Gin g er L . C h e - PowerPoint Presentation

Gin ger L. Chew, ScDEpidemiologist, National Center for EnvironmentalHealthDivision of Environmental Hazards and Health EffectsCenters for Disease Control and Prevention G e t ting i nt o Action: T ools R esou r ce s and Action Plans

A path toward standardizedHome AssessmentQuestionnairesGinger L. Chew, ScD May 18, 2018National Ce nte r f or Env i ro n m e n ta l H e a l t h A i r Po llu t i o n a n d R e sp i r at o r y H e a l t h Bra nc h

T h e H i s t o r y o f H o m eC h a r a c t e r i s t i c s Q u e s t i o n n a i r e s

T he History of Home Characteristics Questionnairesfor asthma triggers (cont’d)Clinicians to directl y h elp pat ien t s ( f or c e n t u r i e s ) R esearchers(since 1960s) Is a mite (Dermatophagoides sp.)the of the house dust allergen?Voorhorst R., Spieksma- Boezeman MI, and Allerg. Asthma,10:329 -34. (1964) producer Spieksma FT H o m e v i s i t s t a f f t o d i r e c t l y h e l p p a t i e n t s ( t h i s i s m o r e r e c e n t 1990 s – p r ese n t )

Wh ich is better?vs.

W hich is better?“We identified a number of housing conditions that are consistently associated with increased allerg en con cen tratio n s.”

Re view articles:Multi-faceted interventionsEffectiveness of home-based, multi-trigger, multicomponent interventions with an envir onment al fo cus for re d uc i ng a s thma m o r b i dityCrocker, Kinyota, Dumitru, Ligo n, Herman, Ferdinands, Hopkins, Lawrence, Sipe, Task Force on Community Preventive Services, Am. J. Prev., Med., 41:S5-32, 2011.Housing interventions and control of asthma- related indoor bi ologic agents: a r ev i ew of the evi dence . Kr iege r , J a c ob s , As hle y , B aede r , Che w , Dea r bo r n , H y ne s , M ille r , M o r le y , Rabi t o , Z eldin . J Publi c Heal t h M ana g P r a ct . 16 ( 5 S uppl ) : S 1 1 - 20 , 2010 .

S hould we standardize the homecharacteristics questionnaires?Study nameQuestions to assess moldL EICES TER • In y o u r child’s b e d roo m, du r in g the winter months, are there patches o f mould or fungus?·····Please list other rooms in your house affected by mould or fungus.In your child’s bedroom, during the winter months, does c ond e ns a t i o n e v er f o rm o n the wall s ? Please list other rooms in your house affected by condensation or damp.Is there ever any damp, condensation or mould in your home? Mould on walls? ALSPAC BAMSE ·· Has there been any visible mould/mildew in the home in the past year?Is there, or has there ever been, any type of moisture damage (spots and the like) in the home? (parental reported) · Is there damage from dampness, mould or rot in wet areas, or is there a suspected (hidden) damage? (inspector reported)(Were or) Are there damp stains or visible mould somewhere in the dwelling (except on food)? GINIplus · PIAMA-NHS · Did you see any damp stains or mould spots in the bathroom/living room/parents’ bedroom, child’s bedroom in the past 12 months?(Were or) Are there damp stains or visible mould somewhere in the dwelling (except on food)? LISAplus · DARC • Is there mould in child’s sleeping room? · Are there visible wet spots or mould spots on walls/ceilings in the bathroom? CO.N.ER • Have you noticed dampness in the child’s bedrooms? · Have you noticed mould on walls? (kitchen, dining room, parents bedroom, bathrooms, other rooms)? Ti s c h e r C , C h e n C - M , an d J H e i n ric h . E u r . R es p ir . J . , 38 : 81 2 - 2 4 , 2011 .

