Abstract: We identified 26 completed trials, of which 17 were randomised. Overall, counselling and educational interventions, with or without provision of free or discounted smoke alarms, modestly increased the likelihood of owning an alarm (OR = 1.21; 95% CI 0.89 to 1.64) and having an installed, functional alarm (OR = 1.33; 95% CI 0.98 to 1.80). Whether or not the intervention programme provided free or discounted smoke alarms in addition to education did not influence these results. The results were sensitive to trial quality, however. Counselling as part of primary care child health surveillance had somewhat greater effects on alarm ownership (OR = 1.96; 95% CI 1.03 to 3.72) and function (OR = 1.46; 95% CI 1.15 to 1.85), results that were generally supported by non-randomised trials evaluating similar interventions. Injury outcomes were reported in only one randomised controlled trial, which found no effect of a smoke alarm give-away programme on total injuries (rate ratio 1.3; 95% CI 0.9 to 1.9) or on hospitalizations and deaths (rate ratio 1.3; 95% CI 0.7 to 2.3), in contrast to the substantial reduction in serious injuries reported in a non-randomised trial that evaluated a similar give-away programme. Neither trial showed a beneficial effect on fires. Mass media and community education showed little benefit in multiple non-randomised trials. Two trials, one of which was randomised, showed that smoke alarm installation programmes increase the likelihood of having a working smoke alarm, and the non-randomised trial reported reductions in fire-related injuries. This review found that programmes to promote smoke alarms have at most modest beneficial effects on smoke alarm ownership and function, and no demonstrated beneficial effect on fires or fire-related injuries. Counselling as part of child health surveillance has a somewhat greater effect on smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give-away programmes have not been demonstrated to increase smoke alarm prevalence or to reduce fires or fire-related injuries. Community-based education programmes have not been shown to reduce burns or fire-related injuries. Community smoke alarm installation programmes may increase the prevalence of working alarms and reduce fire-related injuries, but these results require confirmation, and the cost-effectiveness of such programmes has not been evaluated. Efforts to promote smoke alarms through installation programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes and cost-effectiveness.

Plain-language summary: This review found that programmes to promote smoke alarms increased smoke alarm ownership and function modestly, if at all, and have not demonstrated a beneficial effect on fires or fire-related injuries. Counselling by health care workers, as part of child health care, may increase ownership and use of smoke alarms in homes but effects on injuries have not been examined. There is little evidence to support community-wide mass media or educational programmes or programmes to give away free smoke alarms as effective methods to promote smoke alarms or reduce injuries from fire. More research is needed to examine community-wide smoke alarm installation programmes.