Perceived risk of home fire and escape plans in rural households

BACKGROUND: Homes in rural areas have a higher fire death rate. Although successful exit from a home fire could greatly reduce fire-related deaths and injuries, little is known about factors associated with behaviors of developing and practicing an escape plan. METHODS: Between July 2003 and June 2004, a baseline survey was administered, in person, to 691 rural households. Information collected included a history of previous home fire, perceived risk of home fire, existing smoke alarms and their working status, and home fire safety practices, as well as home and occupant characteristics. The association of residents' perceived risk of home fire and fire escape plans was assessed. RESULTS: Forty-two percent of rural households reported having a fire escape plan. Of the households with a plan, less than two thirds (56.9%) discussed or practiced the plan. Households with children were more likely to develop and practice a fire escape plan. Households with an elderly or disabled person were less likely to develop or practice the plan. Compared to respondents who perceived low or very low risk of home fire, those who perceived a high or very high risk had 3.5 times greater odds of having a fire escape plan and 5.5 times greater odds of discussion or practicing their plan. CONCLUSIONS: Increasing awareness of the potential risk of home fires may help occupants develop and practice home fire escape plans. In order to reduce fire deaths and injuries, different strategies need to be developed for those households in which the occupants lack the ability to escape.     

Smoke alarm ownership and installation: a comparison of a rural and a suburban community in Georgia

As part of a smoke alarm giveaway and installation program (The Get-Alarmed Campaign), a total of 454 households were surveyed in two counties in Georgia, one metropolitan and one nonmetropolitan. The targeted communities in these counties had a high prevalence of low-income and minority populations and thus were at high risk of house fire-related morbidity and mortality. The objectives of the program were to determine the prevalence of and predictors for installed, functioning smoke alarms, and to install at least one smoke alarm and/or smoke alarm batteries in 100% of participating homes in need. Characteristics associated with smoke alarm ownership included home ownership, having a higher income, and having a central heating source, factors which should be considered in targeting future intervention strategies. At onset, 159/454 households (35.0%) had no smoke alarms installed and 56/275 households with existing smoke alarms (20.4%) had none that were functional. Regardless of ownership status, a free smoke alarm was installed in the household of 93.8% of participants and new batteries were installed in existing smoke alarms for 31.7% of participants. This project illustrates the usefulness of a door-to-door campaign in increasing smoke alarm ownership in both a rural and a suburban community with a high concentration of residents at high risk of house fire-related morbidity and mortality.     

Pilot Study of a Novel Partnership for Installing Smoke Alarms

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1–3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses’ relationships with clients made it easier for them to gain access to families who are often described as “hard-to-reach”. Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.     

Do Smoke Alarms Still Function a Year After Installation? A Follow-Up of the Get-Alarmed Campaign

The Get-Alarmed Campaign Follow-up Study was the second phase of an initiative to assure that homes of families at high risk of fire-related injury and death had functioning smoke alarms. Smoke alarms and/or batteries were installed in over 94 percent of 454 participating households in Schley and Henry Counties, Georgia, in 2000. Before the study began, 60.6 percent of these homes had smoke alarms, but only 36.6 percent had functioning smoke alarms. The follow-up study was designed to determine the experiences of participants with smoke alarms and whether participating households had functioning smoke alarms a year after baseline. Participants were phoned or visited and asked about their experiences with smoke alarms since the baseline study. During the interview, they were asked to test a smoke alarm, the results of which could frequently be heard. Respondents included 237 from Schley County and 113 from Henry County, for an overall 77.1 percent response rate. While 80.3 percent of respondents had a smoke alarm that was heard by the interviewer when it was tested, 6.6 percent reported that their smoke alarm had been disabled or had a dead battery. Over 75 percent of respondents had smoke alarm sound offs in the prior year, predominately due to cooking smoke, but only about 5 percent reported removing the battery or otherwise disabling it to prevent sound offs. However, the measures taken may render a household unprotected at a critical time. Efforts to increase protection with smoke alarms should be augmented with programs to insure adequate and timely testing and maintenance of existing smoke alarms.     

