Is the Slogan

WORKING
SMOKE
ALARMS
SAVE LIVES
Morally Correct ?
AT TA C H M E N T S

IsTheSloganWorkingSmokeAlarmsSaveLivesMorallyCorrect?_Attachments.pdf | Published: 25 August 2016

Check for Latest Version at: www.Scribd.com/doc/322141156
1 of 2

Master Document | Page 1

CONTENTS
Description

Page

Cover Page

Summary (this page)

Attachments
1. First Alert BRK | Photoelectric-Specific Legislation

3-4

2. Domestic Smoke Alarms - A Guide for Specifiers

5-6

3. Ionization and Photoelectric Smoke Alarms in Rural Alaskan Homes

7 - 10

4. Randomized Controlled Trial of Ionization and Photoelectric Smoke Alarm Functionality

11 - 17

SUMMARY
25 August 2016
Th World Fire Safety Foundation (WFSF) report, Is the Slogan Working Smoke
Alarms Save Lives Morally Correct? is at:
www.Scribd.com/doc/322111021
This report challenges the decades old fire industry slogan: 'Working Smoke Alarms
Save Lives'.
The following pages cotain the four attachments to the above report that were
contained in the original email sent from Boston Fire Chief Jay Fleming
(see page 6 of the master report at: www.Scribd.com/doc/322111021).

IsTheSloganWorkingSmokeAlarmsSaveLivesMorallyCorrect?_Attachments.pdf | Published: 25 August 2016

Check for Latest Version at: www.Scribd.com/doc/322141156
2 of 2

Master Document | Page 2

3901 Liberty Street Road Aurora, Illinois 60504-8122

Telephone: 630.851.7330 Fax: 630.851.9309

To:

Local Fire Service Administration

From: First Alert

Date: July 17, 2008
Re:

Photoelectric-Specific Legislation

The Vermont State Legislature recently approved Senate Bill 226 requiring
photoelectric-type smoke alarms to be installed in new and existing single-family homes.
This bill was signed by Governor Jim Douglas on Thursday May 29, 2008 for passage into
law. Massachusetts already abides by a state law that mandates the usage of photoelectric
smoke alarms near specified rooms. Similar legislation is pending in Tennessee House Bill
2528 and Senate Bill 2600. Smoke sensing technology type policy discussions are also being
discussed in Indiana, Iowa, Ohio, Utah, and California.

Clearly there is a growing consensus within state legislatures as well as the fire
service community that favors photoelectric technology. First Alert has played a crucial
role in a tremendous industry effort to inform consumers on the importance of the home
safety technologies; and more specifically the differences between smoke sensing
technologies. In light of recent studies and ongoing industry-performed field research
regarding the comparison of photoelectric and ionization smoke alarms, First Alert is
offering the following two scientifically substantiated determinations:
1. Field research indicates photoelectric smoke alarms exhibit significantly
fewer nuisance alarms than ionization smoke alarms.1 2
2. To silence a triggered smoke alarm, about 22% of consumers will remove
the battery, leaving the alarm inoperable and potentially putting the
residence and its occupants at risk should a true fire occur. 3
Considering photoelectric smoke alarms are determined by industry experts to be
significantly less prone to nuisance alarm and potential disabling of the batteries by
consumers, we support and encourage fire service administration and lawmakers that are
moving toward the use of photoelectric smoke sensing technology. In addition, First Alert
aims to reassure all public safety advocates that ours is an organization that actively
supports our consumers amidst this safety-related legislation through our comprehensive
1

Cleary, Thomas. Residential Smoke Alarm Performance. Building and Fire Research Laboratory, National
Institute of Standards and Technology. UL Smoke and Fire Dynamics Seminar. November, 2007.
2
Mueller, B.A. Randomized controlled trial of ionization and photoelectric smoke alarm functionality.
Injury Prevention BMJ, 2008; 14;80-86.
3
1997 Fire Awareness/Escape Planning Study for National Fire Protection Association, Quincy, MA,
August 1997, Tables 3 & 4.

Master Document | Page 3

3901 Liberty Street Road Aurora, Illinois 60504-8122

Telephone: 630.851.7330 Fax: 630.851.9309

photoelectric product line. For your reference, our Battery Operated Photoelectric
Products include:

Photoelectric Smoke Alarms

Photoelectric Smoke Alarms with Escape Light
Photoelectric Smoke Alarms with Long Life Lithium Battery
Combination Photoelectric Smoke and Carbon Monoxide Alarm
Combination Photoelectric Smoke and Carbon Monoxide Alarm with Voice
Output Including Hazard Location
ONELINK Photoelectric Wireless Interconnected with Voice Output
Smoke Alarms
ONELINK Photoelectric Wireless Interconnected Smoke and Carbon
Monoxide Alarms with Voice Output Including Hazard Location

In addition, our Hardwired Photoelectric Product Line will support all new construction
and replacement needs:

Photoelectric Smoke Alarms with Interconnect Capability

Photoelectric Smoke Alarms with Battery Backup with Interconnect
Capability
Photoelectric Smoke Alarms with Escape Light and Battery Backup with
Interconnect Capability
Photoelectric Smoke Alarms with Voice Output Including Hazard Location
and Interconnect Capability

Few entities exist that dedicate more time and resources towards safety-related public
policy and education as effectively as the fire service. Please use this information in your
safety education efforts. You are encouraged to contact our External Communications
department with any questions or concerns. Let us be a resource for your efforts in public
safety education. For more information please contact Tom Russo of Public Relations at
(630) 499-3214.

Master Document | Page 4

"i'
t

'

I
.,1

Fire Prevention281 July/August 1995

Confusionexistsouerthe siting and choiceof domesticsmohealarml Daaid Bmdall, European TechnicalSales

Molagu of BRKBrands E"ipe Lirnited, proaid.esadaiceon how to specifi them
A new code of practice (BS 5839 : Pan 6)
should go a long way towards clarifiing
many of the issues,but until this new code is
oublished later this year, here are a few
Lsential guidelines whlch can be summarised
'liturry' - "the
right
in the form of BRK's
smoke alarm - correctly installed - in the
right place".

interconnected.
However, since the new regulations
been in place, BRK has witnes
considerabieconfusion over the installat

andapplicationof230V
Our experience shows that architects, local
gou..tt^.nt
specifiers and electrical
lngineers all display a distinct lack of
understanding over how the different ryPes
work, when this understanding should be a
moior influence over the choice of smoke
alarm specified. It can also mean the
differenie between life and death should a
smoke alarm perform incorrecdy, becauseit
has been specified and installed incorrectly.

Many people do not realise there are two

types of smoke alarm, both of which are
beiter suited to installation in panicular
parts of a dwelling. Optical (or photoelectronic) smoke alarms are designed to
react to smoke produced rypically by slow
ine fi resrather than the small burnt
:ticles produced by a fast flaming flash
:. Light pulsed from an infra-red emitter
panicles in the
the
smoke panicles
from smoke
reflected
,efleited from

ical's sensingchamberon to a Photo

receiver.The resulting signd triggers

Theopticalsmokealarm
soundercircuit.
is lesslikely to reactto the results
cooking and this makes it far more suitable
r installation near kitchens or in confined

burnt paniclesof materialtypicdly produced

in a fastflamingfire.Theseentertheionised
chamberand causea changein electricd
The slight price differentid between the
two rypes ofdarm can be bdanced out by
the elimination of false alarms being
triggered by steam/cooking from nearby
kitchens and bathrooms. Any apparent
short-term saving from instdling ionisation
alarms where optical ones are more
appropriatewould be lost ifthe installer had
to-be ."I"d back because of complaints

//ff\\
----/

ffi\DUsIcovFR

A dut ovcr and rear-facing protective g*ket arc

esential if the smoke a-lum is to be protected from
dut genemted during the construction of dwcllings

The Home Office recommendation,

BRKsuppons, for a typical two-storey house,
is that an ootical smoke darm should
fitted downstairs in the hall andan ionisati
alarm fitted upstairs on the landing.

