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Healthy home environment assessments

Health Factors: Housing & Transit
Decision Makers: Community Development Professionals Local Government Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Healthy home environment assessments engage home visitors, often community health workers (CHWs), similarly trained asthma outreach workers, other professionals, paraprofessionals, or volunteers to assess and remediate environmental health risks within the home (Primomo 2006, ALA-MHEKearney 2014). Programs typically focus on improving asthma management via low cost changes such as improved ventilation, integrated pest management, and other forms of allergen control. Programs may also provide low emission vacuums, allergen-impermeable bedding covers, air filters, cleaning supplies, and supplies for roach abatement (Campbell 2015Krieger 2015).

Expected Beneficial Outcomes

Reduced exposure to allergens
Reduced hospital utilization
Improved asthma management
Improved quality of life
Improved indoor air quality
Improved health outcomes

Evidence of Effectiveness

There is strong evidence that healthy home environment assessments encourage household behaviors that reduce asthma triggers and exposure to allergens (Krieger 2015, Campbell 2015, Jassal 2013, Margellos-Anast 2012, Primomo 2006, Hoppin 2006) and decrease use of urgent care and related health care costs (Jassal 2013, Campbell 2015, Kearney 2014, Kapheim 2015, Margellos-Anast 2012). Additional evidence is needed to confirm long-term effects on health outcomes (Jassal 2013, Krieger 2015, Margellos-Anast 2012).

Healthy home environment assessments conducted by community health workers (CHWs) or trained asthma outreach workers have been shown to improve asthma self-management, increase the number of asthma symptom free days, and improve quality of life for participating children and their caregivers (Campbell 2015, Kearney 2014, Kapheim 2015, Margellos-Anast 2012). Such interventions can also improve asthma symptoms for those living in lower quality housing (Hoppin 2006, Campbell 2015, Krieger 2015).

Available research suggests that healthy home environment assessment programs are more frequently established in urban areas (Postma 2011). However, such programs have also been shown to improve home air quality and reduce urgent care admissions for minority and disadvantaged families in rural areas (Postma 2011, Kearney 2014). A study of the Home-Based Asthma Support and Education (HomeBASE) program indicates increases in the number of symptom free days and improvements in quality of life for participants of various racial and ethnic backgrounds, genders, ages, and levels of asthma control (Krieger 2015).

Economic evaluations indicate healthy home environment assessments achieve high cost savings largely due to averted urgent care clinic visits, emergency room visits, and hospitalizations (Jassal 2013, Campbell 2015, Kearney 2014, Margellos-Anast 2012).

Implementation

United States

Healthy home environment assessments are in place throughout the country. For example, Seattle, Washington’s King County Asthma Program, Healthy Homes, engages community health workers (CHWs) to conduct home visits focused on controlling asthma (Campbell 2015, Seattle-Asthma program). The Master Home Environmentalist Program (MHEP) launched by Washington’s American Lung Association, trains volunteers to identify health hazards in the home (e.g. dust, lead, household chemicals, mold and other air pollutants), use low cost methods to reduce risks, and train families to improve their home environments (ALA-MHE).

The Eastern Carolina Asthma Prevention Program’s Asthma Case Managers (ACM) provide education and resources to control asthma and allergen triggers in the home, largely to low income families with children (Kearney 2014).

Wisconsin

The Children’s Health Alliance of Wisconsin leads the Wisconsin Asthma Coalition (WAC), a partnership focused on improving asthma management, reducing disparities, enhancing quality of life, and preventing asthma-related deaths. WAC’s Home Walkthrough Program provides guidance on what to assess and where to look for hazards, and recommendations to alleviate asthma triggers, and can be implemented with existing local home visiting programs (WAC).

Implementation Resources

ACEEE-SmarterHouse - American Council for an Energy-Efficient Economy (ACEEE). SmarterHouse: an up-to-date guide on energy savings in the home. Accessed on July 27, 2016
ALA-MHE - American Lung Association (ALA). The Master Home Environmentalist (MHE) Program. Accessed on August 1, 2016
Clean Air-HEAL - Clean Air for Kids Partnership. Directions for the do-it-yourself home environmental assessment list (HEAL). Accessed on August 1, 2016
WAC - Children's Health Alliance of Wisconsin. Wisconsin Asthma Coalition (WAC). Home Walkthrough Program: report and checklist to identify low and no-cost solutions to asthma triggers. Accessed on July 27, 2016

