Special Report from the CDCDisparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies☆
Introduction
Deaths from fires and burns are a leading cause of fatal home injury in the United States. Each year 2,500 to 3,000 people die in home fires (Ahrens, 2010). Households at highest risk of fire deaths include those with children less than 5 years old, adults more than 65 years old, persons with disabilities, and those living in poverty, substandard housing, or rural communities (Private/Public Fire Safety Council., 2006). One of the potential explanations for higher mortality rates in these households is lower access to, or uptake of, effective fire safety practices such as smoke alarms. Individual case studies have provided evidence of lower smoke alarm use in some high-risk homes, although the overall magnitude of disparity in smoke alarm use in high-risk homes remains understudied. Smoke alarm installation programs have been found to be an effective means of increasing smoke alarm prevalence (Private/Public Fire Safety Council). Increasing the proportion of high-risk homes reached by installation programs can potentially contribute to an overall reduction in fire-related deaths.
In this short report, we compile and summarize a comprehensive list of published case studies that have examined the prevalence of smoke alarms in high-risk households. By doing so, we hope to point to the remaining gaps in smoke alarm use in such households in the United States. Our study may help local fire prevention practitioners gauge the need for increasing smoke alarms in communities and households that share characteristics similar to those in the case study samples. Our results may also help national policymakers assess how much room for improvement exists in smoke alarm use.
Section snippets
Search Strategy
We used a two-stage search strategy to identify potential studies. In the first stage, we searched for studies on smoke alarm prevalence in general. As Fig. 1 illustrates, the search string for this stage took the form of A + (B or C or D) where, A, B, C, and D each represented terms associated with smoke alarm, prevalence, fire injury, and intervention, respectively. Including D terms was based on the authors’ prior experience that smoke alarm prevalence is often reported as a component of a
Results
We identified two types of studies in our search. The first type (hereafter “community-based” studies) surveyed smoke alarm use in an entire community with a high concentration of high-risk homes. The second type (hereafter “risk factor-based” studies) focused on homes that have one or more common risk factors, but may or may not be located in the same community. Table 1 summarizes seven studies of the first type (Douglas et al., 1999, Jones et al., 2001, McKnight et al., 1995, Peek-Asa et al.,
Discussion
National estimates based on random digit dialing telephone surveys show that more than 90% of U.S. homes had at least one smoke alarm since the early 1990s and more than 95% since the early 2000s (Ahrens, 2009). Our review focused on high risk homes. Seventeen out of the 18 studies in our sample illustrated a smoke alarm prevalence below 95%. Seven studies showed a prevalence below 80%. Only one study revealed a prevalence above 95%; however, that study had a small sample size (32 homes; Stone
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2012, American Journal of Preventive MedicineCitation Excerpt :Nationwide, more than 95% of homes are estimated to have at least one smoke alarm, although about one quarter of these homes have alarms that are nonfunctional.2 Despite the overall high prevalence of smoke alarms, one review of published studies of disadvantaged high-risk households found that 17 of 18 studies showed a smoke alarm prevalence below 95% and seven studies showed a prevalence below 80%.3 Because the risk of fire and related injury is also greater in such neighborhoods,4 increasing the prevalence of functional smoke alarms may substantially reduce fire-related deaths.
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Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.