C onsiderations for a GoodHome Assessment ToolBased upon evidenceassociations with exposure and/o r h ealth out comes B r ie f Ho m e a ss e ss o r ’ s timeResidents’ time Culturally appropriateLanguagesHow do some words translate? (for example , rats vs. mice)Actionable or “referral- able ”Standard izedCore sho u l d b e a ppr o pr i a t e f o r Hous i n g a c r oss the country (e.g., different climate zones)Different types of housing stock (e.g., single-family, multi-family, brownstones, ranch)Flexible– Some additional module s might be us eful for some asthma pro grams

Th e Core QuestionnaireBased upon:·The American Housing Survey·A standardized population-based surve y adm inis tere d b y U S C en s u s an d s p o n sored by US Departmen t of Housing & UrbanDevelopment (HUD)Peer-reviewed literature ‘Input from CDC-funded state grantees and their st akeholders

The Core Questionnaire Pets, Pests, and Dampness0 YesIn the last 12 months, have you seen cockr oach es i nsid e your h o me? 0 No 0 D o nt kn o w ff Yes, in the l ast 12 months, haoften have you seenIcOckroaches inslIn the last 12 months, have you0 Yes or an exterminator used any pest control measures (pesticides , t raps , e t c . ) t o c o nt r o l c o ckr oa c h es in your home?In the last 12 months, have you0 Yes or an exterminator used any pest control measures (pesticides,traps, etc.) to other insects in y our home?In t he last 12 months, h ave you0 Yesseen evidence of mice or rats inside your home?If Yes, in the last 12 months, howoften have you seen evidence of 0 Daily 2c) mice or rats inside your home?In the last 12 months, have you3 Yes or an exterminator used any pest control measures (pesticides,traps, e tc.) to c ontrol mice or rats in your home?In the last 12 months, how often have you noticed anyDi Daily mottlytinusty smells inside yourhome?In the last 12 months, was there mold covering an area Yesgreat er than or eq ual to the size of an 8" x 11" piece o f pap er in your home?you use a dehumidifier? G YesD. you use a humidifier? Zi Yes 0Mold and Moisture0 No 0 No 0 No 0 Don't know0 Don't know0 Don't know 0 W eek l y 0 N o 0 Mo nthl y 0 A few ti mes a ye a r G i l 0 n n 0 W ee kl y D u o D N o O N o 1 ( A s t h m a T r H i g o g m eres AansdseOssthmeernItnCdooorer Air Issues)Green is verbatim from the American Housing Survey; Yellow = slightly modified; pftenta = New question (based upon research studielel111111111M) General H o usin g Characteristics maw living quarters in a...? H ow many stories are there in your home including finished attics and basements?stare the main bedroom(4ted?eck all that apptDuring the winter, what is the rinm way your home is heated? 0 Baseboard heaterIn addition to the main source of heat, 0 Radiatorsdo you use any other source?0 Baseboard heater How do you cool your home? (check all that apply) 01 unit building 01 unit building, ; detached from any other building 11 O R a d i a t o r s 0 Central AC attachedfront anyotherWIWM9 OForced hotair (vents) 0 Space heater 0 Forced hot air (vents) 0 Space heater0 window AC (or portable free-standing unit) pOccupied without payment of rent 0 Buildingwith two or more apartments? E I M 0 Fireplace/wood-buming stove 0 Other: 0 Fireplace/wood-buming stoveO Fans 0 Other: O Evaporative cooler OManufactured/M obile Home O n/a O Other: ® your home? °Owned Rented Heating & Cooling Do you currently have a workinfo smoke detector inside your homei Do you have a working carbon monoxide detector inside your home? cooking on your stove DoyouusealiMIRIMIII=MDo any members of your household smoke tobacco inside your home?Do any visitors to your household smoke tobacco inside' your home?In the last 12 months, how hofatsensecond-hand tobacco smoke 0 Daily entered inside your home from somewhere else in or around the building? Safetyalarms Sm oking and Cooking What type 0. 0Yes 0 Yen4111yeo ( Front) ( Back)

Green is verbatim from the American Housing Sury Magenta = New question (based upon research sGeneral Housing Characteristics Is your hom e? W w nRente d C l Occup i ed w i thou t pay m en tof rentAre your li ving quarters in a...? bi unit building, 01 unit building, 0 Building with LIdetached from attached from two or moreManufactured/M., any other any other apartments? obile Homebuilding ipilding Sco How many stor i es are there i n your ho m e i nc l uding f i n i s hed att ics and basements? storiWIWhere is/are the main bedrooms)OBasementlocated?(check all that apply)During the winter, what is the CI Radiators CI Forced hot airG Other: primary way your home is heated? (vents)CI Firepl aceCI Baseboard /wood-burning heater CI Space heater stoveIn addition to the main source ofD RadiatorsD Forced hot airD Other:heat, do you use any other source? (vents)Zi FireplaceCI Baseboard /wood-burning heater CI Space heater stoveHow do you cool your home? CI Central ACCI window AC CI Fans0 n/a(check al l that apply) (or portable G Other:free-standing G Evaporative I unit) coolerDo you currently have a working0 Yes0 No smoke detector inside your home? Do you have a work ing carbon0 Yes monoxide detector inside your home?Yellow = slightly modif ied;M " ". I li rireriniirHeating 8 CoolingSafety alarmsI;Home Assessment Core (Asthma Triggers and Other Indoor Air Issues)Smoking and Cookin g Mat type of stove do you have?,anopo you use an exhaust fan whericooking on your stove? Do any members of your 0yog household smoke tobac co nside your home?Do any visitors to your 0 Yes household smoke tobacco inside your home ? · m · c o i n t h e l a s t 1 2 m o n t h s , h o w ofte n h as seco n d - h a n d tobacco s m oke 0 Da il y C I W eekly 0 M ont* enter ed inside you r ho me from 6o mewher e else in or a round the b uilding?

