Evaluation of three smoke detector promotion programs

doi:10.1016/S0749-3797(98)00071-3

American Journal of Preventive Medicine

Volume 15, Issue 3, October 1998, Pages 165-171

https://doi.org/10.1016/S0749-3797(98)00071-3 Get rights and content

Abstract

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.

Section snippets

Minnesota

During 1990 and 1991, the Minnesota Department of Health’s Home Safety Checklist Program conducted home visits in the city of St. Paul, five rural communities, and two Indian reservations. Public health professionals performed walk-through inspections of homes of young children and older adults to identify and correct potential injury hazards, including testing every smoke detector. Detectors and batteries were replaced or installed, as needed. Of the 1,300 homes visited, 338 (26%) received a

Results

Evaluation visits were attempted to 641 addresses, and 436 interviews were completed. Seventy-one (11%) of the sampled addresses were ineligible because they were not residential households (e.g., dwelling was unoccupied), and one household was ineligible because no one in the home spoke English (Table 1 ). At least three homes had been destroyed by fire. Response rates (number of completed interviews/[number of addresses sampled minus number of ineligible addresses])20 ranged from 72% to 82%.

Discussion

This evaluation is one of the first to examine the long-term functional status of detectors distributed by detector promotion programs. It was conducted in both urban and rural sites, with participation rates of 72% to 82%. These rates support the practicality of unannounced home visits to evaluate programs to prevent home injuries in high-risk groups.

In total, the three programs distributed detectors to 10,331 households that reported not having a working\/ detector; 7,934 (77%) were delivered

Acknowledgements

The evaluation was designed, home visits were conducted, and the questionnaire data were electronically coded under a contract with Battelle’s Centers for Public Health Research and Evaluation. The authors acknowledge Michael T. Halpern, MD, PhD, MPH, Peter McMenamin, PhD, Ruth Brown, MS, MSPA, and Leticia Howland, all formerly of Battelle, for their contributions. The authors also thank Pauline Harvey, MSPH, of NCIPC for assisting with data management, and Dana Loomis, PhD, and Carol Runyan,

