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Home safety education and provision of safety equipment for injury prevention

  1. Denise Kendrick1,*,
  2. Ben Young1,
  3. Amanda J Mason-Jones2,
  4. Nohaid Ilyas1,
  5. Felix A Achana3,
  6. Nicola J Cooper4,
  7. Stephanie J Hubbard3,
  8. Alex J Sutton3,
  9. Sherie Smith1,
  10. Persephone Wynn1,
  11. Caroline A Mulvaney5,
  12. Michael C Watson5,
  13. Carol Coupland1

Editorial Group: Cochrane Injuries Group

Published Online: 12 SEP 2012

Assessed as up-to-date: 7 MAY 2009

DOI: 10.1002/14651858.CD005014.pub3


How to Cite

Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney CA, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD005014. DOI: 10.1002/14651858.CD005014.pub3.

Author Information

  1. 1

    University of Nottingham, Division of Primary Care, Nottingham, UK

  2. 2

    University of York, Department of Health Sciences, York, UK

  3. 3

    University of Leicester, Department of Health Sciences, Leicester, UK

  4. 4

    University of Leicester, Health Sciences, Leicester, UK

  5. 5

    University of Nottingham, School of Health Sciences, Nottingham, UK

*Denise Kendrick, Division of Primary Care, University of Nottingham, Floor 13, Tower Building, University Park, Nottingham, NG7 2RD, UK. denise.kendrick@nottingham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 12 SEP 2012

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Characteristics of included studies [ordered by study ID]
Adler 1994

MethodsRCT


ParticipantsChildren aged 5-16 years with a history of firesetting/fireplay


InterventionsI1 = educational material, 2 home visits by fire fighters to provide education, behaviour modification, parental instruction in use of negative consequences in the event of firesetting, plotting events leading up to an incident and discussing alternative ways of responding to incidents in future
I2 = same as I1 plus offer of psychiatric referral
C1 = fire safety educational material
C2 = fire safety educational material plus offer of psychiatric referral


OutcomesOutcomes measured over 12 months:

Rate of fire setting
Number of children setting fires causing or threatening to cause property damage - data not reported separately for treatment arms
No significant difference between experimental and control groups in rate of fire setting or seriousness of fire setting
No P values reported


NotesBlinding - n
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Babul 2007

MethodsRCT


ParticipantsParents of new born infants at a general hospital serving mainly urban or suburban communities


InterventionsI 1= Home visit + home safety inspection +  free safety kit (smoke alarm, coupon for 50% discounted stair gate, corner cushions, cabinet locks, blind cord windups, water temperature card, door stoppers, socket covers, poison control centre sticker + safety brochure + home safety checklist for parents)

I2 = free safety kit (as above)

C = usual care


OutcomesOutcomes measured at 12 months of age:

Medically attended injuries

Safe hot water temperature (temperature not specified)

Possession of fire extinguisher

Hot drinks/food out of reach

Safe storage of medicines

Plants out of reach

Use of baby walker

Left child alone on high surface

Hall and stairways adequately lit I1=169/171, I2=161/162, C=144/146; I1 vs C OR 1.17 (0.08 to 16.37), I2 vs C OR 2.24 (0.11 to 132.72)

Hall and stairways not cluttered I1=160/169, I2=152/162, C=135/144; I1 vs C OR 1.19 (0.40 to 3.47), I2 vs C OR 1.01 (0.35 to 2.87)

Small objects kept out of reach

Blind cords not accessible to child I1=150/171, I2=145/161, C=125/146; I1 vs C OR 1.20 (0.59 to 2.43), I2 vs C OR 1.53 (0.72 to 3.26)

Never left child alone in bath

Pools fully fenced I1 =112/172, I2 = 105/161, C = 104/144; I1 vs C OR 0.72 (0.43 to 1.19); I2 vs C OR 0.72 (0.43 to 1.21)


NotesI1 and I2 arms combined for meta-analyses

Blinding - n
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Barone 1988

MethodsRCT (C)
Allocation at level of parenting classes


Participants5 parenting classes (108 parents of toddlers)


InterventionsI = slides, handouts on burn prevention, bath water thermometer, hot water gauge, usual safety education
C = usual safety education


OutcomesOutcomes measured over 6 months:

Possession of smoke alarm
Functional smoke alarm
Safe hot water temperature


NotesBlinding - n
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)High riskInadequate

Baudier 1988

MethodsRCT (C)
Allocation at level of groups of schools


ParticipantsInfant school children


InterventionsI = teaching kit for use by teachers of infant classes, take home booklet, stickers, exhibitions, parents meetings
C = none of above


OutcomesOutcomes measured during subsequent school term:

Safe storage of poisons


NotesBlinding - u
Outcomes 80% - n
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot used

Bentzen 1997

MethodsCBA (C)
Allocation at level of municipality


ParticipantsPopulation of children aged 0-15 years in 2 municipalities, Odense (intervention) and Randers (control)


InterventionsI = community injury prevention programme including advice in well child clinics and group based health programmes, pamphlets, puppet theatre, posters, exhibitions
C = no community injury prevention programme


OutcomesOutcomes measured over 4 years:

Medically attended injuries (ED attendances)

Incidence of cut injuries - I = 468/10000 boys; 343/10000 girls at baseline and 361/10000 boys; 280/10000 girls at follow-up
C = 7.7/10000 boys; 5.8/10000 girls at baseline and 54.9/10000 boys; 40.9/10000 girls at follow-up
No P values reported


NotesBlinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Blake 1993

MethodsNon-RCT/CBA


ParticipantsParents in two inner city health clinics


InterventionsI = educational video
C = no video


OutcomesPeriod over which outcomes measured not reported.

Functional smoke alarm. Significant increase in purchase and installation of smoke alarms in intervention group
No figures or P values reported


NotesBlinding - u
Outcomes 80% - n
Balance - u
Allocation of participants not described


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Bulzachelli 2009

MethodsNon-RCT

Randomised to I1 or I2 arms on days when mobile child safety centre present (Monday, Wednesday, Friday) and allocated to control arm when mobile child safety centre not present (Tuesday, Thursday)


ParticipantsParents of children aged 1 month to seven years attending a well-child clinic in  low-income urban communities


InterventionsI1= prescribed visit to mobile child safety centre

I2 = optional visit to mobile child safety centre

C = told about purpose of mobile safety centre & given more information on request but not referred to centre


OutcomesOutcomes measured at 2 to 4 weeks:

Functional smoke alarm

Safe storage of poisons


NotesI1 and I2 arms combined for meta-analyses

Blinding - n
Outcomes 80% - n
Balance - n

Control arm participants had higher baseline educational and income levels than intervention arm participants.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Campbell 2001

MethodsRCT (C)
Allocation at level of schools


ParticipantsHispanic migrant youths, aged 11-16 years, low income


InterventionsI = 8 sessions of multimedia first aid and home safety training presented by bilingual and bicultural college students
C = 8 sessions of multimedia tobacco and alcohol prevention education presented by bilingual and bicultural college students


OutcomesOutcomes measured over 12 months:

Possession of fire extinguisher (No figures or P value reported)

Practiced fire escape plan
Safe storage of medicines (No figures or P value reported)
Safe storage of cleaning products (No figures or P value reported)
Removal of small objects (No figures or P value reported)
No significant difference in total number of home safety changes made (No figures or P value reported)


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Carman 2006

MethodsCBA (C)

Allocation at level of electoral wards


ParticipantsChildren under 5 years in deprived electoral wards


InterventionsI = home visit by injury prevention project workers + safety education + free equipment (bath mat, harness and reins, cupboard locks, corner cushions, multi-purpose lock, socket covers) + low cost fitted equipment (stair gates, fireguards, smoke alarm, kitchen cupboard locks, glass safety film) + population wide injury prevention talks to community groups and safety events across locality + follow-up of families whose children had attended the Emergency Department

C = Population wide injury prevention talks to community groups and safety events across locality + follow-up of families whose children had attended the Emergency Department


OutcomesOutcomes measured over 2 years:

Medically attended injuries (ED attendance)


NotesBlinding - u
Outcomes 80% - y
Balance - no

Intervention areas had higher baseline ED attendance rates than control areas


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Chan 2004

MethodsRCT


ParticipantsFamilies in two districts of Hong Kong with children under 3 years admitted to hospital with an unintentional injury


InterventionsI = 4 quarterly home visits and monthly telephone follow-ups focusing on practical solutions to potential for injury, from lay home visitors and standard educational material on injury prevention
C = standard educational material on injury prevention


OutcomesPeriod over which outcomes measured not reported.

Tested temperature of microwaved food
Child proofed boiler and rice cookers, window frames and electrical heating devices
Household rearrangement to avoid staggering furniture layout
Home hazards assessed on a 51 item household environment checklist
Significantly more intervention group families tested temperature of microwaved food (P = 0.05) and child proofed boilers and rice cookers (P = 0.05), window frames (P < 0.01) and electrical heating devices (P = 0.05) and rearranged furniture to avoid staggering layout (P < 0.01)
No figures reported for any of the above outcomes
No figures or P value reported for overall hazard score


NotesBlinding - u
Outcomes 80% - u
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Clamp 1998

MethodsRCT


ParticipantsFamilies with children < 5 years registered at one GP surgery


InterventionsI = general practitioner safety advice, leaflets & low cost safety equipment (smoke alarms, window locks, cupboard and drawer catches, socket covers, door slam devices, fire guards, stair gates)
C = usual care


OutcomesOutcomes measured at 6 weeks:

Functional smoke alarm
Possession of smoke alarm
Fitted fire guard
Safe storage of medicines
Safe storage of cleaning products
Use of stair gate
Use of window locks
Use of socket covers
Sharp objects stored out of reach
Use of door slam devices I = 50/82 C = 14/82 OR 7.59 (3.67 to 15.69)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Coggan 2000

MethodsCBA (C)
Allocation at level of communities


ParticipantsPopulation of two communities, Waitakere (intervention) and a control community matched on demographic variables, new housing developments, road safety and safer community coordinator positions


InterventionsI = community based injury prevention programme focusing on child safety including multi-agency collaboration, education & training, advocacy and action for hazard reduction
C = no community based injury prevention program


OutcomesOutcomes measured over 2 years:

Injury outcomes ascertained from injury surveillance system. Hospital admission rates for injury - Significant reduction in injury hospitalisation rates during intervention and post intervention phase in intervention as compared to control community P < 0.05. Figures not reported.

Fitted fire guard - Intervention community significantly more likely to have a fitted fire guard P = 0.0002. No figures reported.
Acquisition of stair gate - Intervention group significantly more likely to acquire a stair gate P < 0.0001. No figures reported.
Acquisition of appropriate fencing for swimming pools - Intervention group more likely to acquire pool fencing, P = 0.0001. No figures reported.


NotesBlinding - u
Outcomes 80% - y
Balance - n
Intervention community had higher child injury rates at baseline than control community


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Colver 1982

MethodsRCT (C)
Allocation at level of clinics, day nurseries and nursery classes


ParticipantsFamilies with children < 5 years attending child health clinics, day nurseries, nursery classes and a toddler group in deprived area


InterventionsI = encouraged to watch TV safety campaign + home visit + advice on benefits to obtain safety equipment and local availability of safety equipment
C = encouraged to watch TV safety campaign


OutcomesOutcomes measured at 3 months:

Safety changes made to home including cooker guards, fire guards and keeping matches out of reach - Intervention group were more likely to report making safety changes to the home I = 22/37 C = 4/43, OR 14.30 (4.22 to 48.46)
A physical hazard score comprising nine hazards in the home - No figures or P values reported


NotesBlinding - u
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Davis 1987

MethodsRCT (C)
Allocation at level of school class


Participants41 grade 4-6 classes


InterventionsI = six 1 hour fire safety lessons with workbook, demonstrations, teacher training, materials and take home materials for parents
C = usual lessons


OutcomesOutcomes measured immediately after last fire safety lesson:

Possession of smoke alarm


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Dawson 1989

MethodsRCT


ParticipantsWomen aged 16 years and under attending maternity clinic, 20-26 weeks pregnant, English speaking


InterventionsI1 = home visits to provide emotional support, advice on child care including safety advice, practical help e.g. with housing, finding legal advice, transport to clinics; encouragement and transportation to use community resources
I2 = I1 plus 2 weekly parent groups
C1 = usual care

C2 = usual care (selected post randomised enrolment)


OutcomesOutcomes measured at 12 months:

Poison centre phone number accessible - I1+ I2 = 37/54 C1+ C2 = 20/33 OR 1.41 (0.57 to 3.49)
Possession of ipecac I1+ I2 = 28/54 C1+ C2 = 17/33 OR 1.01 (0.43 to 2.41)


NotesBlinding - u
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Dershewitz 1977

MethodsRCT


ParticipantsMothers of children attending a medical clinic enrolled in pre paid medical plan


InterventionsI = safety advice + safety booklet + free safety equipment provided by researcher
C = free safety equipment provided by researcher


OutcomesOutcomes measured at 2 months:

Safe storage of prescription medicines

Safe storage of cleaning products

Use of socket covers

Sharp objects (knives) stored out of reach

Small objects (coins) out of reach

Safe storage of non-prescription medicines I = 1/101 C = 3/104 OR 0.34 (0.03 to 3.29)
Use of cupboard locks (not specified for cupboards containing poisonous substances) I = 34/101 C = 32/104 OR 1.14 (0.64 to 2.05)
Removal of pins and needles I = 33/101 C = 31/104 OR 1.14 (0.63 to 2.06)
Household hazard scale comprising eleven potential hazards - Total hazard score I = 53.2, C = 52.99, P = NS, P value not given


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

DiGuiseppi 2002

MethodsRCT (C)
Allocation at level of electoral wards


ParticipantsHouseholds in council rented accommodation


InterventionsI = free smoke alarm, and offer of free fitting, reminder to change batteries
C = no smoke alarm


OutcomesOutcomes measured at 18 months:

Fire related injuries:

Rate ratio (RR) 1.3 (0.9,1.8), adjusted for baseline rates RR 1.3 (0.9,1.9)

Hospitalisations and deaths:

RR 1.3 (0.7,2.4), adjusted for baseline rates RR 1.3 (0.7,2.3)

Preventable injuries*:

RR 1.1 (0.8,1.7), adjusted for baseline rates RR 1.2 (0.8,1.8)

Preventable hospitalisations and deaths:

RR 1.0 (0.5,1.9), adjusted for baseline rates RR 1.0 (0.5,2.0)

Attended fires:

RR 1.0 (0.9,1.2), adjusted for baseline rates RR 1.1 (0.96,1.3)

*Preventable = independently judged by 2 researchers blinded to treatment arm to be potentially preventable had a working smoke alarm been present.

