A Healthy Home Environment

A healthy home is well ventilatedfree of pests, toxics, and dangerous gasesdrycleancomfortable; and affordable. Good construction and maintenance practices can achieve these conditions, even in an older home.

7 Attributes of a Healthy Home

Dry homes minimize moisture and molds. Moisture and molds can trigger asthma attacks and other allergic reactions. Water and moisture also attract cockroachesrodents, and help dust mites to thrive, all of which can also increase the risk of asthma attacks.

Clean homes have minimal dust and clutter. Researchers and medical experts have proven that dust sensitizes individuals and can trigger asthma attacks. Dust generally comes from two sources:

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Why Children are at Higher Risk

When it comes to harmful environmental exposures, children cannot be considered “little adults.” Their bodies take in proportionately greater amounts of environmental toxins than adults, their rapid development makes them more vulnerable to environmental interference, and their normal behavior patterns place them at greater risk to some toxins.

Children can be exposed to environmental toxins even before birth if the mother is exposed during pregnancy to toxins that can cross the placenta, such as carbon monoxide or lead. Children’s organs, including the brain, lungs, and reproductive systems, begin developing during the fetal stage and continue to develop through adolescence. Organ growth occurs in spurts, and it is during key growth periods that organ systems are most vulnerable to permanent damage. The Environmental Protection Agency recently acknowledged the enhanced risk to children from environmental exposures when it released draft supplemental guidelines for assessing cancer risk from early-life exposure to carcinogens.

Children are exposed to greater amounts of environmental toxins

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Alliance Alert

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Understanding New National Data on Lead Poisoning

In the May 27, 2005, Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) published new national data on lead poisoning (MMWR 54(20); 513-16) (available online at www.cdc.gov/mmwr/preview/mmwrhtml/mm4950a3.htm). This report reports various blood lead statistics for 1999 through 2002, the first significant update since the National Health and Nutrition Examination Surveys (NHANES) data report from 1991 through 1994. These new data document that further gains have been achieved in protecting children from lead poisoning—and that disparities still exist in lead poisoning rates across races and income levels.

New National Data

The report examines new NHANES data collected in 1999-2002. NHANES, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention (NCHS/CDC), is designed to assess the health and nutritional status of adults and children in the United States through interviews and direct physical examinations.

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The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration

The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration was developed with the support of The Commonwealth Fund and showcases strategies from five states where intense effort has gone into improving lead screening among the high-risk population of children who are Medicaid beneficiaries. The report’s practical how-to information is of immediate importance to administrators and staff of state Medicaid agencies and state and local health departments, as well as to advocates and policy makers. Among the various topics covered are: combining lead screening data with Medicaid data; state policies that support screening and follow-up care; and using maps to simplify complex information on screening.

Young Medicaid beneficiaries comprise 83% of children in the US with lead levels high enough to require professional follow-up care. Even so, screening among these children remains astonishingly low. In fact, of 42 states reporting Medicaid screening rates for 1999, 25 reported screening fewer than 10% of enrolled children. These rates are even more startling given that a federal requirement for lead screening has been in for nearly a decade.

The Foundations of Better Lead Screening for Children in Medicaid: Data Systems and Collaboration describes promising strategies to improve lead screening for this high-risk group. Free copies can be obtained from the links below or by contacting the Alliance at [email protected] or 202-543-1147.

This report can be downloaded entirely in three PDF files:

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Carbon Monoxide Poisoning

You cannot see, smell, or taste carbon monoxide, which is a poisonous gas. When carbon monoxide (CO) enters the bloodstream, it reduces the amount of oxygen received by the body’s organs and tissues. Unborn babies, children, the elderly, and people with respiratory problems or heart disease are especially sensitive to carbon monoxide. Even at low levels, carbon monoxide causes serious health problems, and the longer the exposure, the more damage that occurs.
Low levels of carbon monoxide can cause flu-like symptoms, headaches, dizziness, and make it difficult to think clearly. Often a family may not realize that their illnesses are related to chronic exposure to carbon monoxide in the home.

