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Background Prior to the COVID-19 pandemic, 44% of all reported injuries in U.S. households occurred in the home. Spending more time at home due to the pandemic may increase the number of home injuries. Methods A nationally representative sample of 2011 U.S. adults were surveyed online between June 17 – June 29, 2020. Propensity score weighting and T-tests were used. Results Twenty-eight percent (28%) of households reported a home injury or ingestion during the pandemic; 13% reported experiencing both. Injuries were most often due to falls (32%). Medication ingestions were reported by 6%; household product ingestions were reported by 4%. Relative to households that experienced no injuries or ingestions, those that reported either or both were more likely to: be in urban areas, have household incomes > $100,000, and have children living in them. Among households reporting more time spent at home, those with children were significantly more likely than those without to report an injury or ingestion. Conclusions Results help target prevention messages while U.S. families are continuing to work and learn remotely. During this pandemic and future stay-at-home orders, there is a need for public health efforts to prevent home injuries and ingestions.

The growing interest in incorporating prevention into emergency health care make it timely to examine the use of computer technology to efficiently deliver effective education in this setting.This RCT compared results from an intervention group (n=367) that received child passenger safety information, to an attention-matched control (n=375). A baseline survey and two follow-up surveys at 3 and 6 months were conducted.Data were collected from June 2014 to September 2016 from a sample of parents with children aged 4-7 years recruited from a pediatric emergency department in an East Coast urban area and one in a Midwest semi-rural area.A theory-based, stage-tailored educational program, Safety in Seconds v2.0Four car seat behaviors: (1) having the correct restraint for the child's age and weight; (2) having the child ride in the backseat all the time; (3) buckling up the child all the time; and (4) having the child's restraint inspected by a child passenger safety technician.At 3 months, adjusting for baseline behaviors and attrition, the odds of reporting the correct behavior by the intervention group relative to the control group was 2.07 (p0.01) for using the correct car seat; 2.37 (p0.05) times for having the child ride in the back seat; 1.04 (nonsignificant) for riding buckled up all the time; and 1.99 (p0.01) times for having the car seat inspected. At 6 months, there were statistically significant effects for reporting use of the correct car seat (OR=1.84, p0.01) and having the car seat inspected (OR=1.73, p0.01).Mobile apps hold promise for reaching large populations with individually tailored child passenger safety education.Clinical Trial Registration # NCT02345941.

Bicycle-related falls are a significant cause of mortality and morbidity. Use of bicycle helmets substantially reduces risk of severe traumatic brain injury but compliance with this safety practice is particularly low in urban children. We recruited eleven 8- to 15-year-old youth to participate in focus groups to inform the creation of a video promoting helmet use. Key emerging themes included that youth were responsible for keeping themselves safe and that most youth had cell phones with cases to protect them. A video was created that linked the concept of use of cases to protect phones to use of helmets to protect heads. Soliciting information from urban youth was helpful for developing this educational video.

Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription. Among patients who suffer an OPR-related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.

BACKGROUND: Safety centers (SCs) are hospital-affiliated outlets that provide families with safety products and personalized education about preventing injuries. Roughly 40 SCs are in operation across the United States, but no single model for staffing, supplying, or sustaining them has emerged. The project aimed to determine the feasibility of a centralized database for SC evaluation as the first step toward growing this proven intervention. METHODS: An Expert Advisory Committee was convened to determine data collection elements and procedures. Representatives from nine hospital-based SCs collected data about car seat and bike helmet sales and education provided between August 1, 2013, to December 31, 2013. RESULTS: A total of 645 study-related safety products were distributed at cost (72%), below cost (10%), or for free (19%). Education was provided for 96% of all products distributed, including receipt of print materials (81%) and product demonstrations (83%). Visitors to SCs were usually referred by a hospital provider (34%), followed by word of mouth (24%) and walk-in (22%). Seven of nine SCs were able to contribute data. Stability of SCs and capacity of staff emerged as facilitators of centralized data collection feasibility. CONCLUSION: We demonstrate that centralized data collection is feasible and that information to compare centers can be obtained. However, for more meaningful comparisons to emerge and to enable all SCs the ability to participate, support is needed institutionally for staff to be able to capture data and nationally to grow and sustain a database that represents the broader diversity of topics and services offered. Language: en

Statement of purpose This paper reports the effectiveness of the scald prevention intervention on knowledge, self reported prevention behaviours and observed home water temperature. Methods/approach Safe Start is a three-group randomised controlled trial comparing a scald prevention intervention delivered by health education staff (Intervention Group, IG) as part of the 2 week well child visit (WCV) and an attention-matched control group (Control Group, CG) that received a safe sleep prevention intervention, and a standard of care group (Standard of Care Group, SG). A baseline survey was completed in the clinic at the 2 week WCV; follow up surveys were completed in the home at 4–6 weeks. Results 149 participants were enrolled and completed a follow-up interview. The typical participant was a 26 year old African American (90%) mother living in a rental property (87%) receiving medical assistance (80%) with at least a high school education (58%). Compared to the attention matched control and standard of care groups, the intervention group demonstrated increased knowledge on 5 of 9 individual scald risk items and the overall knowledge score (74% (IG)vs. 48%–46%) correct, p=0.00). The IG parents were more likely to report water heater testing behaviour (45% (IG) vs. 11%–7%, p=0.00), and bath thermometer usage (82% (IG) vs. 17% and 8,% p=0.00), Differences were not found between group on home water temperatures. Significance Implementing this intervention is a promising way to reduce the risk of scald burns to infants primarily through increased knowledge and self reported testing behaviours of bath water. Future work needs to focus on barriers to changing the hot water temperature at the water heater, given that 51% of participants in our group had unsafe water temperatures at follow-up.

