An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families

We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting.     

Storage of poisonous substances and firearms in homes with young children visitors and older adults

BACKGROUND: Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children's access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. METHODS: Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. RESULTS: There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged >/=70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. CONCLUSIONS: Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors.     

An injury prevention program in an urban African-American community.

OBJECTIVES. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS. Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS. A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS. There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.     

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.     

Prevention of childhood household injuries: a controlled clinical trial.

Injuries claim the lives of more children each year than the next six leading pediatric disorders combined, and produce injuries that require medical attention for one in three children. In the preschool age group, 91 per cent of these accidents and over one-half the resultant fatalities occur in the home. This paper reports the results of a controlled clinical trial conducted to evaluate the implementation of a health education program intended to reduce the risk of childhood household injuries. The study population was randomly assigned into two demographically comparable groups. Only the experimental group mothers received an educational intervention consisting of a tutorial, home safety-proofing assignments, and follow-up. The homes of the two groups were later assessed for hazards during an unannounced visit by an interviewer who did not know to which group each home belonged. A home safety score mean for the two groups was almost identical. The program stimulated heightened interest and stated intent to improve, but did not result in actual reduction of household hazards. Active health education, as used and evaluated in this study, appears to have limited effectiveness when applied to home safety. Approaches such as "passive" measures may offer greater potential for household injury reduction.     

Safety Practices in Relation to Home Ownership Among Urban Mexican Immigrant Families

We examined home safety hazards, comparing renter- to owner-occupied housing among urban, immigrant Mexican families. Methods: Interviews and home inspections were conducted among urban, Spanish-speaking immigrant families with children. We estimated weighted hazard prevalence and used logistic regression to compare owner- and renter-occupied homes. Of 313 eligible households, 250 (80%) enrolled. Respondents were predominantly Mexican-born (99%), low income (72.6%) and lower education (92.3%). Most homes had fire, burn, fall, poisoning, electrocution and fire escape hazards, including high tap water temperatures (76.4%; 95% CI: 69.0, 83.7%), no working smoke alarms (60.0%; 51.3, 68.8%), slippery bathtub/shower surfaces (58.7%; 49.9, 67.5%), blocked fire escape routes (55.9%; 47.2, 64.5%) and child-accessible medications (71.0%; 60.1, 81.3%). After adjustment for sociodemographics, fire escape (OR = 8.8; 95% CI: 2.8, 27.7), carbon monoxide poisoning (OR = 2.9; 1.4, 6.2) and drowning (OR = 3.5; 1.3, 9.4) hazards were more likely in owner- than renter-occupied homes. Housing age and type explained most differences. Many urban, immigrant Spanish-speaking families live in unsafe homes. For this population, housing safety programs should be targeted based on housing age and type rather than tenure.     

'BeSAFE', effect-evaluation of internet-based,tailored safety information combined with personal counselling on parents' child safety behaviours: study design of a randomized controlled trial

Background  

Injuries in or around the home are the most important cause of death among children aged 0-4 years old. It is also a major source of morbidity and loss of quality of life. In order to reduce the number of injuries, the Consumer Safety Institute introduced the use of Safety Information Leaflets in the Netherlands to provide safety education to parents of children aged 0-4 years. Despite current safety education, necessary safety behaviours are still not taken by a large number of parents, causing unnecessary risk of injury among young children. In an earlier study an E-health module with internet-based, tailored safety information was developed and applied. It concerns an advice for parents on safety behaviours in their homes regarding their child. The aim of this study is to evaluate the effect of this safety information combined with personal counselling on parents' child safety behaviours.     

Work-related deaths of children and adolescents in Australia, 1982 to 1984

Abstract: Work-related deaths of children and adolescents up to the age of 19 years were studied as part of a larger investigation into all work-related fatalities in Australia in the three-year period, 1982 to 1984. This study aimed to characterise the circumstances which led to the deaths of these children. Of 1738 work-related fatalities identified over the three years in the larger investigation, 67 (4 per cent) were aged under 15 years, and 117 (7 per cent) were aged 15 to 19 years. The fatalities were characterised by a number of variables, the most important being age, sex, bystander status, location (farm or other) and vehicle involvement (especially tractors). The causes of death differed between subgroups. Although existing controls may be reasonably effective in minimising child deaths in most work places, farms are an exception. On farms, home and work activities overlap, and informal participation in work by the young is quite common. Preventive efforts should give special attention to farms and tractors, to toddlers and male children, and to measures (such as safety devices and other external control measures) which do not rely on behavioural change in the young people at risk. Adults responsible for young children should be educated to anticipate dangerous situations and thus ensure children are protected from injury hazards.     

