Child Housing Assessment for a Safe Environment (CHASE): a new tool for injury prevention inside the home.

OBJECTIVE: To develop a tool to assess the safety of the home environment that could produce valid measures of a child's risk of suffering an injury. METHODS: Tool development: A four-step process was used to develop the CHASE (Child Housing Assessment for a Safe Environment) tool, including (1) a literature scan, (2) reviewing of existing housing inspection tools, (3) key informants interviews, and (4) reviewing the National Electronic Injury Surveillance System to determine the leading housing elements associated with paediatric injury. Retrospective case-control study to validate the CHASE tool: Recruitment included case (injured) and control (sick but not injured) children and their families from a large, urban paediatric emergency department in Baltimore, Maryland in 2012. Trained inspectors applied both the well-known Home Quality Standard (HQS) and the CHASE tool to each enrollee's home, and we compared scores on individual and summary items between cases and controls. RESULTS: Twenty-five items organised around 12 subdomains were included on the CHASE tool. 71 matched pairs were enrolled and included in the analytic sample. Comparisons between cases and controls revealed statistically significant differences in scores on individual items of the CHASE tool as well as on the overall score, with the cases systematically having worse scores. No differences were found between groups on the HQS measures. CONCLUSION: Programmes conducting housing inspections in the homes of children should consider including the CHASE tool as part of their inspection measures. Future study of the CHASE inspection tool in a prospective trial would help assess its efficacy in preventing injuries and reducing medical costs.

Utilizing Facebook and Automated Telephone Calls to Increase Adoption of a Local Smoke Alarm Installation Program.

CONTEXT: Innovative strategies are needed to improve the prevalence of working smoke alarms in homes. To our knowledge, this is the first study to report on the effectiveness of Facebook advertising and automated telephone calls as population-level strategies to encourage an injury prevention behavior. OBJECTIVE: We examine the effectiveness of Facebook advertising and automated telephone calls as strategies to enroll individuals in Baltimore City's Fire Department's free smoke alarm installation program. PARTICIPANTS: We directed our advertising efforts toward Facebook users eligible for the Baltimore City Fire Department's free smoke alarm installation program and all homes with a residential phone line included in Baltimore City's automated call system. DESIGN: The Facebook campaign targeted Baltimore City residents 18 years of age and older. In total, an estimated 300 000 Facebook users met the eligibility criteria. Facebook advertisements were delivered to users' desktop and mobile device newsfeeds. A prerecorded message was sent to all residential landlines listed in the city's automated call system. RESULTS: By the end of the campaign, the 3 advertisements generated 456 666 impressions reaching 130 264 Facebook users. Of the users reached, 4367 individuals (1.3%) clicked the advertisement. The automated call system included approximately 90 000 residential phone numbers. Participants attributed 25 smoke alarm installation requests to Facebook and 458 to the automated call. CONCLUSION: Facebook advertisements are a novel approach to promoting smoke alarms and appear to be effective in exposing individuals to injury prevention messages. However, converting Facebook message recipients to users of a smoke alarm installation program occurred infrequently in this study. Residents who participated in the smoke alarm installation program were more likely to cite the automated call as the impetus for their participation. Additional research is needed to understand the circumstances and strategies to effectively use the social networking site as a tool to convert passive users into active participants.

Pilot Study of a Novel Partnership for Installing Smoke Alarms.

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1-3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses' relationships with clients made it easier for them to gain access to families who are often described as "hard-to-reach". Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

Information and Communication Technologies Interest, Access, and Use: Cross-Sectional Survey of a Community Sample of Urban, Predominantly Black Women.

BACKGROUND: Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. OBJECTIVE: The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. METHODS: Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. RESULTS: The majority of the participants (212/220, 96.3%) reported use of a cell phone at least weekly, of which 89.1% (189/212) used smartphones and 62.3% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9% (107/206) reported using a cell phone and 39.4% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51%-56%) or alcohol and health (45%-46%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95% CI 0.87-0.97) and employment (OR 5.12, 95% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95% CI 0.20-0.92). CONCLUSIONS: Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted.

Cell Phone and Computer Use Among Parents Visiting an Urban Pediatric Emergency Department.

