Prevalence of residential smoke alarms and fire escape plans in the U.S.: results from the Second Injury Control and Risk Survey (ICARIS-2)

OBJECTIVES: This study was conducted to estimate (1) the proportion of U.S. homes with installed smoke alarms and fire escape plans, and (2) the frequency of testing home smoke alarms and of practicing the fire escape plans. METHODS: The authors analyzed data on smoke alarms and fire escape plans from a national cross-sectional random-digit dialed telephone survey of 9,684 households. RESULTS: Ninety-five percent of surveyed households reported at least one installed smoke alarm and 52% had a fire escape plan. The prevalence of alarms varied by educational level, income, and the presence of a child in the home. Only 15% tested their alarms once a month and only 16% of homes with an escape plan reported practicing it every six months. CONCLUSION: While smoke alarm prevalence in U.S. homes is high, only half of homes have a fire escape plan. Additional emphasis is needed on testing of installed smoke alarms and on preparedness for fire escape plans.     

Childhood Injuries in Pakistan: Results from Two Communities

The study aimed at determining the incidence, nature, and extent of childhood injuries in two suburban and rural communities of Pakistan. The findings of the study are based on a cross-sectional survey of 2,292 children aged 1-8 years. Information was sought retrospectively from the primary caregiver on the occurrence of injury that required formal or informal medical consultation during the past three months. The incidence rate of non-fatal injuries that required care outside home for children aged 1-8 years was 19.7 injuries per 100 person (child)-years of exposure [95% confidence interval (CI) 16.41-23.51]: 26.5 injuries per 100 person (child)-years of exposure (95% CI 21.31-32.63) in the suburban area and 12.1 injuries per 100 person (child)-years of exposure (95% CI 8.68-16.66) in the rural area. The most common non-fatal injuries were falls (10.5 fall injuries per 100 person (child)-years of exposure), burns and scalds (3.5 burn injuries per 100 person (child)-years of exposure), and road traffic injuries (RTIs) (2 RTIs per 100 person (child)-years of exposure). One fatality due to drowning was also reported during the study period. The difference among sex was highly significant (p=0.03). Boys (60%) were at a higher risk of injuries compared to girls (40%). The data also revealed that 61% of the injuries took place inside the home. The magnitude of childhood injuries in the two communities was significant compared to the findings of the National Health Survey of Pakistan (1990–1994). The fact that the majority (61%) of the injuries occurred inside the home raises many questions in relation to the household hazards and adequacy of safety and child-proofing measures in these households. There is a need to develop community-based interventions, creating awareness about the consequences of childhood injuries and educating families about preventive measures to reduce the incidence of injuries during early and middle childhood.Key words: Child, Cross-sectional studies, Injuries, Retrospective studies, Pakistan     

Prevalence of risk factors for residential fire and burn injuries in an American Indian community.

Fatality rates from residential fires are high among American Indians. Contact burns and scalds are also among the leading types of thermal injuries. Information about the prevalence of risk factors for burn injuries is required to design interventions aimed at reducing residential fire and burn injuries. The authors conducted a survey in July and August 1992 of 68 households located in a small American Indian community in Washington State to ascertain the prevalence of selected risk factors for residential fire and burn injuries. Nearly all households (96 percent) in the study had a smoke detector, and 95 percent of those tested were functioning. However, a high prevalence of other household characteristics associated with excess risk of residential fire and burn injuries was identified: 59 percent of households had at least one member who smoked, 25 percent had a member who smoked in bed, 38 percent had a member who drank alcohol and smoked at the same time, 46 percent used wood stoves as a heat source, and 15 percent of households were mobile homes. Thirteen percent of households had at least one fire during the previous 3 years, and the incidence of burns due to all causes and requiring medical treatment was 1.5 per 100 persons per year. Hot water temperature was measured to determine the potential risk for scald burns, and 48 percent of households had a maximum hot water temperature of 130 degrees or more Fahrenheit. Such surveys can guide intervention strategies to reduce residential fire and burn injuries in American Indian communities.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