P ets, Pests, and DampnessIIIIIIIII•1I IIIIn the last 12 months, have youD Yesseen c ockr oach es ins i d e y ou r ho m e ? O N° 0 D on 't know If Yes, in te last Ur—RIMErio often have you seemEMIc o c k r o a c h e s A M E N =pi A fevi times a pi I n the last 1 2 m onths , ha v e y o u 0 ' Y e s o r a n e xterminator used any pestcontrol measures (pesticides, traps, etc.) to controlcockroaches in your home?In the last 12 months, have youD Yesor an exte rminator used any pest control measures (pesticides, traps, etc.) to other insects in your home?In the last 12 months, have you0 Yesseen evidence of mice or r atsinside y our ho me?If Yes, in the last 12 months, howoften have you seen evidence of 0 Dailymice or rats inside your home?In the last 12 months, have youG Yes or an ex termina tor used any pest control measures (pesticides,traps, etc.) to control mice orrats in your home? In the last 12 months, how often'have you noticed anyG Dairymoldy/musty smells inside youi home?In the last 12 months, was there mold covering an area greater tha n or equal to the size of an a" x 11" piece of paper in your home?!Do you use a dehumidifier? CI Y esDo you use a humidifier? D Yes0 No 0 Don't kncyvNo0 Don't knc,A.,No0 Don't knowWeekly0 Monthly Di A few tim e s a y ea r N o G Do n 't k no w

R ecent publications: The Joint Task Forceon Allergy, Asthma, and ImmunologyAnn Allergy Asthma Immunol. 2012JACI 2013Ann All erg y A sthm a I mmuno l . 201 3

T h e D u s t M i t e P r a c t i c e P a r a m e t e rP o r t n o y e t a l , A n n . A l l e r g y A s t h m a I m m u n o l .1 1 1 : 4 6 5 - 5 0 7 , 2 0 1 3(Horne assessment for dust mite allergens ( supplemental questions)Housing characteristi csBuildingAre all y o ur w i nd o w s s ea l ed s hut o r don't ❑ yes ❑ no open?How long have you lived in this home? yearsIf <I year. did you move from a region of the ❑ yes❑ no country that might have high level sof dust mites? (se e dimate maps)If YES. did you bring furniture from your ❑ yes ❑ no previous home?Is any part of your living area below ground❑ yes❑ no lev el? If YES, does this area everget wet o r stay wet for❑ y es❑ no long periods (>1 week)?Heating, ventilation, and coolingDo you use a dehumidifier in your h ome?❑ yes❑ no❑ N/A During winte r, are som e outside walls cold? ❑ yes❑ no ❑ don'tknowDoes your home som etimes smell "stuffy," ❑ yes ❑ no "scale." or "musty"?Does your air conditioner ever leak water onto❑ yes❑ no❑ N/A walls or carpeting? (no NC) Bedroom characteristicsDo you have upholstered furniture in your child's❑ yes❑ nobedroom?Do you allow your child to have stuffed animals/❑ yes❑ no toys in the room ?Dus t reservoirs (overall home)Do you have cloth sofa or chairs? ❑ yes❑ no Do you have cloth c urta i n s ? ❑ y e s ❑ no C an yo u s ee dust o r d i rt o n yo ur f urn i ture, w a l k . ❑ y e s ❑ no c e d i n g. and curtai ns? Do you have wall -to-wal I c arpeting in more than❑ y es❑ nohal f the rooms in your home? Do y ou have wall-to-wall carpeting in your ❑ yes ❑ nokitchen or bathrooms?Do you not own a vacuum cleaner?❑ yes❑ noDo you vacuum less than once a week?❑ yes❑ no Dampness In the past 12 months, have you noticed ❑ yes❑ no❑ don't condensation on windows i n your home? know If YES. does moisture regular ly build up on your❑ yes❑ no wind ows/walls?In the past 12 months, have you had any water 0 yes❑ no ❑ don't leaks? knowAbbreviations: NC, air conditioning; TA, not applicable.This questionnaire can be given to die p atient. Affirmative (ie. YES) answers indicate potential dust mice allergen exposure.

