Perceived Risk of Home Fire and Escape Plans in Rural Households

Transcription

1 Perceived Risk of Home Fire and Escape Plans in Rural Households Jingzhen Yang, PhD, MPH, Corinne Peek-Asa, PhD, MPH, Veerasathpurush Allareddy, DDS, Craig Zwerling, PhD, MD, MPH, John Lundell, MA Background: Homes in rural areas have a higher fire death rate. Although successful exit from a home fire could greatly reduce fire-related deaths and injuries, little is known about factors associated with behaviors of developing and practicing an escape plan. Methods: Between July 2003 and June 2004, a baseline survey was administered, in person, to 691 rural households. Information collected included a history of previous home fire, perceived risk of home fire, existing smoke alarms and their working status, and home fire safety practices, as well as home and occupant characteristics. The association of residents perceived risk of home fire and fire escape plans was assessed. Results: Conclusions: Forty-two percent of rural households reported having a fire escape plan. Of the households with a plan, less than two thirds (56.9%) discussed or practiced the plan. Households with children were more likely to develop and practice a fire escape plan. Households with an elderly or disabled person were less likely to develop or practice the plan. Compared to respondents who perceived low or very low risk of home fire, those who perceived a high or very high risk had 3.5 times greater odds of having a fire escape plan and 5.5 times greater odds of discussion or practicing their plan. Increasing awareness of the potential risk of home fires may help occupants develop and practice home fire escape plans. In order to reduce fire deaths and injuries, different strategies need to be developed for those households in which the occupants lack the ability to escape. (Am J Prev Med 2006;30(1):7 12) 2006 American Journal of Preventive Medicine Introduction Fires and burns were the seventh most common cause of unintentional injury related deaths in the United States. in Each year, 4000 Americans die in fires and approximately 25,000 are injured. In 2002, four of every five fire deaths in the U.S. occurred in homes. 2 Most home deaths occur from smoke inhalation. 3,4 Many of these deaths could have been prevented if the residents had been able to get out of their burning homes quickly. 5 7 Marshall et al. 5 found that almost 50% of decedents from home fires were trying to escape, suggesting that developing and practicing a home fire escape plan may have made the difference between life and death From the Injury Prevention Research Center (Yang, Peek-Asa, Allareddy, Zwerling, Lundell), Department of Community and Behavioral Health (Yang), Department of Occupational and Environmental Health (Peek-Asa, Zwerling), and Department of Health Management and Policy (Allareddy), University of Iowa, Iowa City, Iowa Address correspondence and reprint requests to: Jingzhen Yang, PhD, Department of Community and Behavioral Health, College of Public Health, University of Iowa, 200 Hawkins Drive, E236 GH, Iowa City IA jingzhen-yang@uiowa.edu. for many of them. The protective effects of having and practicing a fire escape plan could be even more significant in rural homes because the fire death rate is 36% higher in rural than urban areas. 8 Although both the Centers for Disease Control and Prevention (CDC) and the National Fire Protection Association (NFPA) recommend that all households develop a fire escape plan and practice this plan twice a year, 1,9,10 the proportion of households that report having a fire escape plan is low. The results from NFPA s 1997 survey on fire safety behaviors revealed that only 53% of households in the United States had a fire escape plan. 11 Harvey et al. 12 reported that 60% of the households studied had designed or discussed a fire escape plan at least once, of which only 17% had actually practiced the plan. A social and behavioral science perspective suggests that people who feel personally susceptible to a health outcome that leads to serious consequences are much more likely to adopt recommended preventive health measures. 13,14 In this context, household residents who perceive a real danger of experiencing a home fire would be expected to be more likely to formulate and practice a fire escape plan. 14 Am J Prev Med 2006;30(1) /06/$ see front matter 2006 American Journal of Preventive Medicine Published by Elsevier Inc. doi: /j.amepre

