Facts of Life

Facts of Life:
Issue Briefings for Health Reporters
Vol. 10, No. 2
February 2005

Staying Safe At Home

The Issue

The Facts

Catching the problem early

Expert Sources

References

The Issue:

More than 18,000 people were killed each year in home accidents from 1992 to 1999, with millions more injured from falls, poisoning, burns and cuts. ^{1 - 2} Clearly, home is where the hazards are, but a growing body of research suggests household dangers can be limited with changes in environment and behavior.

Vunerable Populations

Children and older adults are most at risk for having accidents and for dying from these accidents. In part because they spend so much of their time within a household, the majority of injuries of children under 5 and people 75 and over occur at home. ³ Children are especially vulnerable because they engage in unknowingly risky behaviors and experience a “dosage” effect, where their small bodies suffer more serious consequences from a fall down adult-size stairs or poisoning by an adult-sized dose of aspirin. Older adults are more vulnerable to home accidents because of decreased mobility, balance and eyesight, and a longer recovery time from even minor injury.

Steps Toward Safety

Home accident prevention requires both changes in environment and behavior. Unlike many diseases, household accidents are one kind of health problem where the prevalence of injury and death can be greatly reduced by changes in behavior. For instance, the annual number of childhood poisonings could be reduced simply by locking medicines out of reach. In other cases, environmental fixes like window locks, grab bars in bathrooms and smoke detectors could make a significant difference in keeping residents of all ages safer.

The Facts:

• Home accidents in the United States had a societal cost of $217 billion in 1998. Costs related to lost quality of life made up the biggest portion of this value, at $162 billion. ⁴

• Counseling parents to prevent childhood household injuries is recommended by the U.S. Preventive Services Task Force. The effectiveness of such counseling to prevent injuries in adolescents and adults has not been fully evaluated, according to the USPSTF. ⁵

• A 2005 systematic review published by the Cochrane Library found that community-wide prevention initiatives are effective in reducing falls among the elderly in a population. ⁶

• A 2003 Dallas study of child falls from apartment buildings found two factors common to many falls: balcony rails spaced more than four inches apart and windows set low to the floor. ⁷

• Mothers are more likely to take safety precautions against child falls and burns if they believe their child’s behavior puts them at risk for such injuries. Mothers are less likely to consider child behavior when taking safety precautions against poisoning or drowning, a 2004 study finds. ⁸

• A systematic review of studies of emergency room counseling on the importance of smoke detectors concluded there was not enough evidence to recommend for or against the counseling. ⁹

• Community smoke alarm giveaways are linked to significant decreases in fire-related injuries, according to two studies. ¹⁰

• Caregivers who received safety training after bringing a child to the emergency room for accident treatment were more likely to have better safety knowledge two months later than those who didn't receive the training, according to a 2004 randomized trial. ¹¹

• Children's tap water scalding injuries on the legs, buttocks and perineal region are more likely to be intentionally inflicted rather than accidental, according to a 2004 hospital study. ¹²

• In 2003, the American Academy of Pediatrics reversed a long-standing recommendation to use syrup of ipecac as a home remedy for child poisoning. The Academy now recommends contacting a local poison control center as the first step in treatment. ¹³

Catching the Problem Early:

Carol Runyan, Ph.D., of the University of North Carolina Injury Prevention Research Center, and colleagues know all the ways a home can be dangerous and all the ways Americans fail to make their homes safer. In the researchers’ recent State of Home Safety in America study, they uncovered a variety of missed opportunities in preventing household accidents.

For example, Runyan and colleagues found that only half of the survey participants living with at least one other person had a plan to escape their homes in case of fire. More than 95 percent of the households reported having smoke alarms, yet fewer than 20 percent of those households said they checked the alarms every three months to make sure they were working. ¹⁴ The Centers for Disease Control and Prevention recommends monthly alarm checks.