State-by-State Variation in the Number of Children and Young Adults in Nursing Homes, 2005–2012

Objectives One goal of Healthy People 2020 is to reduce the number of children and young adults living in nursing homes. However, little is known about the prevalence of nursing home use among children and young adults on a state-by-state basis. The objective of this study was to determine the prevalence of nursing home use among children and young adults in each state from 2005 to 2012. The study also looked for prevalence trends between 2005 and 2012. Methods The Centers for Medicare and Medicaid Services Minimum Data Set and US Census data were used to calculate the prevalence of nursing home residents among children and young adults aged 0–30 in each US state in 2012 and assess trends in each state from 2005 to 2012. Results In 2012, the prevalence of nursing home residents among children and young adults aged 0–30 varied across states, ranging from 14 in 100,000 (New Jersey) to 0.8 in 100,000 (Alaska). Testing for trends from 2005 to 2012 also revealed significant trends (p?<?0.05), with Florida trending upward with borderline statistical significance (p?=?0.05) and six states trending downward. Conclusion There is wide variation in the prevalence of nursing home residents among children and young adults aged 0–30 across states. There is also variation in the nursing home prevalence trends across states. Observed variations may represent potential opportunities for some states to reduce their population of children and young adults in nursing homes.     

An Evaluation of Health and Safety Hazards in Family Based Day Care Homes in Philadelphia

In Pennsylvania, Family Day Care Homes (FDCH) are private residences used to care for up to six children in a 24 h period. These homes are often times the most affordable alternative to day care centers parents have in low-income communities. The aims of this study were to evaluate FDCH providers’ knowledge of hazards and their understanding of actions required to mediate hazards. It also objectively assesses the presence of hazards in the home-based childcare facilities in low-income neighborhoods of Philadelphia. Results indicate that while hazard awareness levels among providers were relatively high, action to remove these hazards was not present in many of the homes. These findings suggest that training and enabling FDCH providers on how to carry out safety behavior is warranted to ensure improved safety conditions in these environments.     

Home hazards and falls in the elderly: the role of health and functional status.

OBJECTIVES. This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls. METHODS. A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups. RESULTS. Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons. CONCLUSIONS. While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects.     

Integrating Principles of Safety Culture and Just Culture Into Nursing Homes: Lessons From the Pandemic

Decades of concerns about the quality of care provided by nursing homes have led state and federal agencies to create layers of regulations and penalties. As such, regulatory efforts to improve nursing home care have largely focused on the identification of deficiencies and assignment of sanctions. The current regulatory strategy often places nursing home teams and government agencies at odds, hindering their ability to build a culture of safety in nursing homes that is foundational to health care quality. Imbuing safety culture into nursing homes will require nursing homes and regulatory agencies to acknowledge the high-risk nature of post-acute and long-term care settings, embrace just culture, and engage nursing home staff and stakeholders in actions that are supported by evidence-based best practices. The response to the COVID-19 pandemic prompted some of these actions, leading to changes in nursing survey and certification processes as well as deployment of strike teams to support nursing homes in crisis. These actions, coupled with investments in public health that include funds earmarked for nursing homes, could become the initial phases of an intentional renovation of the existing regulatory oversight from one that is largely punitive to one that is rooted in safety culture and proactively designed to achieve meaningful and sustained improvements in the quality of care and life for nursing home residents.     

Lead dust in Broken Hill homes: effect of remediation on indoor lead levels

This study was undertaken to determine whether home remediation effectively reduced indoor lead levels in Broken Hill, a long-established silver-lead-zinc mining town in outback Australia. A before-after study of the effect of home remediation on indoor lead levels was embedded into a randomized controlled trial of the effectiveness of remediation for reducing elevated blood lead levels in young children. Moist towelettes were used to measure lead loading (microg/m2) on internal windowsills and internal and entry floors of 98 homes; samples were collected before, immediately after, and 2, 4, 6, 8, and 10 months after remediation. Data were log(10) transformed for the analysis. Remediation reduced average indoor lead levels by approximately 50%, and lead levels remained low for the duration of the follow-up period (10 months). The greatest gains were made in homes with the highest initial lead levels; homes with low preremediation lead levels showed little or no benefit. Before remediation, homes located in areas with high soil lead levels or with "poor" dust proofing had higher lead levels than those in areas with lower soil lead levels or with "medium" or "good" dust proofing; these relative differences remained after remediation. There was no evidence that lead loading was reduced by an increased opportunity to become aware of lead issues. We conclude that remediation is an effective strategy for reducing the lead exposure of children living in homes with high indoor lead levels.     

Differences in Home Food and Activity Environments between Obese and Healthy Weight Families of Preschool Children

ObjectiveTo develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children.DesignA modified questionnaire about home environments was tested as an observation tool.SettingFamily homes.ParticipantsA total of 35 obese children with at least 1 obese caregiver were compared with 47 healthy weight children with no obese caregivers.Main Outcome MeasuresHome observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten.AnalysisAgreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05.ResultsHome observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a television in the obese child's bedroom, and had fewer physical activity devices compared with healthy weight preschoolers.Conclusions and ImplicationsFamilies of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.     

Oklahoma Healthy Homes initiative

Compelling scientific evidence suggests that a strong association exists between housing-related hazards and the health and safety of their residents. Health, safety, and environmental hazards (such as asthma and allergy triggers), unintentional injury hazards, lead-based paint hazards, and poor indoor air quality are interrelated with substandard housing conditions. This article describes a Healthy Homes initiative to address these hazards in a coordinated fashion in the home, rather than taking a categorical approach, even in the presence of multiple hazards. It also provides an overview of Oklahoma's Healthy Homes initiative and its pilot project, the Tulsa Safe and Healthy Housing Project, which is currently administered in Tulsa in collaboration with Children First, Oklahoma's Nurse-Family Partnership program. This pilot project seeks to open new areas of research that can lead to a greater understanding of environmental health issues related to substandard housing in the United States, which will eventually make homes safer and healthier.     