2 Despite the fact that successful exit from a home fire could greatly reduce fire-related deaths and injuries, little attention has been given in the literature regarding fire escape plans. Few existing studies examined the factors associated with developing and practicing fire escape planning behaviors. 7 No previous studies have examined how residents perceived risk of home fire influences their decisions about formulating or practicing a fire escape plan. This study aims to describe the home and occupant characteristics associated with having escape plans and practicing such plans in rural households, and to examine the relationships between residents perceived risk of home fire and home fire escape plans in rural households. Methods Study Population and Design This study is based on data from the baseline household survey of a randomized trial on smoke alarm effectiveness, which was nested within a longitudinal cohort study that examines multiple health outcomes in a rural Iowa county. 15 The main focus of the cohort study was occupational and agricultural health, but information on a wide variety of health issues was collected. The county was chosen to represent a rural community, and it is entirely rural according to the U.S. Census Bureau definition (population of largest town is 2500 residents). The cohort was established in 1994 through a complete county census, and has been followed through The original cohort included 1633 individuals in 1004 households, with a 67.1% participation rate. A post-enumeration survey of 200 nonparticipating households found that participating and nonparticipating households were similar. For this study, a total of 1187 households that had participated in either the first or second round of the cohort study were contacted by mail and invited to participate in the randomized trial. Of the 1187 eligible households, respondents in 1005 (84.7%) were located, two had moved out of the county (0.2%), three (0.3%) were deceased, and 177 (14.9%) could no longer be located. Of the 1005 household respondents located, 691 (68.8%) agreed to participate. Both this study and the cohort study were approved by the University of Iowa Human Subject Protection Committee. Data Collection Between July 2003 and June 2004, a baseline survey for the smoke alarm trial was administered in person with an owner or adult head of household in the 691 participating households. Interviews were conducted in participant s homes by trained researchers. Questions included information about a history of previous fire, perceived risk of home fire, existing smoke alarms and their working status, home fire safety practices, and home and occupant characteristics. Additional information on occupant characteristics, such as marital status, education, and income, was obtained from the data collected in the cohort study in which the trial was nested. Variables and Measures A home fire escape plan referred to a plan developed for all members of the household in the event of a fire, including how the family would safely exit the residence if there were a fire or sounding smoke alarm, and where family members would meet outside after they safely exited the building. Having a fire escape plan was measured by asking respondents if they had a fire escape plan for the household should the smoke alarm sound. Practicing the fire escape plan was measured by asking if the respondents discussed and practiced the plan. Both measures were coded dichotomously. Perceived risk of home fire, a categoric variable, was measured by asking respondents to make the choice that is closest to your belief that there will be a fire in your home in the future, using a Likert scale with 5 indicating very high and 1 indicating very low. Actual risk of home fire, a dichotomous variable, was calculated by summing four binary variables: (1) households that reported a previous fire, (2) households using wood as the primary source of heat, (3) households using a wood fireplace and/or wood stove during the past winter, and (4) households in which at least one member is a current smoker. Households with a score of 1 were defined as having a high actual risk of home fire, and those without any of these characteristics were defined as having a low actual risk of home fire. Analysis The number and proportion of households that reported having and practicing a fire escape plan were described. Chi-square tests were used to identify differences in the home fire escape plans among the subgroups. The relationship between perceived risk of home fire and actual risk of home fire was assessed by the McNemar test. Generalized logistic regression was used to predict two different dependent variables: having a fire escape plan and practicing the fire escape plan. Odds ratios were calculated on households with a fire escape plan versus households with no plan, adjusting for home and occupant characteristics, including home ownership, location, marital status, income, and education. A similar analysis was conducted among those households with a fire escape plan to determine the odds ratios for households practicing and not practicing their plan. The analyses were conducted in SAS, version 9.00 (SAS Institute Inc., Cary NC, 2002), and completed in January Results Home and Occupant Characteristics Of the 691 participating households, 493 (71.3%) had married occupants; 599 (86.7%) reported an annual household income of $20,000; 619 (89.6%) owned their home; and 372 (53.8%) were located in a town. Seventy-eight households (11.3%) reported a previous home fire. Twenty-two households (3.2%) used wood as the primary source of heat, and 123 households (17.8%) used either a wood stove or wood fireplace during the past winter. 8 American Journal of Preventive Medicine, Volume 30, Number 1

