Cockroaches

Cockroaches in the home environment are a health hazard not only because of the risks posed by cockroach antigens to asthma sufferers, but also because they can carry disease-causing germs and because some of the methods traditionally used to eliminate them cause additional health hazards.Any home can have cockroaches. However, there are steps you can take to prevent cockroaches from becoming a problem in your home; identify the extent of and solutions to any potential cockroach problem; and reduce or eliminate cockroach problems.

Prevention

General maintenance and cleaning are important because they remove the food, water, and shelter on which cockroaches depend. There are many steps tenants, landlords, and homeowners can take individually and jointly to prevent cockroach infestation of the home environment.

  • Wipe off counters, tables, and stovetops after all meals, snacks, and food preparations.
  • Keep food confined to specific areas of the house and clean any spills immediately.
  • Keep all food and garbage in tightly sealed containers.
  • Do not leave dirty dishes in the sink, on the counter, or in the dishwasher overnight.
  • Remove all piles of boxes, cardboard, newspapers, etc. from both inside and around the home.
  • Fix leaky pipes, faucets, toilets, and other plumbing problems.
  • Use a bathroom fan that vents to the outside after all baths and showers to reduce humidity.
  • Caulk all cracks and crevices throughout the home around systems such as plumbing, electrical, and gas lines, as well as in places like cupboards and walls.

Identification

Generally, determining whether a home has a cockroach problem and the extent of the infestation involves the use of glue traps, which can be purchased at most hardware or grocery stores. The traps are laid out in target areas, where they are left for at least one night. Upon either filling the trap with cockroaches or waiting a predetermined length of time, the number of cockroaches caught on the glue trap is counted to provide an estimate of the extent of the cockroach problem in the home environment. More detailed guidelines on deciding to test for cockroaches and the actual testing itself are available at www.cehrc.org.

If an apartment building is to be sampled, it is best to test more than one unit. If only one unit is tested, the landlord may claim that only that unit is infested and put the blame for the problem solely on that tenant. Most housing codes put responsibility for cockroach control on the landlord if two or more units are infested.

Elimination

The ultimate goal is to keep cockroaches out of a home and when necessary, to eliminate those that are there, while keeping residents safe. Reaching this goal can be difficult, especially in multi-unit housing that is heavily infested. For most apartment buildings, the landlord must take a building-wide approach to controlling cockroaches. Normally, it will take a coordinated effort from the landlords and tenants to eliminate cockroaches. Getting their support takes compelling evidence, such as a trap full of cockroaches coupled with a count of the number of cockroaches.

The initial actions residents and landlords can take are regular cleaning and maintenance to remove the food, water, and shelter for the cockroaches. Not only will this help to prevent a cockroach problem in the first place, it is also crucial to controlling an existing infestation and maintaining a cockroach-free environment.

If a cockroach problem requires remedial action, there are numerous paths of control and products available. Once a cockroach problem has been identified, the landlord or homeowner should call an integrated pest management (IPM) professional to conduct a formal inspection. Care should be taken to avoid residential exposure to pesticides, as these chemicals can be a carcinogenic health hazard in the home. Many pesticides can also trigger asthma attacks and cause developmental disabilities.

Pesticide sprays and fogs should not be used to control the problem. Not only will sprays and fogs leave a residue that is hazardous to human health, they also must be applied periodically and are not effective against cockroaches. Baits and boric acid are safer, more preferable forms of treatment that limit the level of human exposure to pesticides. IPM practices to control cockroaches are a healthier way to eliminate the problem than spraying pesticides in your home.

IPM

  • IPM is effective, economical, and environmentally sensitive.
  • IPM uses a combination of common-sense practices, information on the life cycles of roaches and their interaction with the environment, and available pest control methods.
  • IPM presents the least possible hazard to people, property, and the environment.

Sources and Additional Information:

American Lung Association’s Health House – www.healthhouse.org/tipsheets/TS_cockroaches.pdf

Beyond Pesticides – Integrated pest management to control cockroaches – www.beyondpesticides.org/alternatives/factsheets/COCKROACH%20CONTROL.pdf and www.beyondpesticides.org/infoservices/pesticidesandyou/Winter%2001-02/Good%20Riddance%20to%20Roaches.pdf

Canada Mortgage and Housing Corp. – Farewell to Cockroaches Guide – www.cmhc-schl.gc.ca/en/co/maho/gemare/faco/index.cfm

Community Environmental Health Resource Center (CEHRC) – www.cehrc.org

Environmental Health Watch – Cockroach Control Guide – www.ehw.org/Asthma/ASTH_Cockroach_Control.htm

Gumm, Brian, Home Energy, “Integrated Pest Management in the Home,” Vol. 21 Iss. 6 pp. 36-39 (Nov-Dec 2004)

US Centers for Disease Control and Prevention – www.cdc.gov/asthma/children.htm

US EPA – Asthma Triggers – Cockroaches – www.epa.gov/iaq/asthma/pests.html

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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:

  • outdoor particles that are tracked in on shoes or drawn in through heating and ventilation systems or air leakage
  • dust mites living inside our homes

Nearly two-thirds of the dust in our homes is tracked in from outdoors, making a dust-free home a practical impossibility. However, we can reduce the amount of dust we bring in from outside by designing entryway systems to help remove dust from our shoes before we bring it inside. Filters for heating, ventilation, and air cooling (HVAC) systems are also effective in reducing dust particles in the home. Reducing excessive moisture and relative humidity can also make a home less inviting for dust mites. In all cases, it is helpful to build homes with smooth and cleanable materials that make it easier to remove dust and dust mites through cleaning. Clutter contributes to increased levels of dust by creating surfaces for dust to gather. Keeping floor and countertop areas clear, particularly near vents, will prevent dust from building up. While insufficient housekeeping can be a factor in dust build-up, an overcrowded setting also plays a role.

Well ventilated homes have systems to remove contaminants and allergens that can cause respiratory problems such as dust and byproducts from heating and cooking. These mechanismsinclude fans that exhaust to the outside and changes in air pressure to ensure the movement of air from the outside to the inside.

Combustion product-safe homes minimize carbon monoxide, which can cause death and more subtle health effects (fatigue, headaches, nausea). Products that can create carbon monoxide include cars in an attached garage (when the engine is warming up), gas stoves, gas water heaters, gas furnaces with a cracked heat exchanger or a leaking chimney, non-electric space heaters, and gas fireplaces.

Pest-free homes reduce the presence of pests such as cockroaches. Cockroaches shed feces and skins that can trigger allergic reactions often associated with asthma and other respiratory problems. Adverse health conditions can also arise when homeowners reacting to a pest problem apply harmful pesticides in their homes.

Toxic chemical-free homes reduce and eliminate toxins, such as asbestoslead, volatile organic compounds, and pesticides. Some types of flooring and the adhesives used to attach them can emit volatile organic compounds (VOCs). “Offgassing” refers to the release of gases during the aging and deterioration of a material. The Carpet and Rug Institute had created standards for low-VOC carpets and rugs (see resource below).

Comfortable homes make it unlikely that individuals will unknowingly take actions that can harm their health. For example, excess cold may cause people to use stoves and ovens for heating, leading to chronic and perhaps acute exposure to carbon monoxide. Humidifiers may be installed to relieve an excessively dry environment, creating extra moisture that can contribute to molds and foster the growth of dust mites, both of which are asthma triggers.

Sources and Additional Information:

American Lung Association – Health House – www.healthhouse.org

American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc – www.ashrae.org

Affordable Comfort – www.affordablecomfort.org

Building Science Corporation – www.buildingscience.com

Carpet and Rug Institute – Green Label Program – www.carpet-rug.com/drill_down_2.cfm?page=8&sub=4&requesttimeout=350

US Center for Disease Control and Prevention (Environmental Health) – www.cdc.gov/nceh/

US Department of Housing and Urban Development, Office of Healthy Homes and Lead Hazard Control – www.hud.gov/offices/lead/index.cfm

US Environmental Protection Agency – Indoor Air Quality – www.epa.gov/iaq

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How to Control Moisture

The level of moisture in the home is crucial to achieving a healthy home environment. Too little moisture in the home can cause dryness of the nose and respiratory systems, while too much moisture in the home contributes to numerous health impacts, health hazards, and structural home damage. Asthma, allergies, and other respiratory illness are the main health impacts to children and other residents of homes with excessive moisture. Excessive moisture also causes or contributes to other hazards to human health such as moldcockroachesdust mites, and peeling lead paint.

Several common signs that conditions of excessive moisture exist in the home environment include:

  • Rusting metal
  • Condensation on piping and/or windows
  • Rotting wood
  • Mold growth
  • Peeling paint, wallpaper, or other blistering materials
  • Deterioration of other structural items
  • Visible water leaks and/or stains
  • Discoloration of various surfaces
  • Musty odors
  • Standing water

These signs may be clearly visible or they may be hidden in places such as behind walls, under furniture and carpets, and in crawlspaces or attics. In assessing moisture problems in the home environment, it is important to know such potential hiding places and visually inspect all areas that are reasonably accessible. A low-cost moisture meter can also be used to test for moisture in inaccessible places. See www.cehrc.org for additional information.

Moisture problems inside the home can originate from problems both indoors and out. In general, preventing and eliminating moisture control problems involves removing, diverting, blocking, or otherwise controlling the source of moisture while also providing adequate ventilation. Some specific tips to prevent and eliminate excessive moisture in the home include:

  • Regularly clean and maintain gutters, and ensure that they drain away from the foundation of the building structure.
  • Install and run exhaust fans in the bathroom and kitchen or open windows for adequate ventilation.
  • Vent all fans and appliances to the outside of the home.
  • Do not arrange or store items (furniture, storage boxes, etc.) so that they touch the interior side of exterior walls.
  • Dry all clothes in a dryer that vents to the outside or use a clothesline outside.
  • Cover dirt floors in basements and/or crawlspaces with plastic or other type of vapor barrier.
  • Repair all plumbing leaks, roof leaks or problems, and cracks in foundation walls as soon as possible.
  • Ensure that soil and landscaping near the structure’s foundation are graded away from the structure.
  • Install floor drains or sump pumps in basements as necessary.
  • Keep the temperature inside the home comfortable—not excessively hot in the winter or cool in the summer. Drastic changes between indoor and outdoor temperatures can contribute greatly to moisture problems.

