A Randomized Controlled Trial of Home Injury Hazard Reduction

Objective: To test the efficacy of installing safety devicesinthehomesofyoungchildrenontotalinjuryrates and on injuries deemed a priori modifiable by the installation of these devices. Design: A nested, prospective, randomized controlled trial. Setting: Indoor environment of housing units. Participants: 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. Intervention: 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. Main Outcome Measure: Modifiable and medically attendedinjury(ie,telephonecalls,officevisits,andemergency visits for injury). Results:Themeanageofchildrenatinterventionwas6.3 months. Injury hazards were reduced in the intervention homesbutnotinthecontrolhomesat1and2years(P.004). Therewasnodifferenceintherateforallmedicallyattended injuries in intervention children compared with controls: 14.3injuries(95%confidenceinterval[CI],9.7-21.1injuries) 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 interventionchildrencomparedwithcontrols:2.3injuries(95% CI,1.0-5.5injuries)vs7.7injuries(95%CI,4.2-14.2injuries) per 100 child-years (P=.03). Conclusion:An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury. Trial Registration: clinicaltrials.gov Identifier: NCT00129324

[1]  D. Kendrick,et al.  Home safety education and provision of safety equipment for injury prevention (Review). , 2013, Evidence-based child health : a Cochrane review journal.

[2]  B. Lanphear,et al.  Validation of a HOME Injury Survey , 2009, Injury Prevention.

[3]  D. Schwebel,et al.  Chronic maternal depression and children's injury risk. , 2008, Journal of pediatric psychology.

[4]  S. Stewart-Brown,et al.  Parenting interventions and the prevention of unintentional injuries in childhood: systematic review and meta-analysis. , 2008, Child: care, health and development.

[5]  J. Khoury,et al.  Maternal depression, child behavior, and injury , 2007, Injury Prevention.

[6]  B. Lanphear,et al.  Deaths From Residential Injuries in US Children and Adolescents, 1985–1997 , 2005, Pediatrics.

[7]  Y. Robitaille,et al.  Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial , 2005, Injury Prevention.

[8]  B. Lanphear,et al.  Residential Injuries in U.S. Children and Adolescents , 2005, Public health reports.

[9]  D. Kendrick,et al.  Providing child safety equipment to prevent injuries: randomised controlled trial , 2004, BMJ : British Medical Journal.

[10]  D. Durbin,et al.  A randomized, clinical trial of a home safety intervention based in an emergency department setting. , 2004, Pediatrics.

[11]  A. Gielen,et al.  The burden of injury in preschool children in an urban medicaid managed care organization. , 2002, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[12]  K. Matthews,et al.  Socioeconomic differences in children's health: how and why do these relationships change with age? , 2002, Psychological bulletin.

[13]  I B Pless,et al.  The effectiveness of a home visit to prevent childhood injury. , 2001, Pediatrics.

[14]  R Z Omar,et al.  Analysis of a cluster randomized trial with binary outcome data using a multi-level model. , 2000, Statistics in medicine.

[15]  T. Miller,et al.  Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. , 2000, Pediatrics.

[16]  W. Ray,et al.  Sociodemographic Factors Identify US Infants at High Risk of Injury Mortality , 1999, Pediatrics.

[17]  S. Schappert,et al.  Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1997. , 1997, Vital and health statistics. Series 13, Data from the National Health Survey.

[18]  J. Kronenfeld,et al.  Safety hazards in households with young children. , 1993, Journal of pediatric psychology.

[19]  Andrea Carlson Gielen,et al.  Effects of improved access to safety counseling, products, and home visits on parents' safety practices: results of a randomized trial. , 2002, Archives of pediatrics & adolescent medicine.

[20]  A. Gielen,et al.  Randomized trial of enhanced anticipatory guidance for injury prevention. , 2001, Archives of pediatrics & adolescent medicine.