3 Table 1. Home and occupant characteristics vis-a-vis a fire escape plan in Iowa rural homes (n 691 households) Households (n) Having fire escape plan, n (%) a Practicing plan b n (%) Married occupant c Yes (43.8) 135 (62.5)* No (36.0) 29 (40.9) Household income <$20,000 c Yes (39.5) 13 (38.2) No (42.1) 150 (59.5)* At least one member with high school or higher education c Yes (42.0) 159 (57.6) No (34.4) 5 (45.5) Home ownership c Own house (41.7) 146 (56.6) Rent/other (40.0) 18 (64.3) Residence location c In a town (38.4) 76 (53.2) Out of town (45.3) 88 (61.1) Primary or supplemental heating source is wood Yes (52.3)* 40 (58.8) No (39.2) 124 (56.4) History of home fire Yes (41.0) 19 (59.4) No (41.7) 145 (56.6) Presence of child d Child aged 5 years (55.1) 23 (85.2)* Child aged 5 17 years (74.4)* 59 (63.4) No child aged 18 years (32.5) 82 (48.8) Presence of adult aged >64 d Yes (31.7) 45 (47.4) No (49.4)* 119 (61.7)* At least one member in household with disability Yes (34.0) 26 (50.0) No (43.9)* 138 (58.5) At least one member in household is current smoker Yes (43.6) 28 (58.3) No (41.3) 136 (56.7) a A total of 288 homes (41.7%) reported having a fire escape plan. b Percentages are calculated based on households with a fire escape plan. c Sums less than 691 are due to missing values. d At least one member in home has the characteristic. *p 0.05 (bolded). Approximately 95% of households reported the presence of at least one person with a high school degree or higher education. Of all households studied, 7.1% had at least one child aged 5 years, 18.1% had at least one child aged 5 to 17 years, and 43.4% had at least one elderly resident aged 64 years. Just under a quarter (22.1%) reported at least one resident with disabilities, and 15.9% reported at least one current smoker. Prevalence of Households with Fire Escape Plan Table 1 presents households who reported having a fire escape plan and those who practiced the plan. A total of 288 households (41.7%) reported having a fire escape plan. Households with children aged 17 years, households who used a wood stove and/or wood fireplace during the past winter, or households who used wood as a primary source of heat were more likely to report having a fire escape plan. Interestingly, households with elderly or with disabled persons were less likely to have a fire escape plan. Of the 288 households with a fire escape plan, only 164 (56.9%) reported either discussing or practicing the plan, which means less than one fourth of study households (23.7%) discussed or practiced the fire escape plan. Households with children, with married couples, and with an annual household income $20,000 were more likely to report having discussed and practiced the plan. Households with elderly residents were less likely to discuss or practice their plan. Perceived Risk Among Households with Actual Risk The relationship between perceived risk of home fire and actual risk of home fire (e.g., having a history of previous fire, using wood as primary source of heat, January 2006 Am J Prev Med 2006;30(1) 9

4 Table 2. Perceived fire risk and actual fire risk in Iowa rural homes (n 691 households) Perceived risk high, n (%) Perceived risk average, n (%) Perceived risk low, n (%) Household with high actual risk a 10 (3.7%) 88 (32.3%) 174 (64.0%) b (n 272) Household with low actual risk 10 (2.4%) 115 (27.4%) 294 (70.2%) (n 419) All homes (n 691) 20 (2.9%) 203 (29.4%) 468 (67.7%) a Household with any of following: (1) reported a previous fire, (2) use wood as primary source of heat, (3) used wood fireplace and/or wood stove during past winter, and (4) at least one occupant is a current smoker. b McNemar test, p (bolded). using a wood fireplace and/or wood stove during the past winter, or presence of at least one current smoker) was assessed using the McNemar test and presented in Table 2. A statistically significant disagreement (p ) was found between perceived risk and actual risk of home fire. Of 272 households with high actual risk, only ten (3.7%) reported that they perceived a high risk of home fire, and the majority (64.0%) reported perceived low or very low risk. Perceived Risk of Household Fire and Fire Escape Plans Table 3 presents the adjusted odds ratios (ORs) of households having versus not having a fire escape plan. Compared to households with respondents who perceived low or very low risk of home fire, those households with respondents who perceived a high or very high risk had 3.5 times greater odds of having a fire escape plan and 5.5 times greater odds of discussion or practicing their plan. Households with respondents who perceived an average risk of home fire had slightly increased odds of having a fire escape plan and discussion or practicing their plan (OR 1.21, 95% confidence interval [CI] , and OR 1.37, 95% CI , respectively). Households with an actual Table 3. Perceived fire risk and escape plan in Iowa rural homes (n 691 households) Having fire escape plan (n 691) Adjusted a OR (95% CI) Practicing plan (n 288) Adjusted a OR (95% CI) Perceived fire risk High 3.53 ( ) 5.51 ( ) Average 1.21 ( ) 1.37 ( ) Low Actual fire risk b High 1.30 ( ) 1.05 ( ) Low a Adjusted for home ownership, location, marital status, income, and education. b Household with any of following: (1) reported a previous fire, (2) use wood as primary source of heat, (3) used wood fireplace and/or wood stove during past winter, and (4) at least one occupant is a current smoker. CI, confidence interval; OR, odds ratio. high risk of home fire were associated with slightly greater odds (OR 1.30, 95% CI ) of having a fire escape plan, but not with practicing the plan (OR 1.05, 95% CI ), compared to those households with low actual risk of home fire. Discussion The prevalence of households with a fire escape plan in the U.S. is estimated to be 53% to 70%. 11,12,16 The findings from this study, however, indicated that only 42% of rural households reported having a fire escape plan. Rural areas are isolated, and rural households may thus have less access to fire safety information or programs. Having a fire escape plan is just one component of a household fire safety program, and is not sufficient by itself to ensure protection from fire-related deaths or injuries. 5,9 Practicing the plan is an essential step that will ensure household members understand the plan, reinforce what to do if the plan must be implemented, and also provide an opportunity for the household to justify the plan based on the home conditions and residents needs. 7 The findings that less than one fourth of studied households have discussed or practiced a fire escape plan suggest that future interventions on fire escape plans should emphasize not only the plan design, but also the plan practice in order to effectively prevent deaths and injuries from home fires. Previous studies have shown that living in a household with a child was associated with practicing a fire escape plan. 11 Our study also found that households with children were associated with both having and practicing a fire escape plan. Specifically, nearly 75% of households with children aged 5 to 17 reported having a fire escape plan, and 85% of households with children aged 5 reported that they had discussed or practiced the plan. Several factors may contribute to these results. Because of the high fire-related death and injury rate among children, and their inability to exit a dwelling under highly stressful situations such as home fires, 9 parents and/or care providers may be naturally motivated to develop and/or practice a fire escape plan to protect their children from home fire. Additionally, 10 American Journal of Preventive Medicine, Volume 30, Number 1