OBJECTIVES: The objectives of this study were to estimate the prevalence of cell phone and computer use among urban families bringing their children to an emergency department and to determine which technologies parents prefer to use to receive health information. METHODS: We visited 2 pediatric emergency departments in Baltimore, Md, and Little Rock, Ark. A convenience sample of parents of children 8 years old or younger completed a self-administered survey in the waiting area. RESULTS: Two hundred thirty-eight surveys were completed. Respondents were primarily female (83%), less than 35 years old (74%), and had at least a high school diploma or General Educational Development (94%). Forty-three percent were employed full time. A majority (95%) of respondents reported owning a cell phone, with most (88%) owning a smartphone and 96% reported having some internet access. Of cell phone owners, 91% reported daily text messaging activity. Over half (63%) of respondents reported having computer internet access at home; 31% reported having internet access at work. Patterns of behavior and preferences emerged for both cell phone and computer use. Respondents were more likely to check their email (75% vs 50%, P < 0.0001) and access the internet (78% vs 67%, P = 0.002) with a smartphone rather than their computer. CONCLUSIONS: Both cell phones and computers are prevalent and used among urban families seen in pediatric emergency departments, offering new ways to deliver health information to these often underserved populations. Providers aiming to deliver health information should consider smartphone applications, text message-based programs, and email to communicate with their patients.

Six-month follow-up of lithium-battery smoke alarms and self-reported reasons for disabling.

Although smoke alarms with lithium batteries are often marketed as '10-year alarms', on average, these alarms do not remain functional for 10 years. This paper describes self-reported reasons for non-working lithium-battery alarms 6-9 months following a smoke alarm installation programme. Data presented are for a cohort of 754 homes that participated in the installation programme and subsequently completed follow-up. A total of 1487 smoke alarms were installed. At follow-up, 126 alarms (8%) were missing and 37 (3%) were observed to be non-working. Of the non-working alarms, residents reported that they had been disabled 57% of the time. Reasons for disabling the alarms most often included that the battery was chirping (38%) or that it sounded while someone was cooking (24%). Smoke alarm installation programmes using lithium-battery alarms should consider highlighting education about smoke alarm maintenance, the hush feature and resources to replace alarms that malfunction soon after installation.

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour.

BACKGROUND: Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents' use of child restraints and smoke alarms. METHODS: SIS is a multisite randomised controlled trial. Participants are parents of children aged 4-7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child's age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan. DISCUSSION: Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use. TRIAL REGISTRATION NUMBER: NCT02345941; Pre-results.

Distribution and Evaluation of a Carbon Monoxide Detector Intervention in Two Settings: Emergency Department and Urban Community.

The objective of this study was to describe changes in carbon monoxide (CO) safety knowledge and observed CO detector use following distribution of a CO detector use intervention in two environments, a pediatric emergency department (Ohio) and an urban community (Maryland). A total of 301 participants completed the 6-month follow up (Ohio: n = 125; Maryland: n = 176). The majority of participants was female, 25­34 years of age, and employed (full or part time). We found that CO safety knowledge did not differ between settings at enrollment, but significantly improved at the follow-up visits. The majority of CO detectors observed were functional and installed in the correct location. Of those with CO detectors at follow up, the majority had not replaced the battery. The success of the intervention varied between settings and distribution methods. The majority of participants showed improved knowledge and behaviors. Improved device technology may be needed to eliminate the need for battery replacement.

Scald burns in children under 3†years: an analysis of NEISS narratives to inform a scald burn prevention program.

BACKGROUND OBJECTIVES: To determine the incidence of paediatric scald burns for children under 3 years of age treated in US hospital emergency departments. To quantify injury patterns associated with scald burns to inform prevention recommendation messaging. METHODS: The National Electronic Injury Surveillance System (NEISS) coding manual was reviewed for cause of injury. Its database was queried to identify cases among patients up to age 3 years old with a diagnosis of scald burns between 1 January 2009 and 31 December 2012. The resulting data set was downloaded and case narratives were reviewed to identify injury patterns associated with scald burns. RESULTS: The NEISS query identified 2104 scald burn cases between 2009 and 2012, yielding a national estimate of 11 028 scald burns in children younger than 3 years old annually. The analysis of the case narratives resulted in the identification of six precipitating and/or contributing factors including: grabbed/pulled, cooking, bathing, consuming, appliance and other. CONCLUSIONS: NEISS is a valuable tool to identify scald burn risks. The NEISS data system provided an opportunity to identify and examine scald burns in children under 3 years of age. Interpretation of NEISS results is limited due to the lack of consistency and detail in narratives about the injury event. Nevertheless, the information that was available on precipitating and/or contributing factors suggests that caretakers should test the temperature of their water heaters, test bath water before bathing children and be made aware of risk of scalds from hot liquids so that they exercise close supervision of children.