Further precautionary steps can be taken to control moisture in the home environment during initial construction or any subsequent renovations. The New England Asthma Regional Council has developed excellent guidelines for building healthy homes and also offers links to numerous other healthy homes building resources.

Sources and Additional Information:

A Brief Guide to Mold, Moisture, and Your Home – www.epa.gov/iaq/molds/moldguide.html

Building Science Corporation Building Design by Climate Guides – www.buildingscience.com/designsthatwork/default.htm

Community Environmental Health Resource Center – www.cehrc.org

Home Moisture.org – www.homemoisture.org/homemoisture.htm

Moisture Audit of Residential Structures – www.ehw.org/Healthy_House/HH_Moist_Audit.PDF

New England Asthma Regional Council – www.asthmaregionalcouncil.org/about/housingplan.html

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Carbon Monoxide

Carbon monoxide is a potentially serious hazard that must be addressed to ensure healthy housing. Carbon monoxide poisoning can be fatal, and low levels of carbon monoxide can cause flu-like symptoms, headaches, dizziness, and make it difficult to think clearly.Thankfully, there are ways tenants, landlords, and homeowners can reduce the likelihood of hazardous carbon monoxide exposures.

  • Properly maintain, ventilate, and check regularly all fuel-fired heating systems, water heaters, appliances, fireplaces, wood and coal stoves, and space heaters.
  • Always ensure proper ventilation in any room where a fuel-burning appliance of any sort is in use.
  • Do not use any gas appliances (i.e. range, stove) for home heating purposes.
  • Do not burn any type of fuel in the home except firewood in an appropriately maintained and ventilated fireplace.
  • Leave garage doors open while the car is running and limit the amount of time a running car is in the garage. (It is also important to note that carbon monoxide can build up inside the car itself while operating if there are leaks in the exhaust system.)

Carbon monoxide detectors can be another key part of protecting against carbon monoxide poisoning. The Consumer Product Safety Commission recommends placing carbon monoxide detectors on each level of the home and near all sleeping areas. Although the presence of a carbon monoxide detector can help identify problems, they should not be used in place of preventive efforts, nor should their silence be interpreted as unquestionable proof of the absence of carbon monoxide hazards. The U.S. Environmental Protection Agency (EPA) states that the technology of carbon monoxide detectors is still in development and that they are not generally considered as reliable when compared to current smoke detectors. In fact, in some laboratory tests, very high levels of carbon monoxide were not detected by properly installed units. Concerns have also been raised that these alarms do not sound until the level of carbon monoxide reaches very high levels. Despite these potential reservations, concerns, and questions, carbon monoxide detectors can be useful tools in assessing hazards in the home, but they should not be the only ones.

Even with precautionary measures, a situation involving high levels of carbon monoxide in the home may occur. Whether discovered by an individual experiencing symptoms or an active alarm, there are certain procedures to take if high levels of carbon monoxide are present.

  • Immediately remove anyone who is experiencing symptoms from the environment and seek medical attention.
  • Open windows and doors to ventilate the space, turn off any potential source of the carbon monoxide, and notify the landlord and/or fuel supplier.
  • Arrange for the proper inspection of all fuel-fired systems, appliances, and fireplaces and further arrange for any necessary repairs.

Sources and Additional Information:

American Lung Association Fact Sheet: Carbon Monoxide – www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35370

American Lung Association Health House – Carbon Monoxide Tipsheet –www.healthhouse.org/tipsheets/TS_CarbonMonoxide.pdf

EPA – Indoor Air Quality – www.epa.gov/iaq/co.html

EPA – Protect Your Family and Yourself from Carbon Monoxide Poisoning – www.epa.gov/iaq/pubs/coftsht.html

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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

Pound for pound, children breathe more air, consume more food, and drink more water than adults, due to their substantial growth and high metabolism. For example, a resting infant takes in twice as much air per pound of body weight as an adult. Subject to the same airborne toxin, an infant therefore would inhale proportionally twice as much as an adult.

Children also drink proportionally more water than adults. Pound for pound, infants and children drink more than 2½ times as much water as adults. A formula-fed infant consumes about one seventh of its body weight in water each day—the equivalent of a 154-pound man drinking nearly 6½ gallons of water per day. Standards for most waterborne contaminants are established based on the health impacts on adults, so current standards may not suffice to protect children.

Children also may be exposed to greater amounts of toxins in the environment due to the fact that they spend significant amounts of time on the floor and ground. As a result, they are more likely to come into contact with toxins found in dust, carpets, and soil, such as lead. Some airborne contaminants, such as radon, mercury, and some pesticide vapors concentrate in greater quantities at ground level, so small children would be exposed to higher concentrations of these toxins than adults in the same room.

Young children (ages six months to about two years) have a natural urge to place objects in their mouths. This normal hand-to-mouth activity can cause them to ingest toxins in their environment to which adults would not necessarily be exposed. For example, in homes with high dust lead levels, children may ingest lead when they put their hands or toys in their mouths. Children also may be exposed to arsenic and creosote, two toxic chemicals used to pressure-treat wood, if they play on playground equipment, decks, or porches treated with these chemicals.

Small children also more readily absorb nutrients (and toxins) they ingest. For example, children require more calcium than adults because their bones are growing, and they can absorb more calcium from the same food sources. Although this enhanced ability is a plus when it comes to nutrients, it also can increase a child’s exposure to toxins such as lead. A toddler will absorb about 50 percent of ingested lead, whereas an adult will absorb about 15 percent.

Children’s developing bodies are more susceptible to harm

During the first months and years of life, children’s organs are developing rapidly, making them more prone to functional damage. For example, the nervous system continues to develop throughout childhood and therefore is especially vulnerable to environmental factors. At the same time, the nervous system is not well equipped to repair any structural damage caused by environmental toxins. If a child is exposed to neurotoxins such as lead or mercury, the resulting loss of intelligence or behavioral problems can be irreversible.

Especially during the first year of life, a child’s ability to metabolize, detoxify, and excrete toxins differs from that of an adult. In some cases, this works to a child’s advantage, as when they are unable to break down a relatively harmless substance into harmful byproducts. However, children also may be more susceptible to some toxins because their liver and kidneys are not fully mature and cannot detoxify and excrete harmful substances as readily as adults.

Children have more time to develop latent diseases

Many environmentally related diseases take decades before symptoms develop. Because children have more years to live, they have more time to develop latent diseases. For example, mesothelioma, which is caused by exposure to asbestos, takes years to develop. Early exposure to neurotoxins may lead to Parkinson’s disease later in life, and pesticide exposures may result in cancer years later. Because of the long latency period of these diseases, exposures in childhood are more likely to result in disease than exposures in adulthood.

Sources and Additional Information:

Bearer, C.F., “Environmental Health Hazards: How Children Are Different from Adults,” The Future of Children: Critical Issues For Children and Youths, Vol. 5, No. 2 – Summer/Fall 1995, – http://www.futureofchildren.org/pubs-info2825/pubs-info.htm?doc_id=70953

Children’s Environmental Health Network – http://www.cehn.org

Goldman, L.R., “Case Studies of Environmental Risks to Children,” The Future of Children: Critical Issues For Children and Youths, Vol. 5, No. 2 – Summer/Fall 1995 – http://www.futureofchildren.org/pubs-info2825/pubs-info.htm?doc_id=70953

International Programme On Chemical Safety, Commission Of The European Communities, Principles for Evaluating Risks from Chemicals During Infancy and Early Childhood: The Need for a Special Approach – http://www.inchem.org/documents/ehc/ehc/ehc59.htm

Landrigan, P.J. and Carlson, J.E., “Environmental Policy and Children’s Health,” The Future of Children: Critical Issues For Children and Youths, Vol. 5, No. 2 – Summer/Fall 1995 –http://www.futureofchildren.org/pubs-info2825/pubs-info.htm?doc_id=70953

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Alliance Alert

IN THIS ISSUE:

Cleveland Ordinance Establishes New Lead Safety Rules and Incentives for Property Owners

The Cleveland City Council passed a new lead-based paint ordinance on August 11 that, among other provisions, makes lead paint hazards in residences, schools, and day care facilities a “nuisance” subject to city code enforcement; establishes city lead hazard disclosure requirements and penalties; creates a property certificate program as an incentive for property owners to eliminate lead hazards; and allows the city to regulate exterior paint removal through their permitting process for most pre-1978 properties.

The law makes lead paint hazards (as defined in state regulations) in residences, schools, and day care facilities a “nuisance” under city code, which empowers the city environment commissioner to require the property owner to immediately control the hazards. If the owner fails to act, the commissioner can send a contractor to abate the hazard and assess the costs to the owner by placing a lien on the property.

The ordinance also incorporates the federal lead hazard disclosure law into city code. It gives individuals harmed by the property owner the ability to recover triple damages, and it authorizes nonprofit groups to pursue damages on behalf of individuals. The ordinance also gives the Cleveland Department of Public Health authority to pursue criminal penalties (up to $5,000 per violation) against property owners who fail to distribute the EPA lead hazard information pamphlet, disclose the known presence and location of any lead-based paint or hazard, or fulfill other duties under the federal lead hazard disclosure law.