Purpose Bicycle helmet use has increased in the past three decades, but roughly only half of all cyclists wear helmets. Use is lowest among minority children, among children whose parents have less than a high school education and among poor children. Methods We conducted focus groups with urban youth aged 8 to 15 to better understand their perceptions of barriers and facilitators to helmet use, and to solicit their preferences for a video to promote helmet use to urban youth. We partnered with students from two urban schools to produce a 4 min promotional video. Finally, we tested the impact of the video coupled with receipt of a free helmet and proper fit instructions with families attending a paediatric well-child care clinic in our city. Results Two focus groups were completed with a total of 11 youth in November 2016. Several important themes emerged that informed the video, including that youth were responsible for keeping themselves safe and that most youth had cell phones (and used cases to protect them). A video script was finalised in February 2017 that asked youth why they protect their phones but not their heads/brains with a helmet. We will enrol at least 25 parent-child dyads in our full intervention: viewing video, receiving helmet and fit instruction, and completing baseline and two follow up surveys. The pilot will be completed by September 2017. Conclusions Soliciting information from urban youth is important to developing an effective and persuasive bike helmet promotion video. Significance We must develop persuasive and creative ways to encourage urban youth to wear helmets to reduce bike related injury disparities.

Purpose Although child safety seats are known to reduce the risk of death from motor vehicle crashes, use among children 4–7 years old remains low and misuse is widespread. The aim of this prospective randomised trial was to test the efficacy of a smartphone app, Safety In Seconds 2.0, which delivered theory-based tailored education about child safety seats to parents in Little Rock, Arkansas and Baltimore, Maryland Methods Parents of children aged 4–7 visiting the paediatric emergency room in the two participating sites (regardless of the reason for the visit) were recruited. Study participants downloaded the Safety In Seconds app onto their smartphone and were randomised to the intervention (car seat) or control (fire safety) group. Both groups completed a 10 min assessment about their safety knowledge and behaviours and received tailored feedback relevant to their study group. The app contained a portal with educational links and sent monthly push notification reminders for parents to interact with the app. Parents completed follow-up assessments at 3 months and 6 months. Results A total of n=1129 parents were enrolled, and 742 (66%) completed the 6 month follow-up survey. At follow-up relative to the CG, IG parents were more likely to report using the correct child safety seat for their child’s age and size (OR=1.8; p Conclusions/Significance Smartphone applications hold potential for changing behaviours that are known to improve child passenger safety.

BackgroundFew randomised controlled trials (RCTs) have been conducted to improve infant sleep practices. There is limited research on how best to integrate safe sleep information into routine paediatric anticipatory guidance delivered at well child visits (WCVs). This protocol paper describes the design of the Safe Start Study, which aims to evaluate the impact of safe sleep interventions on parents’ knowledge, beliefs and behaviours related to creating and maintaining a safe sleep environment for their infants.MethodsSafe Start is a three-group RCT comparing a safe sleep health education intervention delivered as part of the 2-week WCV, an attention-matched control group that receives a scald burn prevention intervention, and a standard of care group. A baseline survey is completed at the 2-week WCV; follow-up surveys and observations are completed in the home at 2–4 weeks and 2–3 months. Participants include mother–baby dyads attending a large urban paediatric primary care practice and their paediatricians. Primary outcomes are self-reported behaviours (baby sleeps alone, on back, in crib and in a smoke-free environment), observations of the sleep environment, paediatricians’ anticipatory guidance counselling about safe sleep and participants’ reported exposure to an existing city-wide safe sleep campaign.DiscussionProviding a theory-driven and evidenced-based safe sleep intervention is both a research and a clinical practice priority. This study will advance the application of educational and environmental interventions in the primary care setting to improve the safety of infant sleep environments in high-risk families.Trial registration numberNCT03070639; Pre-results.

Although smoke alarms with lithium batteries are often marketed as '10-year alarms', on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6-9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.

OBJECTIVES:To describe safe storage practices and beliefs among adults who have used a prescription opioid pain reliever (OPR) in the past year; to compare practices and beliefs among those living with younger (METHODS:A survey was administered to a nationally representative sample of adults reporting OPR use in the previous 12 months and who had children RESULTS:Among 681 adults who completed our survey and reported having children in their home, safe storage was reported by 32.6% (95% confidence interval [CI], 21.4–43.8) of those with only young children, 11.7% (95% CI, 7.2–16.2) among those with only older children, and 29.0% (95% CI, 18.3–39.8) among those with children in both age groups. Among those asked to answer survey questions thinking about only their oldest child, the odds of reporting safe storage decreased by half as perceived barriers increased (0.505; 95% CI, 0.369–0.692), increased twofold as efficacy increased (2.112; 95% CI, 1.390–3.210), and increased (1.728; 95% CI, 1.374–2.174) as worry increased.CONCLUSIONS:OPRs are stored unsafely in many households with children. Educational messages should address perceived barriers related to safe storage while emphasizing how it may reduce OPR access among children.

Background Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents9 use of child restraints and smoke alarms. Methods SIS is a multisite randomised controlled trial. Participants are parents of children aged 4–7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child9s age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan. Discussion Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use. Trial registration number NCT02345941; Pre-results.