Using the pediatric emergency department to deliver tailored safety messages: results of a randomized controlled trial.

OBJECTIVE: This study aimed to evaluate the impact of a computer kiosk intervention on parents' self-reported safety knowledge as well as observed child safety seat, smoke alarm use, and safe poison storage and to compare self-reported versus observed behaviors. METHODS: A randomized controlled trial with 720 parents of young children (4 months to 5 years) was conducted in the pediatric emergency department of a level 1 pediatric trauma center. Enrolled parents received tailored safety information (intervention) or generic information (control) from a computer kiosk after completing a safety assessment. Parents were telephoned 4 to 6 months after the intervention to assess self-reported safety knowledge and behaviors; in-home observations were made 1 week after the telephone interview for a subset of 100 randomly selected participants. Positive and negative predictive values were compared between the intervention and control groups. RESULTS: The intervention group had significantly higher smoke alarm (82% vs. 78%) and poison storage (83% vs 78%) knowledge scores. The intervention group was more likely to report correct child safety seat use (odds ratio, 1.36; 95% confidence interval, 1.05-1.77; P = 0.02). Observed safety behaviors were lower than self-reported use for both groups. No differences were found between groups for positive or negative predictive values. CONCLUSIONS: These results add to the limited literature on the impact of computer tailoring home safety information. Knowledge gains were evident 4 months after intervention. Discrepancies between observed and self-reported behavior are concerning because the quality of a tailored intervention depends on the accuracy of participant self-reporting. Improved measures should be developed to encourage accurate reporting of safety behaviors.

Knowledge and injury prevention practices in homes of older adults.

This study aimed to describe the prevalence of preventive safety measures in homes with older, urban-dwelling adults; determine the relationship between sociodemographic variables and injury prevention measures; and describe older adults' knowledge of safety topics. Teams conducted interviews and home observations in 603 homes to confirm preventive safety measures. Households with older adults were rarely observed to have recommended smoke alarm (34%) or carbon monoxide coverage (22%). Water temperature was safe in 64% of homes. Among households headed by someone other than the older adult, odds of having a working smoke alarm on every floor were much lower than in older adult-headed households (95% confidence interval: 0.04-0.35). Few older adults interviewed about safety knowledge correctly answered several items related to fire and carbon monoxide. Effort is needed to improve knowledge and promote the lifesaving benefits of injury countermeasures so that older adults can be adequately protected.

Residential carbon monoxide (CO) poisoning risks: correlates of observed CO alarm use in urban households.

The authors conducted a household survey and observation to assess carbon monoxide (CO) knowledge and risks as well as prevalence of CO alarms in an urban community prior to the enactment of a mandatory ordinance requiring CO alarms in one U.S. city. From July to December 2009, household surveys and observations were completed in 603 residences. Participants were mostly African-American (61%), women (70%), 25-54 years in age (66%), and with a high school education or less (51%). Most homes visited contained CO-producing appliances, including gas stoves (86%), gas furnaces (82%), and gas water heaters (79%). Participants' overall mean percentage correct knowledge score was 57%. CO alarms were reported by 33% of participants and observed among 28% of households. Low rates of CO knowledge and CO alarm ownership, combined with high rates of CO-producing sources in homes, suggests the need for widespread campaigns to promote CO alarms. Recommendations are also made to integrate the lessons learned from the public health community's experience promoting smoke alarms.

CHASE (Children's Housing Assessment for a Safe Environment): a protocol for the inspection and modification of injury risks in children's homes.