Risks to home care workers: Professional perspectives

Care at home is fundamental to community care policy, but the simultaneous growth of health and safety regulation has implications for home care services because of the duty of employers towards home care workers. This grounded theory study set in Northern Ireland used data from 19 focus groups and nine semi-structured interviews with a range of health and social services professionals and managers to explore perspectives on planning long term care for older people. Home care workers faced a wide range of hazards in the homes of clients, who themselves were faced with adapting their living habits due to their changing health and care needs and ‘risks.’ Creative approaches were used to ensure the health and safety of home care workers and simultaneously to meet the choices of clients. Staff experienced feelings of conflict when they judged it necessary to impose their way of providing home care and thus impose their values on clients to create a safe working environment. There was variation between and within organizations in terms of the staff focus on client needs or on their employer responsibility towards home care workers. The planning of home care services must take account of both the choices of clients and the hazards facing home care staff.     

Successful Academic Achievement Among Foster Children: What Did the Foster Parents Do?

Children who spend part of their childhood in foster homes have, as a group, lower academic achievement than their peers. However, some of these children do well and succeed in higher education. Resilience is about positive development enhanced by protective factors despite adversity. Protective factors may be both positive qualities in the children themselves and their social contexts. The purpose of this article is to explore how young people who spent part of their childhood in foster care succeeded in higher education. We interviewed 13 foster parents and 16 young adults with ongoing or completed university studies. Two main themes emerged as particularly important: the young adults’ motivation and effort, and qualities in the foster home. In this article, we focus on the qualities in the foster home. The analysis showed three main themes related to the foster home that supported school achievement: the promotion of a feeling of belonging in the foster home; core values such as taking school work seriously and giving one’s best; and providing order and structure in the foster children’s lives.     

Working in clients' homes: the impact on the mental health and well-being of visiting home care workers

The purpose of this paper is to examine the effects of working in clients' homes on the mental health and well-being of visiting home care workers. This paper reports the results of a survey of 674 visiting staff from three non-profit home care agencies in a medium-sized city in Ontario, Canada. Survey results are also complimented by data from 9 focus groups with 50 employees. For purposes of this study, home care workers include visiting therapists, nurses, and home support workers. Mental health and well-being is measured by three dependent variables: stress; job stress; and intrinsic job satisfaction. Multiple least squared regression analyses show several structural, emotional, physical, and organizational working conditions associated with the health and well-being of visiting home care workers. Overall, results show that workload, difficult clients, clients who take advantage of workers, sexual harassment, safety hazards, a repetitious job, and work-related injuries are associated with poorer health. Being fairly paid, having good benefits, emotional labour, organizational support, control over work, and peer support are associated with better health. Results suggest that policy change is needed to encourage healthier work environments for employees who work in clients' homes.     

Fecal lead excretion in young children as related to sources of lead in their environments

Summary Fecal lead excretion (PbF) was studied in young children with elevated lead exposure. PbB was generally 40–70 g/dl. The children's home environments were classified as to lead-base paint hazard and traffic density. There was a significant correlation between paint hazard classification and PbF but not between traffic density and PbF. There also was a correlation of PbB with paint hazard classification. Long-term fecal collections were instituted using 10 children who lived in high hazard homes and three children with low PbB's, whose PbF's were considered normal. Among the children living in high hazard homes, median fecal lead excretion generally was only moderately elevated. Grossly elevated amounts of lead were found only occasionally and only in a few of the children. Movement of two children from a high hazard home to a low hazard home resulted in prompt and substantial reduction in PbF. By contrast, PbB fell only very slowly.This study was supported by a grant from the US National Science Foundation—RANN Program, Grant 77-22186     

Supervision of children in agricultural settings: implications for injury risk and prevention

Farm environments pose unique safety hazards for children. With this in mind, this paper raises several points about how caregiver supervision influences risk of childhood injuries. First, research suggests that it is not the absence of a supervisor per se but the poorer quality of supervision that leads to pediatric injuries on farms, particularly for young children who behave in unpredictable ways at a time when caregivers are likely to be distracted with farm work. Second, research suggests that "adequate" supervision varies with context. In nonfarm contexts, continuous attention and close proximity (i.e., being within arm's reach) constitute an adequate level of supervision to ensure young children's safety. In agricultural contexts, attention and continuity are also relevant. However, close proximity is less beneficial because this often results in exposing children to hazards (animals, dangerous equipment) if the supervisor is working. Third, research suggests that in both agricultural and nonagricultural contexts, the extent to which supervision is associated with injury varies with a child's developmental level. Specifically, supervision seems to play a more primary role in moderating injury risk for young children (preschool), and this influence decreases as children age and increasingly independent are allowed to engage in more activities without a supervisor present. Building on these findings, practical recommendations are provided to enhance the safety of children on farms and future research directions are discussed.