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The newspaper of The Johns Hopkins University August 20, 2007 | Vol. 36 No. 42
Baltimore Inner-City Homes Unsafe for Young Children, Study Finds

By Katerina Pesheva
Johns Hopkins Medicine

Infants and young children living in Baltimore's inner-city houses are at risk for serious perils, including fires, falls and poisoning, according to a small but revealing study from the Johns Hopkins Children's Center. A survey of 32 urban homes and their residents found that many lacked functioning fire alarms, staircase gates and safe storage for medications, researchers report in the August issue of Pediatrics. Fires, falls and poisonings are the top causes of childhood home injuries in Baltimore.

The study of homes found that:

Ninety-seven percent had smoke detectors, but only half had a working one on each level.

None had staircases blocked correctly.

Only 17 percent had adult medications stored safely in a locked place.

Nearly two-thirds had staircases too narrow and a banister design that wouldn't allow a gate to be fitted across the top of the stairs; one-third would not accommodate a gate at the bottom of the stairs.

Nearly 20 percent had recognized environmental hazards such as using a gas stove for heat.

Two of the 32 had exposed wires in the walls.

Two had broken banisters or railings.

Not using home-safety devices such as stair-blocking gates, fire detectors and medicine- cabinet locks makes these homes dangerous for youngsters, researchers said. Barriers, they point out, include poverty and the structural design of older urban homes that often doesn't allow for proper installation of such devices.

"There are many factors that come into play here, and parental knowledge and financial situation are just part of the problem," said study lead author Kimberly Stone, a pediatrician at the Johns Hopkins Children's Center. "Clearly, the design of older urban homes and the lack of uniform measures to ensure home safety also play a role."

Study participants — 32 low-income, mostly unemployed pregnant women or mothers of children younger than 1 year from inner-city Baltimore — received information on safety products and practices and were given coupons to buy fire alarms, stair gates and medicine-cabinet locks. Researchers then interviewed the mothers about their home-safety practices and visited their homes to observe firsthand the use of safety products. Researchers found that parents tended to over-report their use of fire and smoke alarms, stair gates and cabinet locks, and many failed to use or install these products correctly. Researchers said they suspect that the study, albeit small, probably reflects patterns typical of Baltimore City's impoverished urban pockets.

"The take-home message for us as primary-care pediatricians is that we can't simply ask parents if their homes are childproof," Stone said. "We need to be probing and ask specific questions about stair gates, fire alarms, medication storage, as well as about the state of repair and design of the home."

The problem should be addressed on a macro level as well, she said.

"We need to do more than hand out a free fire alarm and a pamphlet," Stone said. "We need legislators, housing authorities, landlords and manufacturers of safety products to step up to the plate and help ensure compliance."

For example, she said, laws should require landlords to provide medication lock boxes, and install and maintain smoke alarms with lifelong lithium batteries, which may improve safety. Also, requiring manufacturers to design gates that fit narrow staircases in urban homes may help reduce falls.

Past research indicates that more than 90 percent of fatal injuries of children younger than 1 year happen in the home.

The study was funded in part by the Thomas Wilson Sanitarium of Baltimore and by the U.S. Department of Health and Human Services.

Other researchers in the study are Emmanuella Eastman and Janet Serwint, both of the Johns Hopkins Children's Center; Andrea Gielen, Johns Hopkins Bloomberg School of Public Health; Barbara Squires, Baltimore City Health Department; and Glenda Hicks, Baltimore City Healthy Start Program.


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