Smoke alarms by type and battery life in rural households: a randomized controlled trial

BACKGROUND: Although the use of smoke alarms is widely recommended, little guidance is available on the types of alarms and batteries that function best. This study examined smoke alarm and battery function 12 months after installation in rural residential households. METHODS: An RCT, involving the installation of either a photoelectric or ionizing smoke alarm with either a lithium or carbon-zinc battery, was conducted in 643 rural Iowa households in July 2003. The functionality of each installed smoke alarm was tested 12 months later. Generalized estimating equations were used to model the effects of alarm type and battery type on alarm function and false alarms 12 months after installation. RESULTS: Of 643 study homes, 98.8% had at least one functioning alarm, and 81.5% had all alarms functioning 12 months after installation. No difference was observed in alarm function between photoelectric alarms and ionizing alarms 12 months after installation (OR=1.30, 95% CI=0.88, 1.92). However, photoelectric alarms had significantly lower odds of false alarms than ionizing alarms. Alarms with lithium batteries had 91% higher odds of functioning than those with carbon-zinc batteries. The main reasons for nonfunctioning included a missing battery (30.7%); a missing alarm (28%); and a disconnected battery (11.3%). CONCLUSIONS: Although lithium batteries and photoelectric alarms are more expensive than their counterparts, the financial investment might be worthwhile in terms of overall performance.     

Residential carbon monoxide alarm use: opportunities for poisoning prevention

Prevalence of carbon monoxide (CO) alarm usage in localities where they are not required is poorly defined and the reasons for failing to have a home CO alarm have never been described. In this study, the authors conducted a computer-based survey among employees of similar major medical centers in Seattle, Washington, and Salt Lake City, Utah. Questions were asked about the prevalence of use of residential smoke and CO alarms with regard to home style and structure, ownership status, and energy use. Respondents not using home CO detectors were asked the reasons. Among 1,351 individuals participating in the survey, 98% reported residential use of smoke alarms, while only 51% used CO alarms. CO alarm use was more common among residents of Utah than Washington, among home owners than renters, and among those with single family homes rather than other styles. Reasons for failure to use CO alarms related largely to lack of knowledge about the devices and motivation.     

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.     

Estimating the proportion of homes with functioning smoke alarms: a comparison of telephone survey and household survey results.

OBJECTIVES: This study determined the proportion of homes with functioning smoke alarms in a low-income area experiencing a high rate of residential fire-related injuries. METHODS: An on-site survey of households was conducted to confirm the results of a telephone survey. RESULTS: In the telephone survey, 71% of households reported having functioning smoke alarms. In the household survey, 66% of households reported having functioning alarms; however, when the alarms were tested, the percentage dropped to 49%. CONCLUSIONS: Telephone surveys may overestimate the presence of functioning smoke alarms in some populations. Thus, the use of telephone surveys to establish baseline measures could significantly affect the evaluation of smoke-alarm giveaway programs.     

Strategies to Increase Smoke Alarm Use in High-Risk Households

A 3-year project was undertaken to evaluate two methods of promoting residential smoke alarm installation and maintenance in high risk households across the U.S. Five states (Arkansas, Maine, Maryland, Massachusetts, and North Carolina) participated. The two strategies under study were direct installation of smoke alarms and distribution of a voucher for free smoke alarms. The target population included occupants of high-risk households without working smoke alarms who were approached as part of a door-to-door canvassing program. Fire Safety education was provided to both groups. A follow up assessment conducted 6-12 months post intervention assessed the presence and functional status of smoke alarms in each of the two groups. Demographic and fire safety data were also collected at baseline and follow up for each group. 4,455 households were enrolled in the study [Installation Group: 2,206 (49.5%), Voucher Group: 2,249 (50.5%)]. Baseline characteristics of the groups within each state were comparable. Follow up data was obtained on 1,583 installation group households and 1,545 voucher group households. At follow up, 1,421 (89.8%) households in the installation group had working smoke alarms, compared with 997 (65%) households in the voucher group, Odds Ratio 4.82 (95% CI=3.97, 5.85) (p <.0001). On average, 47% of all households enrolled in the voucher group did not redeem their vouchers (range 26-63%). Direct installation of alarms by program staff resulted in working smoke alarms in 90% of households receiving the direct installation intervention. Only 65% of voucher households had functioning alarms at follow up, largely due to failure to redeem vouchers.     