Functional smoke alarms


NotesBlinding - y
Outcomes 80% - y(i) n(sp)
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Emond 2002

MethodsCBA (C)
Allocation at level of health visitor base


ParticipantsFirst time mothers from socio-economically deprived areas


InterventionsI = first parent health visitor scheme (a programme of regular home visits to help, support and advise mothers)
C = conventional health visiting


OutcomesOutcomes measured at 2 years:

Use of stair gate - intervention group significantly more likely to use stair gates. No figures or p values reported
Use of socket covers - Intervention group more likely to use socket covers. No figures or p values reported


NotesBlinding - n
Outcomes 80% - u
Balance - n
Intervention area chosen because of deprivation level. At baseline the intervention arm had higher proportion of black and Asian mothers, lower maternal educational level and less advantaged in terms of housing status than control arm.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Fergusson 1982

MethodsNon-randomised controlled trial (C)
Allocation at level of 2 month time periods and within time periods sequentially by date of birth


ParticipantsFamilies of children aged 2-3 years participating in the Christchurch Child Development Study


InterventionsI = "Mr Yuk" stickers for poisonous substances + list of substances to which sticker should be attached + educational leaflet provided by researcher
C = none of the above


OutcomesOutcomes measured at 12 months:

Medically attended poisonings
Mean number of poisons within child's reach I = 14.80, C = 17.70, P > 0.05
Poisoning hazards score I = 79.96, C = 78.29, P > 0.05.


NotesBlinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Franklin 2002

MethodsCBA


ParticipantsChildren and young people, aged 4-17 years, referred from the county court system, fire departments, schools and parents with fire setting incident


InterventionsI = trauma burn outreach prevention program (TBOPP) - a 1 day multidisciplinary program with interactive content focusing on the impact of fire setting behaviour including a peer counselling approach
C = No TBOPP


OutcomesOutcomes measured between 8 months and 2.5 years:

Firesetting behaviour
Recidivism rate - I = 1/132 C = 37/102, OR 0.01 (0.002 to 0.1)


NotesBlinding - u
Outcomes 80% - u
Balance - n
Control arm were children who were not referred to the prevention programme
Control arm were marginally younger and less likely to have a history of arson


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Gaffney 1996a

MethodsCBA (C)
Allocation level not reported


ParticipantsPopulations of unspecified control and intervention areas


InterventionsI = multi-faceted campaign to reduce risk factors and the rate of hot water scalds in children aged 0-4 years
C = no campaign


OutcomesOutcomes measured at 3 months and 2.5 years:

Awareness and use of scald limiting products - no changes in awareness or use of scald limiting products. No figures or P values reported


NotesBlinding - u
Outcomes 80% - u
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Garcia 1996

MethodsCBA (C)
Allocation at level of schools


Participants4th grade elementary school children and their parents


InterventionsI = safety fair at schools which included interactive safety stations on poisons, fires and home injuries.
C = no safety fairs


OutcomesPeriod over which outcomes measured not reported:

Fire safety behaviours - intervention school parents showed significant improvement in safety behaviour. No figures or P values reported
Poison safety - Intervention school students showed a significant improvement in poison safety. No figures or P values reported


NotesBlinding - u
Outcomes 80% - u
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Georgieff 2004

MethodsCBA (C)
Allocated at level of electoral ward.


ParticipantsChildren < 3 years from 5 deprived wards


InterventionsI1= awareness raising campaign including leaflets, a logo, a radio advert campaign, a bus advertising campaign, burns and scalds road shows, free bath water thermometers and hot tap water temperature testing by researchers
I2 = I1 + free thermostatic mixer valve for baths
C = none of the above


OutcomesPeriod over which outcomes measured not reported:

Safe hot tap water temperature < 49 degrees Celsius
Mean temperature after intervention (degrees Celsius) I (1) = 52, I (2) = 55, C = 58
No p values reported


NotesI2 and C arms used for meta-analyses

Blinding - u
Outcomes 80% - n
Balance - n
Intervention group had higher percentage of single parents


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Gielen 2002

MethodsRCT (C)
Allocation at level of paediatricians


Participants1st and 2nd year paediatric residents and their patient-parent dyads
Low income population of parents of children aged 0-6 months


InterventionsI = safety counselling by paediatricians + referral to child safety centre + home visit
C = safety counselling by paediatricians + referral to child safety centre


OutcomesOutcomes measured over 12 months:

Safe hot water temperature
Functional smoke alarm
Possession of ipecac

Safe storage of poisons

No toxic plants in the home
Use of stair gate

Safety score comprising the number of observed safety practices within the home - zero safety practices I = 4/45 C = 2/40 OR 1.85 (0.32 to 10.71), 1 safety practice I = 22/46 C = 22/43 OR 0.88 (0.38 to 2.01), 2 safety practices I = 14/46 C = 13/43 OR 1.01 (0.41 to 2.49), ≥3 safety practices I = 6/46 C = 6/43 OR 0.93 (0.27 to 3.12)


NotesBlinding - u
Outcomes 80% - u
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Gielen 2007

MethodsRCT


ParticipantsParents of children aged 4-66 months attending an urban paediatric ED


InterventionsI =  personalised report containing tailored, stage-based messages based on the precaution adoption process model

C = report on other child health topics


OutcomesOutcomes measured at 2-4 weeks:

Possession of smoke alarm

Functional smoke alarm

Safe storage of medicines

Safe storage of cleaning products

Safe storage of poisons


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Girasek 2010

MethodsRCT (C)

Allocated at level of pre-natal class


ParticipantsPregnant pool owners


InterventionsI1 = viewing a video tape describing toddler drowning risks and recommended pool precautions
I2 = viewing a videotape as above but including a mother describing how she lost her son to drowning
C = standard care - no videotape


OutcomesInstallation of isolation pool fencing

I1 + I2 = 10/62 C=2/30 OR 2.69 (0.61 to 11.85)

Had first aid training

I1 + I2 = 33/69 C=9/32 OR 2.33 (1.01 to 5.56)


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Gittelman 2007

MethodsCBA (C)

Allocation at level of communities


ParticipantsChildren aged 0-18 years in an intervention community and in 3 control communities


InterventionsI = Injury Free Coalition for Kids community injury prevention programme including after-school programmes, summer educational classes for children, education at school and community fairs, free home safety kits (contents not specified).

C = no community injury prevention programme


OutcomesOutcomes measured over 5 years:

Medically attended injuries (deaths, hospital admissions and ED attendances)


NotesBlinding - n
Outcomes 80% - y
Balance - n

Intervention communities had higher baseline injury rates than control communities


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Guyer 1989

MethodsCBA (C)
Allocation at level of cities and towns


ParticipantsPopulation of 14 cities and towns in Massachusetts


InterventionsI = Community injury prevention programme including injury counselling by paediatricians to parents of young children, school and community burn prevention education, home safety inspections + community wide promotion of poison centre service
C = no community injury prevention programme


OutcomesOutcomes measured over 22 months:

Rate of medically attended poisonings - poisoning rate I = 36.14/10,000 person years C = 92.71/10,000 person years, OR 0.95 (0.57 to 1.58) (adjusted for socio-economic group)
Rate of medically attended fall injuries - I = 175.02/10,000 person years C = 262.44/10,000 person years OR 0.78 (0.61 to 1.00) (adjusted for socio-economic group)
Medically attended thermal injuries - I = 59.68/10000 person years C = 106.03/10000 person years OR 1.26 (0.84 to 1.90) (adjusted for socio-economic group)

Possession of smoke alarm
Preventive behaviour score comprising behaviours for preventing poisonings (14 items), burns (12 items), falls (6 items) - Mean score:
Burns: I = 49.2, C = 46.8
Falls I = 30.3, C = 30.7
Poisoning I =34.3, C = 30.5. P values not reported


NotesBlinding - u
Outcomes 80% - y
Balance - n
Control communities had higher baseline injury rates, a greater proportion of Hispanic residents and lower household income than intervention communities


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Harvey 2004

MethodsRCT (C)


ParticipantsHouseholds without smoke alarms in areas with a high prevalence of residential fire deaths, a low prevalence of functional smoke alarms, a composition of primarily low-income residents, and/or high proportion of rented housing


InterventionsI1 = smoke alarm installation

I2 = vouchers for free smoke alarm


OutcomesOutcomes measured at 6 to 12 months:

Functional smoke alarm. I1=1421/1583, I2=997/1545; OR 4.82 (3.96 to 5.88)

Analyses not adjusted for clustering


NotesBlinding - n
Outcomes 80% - n
Balance -n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Hendrickson 2002

MethodsRCT


ParticipantsMothers with children aged 1-4 years, predominantly Mexican/Mexican American


InterventionsI = safety counselling from researchers, plus identification of home hazards + safety education + provision of safety equipment (door knob covers, smoke detectors or new batteries if smoke alarm already in situ, fire extinguisher, cabinet latches and outlet covers)
C = none of the above


OutcomesOutcomes measured at 6 weeks:

Functional smoke alarm
Possession of a fire extinguisher
Matches stored out of reach
Hot drinks out of reach
Safe storage of cleaning products
Poison control centre number accessible
Use of window locks
Use of socket covers
Small objects kept out of reach
Floors not in need of repair
I = 31/38, C = 28/40, OR 1.90 (0.66 to 5.50)
Stairs not in need of repair
I = 5/38, C = 1/40, OR 5.91 (0.66 to 53.15)
Hand rail on stairs
I = 5/38, C = 2/40, OR 2.88 (0.52 to 15.84)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)High riskInadequate

Hwang 2006

MethodsCBA


Participants3rd and 4th grade students in 2 elementary schools in an urban, poor community


InterventionsI = visit during school hours from fire department personnel who installed a free 10 year lithium smoke alarm on each level of the residence. Provided a fire escape plan verbally and on a dry erase board placed on the refrigerator.

C = usual care


OutcomesOutcomes measured at 4 weeks:

Has a fire escape plan

Has identified a meeting place outside the home in case of fire. OR 1.9 (1.0 to 3.8)

Possession of smoke alarm. No significant difference between groups.

Lighting of matches or lighters. No significant difference between groups.

Child cooking on stove. No significant difference between groups.

Possession of fire extinguisher. No significant difference between groups.

Figures and p values not reported for the latter four outcomes.


NotesBlinding - n
Outcomes 80% - u
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Jenkins 1996

MethodsRCT


ParticipantsFamilies with children aged 0-17 years admitted to a pediatric burns unit


InterventionsI = education about burn care and prevention using specially designed booklet pre discharge from nurses, physiotherapists or occupational therapists
C = routine discharge teaching without booklet


OutcomesOutcomes measured at first out-patient appointment post-discharge:

Possession of smoke alarm


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Johnston 2000

MethodsRCT (C)
Allocation at level of pre school enrichment programme centres


ParticipantsFamilies of children aged 4-5 years enrolled in Head Start program provided to socio-economically disadvantaged children


InterventionsI = home safety inspections + educational material + provision of ipecac, smoke alarms and batteries provided by educational paraprofessionals
C = home safety inspection + written information only


OutcomesOutcomes measured at 3 months:

Functional smoke alarm
Possession of ipecac
Removed poisons from home I = 61/202 C = 20/135 OR 2.48 (1.42 to 4.36)
Disposed of unused medicine I = 18/202 C = 16/134 OR 0.72 (0.35 to 1.47)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)High riskInadequate

Katcher 1989

MethodsRCT (C)
Allocated at level of half day of clinic visit


ParticipantsConsecutive paediatric clinic clients randomised to two groups


InterventionsI = counselling by paediatrician plus tap water thermometer and tap water safety literature
C = counselling and tap water safety literature


OutcomesOutcomes measured at 1 month:

Safe hot water temperature < 54.4 degrees Celsius
Tested hot water temperature I = 122/263, C = 55/239, OR 2.89 (1.97 to 4.26)


NotesBlinding - u
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Kelly 1987

MethodsRCT


ParticipantsParents of 6 month old children attending primary care centre for well child care


InterventionsI = 3 part safety course at well child care visits
C = routine safety education


OutcomesOutcomes measured at 2 weeks;

Medically attended injuries (ED attendance, physician attendance or admission to hospital)

Safe hot water temperature < 52 degrees Celsius
Possession of smoke alarm
Matches stored out of reach
Safe storage of medicines
Safe storage of cleaning products
Possession of ipecac
Uncovered electrical outlets
Sharp objects stored out of reach
No sharp corners on furniture I = 46/55 C = 42/54 OR 1.46 (0.56 to 3.81)
A hazard score comprising 9 possible hazards observed on home visit - Mean hazard score I = 2.4, C = 3.0, P<0.02


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Kelly 2003

MethodsRCT (C)
Allocation at level of well child care class


ParticipantsParents of children aged 15 months to 6 years attending Women, Infant and Children clinics


InterventionsI = videotape + poison control centre pamphlet + poison control centre stickers
C = usual care


OutcomesOutcomes measured at 2 weeks:

Possession of ipecac
Poison centre number accessible


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Kendrick 1999

MethodsNon-randomised controlled trial (C)
Allocated at level of GP practice. Randomised practices to intervention group and matched control group practices on deprivation score


ParticipantsChildren aged 3 to 12 months registered at 36 GP practices


InterventionsI = health visitor safety advice at child health surveillance, low cost equipment (stair gates, fire guards, cupboard and drawer locks, smoke alarms), home safety checks and first aid training
C = usual care


OutcomesOutcomes measured at 25 months:

Medically attended thermal injuries
Medically attended poisonings
Medically attended injuries (primary care attendance, ED attendance, hospital admission or death)
Stores hot iron out of reach I = 353/364, C = 358/366, OR 0.72 (0.28 to 1.80)

Functional smoke alarm
Fitted fire guard
Safe hot water temperature < 54 degrees Celsius
Hot drinks out of reach
Stores matches out of reach
Safe storage of cleaning products
Use of stair gates
Use of window locks
Use of socket covers
Sharp objects stored out of reach
Never left child alone in bath
Rugs fixed to floor I = 88/187, C = 64/169, OR 1.46 (0.96 to 2.23)
Does not have toys small enough to fit in child's mouth I = 201/358, C = 216/365, OR 0.88 (0.66 to 1.19)
Always checks toys with removable small parts I = 179/363, C = 179/365, OR 1.01 (0.76 to 1.35)


NotesBlinding - n
Outcomes 80% - y(i) n(sp)
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Kendrick 2005

MethodsRCT (C)
Allocation at level of general practices


ParticipantsWomen of at least 28 weeks gestation registered at participating general practices


InterventionsI = midwife and health visitor advice to discourage walker use, information cards, fridge magnets, checklists for use in child health surveillance visit at 3 to 4 months. Encouraging use of stair gates and fire guards amongst walker users
C = usual care


OutcomesOutcomes measured when child 9 months of age:

Fitted fire guard
Use of baby walker
Use of stair gate


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Kendrick 2007

MethodsRCT (C)

Allocation at level of schools


ParticipantsChildren aged 7-10 years in state funded primary schools


InterventionsI = teachers were trained by Fire Service Personnel to deliver teaching on falls; poisoning; and fire and burns. Fire Service personnel provided free teaching resources, including Risk Watch folders and “Risky Boxes” which included background information, lesson plans and activities for pupils

C = usual care


OutcomesOutcomes measured at 4 months:

Possession of smoke alarm

Child never cooks without adult present I=117/163 C=141/184, 0.90 (0.45 to 1.82)

Child never uses matches I=137/165 C=139/186, 1.84 (1.06 to 3.20)

Child never gets medicines without asking adult. I=107/123 C=164/187, 0.69 (0.30 to 1.59)

Child never plays on stairs. I=41/76 C=106/186, 0.80 (0.43 to 1.48)


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Kendrick 2010

MethodsRCT


ParticipantsHouseholds with children < 5 years in social housing in disadvantaged communities


InterventionsI = Thermostatic mixer valve fitted by qualified plumber and educational leaflets prior to and at the time of fitting.

