Columbia, MD, United States
Columbia, MD, United States

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Brown M.J.,Centers for Disease Control and Prevention | Jacobs D.E.,National Center for Healthy Housing
Public Health Reports | Year: 2011

Objectives. We examined the relationship between self-reported inadequate residential natural light and risk for depression or falls among adults aged 18 years or older. Methods. Generalized estimating equations were used to calculate the odds of depression or falls in participants with self-reported inadequate natural residential light vs. those reporting adequate light (n?6,017) using data from the World Health Organization's Large Analysis and Review of European Housing and Health Survey, a large cross-sectional study of housing and health in representative populations from eight European cities. Results. Participants reporting inadequate natural light in their dwellings were 1.4 times (95% confidence interval [CI] 1.2,1.7) as likely to report depression and 1.5 times (95% CI 1.2, 1.9) as likely to report a fall compared with those satisfied with their dwelling's light. After adjustment for major confounders, the likelihood of depression changed slightly, while the likelihood of a fall increased to 2.5 (95% CI 1.5, 4.2). Conclusion. Self-reported inadequate light in housing is independently associated with depression and falls. Increasing light in housing, a relatively inexpensive intervention, may improve two distinct health conditions. © 2011 Association of Schools of Public Health.

Korfmacher K.S.,University of Rochester | Ayoob M.,Albany Research Center | Morley R.,National Center for Healthy Housing
Environmental Health Perspectives | Year: 2012

Background: Significant progress has been made in reducing the incidence of childhood lead poisoning in the United States in the past three decades. However, the prevalence of elevated blood lead in children (≥ 10 μg/dL) remains high in some communities, particularly those with high proportions of pre-1978 housing in poor condition. Increasingly, municipalities are using local policy tools to reduce lead poisoning in high-risk areas, but little is known about the effectiveness of such policies. Objectives: In this article, we evaluated the effectiveness of a comprehensive rental housing-based lead law adopted in Rochester, New York, in 2005. Methods: This policy evaluation integrates analyses of city inspections data, a survey of landlords, landlord focus groups, and health department data on children's blood lead levels from the first 4 years of implementation of the 2005 law. Results: Implementation has proceeded consistent with projected numbers of inspections with nearly all target units inspected in the first 4 years. Higher than expected inspection passage rates suggest that landlords have reduced lead hazards in rental housing affected by the law. Implementation of the lead law does not appear to have had a significant impact on the housing market. Conclusions: Although many uncertainties remain, our analysis suggests that the lead law has had a positive impact on children's health. Strong enforcement, support for community-based lead programs, and ongoing intergovernmental coordination will be necessary to maintain lead-safe housing in Rochester. Lessons learned from the Rochester experience may inform future local lead poisoning prevention policies in other communities.

Gottesfeld P.,Occupational Knowledge International | Jacobs D.E.,National Center for Healthy Housing
Science of the Total Environment | Year: 2016

Turner's paper emphasizes “oral bioaccessibility” instead of focusing solely on total lead content. There is no evidence that solubility testing for lead levels in paint correlates with absorption or blood lead levels in exposed children. There are many considerations in determining exposure hazards to paint that are not evaluated in assessing solubility. Although we strongly support the conclusions and recommendations of the study, we are concerned that by reporting “oral bioaccessibility” others will focus on solubility in developing regulatory standards for lead levels in paint or in conducting exposure assessments. Standards for lead in paint should continue to be based on total lead content, not “oral bioaccessibility.” © 2016 Elsevier B.V.

Neltner T.,National Center for Healthy Housing
Journal of public health management and practice : JPHMP | Year: 2010

Recognizing the need to build a cadre of health care and housing professionals prepared to make homes healthier, in 2003, the US Centers for Disease Control and Prevention in partnership with the US Department of Housing and Urban Development launched the National Healthy Homes Training Center and Network (Training Center). Through a competitive process, the Centers for Disease Control and Prevention selected the National Center for Healthy Housing to host and manage the Training Center. The Training Center has flourished with additional support from US Environmental Protection Agency. The training incorporates interventions known to be most effective and helps to disseminate best practices. By 2010, it: developed a curriculum of 8 courses including 1 online course; trained more than 6500 people; credentialed more than 380 people as Healthy Homes specialists; delivered more than 220 one- or two-day trainings in 40 states; grew from 5 to 25 state or regional training partners covering 40 states; and created an extensive Web site of resources at

Nevin R.,National Center for Healthy Housing
Energy Policy | Year: 2010

This paper describes an energy-efficient housing stimulus strategy that can: (1) quickly provide large-scale job creation; (2) reduce home energy bills by 30-50% with associated reductions in emissions and energy assistance spending; (3) stabilize home values and reduce foreclosure inventory; (4) help to eliminate childhood lead poisoning; and (5) implement regulatory reforms that highlight market incentives for cost effective energy efficiency and alternative home energy investments. These benefits, far in excess of costs, can be achieved by combining "lead-safe window replacement" with other weatherization activities and simple regulatory and market reforms. This strategy can help to coordinate American Recovery and Reinvestment Act funding for energy efficiency, the $75 billion Making Home Affordable plan to reduce foreclosures, and the recently announced partnership between the Departments of Energy (DOE) and Housing and Urban Development (HUD) to streamline weatherization efforts and spur job creation. © 2009 Elsevier Ltd. All rights reserved.