Citations - Description

ALA-MHE - American Lung Association (ALA). The Master Home Environmentalist (MHE) Program. Accessed on August 1, 2016
Campbell 2015* - Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for Medicaid-enrolled children with asthma: Effects on asthma outcomes and costs. American Journal of Public Health. 2015;105(11):2366-2372. Accessed on July 27, 2016
Kearney 2014 - Kearney GD, Johnson LC, Xu X, et al. Eastern Carolina Asthma Prevention Program (ECAPP): An environmental intervention study among rural and underserved children with asthma in Eastern North Carolina. Environmental Health Insights. 2014;8:27-37. Accessed on July 27, 2016
Krieger 2015* - Krieger J, Song L, Philby M. Community health worker home visits for adults with uncontrolled asthma: The HomeBASE trial randomized clinical trial. JAMA Internal Medicine. 2015;175(1):109-117. Accessed on July 27, 2016
Primomo 2006* - Primomo J, Johnston S, DiBiase F, Nodolf J, Noren L. Evaluation of a community-based outreach worker program for children with asthma. Public Health Nursing. 2006;23(3):234-41. Accessed on July 27, 2016

Citations - Evidence

Campbell 2015* - Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for Medicaid-enrolled children with asthma: Effects on asthma outcomes and costs. American Journal of Public Health. 2015;105(11):2366-2372. Accessed on July 27, 2016
Hoppin 2006 - Hoppin P, Jacobs M, Ribble M. Enhancing asthma management using in-home environmental interventions: A review of public health department programs. Dorchester: Asthma Regional Council of New England (ARC); 2006. Accessed on July 27, 2016
Jassal 2013* - Jassal MS, Diette GB, Dowdy DW. Cost-consequence analysis of multimodal interventions with environmental components for pediatric asthma in the state of Maryland. Journal of Asthma. 2013;50(6):672-680. Accessed on July 27, 2016
Kapheim 2015* - Kapheim MG, Ramsay J, Schwindt T, Hunt BR, Margellos-Anast H. Utilizing the community health worker model to communicate strategies for asthma self-management and self-advocacy among public housing residents. Journal of Communication in Healthcare: Strategies, Media and Engagement in Global Health. 2015;8(2):95-105. Accessed on July 27, 2016
Kearney 2014 - Kearney GD, Johnson LC, Xu X, et al. Eastern Carolina Asthma Prevention Program (ECAPP): An environmental intervention study among rural and underserved children with asthma in Eastern North Carolina. Environmental Health Insights. 2014;8:27-37. Accessed on July 27, 2016
Krieger 2015* - Krieger J, Song L, Philby M. Community health worker home visits for adults with uncontrolled asthma: The HomeBASE trial randomized clinical trial. JAMA Internal Medicine. 2015;175(1):109-117. Accessed on July 27, 2016
Margellos-Anast 2012* - Margellos-Anast H, Gutierrez MA, Whitman S. Improving asthma management among African-American children via a community health worker model: Findings from a Chicago-based pilot intervention. Journal of Asthma. 2012;49(4):380-389. Accessed on August 1, 2016
Postma 2011 - Postma JM, Smalley K, Ybarra V, Kieckhefer G. The feasibility and acceptability of a home-visitation, asthma education program in a rural, latino/a population. Journal of Asthma. 2011;48(2):139-46. Accessed on July 27, 2016
Primomo 2006* - Primomo J, Johnston S, DiBiase F, Nodolf J, Noren L. Evaluation of a community-based outreach worker program for children with asthma. Public Health Nursing. 2006;23(3):234-41. Accessed on July 27, 2016

Citations - Implementation

ALA-MHE - American Lung Association (ALA). The Master Home Environmentalist (MHE) Program. Accessed on August 1, 2016
Campbell 2015* - Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for Medicaid-enrolled children with asthma: Effects on asthma outcomes and costs. American Journal of Public Health. 2015;105(11):2366-2372. Accessed on July 27, 2016
Kearney 2014 - Kearney GD, Johnson LC, Xu X, et al. Eastern Carolina Asthma Prevention Program (ECAPP): An environmental intervention study among rural and underserved children with asthma in Eastern North Carolina. Environmental Health Insights. 2014;8:27-37. Accessed on July 27, 2016
Seattle-Asthma program - Public Health: Seattle & King County. Guidelines to Practice (G2P): Reducing Asthma Health Disparities through Guideline Implementation. Program works with clinics, health plans, and with patients in their homes to improve asthma care of children and adults. Accessed on July 27, 2016
WAC - Children's Health Alliance of Wisconsin. Wisconsin Asthma Coalition (WAC). Home Walkthrough Program: report and checklist to identify low and no-cost solutions to asthma triggers. Accessed on July 27, 2016

Page Last Updated

July 27, 2016

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