C = usual care


OutcomesOutcomes measured at 3 and 12 months:

Safe water temperature


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

King 2001

MethodsRCT


ParticipantsChildren < 8 years attending A&E for injury or medical complaint


InterventionsI = home safety inspection + information on correcting any deficiencies, discount vouchers for safety equipment, demonstrations of use of safety devices + information on preventing specific injuries provided by researcher
C = home safety inspection & safety pamphlet.


OutcomesOutcomes measured at 12 (safety practices) and 36 (medically attended injuries) months:

Self reported medically attended injuries (injury requiring attention by doctor)

Stores matches or lighters out of reach
Safe hot tap water not exceeding 54 degrees Celsius
Functional smoke alarm
Possession of a fire extinguisher
Safe storage of cleaning products
Use of stair gate
Use of baby walker
Small objects kept out of reach
CRCs on cleaning products in kitchen I = 238/482, C = 233/469, OR 0.98 (0.77 to 1.27)
Safe storage of bathroom cleaning products I = 255/482 C = 261/469 OR 0.90 (0.69 to 1.16)
CRC's on bathroom cleaning products I = 355/482, C = 347/469, OR 0.98 (0.74 to 1.31)
No windows opened easily beyond 6 inches in the living room I = 254/482, C = 238/469, OR 1.08 (0.84 to 1.39)
No windows opened easily beyond 6 inches in the bedroom I = 299/482, C = 285/469, OR 1.05 (0.81 to 1.37)


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Kolko 2001

MethodsNon-randomised controlled trial

Participants only randomised to I1 and I2 arms. C arm families were those scheduled to have a home visit from a fire fighter prior to the study, those living too far from the clinic where CBT and FSE were provided and 2 families who would not agree to randomisation.


ParticipantsBoys referred for services by the City of Pittsburgh bureau of fire


InterventionsI1 = CBT (cognitive behavioural therapy) - designed to encourage behaviours other than fire setting
I2 = FSE (fire safety education) - instruction in fire safety skills, prevention practices, fire protection and evacuation
C = HVF (home visit by firefighter) providing information about the danger of fires, the function of firefighters and asking children to promise not to get involved in unsanctioned fire play


OutcomesOutcomes measured at 13 weeks and 1 year:

Any fire setting incident:
At 13 weeks
I1 = 3/17 I2 = 2/14 C = 4/14
I1 vs C OR 0.54 (0.10 to 2.94)
I2 vs C OR 0.42 (0.06 to 2.77)
At 1 year
I1 = 4/17 I2 = 2/13 C = 7/14
I1 vs C OR 0.31 (0.13 to 1.43)
I2 vs C OR 0.18 (0.03 to 1.14)
Any match play incident
At 13 weeks
I1 = 6/17 I2 = 3/14 C = 4/14
I1 vs C OR 1.36 (0.30 to 6.28)
I2 vs C OR 0.68 (0.12 to 3.83)
At 1 year
I1 = 6/17 I2 = 1/14 C = 8/14
I1 vs C OR 0.41 (0.10 to 1.75)
I2 vs C OR 0.06 (0.01 to 0.57)


NotesBlinding - n
Outcomes 80% - y
Balance - n
I1 arm had higher, and I2 arm had lower frequency of child reported fire setting and match play incidents at baseline than control arm.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Krug 1994

MethodsCBA (C)
Allocated at level of district


ParticipantsPopulations of 2 districts, Gelukspan (intervention) and Lehurutshe (control), Western Transvaal, South Africa


InterventionsI = provision of child resistant kerosene container to households with small children
C = no child resistant kerosene container provided


OutcomesOutcomes measured at 14 months:

Medically attended kerosene poisonings - Mean (SD) incidence of kerosene poisoning after CRC distribution.
I = 4.54 (3.46), C = 9.8 (5.63), P = 0.015


NotesBlinding - u
Outcomes 80% - u
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Lacoutre 1978

MethodsCBA (C)
Allocation at level of towns


ParticipantsSchool children aged 6-14 years in Wilmington (intervention) and Scituate (control), Massachusetts


InterventionsI = community poison prevention education programme, directed at school children
C = no community poison prevention education programme


OutcomesPeriod over which outcomes measured not reported.

Possession of ipecac - reports change in percentage of families having ipecac but does not report baseline prevalence. Significantly more intervention group families had ipecac than control group families, P < 0.05.


NotesBlinding - n
Outcomes 80% - u
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

LeBailly 1990

MethodsNon-randomised controlled trial

Sequential allocation to treatment group


ParticipantsFamilies attending 2 paediatric group practices, 1 in urban area, other in suburban area


InterventionsI1 = well child visit + safety equipment
I2 = well child visit + safety equipment + safety counselling by physician
I3 = well child visit + safety counselling by physician
C = well child visit


OutcomesOutcomes measured at 9 months:

Possession of fire extinguishers
Functional smoke alarm - Intervention groups (counselling and equipment and equipment only) had significantly greater use of fire extinguishers and smoke alarms. No figures or P values reported.
Possession of ipecac - Significantly more intervention group families (counselling and equipment and equipment only) possessed ipecac. No figures or P values reported.
Use of outlet covers - Intervention groups (counselling and equipment and equipment only) had significantly greater use of socket covers. No figures or P values reported.


NotesBlinding - u
Outcomes 80% - n
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Lindqvist 1998a

MethodsCBA (C)
Allocated at level of municipalities.


ParticipantsPopulations of 2 communities, Motala (intervention), Mjolby (control)


InterventionsI = community injury prevention programme including multi-agency collaboration, mass media campaigns, nurses provided age specific safety information in compulsory annual health visits. Video on hazards distributed to all families with children < 6 years, safety products and environmental modifications displayed at public places
C = no community injury prevention programme


OutcomesOutcomes measured over 5-6 years:

Medically attended injuries (health centre attendance, ED attendance, hospital admission and deaths) for home injuries.
Medically attended poisonings - I = 29/8566 pre intervention and 17/8315 post intervention. Not reported for control area.
RR post intervention to pre intervention, in intervention area: 0.60 (0.33 to 1.10)


NotesBlinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Llewellyn 2003

MethodsRCT


ParticipantsParents with intellectual disability who were the primary carers of children < 5 years


InterventionsI1= weekly home visits covering a different topic each week e.g. fire, electrical safety.
I2= lesson books received by mail covering the same topics as I1 but without face to face contact
C1 = current community services
C2 = current community services


OutcomesOutcomes measured over 3 months:

Mean (SD) hazard score comprising precautions taken to deal with 114 possible dangers in and around the home

1st post programme assessment:
I1 = 60.35 (21.94) versus I2 = 48.73 (10.77) versus C1 = 53.3 (12.88), P < 0.001
2nd post programme assessment:
I2 = 88.09 (34.92) versus C1 = 57.5 (11.48), P < 0.001


NotesBlinding - y
Outcomes 80% - n
Balance - n/a
C2 initially randomly allocated but reallocated to C1 to ensure completed program in study period


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Mackay 2002

MethodsRCT (C)
Allocation at level of schools


ParticipantsElementary school children attending 12 schools


InterventionsI = Risk Watch safety curriculum delivered by teachers for one year
C = usual curriculum


OutcomesOutcomes measured over 12 months:

Parental reported medically attended injuries and near misses - No significant difference in medically attended injuries or near misses. No figures or P values reported


NotesBlinding - u
Outcomes 80% - u
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Mallonee 1996

MethodsCBA (C)
Allocation at level of geographical areas of a city


ParticipantsPopulation of a 24 square mile area of Oklahoma City (intervention) and population of the rest of Oklahoma (control)


InterventionsI = distribution of smoke alarms door to door by volunteers and community agencies to homes without a smoke alarm
C = no smoke alarm distribution


OutcomesOutcomes measured over 4 years:

Fire-related injury rates - Injury rate decreased 81% in the intervention area but only 7% in the control area. Only 2 children under 5 years of age were injured in the intervention area in the 6 years post intervention (denominator not reported). Numerator and denominator for child injury rate not reported for control area.


NotesBlinding - n
Outcomes 80% - y
Balance - n
Area with highest fire injury rate chosen for intervention and rest of city chosen as control area. Lower household income in intervention area, lower property values and more fires started by children in the intervention area


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Matthews 1988

MethodsNon-randomised controlled trial

18 mothers allocated using random numbers, 8 by alternation


Participants26 mothers of toddlers recruited from clinics, day care centres


InterventionsI = home safety inspection, video, handouts, modelling re: safety and managing dangerous child behaviour, hot water thermometers, choke tube
C = home visit with video, handouts, modelling on language simulation


OutcomesOutcomes measured over 2 weeks:

Possession of smoke alarm
Functional smoke alarm


NotesBlinding - u
Outcomes 80% - y
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Mayer 1998

MethodsRCT


ParticipantsParents of children attending an orthopaedic outpatient clinic, with at least one child aged 0-9 years


InterventionsI = 20 minute video about lawnmower injuries and safety shown in orthopaedic clinic & educational leaflet
C = no video


OutcomesOutcomes measured over 7 weeks:

Not leaving mower running I = 22/30, C = 17/35, OR 2.91 (1.02 to 8.29)
Making children stay indoors I = 19/30, C = 12/32, OR 2.88 (1.03 to 8.07)
Tell children to leave yard I = 25/29, C = 25/33, OR 2.00 (0.53 to 7.50)
Never leave child in yard I = 19/29, C = 15/34, OR 2.41 (0.87 to 6.69)
Removal of debris prior to mowing I = 29/30, C = 29/34, OR 5.00 (0.55 to 45.48)


NotesBlinding - n
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

McDonald 2005

MethodsRCT


ParticipantsParents of children aged 6 weeks to 24 months, attending well child clinic


InterventionsI = tailored safety advice in well child clinic + feedback report to paediatrician to encourage safety counselling + information on safety equipment savings at child safety centre
C = usual care


OutcomesOutcomes measured over 1 month:

Possession of smoke alarm
Possession of ipecac
Use of stair gate
Safe storage of medicines
Safe storage of cleaning products
Has changed smoke alarm batteries in last 6 months


NotesBlinding - u
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

McLoughlin 1982

MethodsCBA (C)
Allocation at level of communities.


ParticipantsPopulations of Lynn, Quincy and Salem and Saugus (Intervention) and Holyoke and South Hadley (control), Massachusetts.


InterventionsI = mass media campaign and school and community intervention programs
C = media campaign only


OutcomesOutcomes measured over 8 months:
Medically attended thermal injuries - no significant difference in thermal injury rates pre intervention to post intervention in children in the intervention community. No p values reported


NotesBlinding - u
Outcomes 80% - u
Balance - u

Injury outcomes ascertained from injury surveillance system, but hospitals involved did not cover all residents and did not include private practices


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Miller 1982

MethodsNon-randomised controlled trial (C)
Allocated at level of 2 week periods of clinic attendance and sequential allocation by date of attendance


ParticipantsChildren attending for routine paediatrician healthcare


InterventionsI = pamphlet and a one minute educational message by paediatrician, plus low cost smoke detector
C = usual care


OutcomesOutcomes measured at 6 weeks

Functional smoke alarm


NotesBlinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Mock 2003

MethodsCBA (C)
Allocated at level of clinics.


ParticipantsUpper socioeconomic stratum (SES) - two private clinics
Middle stratum - two clinics charging low fees
Lower stratum - subsidised clinics


InterventionsI1 (upper) - lectures and demonstrations lasting 6 hours. Use of audio visual material including The Injury Prevention Program (TIPP)
I2 (middle) - as above but some participants also received clinic-based counselling
I3 (lower) - half hour household visits by nurses and some audio visual materials also used
C = standard injury prevention counselling


OutcomesOutcomes measured at 6 months:

Functional smoke alarm
Tested hot water temperature I1 = 0/25, C1 = 2/29, I2 = 0/18, C2 = 0/36, I3 = 1/27, C3 = 0/15; ORs not calculable
Score of preventive behaviours - Mean (SD) percent safe response scores:
Upper SES I = 64.7 (12.9) pre, 72.8 (9.9) post, P < 0.001; C = 66.3 (12.8) pre, 63.9 (13.4) post, P = 0.12
Middle SES I = 60.2 (13.7) pre, 68.0 (11.5) post, P < 0.001; C = 54.3 (14.8) pre, 56.0 (15.5) post, P = 0.28
Lower SES I = 54.2 (14.9) pre, 61.8 (13.3) post, P < 0.001; C = 55.6 (16.2) pre, 59.7 (19.7) post, P = 0.09.


NotesI1, I2 and I3 arms combined for meta-analyses

Blinding - n
Outcomes 80% - n
Balance - n
Intervention arm had higher percentage of safe responses at baseline than control arm


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Moller 1996

MethodsCBA (C)
Allocation at level of communities.


ParticipantsPopulations of 5 municipalities (number of intervention and control municipalities not specified)


InterventionsI = community injury prevention programme including multi-agency collaboration and utilizing injury data to target injury interventions
C = no community injury prevention programme


OutcomesOutcomes measured at 2 years:
Medically attended injuries (not defined) - Significantly lower risk of home and play accidents amongst children aged 0-5 years in intervention group than control group. No figures or P values reported.