In addition, the ordinance includes a voluntary certificate incentive program for property owners. With proof of a lead inspection, owners of property built before 1978 can obtain a Lead-Free Certificate, granting the owner the legal presumption that the property is free from lead-based paint and lead hazards. For property constructed before 1950 that meets the Essential Maintenance Practices requirements defined in state law, owners can obtain a Lead-Safe Maintenance Certificate which states that the property does not contain a lead hazard but is not certified as lead-free. To obtain either certificate, property owners must meet stringent inspection requirements, and they must abide by all disclosure provisions in order to retain their certificates. Lead-Free Certificates are valid unless they are revoked by the city; Lead-Safe Maintenance Certificates must be renewed annually. Both types of certificates transfer with property ownership, but the new owner must notify the city, pay a small fee, and comply with all the conditions for maintaining the certificate.

The law also requires city permits for residential interior or exterior lead hazard abatement projects and for exterior lead paint removal in pre-1978 housing, except for owner-occupied properties under certain conditions, housing exclusively for seniors or persons with disabilities, and zero-bedroom units. Both the city environment department and the city code enforcement agency are given authority to issue stop work orders if a permit has not been obtained or if work is not being done in compliance with state lead safety standards and methods. For the full text of the Cleveland ordinance, see www.ehw.org/Lead/documents/finalleadordinance.pdf.

Jacobs Cleared of Charges, Shuffled Aside

HUD Secretary Alphonso Jackson has formally notified Dave Jacobs, Director of the Office of Healthy Homes and Lead Hazard Control (OHHLHC), that Jacobs is not being removed from federal service. However, Secretary Jackson has reassigned Jacobs to a special assistant post in the Office of Community Planning and Development. Under federal personnel rules, senior executives have no grounds to appeal such reassignments.

In April, Secretary Jackson notified Jacobs of his intent to fire him for cause. Jacobs refuted each of the charges in a point-by-point rebuttal. More than 60 individuals spanning a broad spectrum—state and local agency staff, grantees, parents, community leaders, and experts in the field—wrote personal letters to Secretary Jackson to express their confidence in Jacobs’ ability to balance public health and affordable housing goals and their support for his continued leadership of the OHHLHC.

Jacobs is widely credited with many of the gains made at HUD and nationally during his nine-year tenure as Director of the OHHLHC. Secretary Jackson’s decision vindicates Jacobs but relegates the country’s leading expert on lead poisoning prevention and healthy homes to a staff assignment in another office.

The Alliance salutes Dave Jacobs’ unflagging commitment to protecting children from lead poisoning and other housing-related health hazards. The Alliance urges HUD and Congress to ensure that the OHHLHC has the leadership, staff, and resources to achieve the national goal of ending lead poisoning by 2010 and protecting children from other health hazards in their homes.

FDIC Proposal Would Undercut Investments in Low-Income Housing

In 1977, Congress enacted the federal Community Reinvestment Act (CRA) to prevent discriminatory practices by lenders and promote private investment in low-income communities. CRA has helped advocates leverage billions of dollars in resources for affordable housing over the past two and a half decades. In some cases, CRA has been used to convince banks to create discounted financing programs specifically for lead paint and other health-related repairs. Now, federal bank regulators are proposing new rules to weaken CRA by relieving some mid-sized banks of their obligation to provide investments and services in low-income areas.

On August 20, the Federal Deposit Insurance Corporation (FDIC) proposed raising the asset threshold from $250 million to $1 billion in assets for “small banks.” This change would exempt approximately 2,000 FDIC-insured institutions from CRA’s more stringent exams. Today, banks with assets of more than $250 million must illustrate the distribution of their loans by geography and income and demonstrate that they provide both services and investments that benefit low- and moderate-income households and neighborhoods in their communities.

According to the National Community Reinvestment Coalition, changing the “small bank” definition will allow the banks, with total assets of more than $754 billion and branches in more than 18,800 communities (96% of all FDIC-regulated banks), to receive a watered-down CRA exam. Because institutions with assets of $250 million to $1 billion comprise substantial market share in rural areas, such a change will also mean that many rural communities and states will not have access to any institutions required to offer services and investments that benefit low- and moderate-income communities.

Advocates are also concerned that other federal agencies that regulate other financial institutions will join the FDIC in significantly scaling back the CRA.

The FDIC is accepting public comments on their proposed rule until Sept. 20. [UPDATE: The public comment deadline has been extended to October 20.] Visit www.fdic.gov/regulations/laws/federal/propose.html and look for the 8/20/04 Community Reinvestment proposed rule. In the far right column, you can click on “Comments” to submit electronic comments. For more information, contact the National Low Income Housing Coalition at [email protected] or 202-662-1530.

Proposed Baltimore Ordinance Would Limit Landlord Liability on Lead Poisoning

A pending Baltimore ordinance, City Council Bill 04-1276, seeks to undo the effects of a November 2003 Maryland Court of Appeals decision. Brooks v. Levin held a landlord liable for a child’s lead poisoning even though the tenant did not notify the owner about the deteriorated paint in the home.

The court noted that Baltimore’s housing code prohibits chipping or peeling paint in residences and that landlords have a continuing duty to adequately maintain their properties in a way that controls paint deterioration. The record showed that the landlord violated the housing code and that the violation was linked to the child’s lead poisoning. According to the court, these elements were sufficient to support a case for negligence and that the tenants were not required to notify the landlord of the lead hazard. Lead poisoning prevention advocates in the state hailed the decision as a firm reminder that the Baltimore housing code has long put landlords on notice that they have a legal obligation to properly maintain their properties.

The proposed bill would limit landlords’ liability if tenants have not given notice of a particular health hazard. Advocates point out that landlords have an obligation to provide safe housing and to abide by the housing code, and that many health hazards are not apparent to tenants. The Coalition to End Childhood Lead Poisoning and several council members oppose the bill. A similar measure failed in the Maryland General Assembly during the last legislative session.

For more information, contact Ruth Ann Norton of the Coalition to End Childhood Lead Poisoning at [email protected] or 410-534-6447, ext. 11.

Integrated Pest Management Beats Spraying Against Roaches

A recent study by researchers at Virginia Tech found that controlling German cockroaches using integrated pest management (IPM) is more effective than traditional pesticide spraying and is safer for pest control workers and residents.

Researchers evaluated methods used in 100 units of a low-income housing development in eastern Virginia, all with cockroach infestation. Half the units received traditional spraying, and the other half received IPM treatments including HEPA filter vacuuming, baiting, and insect growth regulators. While IPM treatments cost more, researchers found that IPM was far more effective than the more toxic chemical treatments.

Controlling cockroach infestations is a critical component of any healthy homes strategy. Cockroach waste, skin, and body parts contain an antigen that triggers attacks in many asthmatic children and adults. Using traditional, high-toxicity pesticides to control roaches, however, can also trigger asthma in sensitive individuals. Many pesticides are also suspected carcinogens, can cause birth defects, and may cause permanent developmental disabilities.

The study, titled “Cost and Efficacy Comparison of Integrated Pest Management Strategies with Monthly Spray Insecticide Applications for German Cockroach Control in Public Housing,” was published in the April 2004 edition of the Journal of Economic Entomology.

New Asthma Threat Detected in Homes

A July study by a team of Swedish researchers found that two chemicals common in household dust pose significant risks for allergic and asthmatic reactions in children. The chemicals, known as phthalates (pronounced tha-lates), are common plasticizers found in a wide variety of consumer goods around the world.

The researchers focused on three phthalates: di-n-butyl phthalate (DnBP), butyl benzyl phthalate (BBzP), and di(2-ethylhexyl) phthalate (DEHP). DnBP was not associated with allergies or asthma. BBzP is found in vinyl tile, carpeting, and artificial leather and was strongly associated with nasal allergies and eczema (a rash-like skin allergy). DEHP is heavily used as a plasticizer in polyvinyl chloride (PVC) and was found to be an asthma trigger.

DEHP could constitute a significant public health concern, as childhood asthma rates have increased sharply around the world in recent years. DEHP is widely used, making up approximately one-half of the global market share of all phthalates. It is found in high concentrations in household dust, and children in industrialized countries are likely exposed to large doses of the chemical each day. The researchers state that inhalation is a likely exposure pathway for DEHP—the chemical is easily inhaled, especially by children whose natural play behaviors place them on the floor, where house dust accumulates.

While several studies have examined the concentration of phthalates in household dust, this research is the first to draw a strong link between the chemicals and asthma.

Since the publication of the book Our Stolen Future in 1996, phthalates have been the subject of growing controversy. The plastics industry claims the chemicals are safe. However, researchers are concerned about a variety of adverse impacts from phthalates. In addition to the asthma risk identified by the Swedish study, scientists also have linked phthalates to endocrine disruption, which negatively affects hormone levels and the reproductive systems of wildlife and humans.

The asthma study will be published in Environmental Health Perspectives and is available at http://ehp.niehs.nih.gov/members/2004/7187/7187.html. For more in-depth information about phthalates, visit www.ourstolenfuture.org.

New EPA Webpage on Remodeling and Indoor Environmental Quality

The EPA recently posted a new webpage, “Addressing Indoor Environmental Concerns when Remodeling.” The page provides tips on how to keep indoor environmental quality in mind when starting a remodeling project, including detailed information on radon, carbon monoxide, lead safety, and good remodeling work practices. The page also contains an interactive diagram of a house that allows users to click on the room they plan to remodel. The page returns pointers tailored to renovation projects for the room selected. To use this resource, visit www.epa.gov/iaq/homes/hip-front.html.

New York City’s Chinese Community Backs Illegal Pesticide Reduction Effort

Throughout New York City and urban New Jersey, street dealers and shops sell illegal pesticides to homeowners and apartment dwellers, many of whom seek to eradicate cockroaches or rodents from their homes. Low-income and minority communities are often targets of these pesticide vendors. The poisons they sell are often far more toxic than legal pesticides, and several people have been killed using the chemicals.