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Smoke alarm giveaway and installation programs: An economic evaluation
2012, American Journal of Preventive Medicine
Citation Excerpt :
The present study assumed that a baseline of 40% (low: 20%, high: 70%) of the homes did not have functional alarms based on a systematic review3 of published studies since 1990. Through a structured literature search (conducted in 2011; Appendix B, available online at www.ajpmonline.org), eight controlled trial studies10,14,22–27 were identified made up of evaluations of four giveaway and six installation programs since 1998. Five studies10,14,23–25 showed short-term (6–15 months) effectiveness.
The burden of residential fire injury and death is substantial. Targeted smoke alarm giveaway and installation programs are popular interventions used to reduce residential fire mortality and morbidity.
To evaluate the cost effectiveness and cost benefit of implementing a giveaway or installation program in a small hypothetic community with a high risk of fire death and injury through a decision-analysis model.
Model inputs included program costs; program effectiveness (life-years and quality-adjusted life-years saved); and monetized program benefits (medical cost, productivity, property loss and quality-of-life losses averted) and were identified through structured reviews of existing literature (done in 2011) and supplemented by expert opinion. Future costs and effectiveness were discounted at a rate of 3% per year. All costs were expressed in 2011 U.S. dollars.
Cost-effectiveness analysis (CEA) resulted in an average cost-effectiveness ratio (ACER) of $51,404 per quality-adjusted life-years (QALYs) saved and $45,630 per QALY for the giveaway and installation programs, respectively. Cost–benefit analysis (CBA) showed that both programs were associated with a positive net benefit with a benefit–cost ratio of 2.1 and 2.3, respectively. Smoke alarm functional rate, baseline prevalence of functional alarms, and baseline home fire death rate were among the most influential factors for the CEA and CBA results.
Both giveaway and installation programs have an average cost-effectiveness ratio similar to or lower than the median cost-effectiveness ratio reported for other interventions to reduce fatal injuries in homes. Although more effort is required, installation programs result in lower cost per outcome achieved compared with giveaways.
The interaction between design and occupier behaviour in the safety of new homes
2007, Accident Analysis and Prevention
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For example, the installation of smoke alarms in properties requires the occupants to check and maintain these safety devices in order for them to be an effective protection measure. Shults et al. (1998) also highlighted the importance of this behavioural component in an evaluation of three smoke detector promotion programs. They found that in 26% of households with non-working detectors, residents reported that they had forgotten to replace the battery.
The design of new homes includes many safety features intended to protect occupiers from injury or ill health within the home, however the effectiveness of these primary intervention measures is likely to be affected by user behaviour. This study examined the interaction between user activity and dwelling design and how this might affect health and safety. It aimed to identify how people use features within new homes and how this may limit the protection afforded by building design, codes and regulations. Forty, home-based, semi-structured, in-depth interviews and home inspections were conducted with individuals recently inhabiting a new home. A range of behaviours were reported in relation to building features including fire doors, pipes and cables, and loft access, which may lead to increased risk of injury or ill-health. For example, occupiers described interfering with the self-closing mechanisms on fire doors and drilling into walls without considering the location of services. They also reported knowingly engaging in unsafe behaviour when accessing the loft, increasing their risk of falls. The accounts suggest that designers and builders need to give greater consideration to how occupier behaviour interacts with building features so that improvements in both design and occupier education can lead to improved health and safety.
Fire safety among the elderly in Western Australia
2006, Fire Safety Journal
Unsafe dwelling environments may contribute to high morbidity and mortality of residential fire among the elderly people. This study investigated the prevalence of fire safety devices and related risk factors in elderly households. A series of convenience surveys was administered at 11 council community centres within metropolitan Perth, Western Australia, between August and October 2004. A total of 1188 older adults aged 65 years or over were recruited. The results found generally low prevalence for electric safety switches (56%), fire extinguishers (18%) and fire blankets (10%), while 72% had a functional smoke detector installed. Nearly a quarter of the participants had never thought of an escape route. Logistic regression analysis based on generalized estimating equations further showed that those living alone had a significantly lower prevalence of smoke detector and functional smoke detector, with adjusted odds ratios 0.48 (95% CI: 0.34–0.69) and 0.55 (95% CI: 0.41–0.75), respectively. Similarly, elderly people living in private rental housing appeared to be less equipped against residential fire relative to those in public rental and those occupying their own homes. As expected, elderly people with home contents insurance coverage had a significantly higher prevalence of fire safety devices. These findings have important implications for the government and policy makers if community fire safety for the elderly is to be improved.
A cost analysis of a smoke alarm installation and fire safety education program
2006, Journal of Safety Research
While smoke alarm installation programs can help prevent residential fire injuries, the costs of running these programs are not well understood.
We conducted a retrospective cost analysis of a smoke alarm installation program in 12 funded communities across four states. Costs included financial and economic resources needed for training, canvassing, installing, and following-up, within four cost categories: (a) personnel, (b) transportation, (c) facility, and (d) supplies.
Local cost per completed home visit averaged $214.54, with an average local cost per alarm installed of $115.02. Combined state and local cost per alarm installed across all four states averaged $132.15. For every 1% increase in alarm installation, costs per alarm decrease by $1.32.
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Carbon monoxide-related deaths in a metropolitan county in the USA: An 11-year study
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Carbon monoxide (CO) poisoning as a cause of death is well documented in industrialized countries. The objective of this study was to compare demographic data in deaths due to accidents (in fires) and suicides in the same population between 1988 and 1998. Furthermore, the potential effect of a community wide education effort regarding safety in the home was assessed. Postmortem reports were reviewed for all deaths examined at the Office of the Cuyahoga County Coroner in Cleveland, OH, USA.
During the study period, there were 209 accidental deaths due to fires in the home (6.5% of all accidents in the home) and 182 CO deaths by suicide (9.8% of all suicides). Demographic characteristics of the two groups differed: while males represented the majority of cases in both groups (55% of accidents, 70% suicides), race specific death rates were higher for whites than blacks (18/100,000 white, 3/100,000 black) in suicides compared with 29/100,000 deaths for blacks and 11/100,000 for whites in accidental cases. Fire deaths were prevalent in the young (0–9 years) and old (>60) whereas in the suicide group the age specific death rate was highest for those over 70 years. The majority of fire deaths occurred in the city of Cleveland but suicides were prevalent in the suburbs. More fire deaths occurred in December than any other month whereas more suicides occurred in April.
In 1992, there was a community wide effort to provide free smoke detectors to residents in Cleveland. In 1992, there were 4.2/100,000 fire deaths in the city. This decreased to 0.6/100,000 in 1996, increased to 1.2/100,000 in 1997 followed by a decrease to 0.8/100,000 in 1998. This suggested that the program may have aided in decreasing these types of deaths. Deaths due to fires in the suburbs were <1/100,000 throughout the study period.
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Research ArticlesEvaluation of three smoke detector promotion programs

Abstract

Section snippets

Minnesota

Results

Discussion

Acknowledgements

Ann Emerg Med

Risk factors for fatal residential fires

N Engl J Med

Residential smoke detector performance in the U.S

Int J Consumer Safety

Prevalence of smoke detectors and safe tap-water temperatures among welfare recipients in Memphis, Tennessee

J Commun Health

Research Articles
Evaluation of three smoke detector promotion programs