Risk Factors for Rural Residential Fires

CONTEXT AND PURPOSE: Rural households report high fire-related mortality and injury rates, but few studies have examined the risk factors for fires. This study aims to identify occupant and household characteristics that are associated with residential fires in a rural cohort. METHODS: Of 1,005 households contacted in a single rural county, 691 (68.8%) agreed to participate. One household with missing information on a reported fire was excluded from the analysis. We used logistic regression to examine the independent association of occupant and household characteristics with reported fires, controlling for years lived in the residence. We also examined the association between the occurrence of previous fires and the adoption of safety measures. FINDINGS: A total of 78 (11.3%) households reported a residential fire. Occupant characteristics that were associated with significantly higher odds of reported fires included the presence of an occupant with alcohol problems (OR = 1.82, 95% CI = 1.01-3.28) and being married (OR = 2.11, 95% CI = 1.14-3.91). Rural farm households were associated with significantly higher odds (OR = 1.72, 95% CI = 1.01-2.93) of reporting a fire when compared to residences in towns, after controlling for all other occupant and household characteristics. The presence of a fire extinguisher (OR = 2.00, 95% CI = 1.10-3.64) was the only fire safety measure that had a statistically significant association with reported fire. CONCLUSIONS: Rural farm households report higher incidences of fire when compared to households located in towns. Experiencing a fire is not associated with an increased likelihood of adopting safety measures to prevent injuries once a fire has started.     

Recruiting and Retaining Physicians in Very Rural Areas

Context: Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians’ decisions to locate in very sparsely populated areas. Purpose: In this study, we investigated whether variables associated with rural background and training predicted physicians’ decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. Methods: Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. Findings: Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. Conclusions: Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.     

The Rural Physician Workforce in Florida: A Survey of US- and Foreign-Born Primary Care Physicians

CONTEXT: To meet the challenge of primary care needs in rural areas, continuing assessment of the demographics, training, and future work plans of practicing primary care physicians is needed. PURPOSE: This study's goal was to assess key characteristics of primary care physicians practicing in rural, suburban, and urban communities in Florida. METHODS: Surveys were mailed to all of Florida's rural primary care physicians (n = 399) and a 10% sampling (n = 1236) of urban and suburban primary care physicians. FINDINGS: Responses from 1000 physicians (272 rural, 385 urban, 343 suburban) showed that rural physicians were more likely to have been raised in a rural area, foreign-born and trained, a National Health Service Corps member, or a J-1 visa waiver program participant. Rural physicians were more likely to have been exposed to rural medical practice or living in a rural environment during their medical school and residency training. Factors such as rural upbringing and medical school training did not predict future rural practice with foreign-born physicians. Overall, future plans for practice did not seem to differ between rural, urban, and suburban physicians. CONCLUSIONS: Recruiting and retaining doctors in rural areas can be best supported through a mission-driven selection of medical students with subsequent training in medical school and residency in rural health issues. National programs such as the National Health Service Corps and the J-1 visa waiver program also play important roles in rural physician selection and should be taken into account when planning for future rural health care needs.     

Evaluation of three smoke detector promotion programs

Context: Seventy percent of U.S. residential fire deaths occur in homes without a working smoke detector. To help prevent residential fire deaths, many programs have distributed or installed detectors in unprotected homes. Because persons receiving a detector may not install it and because detector batteries require annual replacement, the enduring effectiveness of these programs may be questioned.Objective: We evaluated the long-term functional status of smoke detectors distributed to high-risk households in eight areas of Minnesota, Cherokee County (North Carolina), and Oklahoma City (Oklahoma).Design: Cross-sectional.Setting: Home visits were made to check the detectors that were distributed 3 to 4 years earlier.Participants: Randomly selected households from the three detector promotion programs.Main Out-come Measure: At least one working smoke detector.Results: Participation rates ranged from 72% to 82%. The percentage of evaluation households with at least one working detector ranged from 58% in Oklahoma to 73% in North Carolina. In 76% of households with nonworking detectors, the batteries were either missing or disconnected. When batteries in nonworking detectors were replaced, 83% of the detectors regained function.Conclusions: Future programs should consider distributing detectors that do not require annual battery changes or find effective ways to ensure that batteries are routinely replaced. Programs should also provide each household with the number of detectors needed to meet the most current recommended standard of the National Fire Protection Agency. The evaluation’s participation rates support the practicality of unannounced home visits to evaluate home injury prevention programs in high-risk groups.     

Intakes of retinol and carotenoids and its determining factors in the Red River Delta population of northern Vietnam

OBJECTIVE: To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes. SUBJECTS: Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer. RESULTS: Mean (s.d.) intake of carotenoids was 4178 (3154) microg/capita/day in rural and 4208 (3408) microg/capita/day in urban areas and intake of retinol was 101 (275) microg/capita/day in rural and 201 (470) microg/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 microg carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 microg retinol/day more than those with a lower expenditure (first quartile). CONCLUSION: Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.     