If for whatever reason only one smoke

alarm can be installed in a dwelling' BRK
would recommend that it be installed either

,ust ou

Jthoufr-manv domesticfi res

kitche]n,ir is more likely thar

when thev do, the tenant or householder

will be oresent and aware of them
before tire smoke alarm respondF
asleep
hen the
start-anywhere but locating rhe smoke
where it is most likely to waken the
ing occupants obviously gives a heavy
erLehind a closedbedroom door a [ar
r chance of escapethan if the alarm
out of earshot downstairs.
is also important
alarms should
from bathrooms
should not be

Fire prevendon 2g

The dustcovermusr
n,
atterrhefinalclean_up
I
rneproPerry.

Domesticsmokealarms
- a guidefor sPecifiers
N THE surface, current building
regularions governing the installation
ofdomestic smoke darms seemfairly
srraightforward. The basic requirement is
that all homes completed after June 1992
slrould haveat leastone mains-powered smoke
alarm installed on each floor. If more than
one alarm is fitted then each has to be

to remember that
be sited at least 3m
and external doors.
fitted near hot air

The idealprocedure
is :
E At firct fix, contracr,
cabletothepointwhr
rnstalled_ in rhe ca
]o9., ", ccncrallya
r.>mm cablepVC/I
pamress
shouldbe m,
anuedtoiaterminal
b
connectionsshould
aJ
D At secondffx, the
sm
oe ttxed to the pattr,

meansof the resibun<

be baggedand stored
aare.Idcally,fittineof
ro the parrressshJdd
rmmediatelyprior
to ,
owner.smanualshoulc
rssuedto the househol,

ITiring in
There has also been
conf

:":l':'iT,'iro,:,:'li:'J,t"
rnrerpretedas recomriend
rr,r (Insticuteof
Electrir

iff*frui:i,1hr,**

or abovea night storageheateror

systcms
radiator.Thev shouldneverbe installed
in bath or showerrooms,boilerroomsor
garages.
When to install them
Further problems have been caused by theconfusion over the correct timing ot
installation. In a newly built dwelling, both
rypes of smoke alarm, if installed at first fix
"nd |.ft utt"ou.ted, willbe contaminated by

prior to handthesubsequentdusryactivides
oversuchasplastering,carpetingetc,leading
severenuisance alarms when the power is

)n a recent call-out to inspect'faulry'smoke

larms throughout a new housing
development, BRK's technical manager
discovered,on removing the smoke alarms'
casins, that .".f, on. was firll of
st. Thl smoke alarms had been fitted
while carpenters were still working on site
and. the-electrical contractors had not
bothered to use the dust cover and reat'
facing protective gasketwhich are supplied
with-all BRK smoke alarms. These are
essential ifthe smoke alarm is to be protected
from the dust generated by other tradesrneo'

Master Document | Page 5

l8l Juty/August1995

,]-l
I
T

Fire Prevention28 1 July/Augusr 1995

l i l
t , : ii
|
l

The dust cover musr nor be removed until

after the final clean-up before occupation of
the properry.
The ideal procedure is as follows:

, TechnicalSdles

:r reason onlY one smoke

nstalled in a dwelling, BRK
rend that it bc installedeither
re bedroom or at the toP of
houeh manY domestic fires
,.he'n, it is more likelY that
. the tenant or householder
rt and awarc of them even
roke alarm resPonds' Fires
en the houschold is asleeP
ryherebut locating the smoke
t is most likelY to waken the
heavY
oants obviouslY gives a
i a closed bedroom door a tar
:e of escapethan if the alarm
Lrshot downstairs'
lportant to remember that
,s should be sited at least 3m
athrooms and external doors'
I not be fitted near hot air
bove a night storageheater or
rev.houii never be installed
ro*ar roo-t, boiler rooms or

ren to instdl them

blems havc bccn caused bY the
otat ,h. correct timing of
ln a newlv built dwelling, both
fix
,k d"t-, if inrtdled at first
bY
ovcred, will be contaminated
entdustyactivities prior to hand, plastering,carpetingetc, leadtng
ri.ance alarms when the Power rs
t call-out to insPect'hultY smoke
hroughout a new housrng
,.,,, 6RK't technicd mgagel
smoke alarms'
, on **oti"g,tta
of
full of
was full
ottt was
ng,
ou, ,t ", *"f, one
had been fitted
:i? t-"t . "l"t-t
site
lenters were still working on
electrical contractors had not
to use the dust cover and rear,i.cdue g"sk"t which are suPPlied
BRK siroke alarms' Tbese are
Fth.rmok alatm is to be Protected
lust generated by other tradesmen'

E At first fix, conrractors should run the

cableto thepointwhere rhe alarm is to be
installed - in the case of a hallway or
room, as centrally as possible - using
1.5mm cable PVC/PVC. The alarm's
pattress should be mounted and cables
afiixed to its termina.lblock. Inrerconnect
connections should also be tested.
D At second fix, the smoke alarm should
be fixed to the pattress and tested by
meansoFthe testbutton. It should then
be bagged and stored until hand-over
date. Ideally, fitting oIthe smoke alarm
to the pattress should only take place
immediately prior to occupation. The
owner's manual should be retainedand
issuedto the householder.

'$Tiring

in

There has also been confusion over the

correct procedure ofwiring in smoke alarms
- the Building Regulations can be
interpreted as recommending the use of
IEE (Institure of Electrical Engineers)

regulations which in turn are somewhat

ambiguous. There are currently rwo points
of view. On the one hand the British
Standards Institution, backed by
recommendations from the fire industry,
suggeststhat the best method is to run a
dedicated powersource to thesmoke alarms
from the distribution box in the house
when the detectors are installed in a newbuild properry, and not via an ELCB,
However, this view has led to contention
wirh the NICEIC (National Inspection
Council of Electrical lnstailation
Contractors) recommendation which is to
wire them into the upstairslighting circuit.
The NICEIC view is that any mains power
failurewill then becomeapparentwhen the
lights Failto function.
The BSI and fire industry's view is that
should smoke alarms be wired into the
lighting circuit then power could be lost
through the failure of some other item on
the same circuit. It has always been the
policyofthe fire industryto havea dedicated
power source for their installations and this
philosophy, they believe, should be carried
through to the installation ofdomestic 230V
AC smoke alarms.

Smokc alarms should bc rcsrcd oncc each week - usually rhis is done
by prcssing thc tcst button

Regarding the rype of cable

requiredwhen installingsmoke
alarms,contractorsoft en think
they have to use FP200 fireproof cable. Although this is
the casewhen fitting'qystems'
products, there is no need to
when fitting domestic smoke
alarms. The cable BRK
recommends is tlvin and earth
lmm or l.1mm PVC/PVC
cable as the supply to the first
smoke alarm, three-core and
eanh 1.5mm PVC/PVCcable
(6423Y cable) from thereon.
It is also important to note
that the third core is the
interconnect cable and all
cableshave to be mains-rated
even though the interconnect
signal is low voltage.

Battery back-up
To appeasethe concern shown
over mains fulure, BRK also
supplies230VAC smokedarms
with DC back-up which
sustainsthe smoke darm for uo
to two yeifs in the event of a
power failure.. Concern over
mains failure is obviouslyshared
by many specifiers as 85olo of
hard-wired smoke alarm sales
are for DC back-up rypes.

