Prevention of childhood household injuries: a controlled clinical trial. Randomized controlled trial of ionization and photoelectric smoke alarm functionality. Evaluating the impact of a child injury prevention project. Evaluating injury prevention programs: the Oklahoma City Smoke Alarm Project. A randomized controlled trial of home injury hazard reduction: the HOME injury study. An injury prevention program in an urban African-American community. Secondary prevention of childhood firesetting. Prevalence of working smoke alarms in local authority inner city housing: randomised controlled trial. Using a computer kiosk to promote child safety: results of a randomized, controlled trial in an urban pediatric emergency department. Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial. Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Injury prevention counselling to improve safety practices by parents in Mexico. A randomized trial to assess the effectiveness of an infant home safety programme. Promoting children's home safety. A randomized single-blind evaluation of a discharge teaching book for pediatric patients with burns. The effectiveness of a home visit to prevent childhood injury. Promoting health and home safety for children of parents with intellectual disability: a randomized controlled trial. Evaluation of the Waitakere Community Injury Prevention Project. The impact of child-resistant containers on the incidence of paraffin (kerosene) ingestion in children. Providing child safety equipment to prevent injuries: randomised controlled trial. Home injuries in children: a population-based intervention trial. Baby, Be Safe: the effect of tailored communications for pediatric injury prevention provided in a primary care setting. "Risk Watch": cluster randomised controlled trial evaluating an injury prevention program. Promoting child safety in primary care: a cluster randomised controlled trial to reduce baby walker use. Preventing unintentional pediatric injuries: a tailored intervention for parents and providers. [A cooperative program for the prevention of domestic accidents in children at the department of the Doubs. II. Educative aspects and evaluation]. Pediatric counseling and subsequent use of smoke detectors. Poisoning prevention knowledge and practices of parents after a childhood poisoning incident. Liquid-crystal thermometer use in pediatric office counseling about tap water burn prevention. Decreased juvenile arson and firesetting recidivism after implementation of a multidisciplinary prevention program. Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing. An evaluation of a program to reduce home hot tap water temperatures. Evaluation of group well-child care for improving burn prevention practices in the home. Strategies to increase smoke alarm use in high-risk households. Preventing product-related injuries: a randomized controlled trial of poster alerts. Reaching an underserved population with a randomly assigned home safety intervention. The impact of a home visitation programme on household hazards associated with unintentional childhood injuries: a randomised controlled trial. A controlled evaluation of a community injury prevention project in two Greek islands. Quantifying the effect of a community-based injury prevention program in Queensland using a generalized estimating equation approach. A controlled study of health education in accident prevention: the Rockland County Child Injury Project. 1966. Evaluation of a first aid and home safety program for Hispanic migrant adolescents. Safety education in a pediatric primary care setting. An evaluation of the First Parent Health Visitor Scheme. An intervention to reduce kerosene-related burns and poisonings in low-income South African communities. Smoke alarms by type and battery life in rural households: a randomized controlled trial. Evaluation of a community-based poison education program. Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial. A randomized, clinical trial of a home safety intervention based in an emergency department setting. [Interventions to prevent accidental injuries in children between 7 and 13 years of age]. Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial. Preventing injuries in children: cluster randomised controlled trial in primary care. Poisonings. Controlled evaluation of a community based injury prevention program in Australia. Evaluation of kiosk-based tailoring to promote household safety behaviors in an urban pediatric primary care practice. Effects of home-based, informal social support on child health. Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP). Project Burn Prevention: outcome and implications. A randomised controlled trial of general practitioner safety advice for families with children under 5 years. The Lidköping Accident Prevention Programme--a community approach to preventing childhood injuries in Sweden. A randomized trial of an intervention to prevent lawnmower injuries in children. Childhood poisonings from medications: three prevention programs that worked. Impact of a community based fire prevention intervention on fire safety knowledge and behavior in elementary school children. Differences in child injury hospitalizations in Sweden: the use of time-trend analysis to compare various community injury-prevention approaches. [Evaluation on intervening efficacy of health education on accidental suffocation and drowning of children aged 0 - 4 in countryside]. Effects of a videotape to increase use of poison control centers by low-income and Spanish-speaking families: a randomized, controlled trial. Evaluation of a child safety program based on the WHO safe community model. A controlled field trial of a poisoning prevention method. The incidence and severity of burn injuries following Project Burn Prevention. What picture is worth a thousand words? A comparative evaluation of a burn prevention programme by type of medium in Israel. Reducing injury rates using a community-based approach. [Evaluation of an educational action on accident prevention in children]. Studying injury prevention: practices, problems, and pitfalls in implementation. The Harstad Injury Prevention Study: prevention of burns in small children by a community-based intervention. Parental safety-related knowledge and practices associated with visiting a mobile safety center in a low-income urban population. Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial. A preschool program for safety and injury prevention delivered by home visitors. Effectiveness of nurse counselling in discouraging the use of the infant walkers.
Injuries claim the lives of more children each year than the next six leading pediatric disorders combined, and produce injuries that require medical attention for one in three children. In the preschool age group, 91 per cent of these accidents and over one-half the resultant fatalities occur in the home. This paper reports the results of a controlled clinical trial conducted to evaluate the implementation of a health education program intended to reduce the risk of childhood household injuries. The study population was randomly assigned into two demographically comparable groups. Only the experimental group mothers received an educational intervention consisting of a tutorial, home safety-proofing assignments, and follow-up. The homes of the two groups were later assessed for hazards during an unannounced visit by an interviewer who did not know to which group each home belonged. A home safety score mean for the two groups was almost identical. The program stimulated heightened interest and stated intent to improve, but did not result in actual reduction of household hazards. Active health education, as used and evaluated in this study, appears to have limited effectiveness when applied to home safety. Approaches such as "passive" measures may offer greater potential for household injury reduction. To compare functionality, reasons for non-function, and nuisance alarm levels of two common types of smoke alarms after installation in low- to mid-level income households in King County, Washington.
                Randomized controlled trial of 761 households. An ionization or photoelectric smoke alarm was installed between June 1, 2000 and July 31, 2002. Main outcome measures were: percentage of study alarms that were working, observed reasons for non-functional status, and self-reported frequency of nuisance alarms at 9 and 15 months of follow-up.
                At 9 months after installation, 20% of ionization, vs 5% of photoelectric alarms were non-functional, a difference that persisted at 15 months, with the most common reasons for both types being a disconnected or absent battery. The risk ratio for ionization, relative to photoelectric alarms, being non-functional or removed was 2.7 (95% CI 1.8 to 4.1) at 15 months of follow-up. These findings were not altered by educational level, or the presence of smokers, children <5 years, or adults > or =65 years.
                Burn prevention efforts are geared towards increasing smoke alarm ownership and improving maintenance of functional status. Results suggest that the selective use of photoelectric alarms by fire injury prevention programs or consumers may provide longer-term protection in similar populations. Designing smoke alarms that minimize nuisance alarming may also result in longer term functionality. This article describes an evaluation study which assessed the effectiveness of a child injury prevention project in deprived localities. The initiative took place across the Bumley, Pendle and Rossendale Primary Care Trust locality in East Lancashire. Families with children under five years of age living within this locality participated in the study. The intervention consisted of a home safety consultation and the provision and fitting of low-cost safety equipment to 1234 families and their homes within Sure Start programme areas that chose to access the Home Safety Equipment Scheme. In addition to this targeted work in these programme areas, a population-wide education and information campaign was provided across the whole locality. Rates of attendance at an accident and emergency (A&E) department by children aged less than five years of age following an injury were used to assess the outcome of the intervention. Results showed that over two years the proportion of children attending an A&E department reduced at a faster rate in the intervention than in the non-intervention wards, thereby reducing the health inequalities gap. It was therefore concluded that targeted work with parents of young children living in disadvantaged areas, together with the provision and fitting of low-cost safety equipment, can improve health and reduce inequalities among the local under-five population. Evaluation of injury prevention programs is critical for measuring program effects on reducing injury-related morbidity and mortality or on increasing the adoption of safety practices. During the planning and implementation of injury prevention programs, evaluation data also can be used to test program strategies and to measure the program's penetration among the target population. The availability of this early data enables program managers to refine a program, increasing the likelihood of successful outcomes. The Oklahoma City Smoke Alarm Project illustrates how an evaluation was designed to inform program decisions by providing methodologically sound data on program processes and outcomes. This community intervention trial was instituted to reduce residential fire-related injuries and deaths in a geographic area of Oklahoma City that was disproportionately affected by this problem. The distribution of free smoke alarms in targeted neighborhoods was accompanied by written educational pamphlets and home-based follow-up to test whether the alarms were functioning correctly. Early evaluation during the planning and implementation phases of the program allowed for midcourse corrections that increased the program's impact on desired outcomes. During the six years following the project, the residential fire-related injury rate decreased 81% in the target population but only 7% in the rest of Oklahoma City. This dramatic decline in fire-related injuries in the target area is largely attributed to the free smoke alarm distribution as well as to educational efforts promoting awareness about residential fires and their prevention. To test the efficacy of installing safety devices in the homes of young children on total injury rates and on injuries deemed a priori modifiable by the installation of these devices.
