***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives —To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households . Setting —The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership . The target population included low income and rental households and households with elderly persons or young children . Methods —Forty wards , averaging 4000 households each , were r and omised to intervention or control status . Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods . Recipients provided data on household age distribution and housing tenure . Programme costs were documented from a societal perspective . Data are being collected on smoke alarm ownership and function , and on fires and related injuries and their costs . Results —Community and paid workers distributed 20 050 smoke alarms , potentially sufficient to increase smoke alarm ownership by 50 % in intervention wards . Compared with the total study population , recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older .  Total programme costs were £ 145 087 . Conclusions —It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated , multicultural , material ly deprived community . The programme 's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries , and its cost effectiveness , are being evaluated as a r and omised controlled trial A prospect i ve study was design ed to evaluate the effects of education on the incidence of pediatric scald burns .  Demographic data from our Trauma Registry identified the Zip code area of greatest risk . Eighty of 121 families with children in a large rental property were chosen r and omly for the education program . Twenty of these families also had an anti-scald device installed in the bathtub  faucet ; all had two or more children under age 5 years . Families were surveyed before and after intervention . Safety knowledge improved post-education as judged by correct survey responses . Although 90 % of the families had water heaters set at " warm " ( < or = 120 degrees F ) , the actual temperature at the tap was above 130 degrees F in 71 % . The anti-scald devices did work , but at 9 months all but one had been removed because of sediment buildup , which prevented water flow . In the year of the study , the number of scald burns from the target Zip code area decreased from 15 to 12 . This was a pilot project for programs that can test public response to general safety education . An anti-scald device in conjunction with education works well in theory , but a better device needs to be engineered . In view of discrepancies between water heater setting s and tap water temperature , housing authorities could play a vital role in implementing safety measures Abstract Objective : To assess the effectiveness of safety advice at child health surveillance consultations , provision of low cost safety equipment to families receiving means tested state benefits , home safety checks , and first aid training on frequency and severity of unintentional injuries in children at home . Design : Cluster r and omised controlled trial . Setting : 36 general practice s in Nottingham . Subjects : All children aged 3 - 12 months registered with participating practice s. Interventions : A package of safety advice at child health surveillance consultations at 6 - 9 , 12 - 15 , and 18 - 24 months;provision of low cost safety equipment to families on means tested state benefits ; and home safety checks and first aid training by health visitors . Outcome measures : Primary outcomes measures were frequency and severity of medically attended injuries . Secondary outcome measures were self reported safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk of injury and risk of hazards assessed by postal question naire at baseline and follow up at 25 months . Results : At baseline , both groups had similar risk factors for injury , sociodemographic characteristics , safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk . No significant difference was found in frequency of at least one medically attended injury ( odds ratio 0.97 , 95 % confidence interval 0.72 to1.30 ) , at least one attendance at an accident and emergency department for injury ( , 0.76 to 1.37 ) , at least one primary care attendance for injury ( 0.75 , 0.48 to 1.17 ) , or at least one hospital admission for injury ( 0.69 , 0.42 to 1.12 ) . No significant difference in the secondary outcome measures was found between the intervention and control groups . Conclusions : The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home , and larger trials are required to assess the effect on more severe injuries Abstract Objective : To assess effectiveness of general practitioner advice about child safety , and provision of low cost safety equipment to low income families , on use of safety equipment and safe practice s at home . Design : R and omised , unblinded , controlled trial with initial assessment and six week follow up by telephone survey . Twenty families from intervention and control groups were r and omly selected for a home visit to assess validity of responses to second survey . Setting : A general practice in Nottingham . Subjects : 98 % ( 165/169 ) of families with children aged under 5 years registered with the practice . Interventions : General practitioner safety advice plus , for families receiving means tested state benefits , access to safety equipment at low cost . Control families received usual care . Main outcome measures : Possession and use of safety equipment and safe practice s at home . Results : Before intervention , the two groups differed only in possession of fireguards . After intervention , significantly more families in intervention group used fireguards ( relative risk 1.89 , 95 % confidence interval 1.18 to 2.94 ) , smoke alarms ( 1.14 , 1.04 to 1.25 ) , socket covers ( 1.27 , 1.10 to 1.48 ) , locks on cupboards for storing cleaning material s ( 1.38 , 1.02 to 1.88 ) , and door slam devices ( 3.60 , 2.17 to 5.97 ) . Also , significantly more families in intervention group showed very safe practice in storage of sharp objects ( 1.98 , 1.38 to 2.83 ) , storage of medicines ( 1.15 , 1.03 to 1.28 ) , window safety ( 1.30 , 1.06 to 1.58 ) , fireplace safety ( 1.84 , 1.34 to 2.54 ) , socket safety ( 1.77 , 1.37 to 2.28 ) , smoke alarm safety ( 1.11 , 1.01 to 1.22 ) , and door slam safety ( 7.00 , 3.15 to 15.6 ) . Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others . Conclusions : General practitioner advice , coupled with access to low cost equipment for low income families , increased use of safety equipment and other safe practice s. These findings are encouraging for provision of injury prevention in primary care . Key messages We assessed the effectiveness of general practitioner advice about child safety , and provision of low cost safety equipment to low income families , on safe practice s at home The intervention increased safe behaviour and use of safety equipment  The intervention was equally effective in families receiving means tested benefits as in those not receiving benefits The effectiveness of this intervention should be evaluated over longer periods , in other practice s , and when delivered by other members of the primary healthcare In King County , Washington , during 1985 - 1986 , 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions result ing in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner 's Office . Two age- and sex-matched controls were selected for each case , one through r and om digit dialing and the other from children undergoing appendectomy .  Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects . Children living in multifamily dwellings had a risk for injury that was 5.5 times greater than children living in single family homes ( 95 % confidence interval 2.5 - 12.3 ) . In general , areas with busier streets ( greater posted vehicle speeds and /or greater traffic volumes ) were associated with increased risk for pedestrian injuries . The lack of pedestrian crossing devices , crosswalks , or sidewalks , however , was not associated with an increased risk . When the analysis was restricted to the 23 cases injured in front of their homes and their controls , risks were not elevated for any of the street or traffic characteristics . The small size of the study and the lack of relevant information for many subjects limited our ability to adjust for the likely confounding influence of other household/environmental factors . Thus , these results should be viewed as suggestions for future investigations of the causes of childhood pedestrian injuries Abstract Objective : To apply a measure of exposure to injury risk for schoolchildren aged 11 - 14 across a population and to examine how risk factors vary with sex , age , and affluence . Design : Self completion question naire survey administered in schools in May 1990 . Setting : 24 schools in Newcastle upon Tyne . Subjects : 5334 pupils aged 11 - 14 , of whom 4637 ( 87 % ) completed the question naire . Results : Boys were exposed to greater risk than girls in journeys to places to play outdoors : they took longer trips and were more likely to ride bicycles ( relative risk 5.30 ( 95 % confidence interval 4.23 to 6.64 ) and less likely to travel by public transport or car .  Younger pupils ( aged 11 - 12 ) were less exposed to traffic during journeys to and from school : their journeys were shorter , they were less likely to walk ( trip to school , relative risk 0.88 ( 0.83 to 0.94 ) , and they were more likely to travel by car ( trip to school , relative risk 1.33 ( 1.13 to 1.56 ) ) or school bus ( 1.33 ( 1.10 to 1.62 ) ) . Poorer children were exposed to greater risk than affluent children ( from families that owned a car and a telephone ) : they were less likely to travel to school by car ( relative risk 0.26 ( 0.20 to 0.33 ) ) or to be accompanied by an adult ( 0.39 ( 0.32 to 0.48 ) ) . Conclusion : Injury risk data can provide useful information on child injury prevention and can be used to identify priorities and target re sources for injury prevention on a citywide scale or for an individual school Objective —To evaluate the effectiveness of a skills training program in improving safe cycling behavior , knowledge , and attitudes in young children . Methods — Grade 4 children from six elementary schools in East York ( a borough of Metropolitan Toronto ) participated . The intervention — playground based instruction on bicycle h and ling skills by certified instructors — was r and omly allocated to three schools . Altogether 141 children participated : 73 in the intervention group and 68 in the control group , with follow up evaluations available on 117 ( 83 % ) . The primary outcome was safe cycling behavior ( straight line riding , coming to a complete stop , and shoulder checking before a left turn ) . A self report question naire collected data on knowledge and attitudes . Baseline assessment s were made in June , with follow up evaluations in September , 1995 . Results —The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively , were : straight line riding ( 90 % v 88 % ; p=0.782 ) , coming to a complete stop ( 90 % v 76 % ; p=0.225 ) , and shoulder checking ( 0 % v 2 % ; p=1.000 ) . Over time ( from baseline to follow up ) children in both groups were more likely to maintain straight line riding , less likely to ride on the sidewalk , and less likely to consider that a car had more right to the road . Conclusions —This brief skills training program was not effective in improving safe cycling behavior , knowledge , or attitudes among grade 4 children In a prospect i ve trial at two hospitals , 78 of 136 couples received a special 30-minute curriculum  consisting of a lecture , a motion picture demonstrating the consequences of not using child car safety seats , and a question - and -answer session . Four to six months postpartum all parents were interviewed by telephone . When asked how their child rode during the most recent car trip , 96 % of parents who received the special curriculum said they used a crash-tested child car safety seat , compared with 78 % of those who had not received the curriculum . At hospital B , where parents reported demographic factors often associated with low compliance ( eg , lower income , low use of seat belts , lower educational level ) , compliance rose from 60 % before curriculum to 94 % after curriculum ( P<.01 ) . A car safety curriculum added to prenatal classes will increase parents ' use of child car safety seats . Obstetricians and those managing prenatal care should assume a role in educating expectant parents about child passenger safety . ( Obstet Gynecol 65:312 , 1985 HYPOTHESIS Young children can learn safety behavior in the public school system . These children will modify family seat belt use . SETTING DESIGN : This is a prospect i ve cohort analytic study conducted in a 50,000 square mile regionalized trauma center referral area . METHODS A school-based injury prevention program targeting kindergarten through second- grade ( K-2 ) students addressed four aspects of traffic safety : seat belt use , pedestrian and bicycle safety , school bus safety , and unsafe rides . After inservice instruction , teachers taught the program over a 10-week period . A simultaneous community traffic safety program was conducted through the media .  Family seat belt use  was monitored by blinded observation at six study schools and one control school . Income level 
    Output:
    
The literature was not evenly spread across different injury types and did not reflect the burden of injury .
There is a paucity of evidence relating to the prevention of  child pedestrian injury .
Without such evidence , it remains difficult for those involved in health promotion to know how to design and target interventions to address inequalities in child injury rates