Some local authorities have even adooted

'fit
now - wire later' programme using one ,
BRK's dualvoltage(230Vl99 smokealarm
The units are installed initially in batte
mode, giving immediateprotection to tenan
and are then mains-wired in at a larer date
rewiring programmes and budgets allow.
Once connected to the mains, the batte.
then provides back-up power in the event ,
a power cut and lasts approximately for
years before requiring replacement, whir
canbe carriedout during regularinspectior
BRK's tamper-proof option also dete
tenants from removing the battery when tl
smoke alarm is wired ro the mains.
Maintenance
Smoke alarms should be regularly testr
(once eachweek) - this is normally done I
pressinga testbutton. For elderlyor disablt
'tor<
tenants/householdersBRK's range of
test' smoke alarms provides a safe and ea:
way of testing which eliminates the need r
climb onto stairs or step ladders. A torc
beam is simply waved acrossa sensor.
Smokea.larms
shouldalsobecleanedonceeac
month by vacuuming over the outer caslr
with the soft brush auachment of a vacuu;
cleaner. The case c2.n also be wiped over
neessarywithaslightlydampclorhtrchamo'
If theyarebattery-powered,batreriesshouldI
changedwhen their recommendedlife is ov,
(beween one and four yearsdependingon tl
qpe). It is vital that tenants are left wir
adequateinstructionsabout how to cleanar
maintain their smoke alarms. Many loc
authorities leave'tenant maintenance card
giving instructionson what ro do, along wir
generd fire safety guidelines. The owner
manual must also be available to the tenant
On another of his site visia. BRK's technic
maner discovered a contractor had nr
bothered m read the instructions which clear,
state how the baneries should be installed an
had fitted them thewrongwayround in wer
single smoke darm in a large local authori,
refurbishment project! \7hen the power w,
switched on tenantsstartedcomplaining abor
alowregular bleep.This warns the household,
that the batteryback-up in anAC/DC smol
alarmiseitherrunningloworhasbeeninstalk
incorrecdy. The tenants also had no idea wl
the alarms were bleepingas the contracor ha
not left any maintenanceinstructions.
To assist local authorities, housin
associations and private landlords i
providing an effective mainrenant
programme, BRK has recently launched a
initiative whereby specialist personnel ha,
been trained by the company to clean an
serviceBRK's mains-powered smoke a.larn
in situ on acontractbasis.Funherinformatic
on this serviceis availablefrom the compan

Master Document | Page 6

Original Research
ABSTRACT Objective To compare rates of nuisance alarms and disconnection between ionization and

photoelectric smoke alarms. Design A prospective cohort study. Setting Four Inupiat Eskimo villages in
the Northwest Arctic Borough region of Alaska, 48 km (30 mi) above the Arctic Circle. Subjects Households in 4 communities with similar populations, number of homes, mean income, size of household, and
square footage per home. Intervention Two villages had photoelectric alarms installed (58 homes), and 2
other villages had ionization alarms installed (65 homes) in standard locations. Follow-up household surveys
were conducted after 6 months to determine rates of false alarms and detector disconnection. All of the
households that could be contacted 104/123 agreed to participate in the follow-up surveys. Main outcome
measures The proportion of households experiencing false alarms and the proportion of disabled alarms in
households in each of the test communities. Results Homes with ionization alarms had more than 8 times
the rate of false alarms as those with photoelectric alarms. Eleven of the ionization alarms (19%) were
disconnected compared with 2 of the photoelectric devices (4%). Conclusions In small rural residences,
photoelectric smoke alarms have lower rates of false alarms and disconnection. Photoelectric alarms may be the
preferred choice for dwellings with limited living space or frequent false alarms.
Between the years 1986 and 1995, an annual average of
5,000 people lost their lives and another 28,000 were
injured in US fires.1(p2) The problem for Native Americans is even worse, with a fire fatality rate that is 3.6 times
higher than the national rate of 1.28 per 100,000 people.2
Alaska has the highest fire fatality rate among states in the
United States.3 The fire fatality rate for Native Alaskans
(12.3/100,000) is 9.6 times the national rate and 3.5 times
higher than the Alaska rate for all races of 3.47 per
100,000.4 For the 19 Alaska residential fires involving 23
deaths in 1996, only 5 homes (26%) had a smoke alarm
installed, and only 1 of them (5%) was operational at the
time of the fire.5 Most rural Native Alaskans live in small
homes with electrical heating systems that do not meet
accepted industry standards. When the fact that most rural
villages have little or no fire-fighting capabilities is added,
the potential for disaster is great. This situation is not
unlike that seen in other poor rural US communities,
mobile home parks, and some apartment complexes.
Therefore, early detection and escape become essential elements in preventing fire fatalities among these populations.
A working smoke alarm has been reported to reduce
the risk of death from residential fires from 50% to
70%.6,7 There are basically 3 different types of residential
smoke alarms: the ionization alarm, the photoelectric
alarm, and the combination alarm. The US Fire Administration reports that more than 88% of the homes in the
United States have at least 1 smoke alarm installed, but
60% of the residential fire deaths occur in homes without
an operational alarm.8 According to a 1994 study of US
residential smoke alarm use, the leading cause of smoke
alarm disconnection was nuisance alarms.9 Frequent nuisance alarms can generate a dangerous sense of compla-

cency, resulting in needless fatalities. Once disconnected, a

smoke alarm is rarely reconnected, leaving residents at
increased risk of injury or death from fires.
Consumers Union tested ionization and photoelectric
alarms in 1994.10 It found that in a smoldering, smoky
fire, the ionization alarms responded in 25 to 35 minutes,
whereas the photoelectric models reacted in half that time.
The US Fire Administrations data show that the number 1 cause of fire fatalities in the United States is careless
smoking.1(p6) Hall and Harwood showed that about 70%
of the fire deaths in the United States each year are a result
of smoke inhalation rather than burns.11 Slow, smoldering
fires, such as those from cigarettes igniting a mattress or
couch, are the types most commonly associated with residential fire fatalities, yet the ionization alarms that are
found in 87% of US homes are more sensitive to flamingtype fires.12
In this prospective cohort study, we installed smoke
alarms in Alaska Native village homes to compare the
frequency of false alarms and the disconnection rates between ionization and photoelectric alarms. We hypothesized that photoelectric alarms would be associated with
lower rates of nuisance alarms. If one type of alarm has a
lower rate of false alarms, then long-term functional capability may be improved. Physician warnings and counseling of patients have been shown to be effective in creating beneficial changes in behavior.13 Clinicians can have
a tremendous effect on their patients safety by counseling
them on the use of smoke alarms, especially alarms that fit
the patients lifestyles and home environments.

Thomas M Fazzini

Injury Prevention
Specialist
Maniilaq Health Center
Kotzebue, Alaska
Ron Perkins

Director
Injury Prevention
Program
Alaska Area Native
Health Service
Anchorage
David Grossman

.....................................................................................................................................................................

Ionization and photoelectric smoke alarms

in rural Alaskan homes

Co-Director
Harborview Injury
Prevention and Research
Center
Seattle, WA
Correspondence to:
Mr Perkins

Alaska Injury Prevention

Center
PO Box 210736
Anchorage, AK
99521-0736
asc1@alaska.net
Competing interests:
None declared

West J Med
2000;173:89-92

METHODS
This was a prospective cohort study of households in
4 rural Alaskan villages. The outcomes of interest were
Volume 173 August 2000 wjm 89

Master Document | Page 7

.............................................

