Radon and moisture impacts from interventions integrated with housing energy retrofits.

Energy retrofits can reduce air exchange, raising the concern of whether indoor radon and moisture levels could increase. This pre/post-intervention study explored whether simple radon interventions implemented in conjunction with energy retrofits can prevent increases in radon and moisture levels. Treatment homes (n = 98) were matched with control (no energy retrofits or radon intervention) homes (n = 12). Control homes were matched by geographic location and foundation type. t-tests were used to determine whether post-energy retrofit radon and moisture level changes in treatment homes significantly differed from those in control homes. The radon interventions succeeded in preventing statistically significant increases in first floor radon using arithmetic (p = 0.749) and geometric means (p = 0.120). In basements, arithmetic (p = 0.060) and geometric (p = 0.092) mean radon levels statistically significantly increased, consistent with previous studies which found that basement radon levels may increase even if first floor levels remain unchanged. Changes in infiltration were related to changes in radon (p = 0.057 in basements; p = 0.066 on first floors). Only 58% of the change in infiltration was due to air sealing, with the rest due to weather changes. There was no statistically significant association between air sealing itself and radon levels on the first floor (p = 0.664). Moisture levels also did not significantly increase.

Incorporating Injury Prevention Into Energy Weatherization Programs.

Clients receiving weatherization/energy services with an added injury prevention home assessment with modifications/repairs experienced a decline in falls and thus fall-related costs. Interventions in 35 homes were associated with significant reductions in falls from baseline to 6 months postintervention (from 94% to 9%; P < .001) and falls with calls for assistance (from 23% to 3%; P < .02). The decline in falls with calls for assistance in the intervention group was significant when adjusted for a comparison group effect (P = .07). At a median cost of $2058 per home, the addition of an injury prevention component led by an occupational therapist offers the potential to avoid expensive fall-related medical costs (lift assistance, hospital transport and admission, long-term care). Integration of injury prevention into weatherization work, which targets lower-income seniors with high energy use, offers potential to reduce costly hospitalizations and poor health outcomes.

Housing and child health.

The connection between housing and health is well established. Physical, chemical, and biological aspects of the child's home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children's health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children's homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children's lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect children's health.

Healthy energy-efficient housing: using a one-touch approach to maximize public health, energy, and housing programs and policies.

Housing conditions such as leaky roofs, peeling paint, structural problems, chronic dampness, improperly vented combustion appliances, and poor ventilation can cause injury, illness, and increased energy consumption. Homes with moderate and severe housing hazards are more likely to be occupied by families with limited incomes because of the lack of affordable housing choices. As a result, children and older adults in these communities face disproportionate impacts from these housing hazards, including higher asthma and injury rates, greater prevalence of lead poisoning, and higher household energy burdens. Programs and policies addressing home health and energy issues have historically operated in categorical silos, which in turn cause fragmented service delivery and inefficient use of scarce resources by the agencies providing these services. A "one-touch" approach for home interventions that strategically integrates public health and energy efficiency has many potential direct and indirect benefits. Also, this approach plays an important role in housing policy due to the increasing support for green housing and residential energy efficiency.

An evaluation of one-time professional cleaning in homes with lead-based paint hazards.

A key challenge in reducing the burden of lead poisoning is to identify cost-effective interventions that minimize lead-based paint hazards. One-time professional cleaning of lead-contaminated dust and debris was conducted in 37 housing units with deteriorated lead-based paint and dust lead hazards. These study units are a subset of a larger cohort of the nearly 3500 housing units enrolled in the Evaluation of the HUD Lead-Based Paint Hazard Control Grant Program. Dust lead loading measurements were taken prior to cleaning, immediately after cleaning (i.e., clearance), and six months, one, two, and three years post-intervention. The cleaning intervention significantly reduced dust lead loadings on floors, windowsills, and window troughs immediately following the work. However, these reductions did not persist at six months and one year post-intervention. Six months and one year post-intervention dust lead loadings are not significantly different from the pre-intervention loadings on either bare floors or windowsills. Although window trough lead loadings declined over 50 percent from pre-intervention to one year post-intervention, the loadings rebounded markedly from the geometric mean at clearance of 101 microgram/ft(2) to 5500 microgram/ft(2) at 6 months and 5790 microgram/ft(2) at one-year post-intervention. These results demonstrate that a single professional cleaning of dust and debris without addressing potential sources of lead dust (such as deteriorated lead-based paint) or repeating the cleaning are unlikely to result in significant and sustained reductions in dust lead loadings. More extensive interventions that address deteriorated lead-based paint, although more expensive, are likely to provide longer term reductions in dust lead loadings. Cleaning strategies, however, may be useful in emergency situations to reduce lead dust hazards when paint repair and other lead hazard control activities cannot be done immediately.

The effect of interior lead hazard controls on children's blood lead concentrations: a systematic evaluation.

Dust control is often recommended to prevent children's exposure to residential lead hazards, but the effect of these controls on children's blood lead concentrations is uncertain. We conducted a systematic review of randomized, controlled trials of low-cost, lead hazard control interventions to determine the effect of lead hazard control on children's blood lead concentration. Four trials met the inclusion criteria. We examined mean blood lead concentration and elevated blood lead concentrations (> or = 10 microg/dL, > or = 15 microg/dL, and > or = 20 microg/dL) and found no significant differences in mean change in blood lead concentration for children by random group assignment (children assigned to the intervention group compared with those assigned to the control group). We found no significant difference between the intervention and control groups in the percentage of children with blood lead > or = 10 microg/dL, 29% versus 32% [odds ratio (OR), 0.85; 95% confidence interval (CI), 0.56-1.3], but there was a significant difference in the percentage of children with blood lead > or = 15 microg/dL between the intervention and control groups, 6% versus 14% (OR, 0.40; 95% CI, 0.21-0.80) and in the percentage of children with blood lead > or = 20 microg/dL between the intervention and control groups, 2% versus 6% (OR, 0.29; 95% CI, 0.10-0.85). We conclude that although low-cost, interior lead hazard control was associated with 50% or greater reduction in the proportion of children who had blood lead concentrations exceeding 15 microg/dL and > or = 20 microg/dL, there was no substantial effect on mean blood lead concentration.