0 Y e sO Y e sO Y e sO Y e sO Y e sO YesIf < 1 years did you mov e f rom a r eg i o n o f th e c o un t r y that might have high levels of dust mites? (" see climate maps)If YES, did you bring furniture from your previous home?Is any part of your living area bel ow groun d level?If YES, d o es t h i s a r ea ever ge t w et o r st ay w et f o r long periods (more than 1 week)?Do you use a dehumidifier regularly?During winter, are some outside walls cold?O Y e sO Y e s D o you have cloth sofa or chairs? °Yes 0 NoDo you have cloth curtains? 0 Yes 0 NoCan you see dust or dirt on your furnitur e, walls, ceil ing, and curtains? 0 Yes 13 NoDo you have wall-to-wall carpeting in more than half of the rooms in your 0 Yes 0 No home?Do you have wall-to-wall carpeting in your kitchen or bathrooms? Do you no t own a vacuum cleaner?T h e D u s tM i t eM o d u l e ( f o rH o m eV i s i ts t a f f )0 No0 NoHome Assess ment for Dust Mit e Allergens (supplemental questions) Ho using CharacteristicsAre all your windows sealed shut or don't open?How long have you lived in this home?years D oes your air conditioner ever leak wa ter o n t o wa l l s o r ca r pe t i ng ? 0 Y es D o es y o ur h o me s o me t i mes sme l l "st uffy", "sta l e", o r "mu sty"? 0 Yes Bedr oom Characteri stics D o yo u have upho lstered f urniture in your child 's bed room? Do you allow child to have stuffed animals/toys in the room?Dust reservoirs (overall home)Do you vacuum less than once a week? °Yes 0 NoDampnessIn the past 12 months, have yo u noticed condensation on windows in your OYes 0 No 0 Don't home? knowIf YES, d oes mo istur e r egular ly build-up on your wind owslwalls? °Yes 0 NoIn the past 12 mon ths, have you had any water leaks? 0 Yes 0 No 0 Don'tknowAffirmative (i.u„YES) answers indicate potential dust mite allergen exposure.° Y e s Y e s 0 Noq NoVV' g at E0 No 0 No0 NoO No0 No 0 N/ A0 No 0 Don'tknow O No 0 NJA (noNC)q No 0 Don 't know

T he Mold/ MoistureModule(for Home Visit staff)

W hy should questionnaires be consideredliving documents?

C LIMATE CHANGE, THE INDOOR ENVIRONMENT, AND HEALTHHow Dangerous Is Your Couch?By Dashika Slater (September 6, 2012) I nstitute of Medicine (IOM) 2011 J e n s Mort e ns e n f o r T he New York Tim es

T emporal and Spatial VariationChanges by the residents (new pillows, new carpet)Seasonal variationRoom- to-r oom va ria t i o n D ay- to - d a y v a r ia t ion

Tempora l and Spatial Variation(cont’d)FloodsHurricanesWildfires

Ne xt stepsUse core questionnaire (or questions from the core) to augment your home assessment programs) Us e m odul es a cc o r d i n g t o t h e n eeds ofyou and your sta keholders– Ready to use now: Dust mite, Mold/moisture– In development: Natural DisasterCDC, EPA, and HUD – Harmonizing ou r “ a c ti o n s t e p s ” fo r t h e c o r e questionnaire and modules

Than k youFor more information please contact Centers for Disease Control and Prevention1600 Clifto n R oad NE , A tl a n t a , G A 3033 3 T e l ephone : 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govThe findings and conclusions in this report are those of the authors an d do not nece ss a r ily r e p r e s e n t th e offic ial p os i t ion of the Centers for Disease Control and Prevention.National Center for Environmental Health Air Pollution and Respiratory Health Branch

T racy Washington Enger, M.S.Indoor Environments DivisionU.S. Environmental Protection AgencyGetting into Action: ToolsResources and Action Plans