The Potential for Proactive Housing Inspections to Inform Public Health Interventions.

Municipal housing inspection data can inform planning, targeting, and evaluating interventions aimed at reducing housing hazards (lead paint, mold, pests, etc) that may affect residents' health. However, the potential of these data to inform public health initiatives is underexplored. We determined whether home health hazards identified by city inspectors during proactive inspections of single-family private rental housing are predicted by housing age, assessed value, or location in one of 26 geographic "inspector areas" in Rochester, New York. A comparison of linear mixed models, using housing inspector area as a random effect and assessment and construction year as fixed effects, shows that while a large proportion of variation (64%) in violations is due to housing stock, inspectors provide significant additional information about the presence of potential health hazards, particularly in the highest-risk housing stock. This suggests that inspector-generated housing hazard data may be valuable in designing public health interventions.

Announcement: Federally Assisted Housing Standards for Blood Lead Levels Aligned with CDC-Recommended Threshold.

On January 13, 2017, the U.S. Department of Housing and Urban Development (HUD) lowered the threshold of lead in young children's blood that triggers interventions to evaluate and control exposure hazards from 20 µg/dL to 5 µg/dL, matching the reference level used by CDC (1). The rule includes a process to continue HUD alignment with any future updates to CDC's reference level (1).

Evaluation of Tobacco Control Policies in San Francisco Homeless Housing Programs.

BACKGROUND: The 2014 Surgeon General's Report noted that high smoking rates in vulnerable populations such as the homeless have been a persistent public health problem; smoking prevalence among individuals experiencing homelessness exceeds 70%. Historically, service providers for the homeless have not enacted comprehensive tobacco control policies. METHOD: We conducted a qualitative study of homeless housing programs in San Francisco. Administrators representing 9 of the city's 11 homeless service agencies were interviewed to assess institutional smoking-related policies and cessation programs and perceived barriers and receptivity to instituting tobacco control interventions. RESULTS: Respondents indicated that although most programs had adopted smoke-free grounds and some had eliminated evidence of staff smoking, the smoking status of clients was assessed only when required by funders. None of the programs offered smoking cessation interventions. Most administrators were receptive to adopting policies that would promote a tobacco-free culture; however, they noted that their clients had unique challenges that made traditional smoking cessation programs unfeasible. CONCLUSIONS: Homeless housing programs in San Francisco have not yet adopted a tobacco-free culture. Existing policies were created in response to external mandates, and smoking cessation programs may need to be modified in order to effectively reach clients.

Comparison of indoor air quality in smoke-permitted and smoke-free multiunit housing: findings from the Boston Housing Authority.

INTRODUCTION: Secondhand smoke remains a health concern for individuals living in multiunit housing, where smoke has been shown to easily transfer between units. Building-wide smoke-free policies are a logical step for minimizing smoke exposure in these settings. This evaluation sought to determine whether buildings with smoke-free policies have less secondhand smoke than similar buildings without such policies. Furthermore, this study assessed potential secondhand smoke transfer between apartments with and without resident smokers. METHODS: Fine particulate matter (PM2.5), airborne nicotine, and self-reported smoking activity were recorded in 15 households with resident smokers and 17 households where no one smoked in 5 Boston Housing Authority developments. Of these, 4 apartment pairs were adjacent apartments with and without resident smokers. Halls between apartments and outdoor air were also monitored to capture potential smoke transfer and to provide background PM2.5 concentrations. RESULTS: Households within buildings with smoke-free policies showed lower PM2.5 concentrations compared to buildings without these policies (median: 4.8 vs 8.1 µg/m(3)). Although the greatest difference in PM2.5 between smoking-permitted and smoke-free buildings was observed in households with resident smokers (14.3 vs 7.0 µg/m(3)), households without resident smokers also showed a significant difference (5.1 vs 4.0 µg/m(3)). Secondhand smoke transfer to smoke-free apartments was demonstrable with directly adjacent households. CONCLUSION: This evaluation documented instances of secondhand smoke transfer between households as well as lower PM2.5 measurements in buildings with smoke-free policies. Building-wide smoke-free policies can limit secondhand smoke exposure for everyone living in multiunit housing.

Professional development through policy advocacy: communicating and advocating for health and health equity.

Communicating and advocating for evidence-based public health policy is a key component of health promotion practice, but public health professionals often lack experience in policy advocacy. This article provides perspectives from public health professionals who participated in successful public health policy advocacy efforts in their community. Their experiences using evidence-based research to advocate for policies that promote health equity contributed significantly to their career development, and also contributed to community capacity to reduce tobacco-related disparities. This article builds on previous work emphasizing the value of career development opportunities that enhance and diversify the public health workforce, and provides practical tips and "lessons learned" that are relevant to a wide range of public health professionals.

Improving housing, improving health: the need for collaborative working.