Hot water scalds are another serious hazard, causing more than 3,500 hospital visits each year, according to Runyan, who says “scalds from hot tap water often are more severe than other types of scalds, because they tend to involve larger portions of the body surface.” Only 6 percent of those surveyed had an anti-scald device attached to their tap or hot water heater. ¹⁴

In some cases, an extra thought for preventive behavior might be more important than special safety equipment. A 2002 national survey conducted by Tamera Coyne-Beasley, M.D., M.P.H., of the University of North Carolina Injury Prevention Research Center, and colleagues found that household chemicals and firearms were more likely to be left unlocked in homes where small children were visitors rather than residents, such as a grandparent or a babysitter’s house. ¹⁵

The finding was not entirely surprising to the researchers, because they suspected less vigilance against accidental poisonings or gun injuries in homes where the risk to children would be infrequent. However, they found that relaxed safety standards were not limited to those households.

“ The majority of homes, regardless of the presence of older adults, reported medication and storage practices in which medications or household chemicals were not locked up,” says Beasley.

Runyan says the State of Home Safety in America study “showed that the magnitude of home injury death in the United States is substantial,” but also uncovered “considerable gaps” in the data on home accidents. For instance, many vehicle-related accidents are reported without data on their exact location. Runyan believes some of those accidents take place in driveways or garages, which are considered part of the home environment.

“The available data are too limited to make specific recommendations about interventions,” Runyan says. “What is needed is a data system ensuring that the locations of injury are identified and recorded in a consistent manner.”

She also notes that studies still vary in their definition of “home,” with some excluding college dormitories, nursing homes and prisons. “ There may be some interesting differences in patterns of injury associated with these dwellings that warrant closer attention,” Runyan says.

Lisa Schwartz, M.D.
Dartmouth Medical School
(802) 296-5178
lisa.schwartz@dartmouth.edu

Steven Woloshin, M.D.
Dartmouth Medical School
(802) 296-5178
steven.woloshin@dartmouth.edu

Allen Sanderson, Ph.D.
University of Chicago
(773) 256-6269
arsx@uchicago.edu

David Ropeik, M.A.
Harvard Center for Risk Analysis
(617) 432-6011
dropeik@hsph.harvard.edu

References

1. C.W. Runyan et al. (2005) Unintentional injuries in the home in the United States. Part II: Mortality. American Journal of Preventive Medicine, 28, 73-79.

2. C.W. Runyan et al. (2005) Unintentional injuries in the home in the United States. Part II: Morbidity. American Journal of Preventive Medicine, 28, 80-87.

3. R.A. Lyons et al. (2004) Modification of the home environment for the reduction of injuries (Cochrane Review). The Cochrane Library, Issue 4.

4. E. Zaloshnja et al. (2005) The costs of unintentional home injuries. American Journal of Preventive Medicine, 28, 88-94.

5. United States Preventive Services Task Force (1996) Guide to Clinical Preventive Services: Second Edition, U.S. Department of Health and Human Services.

6. R. McClure et al. (2005) Population-based interventions for the prevention of fall-related injuries in older people (Cochrane Review). The Cochrane Library, Issue 1.

7. G.R. Istre et al. (2003) Childhood injuries due to falls from apartment balconies and windows. Injury Prevention, 9, 349-352.

8. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. (2003) Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Pediatrics, 112, 1182-1185.

9. B.A. Morrongiello and S. Kiriakou (2004) Mothers' home-safety practices for preventing six types of childhood injuries: what do they do, and why? Journal of Pediatric Psychology, 29, 285-297.

10. L. Maas Cortes and S.W. Hargarten (2001) Preventive care in the emergency department: a systematic literature review on emergency department-based interventions that address smoke detectors in the home. Academic Emergency Medicine, 8, 925-929.

11. C. DiGuiseppi and JPT Higgins (2004) Interventions for promoting smoke alarm
ownership and function (Cochrane Review). The Cochrane Library, Issue 4.

12. C. Turner et al. (2004) Community-based interventions for the prevention of burns and scalds in children (Cochrane Review). The Cochrane Library, Issue 4.

13. S. Daria et al. (2004) Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 20, 302-310.

14. C.W. Runyan et al. (2005) Risk and protective factors for fires, burns, and
carbon monoxide poisoning in U.S. households. American Journal of Preventive Medicine, 28, 102-108.

15. T. Coyne-Beasley et al. (2005) Storage of poisonous substances and firearms in
homes with young children visitors and older adults. American Journal of Preventive Medicine, 28, 109-115.

The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.

For Information Contact:
Ira Allen
Executive Editor, Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210
Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857
press@cfah.org
http://www.cfah.org

© Copyright 2005, Center for the Advancement of Health

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