Now, New York City’s Chinese community, the U.S. Environmental Protection Agency (EPA), and New York City Councilman John Liu are working together to educate New York’s Chinese population about the dangers of illegal pesticides and more effective ways to combat pests. These leaders helped produce a Chinese language poster to be displayed in storefronts throughout the city, providing important information about pesticides and their use.

EPA has inspected more than 100 stores in New York City and urban New Jersey and found more than 90 different illegal pesticides for sale. Since 2000, the EPA has fined stores more than $1 million for selling these chemicals.

Vendors claim that illegal pesticides are safe, effective, and registered with the EPA. However, only pesticides with official EPA registration numbers are legal—and only for registered uses. People should be aware that even EPA registration does not guarantee that a pesticide is completely safe.

For more information on illegal pesticide sales, see www.epa.gov/pesticides/health/illegalproducts/index.htm. To learn more about the dangers of indoor pesticide use, visit www.beyondpesticides.org.

NPR Series on Indoor Air and Health

On August 16 and 17, National Public Radio (NPR) ran a two-part series on indoor air quality and health impacts during its Morning Edition program. The series focused on chemicals, allergens, and carbon monoxide in homes, all of which can have serious health consequences.

The first part of the series looked at what NPR’s Jon Hamilton called “sick walls.” These walls can harbor mold, an allergen and asthma trigger for many Americans. Composed of paint, primer, gypsum wallboard, a vapor barrier, insulation, and vinyl siding, walls can also emit irritants and toxic chemicals like formaldehyde and vinyl chloride, both of which can irritate the eyes, nose, throat, and lungs, and both can cause cancer. Vinyl chloride and other chemicals emitted from walls can also damage organs, including the liver.

The series’ second segment explored methods for building healthier homes. Some of the solutions presented were highly specialized, including foam insulation made from soybeans and floor coverings made from natural products. Others, however, can easily be integrated into any home, including the elimination of wall-to-wall carpeting (which can emit toxins and trap allergens), effectively venting water heater and furnace burners to prevent indoor emission of carbon monoxide, and installing air filters.

For more information on this two-part series, visit www.npr.org/features/feature.php?wfId=3851857&place=home03.

Research Shows Smoking Creates Harmful Particulate Levels Indoors

A study published in the September 2004 issue of Tobacco Control found that lighted cigarettes produce ten times as much dangerous particulate matter as a passenger vehicle operating on diesel fuel. In an experiment conducted in a private garage in a small mountain town in northern Italy where background levels of particulate pollution were very low, scientists ran a diesel-powered car in an enclosed space for 30 minutes. They compared the vehicle’s emissions with those from three filtered cigarettes burned sequentially in the same enclosed space for the same amount of time.

Not only did the burning cigarettes produce 10 times as much particulate matter as the car, the concentration of particulate matter in the enclosed space where the cigarettes burned was 15 times as high as levels measured outdoors. Particulate matter is known to cause lung cancer and is particularly hazardous in homes because it does not readily dissipate in the indoor environment.

Environmental tobacco smoke has also long been known to be an asthma trigger, and the new research may help explain why secondhand smoke is so dangerous to asthmatics. Eliminating tobacco smoke from the home is one highly recommended way for families to help prevent asthma attacks.

To read the full study, visit http://press.psprings.co.uk/tc/september/219_tc5975.pdf. For more information on how environmental tobacco smoke can harm people with asthma, visit the American Lung Association at www.lungusa.org.

Army Corps Adds Anti-Lead Chemical to DC Water Supply

As part of an ongoing effort to decrease lead levels in Washington, DC’s drinking water, the Army Corps of Engineers started adding phosphoric acid to the citywide water supply on August 23. The chemical is used in other jurisdictions across the United States to coat the inside of plumbing to prevent lead from leaching into drinking water from pipes and solder.

In January 2004, the Washington Post reported that the DC Water and Sewer Authority (WASA) had been detecting high lead levels in drinking water in thousands of District homes, starting in 2002, without notifying consumers of the risk. The coverage caused a storm of controversy. The EPA approved the addition of phosphoric acid and expects that the chemical will show positive results within one year. However, it may take longer before lead contamination drops below federal action levels that trigger a legal requirement to replace lead water service lines.

New Orleans to Create a Lead Safe House

The City of New Orleans announced in August that it will renovate a blighted property to create the city’s first “Lead Safe House.” The property will provide temporary lead-safe shelter for families who are forced to leave their homes because of lead hazards. The families will live in the house while lead hazards in their own properties are corrected.

The project, financed by a $100,000 grant from the U.S. Conference of Mayors, could help families throughout the city. The house is to be finished by the end of 2004 and will accommodate each family for up to 30 days.

EHP Publishes Results of National Center Symposium

Environmental Health Perspectives has posted on its website an article from the National Center for Healthy Homes, “The Relationship Between Housing and Health: Children at Risk.” The article reports on a two-day conference that the Center convened in November 2002. The conference was unique in that it was solely focused on housing’s impacts on children’s health and ways to translate healthy homes research into practical solutions. The article also explains that feasible changes in policy and research goals hold much promise for overcoming current obstacles to providing healthy housing for all children across the United States. The article, which will appear in an upcoming print edition, is currently available online by visitinghttp://ehp.niehs.nih.gov/members/2004/7157/7157.pdf.

Upcoming Conferences and Trainings

The New England Asthma Regional Council (ARC) will sponsor a series of healthy housing trainings for contractors, architects, community development corporation staff, and others in the New England region. The trainings will teach healthy homes concepts and practices to those involved in designing, building, financing, and maintaining affordable housing. Trainings will be offered Sept. 23 in Lebanon, NH; Oct. 12 in Providence, RI; and Oct. 13 in Boston. On Dec. 10, a special session will be offered for code inspectors in New Haven, CT. For more details, contact Stacey Roberts at [email protected]or 617-451-0049. ARC has also posted an important technical resource booklet on how to build and renovate affordable housing while minimizing asthma triggers such as mold, dust mites, and pests like cockroaches and rodents. To view the booklet, visit www.asthmaregionalcouncil.org/documents/READTHIS6.07.04.pdf.

The Children’s Environmental Health Institute will host the “2004 Biennial Scientific Symposium on Children’s Health as Impacted by Environmental Contaminants” on September 24 and 25 in Austin, Tex. The symposium will provide an opportunity for public health professionals, education policymakers, childcare facility administrators, and others to learn how to protect children from environmental health risks. Topics will include asthma, known and potential environmental links to developmental disabilities and autism, and the prevalence of chemicals in air, food, water, and the home. More information is available at www.cehi.org/symposium_2004.html or by writing Sarah Jones at [email protected].

The Housing Justice Network is holding its annual meeting in Washington, DC, on October 3 and 4. The meeting will include workshops and a plenary on environmental justice and environmental health issues, along with other topics of interest to legal aid housing attorneys and low-income housing advocates. For more information, E-mail Steven Fischbach of Rhode Island Legal Services at [email protected].

The Institute on Urban Health Research and the International Society for Urban Health are sponsoring the Third International Conference on Urban Health, to be held October 20-22 at Northeastern University in Boston. The conference will address issues including the effect on urban health from climate change, urban environmental health issues, areas of intense political conflict, and disparities in health status and health care. The conference will also explore how to build local and regional public health infrastructure through community-based partnerships and establishing a new urban health research framework. Further details and registration information are available at www.iuhr.neu.edu/conference.

The American Public Health Association is holding its Annual Meeting and Exposition November 6-10 in Washington, DC. The meeting will include over 900 scientific sessions, a variety of special sessions, a networking reception, and an awards ceremony. More information is available at www.apha.org/meetings or by calling Anna Keller at 202-777-2476.

Indiana is holding its Lead-Safe and Healthy Homes Conference in Indianapolis on November 9 and 10. The conference will include several plenary sessions, and Dr. Mary Jean Brown of CDC, Dennis Livingston, and Don Ryan of the Alliance are scheduled to speak. For more information, visit www.ikecoalition.org or call Improving Kids’ Environment at 317-442-3973.

The Western Regional Conference on Mold, Lead, Healthy Homes, and Children’s Environmental Health will be held in Berkeley, CA, from November 17-19. The conference will cover topics such as children’s environmental health; health education; lead hazard control and healthy homes practices, programs, and policies; and conducting mold prevention, assessment, and remediation work. More information is available at www.leadmoldconferences.com/04pdfs/2004WesternRegConf.pdfor by calling Kristin Joyner at 1-800-590-6522.

Correction to Alliance Alert Article: “Federal Lead Hazard Disclosure Law Largely Unenforced in Alabama”

The last issue of the Alliance Alert (August 2004) reported on the controversy over the release of addresses of homes where lead poisonings have occurred in Birmingham, AL. The Alliance regrets that we did not contact the Jefferson County Department of Health for a response to statements cited in the article. The Department contends that it has and continues to release address data to CDC. The article incorrectly stated that lead poisoning is not a reportable disease under Alabama law.

The disclosure of address data is a complicated and sensitive issue in many jurisdictions, and a dispute still remains about this in Birmingham. For more background, the Alliance publication, “Overcoming Barriers to Data-Sharing Related to the HIPAA Privacy Rule,” a guide for state and local lead poisoning prevention programs, is now available online atwww.afhh.org/res/res_publications.htm#datashare.

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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.

The geometric mean blood lead level (BLL) in children aged 1-5 (i.e. the average blood lead level) dropped from 2.7 micrograms per deciliter (µg/dL) in 1991-1994 to 1.9 µg/dL in 1999-2002. This significant decline reflects continuing progress in reducing the lead burden throughout the US. However, NHANES data by income and race reveal the continuation of significant disparities: African-American children aged 1-5 experience a geometric mean BLL of 2.8 µg/dL, and the average BLL for children aged 1-5 in low-income households is 2.5 µg/dL.

