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Housing and Health Connection: A Short Summary & Review of Existing Healthy Homes Trainings National Healthy Homes Training Center and Network Meeting Mount Washington Conference Center January 21-23, 2004

Housing and Healthy Connection-HH Training Center

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Housing and Health Connection:

A Short Summary&

Review of Existing Healthy

Homes Trainings

National Healthy Homes Training Center

and Network MeetingMount Washington Conference Center

January 21-23, 2004

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Focus on the Indoor 

Environment

� It¶s where we spend our time: ± Children - up to 80%

 ± Adults ± up to 90%

� Estimates of the direct impact of housing quality on human health

vary.

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³The connection

between health and

the dwelling of the

population is one of the most important

that exists´.

Florence Nightingale

Cited in Lowry, S. BMJ, 1991, 303, 838-840

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Current Understanding� Housing is under appreciated as a

determinant of health.

� We need to understand the

interaction among hazards.

� Intervention studies are needed.

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How do Hazards Interact?

Deterioratedhousing

PestInfestation

Increased

Asthma Risk

Pesticide

Use

Pesticideexposure

Neurobehavioral risk(cancer risk)

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What are the Health Effects of 

Mold?

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Water, Moisture, Humidity,

Leaks� Associated with many other vectors

including:

 ± Dust mites

 ± Cockroaches

 ± Domestic animals

 ± Bacteria

 ± viruses

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Combustion Leakage� Combustion appliances

� HVAC systems

� Nitrogen Dioxide and CO

� Strong link to asthma and respiratory

symptoms

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Products Used in the Home� Pressed wood products, paints,

solvents, adhesives

� Volatile organic compounds

� Associated with respiratory

symptoms, rashes, allergies, cancers

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R adon

� Soil gas entering homes through

cracks, sumps, concrete slabs

� Cancer 

� No differentiation between adults and

children

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The real world is complex

� Exposures are not single-substance.

� How do different allergens interact to

cause health effects?

� What are the most appropriate

measures of exposure?

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Need Better Exposure

Assessment Tools

� Sampling Location

� Sampling Method

� Personal Exposure

� How can we take advantage of on-

going program opportunities?

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Which Interventions Work?� Control of water 

� Allergy Avoidance

� ETS Exposure Avoidance

� Pest Control

� Can we develop a comprehensive,home-based primary prevention

strategy?

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Social Behavioral Issues

� What are the barriers to compliance ?

� How can we increase effectiveness of educational recommendations?

� What will make the difference for the

long-term?

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Summary of Research Needs

� Evidence of the health effects of mold and

moisture

� Studies of mixtures and combined effects

� Better exposure assessment tools

� Evaluations of the efficacy of 

interventions to reduce disease� A better understanding of social

behavioral issues

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Implementation Issues� Prevention not reaction

� A combined public health-housingapproach

� Attention to public sector infrastructure issues

� The private sector role� Guidelines and training

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³Until effective standards for the

domestic environment are

devised, it is likely that children

will continue to be employed asbiological indicators of 

substandard housing.´

Donald Barltrop

Am. J. Dis. Child 127:165-166 (1974)

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National Healthy Homes

Training Center & Network

Overview of Existing

Healthy Homes Trainings

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Survey of Existing

Trainings

� Questions focused on:

 ± Names of existing trainings

 ± Sponsors of the training ± Target audience

 ± Length of training

 ± Pre-existing competencies ± Topics of training

 ± Goals of training

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Types of 

Training Identified

� University-based courses

� Public Health Agency Trainings

� Healthy Homes Partnership Projects

� Other types of Trainings

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University Based Trainings

 ² University of California, Berkeley� Mold: Inspection, Assessment and Control

 ² Eastern Kentucky University� EHS 460, Control of Housing Environments

� EHS 855 Emergency Preparedness and Shelter 

Environments

 ² University of Georgia� EHS 3260 Shelter and Institutional Environmental

Health

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University-Based Courses

� Target audience ± Symposiums - Contractors, consultants,

industrial hygienists

 ± Courses - Students in Public health

� Length of trainings ± Symposiums - 3 days

 ± Courses - 30 to 48 hours of classroom, 96hours preparation

� Focus ± Symposiums ± inspection, assessment andcontrol of molds

 ± Courses - comprehensive, cover a widerange of healthy housing concepts

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Public Health Agency

Trainings ² Boston Public Health Commission

� Healthy Homes Training

 ² Alameda County Lead Poisoning

Prevention Program

� Environmental Risk Factors Affecting aHealthy Home

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Public Health AgencyT

rainings� Target audiences:

 ± Community health workers

 ± Public health nurses, public healthprofessionals, health educators,contractors, housing agency staff,outreach workers

� Length of trainings - 3 hours

� Focus ± Childhood Asthma andinjuries

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Healthy Homes Partnerships

Alabama ± Conducts 6 multi-county

Healthy Home Environmental Conferences

Arkansas ± Series of workshops on child

safety ³21st Century Families: Challenges

and Opportunities´.

Connecticut  ± multi-topic workshops on

Healthy Homes and Indoor Air Quality

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Healthy Homes PartnershipsGeorgia  ± ³Help Yourself to a Healthy

Home´ seminars

Kentucky ± Seminars on lead, householdhazardous products, and pesticides

Louisiana  ± Healthy Home information is

incorporated into ³Safety First´ and

³Creating a Learning Environment´ lessons

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Healthy Homes Partnerships

Minnesota  ±  Healthy Homes presentations to

Head Start Program parents

Missouri  ± one day training on Health and

Safety Issues in the Home

New Jersey  ± developed curriculum and

handout sheet: Environmental Health in

Childcare Facilities

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Healthy Homes PartnershipsNorth Carolina  ±  in-services on Healthy

Homes for county educators

Rhode Island  ±  incorporated Healthy

Homes materials into the R hode Island

Home*A*Syst Program

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Healthy Homes PartnershipsTexas ± Train-the-Trainer sessions on

Indoor Air Quality

Utah ± Train-the-Trainer program for 

housing professionals

Virginia ± Training that focused on

childcare environments

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Healthy Homes Partnerships

� Target audiences ±  Providers, parents, social workers, Health

Department Staff 

 ±  Volunteer organizations and general public

 ±  Teachers and childcare providers

� Length of Training

 ±  Seminars or series of seminars

� Focus ±  Lead, hazardous products, pesticides

 ±  Asthma

 ±  Disaster preparedness

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Other Trainings� American Lung Association

 ² Health House Project

� Target audience ± Builders

� Length of Training ± 2 days

� Focus ± Construction issues that can

help create healthier indoor environments

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In Summary - 1

� Current trainings are quite diverse .

� R ange of target audiences is wide.

� Length of trainings range from 3 hours to 2days.

� Most trainings are not based on a set of pre-

existing competencies.

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In Summary - 2� The goals vary but most attempt to provide

 basic education to the target audiences

about Healthy Homes issue.

� Availability is unclear: some are done as a

one time event and some may be

continuing.