The effects of demographics, functioning, and perceptions on the relationship between self-reported and objective measures of driving exposure and patterns among older adults.

The exploratory study reported here was intended to examine: how strongly subjectively reported driving avoidance behaviors (commonly referred to as self-regulation) and exposure were related to their objectively measured counterparts and whether it depended on the specific behavior; the extent to which gender and age play a role in the association between subjectively reported driving avoidance behaviors and exposure and their objectively measured counterparts; and the extent to which demographics, health and functioning, driving-related perceptions, and cognition influence the association between subjective and objective driving avoidance behaviors overall. The study used data from the Longitudinal Research on Aging Drivers (LongROAD) study, a multisite, prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental, and technological factors in driving safety during the process of aging. Objective driving measures were derived from GPS/datalogger data from 2131 LongROAD participants' vehicles. The corresponding subjective measures came from a comprehensive questionnaire administered to participants at baseline that asked them to report on their driving exposure, patterns, and other aspects of driving. Several other variables used in the analyses came from the comprehensive questionnaire and an inperson clinical assessment administered to participants at baseline. A series of simple linear and logistic models were fitted to examine the relationship between the subjective and objective driving measures of interest, and a multivariable analysis was conducted to examine the potential role of selected factors in the relationship between objective and subjective driving avoidance behaviors. Results of the models are presented and overall findings are discussed within the context of the existing research literature.

Brief Report: Self-Injurious Behaviors in Preschool Children with Autism Spectrum Disorder Compared to Other Developmental Delays and Disorders.

We compared the prevalence of self-injurious behaviors (SIB) in preschoolers aged 30-68 months with autism spectrum disorder (ASD) (n = 691) versus other developmental delays and disorders (DD) (n = 977) accounting for sociodemographic, cognitive, and medical factors. SIB prevalence was higher in ASD versus all DD [adjusted odds-ratio (aOR) 2.13 (95% confidence interval (95% CI) 1.53, 2.97)]. In subgroup analyses, SIB prevalence was higher in ASD versus DD without ASD symptoms [aOR 4.42 (95% CI 2.66, 7.33)], but was similar between ASD and DD with ASD symptoms [aOR 1.09 (95% CI 0.68, 1.77)]. We confirmed higher prevalence of SIB in ASD versus DD, independent of confounders. In children with DD, SIB prevalence increased with more ASD symptoms. These findings are informative to clinicians, researchers, and policymakers.

Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorder: Findings from Two Large National Samples.

In this study, we explored potential associations among self-injurious behaviors (SIB) and a diverse group of protective and risk factors in children with autism spectrum disorder from two databases: Autism and Developmental Disabilities Monitoring (ADDM) Network and the Autism Speaks-Autism Treatment Network (AS-ATN). The presence of SIB was determined from children's records in ADDM and a parent questionnaire in AS-ATN. We used multiple imputation to account for missing data and a non-linear mixed model with site as a random effect to test for associations. Despite differences between the two databases, similar associations were found; SIB were associated with developmental, behavioral, and somatic factors. Implications of these findings are discussed in relation to possible etiology, future longitudinal studies, and clinical practice.

Methods to increase response rates to postal questionnaires.

BACKGROUND: Postal questionnaires are widely used for data collection in epidemiological studies but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response rates to postal questionnaires would improve the quality of health research. OBJECTIVES: To identify effective strategies to increase response rates to postal questionnaires. SEARCH STRATEGY: We aimed to find all randomised controlled trials of strategies to increase response rates to postal questionnaires. We searched 14 electronic databases to February 2003 and manually searched the reference lists of relevant trials and reviews, and all issues of two journals. We contacted the authors of all trials or reviews to ask about unpublished trials. Where necessary, authors were also contacted to confirm methods of allocation used and to clarify results presented. We assessed the eligibility of each trial using pre-defined criteria. SELECTION CRITERIA: Randomised controlled trials of methods to increase response rates to postal questionnaires. DATA COLLECTION AND ANALYSIS: We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios and 95% confidence intervals in a random effects model. Evidence for selection bias was assessed using Egger's weighted regression method and Begg's rank correlation test and funnel plot. Heterogeneity among trial odds ratios was assessed using a chi-square test at a 5% significance level and the degree of inconsistency between trial results was quantified using I(2). MAIN RESULTS: We found 372 eligible trials. The trials evaluated 98 different ways of increasing response rates to postal questionnaires and for 62 of these the combined trials included over 1,000 participants. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were at least doubled using monetary incentives (odds ratio 1.99, 95% CI 1.81 to 2.18; heterogeneity p<0.00001, I(2)=78%), recorded delivery (2.04, 1.60 to 2.61; p=0.0004, I(2)=69%), a teaser on the envelope - e.g. a comment suggesting to participants that they may benefit if they open it (3.08, 1.27 to 7.44) and a more interesting questionnaire topic (2.44, 1.99 to 3.01; p=0.74, I(2)=0%). The odds of response were substantially higher with pre-notification (1.50, 1.29 to 1.74; p<0.00001, I(2)=90%), follow-up contact (1.44, 1.25 to 1.65; p<0.0001, I(2)=68%), unconditional incentives (1.61, 1.27 to 2.04; p<0.00001, I(2)=91%), shorter questionnaires (1.73, 1.47 to 2.03; p<0.00001, I(2)=93%), providing a second copy of the questionnaire at follow-up (1.51, 1.13 to 2.00; p<0.00001, I(2)=83%), mentioning an obligation to respond (1.61, 1.16 to 2.22; p=0.98, I(2)=0%) and university sponsorship (1.32, 1.13 to 1.54; p<0.00001, I(2)=83%). The odds of response were also increased with non-monetary incentives (1.13, 1.07 to 1.21; p<0.00001, I(2)=71%), personalised questionnaires (1.16, 1.07 to 1.26; p<0.00001, I(2)=67%), use of coloured as opposed to blue or black ink (1.39, 1.16 to 1.67), use of stamped return envelopes as opposed to franked return envelopes (1.29, 1.18 to 1.42; p<0.00001, I(2)=72%), an assurance of confidentiality (1.33, 1.24 to 1.42) and first class outward mailing (1.12, 1.02 to 1.23). The odds of response were reduced when the questionnaire included questions of a sensitive nature (0.94, 0.88 to 1.00; p=0.51, I(2)=0%), when questionnaires began with the most general questions (0.80, 0.67 to 0.96), or when participants were offered the opportunity to opt out of the study (0.76, 0.65 to 0.89; p=0.46, I(2)=0%). AUTHORS' CONCLUSIONS: Health researchers using postal questionnaires can increase response rates using the strategies shown to be effective in this systematic review.

School-based secondary prevention programmes for preventing violence.

BACKGROUND: Early aggressive behaviour is a risk factor for later violence and criminal behaviour. Despite over 20 years of violence prevention interventions being delivered in the school setting, questions remain regarding the effectiveness of different interventions for children exhibiting aggressive behaviour. OBJECTIVES: To examine the effect of school based violence prevention programmes for children identified as aggressive or at risk of being aggressive. SEARCH STRATEGY: We searched CENTRAL, Cochrane Injuries Group specialised register, MEDLINE, EMBASE, other specialised databases and reference lists of articles. We also contacted authors and organisations to identify any further studies. SELECTION CRITERIA: We included trials meeting the following criteria; 1) participants were randomly assigned to intervention and control groups; 2) outcome data were collected concurrently; 3) participants comprised children in mandatory education identified as exhibiting, or at risk of, aggressive behaviour; 4) interventions designed to reduce aggression, violence, bullying, conflict or anger; 5) school based interventions; 6) outcomes included aggressive behaviour, school and agency responses to acts of aggression, or violent injuries. DATA COLLECTION AND ANALYSIS: Data were collected on design, participants, interventions, outcomes and indicators of study quality. Results of any intervention to no intervention were compared immediately post-intervention and at 12 months using meta-analysis where appropriate. MAIN RESULTS: Of 56 trials identified, none reported data on violent injuries. Aggressive behaviour was significantly reduced in intervention groups compared to no intervention groups immediately post intervention in 34 trials with data, (Standardised Mean Difference (SMD) = -0.41; 95% confidence interval (CI) -0.56 to -0.26). This effect was maintained in the seven studies reporting 12 month follow-up (SMD = -0.40, (95% CI -0.73 to -0.06)). School or agency disciplinary actions in response to aggressive behaviour were reduced in intervention groups for nine trials with data, SMD = -0.48; 95% CI -1.16 to 0.19, although this difference may have been due to chance and was not maintained, based on two studies reporting follow-up to two to four months (SMD = 0.03; 95% CI -0.42 to 0.47). Subgroup analyses suggested that interventions designed to improve relationship or social skills may be more effective than interventions designed to teach skills of non-response to provocative situations, but that benefits were similar when delivered to children in primary versus secondary school, and to groups of mixed sex versus boys alone. AUTHORS' CONCLUSIONS: School-based secondary prevention programmes to reduce aggressive behaviour appear to produce improvements in behaviour greater than would have been expected by chance. Benefits can be achieved in both primary and secondary school age groups and in both mixed sex groups and boys-only groups. Further research is required to establish whether such programmes reduce the incidence of violent injuries or if the benefits identified can be maintained beyond 12 months.