Original Research

the false alarm and disconnection rates of ionization

compared with photoelectric smoke alarms. The geographic area chosen for this research was 48 km (30 mi)
above the Arctic Circle in the Northwest Arctic Borough
of Alaska. This area spans 36,000 sq mi and is inhabited
by 12 Inupiat Eskimo villages with a total population
of about 6,500. Resources were available to study only
4 of the 12 communities in this region of Alaska. Selection
of the 4 villages was based on comparability among
villages in the number of homes, the square footage
per home, population, and average income. Villages,
rather than homes, were assigned to 1 of the 2 groups.
Random assignment of homes was not considered because
of ethical concerns expressed by village leaders. Two of the
communities received ionization alarms, and 2 received
photoelectric alarms, with 1 village from each category
being randomly selected from 2 distinct geographic regions. This was thought to prevent possible crosscontamination in which residents might express preferences for 1 alarm over another. Most of the homes in this
region contain less than 93 m2 (<1,000 sq ft) of living
space, and most of these villages have no fire-fighting capabilities, other than water buckets and portable fire extinguishers. All smoke alarms were provided free to residents through the Injury Prevention Program of the
Alaska Native Health Service. All of the ionization alarms
were 1 brand and model, as were all of the photoelectric
alarms.
As a result of the baseline survey, only homes that were
not built as part of a US Housing and Urban Development (HUD) project were selected to receive smoke
alarms. The HUD homes were deselected because they
had smoke alarms connected directly to the electrical circuits. The estimated number of homes needing smoke
alarms was determined through the administrative office
in each village. Two weeks before installation, the project
and installation dates were advertised to residents in each
of the villages using posters, citizens-band radios, and local
radio stations.
The investigator and a village representative then went
to each house gathering baseline data, testing existing
alarms, and installing new alarms. All of the residents
granted permission for this inspection, but of the 148
homes initially surveyed in the 4 villages, 25 (17%) were
excluded because they had alarms that were wired into the
electrical system. Baseline data were collected on any existing smoke alarms by pushing the test button and by
spraying aerosol smoke into the sensing chamber to activate the alarm. If no alarm sounded, a visual inspection
was conducted for the presence of a battery. Regardless of
the presence or absence of a functioning smoke alarm,
residents were given the opportunity to have a new alarm
installed.
In the 123 homes where new alarms were installed,

Summary points
Functioning smoke alarms can reduce the risk of death
in residential fires from 50% to 70% each year
Of the residential fire deaths in the United States, 60%
occur in homes without a functioning smoke alarm
Smoke alarms are often disconnected because of
frequent false (nuisance) alarms
Higher rates of false alarms seem to be associated
with small dwellings, use of wood fuel for heat, and
location of alarms near cooking areas
Photoelectric smoke alarms have a lower rate of false
alarms and subsequent rates of disconnection than do
ionization alarms
Patients should be informed about the advantages of
photoelectric smoke alarms in dwellings that have
frequent false alarms

smoke alarms were mounted on the ceiling about 3 to 4.6

m (10-15 ft) from the cooking and the heating sources.
The average distance for smoke alarm installation in the
ionization group was 4 m (13 ft) from the heating source
and 4.3 m (14 ft) from the cooking source. In the photoelectric group, the average distance from the heating
source was 4.6 m (15 ft) and 4.4 m (14.5 ft) from the
cooking source (table).
During the baseline survey, functioning smoke alarms
were found in 32 (38%) of 85 homes in the ionization
group compared with 14 (22%) of 63 homes that would
become the photoelectric group. Sixty-five homes (76%)
in 2 of the villages received installation of ionization
alarms, and 58 homes (92%) in the other 2 villages received photoelectric alarms.
Residents were given instructions on smoke alarm
maintenance, testing procedures, how to change batteries,
and how to use the hush button if one was present
(ionization alarms only). After installation, each smoke
alarm was fogged with an aerosol smoke to test the
audible alarm. Residents were also asked to document each
time their smoke alarm sounded its alarm and the reasons.
A 6-month follow-up survey was attempted at each
participating home by the investigator and a village representative. The homeowners had been told to expect a
6-month follow-up visit, but the exact date was unannounced. Residents were asked if they had experienced
false alarms from their smoke alarms. If false alarms were
experienced, they were asked how many occurred, what
were the causes, and how were the alarms silenced. Smoke
alarms were tested and re-fogged during this follow-up
visit to verify their operability.
RESULTS
Of 311 homes from the 4 villages, 148 were included in
the study at baseline. Attempts were made to contact all
123 participants during the 6-month follow-up survey,

90 wjm Volume 173 August 2000

Master Document | Page 8

.............................................

Original Research

Comparability of villages by type of smoke alarm

Photoelectric alarm
Village A
Village B

Variable
Population, No.

298

416

Ionization alarm
Village C
Village D
575

249

..................................................................................................................................................................................................................

Older/total homes

33/71

30/58

40/115

45/67

..................................................................................................................................................................................................................

Persons/home, mean No.

..................................................................................................................................................................................................................
2

Footage/home, mean m (mean sq ft)

88.6 (954)

85.9 (925)

101.3 (1,090)

90.6 (975)

..................................................................................................................................................................................................................

Annual income, mean, $

<20,000

<20,000

<25,000

<20,000

..................................................................................................................................................................................................................

Distance from alarm, mean m (ft)

Heating source
Cooking source

4.0 (13)
4.3 (14)

but 19 were unavailable (85% completion rate). At the

end of the 6-month study period, 48 (81%) of 59 homes
in the ionization group had functioning alarms compared
with 43 of 45 homes (96%) in the photoelectric group.
Fifty-four (92%) of the homes with ionization alarms had
at least 1 false alarm compared with 5 (11%) of the homes
in the photoelectric group. Of the 69 false alarms experienced by the ionization group, 64 (93%) were reported to
be related to cooking, compared with 4 of 6 (67%) in the
photoelectric group. Frying accounted for 52 (81%) of the
64 cooking-related false alarms. The heating source was
the second most-common cause of nuisance alarms, accounting for 5 (8%) of 64 in the ionization group and 2
of 6 (33%) in the photoelectric group.
Eleven homes in the ionization group had nonfunctioning alarms, and the leading reason (9/11) given for
disconnecting these alarms was that it goes off too
much. The other 2 ionization alarms contained dead
batteries. Although 2 alarms were disconnected in the
photoelectric group, neither was related to nuisance
alarms. The reasons given for disconnection were to use
the battery in a toy, and the other was inadvertently
knocked down while changing a light bulb.
DISCUSSION
This study demonstrates that in the test communities,
ionization smoke alarms were almost 5 times more likely
to be disconnected 6 months after installation compared
with photoelectric alarms. It appears that this marked difference in disconnection rates is due to the 8-fold higher
incidence of nuisance alarms in homes with ionization
alarms. Other studies have also found that nuisance alarms
are an important cause of disconnection with ionization
alarms.6,14(p12) However, we are unaware of other community-based studies that have demonstrated that photoelectric alarm installation is associated with a substantially
lower rate of disconnection. These findings have possible
significance for the public health and the fire safety com-

4.6 (15)
4.4 (14.5)