At higher levels of exposure, carbon monoxide is related to visual impairment, reduced work capacity, poor learning ability, and difficulty in performing complex tasks. At very high levels, carbon monoxide can also kill. Each year, more than 200 Americans accidentally die from carbon monoxide poisoning in the home, unrelated to fires and engine exhaust (other sources of carbon monoxide poisoning). Seventy-six percent of these deaths are from carbon monoxide released from heating systems. Another eight percent are from gas water heaters. Many victims of carbon monoxide poisoning die in their sleep. An additional 10,200 people visit the emergency room due to accidental carbon monoxide poisoning from consumer products.

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About Building Blocks

The Lead Poisoning Prevention Branch of the Centers for Disease Control and Prevention (CDC) is fulfilling its commitment to the 2010 goal through its grant program requiring that jurisdictions develop and implement a strategic plan for elimination that includes primary prevention, partnering, and program evaluation.  Through this Building Blocks publication, the Branch now offers grantees and others access to promising approaches, including protective public health policies to reduce lead hazards and other promising strategies.

State and local childhood lead poisoning prevention programs (CLPPPs) universally acknowledge the importance of primary prevention and are beginning to address it in their strategic plans and funding applications.  However, many programs’ primary prevention efforts are confined to parent education about hygiene, nutrition, and housekeeping, despite research that makes clear the limitations of these interventions for families whose homes pose significant hazards.  Inability to institute durable primary prevention is caused in part by the pressure to focus resources and attention on secondary prevention: identifying and managing individual cases of elevated childhood BLL.  Indeed, in communities where follow-up on actual poisonings is limited to educating family members about lead hazards and behavioral change (because public resources are not available to control identified lead hazards and halt further exposure), meaningful primary prevention can seem like an extremely remote target. Programs facing these circumstances need ideas for sharing responsibility within the jurisdiction for stopping repeat offenders, expanding access to lead-safe housing, and ultimately arresting the cycle of inferior housing continually producing new poisonings.

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Cancer Risks

Exposure to several substances found in the home can increase the risk of cancer, which is the second leading cause of death among adults and children in the U.S. According to the American Cancer Society, environmental factors including tobacco, chemicals, infectious diseases, and radiation are responsible for three-quarters of all cancer deaths in the U.S. While many adult cancers can be traced to these environmental factors, the causes of most childhood cancers are unknown. Like many environmentally related diseases, cancer takes a greater toll on African-Americans, who are more likely to develop and die from cancer than persons from other racial and ethnic groups.

According to the American Cancer Society, smoking, unhealthy diet, and physical inactivity play a greater role in determining cancer risk than exposure to trace levels of pollutants in food, air, and drinking water. However, the degree of risk from chemical exposure depends on the concentration and duration of exposure. Individuals exposed to high concentrations of cancer-causing substances bear a significantly higher risk of developing cancer. At the same time, widespread exposure to low concentrations of carcinogens can increase the risk of cancer across the population as a whole. For environmentally related cancers, ten or more years typically pass between exposure to cancer-causing substances and detectable cancer.

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Disparities in Risk

Introduction

Although the health of most Americans has improved significantly over time, not all racial and ethnic groups have benefited equally. African-Americans and Hispanics, for example, are more likely than whites to suffer from poor health and to die prematurely. Minority and low-income families are more likely to live in substandard housing and polluted communities, increasing their risk of childhood lead poisoning, asthma, cancer, and other environmentally related diseases. In addition to being disproportionately affected by disease, minorities often lack adequate insurance and access to health care due to financial and cultural barriers.

To a large extent, disparities in health and access to care among minorities reflect disparities in socioeconomic status. In fact, according to the Health Resources and Services Administration, the connection between socioeconomic status and health disparities is so strong that income and education levels often serve as proxies for health status. The fact that minority populations on average are poorer than whites underlies many health disparities.