NotesBlinding - u
Outcomes 80% - y
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Mueller 2008

MethodsRCT


ParticipantsHouseholds with low to mid-level income


InterventionsI1= Ionization smoke alarm installed + instructions given in maintenance + fire extinguisher provided

I2 = Photoelectric smoke alarm installed + instructions given in maintenance + fire extinguisher provided


OutcomesOutcomes measured at 9 and 15 months:

At 9 months:

Functional smoke alarm. I1=264/332, I2=322/340; OR 0.22 (0.12 to 0.38)

At 15 months:

Functional smoke alarm. I1=239/311, I2=287/314; OR 0.31 (0.19 to 0.51)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Nansel 2002

MethodsRCT


ParticipantsParents of children aged 6-20 months attending well child check


InterventionsI = computer generated tailored safety advice in well child clinic
C = computer generated generic safety advice in well child clinic


OutcomesOutcomes measured at 3 weeks:

Safe hot water temperature <= 48.9 degrees Celsius
Possession of smoke alarm
Hot drinks/food out of reach
Safe storage of medicines
Safe storage of cleaning products
Possession of ipecac
Poison centre number accessible
Use of stair gate
Use of baby walker
Never left child alone in bath
Smoke alarm batteries checked or changed

Use of socket covers

Never left child alone in area of paddling pool I = 10/11, C = 15/16, OR 0.67 (0.04 to 11.94)
Never left paddling pool full of water after use I = 11/11, C = 14/16, OR Not calculable
Swimming pool has fence with locked gate I = 1/1, C = 2/2, OR Not calculable
Never left child alone in pool area I = 1/1, C = 2/2, OR Not calculable
Risk scores comprising injury risk behaviours for burns/fire, falls, poisoning, drowning - Decrease in mean (SD) risk score I = 4.68 (6.44), C = 1.54 (5.58), P = 0.003


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Nansel 2008

MethodsNon-RCT

Participants randomly allocated to I1 and C arms and remainder allocated to I2


ParticipantsParents of children aged <= 4 years attending well child visits at 3 paediatric clinics with mainly low to middle income patients


InterventionsI1 = tailored injury prevention education

I2 = tailored injury prevention education and provider tailored information

C = general education


OutcomesOutcomes measured at 1 month:

Possession of smoke alarm

Safe hot water temperature

Hot drinks/food out of reach

Safe storage of medicines

Safe storage of cleaning products

Poison centre number accessible

Use of stair gates

Use of baby walker

Never leaves child alone on high surface

Never left child alone in bath

Turns pan handles away from edge of stove I1=7/7, I2=11/12, C=12/14, OR combining both I arms: 3.00 (0.14 to 186.62)

Almost always keeps child away from stove or oven I1=4/7, I2=10/12, C=11/13, OR combining both I arms: 0.51 (0.04 to 3.98)


NotesI1 and I2 arms combined for meta-analyses

Blinding - n
Outcomes 80% - n
Balance - n

Participants in I2 arm were older, more likely to be Caucasian and had lower educational level than those in C arm.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Odendaal 2008

MethodsRCT


ParticipantsHouseholds with children <10 years old living in low-income communities


InterventionsI = 4 home visits including safety education, home inspection and distribution of free safety devices with a demonstration of use (first aid kit, roll of insulation tape, safety nails, 2L plastic paraffin container and a bag and hook for safe storage.

C = usual care


OutcomesOutcomes measured at 1 week:

Hazard scores for thermal injuries, poisoning and falls

88 item home safety checklist. Mean (SE) score, Mean difference:

Total safety score. I=20.3 (0.89) C=23.9 (0.92), 3.6 (1.12 to 6.16)

Electrical burns score. I=3.0 (2.70) C=3.9 (0.29), 0.9 (0.15 to 1.70)

Paraffin burns score. I=2.6 (0.24) C=3.3 (0.23), 0.7 (0.04 to 1.37)

Burns safety practices score. I=6.8 (0.19) C=7.1 (0.21), 0.3 (-0.31 to 0.80)

Poisoning score. I=2.9 (0.23) C=4.0 (0.25), 1.1 (0.44 to 1.77)

Falls score. I=5.0 (0.29) C=5.6 (0.30), 0.6 (-0.16 to 1.47)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Ohn 2005

MethodsCBA (C)
Allocation at level of "Sure-Start" areas


ParticipantsChildren aged 0-4 years in 2 Sure Start areas, Foxhill & Parsons Cross (intervention) and Firth Park (control)


InterventionsI = free installation of home safety equipment (smoke alarms, fire guards and stair gates)
C = no free installation of home safety equipment


OutcomesOutcomes measured over 3 years:

Medically attended injuries (ED attendances and hospital admissions) - No significant difference in the odds of an injury attendance being from the intervention area as opposed to the control area. No P value reported, OR 0.91 (0.82 to 1.02)


NotesBlinding - n
Outcomes 80% - y
Balance - n
Control arm more deprived


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Olds 1994

MethodsRCT


ParticipantsPrimiparous women registering before the 26th week of pregnancy from upstate New York, <19 years of age, single parents, or low socio-economic status


InterventionsI1 = families were provided with a home nurse visitor during pregnancy in addition to screening and transportation services
I2 = as I1 but the nurse continued to visit until the child was 2 years of age
C1 = screening for sensory and developmental problems
C2 = free transportation for regular prenatal and well child care clinics


OutcomesOutcomes measured at 34 and 46 months:

Safe storage of poisonous substances - no significant difference. No figures or P values reported
Hazard score comprising exposure to hazards in the home

At 34 months:

log incidence of hazardous exposures I2 = -1.75, C1 + C2 = -1.04, P = 0.04

At 46 months:
log incidence of hazardous exposures I2 = -1.94, C1 + C2 = -0.83, P = 0.003


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Ozanne-Smith 2002

MethodsCBA (C)
Allocated at level of communities


ParticipantsPopulation of 2 communities, Shire of Bulla (intervention) and Shire of Melton (control)


InterventionsI = community injury prevention programme including multi-agency collaboration, promotion of child safety equipment, safety education for parents from healthcare staff, child safety courses, distribution of home safety package, exhibitions, use of mass media
C = no community injury prevention programme


OutcomesOutcomes measured over 4-5 years:
Medically attended injuries (ED attendance, hospital admission or death) - No significant difference between the control and intervention community. Figures and P values not reported.


NotesBlinding - u
Outcomes 80% - y
Balance - n
Control community had higher injury rates at baseline


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Paul 1994

MethodsRCT


ParticipantsFamilies with children aged 10 months to 2 years born at local rural hospital


InterventionsI = home safety check + tailored education booklet + local safety equipment retail outlets identified, mail order addresses provided or equipment ordered through research team and made available at local hospital
C = none of the above


OutcomesOutcomes measured between 5 and 9 months:

Possession of a cooker guard
Thermostatic mixer valves in kitchen/bathroom/laundry
Spring loaded safety taps in kitchen/bathroom/laundry
Fitted fireguard
No significant difference in any thermal injury outcomes. No figures or P values reported
Lockable cabinet for storage of poisons in kitchen/bathroom/laundry - Intervention group more likely to have lockable cabinets post intervention than pre intervention, P < 0.05
Possession of ipecac - Intervention group more likely to have ipecac than control group, P < 0.01. Figures not reported.
Roof areas child can gain access to
Outside steps with no railings and non-climbable barrier
Balcony without adequate non-climbable barrier
High windows which open more than 10 cm
Climbable fencing
Interior steps without railings
Non-climbable barriers
High chair without harness
Intervention group less likely to have accessible roof areas post intervention than pre intervention (P < 0.05). No significant difference in other falls injury outcomes. Figures and P values not reported.
Use of earth leakage circuit breakers
Safety shuttered power points - no significant difference in any electrical injury outcomes. Figures and P values not reported.
Protected sharp edges - Intervention group less likely to have bench tops with sharp edges, P < 0.001. Figures and P values not reported.
No toys with small parts - No significant difference between intervention and control groups. Figures and P values not reported
Adequate pool fencing - no significant difference in any drowning injury outcomes. Figures and P values not reported
Use of safety glass in glass doors - no significant difference. Figures and P value not reported
Hazard score calculated based on a 24 item home hazard checklist - Mean (SD) hazard score: I = 9.39 (2.30), C = 9.91 (2.76), P = NS


NotesBlinding - u
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Petridou 1997

MethodsCBA (C)
Allocation at level of islands


ParticipantsPopulation of two Greek islands, Naxos (intervention) and Spetses (Control)


InterventionsI = community intervention including safety seminars for parents, workshops with teachers promoting school safety, courses with primary and secondary school children on safety and resuscitation, leaflets; plus focused intense intervention: lay home visitors, weekly visits to discuss home safety in households with children ( <=18 years) or older people ( >=65 years)
C = none of the above


OutcomesOutcomes measured over 20 months:

Possession of a fire extinguisher
Poison centre number accessible
Possession of ipecac
Slip resistant bathroom mat
Has a fire escape plan
Safe balconies I = 24/128, C = 36/131, OR 0.61 (0.34 to 1.10)
Safe indoor stairs I = 104/128, C = 110/131, OR 0.83 (0.43 to 1.58)
Safe outdoor stairs I = 32/128, C = 17/131, OR 2.24 (1.17 to 4.27)
Has circuit breaker - Significant increase in the use of circuit breakers in intervention group from baseline. No difference in circuit breakers between intervention and control group I = 115/128, C = 120/131, OR 0.81 (0.35 to 1.88).
Score comprising 28 home safety practices - Mean (SD) score I = 15.18 (2.62), C = 15.24 (2.17)


NotesBlinding - n

Outcomes 80% - y

Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Phelan 2010

MethodsRCT


ParticipantsPregnant women, aged 18 years and over, < 19 weeks gestation, attending pre-natal practices in Cincinnati, USA.


InterventionsI = home safety inspection, provision and fitting of free safety equipment when child is aged 3-6 months (stair gates, non-slip matting under rugs, window guards, repair of stair handrails, cupboard/drawer locks, door knob covers, storage bins, socket covers, smoke detectors, CO detectors, stove guards, stove locks) and safety advice handout.

C = prior to child's birth family given targeted home repairs to control lead hazards (e.g. paint stabilization, water filters)


OutcomesOutcomes measured at 12 and 24 months:

Medically attended injuries (phone consultations, clinic or ED attendances)

Modifiable medically attended injuries (phone consultations, clinic or ED attendances)

Functional smoke alarm

Safe storage of poisons

Poison centre number accessible

Use of baby walker

Use of window locks

Use of stair gate

Non-slip bath mat

Use of socket covers

Sharp objects out of reach

Small objects kept out of reach

Possession of CO detector:

At 12 months:

I=118/139 C=64/138, OR 1.83 (1.22 to 2.74)

At 24 months:

I=89/120 C=56/119, OR 1.58 (1.01 to 2.45)

Number and density of injury hazards. Not reported. Injury hazards were significantly reduced in intervention group but not in control group at 1 and 2 years (p<0.004).


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Pless 2007

MethodsRCT


ParticipantsParents attending 5 private paediatric practices


InterventionsI = product related posters pertaining to the dangers of venetian blinds and one to the risk of strangulation from clothing drawstrings

C = no product related posters


OutcomesOutcomes measured at 2 weeks:

Taken recommended safety measures for clothing drawstrings. I=48/439 C=47/369, OR 0.84 (0.54 to 1.32)

Taken recommended safety measures for blind cords. I=276/439 C=238/369, OR 0.93 (0.69 to 1.26)

Not adjusted for clustering


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Ponce De Leon 2007

MethodsCBA (C)


ParticipantsChildren aged 0-14 years living in 5 WHO Safe Communities (Lidkoping, Skovde, Tidaholm, Mariestad and Falkoping) and the remaining 10 municipalities in the same district (C1) and the rest of Sweden (C2)


InterventionsI = WHO Safe Communities injury prevention programme including multi-agency collaboration, safety education for parents from healthcare staff, training parents in child safety and first aid, exhibitions, posters, use of mass media

C1 =  no community injury prevention programme

C2 = no community injury prevention programme


OutcomesOutcomes measured over 16 years

Medically attended injuries (hospital admissions)

Significant reduction in hospital admission rate in one of the 5 intervention areas (Lidkoping). Significant increase in hospital admission rate in one of the 5 intervention areas (Skovde). No significant difference in other 3 intervention areas.

Lidkoping: place*time interaction regression coefficient -0.562 (SE 0.097) p<0.01.

Skovde: place*time interaction regression coefficient -0.249 (SE 0.067) p<0.01.


NotesBlinding - u
Outcomes 80% - y
Balance - n

Some intervention communities had higher injury rates at baseline than the rest of Sweden (C2).


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Posner 2004

MethodsRCT


ParticipantsCaregivers of children < 5 years attending ED for home injury


InterventionsI = home safety counselling by trained lay personnel, home safety kit (cupboard and drawer locks, socket covers, bath tub spout covers, non-slip bath decals, bath water thermometer, poison control centre number stickers, free small parts tester) + home safety literature
C = home safety literature


OutcomesOutcomes measured over 10 weeks:

Possession of smoke alarm
Hot drinks/food out of reach
Safe storage of medicines
Safe storage of cleaning products
Poison centre number accessible

Plants not accessible
Use of stair gate
Use of baby walker

Non-slip bath decals

Never leaves child alone on high surface

Use of socket covers
Sharp objects stored out of reach
Never left child alone in bath

Time since last tested battery < 6 months

Has a fire escape plan

Use of water thermometer I = 43/49, C = 13/47, OR 18.74 (6.45 to 54.47)
Has spout covers for bath taps I = 39/49, C = 18/47, OR 6.28 (2.53 to 15.61)
Always uses fire guard for electric or kerosene space heater while sleeping I = 4/8, C = 2/3, OR 0.50 (0.03 to 7.99)
Cooks on back burners of cooker I = 25/49, C = 16/47, OR 2.02 (0.89 to 4.60)
Turns pan handles towards back of cooker I = 29/49, C = 23/47, OR 1.59 (0.71 to 3.59)
Often heats kitchen by leaving oven door open I = 0/49, C = 0/47, OR Not calculable
Never leaving burning candles in empty room I = 11/15, C = 17/23, OR 0.97 (0.22 to 4.24)
No overloaded electrical sockets (>=3 items plugged into a socket) I = 23/48, C = 15/47, OR 1.96 (0.85 to 4.52)
Never smoking in bed and method of disposing of ashes I = 6/9, C = 10/11, OR 0.20 (0.02 to 2.39)
Never stores chemicals in drinks bottle I = 49/49, C = 46/47 OR not calculable
Child exposed to lead paint I = 8/49, C = 2/47, OR 4.39 (0.88 to 21.88)
Possession of CO detector I = 14/49, C = 11/47, OR 1.31 (0.52 to 3.27)
Tested CO detector within 6 months I = 6/11, C = 9/11, OR 0.27 (0.04 to 1.85)
Never places a carrier on a high surface I = 6/49 C = 6/47, OR 0.95 (0.28 to 3.20)
Does not let child eat:
Hot dogs I = 15/49, C = 14/47, OR 1.04 (0.43 to 2.49)
Candy I = 25/49, C = 25/47, OR 0.92 (0.41 to 2.04)
Carrots I = 31/49, C = 24/47, OR 1.65 (0.73 to 3.73)
Nuts I = 38/49, C = 28/47, OR 2.34 (0.96 to 5.70)
Grapes I = 11/49, C = 10/47, OR 1.07 (0.41 to 2.82)
Uses small parts tester I = 27/49, C = 5/47, OR 10.31 (3.48 to 30.50)
Eight category safety scores were calculated from responses to questions about safety practices.
Fires (14 items) I = 81.7, C = 80.6, P < 0.61
Burns (12 items) I = 76, C = 68.4, P < 0.03
Poisoning (6 items) I = 74.4, C = 64.9, P < 0.02
Submersion (4 items) I = 95.9, C = 92.9, P < 0.33
Aspiration (6 items) I = 59.7, C = 52.7, P < 0.12
Cuts (6 items) I = 81.0, C = 66.4, P < 0.001
Falls (7 items) I = 58.9, C = 57.4, P < 0.79
Safety device use (9 items) I = 65.4, C = 44.3, P < 0.001


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Rey 1993

MethodsCBA (C)
Allocation at level of towns


ParticipantsPopulation of two towns, Chambery (intervention) and Annecy (control)


InterventionsI = community injury prevention programme including safety education for children in schools, exhibitions, apartment demonstrating home hazards, school children presenting accident projects to members of the public, film show about safety and use of mass media
C = no community injury prevention programme


OutcomesOutcomes measured at 6 months:
Medically attended injuries (physician attendance, clinic attendance, hospital attendance or admission). Significant reduction in domestic accidents requiring a medical consultation in intervention compared to control group, P < 0.02. No figures reported. Significant increase in accidents requiring urgent medical attention for children aged 6-10 years in intervention group comparing post to pre injury rates. No figures reported. No significant difference in hospitalisation rates between intervention and control groups. No figures or P value reported.


NotesBlinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Rowland 2002

MethodsRCT


Participants2145 households from a local authority housing estate


InterventionsI1 = ionisation sensor with a zinc battery
I2 = ionisation sensor with a zinc battery and pause button
I3 = ionisation sensor with a lithium battery and pause button
I4 = optical sensor with a lithium battery
I5 = optical sensor with a zinc battery


OutcomesOutcomes measured at 15 months:

Functional smoke alarm - I1 = 86/141, I2 = 56/116, I3 = 44/63, I4 = 24/79, I5 = 40/57


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Sangvai 2007

MethodsRCT


ParticipantsParents of children aged 0-5 years enrolled at 3 paediatric practices


InterventionsI = safety counselling from physician and researcher, free safety equipment (smoke detectors, gun locks, cabinet locks, and water temperature cards) and brief educational handout for parents.

C = usual care


OutcomesOutcomes measured at 6 months:

Functional smoke alarm

Safe hot water temperature

Safe storage of poisons


NotesBlinding - y
Outcomes 80% - y for injury outcomes, n for safety practices
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Schelp 1987

MethodsCBA (C)
Allocated at level of municipality


ParticipantsPopulation of two municipal districts, Falkoping (intervention) and Lidkoping (control)


InterventionsI = community injury prevention programme including multi-agency collaboration, use of mass media, exhibitions at child health centres, demonstrations of safety equipment, use of checklists in child health surveillance visits, increased local availability of child safety equipment, parent education
C = no community injury prevention programme


OutcomesOutcomes measured at 12 months:
Medically attended injuries (clinic attendance, hospital attendance) occurring at home - incidence I = 48.6/1000 pre, 32.2/1000 post intervention, P < 0.001. Figures not presented for control area


NotesBlinding - u
Outcomes 80% - y
Balance - n
Control municipality had higher injury rates at baseline


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Scherz 1968

MethodsCBA (C)
Allocation at level of geographic area covering Army Post Exchanges


ParticipantsFamilies of army personnel


InterventionsI = free child resistant container attached to boxes of children's aspirin, sold at Post Exchanges
C = children's aspirin sold at other sites without CRC attached


OutcomesOutcomes measured over 6 months:

Medically attended aspirin poisoning - proportion of all poisonings due to aspirin in intervention area pre = 27/38, post = 5/22. No P value reported.


NotesBlinding - u
Outcomes 80% - u
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Schlesinger 1966

MethodsCBA (C)
Allocated at level of housing developments with 10 or more homes


ParticipantsPopulation of children aged < 7 years, in housing developments


InterventionsI = community injury prevention programme including neighbourhood discussion groups, monthly newsletter to families, speakers at group and club meetings, distribution of safety literature
C = no community injury prevention


OutcomesOutcomes measured over 24 months:
Medically attended injuries (physician attendance, dentist attendance, hospital attendance) - No significant difference in the rate of accidents in the intervention and control groups. No figures or P values reported.


NotesBlinding - u
Outcomes 80% - y
Balance - n
Intervention areas had higher injury rates at baseline than control areas


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Schwarz 1993

MethodsCBA (C)
Allocation at census tract level


ParticipantsPopulation of 9 census tracts, predominantly low income, urban, African-American


InterventionsI = home inspection and modification + education in homes and at block and community meetings. Provision of ipecac, smoke alarms and batteries, bath water thermometers, night lights, emergency centre number sticker and fridge sticker with information on preventing injury
C = none of above


OutcomesOutcomes measured over 12 months:

Fire-related injuries/1000 - I - Before: 1.83, During: 1.14, After: 0.86. Incidence change (after vs before): 0.5 (0.4 to 0.6)
C - Before: 1.34, During: 2.68, After: 1.11. Incidence change (after vs before): 0.8 (0.6 to 1.1)

Functional smoke alarms - I = 866/902, C = 816/1060, OR 7.19 (4.98 to 10.64)

Possession of ipecac
Safe storage of medicines
Medicines not in CRCs - I = 66/250, C = 41/250, OR 1.83 (1.81 to 2.83)

analyses not adjusted for clustering


NotesBlinding - n
Outcomes 80% - n
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Schwebel 2009

MethodsRCT


ParticipantsFemale heads of households in 2 low income housing districts


InterventionsI=kerosene safety intervention using a “train the trainers” model where trainers train local paraprofessionals to deliver education to communities, plus educational materials for paraprofessionals to distribute in communities on safe use of kerosene and kerosene powered appliances and treatment of kerosene related injuries.

C=usual care


OutcomesOutcomes measured at 4 weeks:

Paraffin appliances on flat surfaces. I=92/95 C=102/108; OR 1.80 (0.44 to 7.42)

Paraffin appliances on steady surfaces. I=89/96 C=99/107; OR 1.03 (0.36 to 2.95)

Paraffin appliances on surfaces without tablecloths. I=24/95 C=31/108; OR 0.84 (0.45 to 1.57)

Paraffin appliances out of reach. I=28/96 C=33/108; OR 0.94 (0.51 to 1.71)

Flammable materials at least 1 metre away from all paraffin appliances. I=2/96 C=7/108; OR 0.31 (0.06 to 1.52)

Dry sand available to extinguish flames. I=0/98 C=0/109; OR not calculable.

Paraffin stored out of reach. I=16/92 C=32/109; OR 0.51 (0.26 to 1.00)

Paraffin stored away from food. I=85/92 C=89/109; OR 2.73 (1.10 to 6.78)

Paraffin stored in vessel marked “paraffin”. I=2/92 C=2/109; OR 1.19 (0.16 to 8.61)

Paraffin stored in beverage container. I=68/92 C=103/109; OR 0.17 (0.06 to 0.42)

Paraffin stored in vessel with CRC. I=0/92 C=3/109; OR not calculable

Paraffin stored in covered container. I=55/92 C=95/109; OR 1.80 (0.44 to 7.42)

Mean kerosene safety practices score (SD) score

Baseline I=0.38 (0.09) C=0.41 (0.10)

Follow-up I=0.49 (0.17) C=0.46 (0.13)

Mean change from baseline

I=0.10 (0.18) C=0.05 (0.16) p<0.05

Analyses not adjusted for clustering


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Shani 2003

MethodsRCT (C)
Allocation at level of school classes


ParticipantsBedouin schoolchildren aged 12-13 years


InterventionsI1= school safety slide show on burn prevention
I2= school safety video show on burn prevention
I3= school safety slide and video show on burn prevention


OutcomesOutcomes measured over 2 months:

Burn related safety behaviour mean (SD) scores: I1 = 3.56 (0.56), I2 = 3.58 (0.51), I3 = 3.45 (0.76) P > 0.05


NotesBlinding - n
Outcomes 80% - u
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Shapiro 1987

MethodsRCT


ParticipantsWomen admitted to the maternity ward of 3 hospitals


InterventionsI = pamphlet about tap water scalds and thermometer for testing, plus a one minute educational message summarising pamphlet
C = pamphlet and thermometer


OutcomesOutcomes measured between 2 and 9 months:

Tested hot water temperature I = 155/302 C = 88/302, OR 2.56 (1.83 to 3.59)
Lowered hot water temperature Figures and P value not reported


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Steele 1985a

MethodsCBA (C)
Allocated at level of cities


ParticipantsPopulations of Escondido (intervention) and Chula Vista (control), California


InterventionsI = community poison prevention programme including mass media, training of healthcare personnel to provide poison prevention education to clients, safety fairs

C = no community poison prevention programme


OutcomesOutcomes measured over 12 months:

Medically attended poisonings - no significant difference in post versus pre injury rates in intervention or control communities.
Poison centre utilisation
Possession of ipecac - no significant difference in poison centre utilisation or in possession of ipecac. No figures or P value reported.


NotesBlinding - u
Outcomes 80% - u
Balance - u
Unclear how intervention city chosen


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Steele 1985b

MethodsRCT


ParticipantsParents of children aged 6 months to 4 years attending well baby clinics, aged >= 18 years, English speaking with a telephone available


InterventionsI1 = one-to-one poisoning education, with reinforcement by physician
I2 = I1 + burns education
I3 = one-to-one burns education, with reinforcement by physician
C = no education


OutcomesOutcomes measured at 3, 6 and 12 months:

Self reported poisoning - no significant differences for poison injury rates
Poisoning prevention behaviours
Poison centre utilisation - Intervention groups exhibited significantly more hazard reducing behaviour. No figures or P values reported


NotesBlinding - u
Outcomes 80% - u
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Svanstrom 1995

MethodsCBA (C)
Allocated at level of municipalities


ParticipantsPopulation of 5 municipalities; Lidkoping (intervention), 4 bordering municipalities (control)


InterventionsI = community injury prevention programme including multi-agency collaboration, safety education for parents from healthcare staff, training parents in child safety and first aid, exhibitions, posters, use of mass media
C = no community injury prevention


OutcomesOutcomes measured over 7 years:
Medically attended injuries (hospital admissions)


NotesBlinding - u
Outcomes 80% - y
Balance - n
Intervention municipality had higher injury rates at baseline than control municipalities.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Swart 2008

MethodsRCT (C)

Allocation at level of blocks of households


ParticipantsHouseholds with children <= 10 years old living in low-income communities


InterventionsI = 4 home visits focusing on child development and the prevention of burns, poisoning and falls and providing safety education + free safety devices (child proof locks and paraffin container safety caps).

C = usual care


OutcomesOutcomes measured at 2 weeks:

Paraffin stove used as heater. I = 28/189 C = 21/188; OR 1.65 (0.46 to 5.84)

Paraffin stove filled whilst warm. I = 19/189 C = 18/188; OR 1.13 (0.44 to 2.89)

Paraffin heater < 30cm from flammable material. I = 8/189 C = 4/188; OR 2.02 (0.60 to 6.83)

Paraffin heater on unstable surface. I = 0/189 C = 2/188; OR not calculable

Paraffin cooker < 30cm from flammable material. I = 39/189 C = 22/188; OR 2.39 (0.53 to 10.82)

Paraffin cooker on unstable surface. I = 7/189 C = 5/188; OR 1.40 (0.44 to 4.49)

Paraffin lamp < 30cm from flammable material. I = 12/189 C = 17/188; OR 0.60 (0.13 to 2.82)

Paraffin lamp on unstable surface. I = 31/189 C = 45/188; OR 0.53 (0.19 to 1.45)

Paraffin appliances on when family sleeping. I = 79/189 C = 69/188; OR 2.03 (0.57 to 7.26)

Candles placed on unstable surface. I = 18/189 C = 12/188; OR 1.68 (0.38 to 7.51)

Candles used < 30cm from flammable material. I = 27/189 C = 45/188; OR 0.53 (0.08 to 3.50)

Tablecloth under candle, paraffin heater, stove or lamp. I = 34/189 C = 49/188, OR 0.75 (0.17 to 3.20)

Beauty products properly labelled in tightly closed non-glass containers. I = 185/189 C = 185/188; OR 0.75 (0.17 to 3.42)

Safe storage of beauty products. I = 172/189 C = 157/188; OR 2.13 (1.00 to 4.53)

Medicines properly labelled in tightly closed non-glass containers. I = 186/189 C = 187/188; OR 0.33 (0.03 to 3.23)

Safe storage of medicines.

Paraffin properly labelled in tightly closed non-glass containers. I = 173/189 C = 146/188; OR 5.02 (1.26 to 19.98)

Safe storage of paraffin. I = 123/189 C = 114/188; OR 1.47 (0.51 to 4.25)

Paraffin stored in CRC. I = 162/189 C = 128/188; OR 3.39 (1.28 to 9.02)

Cleaning products properly labelled in tightly closed non-glass containers. I = 184/189 C = 176/188; OR 6.04 (0.44 to 83.02)

Safe storage of cleaning products.

Cleaners stored on same shelf as food. I = 5/189 C = 5/188; OR 0.84 (0.17 to 4.14)

Alcohol properly labelled in tightly closed non-glass containers. I = 186/189 C = 185/188; OR 1.01 (0.20 to 5.07)

Safe storage of alcohol. I = 183/189 C = 178/188; OR 1.76 (0.48 to 6.50)

Rat poison properly labelled in tightly closed non-glass containers. I = 187/189 C = 186/188; OR 1.01 (0.14 to 7.25)

Safe storage of rat poison. I = 189/189 C = 185/188; OR not calculable.

90 item home safety checklist: Mean (SE) score, Mean difference:

Total safety score. I = 13.9 (0.53) C = 14.2 (0.54), -0.31 (-1.8 to 1.2)

Electrical burns score. I = 1.1 (0.14) C = 1.3 (0.14), -0.19 (-0.54 to 0.16)

Paraffin burns score. I = 3.2 (0.21) C = 3.2 (0.21), -0.03 (-0.64 to 0.57)

Burns safety practices score. I = 2.5 (0.12) C = 2.9 (0.12), -0.41 (-0.76 to -0.07)

Poisoning score. I = 1.9 (0.11) C = 2.4 (0.20), -0.45 (-1.01 to 0.11)

Falls score. I = 3.7 (0.24) C = 3.6 (0.24), 0.09 (-0.60 to 0.78)


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Sznajder 2003

MethodsRCT


ParticipantsSocio-economically disadvantaged families, with medical or psychological difficulties which place them at high risk


InterventionsI = home safety counselling by health professionals, safety leaflets, free home safety kit (cupboard and drawer locks, door handle covers, furniture corner protectors, socket covers, non-slip bath mat, fitted smoke alarm, poison control centre number stickers)
C = home safety counselling + safety leaflets


OutcomesOutcomes measured over 2 months:

Functional smoke alarm
Possession of a fire extinguisher
Stores matches out of reach
Safe storage of medicines
Safe storage of cleaning products

No toxic plants in the home
Use of stair gate
Use of a baby walker
Use of non-slip bath mats
Use of socket covers
Small objects kept out of reach
Hot water system has adjustable thermostat I = 5/47, C = 5/50; OR 1.07 (0.29 to 3.97)
High chair safe I = 28/47, C = 34/50; OR 0.69 (0.30 to 1.59)
Risk of falling from a window or balcony I = 9/46, C = 17/49; OR 0.46 (0.18 to 1.17)
Cables/leads lying around likely to cause falls I = 6/46 C = 12/48; OR 0.45 (0.15 to 1.32)
Carpets fixed safely I = 7/48 C = 6/50; OR 1.25 (0.39 to 4.04)
Use of furniture corner covers I = 30/35, C = 20/34; OR 4.20 (1.31 to 13.50)
Food items that can cause choking out of reach I = 45/50; C = 45/50, OR 2.50 (0.46 to 13.56)
Cords and chains for blinds out of reach I = 6/25, C = 11/31; OR 0.57 (0.18 to 1.86)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Tan 2004