munity because 1 of the barriers to improved fire protection is the maintenance of smoke alarms already installed
in homes. Replacing ionization alarms in household areas
prone to nuisance alarms with photoelectric alarms could
potentially lead to a marked reduction in the proportion
of disconnected alarms. This research should be useful for
any dwelling in which frequent false alarms are experienced or in dwellings with less than 93 m2 (<1,000 sq ft)
of living space. These criteria are by no means unique to
rural Alaska.
Research on Native American smoke alarm use and
experience is sparse. A 1996 survey of 80 households on
the Devils Lake Sioux Reservation in North Dakota reported that 79% of the 109 ionization smoke alarms installed had false alarms during the previous year.15 Of the
homes experiencing false alarms, almost half had more
than 25 alarms per smoke alarm. Because of these nuisance alarms, 49% of the alarms had been disconnected
over the previous year. Only 3 of the 112 alarms in the
Devils Lake study were photoelectric, none of which had
a nuisance alarm reported.
The fact that ionization alarms produce more false
alarms but are slower to respond to smoky fires is not the
enigma that it seems. Smoke from cooking tends to contain smaller particles (<1 m) that will activate the ionization alarms, whereas larger smoke particles are necessary to
activate the photoelectric alarms.8 A possible barrier to the
increased use of photoelectric alarms is their higher cost
(about $20), which is roughly double that of the ionization alarms. New alarms featuring both types of sensors in
1 unit are currently available but, if located too close to the
kitchen or other ignition sources, nuisance alarms could
still be a problem.
This study has several limitations. First, we are uncertain about the generalizability of our findings. Factors such
as housing size, cooking practices, crowding, and air exchange may all play a role in increasing the likelihood of
nuisance alarms. It is unclear if similar findings would be
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Original Research
encountered if this study were replicated in a middleincome community with a larger average house size. Another limitation of the study was the baseline differences in
the village groups before installation of the alarms. The
groups receiving photoelectric alarms were less likely to
have alarms at baseline.
Bias may have potentially affected the results in 2 ways.
First, recall bias may have influenced respondents answers
regarding alarms. Those who experienced more alarms
may have been more likely to recall their occurrence than
those experiencing fewer alarms. However, it is unlikely
that differential recall bias existed between groups and
highly unlikely that the magnitude of difference between
groups could be explained by recall bias. A larger proportion of the homes in the photoelectric group were also
unable to be recontacted, which may have led to differential bias in the outcome measurements between groups.
However, if every household that could not be contacted
in the photoelectric group had experienced nuisance
alarms (18/58, or 31%), the magnitude of difference between groups would still be an absolute difference of 61%.
Homes in the 2 village groups may have differed in
some unmeasured dimension that could have influenced
the rate of disconnection or nuisance alarms. This is unlikely given that the homes, cultural profiles, and socioeconomic status of the 4 villages were virtually identical.
Furthermore, the distance of the alarms from possible ignition sources was standardized between groups. The primary reason given for false alarms was cooking, and the
average distance differential between the 2 groups was only
15 cm (6 in). Finally, neither the occupants nor the investigators conducting the outcome assessments were
blinded by the type of device installed in the home. This can
lead to differential ascertainment bias between the groups.
We conclude that the incidence of nuisance alarms is
much higher in small dwellings using ionization smoke
alarms. The higher rates of alarm disconnection in the
homes with ionization alarms are likely related to the high

rate of nuisance alarms in these homes. The use of photoelectric smoke alarms in small dwellings may lead to a
lower rate of disconnection and improved survival in the
event of fire. Randomized controlled trials comparing
these types of alarms in different types of dwellings should
be conducted to confirm these findings.
We acknowledge the contributions and support received from Maniilaq
Association and the residents of the participating villages.
....................................................................................................
References

1 Fire in the United States: 1986-1995. 10th ed. Emmitsburg, MD: US

Fire Administration; 1998.
2 Indian Health Service Mortality Data. Atlanta, GA: National Center for
Injury Prevention and Control, Centers for Disease Control and
Prevention; 1994.
3 Unintentional Fire and Flames, State Mortality Rates, 1993-1995.
Atlanta, GA: National Center for Injury Prevention and Control,
Centers for Disease Control and Prevention. Available at:
http://webapp.cdc.gov/cgl-bin/broker.exe. Accessed April 27, 2000.
4 Alaska Native Injury & Poisoning Deaths, 1980-1993. Anchorage, AK:
Division of Planning, Evaluation, and Health Statistics, Alaska Area
Native Health Service; 1995.
5 Alaska Fire Fatalities. Anchorage, AK: Office of the State Fire Marshal;
1996.
6 Ahrens M. The US Experience With Smoke Detectors and Other Fire
Detectors. Quincy, MA: National Fire Protection Association; 1997.
7 Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts J. Risk factors
for fatal residential fires. N Engl J Med 1992;327:859-863.
8 US Fire Administration, National Fire Data Center, July 31, 1998.
Available at: http://www.usfa.fema.gov/nfdc/profiles.htm. Accessed April
27, 2000 [last updated November 15, 1999].
9 Hall JR Jr. The US experience with smoke detectors. NFPA [Natl Fire
Protection Assoc] J 1994;88:36-46.
10 Consumers Union. Smoke detectors; essential for safety. Consumer Rep
1994;59:336-339.
11 Hall JR Jr, Harwood B. Smoke or burns: which is deadlier? NFPA J
1995;89:38-44.
12 Bukowski RW. Studies assess performance of residential detectors.
NFPA J 1993;87:48-54.
13 Miller RE, Reisinger KS, Blatter MM, Wucher F. Pediatric counseling
and the subsequent use of smoke detectors. Am J Public Health
1982;72:392-393.
14 Smith CL. Smoke Detector Operability Survey: Report of Findings.
Bethesda, MD: US Consumer Product Safety Commission; 1993.
15 Kuklinski DM, Berger LR, Weaver JR. Smoke detector nuisance
alarms: a field study in a Native American community. NFPA J
1996;90:65-72.

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Original article

Randomized controlled trial of ionization and

photoelectric smoke alarm functionality
B A Mueller,1,2 E A Sidman,1,2 H Alter,1 R Perkins,3 D C Grossman1,4
1

Harborview Injury Prevention

and Research Center, Seattle,
Washington, USA; 2 Department
of Epidemiology, School of Public
Health and Community
Medicine, University of
Washington, Seattle,
Washington, USA; 3 Alaska
Injury Prevention Center,
Anchorage, Alaska, USA;
4
Department of Health Services,
School of Public Health and
Community Medicine, and
Department of Pediatrics, School
of Medicine, University of
Washington, Seattle,
Washington, USA
Correspondence to:
Dr Beth Mueller, PO Box 19024,
Mailstop M4-C308, Seattle, WA
98109-1024, USA; bmueller@
fhcrc.org
Accepted 27 November 2007

ABSTRACT
Objective: To compare functionality, reasons for nonfunction, and nuisance alarm levels of two common types
of smoke alarms after installation in low- to mid-level
income households in King County, Washington.
Methods: Randomized controlled trial of 761 households.
An ionization or photoelectric smoke alarm was installed
between June 1, 2000 and July 31, 2002. Main outcome
measures were: percentage of study alarms that were
working, observed reasons for non-functional status, and
self-reported frequency of nuisance alarms at 9 and 15
months of follow-up.
Results: At 9 months after installation, 20% of ionization,
vs 5% of photoelectric alarms were non-functional, a
difference that persisted at 15 months, with the most
common reasons for both types being a disconnected or
absent battery. The risk ratio for ionization, relative to
photoelectric alarms, being non-functional or removed
was 2.7 (95% CI 1.8 to 4.1) at 15 months of follow-up.
These findings were not altered by educational level, or
the presence of smokers, children ,5 years, or adults
>65 years.
Conclusions: Burn prevention efforts are geared towards
increasing smoke alarm ownership and improving maintenance of functional status. Results suggest that the
selective use of photoelectric alarms by fire injury
prevention programs or consumers may provide longerterm protection in similar populations. Designing smoke
alarms that minimize nuisance alarming may also result in
longer term functionality.

Smoke alarms are effective interventions for

injuries from residential fires.1 2 Recent surveys
indicate that 9597% of US households have at
least one smoke alarm,3 4 with lower prevalence in
rural areas.5 However, alarms disconnected from
batteries, containing dead batteries, or removed
due to nuisance alarms offer no protection.
Inoperability levels range from 20%6 7 to 36%.8
The most common types of alarms marketed for
home use are ionization, photoelectric, and combination units. Photoelectric and ionization alarms
operate via different mechanisms, detecting visible,
and invisible/fine, byproducts of combustion,
respectively.9 Photoelectric alarms use optical
sensors and are more likely to sound due to slow,
smoldering conditions. Ionization units are more
responsive to flames by detecting charged particles
from rapid combustion.
Nuisance alarms, often set off during cooking,
are often cited as a reason why occupants
disconnect alarms.8 10 11 A study conducted in
Alaskan villages reported that ionization alarms
were more likely to nuisance alarm than were
photoelectric alarms.11 However, a randomized
80

trial of a smoke alarm distribution program in a

poor neighborhood of London reported that photoelectric alarms were more likely to sound nuisance
alarms.12
We conducted a randomized controlled trial to
compare the functionality of ionization and photoelectric smoke alarms by installing them in middleto low-income households in King County,
Washington, and comparing their functional status, reasons for non-function, and frequency of
nuisance alarms at 9 and 15 months of follow-up.