Insurance Coverage and Access to Health Care

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Health Hazards

Many homes fall short of the basic requirements of a healthy home and contain one or more hazards that adversely affect human health. Among the health hazards we may encounter in our homes are those that cause and contribute to asthma (such as dust allergens, mold, and pests), toxic materials (such as lead, asbestos, and chemical pesticides), and poisonous gases (such as carbon monoxide and radon).

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Dust Mites

Dust mites are microscopic creatures that belong to the same class (Arachnida) as spiders and ticks (they have eight legs, not six like insects). They feed primarily on dead skin cells regularly shed by humans and animals. Dust mites thrive in places where their primary food source is most likely to be found: on mattresses, pillows, bedcovers, carpets, upholstered furniture, stuffed toys, clothes, or other fabric items in the home.Unlike insects such as cockroaches, mites are not capable of ingesting water; in order to obtain water, they must absorb it from the air. For this reason, they thrive in humid environments, ranging from 55% to 75% relative humidity. Ideal temperatures for dust mites are between 68º and 77º F. The growth of dust mites can vary on a seasonal basis, or from room to room within a house, depending largely on variations in relative humidity, availability of food sources, and temperature. Mites take about one month to develop from an egg into an adult and have an adult life span of about two to four months. A single adult female may lay up to 100 eggs.

Mite waste products contain an allergen (a substance that causes an allergic immune reaction) that, according to the Asthma and Allergy Foundation of America, adversely affects about 20 million Americans. Sensitive individuals become exposed to this allergen when they inhale household dust, which contains dust mites and their waste products. Exposure to dust mites can trigger an attack in an asthmatic who is sensitive to the dust mite allergen. (Other asthmatics may not be affected by dust mites.) For persons allergic to dust mite allergen, exposure can cause allergic rhinitis (hay fever), which is characterized by nasal congestion, itching, and sneezing. In addition, exposure to dust mites may cause children who are predisposed to develop asthma to do so. (This predisposition is not fully understood, but appears to depend upon a combination of hereditary and environmental factors.) For more information on asthma and allergies, see Asthma, Allergies, and Respiratory Illnesses.

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Ventilation and Indoor Air Quality

Proper ventilation helps improve indoor air quality. Ventilation can control indoor humidity and airborne contaminants, both of which either contribute to or act as health hazards. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) and several states (Minnesota, Washington, and Vermont) have ventilation standards designed to ensure acceptable indoor air quality.

High indoor humidity can spur mold growth. High humidity may result from poor construction/rehabilitation, site design that does not properly manage water, and/or inadequate air exchange. A reasonable target for relative humidity is 30-60 percent. A low cost hygrometer, available at hardware stores, can be used to measure relative humidity. In cool climates, inadequate ventilation in the winter can contribute to excessive moisture and humidity because normal activities create moisture (cooking, bathing, breathing), and there is insufficient natural ventilation (opening windows) or mechanical ventilation (fans, exhaust systems) to remove the moisture. In warmer climates, the heating, ventilation, and air conditioning (HVAC) system can pull warmer, humid air inside. In this case, the ventilation system may help create indoor humidity problems unless the system also dehumidifies the air.

Common sources of airborne contaminants include:

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Carbon Monoxide (CO)

Carbon monoxide (CO) is an odorless, colorless gas formed when carbon in fuels does not burn completely. Hundreds of Americans die every year from carbon monoxide poisoning caused by improperly used or malfunctioning fuel-burning appliances. Fetuses, young children, and the elderly are particularly susceptible to carbon monoxide poisoning.

Carbon monoxide is a “combustion pollutant”—a gas (or particle) that comes from burning carbon-based materials. Combustion pollutants are most often released into the home by vented or unvented appliances and vehicles running in an attached garage. Carbon monoxide is produced when there is a lack of oxygen or enough heat to burn fuels completely. The smoldering burn of incense or cigarettes also produces carbon monoxide.

Indoor Sources of Carbon Monoxide

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