BACKGROUND: Decades of research and practice experience have led to an extensive body of evidence about effective home safety modifications. However, the benefits of safety modifications have not reached all segments of society. Poor quality housing in low-income neighborhoods, along with limited access to safety products and injury prevention information, can be significant barriers to child safety. METHODS: This is a longitudinal study of 300 low-income families in Baltimore City and Baltimore County with children under 7 years of age who are referred from existing Green & Healthy Homes Initiative (GHHI) home visiting programs. Three home visits will be completed to assess home injury hazards using a previously developed tool, the Children's Housing Assessment for a Safe Environment (CHASE), and provide a Scope of Work that includes home modifications specific to the identified home injury hazards. An Assessor will also provide do-it-yourself education materials and injury prevention supplies to assist residents in completing the modifications. If the parent or caregiver is unable to complete the home modifications, a professional Housing Intervention Services team will complete the home modifications necessary to prevent injury in the home. This study will involve both quantitative and qualitative data analysis methods. Paired and regression analyses will be conducted to examine the maintenance of modifications and the variables associated with positive outcomes. A thematic analysis of staff and participant interviews will be used to identify perceived barriers and facilitators of successful program implementation. DISCUSSION: Better data on residential injuries of children and an improvement in the overall surveillance of home injuries are necessitated. This study will set a strong foundation for a larger future study of health and cost effectiveness outcomes and will advance our understanding of the feasibility, costs, and potential benefits of addressing and preventing home injuries to children.

"Before I Could Get Him, He Fell": Experiences, Concerns, and Fall Prevention Strategies of Parents With Young Children.

Little is known about parents' perceptions and prevention strategies regarding childhood falls. In this qualitative study using semi-structured interviews, we sought to describe parental reports of child fall experiences, concerns, and prevention strategies in the home. Sixteen parents with at least one child younger than 18 months were asked about their awareness of fall risks, falls experienced by the child, fall concerns, prevention strategies, and where in the home the child spends time throughout the day. Seven themes emerged: (1) "falls are unexpected," (2) "role of the physical environment," (3) "children's temperament and developmental stage," (4) "physical barriers and baby products," (5) "addressing walking surfaces," (6) "modifying the height of a fall," and (7) "supervision." Parents are aware of in-home fall hazards and actively use strategies to lessen fall risk. Anticipatory guidance should promote evidence-based and evidence-informed prevention strategies and augment effective strategies some parents use to lower fall risk.

Dog bites: an opportunity for parent education in the pediatric emergency department.

OBJECTIVES: This study focuses on parental report of exposure to dogs and highlights the potential for using a computer kiosk in an urban pediatric emergency department to increase knowledge around dog bite safety. METHODS: Nine hundred one parents of young children completed a kiosk assessment and received a report that contained information aimed at increasing knowledge about either dog bite prevention (PAR-DB, n = 453) or other safety behaviors (PAR-S, n = 448). The participants who received the dog bite prevention report (PAR-DB) were asked questions about exposure to dogs as part of the baseline assessment. All participants were telephoned 2 to 4 weeks later for a follow-up interview to measure knowledge differences. RESULTS: The majority of respondents who answered the exposure questions reported seeing stray dogs (53%) and having dangerous dogs (43%) in their neighborhood. Few respondents reported that their child had been bitten by a dog (1%), but the majority (56%) reported having knowledge of another child having been bitten. Few respondents reported having a dog in their home (11%), and only 1 reported that her dog had bitten a child. A majority (56%) of dogs had not been spayed or neutered. Of families with dogs in the home, 20% reported leaving their child unattended with the dog. A minority (45%) of dogs left alone with children had been spayed or neutered. CONCLUSIONS: PAR-DB parents achieved knowledge gains as a result of the Parent Action Report generated by the kiosk, demonstrating the potential to improve knowledge via a computer kiosk in a busy pediatric emergency department.

Characteristics of Ophthalmic Trauma in Fall-Related Hospitalizations in the United States from 2000 to 2017.

PURPOSE: Falls is a leading cause of injuries nationally and can lead to serious ophthalmic injuries. The purpose of this study is to examine the incidence and characteristics of ophthalmic trauma in patients with fall-related hospitalizations in the United States. METHODS: Retrospective, cross-sectional study. National Inpatient Sample (NIS) was queried to identify all ophthalmic trauma associated with fall-related hospitalizations from 2000 to 2017. Patients were identified using relevant International Classification of Diseases (ICD) codes. National estimates, annual incidences and characteristics were produced from trend weights provided by the NIS sampling frame and population data from the US Census Bureau. RESULTS: There were 21,415,120 fall-related hospitalizations of which 425,725 (2.0%) had ophthalmic trauma. Ophthalmic injury incidence increased from 4.26 to 14.31 per 100,000 population (P < .01) from 2000 to 2017. Mean (±SEM) age was 69.2 ± 20.1 years and 56.9% were females. Of the patients with specified fall mechanism, the most common mechanisms were tripping or stumbling (48.0%), falls related to furniture (18.3%), and falls related to stairs (16.3%). The most common ophthalmic injuries were contusions of the eye and adnexa including hyphema and commotio retinae (50.1%), orbital fractures (20.7%), and eyelid lacerations (14.9%). CONCLUSIONS: Incidence of ophthalmic trauma in patients with fall-related hospitalizations has increased and our study provides valuable information for targeting preventive measures particularly for the elderly and falls due to tripping, stairs, and furniture related accidents. The most common associated ophthalmic injuries are contusions, orbital fractures and eyelid lacerations.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in Decedents Undergoing Forensic Postmortem Examination: Feasibility for Real-Time Pandemic Surveillance.