Evaluation of Fire-Safety Programs that use 10-Year Smoke Alarms

The Centers for Disease Control and Prevention began funding a Smoke Alarm Installation and Fire Safety Education (SAIFE) program in 1998. This program involves the installation of lithium-powered “10-year” smoke alarms in homes at high risk for fires and injuries. This study aimed to (1) determine among original SAIFE homes if the lithium-powered alarms were still present and functional 8–10 years after installation and (2) understand factors related to smoke alarm presence and functionality. Data on a total of 384 homes and 601 smoke alarms in five states were collected and analyzed. Only one-third of alarms were still functional; 37% of installed alarms were missing; and 30% of alarms were present, but not functioning. Alarms were less likely to be functioning if they were installed in the kitchen and if homes had a different resident at follow-up. Of the 351 alarms that were present and had a battery at the time of the evaluation, only 21% contained lithium-powered batteries. Of these, 78% were still functioning. Programs that install lithium-powered alarms should use units that have sealed-in batteries and “hush” buttons. Additionally, education should be given on smoke alarm maintenance that includes a message that batteries in these alarms should not be replaced. Lithium-powered smoke alarms should last up to 10 years if maintained properly.     

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.     

EVALUATED COMMUNITY FIRE SAFETY INTERVENTIONS IN THE UNITED STATES: A REVIEW OF CURRENT LITERATURE

The purpose of the study was to assess the state of fire prevention research, provide an updated synthesis of evaluated fire prevention programs, and discuss the role of fire fighters and data systems in prevention efforts. The review included all evaluations of U.S. based fire prevention interventions published between January 1998 and September 2004 and any earlier articles about U.S. fire prevention interventions not included in two prior review articles. We retrieved information from each identified study including evaluation findings, involvement of fire service personnel and use of existing data systems. We identified twelve articles: seven reported on smoke alarm interventions, three on multi-faceted programs, and two other programs. Five programs involved fire service personnel in the design, implementation, and/or evaluation, and three used existing data systems. Studies reviewed suggest that canvassing and smoke alarm installations are the most effective means of distributing alarms and increasing the functional status of distributed alarms. The functionality of smoke alarms, an issue noted in earlier reviews, remains a problem. Programs involving partnerships with fire departments have indicated success in preventing fires and deaths, improving smoke alarm ownership and functional status, and improving children's fire safety knowledge. Using existing data systems to target and to evaluate interventions was effective. In the years since prior reviews, some improvements in the rigor of evaluation designs have been made, but there is still a need for high quality evaluations that will inform fire injury prevention efforts.     

Prevention of deaths and injuries caused by house fires: survey of local authority smoke alarm policies

BACKGROUND: Despite an increased risk of fire in disadvantaged households, smoke alarm ownership is considerably lower than in the general population. The government currently recommends that local authorities install battery-operated smoke alarms in all public sector properties regardless of tenure. However, the extent to which local authorities comply is currently not known. We conducted a survey of local authorities to establish the extent of their smoke alarm provision to public sector households. METHODS: A telephone survey of all 405 local authorities within England and Wales was carried out. RESULTS: We obtained responses from 390 (97 per cent) local authorities, 266 of which had responsibility for housing. Over half of all public-sector households are offered smoke alarms by the local authorities. The majority of local authorities offer ionization and/or optical sensor alarm types (78 per cent), with many local authorities providing battery-operated alarms alone (17 per cent) or in combination with hardwired alarms (31 per cent). CONCLUSIONS: Many local authorities offer smoke alarm provision to their public-sector households. Whether this represents an effective and cost-effective use of resources requires further investigation.     

Carbon Monoxide Alarm and Smoke Alarm Use Among Parents Recruited From a Pediatric Emergency Department

Although the proper installation and maintenance of carbon monoxide (CO) and smoke alarms can protect individuals from residential CO-related and fire-related injuries, these devices are underutilized. We describe characteristics associated with self-reported CO and smoke alarm use of parents recruited from a pediatric emergency department to improve CO alarm use. Parents of children ≤ 18 years (N = 299) reported socio-demographic characteristics and CO and smoke alarm ownership and practices. We assigned participants to a behavioral profile and a Precaution Adoption Process Model stage based on their self-reported CO and smoke alarm use. Most participants (71%) did not have CO alarms in their homes, but reported owning at least one working smoke alarm (98%). Participants who reported “perfect” CO alarm behavior (defined as having a working CO alarm, one near a sleeping area, with batteries replaced every 6 months; 9%) were more likely to earn a higher income, own their home, and have lived at their current residence for at least 2 years. Participants who reported “perfect” smoke alarm behavior (defined as having a working smoke alarm on every level, with batteries replaced every 6 months; 49%) were more likely to rent their home, receive federal assistance, and have lived at their current residence for at least 2 years. Interventions to increase correct CO alarm use are necessary.     