Breysse J.,National Center for Healthy Housing | Dixon S.,National Center for Healthy Housing | Gregory J.,King County Housing Authority | Jacobs D.E.,National Center for Healthy Housing | Krieger J.,Public Health Seattle and King County
American Journal of Public Health | Year: 2014

Objectives: We assessed the benefits of adding weatherization-plus-health interventions to an in-home, community health worker (CHW) education program on asthma control. Methods: Weusedaquasi-experimentaldesigntocompare studygroup homes (n = 34) receiving CHW education and weatherization-plus-health structural interventions with historical comparison group homes (n = 68) receiving only education. Data were collected in King County, Washington, from October 2009 to September 2010. Results: Over the 1-year study period, the percentage of study group children with not-well-controlled or very poorly controlled asthma decreased more than the comparison group percentage (100% to 28.8% vs 100% to 51.6%; P =.04). Study group caregiver quality-of-life improvements exceeded comparison group improvements (P =.002) by 0.7 units, a clinically important difference. The decrease in study home asthma triggers (evidence of mold, water damage, pests, smoking) was marginally greater than the comparison group decrease (P =.089). Except for mouse allergen, the percentage of study group allergen floor dust samples at or above the detection limit decreased, although most reductions were not statistically significant. Conclusions: Combining weatherization and healthy home interventions (e.g., improved ventilation, moisture and mold reduction, carpet replacement, and plumbing repairs) with CHW asthma education significantly improves childhood asthma control.

Jacobs D.E.,National Center for Healthy Housing | Jacobs D.E.,University of Illinois at Chicago
American Journal of Public Health | Year: 2011

The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lackofhousing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing.

Jacobs D.E.,National Center for Healthy Housing
Journal of public health management and practice : JPHMP | Year: 2010

Subject matter experts systematically reviewed evidence on the effectiveness of specific housing interventions in improving health. The panelists reviewed housing interventions associated with exposure to biological and chemical agents, structural injury hazards, and community-level interventions. Intervention studies were grouped together according to recommendations in the Guide to Community Preventive Services, which identifies similarities in the type of intervention, its delivery and setting, and the target population. Review panelists found that 11 interventions had sufficient evidence of effectiveness, 15 required more field evaluation, 19 needed formative research, and 7 either had no evidence of effectiveness or were ineffective. Although many housing conditions are associated with adverse health outcomes, sufficient evidence now shows that specific housing interventions can improve certain health outcomes. The results of these evidence reviews can inform a robust agenda for widespread implementation and further research. This article highlights the project's research methods and summary findings, and its companion articles detail the evidence reviews for specific housing interventions.

Dixon S.L.,National Center for Healthy Housing | Jacobs D.E.,National Center for Healthy Housing | Wilson J.W.,National Center for Healthy Housing | Akoto J.Y.,National Center for Healthy Housing | And 2 more authors.
Environmental Research | Year: 2012

Window replacement is a key method of reducing childhood lead exposure, but the long-term effectiveness has not been previously evaluated. Windows have the highest levels of interior lead paint and dust compared to other building components. Our objective was to conduct a follow-up study of residential window replacement and lead hazard control 12 years after homes were enrolled in an evaluation of the HUD Lead Hazard Control Grant Program, sampling settled lead dust in housing in four cities (n=189 homes). Previous work evaluated lead hazard controls up to 6 years after intervention using dust lead measurements and two years after intervention using both dust and blood lead data. But the earlier work could not examine the effect of window replacement over the longer time period examined here: 12 years. The individual homes were assigned to one of three categories, based on how many windows had been replaced: all replacement, some replacement, or non-replacement. Windows that were not replaced were repaired. We controlled for covariates such as site, housing condition, presence of lead paint, and season using longitudinal regression modeling. Adjusted floor and sill dust lead geometric mean dust lead loadings declined at least 85% from pre-intervention to 12 years after the intervention for homes with all replacement windows, some windows replaced and no windows replaced. Twelve years after intervention, homes with all replacement windows had 41% lower interior floor dust lead, compared to non-replacement homes (1.4 versus 2.4μg/ft 2, p<0.001), and window sill dust lead was 51% lower (25 versus 52μg/ft 2, p=0.006) while controlling for covariates. Homes with some windows replaced had interior floor and window sill dust lead loadings that were 28% (1.7 versus 2.4μg/ft 2, p=0.19) and 37% (33 versus 52μg/ft 2, p=0.07) lower, respectively, compared to non-replacement homes. The net economic benefit of window replacement compared to window repair (non-replacement) is $1700-$2000 per housing unit. Homes in which all windows were replaced had significantly lower lead dust. New windows are also likely to reduce energy use and improve home value. Lead-safe window replacement is an important element of lead hazard control, weatherization, renovation and housing investment strategies and should be implemented broadly to protect children. © 2012 Elsevier Inc.

Lindberg R.A.,National Center for Healthy Housing
Journal of public health management and practice : JPHMP | Year: 2010

A panel of subject matter experts systematically reviewed evidence linking neighborhood-level housing interventions, such as housing programs or policies, to health outcomes. One of the 10 interventions reviewed--the Housing Choice Voucher Program--had sufficient evidence for implementation or expansion. The evidence showed that voucher holders are less likely to suffer from overcrowding, malnutrition due to food insecurity, and concentrated neighborhood poverty than non-voucher holders. Of the other reviewed interventions, 2 needed more field evaluation and 7 needed more formative research. None were determined to be ineffective. Although many of the reviewed interventions lacked sufficient evidence for widespread implementation solely based on their health benefits, this evidence review shows that many interventions positively affect other areas of social, economic, and environmental well-being. Efforts to improve neighborhood environments and to maintain and increase the number of affordable housing units are critical to ensuring safe, healthy, and affordable housing for all people in the United States. Given that people of color disproportionately reside in high-poverty neighborhoods, neighborhood-level interventions may be particularly important in efforts to eliminate health disparities.

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