A 3-year project was undertaken to evaluate two methods of promoting residential smoke alarm installation and maintenance in high risk households across the U.S. Five states (Arkansas, Maine, Maryland, Massachusetts, and North Carolina) participated. The two strategies under study were direct installation of smoke alarms and distribution of a voucher for free smoke alarms. The target population included occupants of high-risk households without working smoke alarms who were approached as part of a door-to-door canvassing program. Fire Safety education was provided to both groups. A follow up assessment conducted 6-12 months post intervention assessed the presence and functional status of smoke alarms in each of the two groups. Demographic and fire safety data were also collected at baseline and follow up for each group. 4,455 households were enrolled in the study [Installation Group: 2,206 (49.5%), Voucher Group: 2,249 (50.5%)]. Baseline characteristics of the groups within each state were comparable. Follow up data was obtained on 1,583 installation group households and 1,545 voucher group households. At follow up, 1,421 (89.8%) households in the installation group had working smoke alarms, compared with 997 (65%) households in the voucher group, Odds Ratio 4.82 (95% CI=3.97, 5.85) (p <.0001). On average, 47% of all households enrolled in the voucher group did not redeem their vouchers (range 26-63%). Direct installation of alarms by program staff resulted in working smoke alarms in 90% of households receiving the direct installation intervention. Only 65% of voucher households had functioning alarms at follow up, largely due to failure to redeem vouchers.