OBJECTIVES: Living in substandard housing may be one factor that increases the risk of fire and burn injuries in low-income urban environments. The purposes of this study are to (1) describe the frequency and characteristics of substandard housing in urban homes with young children and (2) explore the hypothesis that better housing quality is associated with a greater likelihood of having working smoke alarms and safe hot water temperatures. METHODS: A total 246 caregivers of children ages 0 to 7 years were recruited from a pediatric emergency department and a well-child clinic. In-home observations were completed by using 46 items from the Housing and Urban Development’s Housing Quality Standards. RESULTS: Virtually all homes (99%) failed the housing quality measure. Items with the highest failure rates were those related to heating and cooling; walls, ceilings, and floors; and sanitation and safety domains. One working smoke alarm was observed in 82% of the homes, 42% had 1 on every level, and 62% had safe hot water temperatures. For every increase of 1 item in the number of housing quality items passed, the odds of having any working smoke alarm increased by 10%, the odds of having 1 on every level by 18%, and the odds of having safe hot water temperatures by 8%. CONCLUSIONS: Many children may be at heightened risk for fire and scald burns by virtue of their home environment. Stronger collaboration between housing, health care, and injury prevention professionals is urgently needed to maximize opportunities to improve home safety.

Objectives Many residential fire deaths occur in homes with no or non-functioning smoke alarms (SAs). Self-reported SA coverage is high, but studies have found varying validity for self-report measures. The authors aim to: (1) determine over-reporting of coverage, (2) describe socio-demographic correlates of over-reporting and (3) report reasons for over-reporting. Methods The authors surveyed 603 households in a large, urban area about fire safety behaviours and then tested all SAs in the home. 23 participants who over-reported their SA coverage were telephoned and asked about why they had misreported. Results Full coverage was reported in 70% of households but observed in only 41%, with a low positive predictive value (54.2%) for the self-report measure. Most over-reporters assumed alarms were working because they were mounted or did not think a working alarm in a basement or attic was needed to be fully protected. Conclusions If alarms cannot be tested, researchers or those counselling residents on fire safety should carefully probe self-reported coverage. Our findings support efforts to equip more homes with hard-wired or 10 year lithium battery alarms to reduce the need for user maintenance.

This paper presents a cross-sectional study examining the influence of neighborhood violence on multiple aspects of mothers’ health. While the influence of neighborhood violence on health is important to understand for all populations, mothers are especially important as they play a key role in protecting their children from the consequences of violence. Three hundred and ninety-two Baltimore City mothers of children 5 years and younger completed a self-administered survey that included questions about perceptions of their safety as well as their personal experiences with neighborhood violence. Separate models were run to compare the relationship between each measurement of neighborhood violence and five diverse health-related determinants and outcomes: self-reported health status, smoking, exercise, average hours of sleep a night, and sleep interruption. Controlling for mother’s age, child’s age, maternal education, and marital status, mothers with high exposure to neighborhood violence were twice as likely to report poorer health, smoking, never exercising, and poor sleep habits. Maternal perception of neighborhood safety was not related to any of the assessed health-related determinants and outcomes. This study emphasizes the importance of measuring exposure to neighborhood violence rather than solely assessing perceived safety. Neighborhood violence was a common experience for mothers in this urban sample, and should be considered by health professionals in trying to understand and intervene to improve the health of mothers and their children.

Reducing deaths and disability from injury will require pervasive and successful injury prevention efforts in both community and clinical settings. Examples of interventions in the clinical setting include access to and instruction on using safety products, and screening and brief interventions for alcohol problems, intimate partner violence, or child maltreatment. The objectives of this study were to identify and describe injury prevention programs used in emergency departments in one state, to describe facilitators to implementation of these programs, and to suggest ways for overcoming barriers. Language: en

OBJECTIVES. The effects of a computer kiosk intervention on parents' child safety seat, smoke alarm, and poison storage knowledge and behaviors were evaluated in a pediatric emergency department serving predominantly low-income, urban families. The effects of parent anxiety and the reason for the child's emergency department visit also were examined. METHODS. A randomized, controlled trial of a Safety in Seconds program with a 2- to 4-week follow-up interview was conducted with 759 parents of young children (4–66 months of age). The intervention group received a personalized report containing tailored, stage-based safety messages based on the precaution adoption process model. The control group received a report on other child health topics. RESULTS. The intervention group had significantly higher smoke alarm, poison storage, and total safety knowledge scores. The intervention group was more likely to report correct child safety seat use. Neither parent anxiety nor the reason for the emergency department visit was related to the safety behaviors. Virtually all (93%) intervention parents read at least some of the report; 57% read it all, and 68% discussed it with others. Lower-income intervention parents who read all of the report and discussed it with others were more likely than control parents to practice safe poison storage. Higher-income intervention parents were more likely than control parents to report correct child safety seat use. CONCLUSIONS. These results bode well for widespread applicability of computer technology to patient education in busy emergency departments and other child health care settings. Reducing financial barriers to certain safety behaviors should continue to be a high priority.

Summary Background Despite the requirement for and endorsement of injury prevention efforts among U.S. trauma centres, little is known about the breadth and depth of their current activities. Methods A survey was sent to eligible institutions in the National Inventory of Trauma Centres to better describe how level I and II centres are fulfilling their injury prevention requirement, to identify the barriers to conducting prevention activities, and to determine trauma centre personnel's interest in enhancing their prevention role. Results A total of 268 trauma centres (60%) completed the survey. Only 19% reported having an injury prevention director/coordinator but more than half of centres reported participating in 9 of 11 injury prevention activities, including participating in community events (97%), sending speakers to local schools (89%), and preparing or distributing educational materials (84%). Lack of time (68%), dedicated funding (68%), and an injury prevention specialist (45%) were the most frequently cited barriers to conducting injury prevention activities. Injury prevention collaborations were reported with safety groups (24%) and with emergency medical services, fire and police (23%). Trauma centres partnered less frequently with academic institutions (11%) and local or state health departments (16%). Topics and formats for injury prevention training as well as training barriers were also explored. Conclusions Improved partnerships and linkages with established agencies and organisations at the local and state levels could assist trauma centres in leveraging their more limited resources and expertise to offer state-of-the-art injury prevention programs and policies. As low- and middle-income countries are developing or strengthening their trauma systems, they should be encouraged to view injury prevention as a fundamental responsibility.