Approximately 310,000 American children, the equivalent of 1.6% of children aged 1-5, have too much lead in their blood. This EBL prevalence is lower than the 2% reported for 1991-1994. Again, this reflects progress in moving toward the goal of eliminating childhood lead poisoning as a public health problem by 2010. Unfortunately, the statistical power of the EBL data was insufficient to identify disparities of risk across racial/ethnic populations, though CDC found that 3.1 percent of African-American children aged 1-5 are still lead poisoned, higher than for the whole population of children in that age group.

Limitations of the New Data

The current design of NHANES as a nationally representative survey and analysis of NHANES data does not allow for estimates in smaller geographic areas or for identifying risk in certain subpopulations, including recent immigrants. This can cause policymakers and medical practitioners to ignore the disparities in risk that characterize lead poisoning in the United States. Although this report does repeatedly stress that disparities exist, the data presented may still falsely lead some to believe that lead poisoning is no longer a crushing problem, when data from numerous localities demonstrates that children who typically live in older housing in low-income, predominately minority communities are poisoned at rates much higher than the national norm.1

Implications

Experience suggests that the lead, paint, and other industries may try to use these data to argue that lead poisoning is no longer a problem or that further preventive measures are unjustified because “the problem is going away by itself.” In fact, it is important to emphasize the significance of these data and the steps required to achieve the national goal of ending this condition by 2010:

  • The new national data documenting continuing progress on childhood lead poisoning come as welcome news, proving once again that when we control toxic exposures in the environment, human health directly benefits. This progress has not happened spontaneously or magically but is the direct result of controlling environmental lead exposures and making homes burdened with lead-based paint safe for children.
  • The NHANES sample is useful for detecting national trends, such as the decline in BLLs across the U.S. population as a whole in the last three decades. However, because of the peculiarly local and concentrated nature of blood lead elevations, it is conceivable that statistical prevalence estimates based on a small national sample could decline to virtually zero, even though many children continue to be identified with elevated BLLs in concentrated “hot spots” that exist in cities and counties throughout the country. Thus, it is vital to continue analyzing blood lead screening data from children living in high-risk areas and to do so at levels small enough to allow detection of hotspots that need focused prevention efforts.
  • While childhood lead poisoning is entirely preventable, these data make clear that hundreds of thousands of children are still at high risk for lead poisoning. The country should be targeting its resources and efforts to identify hazardous properties and make them safe before a child is poisoned.
  • The new data show that African-American children ages one to five are still twice as likely to be lead poisoning than their white peers.
  • It is clear that children served by Medicaid and those living in older, dilapidated properties are at highest risk. Ending the tragedy of lead poisoning requires increased resources to rehabilitate substandard properties and good maintenance and code enforcement to keep them safe. The challenge is to target our energies and resources to communities at highest risk, to properties that pose hazards, and to children at highest risk. The report itself highlights the success of HUD’s Office of Healthy Homes and Lead Hazard Control grants in contributing to targeted hazard control in communities of highest risk, giving further weight to continuing these grants at current or higher funding levels.
  • These data also highlight the lack of consistent and reliable data about both lead hazards in housing and lead-poisoned children. Federal law requires that all children served by Medicaid be screened and receive appropriate follow up care. Reliable data collection and reporting can help to focus prevention efforts.
  • More than 38 million US homes and apartments are burdened by lead-based paint, and more than 24 million of them contain substantial lead hazards, according to HUD. Lead-safe painting and rehab needs to become the national norm to avoid creating lead hazards in properties now in good condition, and agencies like the Environmental Protection Agency need to draft effective, enforceable rules to ensure that this occurs.

1See Brown MJ, Shenassa E, and Tips N, “Small Area Analysis of Risk for Childhood Lead Poisoning,” April 2001, https://www.afhh.org/res/res_pubs/saa.pdfSee also Goldberg A and Palmer D, “Do You Know Where the Lead Is?” 2002, http://www.nypirg.org/lead/whereslead/; and Philadelphia Citizens for Children and Youth, “Un-leaded Only: Toward a Safer City for Children,” 2002, http://www.pccy.org/PDF/Lead%20Report.pdf.

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Arsenic-Treated Wood

Arsenic-treated wood is the result of a chemical process in which wood is treated with a pesticide/preservative called chromated copper arsenate (CCA) to prevent rotting in lumber designed for outdoor use. CCA contains arsenic, chromium, and copper and was widely used for residential purposes in the United States from the 1970s until EPA phased it out in 2003.

CCA-treated wood can be hazardous to human health because arsenic is classified as a known carcinogen. Exposure to arsenic can cause cancer of the lung, bladder, skin, kidney, prostate, and nasal passage. Data released in November 2003 by the US Environmental Protection Agency (EPA) show that 90 percent of children repeatedly exposed to arsenic-treated wood face a greater than one-in-one million risk of cancer. (One-in-one million is the EPA’s historic threshold of concern about the carcinogenic effects of toxic chemicals.) Arsenic exposure can also lead to nerve damage, dizziness, and numbness. Arsenic has been linked to immune diseases, cardiovascular disease, diabetes, and changes in hormone function. Lung and bladder cancer are the two health effects most often related to exposure to CCA-treated wood. For information on other cancer risks in the home environment, please see Cancer Risks.

CCA-treated wood can be found virtually anywhere outdoor lumber is being utilized. Due to the increased risk to children, the uses currently receiving the most attention are play sets, decks, and picnic tables. Arsenic can leach to the surface of the treated wood, becoming accessible for absorption through exposed hands and skin touching the wood surface and, especially in the case of children, ingestion through normal hand-to-mouth behavior. The arsenic can also leach into the ground surrounding the location of the treated wood, providing yet another exposure pathway for children playing in the area.

Government and public attention to the issue of health hazards from CCA-treated wood, both national and international, has been growing steadily over the past few years. In March 2003, EPA finalized a voluntary agreement with preservative manufacturers to ban the production of CCA-treated wood for most residential uses as of December 31, 2003. However, the ban does not prohibit the sale of CCA-treated wood produced prior to December 31, 2003, nor does the measure address existing structures. With regard to retail sales, a warning label must be displayed in locations where CCA-treated wood is sold. The EPA has also removed chromated copper arsenate from its list of approved chemical pesticides.

The Consumer Product Safety Commission (CPSC) is also involved in the regulation of arsenic-treated wood. The CPSC has officially stated that there is an increased lifetime risk of developing lung or bladder cancer from exposure to arsenic for the individual who plays on CCA-treated wood play sets during early childhood. However, in November 2003, CPSC declined to ban the use of CCA-treated wood in playground equipment, citing the EPA-industry voluntary agreement to phase out the manufacture of CCA-treated wood.

In research that is still underway, the EPA and CPSC are studying whether wood sealants could effectively prevent arsenic from leaching out CCA-treated wood.

Informed individuals need not wait for government action on CCA application. Alternatives do exist to using arsenic-treated wood in new construction, and there are recommendations to reduce exposure from existing structures.

  • When purchasing new materials, some of the available alternatives include wood treated with non-arsenic preservatives; wood that does not require pressure-treatment; and non-wood alternatives such as metal, cement, and plastic. The pros and cons for such alternatives (other potentially hazardous chemical treatments, sustainable harvesting, durability, etc.) should be examined prior to making a purchasing decision.
    • A company called Timber Treatment Technologies announced in April 2006 that a new wood treatment process will replace CCA and other pesticide wood treatments in wood used for decks, porches, fences, and other outdoor home-related structures. The new treatment process, called TimberSil, uses a sodium silicate solution, which is infused into the wood. The solution, which is essentially a type of liquid glass, and the wood are heated, rendering the solution water insoluble. This creates a barrier and makes the wood inedible to insects, microbes, and molds.
  • When dealing with existing structures that cannot be replaced, general recommendations include applying a sealant to the wood at least once a year; washing hands after coming into contact with arsenic-treated wood, particularly before eating; avoiding toy storage under arsenic-treated decks; keeping children and pets away from dirt beneath and surrounding arsenic-treated materials, as rains can transfer leached arsenic to these locations; and not eating at an arsenic-treated picnic table.

Sources and Additional Information:

BANCCA.ORG – The premier online health resource for consumers of CCA Pressure Treated Wood – www.bancca.org

Beyond Pesticides – www.beyondpesticides.org

Children’s Health Environmental Coalition – www.checnet.org/healthehouse/chemicals/chemicals-detail.asp?Main_ID=250

Environmental Working Group – www.ewg.org/issues/arsenic/index.php

Healthy Building Network – www.healthybuilding.net/arsenic/index.html

Safe Playgrounds Project – Center for Environmental Health – www.safe2play.org/

U.S. Agency for Toxic Substances and Disease Registry – ToxFAQ for Arsenic – www.atsdr.cdc.gov/tfacts2.html

U.S. Consumer Product Safety Commission – CCA Fact Sheet and Chairman’s Statement – www.cpsc.gov/phth/ccafact.html and www.cpsc.gov/phth/ccastatement.html

U.S. Environmental Protection Agency – CCA Fact Sheet – www.epa.gov/oppad001/reregistration/cca/

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Lead Poisoning

Exposure to lead in housing poses a significant health risk to young children. Lead is a heavy metal used in many materials and products. When absorbed into the body, it is highly toxic to many organs and systems and seriously hinders the body’s neurological development. Lead is most harmful to children under age six because it is easily absorbed into their growing bodies and interferes with the developing brain and other organs and systems. Pregnant women and women of child-bearing age are also at increased risk, because lead ingested by the mother can cross the placenta and affect the unborn fetus.

