Use of household safety devices among South Texas Colonia Residents Carrillo Zuniga, Genny M.D., M.P.H., M.S.P.H., Sc.D.', Mier, Nelda.^ Ph.D., Seol, Yoon Ho., Ph.D.,^ Zuniga, Miguel A., M.D., Dr.P.H." 'Department of Environmental and Occupational Health, School of Rural and Public Health, Texas A&M Health Science Center, McAllen, TX •^ Department of Social and Behavioral Health, School of Rural and Public Health, Texas A&M Health Science Center, McAllen, TX ^Department of Health Informatics, School of Allied Health Sciences, Medical College of Georgia, Augusta, GA "Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, McAllen, TX ABSTRACT We investigated the prevalence of home safety hazards among Hispanic households with young children living in underserved low income neighborhoods known as colonias in Hidalgo County at the Texas-Mexico Border. The methodology followed was a cross-sectional, non-randomized pilot study using survey-based responses. The sample consisted of 60 colonia households with Hispanic children less than 6 years of age. Trained community health workers also known as "promotoras" identified the household parents and administered the survey. The results showed that 90 percent of the children's parents considered that injury prevention is important. However, 24 families (40%) did not use electrical outlet plugs; 63.3% did not have smoke detectors; 80% did not have fire extinguishers; and 45% did not have stove guards. The number of home hazards ranged from 2 to 15 out of 27 possible hazards (mean=8.5, SD=3.4). This pilot study suggests that the colonia population is at risk of unintentional injuries due to inadequate home safety practices. There is a need to promote home safety through education interventions for children and their families in the Texas-Mexico border colonias. Key terms: home safety, colonias, children safety. INTRODUCTION Unintentional childhood injury is the leading cause of mortality and morbidity in children aged 1-4 years in the United States.' Most childhood injuries occur at home, and many are preventable through home safety modifications, including removal of hazards and adequate use of prevention devices (e.g., smoke detectors and electrical outlet plugs).''^ Health care costs related to fatal injuries in 2002 were $1.1 billion.'"^ During 2000-2005, the death rate varied to some extent between different age groups (less than 1 year of age, 24.4 per 100,000; 1-4, 10.8 per 100,000; 5-9, 6.0 per 100,000; and 10-14, 7.2 per 100,000, respectively).' In addition, males had higher death rates than females.' Furthermore, research underlines an ethnic disparity. Agran et al. (1996) reported the higher injury rates among Hispanics (60%) compared to non24 Hispanic white children. They also concluded that the disparity may be related to differences in exposure to various injuries, parenting practices, family size, and language.* Also, the death rate in 2000-2005 was highest for American Indian or Alaska Native males (29.8 per 100,000). ' Among females, only American Indian or Alaska Native females had higher death rates than the national average. The rate was lowest in Asian or Pacific Islander female children (5.4 per 100,000).6 Due to the preventable nature of injuries at home and the high cost of caring for injuries, this study aims to determine the use of home safety devices in underserved, low-income households with children in the Rio Grande Valley in South Texas. METHODS Study design and participants: This was a cross-sectional, non-randomized exploratory and self-reported survey based study. It was conducted in South Texas from September to December 2008. The households were located in two colonias in Cameron and Hidalgo Counties, Texas. Cameron County is second among the top ten poorest counties in the United States." Colonias are unincorporated, impoverished settlement areas along the Texas-Mexico border that often lack some of the most basic living necessities." Eligibility criteria in this study included being at least 18 years of age, Hispanic or nonHispanic white female or male head of household with one or more children (12 years of age or younger) living at home, residing in one ofthe colonias in Cameron or Hidalgo County, able to respond to a survey, and willing to participate in this study. Two promotoras (community health educators) with experience working in colonias were trained to obtain consent from participants and administer the survey through face-toface interviews in English or Spanish. Interviews were conducted at the home of participants. This study was approved by the Institutional Review Board of Texas A&M University and a gift was offered as incentive for their participation. Measurements: The survey was developed and reviewed by the research team and promotoras for readability. Information from instruments found in the literature and the American Academy of Pediatrics were used to develop the survey,'^"" which included demographic information and an assessment of self-reported home safety. The survey included 24 possible home hazards that were categorized by five types: equipment, window, fire & bum, choking, and poisoning. Examples of hazards are listed in tables 1 and 2. Respondents had to answer each question with "yes", "no," or "not applicable". Data and statistical analyses: Data from the survey were analyzed using SPSS version 16.0 for Windows (SPSS Inc, Chicago, IL). Descriptive statistics were used to characterize the proportions of different hazards in the households. In addition, to assess the difference in the proportions ofthe hazards in the households by different socio-demographic factors, the chi-square/Fisher's exact test was conducted with respect to five hazard types as described above. The socio-demographic factors included the number of children in the household, insurance coverage for children, parents' education, household income, and whether parents were working outside. TPHA Journal Volume 62, Issue 1 RESULTS A majority of the households were Hispanic, with heads of household with less than a high school education, married mothers that stayed at home, and had children 6 years of age or younger. More than half of the families (58,3%) reported an annual income of less than $9,999. Ninety percent of the respondents considered that home safety was important, but more than one third of the families did not use electrical outlet plugs; two-thirds of the families did not have smoke detectors; the majority did not have fire extinguishers; more than half of the families did not have a poison control number magnet on the refrigerator; and almost half of the respondents did not have stove guards. Table 2 shows the hazards by type and the prevalence of each. The number of home hazards ranged from 2 to 15 out of 24 possible hazards (mean=8,5, SD=3,4). Correlations between 24 different possible hazards encountered in each household were analyzed but no significant correlation was found, Chi squared analysis was performed however; no relationships were significant at a statistical level of p 15 cm No window guards Fire & Burn No appropriate temperature regulator set for water heater No stove guards No smoke detector No fire extinguisher Matches / lighters within children's reach No fire escape plan Choking Choking hazards within children's reach Choking hazards in bedrooms Choking hazards in living rooms Poisoning Beauty products within children's reach Cleaning supplies within children's reach No poison control number on refrigerator No child-resistant lids for medications Easy access to bathroom beauty supplies / medications No child-resistant lids on household cleaning supplies Easy access to household cleaning supplies 24 (40%) 8 (13.3%) 19 (31.7%) 24 (40%) 42 (70%) 10 (16%) 7 (11.7%) 8 (13.3%) 6 (10%) 27 (45%) 38 (63%) 48 (80%) 4 (6.7%) 13(21.7%) 9 (15%) 6(10%) 5 (8.3%) 6 (10%) 7 (11.7%) 37 (61.7%) 25 (41.7%) 10 (16.7%) 14 (23.3%) 10 (16.7%) Table 3. Number of households with 2 or more hazards by the hazard type and sociodemographic characteristics Characteristic Equipment Window Fire & Burn Choking Poisoning Number of children 10(34.5%) 7(24.1%) 20(69%) 9(71%) 12(41.4%) = 3 (n=31) Insurance coverage for child Yes (n=49) 16(32.7%) 12(24.5%) 35(71.4%) 14(28.6%) 23(47%) No (n=11 ) 4 (36.4%) 3 (27.3%) 7 (63.6%) 3 (27.3%) 5 (45.5%) Education, Mother < high="" school="" (n="41)" 15(36.6%)="" 10(24.4%)="" 31(75.6%)="" 10(24.4%)="" 18(44%)="">= High School (n=19) 5(26.3%) 3(15.8%) 11(57.9%) 7(36.8%) 10(52.6%) Education, Father + < high="" school="" (n="44)" 18(40.9%)="" 12(27.3%)="" 32(72.7%)="" 10(22.7%)="" 20(45.5%)="">= High School (n=15) 1(6.7%) 3(20.0%) 9(60.0%) 6(40.0%) 7(46.7%) Mother works outside of the house Yes (n=14) 5(35.7%) 6(42.9%) 8(57.1%) No (n=46) 15(32.6%) 9(19.6%) 34(73.9%) Father works outside of the house Yes (n=46) 16(34.8%) 14(30.4%) 32(69.6%) No (n=9) 2 (22.2%) 0 (0%) 8 (88.9%) Income < $9,999="" (n="35)" 10(28.6%)="" 7(20%)="" 26(74.3%)="" 11(31.4%)="" 17(48.6%)="">= $9,999 (n=24) 9(37.5%) 8(33.3%) 16(66.7%) 6(25%) 10(41.7%) Marital status Married (n=48) 14(29.1%) 12(25%) 35(72.9%) 12(25%) 22(45.8%) Not married (n=12) 6(50%) 3 (25%) 7(58.3%) 5(41.7%) 6(50%) 6 (42.9%) 7 (50%) 11 (23.9%) 21 (45.7%) 13(28.3%) 20(43.5%) 2 (22.2%) 4 (44.4%) Chi-Square test / Fisher's exact test, p < 0.05 (note: 1 or more hazards as the cut-off point for choking) tpha joumal volume 62 issue 1 27 copyright of texas public health journal is the property of texas public health association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. however, users may print, download, or email articles for individual use. 0.05="" (note:="" 1="" or="" more="" hazards="" as="" the="" cut-off="" point="" for="" choking)="" tpha="" joumal="" volume="" 62="" issue="" 1="" 27="" copyright="" of="" texas="" public="" health="" journal="" is="" the="" property="" of="" texas="" public="" health="" association="" and="" its="" content="" may="" not="" be="" copied="" or="" emailed="" to="" multiple="" sites="" or="" posted="" to="" a="" listserv="" without="" the="" copyright="" holder's="" express="" written="" permission.="" however,="" users="" may="" print,="" download,="" or="" email="" articles="" for="" individual="">