                A nested, prospective, randomized controlled trial.
                Indoor environment of housing units.
                Mothers and their children from birth to 3 years old participating in the Home Observation and Measures of the Environment study. Among 8878 prenatal patients, 1263 (14.2%) were eligible, 413 (32.7%) agreed to participate, and 355 were randomly assigned to the intervention (n = 181) or control (n = 174) groups.
                Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey.
                Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury).
                The mean age of children at intervention was 6.3 months. Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% confidence interval [CI], 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).
                An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury.
                clinicaltrials.gov Identifier: NCT00129324. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community.
                Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge.
                A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct.
                There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts. The Juvenile Fire Awareness and Intervention Program was established to develop and evaluate an intervention to be offered by fire fighters for children who set fires.
                One hundred thirty-eight children, aged 5 to 16 years, with a history of firesetting participated in a randomized, controlled trial. The intervention involved education about fire safety and a behavior modification program designed to extinguish the desire to set fires through satiation. The frequency and severity of firesetting were recorded for 12 months after the intervention to measure outcome.
                There was a significant decrease in the frequency and severity of firesetting across all groups, with no additional improvement resulting from participation in the fire fighters' intervention.
                There is no evidence to suggest that the multicomponent program offered by trained fire fighters is effective in reducing firesetting. The marked reduction in firesetting across all groups suggests that fire safety education by the fire fighters is the most appropriate approach to this serious community problem. To identify which type of smoke alarm is most likely to remain working in local authority inner city housing, and to identify an alarm tolerated in households with smokers.
                Randomised controlled trial.
                Two local authority housing estates in inner London. Participants: 2145 households.
                Installation of one of five types of smoke alarm (ionisation sensor with a zinc battery; ionisation sensor with a zinc battery and pause button; ionisation sensor with a lithium battery and pause button; optical sensor with a lithium battery; or optical sensor with a zinc battery).
                Percentage of homes with any working alarm and percentage in which the alarm installed for this study was working after 15 months.
                54.4% (1166/2145) of all households and 45.9% (465/1012) of households occupied by smokers had a working smoke alarm. Ionisation sensor, lithium battery, and there being a smoker in the household were independently associated with whether an alarm was working (adjusted odds ratios 2.24 (95% confidence interval 1.75 to 2.87), 2.20 (1.77 to 2.75), and 0.62 (0.52 to 0.74)). The most common reasons for non-function were missing battery (19%), missing alarm (17%), and battery disconnected (4%).
                Nearly half of the alarms installed were not working when tested 15 months later. Type of alarm and power source are important determinants of whether a household had a working alarm. 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.
                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.
                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.
                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. 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.
                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.
                A hospital-based pediatric resident continuity clinic that serves families living in low-income, inner-city neighborhoods.
                First- and second-year pediatric residents and their patient-parent dyads.
                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.
                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.
                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 > or 3).
                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. To examine, during the 3rd and 4th years of life, the health, development, rates of child maltreatment, and living conditions of children who had been enrolled in a randomized trial of nurse home visitation during pregnancy and first 2 years of their lives.
                Prospective follow-up of families who had been randomly assigned to nurse-visited and comparison conditions.
                Study conducted in semirural community in upstate New York. Families dispersed among 14 other states during 2-year period after children's second birthdays.
                Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy. All women had no previous live births and 85% were either teenaged (< 18 years at registration), unmarried, or from Hollingshead social classes IV or V. Analysis focused on whites, who comprised 89% of sample.
                Nurse home visitation from pregnancy through second year of the child's life.
                There were no treatment differences in the rates of child abuse and neglect or children's intellectual functioning from 25 to 48 months of age. Nurse-visited children, nevertheless, lived in homes with fewer hazards for children; they had 40% fewer injuries and ingestions and 45% fewer behavioral and parental coping problems noted in the physician record; and they made 35% fewer visits to the emergency department than did children in the comparison group. Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group. The functional meaning of punishment differed between the nurse-visited and comparison families.
                The program does have enduring effects on certain aspects of parental caregiving, safety of the home, and children's use of the health care system, but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect. To evaluate the effectiveness of educational counselling programmes aimed at increasing parents' practice of childhood safety in Monterrey, Mexico, and to provide information aimed at helping to improve the effectiveness of future efforts in this field.
                Three different counselling programmes were designed to meet the needs of the upper, middle and lower socioeconomic strata. Evaluation involved the use of baseline questionnaires on parents' existing safety-related practices for intervention and control groups and the administration of corresponding questionnaires after the programmes had been carried out.
                Data were obtained on 1124 children before counselling took place and on 625 after it had been given. Overall safety scores (% safe responses) increased from 54% and 65% for the lower and upper socioeconomic strata, respectively, before counselling to 62% and 73% after counselling (P <0.001 for all groups). Improvements occurred both for activities that required caution and for activities that required the use of safety-related devices (e.g. helmets, car seats). However, scores for the use of such devices remained suboptimal even after counselling and there were wide discrepancies between the socioeconomic strata. The post-counselling scores for the use of safety-related devices were 55%, 38% and 19% for the upper, middle and lower socioeconomic strata, respectively.
                Brief educational interventions targeting parents' practice of childhood safety improved safe behaviours. Increased attention should be given to specific safety-related devices and to the safety of pedestrians. Educational efforts should be combined with other strategies for injury prevention, such as the use of legislation and the improvement of environmental conditions. The aim of this study was to test an intervention aimed at addressing the risk of injury in infants 2 - 12 months of age. A non-blinded, randomized controlled trial was conducted, whereby parents were randomly assigned to either a control or one of two intervention groups. Parents completed questionnaires regarding safety behaviours and injuries at the 2 (baseline), 6 and 12 month immunization visit at the community health unit. During the 2 month visit to the health unit, the two intervention groups received a home safety kit containing nine items, an instructional brochure and a risk assessment checklist. Subjects randomized to the safety kit plus home visit group also received a standardized home visit from a community health nurse. Two of the 14 parental safety behaviours showed a significant increase in use among parents in the intervention groups. Neither of the interventions was associated with a reduction in parent-reported injuries among children. It was concluded that home visitation may provide a beneficial adjunct to the provision of safety devices and may increase use by parents. Home accidents are the main cause of death and morbidity in early childhood. Working-class children are at greatest risk. A study in an inner city area of the effects of a national television campaign about child accident prevention and of a locally designed health education initiative showed that 55% of families with young children in the study area did not watch any of the television programmes. Only 9% of a group specially encouraged to watch the programmes took any action to make their homes safer. In a comparable group who also received a home visit at which specific advice was given 60% took action to make their homes safer. The families studied were well aware before the television campaign of the importance and preventability of children's accidents. The problems disadvantaged families face are therefore not ones of ignorance or apathy about hazards but practical difficulties in converting their concern into action. Administrative arrangements must be developed for providing health workers--especially health visitors--with detailed local information to pass on to parents. To evaluate the influence of a modular, multidisciplinary, pediatric burn discharge book on burn-care-related knowledge and satisfaction of caregivers, we studied children less than 17 years of age admitted with an acute thermal injury to the pediatric burn unit of a large, tertiary care hospital in Winnipeg, Canada over a 32 month period. Demographic characteristics of the population are similar to published profiles of other pediatric burn units with the exception that North American Indian (NAI) families were disproportionately admitted, with 59 out of the 123 (48%) admissions from a geographic area that has less than 15% NAIs. We randomly assigned the families to receive discharge instructions with the book (intervention group) or routine discharge teaching without the book (comparison group). Knowledge levels of burn care and satisfaction with discharge teaching of caregivers were evaluated with a questionnaire administered in single-blind fashion at the first outpatient follow-up visit. Sixty-two families received the book and 61 families received standard discharge teaching. Bivariate analysis showed greater knowledge in the intervention group, with an average score (range, 0.0 to 1.0) of 0.79 +/- 0.15 versus 0.73 +/- 0.15 in the comparison group (p < 0.05). We did not observe this positive effect of the book when we analyzed NAI families separately: 28 families instructed with the book scored 0.68 +/- 0.14 versus 0.63 +/- 0.13 in 31 families provided with routine teaching (p = 0.18). Stepwise multiple-regression analysis found that the influence of the book was limited to families with children who sustained scald burns (p < 0.05). Factors negatively related to the knowledge levels of caregivers (p < 0.05) were being of NAI origin and being NAI with no safety devices in the home. A positive correlation (p < 0.05) was found with having English as the first language, having a child with more extensive burns, having a younger age of the child with burns, and having fewer children in the home. In conclusion, we found that the discharge book improved the burn-care-related knowledge of caregivers. However, other factors, particularly ethnic and language background, were of greater influence. To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. We examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention.
                A randomized, controlled trial.
                A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers.
                Children <8 years old, initially enrolled in an injury case-control study, were eligible to participate. Intervention. Subsequent to a home inspection conducted to determine baseline hazard rates for both groups, participants in the intervention group received a single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures. Main
                The median age was 2 years, with males comprising ~60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (ORs) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented.