OBJECTIVE. To shed light on the extent to which childhood obesity affects the types of appropriate child safety seats for young children, by providing an estimate of the number of US children whose weight renders them unable to use safely the majority of child safety seat types currently available. METHODS. The types of appropriate child safety seats were assessed by using National Highway Traffic Safety Administration 2005 Child Safety Seat Ease of Use Ratings. Estimates of the numbers of children weighing above the maximal weight for those child safety seats were calculated by using the tabulations of growth curves based on National Health and Nutrition Examination Survey 1999 to 2000 data that were assembled by the National Center for Health Statistics and the US Census for the year 2000. RESULTS. A total of 283305 children 1 to 6 years of age would have a difficult (if not impossible) time finding a safe child safety seat because of their age and weight. The vast majority of these children are 3 years of age and weigh >40 lb (182661 children). For these children, there are currently only 4 child safety seat types available, each of which costs between $240 and $270. CONCLUSIONS. This study determined that there is limited availability of child safety seat types for the ever-increasing number of obese young children. There are substantial numbers of children who weigh more than the upper weight limit for most currently available child safety seats. While we await reductions in the childhood obesity epidemic, options for maximizing the protection of obese children in automobiles must be identified.

We tested a kiosk-based tailoring intervention with a sample of 144 parents of young children using a two-group randomized controlled design to evaluate the kiosk. Intervention group parents (n = 70) answered 50 questions at a practice-based kiosk and they and their child's physician received immediate feedback reports of their injury prevention needs. Four weeks later, both control (n = 74) and intervention parents completed a telephone interview. Safety knowledge, beliefs, and practices were compared at follow-up. Compared to control group parents, intervention group parents were more knowledgeable about the inappropriateness of young children riding in the front seat of a car (16% versus 5%, p < 0.05), less likely to believe that teaching a child to mind you is the best way to prevent injuries (64% versus 86%, p < 0.05), and more likely to report that they "have syrup of ipecac" (34% versus 9%, p < 0.001) and "know how to use" it (24% versus 4%, p < 0.002). This study provides further support for the use of tailored communication to address the prevention of injuries to young children but calls for continued investigation in the area.

The Johns Hopkins Children’s Safety Center (CSC) is a unique health care provider and patient education resource that elevates the attention injury prevention receives in a medical setting and reduces barriers to injury prevention experienced by low-income, urban families, the Center’s priority population. This article describes the CSC’s development, implementation, and selected elements of its evaluation. Because evaluation has played an important role in the CSC from its inception through its implementation and sustainability, three evaluation activities are described: process evaluation to monitor activity, impact evaluation to understand its effects on parents’ safety behaviors, and qualitative interviews with CSC visitors and non-visitors to enhance services. Implications of each evaluation activity are described and recommendations are made for strengthening the CSC.

Objective To quantify unintentional injuries associated with housing elements among children less than 18 years old treated in US hospital emergency departments. Methods The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed, and all product codes that identified products permanently affixed to a home (housing elements) were identified. A query of the 2008 NEISS data for children under 18 determined the numbers of cases by severity code for each identified housing element. Housing elements were then tabulated by the number of cases for each severity code. The top 10 cases by severity code, (1) hospitalised or (2) treated in emergency departments, were included in a case review. Ten per cent of all cases or a minimum of 100 cases were randomly selected for review for each of the identified housing elements to assess if the case description could inform prevention efforts. Results Twelve housing elements (bathtub, cabinet, carpet, ceiling/wall, counter, door, fence, floor, nail, porch, stairs and window) were identified as the leading causes of injuries resulting in hospitalisations or emergency department visits. A list of potential interventions was generated based on the review of the case histories. Suggested changes for NEISS coding are also offered to enhance future prevention research. Conclusions NEISS is a valuable tool to identify home injury risks and inform design decisions for housing elements. Improved understanding of housing elements associated with injuries has the potential to enhance home inspection forms. However, interpretation of NEISS results is limited by lack of clarity about how the housing element was involved in the injury event.

Background objectives To determine the incidence of paediatric scald burns for children under 3 years of age treated in US hospital emergency departments. To quantify injury patterns associated with scald burns to inform prevention recommendation messaging. Methods The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed for cause of injury. Its database was queried to identify cases among patients up to age 3 years old with a diagnosis of scald burns between 1 January 2009 and 31 December 2012. The resulting data set was downloaded and case narratives were reviewed to identify injury patterns associated with scald burns. Results The NEISS query identified 2104 scald burn cases between 2009 and 2012, yielding a national estimate of 11 028 scald burns in children younger than 3 years old annually. The analysis of the case narratives resulted in the identification of six precipitating and/or contributing factors including: grabbed/pulled, cooking, bathing, consuming, appliance and other. Conclusions NEISS is a valuable tool to identify scald burn risks. The NEISS data system provided an opportunity to identify and examine scald burns in children under 3 years of age. Interpretation of NEISS results is limited due to the lack of consistency and detail in narratives about the injury event. Nevertheless, the information that was available on precipitating and/or contributing factors suggests that caretakers should test the temperature of their water heaters, test bath water before bathing children and be made aware of risk of scalds from hot liquids so that they exercise close supervision of children.

