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Effects of Improved Access to Safety Counseling, Products, and Home Visits on Parents' Safety Practices
Results of a Randomized Trial
Andrea Carlson Gielen, ScD, ScM;
Eileen M. McDonald, MS;
Modena E. H. Wilson, MD, MPH;
Wei-Ting Hwang, PhD;
Janet R. Serwint, MD;
John S. Andrews, MD;
Mei-Cheng Wang, PhD
Arch Pediatr Adolesc Med. 2002;156:33-40.
Objective To present the results of an intervention trial to enhance parents'
home-safety practices through pediatric safety counseling, home visits, and
an on-site children's safety center where parents receive personalized education
and can purchase reduced-cost products.
Design Pediatricians were randomized to a standard- or an enhanced-intervention
group. Parents of their patients were enrolled when the patient was 6 months
or younger and observed until 12 to 18 months of age.
Setting A hospital-based pediatric resident continuity clinic that serves families
living in low-income, inner-city neighborhoods.
Participants First- and second-year pediatric residents and their patient-parent
dyads.
Interventions Parents in the standard-intervention group received safety counseling
and referral to the children's safety center from their pediatrician. Parents
in the enhanced-intervention group received the standard services plus a home-safety
visit by a community health worker.
Outcomes Home observers assessed the following safety practices: reduction of
hot-water temperature, poison storage, and presence of smoke alarms, safety
gates for stairs, and ipecac syrup.
Results The prevalence of safety practices ranged from 11% of parents who stored
poisons safely to 82% who had a working smoke alarm. No significant differences
in safety practices were found between study groups. However, families who
visited the children's safety center compared with those who did not had a
significantly greater number of safety practices (34% vs 17% had  3).
Conclusions Home visiting was not effective in improving parents' safety practices.
Counseling coupled with convenient access to reduced-cost products appears
to be an effective strategy for promoting children's home safety.
From the Department of Health Policy and Management and the Center
for Injury Research and Policy, Bloomberg School of Public Health (Dr Gielen
and Ms McDonald), and the Department of Biostatistics (Drs Hwang and Wang),
Johns Hopkins University, and the Department of Pediatrics, Johns Hopkins
University School of Medicine (Drs Wilson, Serwint, and Andrews), Baltimore,
Md. Dr Wilson is now with the American Academy of Pediatrics, Elk Grove Village,
Ill. Dr Andrews is now with Starship Children's Health, Auckland, New Zealand.
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