                An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome. The objective of this study was to evaluate the efficacy of a home-based intervention targeted to parents with intellectual disability to promote child health and home safety in the preschool years. A total of 63 parents were recruited for the study with 45 parents (40 mothers and 5 fathers) from 40 families completing the project. The research design permitted comparison between the intervention and three alternative conditions with all parents receiving the intervention in an alternating sequence over the life of the project. The intervention consisted of 10 weekly lessons carried out in the parent's home focusing on child health and home safety. The program was adapted to suit the Australian context from the UCLA Parent--Child Health and Wellness Project (Tymchuk, Groen, & Dolyniuk, 2000). Outcome measures assessed parental health and safety behaviours. Standard measures included parental health, intelligence and literacy. The intervention improved parents' ability to recognize home dangers, to identify precautions to deal with these dangers and resulted in a significant increase in the number of safety precautions parents implemented in their homes with all gains being maintained at 3 months post-intervention. Parents' health behaviours including improved understanding of health and symptoms of illness, knowledge of and skills needed to manage life-threatening emergencies, knowledge about visiting the doctor, knowing when to call, what information to provide and what questions to ask, and how to use medicines safely significantly increased. Again, all gains were maintained 3 months post-intervention. The intervention was effective regardless of parental health, literacy skills, and IQ. This form of home-based intervention promotes a healthy and safe environment which is a prerequisite to continuing parental custody. To evaluate the Waitakere Community Injury Prevention Project (WCIPP).
                Process and outcome evaluations were conducted over a three year period. Process activities included analysis of project documentation, participant observation, key informant interviews, and two post-implementation case studies. A quasiexperimental design was used for the outcome evaluation. Three primary sources of data were collected and analysed: injury statistics; a pre-post telephone survey (n=4,000); and a pre-post organisation survey (n=144).
                Process evaluation provided a comprehensive account of the operation and activities of the WCIPP. Findings stress the pivotal role of the coordinators and highlight the value of incorporating a multicultural approach. A positive impact on changes to Waitakere City Council safety policies and practices was also evident. Outcome evaluation findings demonstrated significant reductions in rates of Waitakere child injury hospitalisations (p<0.05), while comparison communities showed an increase in child hospitalisation rates. In addition, compared with pre-intervention and comparison data, significantly more Waitakere residents were aware of injury prevention safety messages (p=0.0001) and had acquired appropriate child safety items (p=0.0001).
                The community injury prevention model appears to be an effective strategy for injury prevention. The support provided by the council for the WCIPP has provided a benchmark for the role of local governments in injury prevention. The commonest cause of accidental poisoning in the South African black paediatric population is paraffin ingestion. In this intervention study a specifically designed child-resistant container (CRC) was introduced to evaluate whether its use would decrease the incidence of paraffin ingestion. CRCs were distributed to 20,000 households in the study area (Gelukspan district). No CRCs were distributed in the control area (Lehurutshe district). Health education about paraffin poisoning prevention was given in both the control and the study areas. The monthly incidence rates of paraffin ingestion were monitored during the 14-month intervention period after the distribution and were compared with the pre-intervention incidence rates in the study and control areas. The main finding was that the incidence of paraffin ingestion dropped by 47% in the study area during the intervention period. The circumstances surrounding the cases of paraffin ingestion that still occurred in the study and control areas were investigated by means of a questionnaire. We recommend that paraffin be sold in CRCs, and suggestions are made for improving health education to prevent paraffin poisoning. To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas.
                Randomised controlled trial.
                47 general practices in Nottingham.
                3428 families with children under 5.
                A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks.
                Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices.
                No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small.
                The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates. We conducted a population-based intervention trial to evaluate the effectiveness of a program to prevent home injuries in children. We recruited a population of 1,015 young parent couples. Among those couples, we measured attitudes toward prevention of home injuries to children before and after the intervention. The intervention had limited effectiveness, which was somewhat greater among white-collar families and families with a higher paternal educational level. We found an association between the occurrence of injuries and educational level of the fathers (odds ratio = 1.7 and 1.9 for 6-12 years and < 6 years of school completed, respectively, vs > or = 13 years). Injuries are a major cause of morbidity and mortality to young children. The provision of individually tailored educational materials in primary care settings may be an effective and efficient way to promote adoption of injury prevention measures by parents. A randomized controlled study compared the effectiveness of tailored and generic persuasive communications delivered in a primary care setting on the adoption of home and car safety behaviors. During routine well-child visits, a primarily African-American sample of parents of children ages 6-20 months (n=213) was randomized to receive either tailored or generic information regarding the prevention of injuries to their child. At follow-up, participants who received tailored information reported greater adoption of home and car safety behaviors than those receiving generic information. In addition, within the tailored information group, those who discussed the information with their physician showed significantly greater change than those who did not. However, this difference was not observed among those receiving generic information. Findings support the use of office-based tailored injury prevention education as a component of routine well-child care. to evaluate the effectiveness of a school-based injury prevention program.
                Cluster randomised controlled trial.
                20 primary schools in Nottingham, UK.
                459 children aged 7 to 10 years.
                The "Risk Watch" program delivered by teachers, aimed at improving bike and pedestrian, falls, poisoning and fire and burns safety.
                Safety knowledge, observed safety skills and self-reported safety behaviour.
                At follow-up, intervention group children correctly answered more fire and burn prevention knowledge questions than control group children (difference between means 7.0% (95% CI 1.5% to 12.6%)). Children in intervention group schools were more likely to know the correct actions to take if clothes catch fire and the correct way to wear a cycle helmet (difference between school means 35.3% (95% CI 22.7% to 47.9%) and 6.3% (95% CI 1.4% to 11.1%) respectively). They were also more likely to know the correct actions to take in a house fire and on finding tablets (OR 2.80 (95% CI 1.08 to 7.22) and OR 3.50 (95% CI 1.18 to 10.38) respectively) and correctly demonstrated more safety skills than control group children (difference between means 11.9% (95% CI 1.4% to 22.5%)). There was little evidence to suggest the first year of the program impacted on self-reported safety behaviours.
                The Risk Watch program delivered by teachers in primary schools increased some aspects of children's safety knowledge and skills and primary schools should consider delivering this program. Longer term, larger scale evaluations are required to examine retention of knowledge and skills and impact on safety behaviours and child injury rates. Baby walkers are commonly used items of nursery equipment, but cause more than 3000 injuries each year in the UK. There is currently little evidence regarding the effectiveness of interventions in primary care to reduce walker use.
                To evaluate the effectiveness of an educational package provided by midwives and health visitors to reduce baby walker possession and use.
                Cluster randomised controlled trial.
                Sixty-four general practices in Nottingham and North Nottinghamshire, UK.
                An educational package aimed at discouraging mothers-to-be from obtaining and using a walker was delivered by midwives and health visitors to 1174 mothers-to-be of at least 28 weeks gestation. The control arm received usual care. Primary outcome measures were the possession and use of a walker. Secondary outcome measures included the frequency and duration of walker use, knowledge and attitudes towards walkers, plans to use a walker with future children, recommending a walker to a friend, and use of stair gates and fire guards.
                Intervention arm participants were significantly less likely to own (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.43 to 0.93) or to use a walker (OR = 0.26, 95% CI = 0.08 to 0.84). They were significantly less likely to plan to use a walker with their next child (OR = 0.52, 95% CI = 0.31 to 0.86) or to agree that walkers keep children safe (OR = 0.35, 95% CI = 0.16 to 0.78). There was some evidence that they were less likely to recommend a walker to a friend (OR = 0.51, 95% CI = 0.28 to 0.91) or to agree that they help children to walk more quickly (OR = 0.53, 95% CI = 0.29 to 0.95).
