The New York State Healthy Neighborhoods Program: Findings From an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program.

CONTEXT: A growing evidence base suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation. OBJECTIVE: To evaluate the impact of a large-scale, multisite, state-funded healthy homes program. SETTING: Homes in high-risk neighborhoods of 13 counties funded under the New York State Healthy Neighborhoods Program (NYS HNP) from 2008 to 2012. PARTICIPANTS: A total of 28 491 homes received an initial visit and 6436 dwellings received a revisit (follow-up assessment 3 to 6 months after the intervention). A majority of residents are low-income renters living in buildings built prior to 1950. INTERVENTION: The NYS HNP is a low-intensity healthy homes program. Participating homes undergo a visual assessment to identify potential environmental health and safety hazards, and interventions (education, referrals, and products) are provided to address any hazards identified during the visit. MAIN OUTCOME MEASURES: The proportion of homes affected by several types of housing hazards, improvement in hazards among revisited homes, and the change in the overall number of hazards per home were assessed. RESULTS: Among the homes that were revisited, there were significant improvements in the conditions assessed for tobacco control, fire safety, lead poisoning prevention, indoor air quality, and other hazards (including pests and mold). There was a significant reduction in the number of hazards per home (2.8 to 1.5; P < .001), but homes were not hazard-free at the revisit. CONCLUSION: This evaluation suggests that a comprehensive, low-intensity healthy housing approach can produce short-term impacts with public health significance. This evaluation provides information about hazards that are common, easily assessed, and easily corrected or improved, which may be of use to a variety of programs that already provide in-home services and are seeking to expand the scope of their visits or to inform the development of new programs.

Self-reported health outcomes associated with green-renovated public housing among primarily elderly residents.

OBJECTIVES: Assess the benefits of green renovation on self-reported health of primarily elderly residents of a low-income public housing apartment building. DESIGN AND SETTING: Using questions from the Medicare Health Outcomes Survey, we interviewed residents at baseline and 1 year after green renovation of their 101-unit building in Mankato, Minnesota, comparing self-reported mental and physical health outcomes of 2 sets of residents (all-ages: median, 66 years, n = 40; elder: median, 72 years, n = 22) with outcomes for 2 same-aged low-income Minnesota comparison groups taken from Medicare Health Outcomes Survey participants (n = 40 and 572, respectively). STUDY GROUP: Mankato apartment building residents. INTERVENTIONS: Green renovation including building envelope restoration; new heating, electrical, and ventilation systems; air sealing; new insulation and exterior cladding; window replacement; Energy-Star fixtures and appliances; asbestos and mold abatement; apartment gut retrofits; low volatile organic chemical and moisture-resistant materials; exercise enhancements; and indoor no-smoking policy. MAIN OUTCOME MEASURES: Self-reported health status including Activities of Daily Living and Veteran's Rand 12 (VR-12) survey results; housing condition visual assessment; indoor environmental sampling; and building performance testing. RESULTS: The all-ages study group's mental health improved significantly more than the comparison group's mental health on the basis of mean number of good mental health days in the past month (P = .026) and mean VR-12 mental component score (P = .023). Sixteen percent fewer all-ages study group people versus 8% more comparison group people reported falls (P = .055). The elder study group's 9% improvement in general physical health was not statistically significantly better than the elder comparison group's decline (6%) (P = 0.094). Significantly fewer people in the all-ages group reported smoke in their apartments because of tobacco products (20% vs 0%, P = .005), likely reflecting the new no-smoking policy. CONCLUSIONS: Green healthy housing renovation may result in improved mental and general physical health, prevented falls, and reduced exposure to tobacco smoke.

A side-by-side comparison of three allergen sampling methods in settled house dust.