The impact of poor housing on health was recognized 150 years ago, and doing something about it was the first real public health initiative. Today, standards in much of the older housing stock continue to fall and, exacerbated by the current free market boom in fuel costs, many people cannot afford to heat or maintain their homes. In response to this crisis, there is an increasing amount of housing help available which would directly improve the health of patients but, apart from pockets of exemplary practice, most health practitioners seem to do little about it. Yet housing issues feature prominently in nurse training, as well as receiving increasing emphasis through the current national and regional fuel poverty initiatives. In exploring this paradox the author examines the mixed fortunes of an innovative project which tried to stimulate collaborative working between professions by providing a successful combined health and housing intervention. Drawing on his evaluation of this project over five years, he considers what some of the barriers to collaboration might be, how they arise and what needs to be done to overcome them.

Health and housing collaboration at LAST: the Philadelphia Lead Abatement Strike Team.

The Lead Abatement Strike Team (LAST) was developed in 2002 by the Philadelphia Department of Public Health (PDPH) in response to community concern about management of children with elevated blood lead levels (EBLLs). Fourteen hundred backlog properties (housing at least one child with EBLLs) were identified through inspection as having housing-based lead hazards for which no satisfactory environmental remediation (control of lead hazards) had been achieved. In the first two years of LAST, 834 new housing cases also were identified. The heightened awareness of this problem, sparked in part by community advocacy efforts, led to the appropriation of 1.5 million dollars for environmental remediation. A collaborative group of health, housing, and other officials was convened. Enforcement for remediation of properties with lead hazards was strengthened with the development of the Lead Court, a special judicial court devoted exclusively to hearing cases where owners had violated local lead poisoning prevention laws. Identifying a group of Pennsylvania-certified lead abatement contractors, expanding the health department's abatement team, creating temporary relocation capacity, and providing funding for basic housing system repair work were crucial to obtaining rapid remediation of homes. In the first two years of the LAST program, 1,037 properties (both backlog and new properties) that housed 1,476 children were remediated, representing a significant increase in remediation capacity.

Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes.

OBJECTIVE: This systematic review analyzed the best available research in the United States on permanent supportive housing programs for homeless individuals with mental illness and the effect of these programs on housing status and mental health. It updates older and broader reviews that included weaker studies or those that did not analyze permanent housing as an input and housing and mental health as primary outcomes. METHODS: The literature search (1980-2013) yielded 14 studies (randomized controlled trials and quasi-experimental studies). RESULTS: The studies found that a majority of participants placed in experimental housing programs with case management support remained in housing for at least one year or experienced more days housed than homeless relative to a comparison group. Although this finding is in line with previous literature reviews on permanent supportive housing, this analysis found limitations in each of the 14 reviewed studies, such as attrition, selection and response bias, imprecise definitions and implementation of housing programs, and a lack of appropriate controls. Only three of the reviewed studies reported using a housing fidelity assessment tool to test whether the housing intervention was faithful to theoretical standards, and conceptions and implementation of housing varied widely across studies, threatening internal and external validity. CONCLUSIONS: Pitfalls in the best available studies on permanent supportive housing programs in the United States limit the ability of research to inform the policy goal of ending chronic homelessness and demonstrate a need for further experimental research upon which to make funding and policy decisions, especially in light of prioritized federal funds.

A need for community education in development: the Mit Abu El Kom case.

A quasi-experimental study was performed in Mit Abu El Kom Village, Egypt, where one-quarter of the 500 village households had been provided with new housing and indoor water and sanitation facilities and where, prior to this provision, water and sanitation facilities were inadequate or nonexistent among all households. No community health education had taken place among relocatees (subjects) or nonrelocatees (controls) in conjunction with the provision of water and sanitation facilities. This study investigated if subjects' access and exposure to facilities had alone been sufficient to significantly alter their relevant knowledge, attitudes and practices as compared to controls. This was accomplished primarily through structured household interview. Given that women are traditionally most affected by facilities and most effective in matters related to household health, one adult female from each sampled household was the respondent, totalling 123 for subjects and 111 for controls. Between-group comparisons of responses revealed overall nonsignificant differences in knowledge and attitudes and that respondent age and sex had no significant overall impact on responses. Age and sex were also discounted as affecting variables in within-group response analyses. Some significant changes in practices had occurred among subjects. However, these mainly resulted out of convenience and their potential benefits were often denigrated by changes which had not occurred or had not continued. The data indicate a need for community health education if health-related benefits of water and sanitation facilities are to be realized, and specifically indicate the need to address the educational needs of all village women.

Leadership in a public housing community.

Community Health Advocate (CHA) programs train community members to assist and advocate for other members of the community regarding health and other community issues. These programs have been successful in improving the health and quality of life of communities. We developed a CHA program in a single public housing development. This program faced unique challenges since the advocates both worked and lived in the same setting. However, confronting and resolving these issues ultimately enhanced the quality of the program.

Integrating housing and long-term care services for the elderly: a social marketing approach.

Subsidized senior high-rise apartments have tended to neglect the needs of an increasingly aged and frail resident population. Research demonstrates that this population has greater unmet needs than elderly who reside in traditional community housing. This paper makes the case for a vertically integrated marketing approach to serving the elderly. Such an approach would combine housing and community based long-term care services into a single system of care. Enriched senior high-rise apartments are a viable alternative for elders who need assistance in order to maintain an independent lifestyle.