                An educational package delivered by midwives and health visitors was effective in reducing baby walker possession and use. Providers of primary healthcare services should include baby walker education in their injury prevention strategy and child health promotion programme. The purpose of this study was to determine the efficacy of providing (i) tailored injury prevention information (T-IPI) to parents and (ii) concurrent T-IPI to parents and providers to promote parent adoption of safety practices. During well-child visits, parents of children ages 4 and younger completed a computer assessment and were randomized to receive generic injury prevention information, T-IPI or T-IPI supplemented with a tailored summary for providers. Follow-up assessments were completed by telephone 1 month later. Parents receiving T-IPI alone or with supplementary provider information were more likely to report adopting a new injury prevention behavior than those receiving generic information (49 and 45%, respectively, compared with 32%; odds ratio=2.0 and 1.9, respectively), and these effects were greatest among the least educated parents. In addition, more complicated behavior changes were reported by those receiving tailored information. Provider receipt of feedback did not result in significantly different provider-parent communication or change in parents' safety practices. Providing parents with individually tailored pediatric injury prevention information may be an effective method for delivering injury prevention anticipatory guidance. Tailoring may have particular utility for more complicated behaviors and for communication with less educated parents. Effective prevention of domestic accidents in children includes regimental and/or legislative action, information for parents and education of the children. The latter two strategies have been applied in the deparment of the Doubs in a cooperative health promotion program. Preschool and kindergarten structures were chosen and the pedagogical project involved acquainting the children with the idea of danger by use of a kit prepared by the "Comité Français d'Education pour la Santé" (French Committee for health education). This study was set up in two stages: "experimental" in 2 schools (1983-1984) and "operational" in 40 schools (1984-1985). In order to evaluate it, the population was divided into a control group and an experimental group. A total of 5,720 tests were carried out among 520 children. 494 parents and 82 teachers answered the questionnaires sent to them. The teachers were generally very positive about the effectiveness of education about dangers and the teaching activities which could be employed: discovery of environment, awareness of body, a.s.o. The changes in attitude were real and enduring among children. The parents changed their behavior significantly concerning the storing of poisonous products (medicines and household cleaning products), which allows to feel that this program can be effective in terms of risk reduction. Effects of a brief educational and purchase program concerning home fires and smoke detectors by two pediatricians were compared to "routine" counseling without such a program using two groups each of 120 patients of well children. Inspection performed four to six weeks after the office visits showed that of 55 experimental group parents without detectors prior to the program, 26 purchased and 19 installed them correctly. No control group parents did so. This study investigated the effectiveness of a poison center-initiated mailed intervention on improving the preventive practices of families whose preschool child had recently experienced a poisoning incident. A low-cost, mailed poisoning prevention packet consisting of telephone stickers, a +f41 coupon for syrup of ipecac, one slide-style cabinet lock, a nine-step checklist for "poison-proofing" the home, pamphlets, and a cover letter was tested prospectively on a population of parents calling a poison center for advice about possible poisoning exposures involving their preschool children. Parents without ipecac 1 week after the incident were randomized so that half received the mailed intervention. A "blind" follow-up telephone interview was conducted 3 months later. Of the 336 original families enrolled in the study, 301 (90% retention) completed the follow-up interview. Those who had received the intervention were more likely to have a telephone sticker than control families (78% vs 39%; P < .0001) and were more likely to be using at least one slide lock in the home (59% vs 40%; P < .001). However, intervention families were no more likely to have ipecac on hand than control families (57% vs 52%; P = not significant) and did not indicate a higher rate of compliance with suggested changes in other behaviors and practices to prevent poisonings. A poisoning recurrence rate of 3.7% was seen in the total sample during the 3-month period of surveillance; there was no difference between groups in recurrence rate. Even after a poisoning event, parents may not be sufficiently motivated to take poisoning prevention measures on their own.(ABSTRACT TRUNCATED AT 250 WORDS) Tap water scald burns are an important topic of injury prevention in pediatricians' offices. Consecutive pediatric clinic clients, randomized to two groups, received an informational pamphlet, a one-minute discussion about tap water safety, and a baseline questionnaire. The first group also received a liquid-crystal thermometer for testing maximum hot tap water temperature. One month later in a follow-up telephone interview (n = 503), the impact of the added thermometer on knowledge regarding scalding, temperature testing, and thermostat lowering was assessed. Approximately 80% of each group read the pamphlet. Reading the pamphlet was associated with greater temperature testing in the thermometer (T) group but not in the pamphlet only (P) group. Temperatures were checked by 46.4% of the T group but by only 23.0% of the P group (P less than .001). In the households in which the reported water temperature exceeded 54.4 degrees C (130 degrees F) and the water heater was accessible, 77.3% reported lowering the setting, independent of receiving the thermometer. The reliability of self-reported water temperature was assessed after 1 year by home visits. The use of relevant facilitating devices, such as a liquid-crystal thermometer, in-office anticipatory guidance efforts may increase behavioral compliance. In 1999, we developed the multidisciplinary Trauma Burn Outreach Prevention Program (TBOPP), which focuses on the medical and societal consequences of firesetting behavior. The basis for this program development was a 17% increase in pediatric burn admissions. The purpose of this study was to determine the value of this trauma burn center prevention program from a financial, clinical, and recidivism perspective.
                Juveniles (ages 4-17 years) were enrolled into our 1-day program on the basis of referrals from the county court system, fire departments, schools, and parents. The program's interactive content focuses on the medical, financial, legal, and societal impact of firesetting behavior, with emphasis on individual accountability and responsibility. The court system and fire departments tracked all episodes of firesetting behavior within their respective communities. Arson is defined as behavior with the intent to produce damage, whereas firesetting is defined as having no ill intent. The recidivism rate was determined using fire department and court follow-up records. Follow-up was from 8 months to 2.5 years. A random control group that did not receive TBOPP education (noTBOPP group) with identical entry criteria was used for comparison. Institutional review board approval was obtained.
                There were 132 juveniles in the TBOPP group (66 arsonists and 66 firesetters) and 102 juveniles in the noTBOPP group (33 arsonists and 66 firesetters). Fifty-nine TBOPP participants had a medical history of behavioral disorders. Property damage for arson averaged $4,040, with additional court costs of $1,135 per incident. Family environment was an independent predictor for risk of repeat offense. The odds ratio for risk of repeat offense in foster care was 17.9 (p < 0.05) as compared with two-parent homes. The recidivism rate was 1 of 32 (<1%) for the TBOPP group and 37 of 102 (36%) for the noTBOPP group (adjusted odds ratio, 0.02; p < 0.001).
                When compared with the noTBOPP group, TBOPP participants had essentially no recidivism. The financial impact of arson behavior was over $6,000 per incident. The implementation of a juvenile firesetting prevention program has demonstrable benefits to the participants and to society. To assess the effectiveness of thermostatic mixing valves (TMVs) in reducing bath hot tap water temperature, assess acceptability of TMVs to families and impact on bath time safety practices.
                Pragmatic parallel arm randomised controlled trial.
                A social housing organisation in Glasgow, Scotland, UK.
                124 families with at least one child under 5 years.
                A TMV fitted by a qualified plumber and educational leaflets before and at the time of TMV fitting.
                Bath hot tap water temperature at 3-month and 12-month post-intervention or randomisation, acceptability, problems with TMVs and bath time safety practices.
                Intervention arm families had a significantly lower bath hot water temperature at 3-month and 12-month follow-up than families in the control arm (3 months: intervention arm median 45.0°C, control arm median 56.0°C, difference between medians, -11.0, 95% CI -14.3 to -7.7); 12 months: intervention arm median 46.0°C, control arm median 55.0°C, difference between medians -9.0, 95% CI -11.8 to -6.2) They were significantly more likely to be happy or very happy with their bath hot water temperature (RR 1.43, 95% CI 1.05 to 1.93), significantly less likely to report the temperature as being too hot (RR 0.33, 95% CI 0.16 to 0.68) and significantly less likely to report checking the temperature of every bath (RR 0.84, 95% CI 0.73 to 0.97). Seven (15%) intervention arm families reported problems with their TMV.
                TMVs and accompanying educational leaflets are effective at reducing bath hot tap water temperatures in the short and longer term and are acceptable to families. Housing providers should consider fitting TMVs in their properties and legislators should consider mandating their use in refurbishments as well as in new builds. Children are more likely to be hospitalised because of burns from hot liquids than from contact with fire and flames. Many of these hot liquid burns are from contact with hot tap water, usually in the home. Hot tap water burns to young children can be prevented completely by lowering the delivery temperature of the hot tap water. This study reports on the evaluation of a program designed to lower the temperature of home hot tap water in Dunedin, New Zealand. In conjunction with a national media campaign, the program provided an educational intervention to households with young children. Before and after measures were made and comparison groups were used to determine the effect of the intervention on tap water temperatures. Mean tap water temperature was 64.2 degrees C at baseline and 61.2 degrees C at follow-up. The proportion of households with water temperatures above 70 degrees C decreased by 50 per cent between baseline and follow-up while the proportion below 60 degrees C increased from 33 per cent to 47 per cent. The group receiving the intervention did not differ significantly from the comparison groups. There were significant decreases in tap water temperature across all groups, but the majority of households still had temperatures above 55 degrees C at the end of the study. The inclusion of counseling on home safety procedures has been recommended by the American Academy of Pediatrics as a routine part of well-child care. However, few, if any, data exist to give direction to the pediatrician interested in advising parents about home safety. In the present study, 58 couples were randomly assigned, prospectively, to an experimental group and a control group. Both were enrolled in a single group well-child care class that lasted 90 minutes. The control group was provided with information and discussion on nutrition, dental care, safety in the car and home, child development, child rearing, illness management, and immunizations. The experimental group received information and discussion on the same topics, and they also received specific information on burn prevention: hot water heater settings and smoke detectors. On a subsequent home visit, 65% of the couples in the experimental group had their hot water temperature measured at 54.4 degrees C (130 degrees F) or less, whereas all of the couples in the control group had hot water temperatures of more than 54.4 degrees C (130 degrees F) (a significant difference). Although only one couple in the experimental group did not have an operational smoke detector, enough of the couples in the control group had operational smoke detectors that results were not significant.(ABSTRACT TRUNCATED AT 250 WORDS) 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. The Product Safety Programme (PSP) of Health Canada is responsible for preventing product-related injuries. If PSP decides a product is dangerous, it can publicize its dangers, prohibit, or control its distribution; but for child products, the preferred option is to publicize its concerns. In the past, this included sending posters to paediatricians' offices and, more recently, placing alerts on the PSP website. This study examines the effectiveness of this process.