Lead poisoning causes irreversible health effects and there is no cure for lead poisoning. At very low levels of exposure in children, lead causes reduced IQ and attention span, hyperactivity, impaired growth, reading and learning disabilities, hearing loss, insomnia, and a range of other health, intellectual, and behavioral problems. At low levels, lead poisoning may not present identifiable symptoms, and a blood test is the only way to know if a child is poisoned. At very high levels of exposure, which are now very rare in the U.S., lead poisoning can cause mental retardation, coma, convulsions, and even death.

As lead poisoning rates have declined nationally, the disparities of this disease have increased. In some communities, the rate of exposure is about five times the national average, which is estimated at 1.6 percent of children aged 1-5. In the U.S., children from poor families are more likely to be poisoned than those from higher income families. African-American children are also at increased risk, when compared with both Hispanic and white children.

National health experts agree that exposure to lead-contaminated dust from deteriorated lead-based paint in older homes is the primary pathway for lead exposure in young children. Lead dust settles quickly, is difficult to clean up, and is invisible to the naked eye. Young children usually are poisoned through normal hand-to-mouth activity, as lead dust settles on their toys and the floor. Children may also be seriously poisoned by eating lead-based paint chips, but this is relatively rare.

Soil in the vicinity of the home can also be contaminated by flaking exterior lead-based paint, previous deposits of leaded gasoline, and exterior sandblasting. In yards where soil is contaminated with lead, children can become exposed to harmful levels of the heavy metal when they get their hands dirty and place their fingers or a dirty or dusty toy in their mouths during normal play activity. Lead-contaminated soil and dust can also be tracked into homes on shoes or by pets or can be blown in through open windows and doors. Vegetables grown in lead-contaminated soil may absorb lead and poison children and adults.

Drinking water may become contaminated with lead from pipes or solder when water corrodes them. Less common sources include workplace exposures to lead where workers may receive doses well above those experienced by the general population. Exposed workers may carry lead particles home on their clothing, shoes, or hair, putting family members at risk. Those who work in construction, demolition, painting, with batteries, in radiator repair shops, lead factories, or with a hobby that involves lead are often exposed to lead. Rare sources of exposure include food and drink stored in leaded crystal, lead-soldered cans, or lead-glazed ceramicware; home remedies and cosmetics that are popular in some cultures; and some consumer products.

Except for severely poisoned children, there is no medical treatment for this disease. While drug therapy can reduce high levels of lead in the body, it does not undo the harm caused to developing organs and systems. A blood lead test is the only way to determine if a child has lead poisoning. The U.S. Centers for Disease Control and Prevention (CDC) defines a blood lead level of 10 µg/dl as a level of concern, indicating that steps should be taken to reduce ongoing lead exposure. Recent research has found adverse health effects, including learning disabilities, at much lower levels of exposure.

Most health department lead poisoning prevention programs postpone action to address lead-based paint hazards until after a child has been identified as lead poisoned. In effect, children are used to detect lead hazards in their homes. Over the past decade, emphasis has shifted to primary prevention to prevent and control lead hazards in housing before a child’s health is harmed.

Sources and Additional Information:

National Safety Council – nsc.org/library/facts/lead.htm

U.S. Centers for Disease Control and Prevention, Third National Report on Human Exposure to Environmental Chemicals (July 2005) – www.cdc.gov/exposurereport/metals/pdf/lead.pdf

U.S. Department of Housing and Urban Development Office of Healthy Homes and Lead Hazard Control – www.hud.gov/offices/lead/

U.S. Environmental Protection Agency – www.epa.gov/lead/ 

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Lead

The major remaining cause of lead poisoning is lead-based paint in housing, especially housing built before 1950, when lead paint was commonly used. Most children with elevated lead levels are poisoned in their own homes by peeling lead-based paint and the lead dust it generates. The mere presence of lead-based paint in a home is not a hazard, as about 40 percent of all U.S. housing contains some leaded paint, and the vast majority of children live safely in these homes and apartments.

Housing age is an important predictor of risk, because the lead content of paint varied substantially over the past century. During the first half of the twentieth century, the lead content of paint was marketed as a measure of its quality—the more lead the better. Prior to about 1940, leaded paints typically contained high amounts of lead, ranging from 10 percent to as much as 50 percent. Lead was added to make paint durable, so lead paint was frequently used in high-traffic and high-moisture areas, including kitchens and bathrooms, exterior siding and trim, window and door trim, stairs, porches, etc. In the early 1950s, the paint industry began reducing lead content, although many paints still contained harmful amounts of lead. Federal regulations limited lead content in 1972 and effectively banned lead in residential paints in 1978.

Two situations account for the vast majority of poisoning in children. Most commonly, children are poisoned by lead dust from deteriorated paint in poorly maintained older housing. A lesser number of cases—though often more serious—are caused by repainting and remodeling projects that disrupt old painted surfaces without proper safeguards to control, contain, and clean up lead dust. In both scenarios, small amounts of lead dust can create substantial health risks. For example, imagine the amount of sugar in a 1-gram packet. The same amount of lead particles evenly spread over 100 rooms, each measuring 10 feet by 10 feet, would leave dust levels of 100 µg/ft2, an amount of lead that is more than twice the federal standard (40 µg/ft2) for a hazardous level of lead on floors.

Lead in soil can come from many sources, including exterior lead-based paint that is peeling or flaking, dust or paint chips resulting from repainting or renovation projects, deposition from emissions of vehicles that used leaded gasoline, and demolition of buildings with lead-based paint. The U.S. Geological Survey estimates the mean naturally occurring lead in soil concentration to be 16 parts per million (ppm). EPA defines a soil lead hazard as 400 parts per million (ppm) in play areas and a 1,200 ppm average for bare soil in the rest of the yard.

Drinking water may become contaminated with lead from pipes or solder leached out by corrosion. EPA estimates that drinking water accounts for 10 to 20 percent of human exposure to lead. Infants may be put at increased risk from lead in drinking water when contaminated tap water is used to make baby formula. EPA recommends that action be taken if more than 10 percent of tap water samples exceed the action level of 15 parts per billion.

Primary prevention of lead exposure, including testing for lead content in paint, soil, and water; housing maintenance; and remediation of existing hazards is key to protecting children’s health. Lead poisoning is a concrete expression of the affordable housing crisis, more prevalent among poor children, children of color, and those living in older housing. Responsible property management, the need for enforceable housing quality standards that are both practical and cost-effective, and increased resources are needed to protect high-risk communities and preserve the nation’s affordable housing stock.

Sources and Additional Information:

U.S. Department of Housing and Urban Development Office of Healthy Homes and Lead Hazard Control – www.hud.gov/offices/lead/

Environmental Health Perspectives, The Prevalence of Lead-Based Paint Hazards in U.S. Housing – www.hud.gov/offices/lead/techstudies/LeadPaintHousingSurvey.pdf

U.S. Environmental Protection Agency – www.epa.gov/lead & www.epa.gov/safewater/lead/index.html

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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.

While no city or state with a significant stock of leaded housing has successfully assembled all of the elements needed to make primary prevention a reality across the jurisdiction, state and local lead poisoning prevention programs across the country and their partners in other agencies and the private sector have implemented a multitude of innovative and successful primary prevention strategies over past years.  Workshops and conferences periodically feature model programs, but the prospect of replicating an entire program with multiple components and elements can be daunting to the CLPPP seeking to evolve beyond screening and case management.  Difficulty in achieving program transformation to primary prevention is only compounded within an overwhelmed public agency that is surrounded by a change-resistant or risk-averse political environment.Since most successful primary prevention programs consist of multiple elements, specific strategies can be considered individually or in combination.

The multitude of innovative strategies to identify, control, and prevent lead hazards in housing before a child is poisoned that are currently being implemented across the country have never been systematically documented or described in a way that makes information about their design and implementation readily accessible.  Programs and their jurisdictions need this information at the “building block” level in order to decide which strategies to pursue based on local needs and conditions.  CDC’s Lead Poisoning Prevention Branch contracted with the Alliance for Healthy Homes (formerly the Alliance to End Childhood Lead Poisoning) to identify and describe individual building blocks across the spectrum of primary prevention strategies in order to create access to knowledge about tangible and realistic opportunities for progress and program evolution in identifying, controlling, and preventing lead poisoning and other housing-related health hazards.

Scope and Limitations

The research for Building Blocks for Primary Prevention: Protecting Children from Lead-Based Paint Hazards was guided by the descriptions of primary prevention in CDC’s 1997 screening guidelines and 2002 case management guidelines, which emphasize eliminating and controlling toxic exposures at the source.  While primary prevention necessarily encompasses activities that address all sources of exposure to lead, Building Blocks is focused on strategies for preventing and controlling lead hazards in housing, the foremost cause of poisoning.

A strategy has been considered for inclusion as a building block if it is sensitive to the economics of affordable housing, consistent with the principles of public health, holds the potential for broad-scale impact, stands a reasonable possibility of implementation, and offers real promise for reducing lead and other environmental health hazards in high-risk housing.  Building blocks are not only technical tools and program elements but also strategies such as techniques for targeting high risk housing, leveraging opportunities, innovative partnerships, enforcement mechanisms, expanded financial resources, and new ways to bring lead safety and healthy homes tools into broader use.  A building block is more likely to be a key ingredient of a prevention-based system, rather than an entire program.

The heart of the challenge to public health agencies is leveraging action to make privately owned housing lead-safe.  Many CLPPPs are increasingly viewing leveraging action to address lead hazards in housing as a part of their leadership role.  While public health program directors and staff are clearly the primary audience for Building Blocks, some strategies entail fostering changes in other organizations and systems to advance prevention in high-risk housing.  The summary of each building block is coupled with an illustration of how the strategy has been implemented and contact information for at least one individual who is knowledgeable about this activity.

Building Blocks has some inherent limitations that deserve note. The information listed in illustrations (partners, resources, constraints) is not comprehensive but rather an enumeration of specific and strong examples of a building block in play.  Results of efforts to replicate a given building block will vary depending on individual state and local laws, maturity of partnerships, political will, and the existence and strength of community-based partners.  The applicability of a building block selected for implementation will depend on the maturity and capacity of the jurisdiction and its CLPPP.

