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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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