5 What This Study Adds... Previous studies show that the proportion of households reporting a fire escape plan is low. Homes in rural areas have a higher fire death rate. This article reports the results from an inperson survey to rural households regarding home fire safety practice. The study found perception of high risk for home fire, rather than actual risk, was more strongly associated with whether a household would develop or practice a fire escape plan. children may initiate fire safety planning as the result of successful elementary-school fire safety programs. 17,18 The results of this study also revealed that households with elderly or disabled persons were less likely to have or practice a fire escape plan. This group is an important prevention focus because lack of mobility due to age or disability has been identified as an important barrier in escaping a fire. 5,6,16 Future intervention efforts on fire escape planning should examine various strategies for households with residents who require special assistance, especially those households with elderly or disabled persons. 19 Consistent with previous research on how health beliefs predict changes in behavior, 13,14,20 this study found that the perception of high risk for a home fire, rather than an actual risk, is more strongly associated with whether household residents will take steps to lower their risk by developing or practicing a fire escape plan. The findings that residents who perceived a high risk of home fire were much more likely to develop and practice a fire escape plan, suggest that perception is an important determinant in leading to fire-related protective behaviors. Although a perceived high risk of home fire was associated with the presence and practice of fire escape plans, only 20 household respondents (2.9%) in our study perceived a high risk of home fire. The majority of respondents were either not aware or denied the risk of home fire. In fact, 64% of respondents with high actual risk of fire perceived their fire risk as low or very low. This perception may be a barrier to developing or practicing a fire escape plan, and this is most concerning in households that have a high actual risk of fire. Rural households in general are at greater risk of fire-related deaths and injuries than homes in urban areas because of a greater use of alternative heating equipment, a higher proportion of homes made of wood, and a slower emergency response in extinguishing fires. 2,8,21 Therefore, it is especially crucial to educate rural residents by increasing their awareness of potential risks of home fire. Intervention efforts aimed at modifying the residents health beliefs or perceptions may be an important step in developing more effective programs in motivating residents to take preventive actions. The presence and practice of fire escape plans reported in this study were based on self-report; these variables may be subject to social desirability bias and thus may have been over-estimated. However, there are few other options for measuring the variables used in this analysis. In addition, because of differences in age, education level, and other personal characteristics among the household members, the reported perceptions on risk of home fire may not reflect the perceptions of other members in the same household. Moreover, because several other contributing factors (e.g., cooking, space heaters, old electrical systems, or frequent use of candles) to actual risk of home fire were not collected in this study, our estimation of actual risk of home fire is conservative. Finally, the relationship between perceived risk of home fire and developing or practicing a fire escape plan may have been biased because of the nature of the cross-sectional design. In conclusion, this study found that 42% of rural households reported having a fire escape plan. Of those households with a plan, less than two thirds of respective occupants discussed or practiced the plan, which means less than a quarter of study households are practicing a fire escape plan. Further studies are needed to identify why so few households have developed fire escape plans and why even fewer practice the fire escape plans. Future fire safety interventions should increase household residents awareness of their risk of home fire. Different strategies may also be developed for those households in which the occupants lack the ability to escape because of age or other cognitive or physical limitations. Developing and practicing escape plans are essential to greatly reduce fire deaths and enhance the chance to escape from fire if a fire occurs. Future intervention efforts should also consider formulating and practicing the escape plan as part of the correct use and maintenance of smoke alarms, in addition to acquisition, installation, and maintenance of the alarms, in preventing deaths and injuries from home fires among rural households. This work was supported by the University of Iowa Injury Prevention Research Center, funded by the Centers for Disease Control and Prevention (CDC)/National Center for Injury Prevention and Control (CDC CCR ), and the Great Plains Center for Agricultural Health, funded by the CDC/National Institute of Occupational Safety and Health (U07/CCU706145), both housed in the University of Iowa, College of Public Health, Department of Occupational and Environmental Health. No financial conflict of interest was reported by the authors of this paper. January 2006 Am J Prev Med 2006;30(1) 11

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