MethodsNon-randomised controlled trial (C)
Allocation at level of week of clinic attendance and sequential allocation to treatment arm


ParticipantsCaregivers and infants aged 4-5 months attending three health clinics


InterventionsI = structured nurse counselling + leaflets aimed at discouraging walker use
C1 = no nurse counselling
C2 = no nurse counselling and no baseline data collection


OutcomesOutcomes measured when child 9 months of age:

Self reported walker injuries:
Toppling over on flat ground I = 12/228, C1+ C2 = 19/480; OR 1.35 (0.64 to 2.83)
From falling down steps I = 2/228, C1+ C2 = 6/480; OR 0.70 (0.14 to 3.49)
Hospitalised due to walker injury I = 0/228; C1+ C2= 1/480, OR not calculable

Use of baby walker


NotesC1 and C2 arms combined for meta-analyses

Blinding - u
Outcomes 80% - y
Balance - y


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Thomas 1984

MethodsRCT


ParticipantsParents attending well-baby classes


InterventionsI = standard information and literature plus a lecture on burn prevention provided by nurse practitioners, leaflets on protecting home against fire, adjusting hot water settings and cost of smoke alarms at local stores, plus $7 discount coupon for a smoke alarm.
C = standard information and literature


OutcomesOutcomes measured at 6 weeks:

Safe hot water temperature
Functional smoke alarm I = 28/29 C = not reported P > 0.05


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)High riskInadequate

Vineis 1994

MethodsNon-randomised controlled trial (C)
Allocation at level of 2-3 week periods of clinic attendance and sequential allocation to treatment group


ParticipantsParents of newborn babies


InterventionsI = 15 minutes counselling by nurse + distribution of 3 educational booklets - 1 on prevention of home injuries in childhood, 1 on smoking and one on passive smoking
C = none of the above


OutcomesOutcomes measured over 2 and 4 years:

Risk of burns - no significant difference in preventive behaviours. No P values reported.
Scores of risk of poisoning by (a) cleaning products and (b) medicines - no significant difference in preventive behaviours. No P values reported.
Scores of risk of falls - no significant difference in preventive behaviours. No P values reported.
Scores of risk of electric shock - no significant difference in preventive behaviours. No P values reported.
Risk of home injury score comprising behaviours relating to burns, poisonings, falls and electrical injury - reports change from baseline in risk scores, but baseline scores not presented. No significant difference in risk scores between groups. No P values reported.


NotesBlinding - n
Outcomes 80% - n
Balance - u


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Waller 1993

MethodsRCT


ParticipantsA random sample of Dunedin area children taken from birth records


InterventionsI = free plumbing advice, home visit to measure tap water temperature, discuss dangers of hot water in the home and how to reduce tap water temperature provided by nurses
C1 = no home visit
C2 = no home visit and no baseline data collection


OutcomesOutcomes measured at 4 months:

Safe hot water temperature < 60 degrees Celsius


NotesC1 and C2 arms combined for meta-analyses

Blinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Watson 2005

MethodsRCT


ParticipantsFamilies with children < 5 years on caseloads of health visitors in deprived areas


InterventionsI = health visitor safety consultation, free fitted safety equipment (stair gates, fire guards, cupboard and drawer locks, smoke alarms, window locks)
C = usual care


OutcomesOutcomes measured at 12 and 24 months:

Medically attended thermal injuries

Medically attended poisonings

Medically attended injuries (primary care attendance, ED attendance, hospital admission or death)

Functional smoke alarms
Fitted fire guard
Safe storage of medicines
Safe storage of cleaning products
Use of stair gate
Use of window locks
Sharp objects stored out of reach


NotesBlinding - y(injuries) n(safety practices)
Outcomes 80% - y(injuries) n(safety practices)
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate

Williams 1988

MethodsRCT (C)
Allocation at level of prenatal classes


ParticipantsPregnant women attending prenatal classes


InterventionsI = 1 hour lecture, handouts on burn prevention, usual safety education.
C = usual safety education.


OutcomesOutcomes measured at 1 month:

Safe hot water temperature (not defined)
Possession of smoke alarm
Functional smoke alarm - no significant difference in alarm ownership between groups. Figures and P values not reported


NotesBlinding - n
Outcomes 80% - u
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Wissow 1989

MethodsRCT


ParticipantsFamilies with children < 6 years attending paediatric ED or clinic following injury


InterventionsI = home hazard inspection + education + free safety equipment provided at home
C = free safety equipment provided at hospital


OutcomesPeriod over which outcomes measured not reported.

Possession of a fire extinguisher - no figures or P value reported
Fire escape plan - no figures or P value reported
Possession of ipecac - significantly more control group families had ipecac, P = 0.009.
Poison centre number accessible - no figures or P value reported
Testing for lead poisoning - no figures or P values reported
Peeling paint - no figures or P values reported
Possession of bathmat slip guard - no figures or P value reported
Use of stair gates - no P values reported
Use of socket covers - no figures or P values reported

Sharp objects stored out of reach - no figures or P values reported
Mean number of hazards present calculated based on a 50 item home hazard inventory - No significant difference in the mean number of hazards, P >0.05 No figures reported


NotesBlinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Woolf 1987

MethodsRCT (C)
Allocated at level of week of clinic visit


ParticipantsFamilies attending medical ED with children < 5 years
Urban poor population


InterventionsI = counselling by medical staff on poisoning treatment methods, leaflet on poison prevention, poison control centre number sticker + ipecac
C1 = none of the above
C2 = none of the above and no baseline data collection


OutcomesOutcomes measured over 6 months:

Possession of ipecac
Poison centre number accessible
Storage of cleaning products, medicines, perfume - no figures or P values reported


NotesC1 and C2 arms combined for meta-analyses

Blinding - y
Outcomes 80% - n
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Woolf 1992

MethodsRCT (C)
Allocated at level of day of recruitment


ParticipantsFamilies of children less than or equal to 5 years with a poisoning who contacted the poison control centre and did not have ipecac


InterventionsI = mailed $1 coupon for ipecac, one cupboard lock, checklist for poison proofing the home, leaflets
C = none of the above


OutcomesOutcomes measured over 3 months:

Self reported repeat poisoning - no significant difference. No figures or P value reported

Possession of ipecac
Poison centre number accessible
Safe storage of cleaning products


NotesBlinding - y
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Yang 2008

MethodsRCT


ParticipantsRural households participating in a cohort study examining multiple health outcomes


InterventionsI1 = installation of photoelectric smoke alarm with lithium battery

I2 = installation of photoelectric smoke alarm with carbon-zinc battery

I3 = installation of ionizing smoke alarm with lithium battery

I4 = installation of ionizing smoke alarm with carbon-zinc battery


OutcomesOutcomes measured at 12 months:

Number of  photoelectric vs. ionising alarms:

I1+ 12=952/1018 I3+ I4=889/973; OR 1.30 (0.88 to 1.92)

Number of alarms with lithium vs. carbon-zinc battery:

I1+ I3=975/1030 I2+ I4=866/961; OR 1.91 (1.30 to 2.82)

Number of false alarms photoelectric vs. ionising alarms:

I1+ 12=55/1018 I3+ I4=120/973; OR 0.41 (0.29 to 0.56)

Number of false alarms with lithium vs. carbon-zinc battery:

I1+ I3=91/1030 I2+ I4=84/961; OR 1.05 (0.78 to 1.42)


NotesBlinding - n
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

Yorkston 2007

MethodsCBA (C)


ParticipantsChildren aged 0-4 years living in 2 intervention and 16 control communities


InterventionsI = WHO Safe Communities injury prevention programme

C = no community injury prevention programme


OutcomesOutcomes measured over 7 years which included 2 years post commencement of intervention:

Medically attended injuries (hospital admissions)

No significant reduction in logarithmically transformed injury rates.

Reduction in logarithmically transformed injury rates of 0.09 per 10,000 children aged 0-4 years associated with intervention (95% CI -0.29 to 0.11) p=0.36. Adjusted for remoteness of area, marital status, indigenous population.


NotesBlinding - u
Outcomes 80% - y
Balance - no

Intervention communities had higher baseline injury rates than control communities


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Ytterstad 1998

MethodsCBA (C)
Allocated at level of cities


ParticipantsChildren < 5 years in the city of Harstad (intervention) and Trondheim (control)


InterventionsI = promotion of cooker guards in electrical stores, mass media campaign to lower tap water thermostat to 55 degrees Celsius, health education, parental counselling and home assessment.
C = none of the above


OutcomesOutcomes measured over 10 years:
Medically attended thermal injuries
Thermal injury severity and mechanism - severity of stove and tap water scalds reduced in intervention area but figures only reported for intervention area. No P values reported.


NotesBlinding - u
Outcomes 80% - y
Balance - n
Control city had higher injury rates and educational level than intervention city at baseline


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Zhang 2003

MethodsCBA (C)
Allocation at level of counties


ParticipantsChildren aged 0-4 years from 12 townships from 6 counties; 6 intervention and 6 control townships


InterventionsI = health education comprising booklet containing methods of preventing suffocation and drowning, education by paediatricians to prevent suffocation and teaching sessions on vaccination day
C = usual care


OutcomesOutcomes measured over 12 months:

Mortality from suffocation I = 1/1414, C = 4/1447, OR 0.26 (0.03 to 2.30)
Parents not swaddling babies - no figures or P values reported
Mortality from drowning I = 3/8293 C = 5/7653, P > 0.05, OR 0.55 (0.13 to 2.32)
Use of fencing round pools - No figures or P values reported


NotesBlinding - n
Outcomes 80% - n
Balance - n
Intervention areas had higher baseline injury rates than control areas


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskNot applicable - non-randomised study

Zhao 2005

MethodsRCT


ParticipantsChildren aged 7-13 years attending 4 primary schools


InterventionsI = safety education provided to parents and children

C = usual care


OutcomesOutcomes measured at 1 and 2 years:

Self reported injuries (unclear if children reported multiple injuries)

Self reported all injuries combined 1 year after intervention I=262/3172 C=234/2699; not significant (p value not given)

Self reported all injuries combined 2 years after intervention I=211/3226  C=229/2654, χ2 =9.26, p<0.01

Self reported falls 1 year after intervention I=90/3172 C=67/2699; not significant (p value not given)

Self reported falls 2 years after intervention I=64/3226 C=75/2654, p<0.05

Self reported scalds/burns 1 year after intervention I=28/3172 C=25/2699; not significant (p value not given)

Self reported scalds/burns 2 years after intervention I=10/3226 C=18/2654, p<0.05

Self reported poisoning 1 year after intervention I=6/3172 C=8/2669; not significant (p value not given)

Self reported poisoning 2 years after intervention I=4/3226 C=11/2654, p<0.05

Self reported electrical injury 1 year after intervention I=11/3172 C=10/2699; not significant (p value not given)

Self reported electrical injury 2 years after intervention I=2/3226 C=6/2654; not significant (p value not given)

Self reported inhalation injury 1 year after intervention I=10/3172 C=9/2699; not significant (p value not given)

Self reported inhalation injury 2 years after intervention I=8/3226 C=5/2654; not significant (p value not given)

Self reported cuts 1 year after intervention I=12/3172 C=11/2699; not significant (p value not given)

Self reported cuts 2 years after intervention I=20/3226 C=9/2654; not significant (p value not given)

Self reported other injuries 1 year after intervention I=1/3172 C=6/2699; not significant (p value not given)

Self reported other injuries 2 years after intervention I=5/3226 C=6/2654; not significant (p value not given)


NotesBlinding - u
Outcomes 80% - y
Balance - n/a


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Unclear riskUnclear

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Abdelilah 1991Does not report study design of interest