Home injuries cause more than 30,000 deaths and 12 million nonfatal injuries annually in the United States. They generate an estimated $222 billion in lifetime costs annually. Despite some data limitations in documenting home as the location of an injury, much progress has been made in identifying effective prevention strategies that reduce injury or mitigate risk behaviors.The current interest in public health in the role of housing in health offers unparalleled opportunities for injury prevention professionals concerned with home injuries. Sharing the science of injury prevention with the wide array of professionals—such as architects, home builders, home visitors, and fire and emergency medical services providers—who create home environments and interact with residents could be a useful approach. A collaborative national effort to reduce the burden of home injuries is needed.

Background Door-to-door canvassing and installation of smoke alarms have been found to be effective at increasing the number of homes protected. This analysis reports on how smoke alarm coverage changes six months after a home visiting program in a large urban sample, and how this change varies by characteristics of the residents and characteristics of the services delivered during the home visit. Methods Fire department Standard and Enhanced home visiting programs were compared. During the home visit, fire fighters installed lithium battery smoke alarms. Residents in the Enhanced program received tailored education about fire safety. Six months after the home visit, participating residences were visited to complete a follow-up survey and to have the installed alarms checked. Results 81% of the 672 homes that had a working smoke alarm on every level of the home at the end of the home visit remained safe at follow-up, and 87% of the residents found the home visit was very useful, and these rates did not differ between the Enhanced and Standard programs. The degree to which firefighters delivered their services varied, although households in which the resident’s engagement with the fire department team was rated as excellent were 3.96 times as likely to be safe at follow-up compared to those with poor or fair resident engagement (p=0.03). Conclusions There is a need to better understand how to maximize the time spent with residents during smoke alarm home visiting programs. This study helps with the development of methods needed for implementing and evaluating such programs in real-world settings. Electronic supplementary material The online version of this article (doi:10.1186/s40621-014-0030-3) contains supplementary material, which is available to authorized users.

The Baltimore City Fire Department (BCFD) has been installing smoke alarms city wide for more than three decades. Though data on each visit are entered into a database, no system existed for using these data for planning or evaluation. The objective of this study is to use Geographic Information System (GIS) technology and existing databases to: 1) determine the number of residences in need of a home visit; 2) determine total visits, visits per household, and number of homes entered for eligible households; and 3) demonstrate integration of various data via GIS for use in prevention planning. The tax assessment database was queried to determine the number of eligible (as determined by BCFD policy) residences in need of a visit. Each attempted BCFD home visit was coded to identify, if the BCFD personnel interacted with residents ("pass door") and installed alarms. Home visits were geocoded and compared to the tax assessment database to determine city wide pass door rates. Frequency of visits was run by individual residences to measure efficiency. A total of 206,850 residences met BCFD eligibility for a home visit. In 2007, the BCFD attempted 181,757 home visits and 177,213 were successfully geocoded to 122,118 addresses. A total of 122,118 eligible residences (59%) received a home visit. A total of 35,317 residences (29%) received a repeat visit attempt. The pass door rate was 22% (46,429) of all residences. GIS technology offers a promising means for fire departments to plan and evaluate the fire prevention services they provide. Language: en

OBJECTIVE: This study aimed to evaluate the impact of a computer kiosk intervention on parents' self-reported safety knowledge as well as observed child safety seat, smoke alarm use, and safe poison storage and to compare self-reported versus observed behaviors. METHODS: A randomized controlled trial with 720 parents of young children (4 months to 5 years) was conducted in the pediatric emergency department of a level 1 pediatric trauma center. Enrolled parents received tailored safety information (intervention) or generic information (control) from a computer kiosk after completing a safety assessment. Parents were telephoned 4 to 6 months after the intervention to assess self-reported safety knowledge and behaviors; in-home observations were made 1 week after the telephone interview for a subset of 100 randomly selected participants. Positive and negative predictive values were compared between the intervention and control groups. RESULTS: The intervention group had significantly higher smoke alarm (82% vs 78%) and poison storage (83% vs 78%) knowledge scores. The intervention group was more likely to report correct child safety seat use (odds ratio, 1.36; 95% confidence interval, 1.05-1.77; P = 0.02). Observed safety behaviors were lower than self-reported use for both groups. No differences were found between groups for positive or negative predictive values. CONCLUSIONS: These results add to the limited literature on the impact of computer tailoring home safety information. Knowledge gains were evident 4 months after intervention. Discrepancies between observed and self-reported behavior are concerning because the quality of a tailored intervention depends on the accuracy of participant self-reporting. Improved measures should be developed to encourage accurate reporting of safety behaviors. Language: en

While largely preventable, fire and hot water-related injuries are common in the United States. Measures recommended to reduce these injuries are smoke alarms (SAs) and lowered hot water temperatures. This study aims to: (i) describe the prevalence of working SAs and safe water temperatures among low-income, urban communities and (ii) explore the relationship between these behaviors and individuals’ knowledge and beliefs about them. In this cross-sectional study, the Health Belief Model was used as a guide for understanding the safety behaviors. A total of 603 households had their SAs and hot tap water temperatures tested and were surveyed about their knowledge and beliefs related to these safety behaviors. We found that 40% of households had working SAs on every level and 57% had safe hot water temperatures. Perceived severity and self-efficacy were significantly associated with SA coverage, whereas perceived susceptibility and beliefs about benefits were significantly associated with safe hot water temperatures. This study demonstrates the need to increase the number of homes with working SAs and safe hot water temperatures. Messages focused on a safe home environment could communicate the ease and harm reduction features of SAs and benefits and risk reduction features of safe hot water temperatures.