                15 Montreal paediatricians participated in a modified crossover randomized trial. During a randomly chosen intervention week, two product-related notices were posted in the paediatricians' waiting area. In the following or preceding week, these notices did not appear. Parents were interviewed by telephone to determine if they saw the posters and acted on the information received.
                We interviewed 808 parents (86%) of the 940 who agreed to participate. Of these, only 16% of the intervention and less than 1% of the control group reported seeing the posters. There were no differences in reported changes in behaviours related to the notices. These findings are unchanged after taking account of socio-economic status. No parents cited the posters, websites, or paediatricians as their main source of information about dangerous products.
                Product safety notices, whether sent to paediatricians' practices or posted on a website, cannot be relied upon to reach parents of preschool age children. Other approaches require consideration, such as increasing the power of PSP to regulate product safety. To access an underserved, mobile segment of a monolingual Spanish speaking population and to improve maternal self efficacy for home safety behaviors using a culturally appropriate intervention.
                A pre- and post-test experimental design tested differences in maternal childhood injury health beliefs (MCIHB) and controllable safety hazards (CHS). Participants were randomly assigned to experimental and control groups. Baseline data assessed demographic and study variables comparability. The intervention included counseling, assessment of maternal safety practices, and provision of safety items.
                A non-urban area in Texas where low income, largely migrant Hispanics represent the majority of residents.
                Eighty two mothers of 1--4 year old children.
                The 95% retention rate of an itinerant, hard to reach population suggests that minority participants may be receptive to culturally appropriate home visits. The intervention group demonstrated improved self efficacy for home safety behaviors (F (2, 77)=7.50, p=0.01). Mothers with stronger self efficacy and fewer perceived barriers had fewer accessible in-home hazards. Observed home hazard predictors were: (a) never being married; (b) poor home repair, (c) lower self efficacy for safety behaviors; and (d) control group status.
                Safety items coupled with a home visit tailored to child age and maternal culture was an effective intervention in a hard to reach population. This study contributes to designing research for a monolingual population with limited local language proficiency and community residency. Injuries represent a major source of health disparities in these neglected populations. The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern. This article reports on the influence of a home visitation programme (HVP) on household hazards associated with unintentional childhood injuries in a South African low-income setting.
                A randomised controlled trial (n=211 households) was conducted in a South African informal settlement. Community members were recruited and trained as paraprofessional visitors. Four intervention visits were conducted over 3 months, focusing on child development, and the prevention of burn, poison, and fall injuries. The HVP, a multi-component intervention, included educational inputs, provision of safety devices, and an implicit enforcement strategy. The intervention effect (IE) was measured with a standardised risk assessment index that compared post-intervention scores for intervention and control households.
                A significant reduction was observed in the hazards associated with electrical and paraffin appliances, as well as in hazards related to poisoning. Non-significant changes were observed for burn safety household practices and fall injury hazards.
                This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting. During the 20-month period September 1993 to April 1995, a health education injury prevention programme focusing on home injuries among the young (< or = 18 years old) and elderly (> or = 65 years old) on the Greek island of Naxos was undertaken, its effectiveness was evaluated by comparing the subsequent injury experience in sentinel population groups in Naxos as well as in Spetses, another island of similar sociodemographic profile, where no such intervention programme had been formally implemented.
                On the island-of Naxos an injury prevention campaign was initially undertaken involving virtually all opinion leaders and implemented through lectures, workshops and publicity in the local media. The main intervention focused on 172 households on the island of Naxos and was done by trained local collaborators who visited each household weekly to provide injury prevention advice and assess home safety. Similar visits were done by untrained collaborators in 177 households on the island of Spetses in order to assure collaboration of household members in the comparative evaluation stage of the programme. The process evaluation was based on ascertained changes of safety features and attitudes in the participating households, whereas the outcome evaluation was based on the incidence of injuries among members of the participating households in the two islands over a period of 8.5 months (255 days).
                On the intervention island of Naxos there were statistically significant improvements with respect to 11 of the 28 examined variables, whereas on the island of Spetses, such improvement was only noted for one variable. The age-adjusted incidence rate ratio of injuries overall among the target groups, contrasting the intervention and the control households was 0.85 with 90% confidence interval (CI): 0.69-1.05. With respect to home accidents the corresponding ratio was 0.79 with 90% CI: 0.60-1.04.
                An intensive and focused injury prevention intervention had only modest success when injuries themselves were the outcome variable. To develop a generalized estimating equation (GEE) model of childhood injury rates to quantify the effectiveness of a community-based injury prevention program implemented in 2 communities in Australia, in order to contribute to the discussion of community-based injury prevention program evaluation.
                An ecological study was conducted comparing injury rates in two intervention communities in rural and remote Queensland, Australia, with those of 16 control regions. A model of childhood injury was built using hospitalization injury rate data from 1 July 1991 to 30 June 2005 and 16 social variables. The model was built using GEE analysis and was used to estimate parameters and to test the effectiveness of the intervention.
                When social variables were controlled for, the intervention was associated with a decrease of 0.09 injuries/10,000 children aged 0-4 years (95% CI -0.29 to 0.11) in logarithmically transformed injury rates; however, this decrease was not significant (p = 0.36).
                The evaluation methods proposed in this study provide a way of determining the effectiveness of a community-based injury prevention program while considering the effect of baseline differences and secular changes in social variables. The Rockland County Child Injury Prevention Project was designed to test the effects of public health education for parents on the incidence of accidental injuries to children under 7 years of age in a controlled situation. The incidence of accidental injuries, defined as any actual or presumed trauma following an accident for which medical or dental attention was obtained, was determined in a study population before, during, and after exposure to the educational program and in a comparable control group during a corresponding period of time. The study group was exposed to an intensive education program involving neighborhood discussion groups conducted by lay and professional leaders, meetings with organized groups, and a monthly newsletter. The study population was organized into small neighborhood units of about 24 homes within the suburban housing developments. To measure the effect of the education program, accident rates were computed for each three month reporting period, projected on an annual basis. No consistent differences were discernible in the trends in the accident rates between the study and control groups during the three years of the project. On the contrary, the curve for the study group crossed that of the control group on no less than five occasions. There was a sharp decline in accidents during the second half of the education phase. Any conclusions regarding a positive effect of the education program proved untenable in the light of the sharp and disproportionate increase in the accident rate in the study group during the six month phase after education had stopped. After what appeared to be a contrary trend earlier, developments during this period demonstrated vividly the need to continue reporting for a sufficient time in a controlled situation to be sure that fortuitous changes over short periods do not lead to unwarrented conclusion. The flow of reports from hospitals was more consistent than from physicians. This suggested that, in selected control studies, adequate rates for comparative purposes might have been obtained entirely from hospital records. Unintentional injuries are the major cause of death among children, adolescents, and young adults. This article presents an evaluation of an injury-prevention program for 11- to 16-year-old, Hispanic migrant youth.
                Randomized controlled trial with two conditions: first aid and home safety training and tobacco and alcohol prevention. Participants were assessed at baseline, at immediate post-intervention, and at 1-year follow-up.
                A total of 660 Hispanic adolescent and parent pairs participated in a program entitled Sembrando Salud (sowing the seeds of health).
                The intervention consisted of two conditions: first aid and home safety training and tobacco and alcohol prevention. Both groups were exposed to an eight-session, multimedia program presented by bilingual, bicultural college students. The sessions consisted of lectures, discussions, and skills development and practice.
                To examine the efficacy of the first aid and home safety intervention, adolescents were assessed for changes in first aid confidence, knowledge of items in a first aid kit, knowledge of how to respond in an emergency situation, acquisition of a first aid kit, and behavioral skills testing in response to two emergency scenarios.
                Similar changes in confidence were observed in both groups after the intervention. Participants in the first aid and home safety program were better able to identify items to include in a first aid kit, how to respond in an emergency situation, and reported fewer erroneous victim-caring procedures than the tobacco and alcohol prevention group.
                Sembrando Salud was successful at achieving and maintaining change in confidence and knowledge of first aid and emergency response skills over a yearlong period. Parents of 171 children coming to the Yale-New Haven Hospital Primary Care Center for their 6-month checkup were randomized into an intervention group (n = 85) and a control group (n = 86). Parents in the intervention group received a three-part individualized course in child safety that required active parental participation. Parts 1, 2, and 3 were given at the 6-month, 9-month, and 12-month well-child visits, respectively. Parents in the control group received routine safety education as provided at well-child visits. The educational phase of the study was completed by 129 families, 65 in the intervention group and 64 in the control group. Safety knowledge, number of hazards in the home, and reported accidents were assessed by a "blinded" community health worker approximately 1 month after the 12-month well-child visit. A total of 109 home visits were made, 55 for the intervention group and 54 for the control group. Parental safety knowledge was assessed based upon pictorial hazard recognition. Of 13 possible hazards, the mean number of hazards recognized by the intervention group parents was 9.4 (n = 55) v 8.4 (n = 50) by the control group parents (t = 2.1, P less than .05, two-tailed). A hazard score was determined for each family based on nine possible hazards observed at the home visit. The mean hazard score for the intervention group was 2.4 (n = 55 v 3.0 (n = 54) for the control group (t = 2.4, P less than .02, two-tailed). Parentally reported accidents and accidents reported in hospital records were similar for both groups. Results of this study suggest that age-appropriate safety education that is repetitive and individualized and that requires active parental participation results in an increase in parental knowledge and an improvement in certain safety practices. To assess outcomes in families who received the First Parent Health Visitor Scheme (FPHVS), in comparison with families who received conventional ("generic") health visiting.