Adesso 1974Does not report outcome of interest

Adler-Grinberg 1985Does not report outcome of interest

Alaii 2003Does not report outcome of interest

Alpert 1966Does not report study design of interest

Altundag 2007Does not report study design of interest

Anonymous 1994Does not report study design of interest

Armstrong 2000Does not report intervention of interest

Aronson 1980Does not report study design of interest

Asher 1995Does not report outcome of interest

Atkins 2004Does not report outcome of interest

Bablouzian 1997Does not report study design of interest

Barnes-Boyd 1995Does not report study design of interest

Barone 1986Does not report study design of interest

Bass 1985Does not report study design of interest

Baudier 1996Does not report study design of interest

Beirens 2008Does not report study design of interest

Belanger-Bonneau 2002Does not report study design of interest

Bernard-Bonnin 2003Does not report study design of interest

Bjerre 1997Does not report participants of interest

Bjerre 1998aDoes not report participants of interest

Bjerre 1998bDoes not report participants of interest

Bjerre 2000Does not report participants of interest

Bouter 1989Trial did not take place

Braden 1979Does not report outcome of interest

Cagle 2006Does not report study design of interest

Cardenas 1993Does not report outcome of interest

Carmel 1991Does not report outcome of interest

Chapman 2000Does not report outcome of interest

Charney 1983Does not report intervention of interest

Chen 2003Does not report study design of interest

Chevallier 1999Does not report study design of interest

Chung 2004Does not report outcome of interest

Cooper 1988Does not report study design of interest

CPSC (USA) 2004Does not report study design of interest

Davidson 1994Does not report outcome of interest

Day 2001Does not report study design of interest

Dershewitz 1984Does not report study design of interest

Dickson 1964Does not report study design of interest

DiGuiseppi 1999Does not report study design of interest

DiLillo 2001Does not report outcome of interest

Duckart 1998Does not report study design of interest

Duff 2002Does not report study design of interest

Dugdill 1991Does not report study design of interest

Duggan 1999Does not report intervention of interest

Duncan 1996Does not report outcome of interest

Duperrex 1999Does not report study design of interest

Eaton-Jones 2000Does not report study design of interest

Eckelt 1985Does not report study design of interest

Ekman 1996Does not report study design of interest

Facchin 2004Does not report study design of interest

Fallat 1993Does not report study design of interest

Farmakakis 2004Does not report study design of interest

Fergusson 2005Does not report outcome of interest

Fisher 1985Does not report study design of interest

Frank 1992Does not report outcome of interest

Frankenfield 1991Does not report study design of interest

Frederick 2000Does not report outcome of interest

Gaffney 1996bDoes not report outcome of interest

Gallagher 1984Does not report study design of interest

Gallagher 1985Does not report study design of interest

Gatheridge 2004Does not report outcome of interest

Geddis 1989Does not report study design of interest

Gielen 1996Does not report outcome of interest

Gielen 2001Does not report participants of interest

Ginnelly 2005Does not report study design of interest

Glotzer 1997Does not report study design of interest

Grant 1992Does not report outcome of interest

Grant 2004Does not report study design of interest

Gray 1979Does not report intervention of interest

Gresham 2001Does not report outcome of interest

Gross 1990Does not report intervention of interest

Grossman 2000Does not report outcome of interest

Guldvog 1993Trial did not take place

Gutelius 1977Does not report intervention of interest

Guyer 2000Does not report intervention of interest

Hall 1985Does not report study design of interest

Hall 1994Does not report study design of interest

Hardy 1989Does not report intervention of interest

Hardy 1996Does not report outcome of interest

Hardy 2002Does not report outcome of interest

Harre 1998aDoes not report study design of interest

Harre 1998bDoes not report study design of interest

Harre 2000Does not report study design of interest

Hemmo-Lotem 2005aDoes not report study design of interest

Hemmo-Lotem 2005bDoes not report study design of interest

Himle 2004Does not report outcome of interest

HIPRC 2004Does not report study design of interest

Huxley 1993Does not report intervention of interest

Jackson 1980Does not report study design of interest

Jackson 1983Does not report study design of interest

Johnson 1993Does not report intervention of interest

Johnson 2000Does not report intervention of interest

Johnston 2002Does not report outcome of interest

Jones 2001Does not report study design of interest

Jordan 1993Does not report study design of interest

Jordan 2003Does not report intervention of interest

Kaplan 1999Does not report study design of interest

Katcher 1987Does not report study design of interest

Kendrick 2009Does not report study design of interest

Ketvertis 2003Does not report study design of interest

King 1999Does not report study design of interest

Kitzman 1997Does not report intervention of interest

Klassen 1995Does not report study design of interest

Koniak-Griffin 2003Does not report intervention of interest

Korn 2009Does not report study design of interest

Kravitz 1973Does not report study design of interest

Krenzelok 1981Does not report study design of interest

Kuhn 1994Does not report study design of interest

Lagerberg 2000Does not report study design of interest

Lamb 2006Does not report outcome of interest

Lane 1971Does not report participants of interest

Lanphear 1999Does not report intervention of interest

Larcher 1987Does not report study design of interest

Larson 1980Does not report intervention of interest

Lealman 1983Does not report study design of interest

Lechman 1991Does not report outcome of interest

Leduc 1999Does not report study design of interest

Lee 2002Could not obtain reference

LentonDoes not report study design of interest

Lenton 2000Trial did not take place

Liller 1998Does not report study design of interest

Liller 2003Does not report outcome of interest

Linares 1979Does not report study design of interest

Lindqvist 1998bDoes not report study design of interest

Loescher 1995Does not report outcome of interest

Lowe 1999Does not report outcome of interest

Luria 2000Does not report outcome of interest

Mackenzie 2004Does not report study design of interest

Malouin 2003Does not report outcome of interest

Margolis 2001Does not report study design of interest

Marion 2004Does not report outcome of interest

McConnell 1996aDoes not report study design of interest

McConnell 1996bDoes not report outcome of interest

McWhirter 2000Does not report outcome of interest

Melhuish 2008Does not report outcome of interest

MET 1986Does not report outcome of interest

Milliner 1980Does not report study design of interest

Milne 1999Does not report outcome of interest

Milne 2000Does not report outcome of interest

Milne 2002Does not report outcome of interest

Minchom 1984Does not report study design of interest

Minkovitz 2001Does not report intervention of interest

Minkovitz 2003Does not report intervention of interest

Mondozzi 2001Does not report outcome of interest

Moore 2004Does not report study design of interest

Mori 1986Does not report outcome of interest

Morrison 1988Does not report study design of interest

Morrongiello 1998Does not report outcome of interest

Naidoo 1984Could not obtain reference

Nicholson 2002Does not report study design of interest

Nossar 2001Does not report study design of interest

Novick 1997Does not report outcome of interest

O'Connor 1982Does not report study design of interest

O'Connor 1990Does not report outcome of interest

O'Donnell 1996Does not report study design of interest

Oakley 1998Does not report intervention of interest

Olds 1986Does not report intervention of interest

Olds 1999Does not report intervention of interest

Olds 2002Does not report study design of interest

Palmisano 1981Does not report study design of interest

Parcel 1983Does not report study design of interest

Paulson 1981Does not report study design of interest

Pena 1994Does not report outcome of interest

Peterson 1984aDoes not report outcome of interest

Peterson 1984bDoes not report outcome of interest

Petridou 1994Does not report study design of interest

Petridou 1995Does not report study design of interest

Petridou 2002Does not report study design of interest

Phillips 1980Does not report study design of interest

Phillips 1986Does not report study design of interest

Pocknall 1993Does not report study design of interest

Polivka 1999Does not report study design of interest

Potts 1998Does not report study design of interest

Powell 2000Does not report study design of interest

Quan 1990Does not report outcome of interest

Rahman 2002Could not obtain reference

Reichelderfer 1976Does not report study design of interest

Rhoads 1999Does not report intervention of interest

Rutstein 1977Does not report study design of interest

Sadan 1995Does not report study design of interest

Sahlin 1990Does not report study design of interest

San Agustin 1973Does not report study design of interest

Schnell 1993Does not report study design of interest

Schwebel 2002Does not report study design of interest

Sell 1977Does not report study design of interest

Sherman 1980Does not report study design of interest

Sibert 1977Does not report study design of interest

Sibert 1999Does not report study design of interest

Sibert 2002Trial did not take place

Smith 1984Does not report outcome of interest

Smith 2002Does not report study design of interest

Smith 2006Does not report outcome of interest

Smithson 1998Does not report study design of interest

Smithson 2000Does not report study design of interest

Solis 1991Does not report study design of interest

Sorensen 1976Does not report study design of interest

Spallek 2004aDoes not report study design of interest

Spallek 2004bDoes not report study design of interest

Speigel 1995Does not report study design of interest

Spiller 2004Does not report outcome of interest

St Pierre 1999Does not report intervention of interest

Stanley 1979Does not report study design of interest

Stennies 1999Does not report outcome of interest

Stephen 1993Does not report study design of interest

Stevens 2002Does not report outcome of interest

Sullivan 1990Does not report study design of interest

Sundelin 1996Does not report outcome of interest

Svanstrom 1996Does not report study design of interest

Swaine 2000Does not report study design of interest

Taha 1999Does not report study design of interest

Temple 1978Does not report study design of interest

Tenn 1996Does not report outcome of interest

Terzidis 2007Does not report study design of interest

Thompson 1998Does not report study design of interest

Thomson 1999Does not report intervention of interest

Thuen 1994Does not report study design of interest

Timpka 1999Does not report outcome of interest

Towner 1996Does not report outcome of interest

Towner 1998Does not report outcome of interest

Velsog 1996Does not report outcome of interest

Vernberg 1984Does not report outcome of interest

Vogel 1968Does not report outcome of interest

Webne 1989Does not report study design of interest

Wester 1985Does not report study design of interest

Whitfield 2000Does not report study design of interest

Whitt 1982Does not report outcome of interest

Wiggins 2004Does not report intervention of interest

Wortel 1991Does not report study design of interest

Wurtele 1989Does not report outcome of interest

Young 2000Does not report outcome of interest

Ytterstad 2000Does not report study design of interest

Zwi 2004Does not report study design of interest

 
Characteristics of ongoing studies [ordered by study ID]
Cusimano (Canada)

Trial name or titleThe long term persistence of the "Think First for Kids" injury prevention programme at six and eighteen months

Methods

ParticipantsElementary school children

InterventionsI = 8 week implementation of "Think First for Kids" programme
C = no "Think First for Kids" programme

OutcomesReduction in risky behaviour

Starting date2002

Contact informationcusimanom@smh.toronto.on.ca

Notes

Grossman (USA)

Trial name or titleRaise the Alarms (A trial of smoke detector types)

Methods

Participants784 owner occupied dwellings in King County

InterventionsI1 = installation of ionisation smoke detector
I2 = installation of photoelectric smoke detector

OutcomesFunctional smoke alarm at 9 and 15 months follow-up

Starting datenot reported

Contact informationbmueller@fhcrc.org

Notes

 
Comparison 1. Medically attended or self reported injury rates

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Comparing medically attended or self-reported injury rates - unadjusted for baseline rates1524406IRR (Random, 95% CI)0.93 [0.83, 1.05]

 2 Comparing medically attended or self-reported injury rates - adjusted for baseline rates1524406IRR (Random, 95% CI)0.89 [0.78, 1.01]

 
Comparison 2. Thermal injury rates

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Comparing thermal injury rates422682IRR (Random, 95% CI)0.85 [0.51, 1.42]

 
Comparison 3. Poisoning injury rates

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Comparing poisoning rates417997IRR (Random, 95% CI)0.93 [0.65, 1.32]

 
Comparison 4. Thermal injuries

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Safe hot tap water temperature163727Odds Ratio (M-H, Random, 95% CI)1.41 [1.07, 1.86]

 2 Possession of a functional smoke alarm175107Odds Ratio (M-H, Random, 95% CI)1.81 [1.30, 2.52]

 3 Use of fire guards42945Odds Ratio (M-H, Random, 95% CI)1.40 [1.00, 1.95]

 4 Keeping hot drinks or food out of reach of children61660Odds Ratio (M-H, Random, 95% CI)0.95 [0.61, 1.48]

 5 Storage of matches or lighters out of reach of children62169Odds Ratio (M-H, Random, 95% CI)1.03 [0.63, 1.68]

 6 Possession of a fire extinguisher51803Odds Ratio (M-H, Random, 95% CI)0.90 [0.53, 1.51]

 7 Has a fire escape plan4Odds Ratio (Random, 95% CI)2.01 [1.45, 2.77]

 8 Smoke alarm batteries checked or changed4633Odds Ratio (M-H, Random, 95% CI)1.15 [0.63, 2.08]

 
Comparison 5. Poisoning outcomes

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Storage of medicines out of reach134338Odds Ratio (M-H, Random, 95% CI)1.53 [1.27, 1.84]

 2 Storage of cleaning products out of reach154847Odds Ratio (M-H, Random, 95% CI)1.55 [1.22, 1.96]

 3 Possession of syrup of ipecac102183Odds Ratio (M-H, Random, 95% CI)3.34 [1.50, 7.44]

 4 Having a poison control centre sticker available91839Odds Ratio (M-H, Random, 95% CI)3.30 [1.70, 6.39]

 5 Storage of poisons out of reach51252Odds Ratio (M-H, Random, 95% CI)2.07 [0.92, 4.66]

 6 Storage of plants out of reach3608Odds Ratio (M-H, Random, 95% CI)1.18 [0.40, 3.48]

 
Comparison 6. Falls outcomes

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Having a fitted stair gate124987Odds Ratio (M-H, Random, 95% CI)1.61 [1.19, 2.17]

 2 Possession and use of a baby walker93273Odds Ratio (M-H, Random, 95% CI)1.57 [1.18, 2.09]

 3 Possession of window locks, screens or mechanisms to limit opening on at least some windows63724Odds Ratio (M-H, Random, 95% CI)1.17 [0.87, 1.57]

 4 Possession of non-slip bath mats or decals4690Odds Ratio (M-H, Random, 95% CI)1.10 [0.68, 1.79]

 5 Does not leave child unattended on a high surface3661Odds Ratio (M-H, Random, 95% CI)0.84 [0.58, 1.20]

 
Comparison 7. Electrical injuries

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Use of socket covers91917Odds Ratio (M-H, Random, 95% CI)2.69 [1.46, 4.96]

 
Comparison 8. Lacerations and bruising

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Storage of sharp objects out of reach72983Odds Ratio (M-H, Random, 95% CI)1.54 [0.90, 2.64]

 
Comparison 9. Suffocation

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Keeping small objects out of reach62114Odds Ratio (M-H, Random, 95% CI)0.79 [0.36, 1.77]

 
Comparison 10. Drowning

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Never leaving child alone in the bath51685Odds Ratio (M-H, Random, 95% CI)1.21 [0.85, 1.72]

 
Table 1. Demographic and social characteristics of studies included in meta-analyses (%)

1st AuthorMean/median age, yearsMaleNon-owner occupierSingle parentsBME groupUnemployment

Yorkston 2007-51--9-

Zhao 2006------

Phelan 20100 (prenatal mothers)46-183017

Bulzachelli 20092.553-709653

Sangvai 2007----48-

Swart 2008---52-67

Kendrick 2010--10070865

Nansel 20081.252713266-

Kendrick 20078.752----

Hwang 2006------

Gittelman 2007----84-

Gielen 2007-50-699348

Carman 2006------

Babul 20071523911--

Dershewitz 1977---0-81

Baudier 1988------

Campbell 20011351----

Kendrick 20050.75-2054-

McDonald 20050.8148835493-

Watson 20052.155146281570

Posner 20042.265755-8434

Kelly 2003---1393-

Sznajder 20031.36 (youngest child)--13-34

DiGuiseppi 2002 (smoke alarm ownership data only)--1001318-

Gielen 20020.25--879477

Hendrickson 2005262-278874

Nansel 20020.9548731995-

King 2001259----

Johnston 20004.553-563057

Clamp 19982.59-2110112

Waller 19932-----

Woolf 19921.92--1110-

Katcher 19898.5---3-

Barone 1988------

Williams 1998------

Matthews 1988------

Davis 19879-----

Kelly 19870.5-898195-

Woolf 1987---425656 (maternal)

Thomas 1984------

Kendrick 19990.67523312711

Fergusson 19822--97-

Miller 1982--13---

Tan 20040.75-79---

Georgieff 20041.5--252-

Mock 20036-----

Lindquist 1998, 1999, 2001, 2002, 2004------

Ytterstad 1995, 19982-----

Petridou 19979.5--4--

Bentzen 1997------

Svanstrom 1995------

Schwarz 1993----96-

Guyer 1989, 1991--48-8-

Jenkins 1996-63-284822 (paternal)

 
Table 2. Odds ratios for thermal injury prevention practices (95% credible interval) by social variables

Social variablesFunctional Smoke AlarmFire GuardsKeeping matches out of reachSafe Hot Water Keeping hot drinks and food out of reachFire extinguishersFire Escape PlansChecking/changing smoke alarm batteries

GENDER    

Boys2.00 (0.55, 12.82)N/AN/A1.07 (0.63, 1.79)0.88 (0.36, 2.38)1.14 (0.50, 2.57)*N/A2.12 (0.84, 5.68)

Girls1.88 (0.52, 12.22)N/AN/A1.66 (0.97, 2.79)1.02 (0.43, 2.84)0.64 (0.22, 1.91)N/A1.11 (0.38, 3.34)

Interaction term (ratio of odds ratios)1.06 (0.63, 1.74)N/AN/A0.65 (0.38, 1.07)0.86 (0.48, 1.54)1.77 (0.27, 11.25)N/A1.92 (0.37, 10.18)

ETHNIC GROUP       

Black and minority ethnic groups3.21 (0.94, 15.14)1.50 (0.41, 6.28)1.28 (0.01, 184.7)1.14 (0.51, 2.72)1.38 (0.36, 7.51)N/AN/A1.29 (0.80, 2.07)

White2.74 (0.89, 12.86)1.45 (0.43, 5.43)1.04 (0.01, 329.10)1.23 (0.54, 2.82)0.91 (0.19, 4.17)N/AN/A0.39 (0.08, 1.40)

Interaction term (ratio of odds ratios)1.16 (0.54, 2.50)1.02 (0.57, 1.86)1.04 (0.02, 28.40)0.94 (0.49, 1.83)1.58 (0.57, 5.02)N/AN/A3.33 (0.82, 18.15)

FAMILY TYPE      

Single parent family1.63 (0.66, 4.64)1.38 (0.83, 2.45)N/A1.45 (0.45, 6.18)0.95 (0.16, 5.16)2.18 (0.27, 23.74)*N/A1.10 (0.39, 2.99)