Objectives: To examine the validity of self reported data on parents' home safety practices of using smoke alarms and stair gates, and having syrup of ipecac. Setting: Families from a pediatric continuity clinic in a large, urban teaching hospital with infants from birth to 6 months were enrolled in the study. Methods: As part of a randomized controlled trial to promote home safety, parents' responses to personal interviews were compared to observations made in the respondents' homes two to four weeks after the interview. Positive and negative predictive values, sensitivity, and specificity were computed and compared between the intervention and control group families. Results: Sensitivities were high among the four safety practices. Specificities were much lower and fell into a much wider range than sensitivities. The positive predictive values were low and the negative predictive values were high. No differences in these indicators of validity were found between intervention and control group families. Conclusions: If the main interest in an evaluation is on the relative difference between study groups, rather than the absolute value of the outcome measure, our results suggest that self reported data may be of acceptable validity. However, when assessing a patient's risk, clinicians need to recognize the problem of over-reporting of safety practices.

This study aimed to describe the prevalence of preventive safety measures in homes with older, urban-dwelling adults; determine the relationship between sociodemographic variables and injury prevention measures; and describe older adults' knowledge of safety topics. Teams conducted interviews and home observations in 603 homes to confirm preventive safety measures. Households with older adults were rarely observed to have recommended smoke alarm (34%) or carbon monoxide coverage (22%). Water temperature was safe in 64% of homes. Among households headed by someone other than the older adult, odds of having a working smoke alarm on every floor were much lower than in older adult-headed households (95% confidence interval: 0.04-0.35). Few older adults interviewed about safety knowledge correctly answered several items related to fire and carbon monoxide. Effort is needed to improve knowledge and promote the lifesaving benefits of injury countermeasures so that older adults can be adequately protected.

A mobile safety center (MSC) provided education and reduced-cost safety products to low-income urban families. We evaluated uptake of this service under 3 different conditions, and safety-related knowledge and behavior associated with visiting the MSC among 210 families. Utilization varied widely under the 3 different conditions. At follow-up, MSC visitors scored slightly higher on a knowledge test than nonvisitors and improved more in reported car safety seat use, but did not differ in observed safety product use. This study provides very modest evidence of a positive impact of the MSC when its services are provided at a community health center. Language: en

Objective: To assess childhood injury risk and parents’ injury interests, and the association between the two. Method: A cross-sectional computer and telephone survey was conducted as part of a randomized controlled trial. The authors enrolled parents of children being seen at an urban pediatric primary care practice and measured selected injury knowledge, beliefs and safety practices. Parents were asked to select two of four topics of interest and recommendations regarding them were included in a computer-tailored report. Results: Participants (N = 105) were assessed as being at risk for all four areas: poisoning (88%), fires (85%), falls (55%), and car crashes (18%). Parents were interested in poisoning (81%) and car crashes (49%); their interests were unrelated to child’s assessed risk. Conclusion: Soliciting parents’ interests prior to counseling may help to identify priority areas for counseling as well as dispel myths and unfounded fears regarding childhood injury risks.

Objective To present the results of an intervention trial to enhance parents' home-safety practices through pediatric safety counseling, home visits, and an on-site children's safety center where parents receive personalized education and can purchase reduced-cost products. Design Pediatricians were randomized to a standard- or an enhanced-intervention group. Parents of their patients were enrolled when the patient was 6 months or younger and observed until 12 to 18 months of age. Setting A hospital-based pediatric resident continuity clinic that serves families living in low-income, inner-city neighborhoods. Participants First- and second-year pediatric residents and their patient-parent dyads. Interventions Parents in the standard-intervention group received safety counseling and referral to the children's safety center from their pediatrician. Parents in the enhanced-intervention group received the standard services plus a home-safety visit by a community health worker. Outcomes Home observers assessed the following safety practices: reduction of hot-water temperature, poison storage, and presence of smoke alarms, safety gates for stairs, and ipecac syrup. Results The prevalence of safety practices ranged from 11% of parents who stored poisons safely to 82% who had a working smoke alarm. No significant differences in safety practices were found between study groups. However, families who visited the children's safety center compared with those who did not had a significantly greater number of safety practices (34% vs 17% had ≥3). Conclusions Home visiting was not effective in improving parents' safety practices. Counseling coupled with convenient access to reduced-cost products appears to be an effective strategy for promoting children's home safety.

Purpose In the US, unintentional injury is the third leading cause of death in the Latino population compared to fifth in the White population. The Children are safe (CARES) mobile safety centre is a 40-foot vehicle designed like an urban home to teach injury prevention messages and provide access to low cost safety products. Interested in reaching out to Latino communities with CARES, we needed to better understand their injury prevention needs, cultural issues and barriers to using CARES. Methods We planned, conducted (in Spanish) and then transcribed and coded the groups using the open coding method. Focus group facilitators asked questions to explore injury-related practices in the country of origin, knowledge of specific injury countermeasures, and perceptions of the CARES centre. Results Five focus groups were conducted with 36 adults. Most participants were female (86%), from Mexico (64%), ranging in age from 19–51 with an average of 2.3 children. Most (89%) went to school in their country of origin and 66% had less than a high school education. Focus groups revealed that none of the participants had used smoke alarms, 92% did not have a fire escape plan and 81% had never heard of carbon monoxide alarms. Distrust and lack of awareness of its services were cited as the two main reasons for not visiting CARES. Additional cultural issues and barriers to using CARES will be reported. Conclusions Focus group results revealed important information to develop culturally appropriate and effective educational messages and services.

