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Increasing smoke alarm operability through theory-based health education: a randomised trial
  1. Ted R Miller1,2,
  2. Gwen Bergen3,
  3. Michael F Ballesteros3,
  4. Soma Bhattacharya1,
  5. Andrea Carlson Gielen4,
  6. Monique S Sheppard5
  1. 1Pacific Institute for Research and Evaluation, Calverton, Maryland, USA
  2. 2Faculty of Health Sciences, Centre for Population Health Research, Curtin University, Perth, Australia
  3. 3Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
  4. 4Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5Econometrica, Inc., Bethesda, Maryland, USA
  1. Correspondence to Dr Ted R Miller, Pacific Institute for Research and Evaluation, 814 Bromley St, Silver Spring, MD 20902, USA; miller{at}


Background Although working smoke alarms halve deaths in residential fires, many households do not keep alarms operational. We tested whether theory-based education increases alarm operability.

Methods Randomised multiarm trial, with a single arm randomly selected for use each day, in low-income neighbourhoods in Maryland, USA. Intervention arms: (1) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm's hush button; (2) Hands-on Practice social-cognitive module supplemented by typical fire department education; (3) Current Norm receiving typical fire department education only. Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005–2008. Follow-up visits checked alarm operability in 370 homes (85%) 1–3.5 years after installation. Main outcome measures: number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms per home. Regressions controlled for alarm status preintervention; demographics and beliefs about fire risks and alarm effectiveness.

Results Homes in the Full Education and Practice arms were more likely to have a functioning smoke alarm at follow-up (OR=2.77, 95% CI 1.09 to 7.03) and had an average of 0.32 more working alarms per home (95% CI 0.09 to 0.56). Working alarms per home rose 16%. Full Education and Practice had similar effectiveness (p=0.97 on both outcome measures).

Conclusions Without exceeding typical fire department installation time, installers can achieve greater smoke alarm operability. Hands-on practice is key. Two years after installation, for every three homes that received hands-on practice, one had an additional working alarm.

Trial registration number number NCT00139126.

  • Injuries
  • Health Education Sa
  • Randomised Trials
  • Housing
  • Accidents

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