Recurrent early childhood injuries among disadvantaged children in primary care settings.

OBJECTIVE: To examine differences in social risk factors and health care use between young children with and without recurrent injuries. DESIGN: Retrospective cohort study using administrative claims and medical records. Children with no, one, or more than one injury were compared. SETTING: Integrated public healthcare system. SUBJECTS: All children born at Denver Health Medical Center (DHMC) in 1993 who continued care there beyond 15 months of age. Children were followed to 36 months. OUTCOME MEASURES: Sociodemographic information, service use, injury episodes, cause of injury, and social risk factors. RESULTS: 371 injury episodes occurred among 817 children. In the study cohort, 7% had >1 injury episode, 26% had one injury, and 67% had none. Among children with >1 injury episode, 78% had at least one social risk factor compared with 63% of children with one injury and 52% of children with none (p<0.0001). Risk factors for >1 injury included maternal substance abuse (p = 0.0003), maternal age under 18 years (p = 0.04), a primary caregiver who was single (p<0.0001) or mentally ill (p = 0.03), and a history of family violence (p = 0.01). Multiple injury episodes were associated with increased non-injury service use, including primary care visits (p<0.0001), emergency department visits (p<0.0001), and total non-injury encounters (p<0.0001). CONCLUSIONS: Children with recurrent injury were more likely to have social risk factors, and used DHMC more frequently, than children with one or no injuries. Children with risk factors for recurrent injury can be identified and injury prevention counseling can be delivered to their families at their multiple visits to the system.

Interventions for preventing injuries in problem drinkers.

BACKGROUND: Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal. OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: We searched 12 twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PsycINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. The electronic and bibliographic searches were updated in May 2002. SELECTION CRITERIA: Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. DATA COLLECTION AND ANALYSIS: Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials of problem drinkers that compared interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes. REVIEWERS' CONCLUSIONS: Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.

Putting public health evidence into practice: increasing the prevalence of working smoke alarms in disadvantaged inner city housing.

STUDY OBJECTIVES: The UK government recommends that local authorities install battery operated smoke alarms to prevent fire related injury. However, a randomised controlled trial of smoke alarm installation in local authority housing found a low level of working alarms at follow up. Qualitative work, which accompanied the trial explored barriers and levers to the use of this public health intervention. DESIGN: Semi-structured group and individual interviews were conducted with a sample of the adult participants in a randomised controlled trial of free smoke alarm installation. Group interviews and "draw and write" exercises were conducted with children at a local primary school. PARTICIPANTS: A sample of trial participants and primary school children in the trial neighbourhood. SETTING: An inner city housing estate in central London. MAIN RESULTS: The main barrier to smoke alarm use was the distress caused by false alarms. Although trial participants considered themselves to be at high risk for fires and would recommend smoke alarms to others, respondents' reports on the distress caused by false alarms suggest that people balance immediate and longer term risks to their health and wellbeing when they disable alarms. CONCLUSIONS: This study identified some of the reasons for the low level of functioning smoke alarms, and problems experienced with alarms. The results have implications for the implementation of this public health intervention. The effectiveness of smoke alarm installation could be improved if alarm manufacturers and those responsible for implementation programmes considered ways of tackling the issues raised in this study.

