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DEVELOPING CAPACITY IN ENVIRONMENTAL HEALTH
&INDOOR AIR QUALITY PROGRAMS
2019 EPA TRIBAL ENVIRONMENTAL LEADERS’ SUMMIT
PORTLAND, OR
CELESTE L. DAVIS, REHS, MPH
NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD
SOCIO-ECOLOGICAL MODEL OF HEALTH
State & National
Community
Organizational
Interpersonal
Individual
• INDIVIDUAL: AGE, SEX, GENETICS, BEHAVIORS, KNOWLEDGE
• INTERPERSONAL: FAMILY & FRIENDS SUPPORT, KNOWLEDGE, BELIEFS, HEALTH HABITS/BEHAVIORS, JOB/FINANCES, STRESS
• ORGANIZATIONAL: SCHOOL, WORK, CHURCH, INTERACTIONS WITH
• COMMUNITY: SOCIAL SERVICES & SUPPORTS, ACCESS TO HEALTH CARE, HOUSING & BUILT ENVIRONMENT, NATURAL ENVIRONMENT, SAFETY
• STATE & NATIONAL/PUBLIC POLICY: POLICIES & LAWS
PUBLIC HEALTH APPROACH TO IAQ – APPLICATION TO ASTHMA MANAGEMENT
1. STEP 1. DEFINE & MONITOR THE PROBLEM
2. STEP 2. IDENTIFY RISK & PROTECTIVE FACTORS
3. STEP 3. DEVELOP & TEST PREVENTION OR INTERVENTION STRATEGIES
4. STEP 4. ASSURE WIDESPREAD ADOPTION
PH APPROACH STEP 1: DEFINE & MONITOR THE PROBLEM
Guiding Questions Potential Sources of Data
How many people have asthma? What age groups? How severe – hospitalizations, deaths….?
IHS or Tribal Health Clinic; Tribal Epidemiology Centers, State Health Department, behavioral surveys
When and where are the cases of asthma occurring? Use health data to develop a map – Housing Department, Planning Department, GIS program; Environmental Health Data: air quality monitoring; school IAQ inspections; other surveys
PH APPROACH STEP 2: IDENTIFY RISK & PROTECTIVE FACTORS
Guiding Questions Potential Sources of Data
What are the risk factors that lead to poorly controlled asthma?
IHS, CDC;; clinical practice standard from medical organizations; environmental health leaders
What are protective factors?
PH APPROACH STEP 3: DEVELOP & TEST INTERVENTION STRATEGIES
Guiding Questions Potential Sources of Data
Are there existing, effective strategies based on bestavailable evidence?
IHS, CDC; The Community Guide; Scientific research and peer reviewed journals; clinical practice
standards; environmental health best practices
If none exist, what resources do I need to develop a new strategy based on what was learned in steps one and two?
Where can I find research partners to help evaluatethe selected strategy?
Is the strategy effective – did it do what was intended?
PH APPROACH STEP 4: ASSURE WIDESPREAD ADOPTION
Guiding Questions Potential Sources of Data
Who would benefit from this strategy (parents, educators, policy makers, etc.)?
IHS, CDC; The Community Guide; National Implementation Research Network -
http://www.fpg.unc.edu/~nirn/; University of Kansas Community Toolbox -
http://ctb.ku.edu/en/default.aspx
How do I get this strategy to the people who need it?
Where can I find assistance and support for implementing an effective strategy and on-going monitoring and evaluation of the strategy?
Where can I find model policies or codes?
IMPLEMENTING ENVIRONMENTAL HEALTH IAQ PROGRAMS
In WA, hospitalization due
to asthma is
more likely for native patients vs. white
patients
WA Comprehensive Hospital Abstract System, 2012-13, corrected for AI/AN misclassification by the IDEA-NW Project.
UNPUBLISHED. PLEASE DO NOT DISTRIBUTE.
REDUCING INDOOR AIR POLLUTANTS IMPROVES ASTHMA
TRIBAL PROGRAMS
• Continue work with IHS funds, referrals from pharmacy for home visits
• Continuing and expanding
Yakama Nation IHS Clinic
• Goal of reaching 10-12 pediatric patients• Building referral system and forms to institutionalize• Staff undergoing formal training
Tulalip Tribes –GAP Funded
YAKAMA NATION & IHS ASTHMA PILOT
• Clinic & pharmacy referrals to IHS Environmental Health Officer through electronic health record, 25 home visits
• 72% of patients made environmental or habit modifications • 47% patients decreased use of asthma rescue medication• Urgent Care visits reduced from 53% to 12%• Emergency Room visits decreased from 47% to 18% • 90% of patients went from reporting asthma as being not-well
controlled, to well controlled
NW PORTLAND
AREA INDIAN HEALTH BOARD
Project Aims
Measure impacts of
combined clinic and home visit
program.
Document protocols and practices.
Develop training materials for other
tribal clinics.
Implement at 3 other tribal
communities in WA and OR.
National Institutes of Health Native American Research Centers for Health
IHS SERVICE MODEL FOR ASTHMA MANAGEMENT
INTAKE & RISK ASSESSMENT
COMPREHENSIVE ASSESSMENT & SERVICE
HEALTHY HOMES VISIT
• REFERRALHOSPITALIZATION OR ED VISIT
• REFERRALPRIMARY CARE VISIT
PHARMACY CONSULT
HEALTHY HOME VISIT
EH, EP/IAQ, Nurse, CHW
SUMMARY
• WE SPEND UP TO 90% OF OUR TIME INDOORS• HOME, SCHOOL, WORK…
• INDOOR AIR QUALITY IS AFFECTED BY OUTDOOR POLLUTANTS & INDOOR CONTAMINANTS• TRAFFIC & INDUSTRY, COMBUSTION SOURCES, EMISSIONS FROM FURNISHINGS, PETS & PESTS, HOUSEHOLD CLEANING PRODUCTS,
BEHAVIORS & HOBBIES, DAMPNESS & MOLD
• HUMAN EXPOSURE CAN LEAD TO DISEASE OR POOR HEALTH MANAGEMENT• ASTHMA, ALLERGIC RHINITIS, RESPIRATORY INFECTIONS
• EXPOSURE & DISEASE CAN BE PREVENTED AND CONTROLLED
• EFFECTIVE IAQ MONITORING PROGRAMS – PROACTIVE OR COMPLAINT-DRIVEN
• HEALTH CARE REFERRALS TO EH FOR IAQ ASSESSMENT (SUSCEPTIBLE INDIVIDUALS OR CASES)
• EDUCATION FOR PARENTS, SCHOOL STAFF, WORKPLACE OCCUPANTS
• POLICIES THAT PROMOTE HEALTH – INDOOR SMOKING BANS OR DISTANCE REQUIREMENTS, HOUSING CODES
THANK YOU!
•MY CONTACT INFO:
• CELESTE L. DAVIS
• NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD