure after an extensive snowstorm. Most exposures occurred within the first day after the snowstorm, and on the second and third days after the power outage storm. There were no significant differences between the two storms in terms of patient age, gender, or median carboxyhemoglobin concentration.

CONCLUSIONS

Future public health and medical education regarding the dangers of carbon monoxide in the aftermath of storms should include attention to the differences in the typical exposure sources and timing.

A survey of residential carbon monoxide detector utilization among Connecticut Emergency Department patients

CONTEXT

The use of carbon monoxide detectors may prevent deaths due to unintentional carbon monoxide poisoning. Currently, there is limited data regarding the characteristics of residential carbon monoxide detector use.

OBJECTIVE

To determine the characteristics of residential carbon monoxide detector use.

METHODS

A survey was administered to a convenience, cross-sectional sample of Emergency Department patients between June and August 2011. Inclusion criteria included patients who were older than 18 years, able to understand written or spoken English or Spanish, and lived in independent residential settings. Survey questions assessed the presence or absence of carbon monoxide and smoke detectors within the participant's home, the frequency of regular battery changes for both devices, location of carbon monoxide detectors within the home, and reasons for not installing carbon monoxide detectors (if applicable). Correlations between racial background, geographical area of residence (urban versus suburban), and income were also assessed.

RESULTS

A total of 1030 patients were surveyed. While 97.8% of respondents reported smoke detector use, only 44.4% had home carbon monoxide detectors installed. Only 17.2% had carbon monoxide detectors installed in or near their sleeping area, the correct location for detector placement. Carbon monoxide detector usage was found to be lowest among households earning less than $25,999 per year (27.3% reported having detectors), non-Caucasians (only 42.0% of African-Americans and 24.7% of Hispanics surveyed reported using detectors compared with 57.8% of Caucasians), renters, and urban residents. Reasons given for not having a carbon monoxide detector varied; many answers were consistent with a lack of awareness of the importance of using carbon monoxide detectors.

DISCUSSION AND CONCLUSIONS

Residential carbon monoxide detectors were underutilized compared to smoke detectors. Increased public education, especially for minorities and lower income populations, is necessary regarding the use of carbon monoxide detectors for poisoning prevention.