METHODS
Participant identification
A proprietary database of all private property in
King County in 2000 (MetroScan) identified
owner-occupied dwellings within the lower quartile of assessed values (,$164 000) in census tracts
with above-median density (755+ homes). This
was to include homes at greatest risk of injury
from residential fires, given the inverse association
observed between socioeconomic status or income
level and fire injury risk.13 14 Condominiums were
excluded, as the studys smoke alarm installation
and placement protocols may conflict with those
specified in condominium covenants. Selected
residences were mailed a letter inviting participation in a fire safety study in cooperation
with the King County Fire Chiefs Association,
involving installation of smoke alarms and provision of fire extinguishers. Homeowners were not
informed of underlying hypotheses. Up to 10
phone calls and 2 messages were attempted to
invite participation.
Only 58 participants enrolled after 4 months, an
accrual rate that would have yielded insufficient
participants. Thus, a blockwalk approach was
initiated in which study staff visited households.
From the pool of eligible dwellings, we identified
clusters of potential participants using Thomas
Guide map grids15 to maximize efficiency of
identification. Twenty multi-day blockwalks to
these areas were conducted, each targeting 200800
potential residences. Within each blockwalk,
households were randomly selected to receive
either an ionization or photoelectric alarm.
Ultimately, 6236 homes were identified for
approach using this method (fig 1).
Staff worked in pairs during home visits during
June 1, 2000 to July 31, 2002. If potential
participants were at home, the team invited
participation, either then or later. If nobody was
at home, they left a letter indicating that a smoke
alarm installation team would return on a future
date. Residents could call to refuse, schedule an
appointment, or be visited on the return date.
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Figure 1 Flow of households through the trial. *Four homes in ionization and two in photoelectric study groups excluded from follow-up analyses
because original zinc batteries replaced with alkaline batteries. {Study smoke alarm never installed. {Renters.
Procedures were approved by the Human Subjects Division at
the University of Washington prior to study conduct.

Baseline visits
A standardized survey was conducted, followed by installation
of one study alarm per household. The survey queried
demographics, fire safety practices and behaviors, history of
fire or related injuries, building characteristics, heating and
cooking fuel sources, sources of fires, flames, or smoke, and
presence and locations of existing smoke alarms. A target date
was set for the first 9-month follow-up. No appointment time
was arranged, to keep subsequent inspections unannounced and
decrease the likelihood of observing behavior altered by
anticipation of a repeat visit.
Study personnel were trained in smoke alarm installation as
described by the US Fire Administration16 using the National
Fire Alarm Code Handbook.17 Participants were not informed of
hypotheses or type of alarm installed, although they were
informed they would receive an alarm endorsed by the National
Fire Protection Agency (NFPA) for residential use. Because of
the different appearance of the two alarms, it was not possible
to blind study staff to alarm type; however, staff were not
informed of underlying hypotheses. Teams were asked to install
study alarms on main levels, in rooms adjacent to kitchens.
Adjacent rooms without alarms were the highest priority in
selecting the location. Alarms were mounted on the wall 3 feet
from the kitchen entrance and 412 inches from the ceiling, a
Injury Prevention 2008;14:8086. doi:10.1136/ip.2007.016725

location with potentially greater chance of having nuisance

alarms. If alarms were already installed in that room, the study
alarm would be installed in the same room; however, the
installer would re-install the existing alarms elsewhere if
requested. Both alarm units had hush buttons and zinc
batteries, which were tested and installed with the alarm.
Original batteries were marked with indelible ink to later
determine whether new batteries had been installed. The
alarms baseline function was tested with canned smoke, and
participants instructed in alarm maintenance. The operation
manual and a fire safety brochure were provided. Residents
were also given a fire extinguisher, instruction in its use, and
information regarding optimal location.
At baseline, 761 homeowners were interviewed. Three were
later found ineligible because they rented; 1 elected to have no
alarm installed. The 757 remaining households included 371
randomized to receive ionization and 386 randomized to receive
photoelectric study alarms.

Follow-up visits
At both follow-ups, we queried the status of all smoke alarms,
occurrence of any fires and related alarms, and occurrence of
nuisance alarms (ascertained separately for study and existing
alarms) and their perceived causes. If alarms were reported nonfunctional, the reasons were asked. Teams inspected and tested
study alarms to determine functionality, noted reasons for nonfunction, and observed battery status. If batteries were
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Original article
Table 1 Characteristics of respondents, households, and houses
reported at baseline interview, by randomized study alarm type
Characteristic
Respondent
Female
Age (years)
(24
2544
4564
>65
Race/ethnicity
White
Asian/Pacific Islander
African-American
Hispanic
Native American
Multiracial
Other
Education
,High school
High school/GED
Vocational/technical/some college
>College
Household
Number of residents
1
2
34
>5
>1 resident aged
(4 years
(14 years
>65 years
>1 resident smokes{
>1 resident drinks alcohol{
House
Single family residence
Year built
(1920
19211940
19411960
19611980
19811996
Ever structurally remodeled
Year built or last remodeled
(1940
19411960
19611980
19812001
Number of floors
1
2
>3
Years in current house
,1
15
610
>11
Kitchen stove type1
Electric
Gas
Frequency of kitchen stove use
Daily
Multiple days per week

Ionization
(n = 366*) (%)

Photoelectric
(n = 384*) (%)

64.7

63.5

2.6
42.5
31.9
23.1

2.3
38.3
40.3
19.2

78.2
10.7
3.6
3.0
0.8
3.0
0.6

76.2
11.4
5.0
3.2
1.3
1.3
1.6

5.2
21.2
30.0
43.7

8.7
25.2
30.5
35.7

20.5
32.5
36.9
10.1

19.0
31.5
35.7
13.8

16.2
33.8
29.0
24.4
25.9

15.7
35.3
25.5
25.0
25.3

98.9

100.0

9.1
17.8
42.7
22.5
7.9
51.0

11.2
15.2
41.3
21.2
11.2
52.7

9.2
27.4
28.4
35.0

7.4
22.9
26.3
43.3

39.9
47.3
12.8

40.1
48.7
11.2

6.6
31.7
16.9
44.8

4.2
29.0
21.9
44.9

89.6
10.7

90.6
9.4

64.5
27.2

66.6
24.5

Continued
Ionization
(n = 366*) (%)

Characteristic
Rarely/occasionally/weekends only
Main heat source
Electric
Natural gas
Oil
Wood
Other
Electric main or secondary heat source
Natural gas main or secondary heat source
Oil main or secondary heat source
Open-element space heater
Wood fireplace
Gas fireplace insert
Wood or pellet stove
Frequency of fireplace or stove use"
Daily/weekly
Bi-monthly/monthly
Rarely/never

Photoelectric
(n = 384*) (%)

8.3

9.0

24.9
54.4
18.8
1.7
0.3
33.6
53.5
19.0
19.5
37.5
4.9
20.8

31.8
49.2
17.4
1.3
0.3
40.6
49.3
18.5
20.8
47.1
1.8
20.8

39.1
12.1
48.8

30.2
14.3
55.5

*Among households that were eligible for analyses (had study alarm installed, were
home owners, and received a zinc battery in the study alarm).
{Defined as smoking a pack (20 cigarettes) or more per week.
{Defined as drinking 5 or more alcoholic beverages on occasion.
1Not mutually exclusive since some kitchens have two stoves, so percentages may
add to .100%.
"Based on the single most frequently used fireplace or stove per household.

inoperable, new alkaline batteries were installed. A $10

reimbursement was provided per visit.
First follow-ups were completed with 336 (91%) ionization
and 342 (89%) photoelectric study group homes. Mean (SD)
elapsed times between baseline and first follow-ups were 9.0
(0.6) months (range 8.412.8) and 9.0 (0.6) months (range 8.4
13.4) for ionization and photoelectric alarms, respectively.
Second visits were completed for 315 (85% of baseline) homes
randomized to the ionization and 316 (82%) to the photoelectric group. Mean (SD) elapsed times between baseline and
second follow-ups were 14.9 (0.7) months (range 14.018.9) for
the ionization group, and 14.9 (0.8) months (range 14.119.0)
for the photoelectric group. Reasons for exclusion were similar
across study groups at both follow-ups.

