BMJ 2002;325:995 ( 2 November )

Papers

Incidence of fires and related injuries after giving out free smoke alarms: cluster randomised controlled trial

Editorial by Pless

Carolyn DiGuiseppi, associate professor, ^a Ian Roberts, professor, ^b Angie Wade, senior lecturer, ^c Mark Sculpher, professor, ^d Phil Edwards, research fellow, ^b Catherine Godward, research fellow, ^c Huiqi Pan, research fellow, ^c Suzanne Slater, public health project officer. ^e

^a Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Campus Box B-119, Denver, CO 80262, USA, ^b London School of Hygiene and Tropical Medicine, London WC1B 3DP, ^c Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London WC1N 1EH, ^d Centre for Health Economics, University of York, York YO1 5DD, ^e Department of Public Health, Camden and Islington Health Authority, London NW1 1LJ

Correspondence to: C DiGuiseppi
Carolyn.DiGuiseppi{at}uchsc.edu

Objective: To measure the effect of giving out free smoke alarms on rates of fires and rates of fire related injury in a deprived multiethnic urban population.
Design: Cluster randomised controlled trial.
Setting: Forty electoral wards in two boroughs of inner London, United Kingdom.
Participants: Primarily households including elderly people or children and households that are in housing rented from the borough council.
Intervention: 20 050 smoke alarms, fittings, and educational brochures distributed free and installed on request.
Main outcome measures: Rates of fires and related injuries during two years after the distribution; alarm ownership, installation, and function.
Results: Giving out free smoke alarms did not reduce injuries related to fire (rate ratio 1.3; 95% confidence interval 0.9 to 1.9), admissions to hospital and deaths (1.3; 0.7 to 2.3), or fires attended by the fire brigade (1.1; 0.96 to 1.3). Similar proportions of intervention and control households had installed alarms (36/119 (30%) v 35/109 (32%); odds ratio 0.9; 95% confidence interval 0.5 to 1.7) and working alarms (19/118 (16%) v 18/108 (17%); 0.9; 0.4 to 1.8).
Conclusions: Giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire, mostly because few alarms had been installed or were maintained.

What is already known on this topic In the United Kingdom, residential fires caused 466 deaths and 14 600 non-fatal injuries in 1999 The risk of death from fire is associated with socioeconomic class One study reported an 80% decline in hospitalisations and deaths from residential fires after free smoke alarms were distributed in an area at high risk, but these results may not apply in other settings, and evidence from randomised controlled trials is lacking What this study adds Giving out free smoke alarms in a multiethnic poor urban population did not reduce injuries related to fire or fires Giving smoke alarms away may be a waste of resources and of little benefit unless alarm installation and maintenance is assured

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© BMJ 2002
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