Objective: To determine the content of injury prevention counseling (an expected component of pediatric anticipatory guidance) and the communication methods used with data from an urban pediatric clinic that serves low-income families. Design: Audiotapes of well-child visits with 52 pediatric residents were analyzed for 178 children aged 0 to 4 years. A specific coding methodology was developed to analyze counseling by injury topics, prevention strategies, and communication methods. Results: Less than half (ie, 47%) of the visits included injury prevention counseling. During the 83 visits that included counseling, an average of 1.96 injury topics were discussed. The average time spent on injury topics was 1.08 minutes per visit and 33 seconds per injury topic. An average of 2.68 prevention strategies were mentioned, although a statement specifically recommending their use was made for only 35% of the prevention strategies. The most frequently discussed injury topics were ingestion, falls, and pedestrian safety; house fires and firearms were never discussed. The most frequently mentioned prevention strategies were storing dangerous substances and items out of reach, using cabinet locks, calling the poison-control center, having outlet covers, using stair gates, and using car seats. Information-giving by the resident was the most frequently used communication method. Physician elicitation of information from parents was associated with more parental participation in the discussion. Conclusions: Pediatric residents in this sample spent little time discussing injury prevention, and problems thought to be important to the specific population being served were never mentioned. Communication methods to enhance compliance other than eliciting and giving information (ie, soliciting feedback, obtaining a commitment, and giving reinforcement) were rarely or never used. Priorities need to be defined so that the most important injury prevention topics and strategies are discussed effectively in the limited time available. Further research about pediatric injury prevention counseling is needed to examine the feasibility and effect of resident training in communication methods that enhance compliance. Arch Pediatr Adolesc Med. 1997;151:146-151

Background Effective child injury prevention involves taking an ecological approach, intervening at multiple levels of influence. Efforts to change the behaviour of individual children and/or caregivers can be strengthened by addressing environmental influences on injury risk. How to change the behaviour of those who shape these environments is a critical question. Purpose To inform research and practice, we provide three case examples of promoting safer environments for children through behaviour change in other audiences—health care providers, manufacturers, and legislators. Methods Literature review Results (1) The SAFE Home Project changed the delivery of paediatric anticipatory guidance and increased the use of home safety products. Important to success were high levels of institutional support, collaboration among key stakeholders, and the use of behaviour change theory in programme content. (2) Following scald burn educational efforts and the use of warning labels, manufacturers voluntarily agreed to preset new water heaters at 120°F. Motivating this change was concern about variations in requirements across states, a significant burden for companies. (3) Why state legislators vote for injury prevention policies was the subject of one behavioural science study. Constructs from the Theory of Planned Behaviour predicted voting behaviour. Significance As the injury field has matured and there are success stories, it is important to understand how these changes occur at all levels of an ecological framework. Behavioural science theory and methods represents a largely untapped potential for both understanding how change occurs and facilitating it in individuals whose decisions affect the safety of entire populations.

Background Injuries from burns, scalds and carbon monoxide (CO) remain serious hazards in urban environments internationally. In preparation for a community intervention, trial baseline data was collected from a sample of homes in 12 census tracts to establish comparability between communities. Aims/Objectives/Purpose To report on baseline knowledge and observed safety behaviours for fire, scald and CO in a large urban sample. Methods Pairs of data collectors visited a random sample of homes in 12 census tracts. Residents completed an interview administered survey. The survey consisted of demographic data, knowledge and observed safety behaviours. Following the survey, data collectors tested the temperature of the hot water and all CO and smoke alarms. Results/Outcome Data were collected from 603 homes between July and December 2009. A majority of respondents were African American (61%), female (70%), between the ages of 25 and 54 (66%), and had a high school education or less (51%). A majority of respondents (74%) reported a per capita income of US$25 000 or less and (52%) reported renting their home. Children ( Significance/Contribution to the Field The study demonstrate the need for continued efforts to promote live saving injury prevention counter measures such as smoke alarms and CO alarms as well as the need for testing hot water temperatures in our urban environment.

Background Tap water burns result in an estimated 1500 hospital admissions and 50 deaths in the USA annually despite national efforts to preset water heaters at the factory. Aims/Objectives/Purpose This study reports on observed water temperature, water heater characteristics (age, size, capacity, gauge setting) knowledge and reported testing behaviours in a sample of 1033 urban homes. Methods Data on knowledge, self-reported testing behaviours, observed water temperature, heater characteristics and demographics were recorded as part of a home observation in a randomised community trial which aimed to improve home safety behaviours. Homes were visited between 6–9 months after a visit from the fire department to check the status of home safety behaviours. Results/Outcomes Hot water was observed to be above the recommended 120 degrees in 41% of homes. In a univariate analysis, electrical water heaters were statistically significantly more likely to have a safe hot water temperature than gas water heaters. In a multivariate logistic regression, water heaters with fewer gallons per person in the household were more likely to be set above the recommended 120 degrees. Knowledge outcomes varied between items ranging from 59% to 87% correct. A minority (14%) of respondents reported having tested the temperature of their tap water. Significance/Contribution to the Field Our results suggest hot water temperatures remains at dangerously high in our urban sample despite national efforts to preset water heater to safe temperatures at the factory. This research highlights the needs for the use of passive prevention strategies such as anti-scald devices.