Two parent family1.99 (0.81, 5.42)1.20 (0.81, 1.87)N/A1.64 (0.59, 7.91)1.06 (0.31, 4.64)0.86 (0.54, 1.36)N/A1.11 (0.63, 1.98)

Interaction term (ratio of odds ratios)0.83 (0.51, 1.33)1.16 (0.76, 1.76)N/A0.85 (0.42, 1.72)0.87 (0.22, 3.16)2.52 (0.24, 36.80)N/A0.99 (0.26, 3.43)

HOUSING TENURE      

Non-owner occupied1.73 (0.67, 4.99)1.39 (0.91, 2.32)N/A1.70 (0.48, 7.48)0.94 (0.32, 2.53)N/AN/A1.75 (0.85, 3.65)

Owner occupied1.88 (0.72, 5.44)1.13 (0.77, 1.76)N/A1.88 (0.54, 9.21)0.78 (0.27, 2.09)N/AN/A0.96 (0.23, 4.27)

Interaction term (ratio of odds ratios)1.09 (0.64, 1.90)1.22 (0.88, 1.71)N/A0.89 (0.43, 1.83)1.20 (0.61, 2.36)N/AN/A1.82 (0.32, 10.14)

PARENTAL UNEMPLOYMENT

1 or more parent not in paid employmentN/AN/AN/AN/AN/A2.72 (1.14, 6.79)*N/AN/A

Both parents in paid employmentN/AN/AN/AN/AN/A0.76 (0.24, 2.32)N/AN/A

Interaction term (ratio of odds ratios)N/AN/AN/AN/AN/A3.56 (0.84, 15.97)N/AN/A

AGE     

Odds ratio at age 0Model does not converge1.13 (0.70, 1.89)Model does not converge1.36 (0.89, 1.93)1.37 (0.50, 4.99)1.12 (0.74, 1.69)1.37 (0.52, 3.69)1.35 (0.71, 2.57)

Odds ratio at age 4Model does not converge1.30 (0.79, 2.31)Model does not converge1.22 (0.54, 3.02)0.35 (0.04, 2.56)0.93 (0.66, 1.29)1.55 (0.80, 3.06)0.61 (0.14, 2.32)

Interaction term (ratio of odds ratios)Model does not converge1.04 (0.91, 1.16)Model does not converge0.97 (0.75, 1.31)0.72 (0.38, 1.29)0.96 (0.82, 1.10)1.03 (0.94, 1.13)0.82 (0.52, 1.27)

 * Fixed effect model used
 
Table 3. Odds ratios for poisoning prevention practices (95% credible interval) by social variables

Social variablesStorage of cleaning products out of reachPossession of ipecacPoison centre numberStorage of poisons out of reachStorage of medicines out of reachPlants*

GENDER      

Boys1.63 (0.80, 3.76)3.21 (1.25, 8.63)*2.53 (0.05, 157.3)2.26 (0.04, 201.2)1.72 (0.76, 4.56)N/A

Girls1.83 (0.89, 4.32)2.58 (1.02, 6.92)3.48 (0.07, 234.50)2.41 (0.04, 227.30)1.41 (0.64, 3.81)N/A

Interaction term (ratio of odds ratios)0.89 (0.62, 1.27)1.23 (0.27, 5.83)0.72 (0.26, 2.00)0.93 (0.49, 1.75)1.22 (0.72, 2.00)N/A

ETHNIC GROUP      

Black and minority ethnic groups1.79 (1.05, 3.04)3.53 (1.10, 12.68)5.37 (1.42, 21.17)2.05 (0.38, 17.43)3.64 (0.98, 14.44)N/A

White1.88 (1.16, 3.59)1.98 (0.28, 12.99)2.25 (0.50, 9.16)3.02 (0.42, 20.55)2.54 (0.62, 10.93)N/A

Interaction term (ratio of odds ratios)0.94 (0.54, 1.54)1.79 (0.21, 17.04)2.40 (0.88, 7.12)0.73 (0.21, 2.43)1.43 (0.65, 3.23)N/A

FAMILY TYPE      

Single parent family1.74 (1.10, 3.08)2.67 (0.90, 8.07)3.64 (0.88, 15.65)1.59 (0.19, 16.07)2.60 (0.99, 7.06)Model does not converge

Two parent family1.60 (1.09, 2.66)2.37 (1.00, 6.86)3.64 (1.04, 12.35)2.23 (0.22, 18.89)2.48 (0.99, 6.29)Model does not converge

Interaction term (ratio of odds ratios)1.10 (0.73, 1.63)1.11 (0.30, 3.75)0.99 (0.38, 2.77)0.75 (0.37, 1.57)1.05 (0.59, 1.88)Model does not converge

HOUSING TENURE

Non-owner occupiedN/AN/AN/AN/AN/AN/A

Owner occupiedN/AN/AN/AN/AN/AN/A

Interaction term (ratio of odds ratios)N/AN/AN/AN/AN/AN/A

PARENTAL UNEMPLOYMENT      

1 or more parent not in paid employment2.00 (1.15, 3.86)0.38 (0.07, 2.00)*5.95 (0.21, 172.10)2.17 (0.31, 21.97)2.86 (0.97, 9.21)N/A

Both parents in paid employment1.71 (1.02, 3.31)59.96 (4.37, 1001.00)6.15 (0.23, 202.90)2.35 (0.30, 20.73)2.27 (0.80, 7.56)N/A

Interaction term (ratio of odds ratios)1.17 (0.80, 1.73)0.01 (0.00, 0.43)0.94 (0.27, 3.33)0.97 (0.47, 1.95)1.25 (0.72, 2.14)N/A

AGE      

Odds ratio at age 01.34 (0.95, 1.96)1.54 (0.57, 4.57)1.99 (0.24, 12.63)3.05 (0.38, 30.10)1.03 (0.56, 2.10)0.80 (0.18, 3.80)

Odds ratio at age 41.18 (0.84, 1.78)1.20 (0.38, 5.04)3.59 (0.44, 35.44)0.77 (0.09, 7.22)1.89 (1.02, 3.84)0.22 (0.01, 2.00)

Interaction term (ratio of odds ratios)0.97 (0.85, 1.10)0.94 (0.71, 1.26)1.17 (0.76, 1.84)0.71 (0.54, 0.93)1.16 (0.95, 1.43)0.73 (0.25, 1.53)

 * Fixed effect model used
 
Table 4. Odds ratios for falls prevention practices (95% credible interval) by social variables

Social variablesFitted stair gateNo baby walkerNon-slip bath matWindow locksNot leaving child unattended on high surfaces

GENDER    

Boys1.64 (0.85, 3.31)0.67 (0.32, 1.37)N/A1.45 (0.80, 2.92)N/A

Girls1.92 (0.99, 3.85)1.04 (0.49, 2.18)N/A0.85 (0.46, 1.70)N/A

Interaction term (ratio of odds ratios)0.86 (0.62, 1.18)0.64 (0.26, 1.59)N/A1.72 (1.16, 2.57)N/A

ETHNIC GROUP     

Black and minority ethnic groups1.98 (1.17, 3.34)0.77 (0.29, 2.49)N/A1.58 (0.58, 5.11)N/A

White1.65 (1.01, 2.76)1.03 (0.30, 2.59)N/A1.36 (0.57, 3.43)N/A

Interaction term (ratio of odds ratios)1.19 (0.77, 1.85)0.79 (0.33, 2.02)N/A1.13 (0.62, 2.05)N/A

FAMILY TYPE     

Single parent family2.03 (1.16, 3.62)0.89 (0.32, 2.46)0.60 (0.16, 1.99)*0.98 (0.37, 3.19)N/A

Two parent family1.82 (1.12, 3.02)0.92 (0.41, 1.87)1.00 (0.69, 1.44)1.51 (0.63, 4.76)N/A

Interaction term (ratio of odds ratios)1.11 (0.75, 1.65)0.99 (0.44, 2.24)0.60 (0.15, 2.14)0.65 (0.40, 1.05)N/A

HOUSING TENURE    

Non-owner occupied1.98 (1.48, 2.66)1.22 (0.48, 2.93)N/A 1.13 (0.03, 54.7)*0.44 (0.04, 3.65)*

Owner occupied1.22 (0.96, 1.61)1.36 (0.53, 3.34)N/A1.48 (0.04, 75.5)2.51 (0.58, 13.06)

Interaction term (ratio of odds ratios)1.62 (1.18, 2.24)0.90 (0.54, 1.47)N/A0.76 (0.50, 1.17)0.18 (0.003, 5.76)

PARENTAL UNEMPLOYMENT    

1 or more parent not in paid employment2.08 (0.77, 5.86)0.39 (0.14, 1.04)*2.07 (0.91, 4.78)*1.40 (0.58, 4.23)N/A

Both parents in paid employment1.82 (0.67, 5.01)0.87 (0.49, 1.51)0.91 (0.59, 1.42)1.40 (0.63, 4.49)N/A

Interaction term (ratio of odds ratios)1.15 (0.77, 1.71)0.45 (0.14, 1.40)2.28 (0.88, 5.86)0.98 (0.62, 1.55)N/A

AGE   

Odds ratio at age 01.40 (1.02, 2.06)N/A due to age of walker use1.16 (0.80, 1.71)*1.00 (0.30, 4.87)N/A due to age for leaving child on high surfaces

Odds ratio at age 41.26 (0.81, 2.02)N/A due to age of walker use1.08 (0.78, 1.50)1.27 (0.35, 5.84)N/A due to age for leaving child on high surfaces

Interaction term (ratio of odds ratios)0.97 (0.84, 1.13)N/A due to age of walker use0.98 (0.90, 1.06)1.06 (0.90, 1.23)N/A due to age for leaving child on high surfaces

 * Fixed effect model used
 
Table 5. Odds ratios for use of socket covers (95% credible interval) by social variables

Social variablesSocket covers

GENDER 

Boys0.50 (0.00, 53.26)

Girls1.17 (0.00, 129.70)

Interaction term (ratio of odds ratios)2.36 (0.68, 8.27)

ETHNIC GROUP 

Black and minority ethnic groups1.96 (0.09, 29.00)

White1.25 (0.05, 18.05)

Interaction term (ratio of odds ratios)1.59 (0.56, 4.49)

FAMILY TYPE 

Single parent family2.15 (0.45, 11.07)

Two parent family2.58 (0.63, 11.85)

Interaction term (ratio of odds ratios)0.82 (0.33, 2.11)

HOUSING TENURE 

Non-owner occupied0.68 (0.00, 111.70)

Owner occupied0.25 (0.00, 38.68)

Interaction term (ratio of odds ratios)2.76 (0.76, 11.09)

PARENTAL UNEMPLOYMENT 

1 or more parent not in paid employmentModel does not converge

Both parents in paid employmentModel does not converge

Interaction term (ratio of odds ratios)Model does not converge

AGE 

Odds ratio at age 00.86 (0.01, 32.12)

Odds ratio at age 40.38 (0.00, 14.98)

Interaction term (ratio of odds ratios)0.76 (0.51, 1.11)

 
Table 6. Odds ratios for storage of sharp objects out of reach (95% credible interval) by social variables

Social variablesSharp objects

GENDER 

Boys0.56 (0.04, 7.78)

Girls0.49 (0.03, 6.79)

Interaction term (ratio of odds ratios)1.15 (0.78, 1.66)

ETHNIC GROUP 

Black and minority ethnic groups0.77 (0.16, 3.54)

White0.85 (0.18, 3.72)

Interaction term (ratio of odds ratios)0.92 (0.53, 1.58)

FAMILY TYPE* 

Single parent family0.95 (0.22, 4.11)

Two parent family0.85 (0.21, 3.58)

Interaction term (ratio of odds ratios)1.12 (0.72, 1.76)

HOUSING TENURE 

Non-owner occupied1.58 (0.55, 4.54)

Owner occupied1.18 (0.40, 3.27)

Interaction term (ratio of odds ratios)1.36 (0.92, 2.02)

PARENTAL UNEMPLOYMENT 

1 or more parent not in paid employment0.91 (0.11, 6.46)

Both parents in paid employment0.70 (0.09, 4.91)

Interaction term (ratio of odds ratios)1.29 (0.87, 1.93)

AGE 

Odds ratio at age 01.89 (0.50, 7.22)

Odds ratio at age 41.58 (0.41, 6.24)

Interaction term (ratio of odds ratios)0.96 (0.83, 1.09)

 * See text for odds ratios from modelling within and between study variance separately
 
Table 7. Odds ratios for storage of small objects out of reach (95% credible interval) by social variables

Social variablesStorage of small objects out of reach

GENDER 

Boys0.35 (0.20, 0.62)

Girls0.14 (0.06, 0.27)

Interaction term (ratio of odds ratios)2.54 (0.86, 7.91)

ETHNIC GROUP

Black and minority ethnic groupsN/A

WhiteN/A

Interaction term (ratio of odds ratios)N/A

FAMILY TYPE 

Single parent family0.72 (0.19, 2.86)

Two parent family0.38 (0.28, 0.52)

Interaction term (ratio of odds ratios)1.90 (0.44, 8.31)

HOUSING TENURE

Non-owner occupiedN/A

Owner occupiedN/A

Interaction term (ratio of odds ratios)N/A 

PARENTAL UNEMPLOYMENT 

1 or more parent not in paid employment1.90 (0.79, 4.89)

Both parents in paid employment0.63 (0.38, 1.04)

Interaction term (ratio of odds ratios)3.02 (1.06, 9.04)

AGE 

Odds ratio at age 00.03 (0.01, 0.08)

Odds ratio at age 443.43 (10.06, 179.00)

Interaction term (ratio of odds ratios)6.37 (3.43, 11.73)

 
Table 8. Odds ratios for never leaving a child alone in the bath (95% credible interval) by social variables

Social variablesBath Alone

GENDER 

Boys1.17 (0.51, 3.12)

Girls1.73 (0.75, 4.97)

Interaction term (ratio of odds ratios)0.67 (0.29, 1.53)

ETHNIC GROUP 

Black and minority ethnic groups0.89 (0.23, 5.04)

White1.0 (0.25, 5.46)

Interaction term (ratio of odds ratios)0.89 (0.33, 2.45)

FAMILY TYPE 

Single parent family0.53 (0.14, 1.93)*

Two parent family1.13 (0.71, 1.83)

Interaction term (ratio of odds ratios)0.47 (0.11, 1.82)

HOUSING TENURE 

Non-owner occupied1.80 (0.76, 4.34)

Owner occupied1.05 (0.45, 2.86)

Interaction term (ratio of odds ratios)1.68 (0.68, 4.09)

PARENTAL UNEMPLOYMENT 

1 or more parent not in paid employmentN/A

Both parents in paid employmentN/A

Interaction term (ratio of odds ratios)N/A

AGE 

Odds ratio at age 00.62 (0.17, 2.14)

Odds ratio at age 43.02 (0.66, 18.18)

Interaction term (ratio of odds ratios)1.50 (0.96, 2.43)

 * Fixed effect model used