Determining the cost effectiveness of a smoke alarm give-away program using data from a randomized controlled trial

BACKGROUND: In 2001, 486 deaths and 17,300 injuries occurred in domestic fires in the UK. Domestic fires represent a significant cost to the UK economy, with the value of property loss alone estimated at pounds 375 million in 1999. In 2001 in the US, there were 383 500 home fires, resulting in 3110 deaths, 15,200 injuries and dollar 5.5 billion in direct property damage. METHODS: A cluster RCT was conducted to determine whether a smoke alarm give-away program, directed to an inner-city UK population, is effective and cost-effective in reducing the risk of fire-related deaths/injuries. Forty areas were randomized to the give-away or control group. The number of injuries/deaths and the number of fires in each ward were collected prospectively. Cost-effectiveness analysis was undertaken to relate the number of deaths/injuries to resource use (damage, fire service, healthcare and give-away costs). Analytical methods were used which reflected the characteristics of the trial data including the cluster design of the trial and a large number of zero costs and effects. RESULTS: The mean cost for a household in a give-away ward, including the cost of the program, was pounds 12.76, compared to pounds 10.74 for the control ward. The total mean number of deaths and injuries was greater in the intervention wards then the control wards, 6.45 and 5.17. When an injury/death avoided is valued at pounds 1000, a smoke alarm give-away has a probability of being cost effective of 0.15. CONCLUSIONS: A smoke alarm give-away program, as administered in the trial, is unlikely to represent a cost-effective use of resources.     

Use of supermarket receipts to estimate energy and fat content of food purchased by lean and overweight families

The aim of this study was to compare the energy and fat content of food purchased for home consumption by households comprising mainly overweight individuals (OH), with those comprising mainly lean individuals (LH). 214 supermarket shoppers and their household were recruited from a Tesco supermarket in Leeds (UK). Households collected supermarket receipts and completed a shopping diary for 28-days, and each member of the household completed a 4-day food record. OH purchased food higher in fat (38% total energy from fat) than LH, (34.9%: p=0.001) and they purchased more energy and fat per adult equivalent, per day than LH (10.05 MJ compared to 9.15 MJ: p=0.01 and 103 g compared to 86 g:p=0.001). Households were 15% more likely to be classified as OH for each additional MJ of energy purchased per person, per day, after adjusting for number of children, household size, age, sex and social class. It was concluded that food purchasing behaviour may be linked to the prevalence of obesity in households who shop at supermarkets.     

Safety belt use, ejection and entrapment

One in every five occupants thrown from a car receives fatal injuries. A motorist who uses a safety belt, in all probability, will not be thrown from the car during a crash. The rate of fatal injury for ejected occupants was found to be 40 times the rate for occupants not thrown from their cars, as determined from national accident sampling data. These data refute the popular notion that "being thrown clear" has survival benefit. In addition, there was no evidence that wearing a safety belt increased fatality risk from vehicle fire or submersion.     

The Implementation and Utility of Fire Incident Reporting Systems: The Delaware Experience

Fires and burns are the fifth most common cause of unintentional injury deaths in the United States. To address fires and fire deaths, the National Fire Data Center (NFDC) established the National Fire Incident Reporting System (NFIRS) as a surveillance system for fires. Delaware implemented NFIRS as the Delaware Fire Incident Reporting System (DFIRS), and is currently capturing all fires reported in the system. The objectives of this study are to: 1) understand the implementation of DFIRS; 2) analyze data from DFIRS to describe fire incidents; and 3) inform other states’ fire surveillance efforts. We interviewed Delaware State Fire Marshal’s Office personnel to understand the implementation of DFIRS and analyzed DFIRS data from May 2003 to December 2004 to examine data completeness, and characteristics of fires, smoke alarms, and fire injuries and deaths. DFIRS captures 100% of Delaware fires reported to fire departments. Data completeness for the fields examined ranged from 33% to 100%. Fires in which smoke alarms alerted occupants were significantly less likely to result in injury or death than fires in which smoke alarms did not. DFIRS has the potential to serve as a valuable fire prevention and fire analysis tool. For DFIRS to reach its full potential as a surveillance system, increased attention to data completeness is necessary. The authors Gwendolyn Bergen and Van M. Ta performed their work at Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy.     