                Retrospective data on 2113 families were collected during 1986-92 as part of National Health Service (NHS) service provision. Prospective data were collected during 1993-98 on 459 mothers and their children, with outcomes assessed at one year (93% follow up) and two years (80% follow up).
                There were no differences between the groups of mothers in self esteem, locus of control, or depression rates. The women who received the FPHVS were more likely to have changed partners, but they also had a wider support network than comparison women, and consulted their general practitioner (GP) less often. Breast feeding rates were higher in the FPHVS mothers, who also gave their infants more fruit juice drinks than the comparison group. No differences were apparent in developmental outcome using the Bayley Scales at 1 and 2 years of age. Both height and weight Z scores at 2 years of age were lower in the FPHVS children than the comparison children. Receipt of the FPHVS was associated with increased use of electric socket covers and lower accident rates in the second year of life. No differences were seen in immunisation rates, uptake of child health surveillance, or use of hospital services. A higher proportion of families who received the FPHVS were registered on the local child protection register compared with comparison families.
                Clustering effects dominated the analysis, but overall this evaluation could not show a clear advantage for the FPHVS over conventional health visiting. Unintentional injury rates in low- and middle-income countries are up to 50 times higher than high-income nations. In South Africa, kerosene (paraffin) is a leading cause of poisoning and burns, particularly in low-income communities where it serves as a primary fuel for light, cooking, and heating. This study tested a community-based intervention to reduce kerosene-related injury risk. The intervention used a train-the-trainers model, whereby expert trainers train local paraprofessionals, who in turn deliver educational materials to community residents. The intervention was theory-driven, pragmatically motivated, and culturally sensitive.
                Prospective quasi-experimental intervention design with nonequivalent case versus control groups.
                Three primary outcome measures were considered: self-reported knowledge of kerosene safety, observed practice of safe kerosene use, and self-reported recognition of risk for kerosene-related injury.
                ANOVA models suggest a large and significant increase in self-reported kerosene-related knowledge in the intervention community compared to the control community. There were smaller, but statistically significant changes, in kerosene-related safety practices and recognition of kerosene injury risk in the intervention community compared to the control community.
                The intervention was successful. A train-the-trainers model might be an effective educational tool to reduce kerosene-related injury risk in low-income communities within low- and middle-income countries. 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.
                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.
                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%).
                Although lithium batteries and photoelectric alarms are more expensive than their counterparts, the financial investment might be worthwhile in terms of overall performance. This study suggests that: (1) a program directed at a specific town and coordinated by a local community group is more effective in transmitting poison control knowledge than is a statewide poison prevention week effort; (2) that transmission of educational material is optimized through programs directed at a specific age group (in this study ages 6 through 14); and, (3) that information about where to get the poison center number and actual acquisition of Ipecac syrup in homes was well transmitted. To measure the effect of giving out free smoke alarms on rates of fires and rates of fire related injury in a deprived multiethnic urban population.
                Cluster randomised controlled trial.
                Forty electoral wards in two boroughs of inner London, United Kingdom.
                Primarily households including elderly people or children and households that are in housing rented from the borough council. Intervention: 20 050 smoke alarms, fittings, and educational brochures distributed free and installed on request.
                Rates of fires and related injuries during two years after the distribution; alarm ownership, installation, and function.
                Giving out free smoke alarms did not reduce injuries related to fire (rate ratio 1.3; 95% confidence interval 0.9 to 1.9), admissions to hospital and deaths (1.3; 0.7 to 2.3), or fires attended by the fire brigade (1.1; 0.96 to 1.3). Similar proportions of intervention and control households had installed alarms (36/119 (30%) v 35/109 (32%); odds ratio 0.9; 95% confidence interval 0.5 to 1.7) and working alarms (19/118 (16%) v 18/108 (17%); 0.9; 0.4 to 1.8).
                Giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire, mostly because few alarms had been installed or were maintained. To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety.
                We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatric ED for evaluation of an acute unintentional injury sustained in the home. After completing a structured home safety questionnaire via face-to-face interview, caregivers were randomly assigned to receive either comprehensive home safety education and free safety devices or focused, injury-specific ED discharge instructions. Participants were contacted by telephone 2 months after the initial ED visit for repeat administration of the safety questionnaire. The pretest and posttest questionnaires were scored such that the accrual of points correlated with reporting of safer practices. Scores were then normalized to a 100-point scale. The overall safety score reflected performance on the entire questionnaire, and the 8 category safety scores reflected performance in single areas of home injury prevention (fire, burn, poison, near-drowning, aspiration, cuts/piercings, falls, and safety device use). The main outcome was degree of improvement in safety practices as assessed by improvement in safety scores.
                The intervention group demonstrated a significantly higher average overall safety score at follow-up than the control group (73.3% +/- 8.4% vs 66.8% +/-11.1) and significant improvements in poison, cut/piercing, and burns category scores. Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices.
                This educational and device disbursement intervention was effective in improving the home safety practices of caregivers of young children. Moreover, the ED was used effectively to disseminate home injury prevention information. Accidents are an important cause of childhood injury. It is hypothesized that safety education programs can reduce accidents in primary school-aged children. This study aimed to determine whether child and parent safety education programs can decrease the incidence of accidental injury in children when compared with controls.
                The study population (aged 7-13 years) were recruited from four local primary schools, and randomly assigned into an Intervention or a Control group. The Intervention group received child and parent safety education and was taught injury prevention strategies. The Control group received no injury prevention education or intervention. The incidence of accidental injury was compared between the two groups.
                In the first year after intervention the incidence of accidental injury was 262 cases in the Intervention group (8.26%) and 234 cases (8.67%) in the Control group (P > 0.05). In the second year after intervention, however, the incidence of accidental injury was significantly less in the Intervention group (211 cases, 6.54%) compared with the Control group (229 cases, 8.63%) (P < 0.01).
                Injury prevention strategies and child and parent safety education can reduce risks of accidental injury in children. To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings.
                The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged < or = 10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls.
                Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks.
                Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities. To assess the effectiveness of safety advice at child health surveillance consultations, provision of low cost safety equipment to families receiving means tested state benefits, home safety checks, and first aid training on frequency and severity of unintentional injuries in children at home.
                Cluster randomised controlled trial.
                36 general practices in Nottingham.
                All children aged 3-12 months registered with participating practices.
                A package of safety advice at child health surveillance consultations at 6-9, 12-15, and 18-24 months; provision of low cost safety equipment to families on means tested state benefits; and home safety checks and first aid training by health visitors.
                Primary outcomes measures were frequency and severity of medically attended injuries. Secondary outcome measures were self reported safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk of injury and risk of hazards assessed by postal questionnaire at baseline and follow up at 25 months.
                At baseline, both groups had similar risk factors for injury, sociodemographic characteristics, safety practices, possession and use of safety equipment, knowledge and confidence in dealing with first aid, and perceptions of risk. No significant difference was found in frequency of at least one medically attended injury (odds ratio 0.97, 95% confidence interval 0.72 to 1.30), at least one attendance at an accident and emergency department for injury (1.02, 0.76 to 1.37), at least one primary care attendance for injury (0.75, 0.48 to 1.17), or at least one hospital admission for injury (0.69, 0.42 to 1.12). No significant difference in the secondary outcome measures was found between the intervention and control groups.
                The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home, and larger trials are required to assess the effect on more severe injuries. While the three demonstration programs failed to document a major impact on prevention of poisoning, they do provide a rationale for selected strategies that may have wide application. Future efforts and successes in poison prevention will involve both the primary care physician and the poison center, using primary and passive interventions. The primary physician can be a source of information and counseling, while the poison center, having succeeded in secondary prevention, can expand its role into primary prevention. To evaluate the effects of a community based, all age, all injury prevention program, the Safe Living Program, on injury risk and injury rates.
                A quasiexperimental population based evaluation using an intervention and comparison community design.
                The intervention community (Shire of Bulla, n = 37,257) is an outer metropolitan area of Melbourne, Australia. The demographically matched comparison community (Shire of Melton, n=33,592) is located nearby.
                The Safe Living Program in the Shire of Bulla targeted injury reduction in all settings with a focus on high risk groups. Strategies included program publicity, education and training, injury hazard reduction, and environmental change. Baseline and follow up measures of program reach, risk factors, and injury rates in both communities were used to evaluate program process, impact, and outcome.