Understanding allergen exposure and potential relationships with asthma requires allergen sampling methods, but methods have yet to be standardized. We compared allergen measurements from dust collected from 200 households with asthmatics and conducted a side-by-side vacuum sampling of settled dust in each home's kitchen, living room and subject's bedroom by three methods (EMM, HVS4 and AIHA). Each sample was analyzed for dust mite, cockroach, mouse, rat, cat and dog allergens. The number of samples with sufficient dust mass for allergen analysis was significantly higher for Eureka Mighty Mite (EMM) and high volume small surface sampler (HVS4) compared with American Industrial Hygiene Association (AIHA) in all rooms and surfaces tested (all P<0.05). The allergen concentration (weight of allergen divided by total weight of dust sampled) measured by the EMM and HVS4 methods was higher than that measured by the AIHA. Allergen loadings (weight of allergen divided by surface area sampled) were significantly higher for HVS4 than for AIHA and EMM. Cockroach and rat allergens were rarely detected via any method. The EMM method is most likely to collect sufficient dust from surfaces in the home and is relatively practical and easy. The AIHA and HVS4 methods suffer from insufficient dust collection and/or difficulty in use.

Exposure of U.S. children to residential dust lead, 1999-2004: I. Housing and demographic factors.

BACKGROUND: Lead-contaminated house dust is a major source of lead exposure for children in the United States. In 1999-2004, the National Health and Nutrition Examination Survey (NHANES) collected dust lead (PbD) loading samples from the homes of children 12-60 months of age. OBJECTIVES: In this study we aimed to compare national PbD levels with existing health-based standards and to identify housing and demographic factors associated with floor and windowsill PbD. METHODS: We used NHANES PbD data (n=2,065 from floors and n=1,618 from windowsills) and covariates to construct linear and logistic regression models. RESULTS: The population-weighted geometric mean floor and windowsill PbD were 0.5 microg/ft2 [geometric standard error (GSE)=1.0] and 7.6 microg/ft2 (GSE=1.0), respectively. Only 0.16% of the floors and 4.0% of the sills had PbD at or above current federal standards of 40 and 250 microg/ft2, respectively. Income, race/ethnicity, floor surface/condition, windowsill PbD, year of construction, recent renovation, smoking, and survey year were significant predictors of floor PbD [the proportion of variability in the dependent variable accounted for by the model (R2)=35%]. A similar set of predictors plus the presence of large areas of exterior deteriorated paint in pre-1950 homes and the presence of interior deteriorated paint explained 20% of the variability in sill PbD. A companion article [Dixon et al. Environ Health Perspect 117:468-474 (2009)] describes the relationship between children's blood lead and PbD. CONCLUSION: Most houses with children have PbD levels that comply with federal standards but may put children at risk. Factors associated with PbD in our population-based models are primarily the same as factors identified in smaller at-risk cohorts. PbD on floors and windowsills should be kept as low as possible to protect children.

Exposure of U.S. children to residential dust lead, 1999-2004: II. The contribution of lead-contaminated dust to children's blood lead levels.

BACKGROUND: The U.S. Centers for Disease Control and Prevention collected health, housing, and environmental data in a single integrated national survey for the first time in the United States in 1999-2004. OBJECTIVES: We aimed to determine how floor dust lead (PbD) loadings and other housing factors influence childhood blood lead (PbB) levels and lead poisoning. METHODS: We analyzed data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES), including 2,155 children 12-60 months of age with PbB and PbD measurements. We used linear and logistic regression models to predict log-transformed PbB and the odds that PbB was >or=5 and >or=10 microg/dL at a range of floor PbD. RESULTS: The population-weighted geometric mean (GM) PbB was 2.0 microg/dL (geometric standard error=1.0). Age of child, race/ethnicity, serum cotinine concentration, poverty-to-income ratio, country of birth, year of building construction, floor PbD by floor surface and condition, windowsill PbD, presence of deteriorated paint, home-apartment type, smoking in the home, and recent renovation were significant predictors in either the linear model [the proportion of variability in the dependent variable accounted for by the model (R2)=40%] or logistic model for 10 microg/dL (R2=5%). At floor PbD=12 microg/ft2, the models predict that 4.6% of children living in homes constructed before 1978 have PbB>or=10 microg/dL, 27% have PbB>or=5 microg/dL, and the GM PbB is 3.9 microg/dL. CONCLUSIONS: Lowering the floor PbD standard below the current standard of 40 microg/ft2 would protect more children from elevated PbB.