Organization of Building Blocks

The description of each strategy is structured according to the template (Appendix A) that has shaped the research and compilation of Building Blocks.The generalized information includes the title, brief summary, potential applications and benefits (including scope of impact), and critical elements such as staffing patterns, other resource needs, institutional capacity, cost and timing considerations, and indication of feasibility of implementation.

At least one real-world illustration amplifies most building block descriptions, documenting: the scope and particulars of the example in given jurisdiction or other target areas; the staffing and other resources utilized; magnitude of its impact; factors essential to implementation; limitations encountered; estimated potential for replication; and specific contact information and references for additional information.  The illustrations offer strong examples of how each strategy has been recently implemented but do not provide an inclusive or exhaustive review of all efforts to ever plumb the benefits of the given strategy.

The building blocks on this site are grouped by the category that best fits their essential contribution to primary prevention:

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Rodents

Exposure to rodents (mice and rats) has been linked to increased asthma symptoms among laboratory workers who handle rodents and are sensitized to them. Other studies have established links between rodent allergies and asthmatic symptoms in lab workers. Research published in 2004 found similar linkages in residential settings. Rodent allergens are likely from rodent urine, saliva, or skin.

It is clear that many inner-city residents are exposed to and allergic to rodents. A major study on asthma among inner-city children found that nearly 20 percent of asthmatic children had been sensitized to rats and 15 percent were sensitized to mice. This is important to note, as research has found mouse allergen in 82 percent of US homes.

Rodents can also expose humans to diseases such as hantavirus. Exposure to such disease vectors is rare but can cause severe health problems.

Integrated pest management (IPM) approaches offer effective means of eliminating rodents from the home. IPM methods focus on preventing infestations, trapping rodents, and limited use of lower-toxicity pesticides. However, even after a rodent population is controlled, rodent hair, urine, and fecal allergens may remain and can trigger allergic reactions in some people.

Sources and Additional Information:

Asthma and Allergy Foundation of American – www.aafa.org

Asthma Regional Council – www.asthmaregionalcouncil.org

Beyond Pesticides – Integrated pest management to control mice –www.beyondpesticides.org/alternatives/factsheets/MOUSE%20CONTROL.pdf and www.beyondpesticides.org/infoservices/pesticidesandyou/Winter%2000-01/Minimizing%20Mouse%20Madness.pdf

Cohn R PhD, Arbes S, Jr. PhD, Yin M PhD, Jaramillo R MStat, and Zeldin D MD. Journal of Allergy and Clinical Immunology, National prevalence and exposure risk for mouse allergen in US households, June 2004 – http://dx.doi.org/10.1016/j.jaci.2003.12.592 (Abstract only)

Kattan M, H. Mitchell, P. Eggleston, P. Gergen, E. Crain, S. Redline, K. Weiss, R. Evans III, R. Kaslow, C. Kercsmar, F. Leickly, F. Malveaux, H.J., Wedner, Pediatr. Pulmonol, Characteristics of Inner-City Children with Asthma: The National Cooperative Inner-City Asthma Sutdy, 24:253-262, 1997

National Academy of Science, Institute of Medicine report Clearing the Air: Asthma and Indoor Air Exposures 2000 – http://books.nap.edu/books/0309064961/html/index.html

US Centers for Disease Control and Prevention – www.cdc.gov (Search under rodents)

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Pesticides

Pesticides are substances designed to kill, repel, or mitigate pests. They include a number of chemical and biological agents commonly used in and around the home to control a broad range of pests: insecticides (for insects, including cockroaches, ants, and termites), rodenticides (for mice and rats), fungicides (for mold and fungi), herbicides (for plants), and antimicrobials (for bacteria and viruses).

Use and Exposure

Approximately 4.4 billion pesticide applications are made each year to American homes, gardens, and yards. According to surveys by the Environmental Protection Agency (EPA), more than three-quarters of U.S. households use pesticides, with 66 percent treating major living areas in the home one or more times per year. Cockroaches and ants are the most common targets. More than one-third of households used insecticides in the absence of a major insect problem.

Children may be exposed to pesticides in food, water, and their environments. However, pesticide use in the home, lawn, and garden is responsible for most children’s exposures. Children may come into contact with pesticides that have been applied in the home, or they may gain access to pesticides that have not been stored safely. They also can be exposed to pesticides applied outdoors or to pets. Pesticides used outdoors can contaminate the home when pesticide-laden dust is tracked inside on shoes and pets. The number and concentrations of pesticides found in household dust exceed those found in food, soil, or air. To make matters worse, pesticide contamination in the home can persist for years, particularly in carpets, due to the lack of sun, rain, and other factors that help to break down pesticides outdoors.

Health Impacts

Pesticides can cause a wide range of health problems, ranging from acute and persistent injury to the nervous system, injury to reproductive systems, birth defects, and cancer. Of the 28 pesticides estimated by EPA to be most widely used in agriculture, in and around U.S. homes, and by commercial pesticide applicators, more than 40 percent are classified by EPA as likely, probable, or possible carcinogens, according to a review by the Northwest Coalition for Alternatives to Pesticides (NCAP). Use of these pesticides totals 350 million pounds per year. An EPA database summarizing studies of 19 of these commonly used pesticides indicates that 18 of the 19 have caused reproductive problems in laboratory tests. Immediate health impacts can include dizziness; vomiting; headaches; sweating; skin, eye, and respiratory tract irritation; and fatigue. The health effects from exposure to pesticides vary depending upon the level and duration of exposure. As with most environmental toxins, children are at greater risk from exposure than adults.

Regulation

EPA regulates pesticides used for residential purposes under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA). Under FIFRA, EPA can register the use of pesticides or ban or limit their use if they are found to cause unreasonable risks to human health and the environment. The Food Quality Protection Act (FQPA) establishes a higher standard for pesticides used on food: tolerance levels (the maximum amount of pesticide residue permissible on food) must be safe, taking into account exposures from dietary and other sources, as well as the special vulnerability of children to pesticide exposures. While many pesticides are registered for agricultural use, some are registered only for other uses, such as controlling pests in the home.

Subject to some limited exemptions, a pesticide cannot be used legally in the US unless it has been registered with EPA. Since FIFRA was amended in 1988, EPA has been reviewing the health and environmental effects of pesticides registered prior to 1984 to ensure that they meet current, more stringent standards. The 1996 FQPA also requires EPA to review food tolerance levels to ensure their safety and to review pesticide registrations every 15 years.

These review processes have led to bans and use restrictions on some pesticides widely used in the home. For example, chlorpyrifos (marketed by Dow as Dursban) was the most commonly used insecticide in homes, gardens, schools, hospitals, and day care centers for control of cockroaches, ants, fleas, spiders, and ticks. In addition to acute poisonings, chlorpyrifos was found to cause chronic headaches, blurred vision, fatigue, memory loss, depression, irritability, and low birth weights among infants. EPA banned all residential uses in 2004.

In addition to risks presented by older pesticides, some recently registered pesticides may pose health or environmental hazards. According to NCAP, a survey of 19 pesticides registered since 1997 found that nearly all of them posed hazards, including increased risk of cancer, genetic damage, birth defects, and other serious health problems. Some “inert” ingredients cleared for use by EPA also may be harmful.

States also regulate the use of pesticides. States may register pesticides, restrict their use, and establish certification requirements for pesticide applicators. They also may require notification prior to pesticide use and/or posting of areas where pesticides are applied.

Controlling Pests Safely

Pesticides do not offer a long-term, complete solution to pest problems; they kill pests, but typically need to be re-applied periodically. In order to more effectively eliminate pests, it is necessary to identify the factors that are allowing the pests to thrive and alter them. This typically involves eliminating food and water sources and preventing pests from entering the home. This process is known as integrated pest management, or IPM.

Sources and Additional Information:

Asthma, Children, and Pesticides brochure [PDF] – www.beyondpesticides.org/children/asthma/asthma%20brochure%20high%20res.pdf

Beyond Pesticides – www.beyondpesticides.org

Cox, C., Journal of Pesticide Reform, “EPA Takes Action on Diazinon: Too Little, Too Late” (Winter 2000) – www.pesticide.org/diazinonNEWS.pdf

Cox, C., Journal of Pesticide Reform, “Ten Reasons Not to Use Pesticides” (Winter 2001) – www.pesticide.org/TenReasons.pdf

Environmental Health Watch, Pests and Asthma Resources (includes IPM information) – www.ehw.org/Asthma/ASTH_home1.htm#Pests

Gumm, Brian, Home Energy, “Integrated Pest Management in the Home,” Vol. 21 Iss. 6 pp. 36-39 (Nov-Dec 2004)

Natural Resources Defense Council – www.nrdc.org

Northwest Coalition for Alternatives to Pesticides – www.pesticide.org

Northwest Coalition for Alternatives to Pesticides, Journal of Pesticide Reform, “Does Government Registration Mean Pesticides are Safe?” (Summer 1999) – www.pesticide.org/BasicRegistration.pdf

Our Stolen Future – www.ourstolenfuture.org

Pesticide Action Network – www.pesticideinfo.org

Safer Pest Control Project – http://spcpweb.org/

Silent Spring Institute – www.silentspring.org

U.S. Environmental Protection Agency, Pesticides Program – www.epa.gov/pesticides/index.htm

Zahm, S.H., and Ward, M.H., Environmental Health Perspectives, “Pesticides and Childhood Cancer,” Vol. 106 Suppl. 3, pp. 893-908 (June 1998) – http://ehp.niehs.nih.gov/members/1998/Suppl-3/893-908zahm/zahm-full.html

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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.