                Increase in program awareness was moderate and similar to other community based programs. The program achieved injury hazard reduction on the road, in schools, and, to a more limited extent, in the home. Other changes in injury risk factors could not necessarily be attributed to the program as similar changes were observed in the comparison community. No significant changes were found in rates of injury deaths, hospitalisations, or emergency department presentations in the Shire of Bulla after six years. Self reported household injuries, mostly minor, were reduced in the intervention community, but had been higher at program launch than in the comparison community.
                The Safe Living Program was unable to replicate the significant reductions in injuries reported in other community based interventions. Replication of apparently successful community based injury prevention programs in different settings and populations requires evidence based interventions, sustained and effective program penetration, reliable data systems to measure change, at least one control community, and sufficient budget and time for effects to be observable. 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. To enhance mother-infant interaction, paraprofessional home visitors provided parents with emotional support, information, and help in using community resources during pregnancy and throughout the infants' first 14 months. This study reports effects on child health. Both home-visited women and controls made good use of well-child care. Home-visited women made greater use of sick-child care (p = 0.002), most of which was appropriate. The greater use of sick-child care was concentrated among mothers with moderate or high family stress, with whom home visitors had closer relationships. Case histories showed a variety of individual effects on parents. We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings. Project Burn Prevention was designed and implemented to determine the ability of a public education program to increase awareness about burn hazards and reduce the incidence and severity of burn injuries. Media messages were transmitted to residents of a large metropolitan area; separate school and community interventions were implemented in two demographically similar communities within the Standard Metropolitan Statistical Area (SMSA). A second metropolitan area and two of its communities served as control sites. Messages for specific, high-risk age groups emphasized flame burns because of their severity and scalds because of their frequency. Knowledge gains were demonstrable only as a result of the school program. Neither the school program nor the media campaign reduced burn incidence or severity; the community intervention may have brought about a moderate, temporary reduction in injuries. Multiplicity of messages, brevity of the campaign, and separation of the interventions are among possible reasons for the program's failure to significantly reduce burn injuries. Education for personal responsibility is not sufficient. Product modification and environmental redesign must be instituted through education and legislation for successful control of burn injuries. To assess effectiveness of general practitioner advice about child safety, and provision of low cost safety equipment to low income families, on use of safety equipment and safe practices at home.
                Randomised, unblinded, controlled trial with initial assessment and six week follow up by telephone survey. Twenty families from intervention and control groups were randomly selected for a home visit to assess validity of responses to second survey.
                A general practice in Nottingham.
                98% (165/169) of families with children aged under 5 years registered with the practice.
                General practitioner safety advice plus, for families receiving means tested state benefits, access to safety equipment at low cost. Control families received usual care.
                Possession and use of safety equipment and safe practices at home.
                Before intervention, the two groups differed only in possession of fireguards. After intervention, significantly more families in intervention group used fireguards (relative risk 1.89, 95% confidence interval 1.18 to 2.94), smoke alarms (1.14, 1.04 to 1.25), socket covers (1.27, 1.10 to 1.48), locks on cupboards for storing cleaning materials (1.38, 1.02 to 1.88), and door slam devices (3.60, 2.17 to 5.97). Also, significantly more families in intervention group showed very safe practice in storage of sharp objects (1.98, 1.38 to 2.83), storage of medicines (1.15, 1.03 to 1.28), window safety (1.30, 1.06 to 1.58), fireplace safety (1.84, 1.34 to 2.54), socket safety (1.77, 1.37 to 2.28), smoke alarm safety (1.11, 1.01 to 1.22), and door slam safety (7.00, 3.15 to 15.6). Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others.
                General practitioner advice, coupled with access to low cost equipment for low income families, increased use of safety equipment and other safe practices. These findings are encouraging for provision of injury prevention in primary care. In Sweden about 100 children 0-14 years die from accidental injuries every year, roughly 40 girls and 60 boys. To reduce this burden the Safe Community concept was developed in Falköping, Sweden in 1975. Several years later a second programme was initiated in Lidköping. The objectives of this paper are to describe the programme in Lidköping and to relate it to changes in injury occurrence.
                The Lidköping Accident Prevention Programme (LAPP) was compared with four bordering municipalities and to the whole of Skaraborg County.
                The programme included five elements: surveillance, provision of information, training, supervision, and environmental improvements. Process evaluation was based mainly on notes and reports made by the health planners, combined with newspaper clippings and interviews with key people. Outcome evaluation was based on information from the hospital discharge registry.
                In Lidköping there was an on average annual decrease in injuries leading to hospital admissions from 1983 to 1991 of 2.4% for boys and 2.1% for girls compared with a smaller decline in one comparison area and an increase in the other.
                Because the yearly injury numbers are small there is a great variation from year to year. However, comparisons over the nine year study period with the four border municipalities and the whole of Skaraborg County strengthen the impression that the programme has had a positive effect. The findings support the proposition that the decrease in the incidence of childhood injuries after 1984 could be attributed to the intervention of the LAPP. Nevertheless, several difficulties in drawing firm conclusions from community based studies are acknowledged and discussed. The U.S. Consumer Product Safety Commission reports about 60,000 emergency room visits for lawnmower injuries annually with 20% to children under 15 years. Employing a randomized pre-post control group design, the current study evaluated a 20-minute video intervention to increase parents' (n = 80) safety awareness and preventive actions. The setting was an outpatient clinic at a Children's Hospital. Differences favoring the intervention group were found for four of six behavior outcomes. For example, the proportion reporting never allowing children near operating mowers increased from half to two-thirds with no change among comparison group parents. In addition, significant increases in severity beliefs were found. The results provide formative support for the video intervention which possesses the key advantages of ease of use and constancy of message. nan The objective of this study was to determine the impact of a community based fire prevention intervention directed only to parents on the fire safety knowledge and behavior in elementary school children. This was a prospective, quasi-randomized controlled study in which third and fourth grade students from two elementary schools in an urban, poor, minority community completed knowledge/behavior surveys at baseline and following completion of the intervention. The intervention group received an in-home visit from fire department personnel who installed free lithium smoke detectors and provided a fire escape plan. After accounting for a small difference in baseline summary scores of knowledge and behavior between the control and intervention groups, this study found a modest improvement in fire safety behavior among children whose families received a fire prevention intervention reflecting a change in household fire safety practices. However, there was no significant change in fire safety knowledge. Sweden's child injury fatality rates are among the lowest in the world. The country has engaged in a number of community injury-prevention programmes. The purpose of this study was to compare child injury hospitalization rates from the Skaraborg District with the rest of Sweden. Our study hypothesis was that municipalities that offered comprehensive child injury-prevention programmes would see significant decreases in their child injury hospitalization rates, compared with other areas.
                The study areas comprised three groups, consisting of municipalities in Skaraborg that had adapted the Safe Communities approach to injury prevention programmes, other municipalities in the District, and the rest of Sweden. The aim of the analysis was twofold: (1) to fit time trends for children's injuries in various areas in an integrated manner; and (2) to compare time trends across locations between community safety-promotion programmes as well as with the control areas. Panel data models and parametric splines were used.
                There were differences between incidence rates in the study areas and with regard to gender. There was a steep decrease in injury rates in one of the Safe Communities study areas for both genders.
                The methods applied in this analysis reveal more detailed and sophisticated time trends than the usual simple linear regression approach. The model provided a clearer view of the interactions of gender, area, and time as they impacted on children's injuries, and allowed for better insight into the impact of safety programmes. The main causes of death in children aged 0 - 4 were accidental suffocation and drowning which had a significant relation with parents' lack of prevention knowledge and effective measures. By comparing parents' acknowledge and behavior in preventing accidental suffocation and drowning and the mortality rate of accidental suffocation and drowning after intervening with those before the intervening, evaluation was made on intervening efficacy of health education.
                Six counties in north Jiangsu were involved in the survey. Two townships drawn from each county were divided into the intervened group and the controlled group. Health education was carried out in the intervened group for one year in 2000. Twenty to 30 parents of infants and children aged 1 - 4 drawn randomly from every township in the intervened group were taken as investigation subjects before and after intervening, and a questionnaire was made for them to answer. Meanwhile, the mortality rates of accidental suffocation and drowning were measured.
                Followed by health education for a year, the parents' opinion about whether unintentional injury can be avoided or not has changed from 18.8% to 20.5% to 1.8% - 2.9%, and parents' knowledge about how to give first aid in spot has increased from 11.1% - 13.5% to 41.1% - 56.8%. The parents' behavior that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and setting up fence beside pools and rivers has increased by 75.7%, 61.5% and 61.2%, respectively, while their relative knowledge has increased by 212.7% and 194.3%. In the intervened group, the mortality rates of infants' accidental suffocation per 100,000 has fallen from 487.8 to 71.2, dropped by 85.4%; and the mortality rates of drowning in children aged 1 - 4 per 100,000 has fallen from 60.0 to 36.2, dropped by 39.7%. In comparison, in the controlled group, the mortality rates of infants' accidental suffocation per 100,000 has fallen from 344.1 to 276.4, dropped by 19.7%; and the mortality rates of drowning in children aged 1 - 4 per 100,000 has increased by 26.3%, from 51.7 to 65.3.