Randomised controlled trial of site specific advice on school travel patterns.

AIMS: To evaluate the effect of site specific advice from a school travel coordinator on school travel patterns. METHODS: Cluster randomised controlled trial of children attending 21 primary schools in the London boroughs of Camden and Islington. A post-intervention survey measured the proportion of children walking, cycling, or using public transport for travel to school, and the proportion of parents/carers very or quite worried about traffic and abduction. The proportion of schools that developed and implemented travel plans was assessed. RESULTS: One year post-intervention, nine of 11 intervention schools and none of 10 control schools had travel plans. Proportions of children walking, cycling, or using public transport on the school journey were similar in intervention and control schools. The proportion of parents who were very or quite worried about traffic danger was similar in the intervention (85%) and control groups (87%). However, after adjusting for baseline and other potential confounding factors we could not exclude the possibility of a modest reduction in parental concern about traffic danger as a result of the intervention. CONCLUSIONS: Having a school travel coordinator increased the production of school travel plans but there was no evidence that this changed travel patterns or reduced parental fears. Given the uncertainty about effectiveness, the policy of providing school travel coordinators should only be implemented within the context of a randomised controlled trial.

Interventions for promoting smoke alarm ownership and function.

BACKGROUND: Residential fires caused at least 67 deaths and 2,500 non-fatal injuries to children aged 0-16 in the United Kingdom in 1998. Smoke alarm ownership is associated with a reduced risk of residential fire death. OBJECTIVES: We evaluated interventions to promote residential smoke alarms, to assess their effect on smoke alarm ownership, smoke alarm function, fires and burns and other fire-related injuries. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Cochrane Injuries Group database, MEDLINE, EMBASE, PsycLIT, CINAHL, ERIC, Dissertation Abstracts, International Bibliography of Social Sciences, ISTP, FIREDOC and LRC. Conference proceedings, published case studies, and bibliographies were systematically searched, and investigators and relevant organisations were contacted, to identify trials. SELECTION CRITERIA: Randomised, quasi-randomised or nonrandomised controlled trials completed or published after 1969 evaluating an intervention to promote residential smoke alarms. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: We identified 26 trials, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR=1.26; 95% CI: 0.87 to 1.82) or having a functional alarm (OR=1.19; 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR=1.96; 1.03 to 3.72) and function (OR=1.72; 0.78 to 3.80). Results were sensitive to trial quality, however, and effects on fire-related injuries were not reported. In two non randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire-related injuries. Media and community education showed little benefit in non randomised trials. REVIEWER'S CONCLUSIONS: Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give-away programmes apparently reduce fire-related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give-away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.

Individual-level injury prevention strategies in the clinical setting.

Health care providers have numerous opportunities to intervene with parents and children to promote child safety practices that reduce rates of unintentional injuries. These individual-level interventions may be delivered in a variety of settings such as physician offices, clinics, emergency departments, or hospitals. This article systematically reviews 22 randomized controlled trials (RCTs) that examined the impact of interventions delivered in the clinical setting on child safety practices and unintentional injuries. The results indicate that counseling and other interventions in the clinical setting are effective at increasing the adoption of some safety practices, but not others. Specifically, motor vehicle restraint use, smoke alarm ownership, and maintenance of a safe hot tap water temperature were more likely to be adopted following interventions in the clinical setting. Clinical interventions were not proven effective at increasing a variety of safety practices designed to protect young children from injuries in the home, increasing bicycle helmet use, or reducing the occurrence of childhood injuries, though few studies examined the latter two outcomes. Clinical interventions were most effective when they combined an array of health education and behavior change strategies such as counseling, demonstrations, the provision of subsidized safety devices, and reinforcement. The article concludes with implications for research and practice.

Interventions for preventing injuries in problem drinkers.

OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: Data Sources.- Twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PSYCHINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. SELECTION CRITERIA: Data Selection.- Randomized controlled trials of interventions among particiapnts with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. Of 7014 studies identified, 19 (0. 3%) met the inclusion criteria. DATA COLLECTION AND ANALYSIS: Data Extraction.- Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Data Synthesis.- In completed trials, interventions for problem drinking were associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27-65%. Several interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. REVIEWER'S CONCLUSIONS: Conclusion.- Interventions for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to evaluate the effect of treating problem drinking on injuries.

Systematic review of controlled trials of interventions to promote smoke alarms.

AIMS: To evaluate the effects of promotion of residential smoke alarms. METHODS: Electronic databases, conference proceedings, and bibliographies were systematically searched, and investigators and organisations were contacted, in order to identify controlled trials evaluating interventions designed to promote residential smoke alarms. The following were assessed: smoke alarm acquisition, ownership, and function; fires; burns; and fire related injuries. Odds ratios (OR) were estimated by meta analysis of randomised trials. RESULTS: A total of 26 trials were identified, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR = 1.26; 95% confidence interval (CI): 0.87 to 1.81) or having a functional alarm (OR = 1.19; 95% CI: 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR = 1.93; 95% CI: 1.04 to 3.58) and function (OR = 1. 72; 95% CI: 0.78 to 3.78). Results were sensitive to trial quality, however, and effects on fire related injuries were not reported. In two non-randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire related injuries. Media and community education showed little benefit in non-randomised trials. CONCLUSION: Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give away programmes apparently reduce fire related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.

Urban residential fire and flame injuries: a population based study.

BACKGROUND: Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised. METHODS: To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997. RESULT: There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100,000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100,000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100,000 person years). Injury rates were highest in those 0-4 (68 (95% CI 39 to 112)/100,000 person years) and > or = 85 years (90 (95% CI 29 to 213)/100,000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker's materials (18%) were leading fire sources. CONCLUSIONS: Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

OBJECTIVES: To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. SETTING: The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. METHODS: Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. RESULTS: Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. CONCLUSIONS: It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Smoke alarm installation and function in inner London council housing.

AIM: To determine the prevalence of and predictors for installed, functioning smoke alarms in council (public) housing in a low income, multi-ethnic urban area. DESIGN: Cross sectional study. SETTING: 40 materially deprived electoral wards in two inner London boroughs. PARTICIPANTS: Occupants of 315 addresses randomly selected from council housing lists, with 75% response rate. MAIN OUTCOME MEASURES: Installation and function of smoke alarms based on inspection and testing. RESULTS: 39% (95% confidence interval (CI) 33% to 46%) of council tenants owned a smoke alarm, 31% (95% CI 25% to 38%) had an installed alarm (of which 54% were correctly installed), and 16% (95% CI 12% to 22%) had at least one installed, functioning alarm. Alarms most commonly failed because they lacked batteries (72%). In multivariate modelling, having an installed, functioning alarm was most strongly associated with living in a house versus a flat (apartment) (odds ratio (OR) 3.2, 95% CI 1.1 to 10.0), having two resident adults versus one (OR 2.8, 95% CI 1.2 to 6.5), and recognising stills from a Home Office television smoke alarm campaign (OR 2.4, 95% CI 1.1 to 5.5). CONCLUSIONS: Fires are a leading cause of child injury and death, particularly among those younger than 5 years of age and those in social classes IV and V. Smoke alarms are associated with a significantly reduced risk of death in residential fires, and are more protective in households with young children. Few council properties in a multi-ethnic, materially deprived urban area had any installed, functioning smoke alarms, despite a high risk of residential fires and fire related injuries in such areas. Effective methods to increase the prevalence of installed and functioning alarms must be identified.

Preventing injuries through interventions for problem drinking: a systematic review of randomized controlled trials.

To assess the effect of treatment of problem drinking on injury risk, we conducted a systematic review of randomized controlled trials by searching 12 computerized databases, cross-checking bibliographies, and contacting authors and governmental agencies. We identified 19 trials of interventions for problem drinking that measured injury outcomes. Treatment for problem drinking was associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27 to 65%. Interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. The precision of all the point estimates was low, however. We did not combine the results quantitatively, because the interventions, patient populations, and outcomes were so heterogeneous. The results suggest that treatment for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to confirm these effects.