Theme articles
Risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households

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Background

More needs to be known about the prevalence of risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households.

Methods

A random-digit-dial survey was conducted about home safety with 1003 respondents representing households in the continental United States. Descriptive statistics assess the prevalence of risk and protective factors for fires, burns, and carbon monoxide overall, and by demographic characteristics, household structure, region, and residential tenure. The data were weighted to adjust for nonresponse and to reflect the U.S. population.

Results

Although most respondents reported having a smoke alarm (97%), and 80% reported having one on each level of their home, <20% reported checking the alarm at least every 3 months. Seventy-one percent reported having a fire extinguisher, 29% had a carbon monoxide detector, and 51% of those living with at least one other person had a fire escape plan. Few could report the temperature of their hot water at the tap (9%), or the setting on the hot water heater (25%). Only 6% had an antiscald device.

Conclusions

Results suggest that there is much room for improvement regarding adoption of measures to prevent fires, burns, and carbon monoxide poisoning. Further investigations of the efficacy of carbon monoxide detectors, fire extinguishers, and escape plans, as well as effectiveness studies of fire and burn-prevention efforts are needed.

Introduction

Thermal and fire-related injuries, including burns from steam and hot liquids or objects, and injuries from flames, smoke, fumes, or carbon monoxide from a fire, are important public health problems. In 2001, there were 3796 deaths resulting from burns and fire-related injuries in the United States.1 The fire/burns death rate is higher among older adults, young children, those in the South, and among people living in manufactured housing, or who have relatively low incomes.1, 2, 3, 4, 5

An additional 498,507 persons experienced serious, but nonfatal, injuries.1, 6, 7, 8 As with fire/burns deaths, the nonfatal fire/burns injury rate is higher among young children and older adults.1, 7, 9 Children aged <5 years and adults aged >60 years compose about one fourth of all emergency department visits for burns and fire-related injuries, with scalds as a leading type of injury.1, 7, 10, 11, 12 Hot tap water is a major cause of scalds, resulting in >3500 emergency department visits each year. Scalds from hot tap water often are more severe than other types of scalds, because they tend to involve larger portions of the body surface.9

The home is the principal environment in which burns and fire-related injuries occur.13, 14, 15, 16, 17, 18, 19, 20 From 1992 to 1999, 90% of fatal fire/burn injuries, and 57% of the injuries requiring emergency department visits took place in a residential environment.21 Tap water that is above 120°F represents a scald hazard for young children, older adults, and those with sensory deprivation.7, 10, 11, 22 Stoves, ovens, space heaters, and other appliances are also important sources of residential fires and burns.18, 23

In addition to being associated with residential fires, heating equipment and other appliances can result in carbon monoxide poisoning.24, 25, 26 Any time a carbon-based fuel (e.g., gas, oil, kerosene, propane, wood, or charcoal) is burned, carbon monoxide is released. If the appliance is not working properly, is being used incorrectly, or if there is insufficient ventilation, dangerous levels of carbon monoxide may be emitted.25, 26, 27, 28, 29 Each year in the United States, there are >200 residential nonfire, nonautomobile carbon monoxide poisoning deaths, two thirds of which are associated with heating equipment.13, 26

Some injuries could be prevented through adoption of specific safety practices. Installation of smoke alarms on each level of a home is an effective strategy for preventing injuries and deaths due to residential fire, provided that they are properly maintained.5, 6, 7, 18, 30, 31, 32 The Centers for Disease Control and Prevention (CDC) recommends that the batteries in battery-operated smoke alarms be changed annually, and that smoke alarms be tested monthly to ensure that they are working properly.18, 23 Installation of carbon monoxide detectors is also recommended in order to prevent carbon monoxide poisoning.24, 25, 33, 34 Some evidence suggests that homes with carbon monoxide detectors may have fewer and less severe episodes of carbon monoxide poisoning.35, 36, 37 Maintaining tap water at 120°F is a successful strategy for reducing scalds.7, 38, 39, 40 Water temperature can be lowered by adjusting the thermostat on the water heater or by an antiscald device at the tap.1, 9, 10, 12, 41 Although not as well documented in terms of efficacy, other safety recommendations include keeping a fire extinguisher in the kitchen for small fires,7, 23 and having a fire escape plan for the household.7, 18, 23, 30

The purpose of this study was to build on what is known regarding safety practices in U.S. households. Patterns of safety practices were examined among respondents representing a national sample of households, and variations investigated according to the presence of young children and/or older adults in the home, annual income, structural characteristics of the home, presence of carbon-releasing appliances, and region of residence.

Section snippets

Methods

Data for this investigation derive from the State of Home Safety in America (SOHS) study, which included a national telephone survey conducted with adults to assess the prevalence of home hazards and injury preventive practices. Respondents were required to be aged ≥18 years and to have a role in making safety decisions for the household. Respondents were also required to speak English well enough to complete the interview, and to reside in a private residence. Those living in group facilities

Survey response and representativeness

Of the 1539 individuals identified as eligible to participate in the SOHS survey, interviews were completed with 1003 (65%). There were 498 refusals, 38 incomplete interviews, and 1144 unanswered calls for which eligibility could not be determined (e.g., busy signal, no answer on repeated calls, answering machine). In addition, there were 1942 calls attempted to telephone lines determined to be no longer in service, used for dedicated fax lines, or at which respondents could not communicate in

Discussion

The reported prevalence of smoke alarms in the homes of respondents (97%) was slightly higher than the 1991 estimate by the CDC that 91% of households had a least one smoke alarm,30 which suggests that efforts to increase smoke alarm usage in the United States over the past decade have been successful. However, an estimated 3 million U.S. homes are still without smoke alarms,45 putting the residents at unnecessary risk in the event of a fire. In 2000, there was no smoke alarm present in more

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