                Health education to parents is an effective intervening measure for prevention of accidental suffocation and drowning. The goal of health education should be to change inadequate behavior and dangerous environment in which unintentional injury is easily happened. The intervening measures that not sleeping with their infants in the same beds and not tying infants in a candle with blanket, and putting up fence beside pools and rivers are feasible and practicable. Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use.
                To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California.
                Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.
                Compared with the control group, the video group showed an increase in knowledge about the PCC's function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.
                This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families. To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.
                A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjölby municipality) areas, both in Ostergötland county, Sweden.
                The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% Cl 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3-6) injuries remained constant.
                After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs. A controlled field trial was conducted to determine the effectiveness of Mr Yuk labels as a poisoning prevention aid for children aged 2 to 3 years. Comparison of poisoning rates and levels of household hazard in a group of 583 families supplied with Mr Yuk labels and a control group of 543 families not given Mr Yuk labels failed to reveal any significant differences. Consumer reactions to the program were mixed: approximately 60% of users gave a favorable evaluation of the method and 40% either did not use the method or made adverse comments. Examination of the reasons for the failure of the experimental manipulation suggested that three factors were involved: parents failed to provide an adequate coverage of all poisons in the home; a significant number of poisonings occurred with substances that could not be labeled with Mr Yuk; and, in a minority of cases, clear failures of the method were observed. Results of the study do not support the view that simply supplying Mr Yuk stickers to families with young children reduces risks of accidental poisoning. However, the method may be effective with older children or as an adjunct to an integrated poisoning prevention campaign. Project Burn Prevention, an educational program about burn safety, was implemented in the Greater Boston area from October 1977 through May 1978. The program consisted of three components: a media campaign, a school-initiated intervention, and a community-initiated intervention. Estimates of burn incidence and severity of injury because of scald, flame, electrical or contact burns, or smoke inhalation were made on all patients coming to target- or comparison-area hospitals for a four-year period before the program, the eight months during the program, and the 12 months after the program. Analysis of burn incidence during and after the interventions showed that the school-initiated intervention did not reduce the incidence or severity of burn injuries. The community-initiated intervention may have brought about a moderate, temporary reduction in the rate of burn injuries, although the increase in burn incidence observed for the media campaign of educational messages broadcast to the Greater Boston area suggests that the more plausible explanation for this effect is random variation in burn incidence. Burns are associated with longer hospital stay, permanent disfigurement and emotional stress disorders, and represent a health problem, especially among economically and socially deprived populations, such as the Bedouin population in Israel, hence the importance of intervention programmes. The objective of this research was to examine the extent to which the effect of a visual one-session burn prevention programme was determined by the type of medium used. We also examined the possibility that fear motivates action only when someone feels confident in his/her ability to control the threat. Data were based on the pre-/post-programme self-report questionnaires administered to a randomly selected three-group sample of 12- to 13-year-old Bedouin children (n=179). All three sessions were identical, but differed in the type of medium used: slides (S), video (V), or slides and video consecutively (S + V). We measured health beliefs (perceived threat, internal/external control, self-efficacy) and sense of coherence (SOC), both before and 2 months after completion of the intervention. We also measured post-programme fear reaction and the improvement in burn-related knowledge, understanding and safety behaviour as the outcome measure. No significant post-programme differences between intervention groups were found, either in terms of outcome measure or in terms of health beliefs and SOC. However, within- person analysis indicated that the S group participants had the highest level of post-exposure fear and a decrease in luck control over injuries. The S + V group demonstrated the lowest within change. The hierarchical regression analysis revealed that self-efficacy, fear, higher socio-economic status and female gender predicted improvement. As hypothesized, the interaction between fear and self-efficacy added significantly to prediction. It seems that health beliefs and demographic characteristics were more powerful in predicting the effect of the intervention than the choice of medium per se. A multifaceted approach and more comprehensive interventions are needed in order to promote health among disadvantaged populations. Injuries are the number one cause of morbidity and mortality to persons aged 1-44 years in the United States. Community-based interventions offer one approach to reducing injuries.
                To determine whether injuries could be reduced over a 5 year period by at least 20% in a midwestern community using a proven community-based model compared with three control communities.
                The Injury Free Coalition for Kids of Greater Cincinnati began its injury-reducing efforts within one Intervention Community (IC) in 2000. After reviewing injury data, engaging community members, and holding focus groups to assess community needs, specific structural and social alterations were made to engage youth in safe, supervised activities and provide them with safe play places. Data were obtained from the Hamilton County Injury Surveillance System from 1999-2004 for deaths, hospitalizations, and emergency department visits. Data in our IC were compared with three control communities in the city with similar demographics and socioeconomic characteristics. 2000 Census data were used to calculate injury rates.
                During study period, 5065 IC youth sustained 3796 injuries, while 9297 youth from the control settings sustained 5445 injuries. Injury rate in the IC decreased 42% from 1999 to 2004, 17551.83 to 10187.56 injuries/100,000 children/year, respectively, compared with the mean rate among the three control sites, which decreased 25.7%, 12950.41 to 9626.76 injuries/100,000 children/year. This difference was statistically significant, p < 0.001.
                Community prevention efforts that engage youth in supervised activities and provide safe play areas can help to reduce youth injuries within specific high-risk communities. A health education action for childhood injuries prevention took place from october 1988 to march 1989 in the town of Chambéry (Savoie), a town of 95,000 inhabitants. The health education concerned 21,950, 0 to 15 years old children and their close relatives (parents or educators). Two assessment means were applied: 1) a questionnaire submitted to the parents and the children before and after the intervention; 2) a comparison with the evolution of chosen indicators in a control town (Annecy, Haute-Savoie, 112,000 inhabitants), the informations being supplied by private doctors, hospital, clinics, pupils insurance and anti poison centres. The comparison between the action and the control areas shows a tendency towards a decrease in the action area of the frequency of home accidents and calls to the anti-poison centres. However the overall impact of the action looks weak and possible variations appears difficult to ascertain. This work highlights the methodological difficulties of the evaluation of community health education actions. This prospective, randomized, controlled trial was conducted to determine feasibility and effectiveness of a chronic care model approach to injury prevention compared with standard anticipatory guidance. Enrolled caregivers of children aged 0 to 5 years received focused counseling from a physician and health assistant, educational handouts, phone follow-up, and access to free safety devices and automobile restraint evaluations. Only 35.1% of eligible parents participated. Home visits were completed at 6 months to observe safety practices. Injuries were gleaned from parent report and medical record review. Safety practices were evaluated in 27 households. Chart review showed no significant difference in the number of medically attended injuries between groups (P = 0.6). The impact of the chronic care model on injury prevention in primary care could not be determined with certainty. Evaluating effectiveness of injury prevention strategies on actual safety practices with direct observation is challenging. Burns are known to cause considerable morbidity and mortality, and scalding is the most common type of burn injury in small children. A community-based injury prevention programme was initiated in the Norwegian city of Harstad (22,000 inhabitants) in 1987 and evaluated by means of data from a hospital-based injury recording system. One part of the programme aimed at reducing burns in children below 5 years of age. Accident analyses based on the local database revealed coffee to be the most frequent liquid causing scalds, which mostly occurred in the kitchen. Sixty-six per cent of the injured were boys and two-thirds were below 2 years of age. The prevention study was divided in a baseline period (19.5 months) with no local intervention-and a succeeding 7-year period containing a wide range of active and passive prevention strategies. From the first to the second period the mean burn injury rate decreased 52.9 per cent, from 52.4 to 24.7 per 10,000 person years (P < 0.05). In a reference city located 1,000 km away, the rates increased from 61.9 to 68.0 per 10,000 person years (NS). The burn injury rate reduction was considered mainly attributable to the strengthening of public participation and the enhancement of community empowerment achieved by recording and actively using the local burn injury data. 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. Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada).
                One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties.
                During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later.
                The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers.
                Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93).
                Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks. To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State.
                The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial.
                Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were offered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection.
                At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed.
                Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention.
                Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up. Infant walkers are widely used by caregivers in Singapore despite being recognized as a household hazard. The study determined the effectiveness of nurse counselling in dissuading caregivers from using the walker. Caregivers of children 4 months of age were recruited and divided into the intervention group (nurse's advice and illustrated pamphlets), a conventional group (questionnaire alone) and a control group (without any intervention in separate polyclinic). The percentage of the caregivers, who used the walkers in each group when their child was 9 months old, was taken as a surrogate indicator of effectiveness of nurse's intervention. The study analyzed 708 caregivers. Fewer caregivers (62.7% intervention vs. 80.4% questionnaire alone vs. 83.0% control) used the walker after nurse's advice with illustrated pamphlets. 8% of the users reported walker-related injuries (n=43). Nurses' counselling could be a simple yet effective method to discourage the use of walkers.
Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.