Shane T. Diekman

Comparison of binge drinking among pregnant and nonpregnant women, United States, 1991-1995

Our goal was to measure the pregnancy-related reduction in the prevalence of reported binge drinking (>/=5 alcoholic drinks per occasion) and to characterize binge drinkers among pregnant and nonpregnant women aged 18-44 years, in the United States, 1991-1995. We used the Behavioral Risk Factor Surveillance System data from 46 states. We used the prevalence rate ratio between pregnant and nonpregnant women to determine the magnitude of the reduction in reported binge drinking and multiple logistic regression models to identify characteristics associated with binge drinking. Between 1991 and 1995, the prevalence of binge drinking among pregnant women increased significantly from 0.7% (95% confidence interval 0.2-0.9) to 2.9% (95% confidence interval 2.2-3.6), whereas among nonpregnant women the prevalence changed little (11.3% vs 11.2%). Over the study period pregnant women were one fifth (prevalence rate ratio 0.2, 95% confidence interval 0.1-0.2) as likely as nonpregnant women to binge drink. Among various population subgroups of women, pregnancy-related reduction in binge drinking was smallest among black women and largest among women aged </=30 years and among those who had quit smoking. Among pregnant women binge drinking was independently associated with being unmarried, being employed, and current smoking. Among nonpregnant women binge drinking was independently associated with age </=30 years, nonblack race, college level education, being unmarried, being employed or a student, and current smoking. Clinicians serving women of childbearing age need to be aware of the recent rise in reported binge drinking during pregnancy, as well as the known risk factors for binge drinking.

Ecological level analysis of the relationship between smoking and residential-fire mortality

Objectives: To examine the association between tobacco smoking and residential-fire mortality and to investigate whether this association is explained by the confounding effects of selected socioeconomic factors (ie, educational attainment and median household income). Design: An ecological analysis relating state-level residential-fire mortality to state-level percentages of adults who smoke was conducted. Negative binomial rate regression was used to model this relationship, simultaneously controlling for the selected socioeconomic factors. Results: After educational attainment and median household income had been controlled for, smoking percentages among adults correlated significantly with state-level, population-based residential-fire mortality (estimated relative rate for a 1% decrease in smoking = 0.93; 95% CI 0.89 to 0.97). Conclusions: Mortality from residential fires is high in states with high smoking rates. This relationship cannot be explained solely by the socioeconomic factors examined in this study.

Preventing Unintentional Injury: A Review of Behavior Change Theories for Primary Care

Many injuries are preventable, and most have a behavioral component on their causal pathway. However, far more effective use of theory-based approaches to behavioral risk management is needed, which remains a challenge for practitioners. This review discusses theories and applications of behavioral change principles for use in primary care and community health settings. Injury-related behaviors cannot be separated from the environments in which they take place. Preventing unintentional injuries requires an understanding of patient knowledge, attitudes, and behaviors, as well as community norms, that lead to injuries. In addition to the role clinicians have in counseling for lifestyle change to prevent injuries, reducing exposure of patients to hazardous products and environments, and fostering social and organizational change to improve public policy, legislation, and enforcement to prevent injuries are equally important. Challenges lie ahead in testing the applicability of these theories in primary care settings and in predicting and understanding injury-related behaviors of patients. Training more medical practitioners in the epidemiology of injury and the science of injury control is an urgent priority. Success will partly depend on how behavioral theories can be integrated into practice and adapted through clinical experience to benefit patients.

Disparities in the prevalence of smoke alarms in U.S. households: Conclusions drawn from published case studies

INTRODUCTION Deaths from fires and burns are a leading cause of fatal home injury in the United States. Smoke alarms are one of the most effective interventions to prevent residential fire deaths. Nationwide, more than 95% of homes are estimated to have at least one smoke alarm. There is evidence that homes at highest risk of fire deaths lag behind national averages in smoke alarm use and maintenance. METHOD We compiled a comprehensive list of published studies that focus on smoke alarm prevalence in high-risk homes. Our findings show that there are substantial gaps in both smoke alarm presence and functional status between high-risk homes and national average estimates. CONCLUSIONS To save more lives, improved efforts are needed to reduce the disparity in smoke alarm prevalence and functional use in the United States.

A Qualitative Evaluation of Fire Safety Education Programs for Older Adults

This article presents a qualitative evaluation of six fire safety education programs for older adults delivered by public fire educators. Our main aims were to explore how these programs are implemented and to determine important factors that may lead to program success, from the perspectives of the public fire educators and the older adults. For each program, we interviewed the public fire educator(s), observed the program in action, and conducted focus groups with older adults attending the program. Analysis revealed three factors that were believed to facilitate program success (established relationships with the older adult community, rapport with older adult audiences, and presentation relevance) as well as three challenges (lack of a standardized curriculum and program implementation strategies, attendance difficulties, and physical limitations due to age). More fire safety education should be developed for older adult populations. For successful programs, public fire educators should address the specific needs of their local older adult community.

Home Fires in America: Progress and Opportunities

Fires are the third leading cause of unintentional home injury deaths. Young children and older adults are especially at risk for home fire deaths. Other high-risk groups include males, people with physical disabilities, people impaired by alcohol or other drugs, and people living in rural communities or in poverty. Lifestyle decisions (eg, choosing products) and behaviors (eg, maintaining working smoke alarms or smoking) can influence the risk of being in and surviving a home fire. Fortunately, medical practitioners can foster safer home environments for their patients by promoting effective fire prevention and protection strategies to reduce home fire risks. This review highlights the association between lifestyle and home fires with a focus on achievable lifestyle changes that can prevent fires and fire-related injuries and deaths.