Use of carbon monoxide alarms to prevent poisonings during a power outage--North Carolina, December 2002

Each year in the United States, approximately 500 persons die from unintentional carbon monoxide (CO) poisoning, often during electric power outages caused by severe storms. Use of residential CO alarms has been recommended to reduce the incidence of CO poisoning. In September 2000, Mecklenburg County, North Carolina (2002 population: 722,367), adopted a public health ordinance requiring a CO alarm in the majority of residences; all-electric residences without attached garages (35.4% of all homes) were exempt. The ordinance also permitted use of alarms without battery back-up. On December 4, 2002, an ice storm caused 78.9% of county households to lose power. During the next 9 days, 124 cases of symptomatic CO poisoning were reported. To characterize these poisonings and the effectiveness of the CO alarm ordinance, local emergency physicians, fire department authorities, and CDC conducted an investigation. This report summarizes the results of that investigation, which determined that 96.2% of the severe poisonings occurred in homes with no reported functioning CO alarm. As a result of these findings, on October 8, 2003, Mecklenburg County officials amended the ordinance to require alarms with battery back-ups in all residences. Officials in other communities should consider enacting such alarm ordinances to prevent CO poisonings.     

Preventing unintentional injuries to children in the home: a systematic review of the effectiveness of programmes supplying and/or installing home safety equipment

In children under the age of five, the majority of unintentional injuries occur in the home, with higher levels of injury morbidity and mortality being found among those from more deprived backgrounds. This paper presents the findings of a systematic review about the effectiveness of programmes in decreasing unintentional injury rates to children (aged up to 15 years) in the home. The effectiveness of the provision of home safety equipment with or without installation, safety education or a home risk assessment is presented by outcome: injury rates, installation of smoke alarms and installation of other home safety equipment. Analysis of the statistically significant evidence suggests that few programmes reduce injury rates in children except where home safety equipment is supplied in conjunction with a home risk assessment, although this effect was only evident in households where a child had previously suffered an unintentional injury. The distribution of smoke alarms alone is insufficient for improving installation rates; programmes containing an education component showed more success. Interventions integrated into wider health programmes, where trusting relationships with householders were cultivated and/or where specific safety issues identified by a community were responded to also showed greater success in increasing smoke alarm installation rates. The evidence of effectiveness on installation rates of other home safety equipment is highly mixed, although there is some evidence to suggest that installation rates always decrease after 6 months. Where stair gates are both supplied and installed, inequalities in rates of use may be reduced.     

Nonfatal residential fire-related injuries treated in emergency departments--United States, 2001

During 2000, the most recent year for which national mortality data are available, 3,907 persons died in the United States from fire-related injuries; residential fires accounted for 2,955 (76%) of these deaths. The National Fire Protection Association (NFPA) reported that approximately 396,500 residential fires occurred in 2001. Injuries from residential fires are preventable by improving awareness of the common causes of fires and by using simple interventions (e.g., properly maintained smoke alarms and fire escape plans). Surveillance of fire-related injuries can aid prevention by increasing the understanding of these injuries and by identifying at-risk populations to target for interventions and education. To characterize nonfatal residential fire-related injuries treated in U.S. hospital emergency departments (EDs) during 2001, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicate that, in 2001, an estimated 25,717 nonfatal residential fire-related injuries were treated in U.S. hospital EDs. Fire prevention and safety interventions and education should target at-risk populations for fire-related injuries.     

Putting public health evidence into practice: increasing the prevalence of working smoke alarms in disadvantaged inner city housing

STUDY OBJECTIVES: The UK government recommends that local authorities install battery operated smoke alarms to prevent fire related injury. However, a randomised controlled trial of smoke alarm installation in local authority housing found a low level of working alarms at follow up. Qualitative work, which accompanied the trial explored barriers and levers to the use of this public health intervention. DESIGN: Semi-structured group and individual interviews were conducted with a sample of the adult participants in a randomised controlled trial of free smoke alarm installation. Group interviews and "draw and write" exercises were conducted with children at a local primary school. PARTICIPANTS: A sample of trial participants and primary school children in the trial neighbourhood. SETTING: An inner city housing estate in central London. MAIN RESULTS: The main barrier to smoke alarm use was the distress caused by false alarms. Although trial participants considered themselves to be at high risk for fires and would recommend smoke alarms to others, respondents' reports on the distress caused by false alarms suggest that people balance immediate and longer term risks to their health and wellbeing when they disable alarms. CONCLUSIONS: This study identified some of the reasons for the low level of functioning smoke alarms, and problems experienced with alarms. The results have implications for the implementation of this public health intervention. The effectiveness of smoke alarm installation could be improved if alarm manufacturers and those responsible for implementation programmes considered ways of tackling the issues raised in this study.