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Fires and Burns
Interventions to Increase Smoke Detector Use
Background
The effectiveness of smoke detectors is well
established. Smoke detector use in residential housing increased from about 5% in
1970 to 67% in 1982.11,12 A number of factors probably contributed to increased
use; specifically, price reduction, marketing campaigns, programs by local fire
departments, building code modifications, and legislation. By 1983, 29 states required
smoke detectors in all new residential construction and 22 states required retrofitting
for some types of housing.13 Nevertheless, homes that need protection the most (low
income dwellings) are least likely to have working smoke detectors. Strategies to
increase smoke detector use (legislation, public education campaigns and give away
programs) are reviewed below.
Review of studies evaluating
programs to increase smoke detector use:
Author | DiGuiseppi, 2000 |
Study design and target population | Systematic review of controlled trials
to promote smoke alarms. |
Intervention | Promotion of SD 13 RCT 13 controlled. |
Outcomes | Ownership of SD.
Ownership of working SD. |
Results | Counseling and education had modest
effects on owning an alarm (OR=1.26, 95% CI 0.87, 1.81) or having a functioning
SD (OR=1.19, 95% CI 0.85, 1.66).
Counseling as part of primary child care had greater effects
on ownership (OR=1.93, 95% CI 1.04, 3.58) and function (OR=1.72, 95% CI 0.78,
3.78). |
Study quality and conclusions | Excellent Systematic Review. |
Author | Mallonee, 2000 |
Study design and target population | Oklahoma project. |
Intervention | See below. |
Outcomes | Injury rates 72 months after interventions. |
Results | Injury rates per 100,000 pop. Decreased by 81% in the target
areas compared to 7% in the rest of the city.
Injury rates per 100 residential fires decreased by 76% in
target areas and increased by 12% in the rest of the city. |
Study quality and conclusions | |
Author | Douglas, 1998 |
Study design and target population | Evaluation of different methods to distribute SD. |
Intervention | Comparison of 4 methods of participant solicitation (Canvass
door-to-door, flyers in public places, mailed flyers, flyers placed on doors). |
Outcomes | Comparison of number of SD distributed to total number of homes. |
Results | 3564 SD distributed. % of homes receiving SD were 31% for canvassing,
3% for flyers in public places, and 6% for other two methods.
Cost was lowest for canvassing. |
Study quality and conclusions | Canvassing door-to-door was the most effective method to distribute
SD. |
Author | Shults et al, 1998 |
Study design and target population | Cross sectional. |
Intervention | 3 programs.
Minnesota: Home visits with installation.
North Carolina: Some installations, some SD giveaways.
Oklahoma: see below. |
Outcomes | Home visits to detect if SD were working 3 years after intervention. |
Results | 436 homes visited, 88% of homes had at least one SD.
64% has at least one working SD. |
Study quality and conclusions | No control group. |
Author | Mallonee et al., 1996 |
Study design and target population | Non-equivalent control group design
The section of Oklahoma City with the
highest rate of residential fires. |
Intervention | Smoke alarm give-away program combined with education
and publicity campaign. Surveillance data used to target area with highest risk. |
Outcomes | Deaths and injuries from burns in residential fires;
injuries per 100,000 population and injury rate per 100 fires in Oklahoma City;
comparing the south central section to the rest of the city.
Number of operational smoke detectors 4 years
post intervention |
Results | 80% decrease in annualized injury rate per 100,000
population (from 15.3 to 3.1; incidence-density ratio 0.20 (0.10-0.40) compared
to an 8% increase in the rest of the city (from 3.6 to 3.9; incidence density
ratio 1.10 (0.70-1.7).
Annual rate of fires per 1000 homes decreased 25% in
target area and 18% in rest of city. Home inspection found 45% of smoke detectors
functioning 4 years later. |
Study quality and conclusions | Well-designed and executed study used surveillance
data to target intervention area. Analyzed 3 years of burn incidence data prior
to intervention and 4 years post intervention to stabilize rates.
Temporal variation minimized by analyzing
injuries per fire and per population. Suggests that a portion of the decrease
in injuries is due to campaign education and publicity.
Smoke detector give-away is an effective
strategy to decrease fire-related injuries in high rate areas. |
Author | Gorman et al., 1985 |
Study design and target population | Before/after design
Baltimore, MD, city census tracts at high
risk for fires |
Intervention | Smoke detector give-away program.
Free smoke detectors given to citizens who
called to request them (n=3720). |
Outcomes | Installation and proper functioning of smoke detector
Risk status of population reached via random sample
of home visits (n=231) and in-person interview.