Data analysis

Continued

82

Table 1

Five households randomized to receive ionization alarms and 17

randomized to receive photoelectric alarms instead received the
opposite type. Data were analyzed using an intention-to-treat
approach in which participating households were categorized by
alarm type to which they were randomized. For 5 ionization
and 2 photoelectric study households, original batteries were
inoperable, and new alkaline batteries installed. These were
excluded from analyses. Although main analyses included all
eligible households recruited, a sensitivity analysis was conducted using only the 700 eligible households recruited using the
blockwalk method, yielding comparable results.
Baseline respondent and household demographics, structural
and heating characteristics, safety practices, fire histories, and
alarm installation locations were compared between study
groups. Pearsons x2 and Fishers exact tests were used to
compare groups with respect to frequency of household
nuisance alarming and fire incidence between baseline and first
follow-up, and between first and second follow-up (overall and
after excluding households with inoperable alarms due to
battery or alarm removal, or with otherwise malfunctioning
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Original article
alarms at first follow-up). The functional status of study alarms
at each visit was compared. Associations between alarm type
and non-functional or removed status at follow-up were
estimated with cumulative incidence risk ratios (RR) and 95%
CIs. Effect-modification by respondent and household characteristics was explored using stratified analyses and the
MantelHaenszel test for homogeneity. Generalized linear
models specifying the binomial family and log link, appropriate
for cohort studies of common binary outcomes, were used to
adjust simultaneously for combinations of respondent and
household characteristics.18 The presence of confounding was
evaluated by the magnitude of change in RRs after adjustment
for relevant factors, alone and in combination. No appreciable
changes were noted after adjustment for potential confounders;
unadjusted RRs are presented.
The majority of study variables were missing few values (0
2%). Exceptions included the years homes were built or
remodeled, secondary heating sources, household testing of fire
safety devices, and fire history. Participating households with
missing values were dropped from analyses requiring the
specific missing variable(s).

RESULTS
Nearly all alarms (99%) were installed on main floors, with 65% in
both ionization and photoelectric groups installed in hallways,
dining rooms, or living rooms adjacent to kitchens. Study alarms
were installed in kitchens for 20% of residences randomized to
receive ionization alarms and 16% of those with photoelectric
alarms; 16% and 18%, respectively, were installed elsewhere.
Similar proportions of ionization (88%) and photoelectric (90%)
alarms were installed on walls, the remainder on ceilings. The
mean (SD) distances between alarm locations and kitchen stoves
were similar, at 136.0 (44.1) and 137.8 (47.2) inches.
Respondent, household, and house characteristics were
similar for both groups, including the proportions of smokers
and use of kitchen stoves and fireplaces, with a few exceptions
(table 1). A slightly greater proportion of respondents with
ionization alarms had college degrees (44%) than those with
photoelectric alarms (36%). Homes receiving ionization alarms
were slightly less likely to have been built or remodeled after
1980 (35% vs 43% of homes with photoelectric alarms), and
have electrical heating as their main heat source (25% vs 32%),
or wood-burning fireplaces (38% vs 47%). Homes with
ionization alarms were slightly more likely to report natural
gas as their main heating source (54% vs 49%), or have gas
fireplace inserts (5% vs 2%).
The self-reported number of smoke alarms already present,
presence of fire safety equipment, and residential fire history
were similar across groups (table 2). Photoelectric study group
households reporting a prior residential fire were slightly more
likely to have had fire-related injuries among residents (9%)
than were those within the ionization group (6%).
Nuisance alarms by non-study alarms between baseline and
first follow-up visits were similarly common among homes with
ionization (43%) and photoelectric (45%) study alarms (table 3).
Ionization units, however, reportedly were more likely than
photoelectric units to have alarmed (78% vs 39%, p,0.001), and
alarmed more often (56% vs 17% had .3 alarm episodes,
p,0.001). Similar differences were observed for the interval
between first and second follow-ups. On direct observation at
first follow-up, ionization study alarms were more likely to be
non-functional (20% vs 5% photoelectric, p,0.001), with the
most common reasons being a disconnected (6% ionization vs
1% photoelectric, p,0.001), or absent battery (13% ionization
Injury Prevention 2008;14:8086. doi:10.1136/ip.2007.016725

Table 2 Reported use of fire safety interventions and fire history at

baseline visit in study households, by alarm type
Characteristic

Ionization
(n = 366) (%)

Safety practice
No. of smoke alarms present*
0
9.3
1
40.2
2
29.2
>3
21.3
Smoke alarm tested within past{
06 months
77.0
612 months
14.2
.12 months
5.7
Never
3.2
>1 carbon monoxide alarm
20.3
Carbon monoxide alarm tested within past{
06 months
48.5
612 months
27.3
.12 months
6.1
Never
18.2
>1 fire ladder{
7.8
>1 fire extinguisher
67.5
Extinguisher pressure check within past
31.1
9 months1
Designated meeting location"
31.7
Know water temperature
47.0
Water temperature ,120u F**
64.9
Fire history
Prior fire
11.0
Fire-related injuries{{
5.9
Prior fire
Never
89.0
Fire without injuries
9.0
Fire with injuries
0.6
Fire with unknown injuries
1.4

Photoelectric
(n = 384) (%)

9.9
35.9
33.6
20.6
73.9
14.4
6.4
5.2
21.0
50.7
14.5
10.1
24.6
5.8
67.4
32.4
34.6
44.0
66.7
10.5
8.8
89.5
8.4
0.8
1.4

*Not including study alarm.

{Restricted to households self-reporting at least one such alarm.
{Restricted to houses of more than one floor.
1Restricted to households self-reporting at least one fire extinguisher.
"Restricted to households with more than one resident at some point during the
9 months prior to interview.
**Restricted to respondents who knew water temperature.
{{Restricted to households self-reporting prior fire.

vs 1% photoelectric, p,0.001). These differences persisted at

second follow-up. Ionization alarms were not, however, more
likely to have been removed than were photoelectric alarms.
The RR associated with having an ionization study alarm,
relative to a photoelectric alarm, be non-functional or removed
at first follow-up was 3.8 (95% CI 2.3 to 6.3), and 2.7 (95% CI
1.8 to 4.1) at second follow-up (data not shown). When
analyses for second follow-up were restricted to homes with
alarms observed to be functional at first follow-up, the RR was
2.1 (95% CI 1.2 to 3.5). The RR associated with having a
disconnected or absent battery or removed alarm observed
among ionization study alarms, relative to photoelectric alarms,
was 5.3 (95% CI 2.9 to 9.6) at first follow-up and 3.2 (95% CI
2.0 to 5.1) at second follow-up. Restriction of second follow-up
analyses to homes with functional alarms at first follow-up
resulted in an RR of 2.6 (95% CI 1.4 to 4.7). Stratification by
respondent gender, race/ethnicity, education, number of occupants, presence of children, the elderly, smokers, or alcohol
consumers, did not alter these results.
The most commonly reported reasons for nuisance alarms
during the 15 month follow-up were cooking (93% nuisance
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Table 3 Follow-up status of study smoke alarms, by follow-up visit and alarm type

Characteristic
Participant-reported status
since last visit
Fire
Study alarm sounded
No. of times study alarm
sounded{
13
410
>11
Other alarm(s) sounded1
No. of times other alarm(s)
sounded{
13
410
>11

Follow-up 1

Follow-up 2

Ionization
Photoelectric
(n = 332) (%) (n = 340) (%)

Ionization
Photoelectric
(n = 311) (%) (n = 314) (%)