Special report. Revising your fire safety plans

Every hospital has a fire safety plan, although some fail to update their plans when circumstances change, such as when the facility is refurbished or new fire protection equipment is added, or when new wings bring in additional patients and staff. Others may fail to develop new education programs to heighten staff awareness of what is expected of them during a fire and to train employees to meet those expectations. In this report, we'll examine the new fire safety plans at two Massachusetts hospitals and the revisions they made to address these issues. We'll offer suggestions for effectively evaluating and revising your own fire safety plans.     

What are consumers willing to pay for a broad network health plan?: Evidence from covered California

Health Insurance Marketplaces have received considerable attention for their narrow network health plans. Yet, little is known about consumer tastes for network breadth and how they affect plan selection. I estimate demand for health plans in California’s Marketplace, Covered California. Using 2017 individual enrollment data and provider network directories, I develop a geospatial measure of network breadth that reflects the physical locations of households and network providers. I find that households are sensitive to network breath in their plan choices. Mean willingness to pay for a broad network plan relative to a narrow network plan, defined as a two standard deviation, 17.44 percentage point increase in network breadth, is $45.83 in post-subsidy monthly premiums. Variation in WTP indicates a selection mechanism exists whereby older households sort into broader network plans. I also find that households are highly premium sensitive, which may be a result of plan standardization in Covered California.     

Availability of Rural Minnesota Obstetric Services: Is It a Problem?

In the late 1980s several published articles predicted a crisis in the availability of obstetric care due to declining numbers of rural obstetrical providers. Several state and national studies documented the adverse impact of malpractice and time demands on both urban and rural physicians. But only limited information is available to document current trends in rural obstetrical practice and assess whether or not the predicted crisis occurred. This study sought to provide that updated information for rural Minnesota. A telephone survey of all rural Minnesota obstetrical providers was used to document the number, location, and specialty of rural obstetrical providers, their practice limitations, and plans for future practice. This data was combined with state perinatal statistics for each county to further assess obstetrical care availability and perinatal outcomes. All rural Minnesota obstetricians and certified nurse midwives provide obstetrical care as did 69 percent of all rural family physicians. Only 27 percent of rural obstetrical providers put any type of restrictions on their obstetrical practices. During the past year, 67 currently practicing rural physicians have stopped providing obstetrical care while 55 new obstetrical providers have begun rural practice. Two to 3 percent of current rural providers plan to retire or discontinue obstetrical services during the next five years. The provider demographics from the survey identified eight counties with no prenatal providers, and 12 additional communities of decreased provider availability. However, only two of the counties with no prenatal providers and five of the counties with areas of limited providers had increased percentages of adverse prenatal outcomes such as low birthweight or late prenatal care. This study concluded that Minnesota does not have a serious statewide problem with availability of rural obstetrical providers. However, a few isolated regions of the state have limited provider availability, including limited availability of local high-risk services and consultants.     

Injury-Related Unsafe Behavior Among Households from Different Socioeconomic Strata in Pune City

Introduction:

Behavior pattern influences the risk of unintentional injuries. This study was conducted to identify the pattern of household unsafe behavior in different socioeconomic strata, in Pune city, India.

Materials and Method:

Population-based, cross-sectional study. Behaviors influencing the risk of burn, poisoning, drowning, and road traffic injuries were questioned from 200 randomly selected households.

Results:

Nearly 28% of the households did not have a separate kitchen, 37.5% cooked at the ground level, 33.5% used a kerosene pressure stove, 12% used unprotected open fire as a source of warmth in winter, and 34.5% stored inflammable substances at home. Ninety one percent of the households reported storing poisonous chemicals in places that could not be locked. In 68.3% of the households with children below five years, these chemicals were kept in places accessible to children. Nearly 21% of the individuals, who could swim, did so in unsafe places and 25.2% of them were not trained in swimming. In 35.5% of the households, children used streets as playgrounds. Among all two-wheeled vehicle riders, 35.6% reported not having a helmet and 57.7% of those who had a helmet did not use it regularly. Socioeconomic status was strongly associated with the unsafe behaviors related to burns, drowning, and road traffic injuries.

Conclusion:

The study identifies the sociocultural and behavioral factors leading to unsafe behaviors, placing individuals at risk of unintentional injuries, which can be used as a first step toward prevention.