Background House fires remain a significant problem in the U.S. and around the world. Despite a decades-long Home Visit (HV) program by the Baltimore City Fire Department (BCFD), including free smoke alarm installation, homes remain unprotected and fire-related injuries persist. We collaborated with BCFD to enhance their HV program and monitor its implementation. Aims/Objectives/Purpose To describe HV program enhancements, present novel program monitoring data, and discuss implications for program implementation monitoring in injury prevention programs. Methods Focus groups with firefighters identified needed HV program enhancements. When the enhanced HV program was in place, study observers accompanied BCFD teams and documented what transpired at each HV. Results/Outcomes Data were collected on 2139 HV conducted between April 2010 to April 2011 after program enhancements were made. Most of the time, BCFD staff followed the new protocol of installing the alarms using screws (73%) and explaining the 10-year lithium battery feature (66%). BCFD staff rarely explained how to use the alarm (18%) or pointed out its ‘hush’ feature (19%). Other educational messages were also conveyed infrequently: carbon monoxide risks (27%), escape planning (25%) and cooking (10%) and electrical (6%) safety. Results were shared with BCFD leadership. Significance/Contribution to the field Careful monitoring of program implementation is feasible and necessary to document compliance with protocols, to identify needed program improvements, to better understand program impacts, and to discover additional training needs.

Background The increased risk to low income, urban children from fire and burn injuries is well documented. However, little is known about how housing quality affects young children's injury risk, even though the majority of their injuries occur in and around the home in the US and globally. Aims To describe the frequency and characteristics of substandard housing in homes with young children; and to examine the association between substandard housing and the presence of working smoke alarms and safe hot water temperatures. Methods In-home observations were made in 246 homes in low income urban neighbourhoods in Baltimore, MD using 46 items from the US Housing and Urban Development's Housing Quality Standards form. Results Virtually all homes (99%) failed the housing quality measure. Items with the highest failure rates were those related to heating and cooling systems; wall, ceiling and floor conditions; and sanitation and safety issues. Only 42% of the homes had a working smoke alarm on every level of the home; 62% had safe hot water temperatures. Logistic regression analyses found that the odds of having a working smoke alarm on every level increased by 18% and the odds of having safe hot water temperatures by 8% for every one item increase in the number of housing quality items passed. Significance These results demonstrate that many low-income children may be at heightened risk for fire and scald burns simply by virtue of living in poor quality housing. Stronger collaboration between housing and injury prevention professionals is urgently needed. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Purpose Preventing carbon monoxide (CO) poisoning is increasingly recognised by safety advocates as a public health priority. CO alarms are the best defence against CO poisoning yet little attention has been placed on developing and evaluating comprehensive CO programs. The presentation shares CO knowledge, attitudes and practices from a household survey conducted in an urban area prior to the implementation of a community intervention trial to enhance a fire departments home visit program. Methods Interview households were randomly selected from 12 census tracks selected for comparability on fire department home visit rates, fire rates and vacancy rates. A letter mailed to the home preceded an interview team who, after consent, led participants through a structured survey and observation to confirm CO alarms. Results After applying exclusion criteria (non-English speakers, businesses, refusals), 618 households were consented; 609 completed the survey, for a response rate of 46%. The typical respondent is a Black (60%) female (70%) with a high school diploma or less (52%) and a per capita income of $25,000 or less (74%). Despite reporting numerous CO sources in homes (gas furnaces (78%), water heaters (66%) and stoves (86%)) and a recognition that CO alarms save lives (96%), CO alarms were reported in only 33% of homes and confirmed by observation in only 27%. Additional knowledge and attitude results will be presented. Conclusions More effort is needed to promote the life-saving benefits of CO alarms so that more households will be protected by them.

Purpose For young children, developmental capabilities influence their injury risk, often because their motor skills are more advanced than their ability to recognise and respond to hazards. This study explores the extent to which parents are knowledgeable about developmental milestones and whether this knowledge is related to their injury prevention beliefs. Methods Parents with children ( Results Among this sample of predominantly African American, low income families, a majority thought children would be older than the standardised norm when they could reach for items (72%) and feed themselves (67%). Two thirds thought children could walk up steps without help earlier than the norm. One third of parents thought that children would be older when they can pull themselves up to stand. One third thought children could follow instructions earlier than the norm. Bivariate and multi-variate analyses to adjust for child age and mothers education will examine the relationship between knowledge of developmental milestones and preventability beliefs. Conclusions Because young children depend on their parents to protect them from hazards, their inaccurate knowledge of children9s developmental capabilities can unnecessarily put children at increased injury risk.

Purpose Seniors and disabled persons suffer disproportionate risks from fires, scalds and carbon monoxide (CO) poisoning compared to the general population. Little has been done to evaluate the presence of injury counter measures in the homes of these groups. This presentation shares observed behaviours and residents safety knowledge from household surveys conducted in an urban area prior to the implementation of a community intervention trial. Methods Households were randomly selected from twelve census tracks. A letter mailed to the home preceded an interview team who consented participants, conducted a survey including observations to confirm the presence of CO and smoke alarms and tested the hot water temperature. Results 609 households completed the survey and observation. 196 households were occupied by an individual age 60 or older and/or a person with a physical disability. The typical respondent in this sample is a black (61%) female (71%) with a high school diploma or less (52%) and a per capita income of less than $25 000 (77%). Households with seniors or disabled persons were rarely observed to have recommended smoke alarm coverage (36%) or a working CO alarm (26%). Safe hot water temperature was present in 61% of homes. In bivariate analyses, no differences were found between homes with and without seniors or disabled persons or by income level. Additional results describing residents knowledge about safety behaviours will be presented. Conclusions Effort is needed to promote the life-saving benefits of injury counter measures so that seniors and disabled persons can be adequately protected.