Interventions for promoting smoke alarm ownership and function

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Abstract
Globally, fire‐related burns and smoke inhalation accounted for 238,000 deaths in 2000, a rate of 3.9 deaths/100,000, with children and young persons aged less than 44 years accounting for the highest proportion of deaths. Smoke alarm ownership has been associated with a reduced risk of residential fire death. We evaluated interventions to promote residential smoke alarms, to assess their effect on the prevalence of owned and working smoke alarms, and the incidence of fires and burns and other fire‐related injuries. We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Dissertation Abstracts, IBSS, ISTP, FIREDOC, LRC, conference proceedings, published case studies, and bibliographies, and contacted investigators and relevant organisations to identify trials. Most of the searches were last updated in September 2007. Randomised or non‐randomised controlled trials completed or published after 1969 evaluating interventions to promote residential smoke alarms. Two authors independently extracted data and assessed trial quality. We performed meta‐analysis of randomised controlled trials to combine odds ratios (OR) between intervention and control groups, using a random effects model. A chi‐square test for heterogeneity used a significance level of 10%. Non‐randomised trial results are described narratively. We identified 26 completed trials, of which 17 were randomised. Overall, counselling and educational interventions, with or without provision of free or discounted smoke alarms, modestly increased the likelihood of owning an alarm (OR = 1.21; 95% CI 0.89 to 1.64) and having an installed, functional alarm (OR = 1.33; 95% CI 0.98 to 1.80). Whether or not the intervention programme provided free or discounted smoke alarms in addition to education did not influence these results. The results were sensitive to trial quality, however. Counselling as part of primary care child health surveillance had somewhat greater effects on alarm ownership (OR = 1.96; 95% CI 1.03 to 3.72) and function (OR = 1.46; 95% CI 1.15 to 1.85), results that were generally supported by non‐randomised trials evaluating similar interventions. Injury outcomes were reported in only one randomised controlled trial, which found no effect of a smoke alarm give‐away programme on total injuries (rate ratio 1.3; 95% CI 0.9 to 1.9) or on hospitalizations and deaths (rate ratio 1.3; 95% CI 0.7 to 2.3), in contrast to the substantial reduction in serious injuries reported in a non‐randomised trial that evaluated a similar give‐away programme. Neither trial showed a beneficial effect on fires. Mass media and community education showed little benefit in multiple non‐randomised trials. Two trials, one of which was randomised, showed that smoke alarm installation programmes increase the likelihood of having a working smoke alarm, and the non‐randomised trial reported reductions in fire‐related injuries. This review found that programmes to promote smoke alarms have at most modest beneficial effects on smoke alarm ownership and function, and no demonstrated beneficial effect on fires or fire‐related injuries. Counselling as part of child health surveillance has a somewhat greater effect on smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give‐away programmes have not been demonstrated to increase smoke alarm prevalence or to reduce fires or fire‐related injuries. Community‐based education programmes have not been shown to reduce burns or fire‐related injuries. Community smoke alarm installation programmes may increase the prevalence of working alarms and reduce fire‐related injuries, but these results require confirmation, and the cost‐effectiveness of such programmes has not been evaluated. Efforts to promote smoke alarms through installation programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes and cost‐effectiveness. 促進煙霧警報器擁有與作用的介入措施 2000年，全球與火災相關的燒傷與煙霧吸入事件共計造成238,000人死亡，其中兒童與44歲以下年輕人所佔的死亡比例最高，每10萬就有3.9人死亡。煙霧警報器的擁有與減少住家火災死亡的風險有關。 我們評估促進住家煙霧警報器的介入措施，評估它們對於擁有與煙霧警報器運作的盛行率，以及火災與燒傷與其他火災相關傷害的發生率。 我們檢索the Cochrane Injuries Group's專科的登記資料庫，CENTRAL，MEDLINE，EMBASE，PsycINFO，CINAHL，ERIC，Dissertation Abstracts，IBSS，ISTP，FIREDOC，LRC，會議紀錄，已發表的病例研究，與參考書目，並連絡研究人員與相關組織以確定試驗。最後一次更新檢索是在2007年9月。 1969年後發表或完成之評估促進住家煙霧警報器介入措施的隨機或非隨機對照試驗。 兩名作者分別摘錄資料並評估試驗品質。我們採用隨機效果模式來合併隨機對照試驗中介入組與對照組的odds ratios (OR)以進行統合分析。採用chisquare test評估異質性，顯著水準為10%。非隨機試驗的結果採用描述性的方式呈現。 我們確定26篇完成的試驗，其中17篇為隨機試驗。整體來說，不管有沒有提供免費或折扣的煙霧警報器，輔導與教育介入措施可以適度地增加擁有警報器(OR = 1.36；95% CI為0.92至2.00)及有安裝實用警報器(OR = 1.29；95% CI為1.04至1.58)的可能性。除了教育，不論介入計畫是否提供免費或折扣的煙霧警報器並不影響這些結果。然而，結果受到試驗品質影響。輔導作為部分的初步照護兒童健康監督比警報器擁有(OR = 1.96；95% CI為1.03至3.72)與作用(OR = 1.46；95%...