Background: Population-based seroprevalence studies offer comprehensive characterization of coronavirus disease 2019 (COVID-19) spread, but barriers exist and marginalized populations may not be captured. We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence among decedents in Maryland over 6 months in 2020. Methods: Data were collected on decedents undergoing forensic postmortem examination in Maryland from 24 May through 30 November 2020 from whom a blood specimen could be collected. Those with available blood specimens were tested with the CoronaCHEK lateral flow antibody assay. We assessed monthly seroprevalence compared to the statewide estimated number of cases and proportion of positive test results (testing positivity). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for associations of demographic characteristics, homelessness, and manner of death with SARS-CoV-2 antibodies. Results: Among 1906 decedents, 305 (16%) were positive for SARS-CoV-2 antibodies. Monthly seroprevalence increased from 11% to 22% over time and was consistently higher than state-level estimates of testing positivity. Hispanic ethnicity was associated with 2- to 3.2-fold higher seropositivity (P < .05) irrespective of sex. Deaths due to motor vehicle crash were associated with 62% increased seropositivity (aPR, 1.62 [95% CI, 1.15-2.28]) vs natural manner of death. Though seroprevalence was lower in decedents of illicit drug overdose vs nonoverdose in early months, this shifted, and seroprevalence was comparable by November 2020. Conclusions: Decedents undergoing forensic postmortem examination, especially those dying due to motor vehicle trauma, may be a sentinel population for COVID-19 spread in the general population and merits exploration in other states/regions.

Efficacy of a mobile technology-based intervention for increasing parents' safety knowledge and actions: a randomized controlled trial.

BACKGROUND: Leading causes of unintentional child injury such as poisoning and falls are preventable, and the majority occur in the home. Numerous home safety interventions have been developed and tested to increase safety behaviors; however, no smart phone-based applications (apps) have been developed and evaluated for this purpose. The objective of this study was to evaluate whether a mobile technology-based health behavior change intervention, the Make Safe Happen® app, was an effective tool to increase safety knowledge and safety actions/behaviors for the prevention of child unintentional injuries in and around the home. METHODS: Data were collected in pretest and posttest online surveys from an existing nationwide population-based survey panel. Intervention subjects were randomized to organically (participant-driven) use the Make Safe Happen® app for 1 week, which provided home safety information and the ability to purchase safety products, while control participants were assigned to download and use an app about a topic other than home safety. The primary outcomes of safety knowledge and home safety actions were assessed by using linear mixed model regressions with intention-to-treat analyses. RESULTS: A total of 5032 participants were randomized to either the intervention (n = 4182) or control (n = 850) group, with 2055 intervention participants downloading and entering their participant IDs into the Make Safe Happen® app. The online posttest survey was completed by 770 intervention and 283 control subjects. Mean knowledge parent safety score increased at a greater rate for intervention than control subjects (p < 0.0001), and at posttest was significantly higher for intervention than control subjects (p < 0.0001). The percentage of intervention subjects who reported doing all one-time and repeated safety actions significantly increased from pretest to posttest (p < 0.0001 and p = 0.0001, respectively), but there was no change among the control subjects (p = 0.1041 and p = 0.9755, respectively). At posttest, this percentage was larger for intervention than control subjects only for repeated safety actions (p = 0.0340). CONCLUSIONS: The mobile application significantly improved safety knowledge and safety actions for participants using the Make Safe Happen® app, although loss to follow-up was a limitation. The results of this study indicate the usefulness of widespread distribution and use of the Make Safe Happen® app. Trial registration number NCT02751203 ; Registered April 26, 2016.