2.4
77.9

2.4
38.7

44.1
26.6
29.4
42.5

83.5
11.0
5.5
45.4

73.0
13.9
13.0

72.5
15.8
11.7

Observed status of study alarm

Functional
79.6
Non-functional due to
Malfunctioning alarm
0.3
Disconnected battery
5.8
Absent battery
12.8
Dead battery
0.9
Incorrect battery placement
0.0
Unknown
0.3
Study alarm removed
0.3

p-value{

0.97
,0.001
,0.001

0.49
0.89

Follow-up 2*

1.6
76.8

2.6
42.0

56.3
27.7
16.0
33.0

88.2
11.0
0.8
37.6

65.5
27.6
6.9

73.0
18.0
9.0

p-value{

0.41
,0.001
,0.001

0.26
0.28

Ionization
Photoelectric
(n = 248) (%) (n = 296) (%)

0.8
74.2

2.4
41.8

61.4
21.7
16.9
30.2

89.9
9.2
0.8
36.7

60.9
32.8
6.3

73.1
17.2
9.7

p-value{

0.19
,0.001
,0.001

0.14
0.07

94.7

,0.001

76.8

91.4

,0.001

85.8

93.2

0.004

0.0
0.6
1.2
1.5
0.0
0.3
1.8

0.49
,0.001
,0.001
0.73

1.00
0.12

0.3
5.5
14.5
1.3
0.0
0.3
1.3

0.3
1.3
2.2
1.3
0.3
0.0
3.2

1.00
0.004
,0.001
1.00
1.00
0.50
0.11

0.4
4.1
7.7
1.6
0.0
0.0
0.4

0.3
0.7
2.4
1.4
0.3
0.0
1.7

1.00
0.008
0.004
1.00
1.00

0.23

*Restricted to households with functional study alarms at follow-up 1.

{Based on Pearsons x2 test if expected >5 in all cells; based on Fishers exact test if expected ,5 in any cell.
{Restricted to households whose smoke alarm(s) had alarmed since the last visit.
1Restricted to households with reported non-study alarms at baseline.

alarms in ionization group, 74% in photoelectric group), low

batteries (5% and 22%, respectively), fireplaces (2% both
groups), and steam (1% ionization, 2% photoelectric).
Smoking was reported as a source of nuisance alarms only
among 1% in the photoelectric group. Other reasons for
nuisance alarming of study detectors were incense (,1%
ionization group), candles (1% both groups), construction
(,1% ionization, 2% photoelectric), and heat from lights (2%
ionization group).

DISCUSSION
Compared to ionization alarms, photoelectric alarms were more
likely to be functional both 9 and 15 months after installation,
and had fewer absent or disconnected batteries. The greater
proportion of functioning photoelectric alarms may be attributable to fewer nuisance alarms. Thus, photoelectric alarms may
be preferred when a single unit is selected by consumers or
safety campaigns targeting similar populations, particularly
when the alarm is installed adjacent to a cooking area as in our
study.
These findings are consistent with previous work conducted
by this center. Among smaller residences in rural Alaskan Native
villages, eight times as many nuisance alarms by ionization
units were reported, compared to photoelectric units, after
6 months of follow-up. Ionization alarms were also more likely
to be disabled or missing batteries.11
Our findings differ from those of another trial conducted
among residents of low-income housing units in London, in
which ionization alarms were more likely than photoelectric
84

alarms to be functional 15 months after installation.12 The

proportions of functional alarms among both groups (47%
ionization vs 36% photoelectric) were considerably lower at
follow-up than what we observed (77% ionization, 91%
photoelectric). The difference in proportions of homes with
alarms present at baseline (11% London vs 90% our study)
suggests wide differences in population characteristics, and
emphasizes the importance of appropriately designed injury
prevention strategies. Smoke alarms are less common in rented
than owner-occupied dwellings,19 which may account for some
of the difference. Although the London and Seattle-area study
households contained similar proportions of young and elderly
occupants, smokers resided in nearly 50% of the London homes
versus 24% in our study. If cigarette smoking is more likely to
cause nuisance alarming by photoelectric units (which respond
more quickly to smoldering fires), this difference in households
with smokers may be partly responsible. Differences in cooking
styles, heating sources, ventilation, or use of wood-burning
fireplaces may also have accounted for variation in air
particulates emitted, and resulted in differing false alarm
patterns. Homes in our study, all single family residences, were
likely larger than in the UK study, potentially affecting the
concentration and circulation of air particulates, and relative
potential for nuisance alarms by detector type. Finally, although
both studies targeted lower income groups, our participants
were likely of relatively greater socioeconomic status, given that
home ownership was required for eligibility.
Because of the poor long-term functional prognosis for either
alarm type in the London study, the authors concluded that
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sprinkler systems may provide the most efficient use of limited
government resources in that environment. This contrasts with
some studies in other environments, where smoke alarm
installation programs appear effective.20

Limitations
Although study staff directly observed functional status of the
smoke alarms and reasons for non-function, the occurrence and
reasons for nuisance alarms were participant-reported. Another
potential limitation involved the method used to recruit
households. Because of low success using targeted mail
invitation, we switched to blockwalk recruitment targeting
high density areas and recruited people at home, given that mail
response is generally lower than in-person contact.21 We
attempted to reduce potential bias associated with nonresponse by leaving letters if occupants were absent, and
attempting re-contact. Nonetheless, some potentially eligible
homes could not be reached. The impact of this is unclear, but
we doubt differential bias because proportions consenting and
reasons for non-participation were similar between study
groups. We are also reassured that the proportion of enrolled
homes with existing smoke alarms is similar to that in surveys
from the same time.8 22 Potential biases may have been
introduced in using two different recruitment methods,
although there is evidence of no significant differences in
subjects identified by mailing and home visit.23 We also obtained
no information about presence or use of fans over cooking
surfaces. Our results are based on single family, owner-occupied
households, and it is possible that household characteristics may
vary between those in the study and those of rental units or
condominiums. Finally, it should be noted that although we
installed alarms in the room adjacent to the kitchen, current
recommendations are that alarms be installed on every level of a
home, in particular, outside every sleeping area.24

Key points
c

homes similar to those in our study may increase the proportion

of functioning alarms and therefore provide longer term
protection.
Acknowledgements: We wish to thank the King County Fire Chiefs Association for
their support. We are also indebted to Ms Luann DAmbrosio and Ms Milda Tautvydas
for their organizational efforts, and to Mr Chris Mack for programming and data
management assistance.
Funding: This work was supported in part by grant no. R49/CCR002570 from the
Centers for Disease Control, with additional assistance from the King County Fire
Chiefs Association.
Competing interests: None.

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Implications for prevention

Improving functional status of smoke alarms is important. Even
after installing alarms at no cost to homeowners, 1025% were
non-functional at follow-up. Battery removal by residents was
the most common reason for non-functional alarms, with
cooking most commonly identified as the reason for nuisance
alarms. Although lithium batteries may reduce the prevalence of
non-functional alarms from dead batteries, they do not address
the issue of frequent nuisance alarms, which homeowners
appear unwilling to tolerate. Design improvements to reduce
false alarms may help to reduce disarming by residents.
A recent survey of US department and home improvement
stores shows that battery operated ionization devices are
available for $10 (US), photoelectric devices for $15, and dual
sensor units for approximately $25. Some manufacturers
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cost. An alarm containing both technologies is more expensive;
it may also be more likely rendered non-functional if either
technology causes frequent nuisance alarms. Our results suggest
that installing photoelectric smoke alarms on main floors of
Injury Prevention 2008;14:8086. doi:10.1136/ip.2007.016725

Among urban households in Washington state, ionization

smoke alarms were more than twice as likely as photoelectric
alarms to be non-functional 15 months after installation.
The most common reasons for non-function were a
disconnected or absent battery due to nuisance alarming.
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A maximum sum of 5000 will be allocated to any one project, but applications for smaller sums are
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The terms and conditions of the Grant are as follows:
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