82.5% response rate from random home
visits. |
Results | 81% of homes inspected had installed and functioning
smoke detectors. High-risk population reached.
Linear correlation between the likelihood of receiving
a smoke detector and the prior rate of fire injury and death (r=0.90, p<.001). |
Study quality and conclusions | Successful smoke detector give-away program required
active participation of a high risk population.
Total program provided 110,000 smoke detectors to Baltimore
households. (sold at cost and given away) |
Author | McLoughlin et al., 1985 |
Study design and target population | Non equivalent control group design
2 affluent suburban counties: Montgomery
County, Maryland (MC) and Fairfax county, Virginia (FC). |
Intervention | Legislation-1978 required retrofitting of smoke detectors
in all homes, (MC) vs. only new construction (FC). |
Outcomes | Homes with working smoke detectors.
Compliance with building code as judged by
home visits |
Results | Higher percentage of working detectors in intervention
county (83% vs. 70%), OR=2.1 1.01-4.34.
Similar compliance with code in MC (42%) vs.
FC (44%). Only 6% of intervention homes were without detectors vs.16% for
control community. |
Study quality and conclusions | Evaluation in 1983. Unenforced law obeyed because it
conforms to community values. Authors believe penalties attached to the law
increased compliance.
These are low risk communities. Study limited to single
family homes which limits generalizability. |
Author | Miller, 1982 |
Study design and target population | Non-equivalent control group design.
Suburban pediatric practice in Pittsburgh,
PA (n=240). |
Intervention | Education, physician counseling with the option to
purchase smoke detector at office visit (n=120).
Control group received usual/routine care (n=120). |
Outcomes | Correctly-installed and working smoke detector as determined
by home visit. |
Results | 88.8% consented to home inspection. Moderate baseline
use of smoke detectors (42.6% of intervention group vs. 53% of control group).
47.3% of intervention group purchased units vs. none of the controls. Intervention
group less likely not to have operational smoke detector (OR=0.75, 0.41-1.4). |
Study quality and conclusions | Rental units less likely to have smoke detectors than
owned housing units (18% vs. 55%).
Brief intervention which included offering
smoke detectors for sale was successful in this middle class practice setting. |
Author | Thomas, 1984 |
Study design and target population | Randomized controlled trial, single blinded.
Members of HMO in Kansas City, Kansas who selected
90 min. "well baby" classes.
Randomized to experimental (n=29) or
control group (n=26); children under 1 year. |
Intervention | Module on burn prevention including coupon for reduced
price smoke alarm added to usual well baby class curriculum; home visit after
4-6 weeks for both groups |
Outcomes | Scores on Fire Safety Knowledge Test
Home tap water temperature
Smoke alarm installation |
Results | Mean score on Knowledge test 20.3 (experimental group)
vs. 18.9 (control group), p=0.0001.
76% of experimental group had safe water temperature
vs. 23% of controls; 66% of experimental group lowered temperature setting
vs. none of the controls, p=0.01.
No significant difference in smoke
alarm installation. |
Study quality and conclusions | Single education session effective.
However, the study was small and had the following
weaknesses:
selection bias-volunteers for classes;
population employed, married and in late 20’s; post-test measures only
for water temperature and smoke detector installation. |
Summary of interventions
to increase smoke detector use
Legislation requiring installation of smoke
detectors in new and existing housing11 when combined with multi-factorial community campaigns
and reduced price coupons seem to be best way to increase use.18 Smoke detector give away programs have proven successful
when high risk areas are targeted.14,18 The successful programs have had one specific goal,
installation of working smoke detectors and used multi-faceted community campaigns.
Multi-focus general injury prevention campaigns seem to have little effect (see section on multi-faceted
interventions). Two barriers to effective use of smoke detectors are proper
installation and maintenance and the reluctance of renters to purchase the devices.7,16
Recommendations on interventions
to increase smoke detector use
Legislation requiring smoke detectors in
all housing units should be universal. Building codes should be amended to include
installation and inspection of smoke detectors. Strict codes backed up by inspection
can also address the issue of substandard heating and electrical equipment. Product
modification, specifically child resistant cigarette lighters18 and self-extinguishing
cigarettes6 are primary prevention strategies which would
prevent many fires from starting. These technologies have been developed, tested
and found feasible.19
Recommendations for future
research
Reliable low price smoke detectors
are available throughout the country. Improvements in current models should focus
on developing a long lasting power source. Combination smoke and carbon monoxide
detectors should be considered.
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