Several substances that may be found in or around the home, such as radon, some pesticides, asbestos, formaldehyde, and arsenic, are known carcinogens. Becoming aware of these substances and their potential risks is the first step in reducing potential exposures.

Radon

Radon, a naturally occurring radioactive gas produced by decaying uranium, is the second leading cause of lung cancer after smoking. EPA estimates that radon is responsible for approximately 21,000 lung cancer deaths per year. Smoking has been shown to increase the risk of lung cancer in those exposed to radon.

Radon gas enters homes through dirt floors, cracks in concrete walls and floors, floor drains, and sumps. Any home may have a radon problem—new or old, well-sealed or drafty, with or without a basement.

Because radon is colorless and odorless, it is necessary to measure radon levels in the home in order to determine the extent to which it is present. EPA provides guidance regarding the risks associated with different levels of exposure and recommends corresponding corrective actions.

Pesticides

Exposure to some pesticides also may increase a person’s risk of cancer. Pesticides are commonly used in and around the home to control insects, termites, rodents, and fungi, as well as to disinfect. According to surveys cited by EPA, 75 percent of U.S. households use at least one pesticide product over the course of a year, and 80 percent of most people’s exposure to pesticides occurs indoors. During 2001, the American Association of Poison Control Centers reported that nearly 50,000 children under age six were exposed to pesticides.

The health impact from exposure to pesticides varies depending upon the level and duration of exposure. Immediate impacts may include skin, eye, and respiratory tract irritation; headaches; dizziness; visual disorders; and memory impairment. Many pesticides are known to cause cancer in animals, and some are suspected or known to cause cancer in humans. Some studies have demonstrated a link between childhood cancers and pesticides.

Asbestos

Exposure to asbestos also increases the risk of developing cancer. Asbestos can cause lung cancer, mesothelioma (cancer of the chest and abdominal linings), and asbestosis (irreversible and potentially fatal scarring of the lung). As is the case with radon, smoking significantly increases the risk of cancer in those exposed to asbestos. The health impacts of asbestos typically appear 20 to 30 years after exposure.

Asbestos may be found in a number of locations in the home. Until the 1970s, many building products and insulation materials contained asbestos, including insulation on steam and furnace pipes, ducts, and boilers; vinyl, rubber, or asphalt floor tiles; soundproofing or decorative material sprayed on walls or ceilings; and roofing, shingles, and siding. Today, asbestos-containing products must be labeled.

As a general rule, asbestos that is in good condition does not pose a risk and should be left undisturbed. If disturbed, asbestos material may release asbestos fibers, which can be inhaled into the lungs and increase the risk of disease.

Other substances around the home that may increase the risk of cancer include formaldehyde (found in pressed-wood products), which is used largely for new construction, and arsenic (present in most pressure-treated wood manufactured before prior to 2002), which was widely used for decks and playgrounds.

Sources and Additional Information:

American Cancer Society – www.cancer.org

American Lung Association – www.lungusa.org

Biological Effects of Ionizing Radiation (BEIR) VI Report: “The Health Effects of Exposure to Indoor Radon” – www.nsc.org/ehc/radon/public.htm

Cancer Information Service – http://cis.nci.nih.gov

CureSearch – www.curesearch.org

Rachel Carson Council, Inc. (information on pesticides) – www.RachelCarsonCouncil.com

Silent Spring Institute – www.silentspring.org

U.S. Environmental Protection Agency, Asbestos in Your Home – www.epa.gov/asbestos/pubs/ashome.html

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Mold

Molds are simple, microscopic organisms that can grow virtually anywhere, both in homes and outdoors. Along with mushrooms, yeasts, and mildew, molds are classified as fungi. Molds typically consist of a network of threadlike filaments that infiltrate the surface on which the mold is growing. Molds reproduce by releasing spores, which are lightweight and small enough to travel through the air. Spores can resist dry, adverse environmental conditions, allowing them to outlive the mold that produced them.Molds play an important ecological role in breaking down dead organic matter and returning nutrients to the environment. They require moisture and food to grow, and they typically thrive in warm, moist environments. Moisture is the key factor determining mold growth in the home, influencing both the types of mold present and the extent of mold colonization. A variety of materials found in the home, including insulation, wallpaper, glues used to affix carpet, backing paper on drywall, dust, and dirt, can serve as a food source for mold. Mold colonies can go dormant under adverse conditions and revive when favorable conditions return.

Mold growth often appears as green, gray, black, brown, or other discoloration. Eventually, mold growth results in the breakdown of the substrate. More than 1,000 types of molds have been found in US homes.

Exposure and Health Impacts

People are exposed to mold on a daily basis. Most exposures in the home occur when occupants inhale spores or mold fragments, which are components of household dust. They also may be exposed when their skin comes into contact with mold-contaminated materials.

Most people are unaffected by exposure to moderate amounts of mold. However, mold exposure can cause allergic reactions in some people. Approximately 6-10 percent of the general population, and 15-50 percent of persons who are genetically prone to develop allergies (atopic individuals), are allergic to mold, according to the National Academy of Sciences. The most common symptoms include runny nose, eye irritation, coughing, congestion, and exacerbation of asthma in persons who have the disease. At this point, it is unclear whether mold can cause individuals to become asthmatic. For more information on asthma and allergies, see Asthma, Allergies, and Respiratory Illnesses.

Some types of mold produce toxic substances known as mycotoxins, which can cause health problems when they are inhaled, absorbed through the skin, or ingested. One mold species may produce a number of different mycotoxins; conversely, one mycotoxin may be produced by several different types of mold. Mycotoxin production varies depending on environmental conditions such as moisture level, temperature, and substrate content. As a general matter, toxin-producing molds have higher water requirements than most household molds, so they thrive indoors only under wet conditions.

Although the health impacts of exposure to mycotoxins in the home are not well studied, adverse health effects have been observed in occupational settings and in animal studies. Of course, health impacts vary depending on the mycotoxin at issue and the nature of the exposure. Skin rashes, fatigue, dizziness, flu-like symptoms, nausea, respiratory and eye irritation, immuno-suppression, birth defects, lung inflammation, and cancer have been associated with exposure to mycotoxins. Persons exposed to high levels of mold toxins, e.g., mold remediation workers or farm workers, may be at risk for organic toxic dust syndrome (OTDS) or hypersensitivity pneumonitis (HP). ODTS may occur after a single, heavy exposure to mycotoxins, and usually carries with it fever, respiratory, and flu-like symptoms. HP is an immunological disease caused by repeated, high-level exposures to the same agent, and can result in permanent lung damage.

Mold exposure also may lead to infections such as fungal pneumonia in persons with compromised immune systems.

Mold Assessment

The most reliable way to identify a mold problem is through visual inspection. According to experts with the Building Science Corporation, “If you see mold or you smell mold, you have mold.” Since mold requires water in order to grow, looking for water or moisture problems is usually the best way to locate mold. This may require looking behind walls or ceilings, under furniture, in crawlspaces and basements, or behind cabinets and toilets. While assessing mold contamination, workers should wear gloves and eye protection and a respirator. They also should take steps to ensure that large amounts of mold are not released into the home from concealed areas, by misting moldy surfaces before disturbing them or using a HEPA vacuum attachment when cutting mold-contaminated surfaces, for example.

Prevention and Control

Although health-based standards for mold currently do not exist, it is generally accepted that no one should live or work in an indoor environment beset by extensive mold growth. Since mold requires moisture to grow, mold problems can be prevented by solving moisture problems quickly and effectively. Moisture in the home may be caused by poor ventilation, excess condensation (due to humidifiers or unvented clothes dryers, for example), water leaks, or floods. In the case of a flood or leak, mold growth can be prevented if water-damaged materials are dried and cleaned and/or removed within 24-48 hours. Additional preventative measures include regularly checking plumbing and promptly repairing leaks; maintaining relative humidity below 60 percent; venting clothes dryers; and installing exhaust fans in kitchens and bathrooms vented to the outside. For more information on addressing moisture problems in the home, see How to Control Moisture.

If mold is obviously present, the first step in controlling the problem is to assess the extent of the contamination. The Environmental Protection Agency (EPA) has developed mold remediation guidelines for schools and commercial buildings, and the New York City Department of Health (NYC) has created assessment and remediation guidelines for fungi in indoor environments. Both of these guidelines recommend remedial measures and precautions calibrated to the amount of mold present.

As a general matter, the goal of mold remediation is to remove or clean contaminated materials in a manner that prevents mold and contaminated dust from escaping the work area, while protecting the workers performing the remediation. The underlying water or moisture problems must be addressed prior to or during remediation; otherwise, mold growth will recur.

Regulation

Despite the flurry of activity around the country to pass laws relating to mold, legislation on the problem remains in the nascent stages. Currently, there are no health-based standards for mold exposure. The EPA and NYC guidelines set forth recommendations for safe assessment and remediation of mold contamination, but they are not legally binding. The laws being considered, and in some cases adopted, address a few common themes. Some laws seek to establish committees or task forces to study the issues surrounding mold. Other laws have sought to implement licensing schemes for mold inspectors and/or remediators. Some laws under consideration have addressed insurance issues, while others have sought to require disclosure of mold during sale or lease transactions. In some cases, legislatures have focused on indoor air quality issues in schools and public buildings.

Several states also have considered adopting more comprehensive mold legislation, modeled in some cases on California’s Toxic Mold Protection Act, which requires the state’s Department of Health Services (DHS) to convene a task force to consider the feasibility of adopting exposure limits to mold in indoor environments (and to adopt standards if feasible). The Act also directs DHS to adopt practical standards to assess the health threat posed by mold, develop remediation guidelines, and assess the need for standards covering mold assessment and remediation professionals. Landlords are required to provide written disclosure of known mold contamination to tenants prior to entering into a lease and to provide a DHS brochure on mold. However, these requirements do not become effective until after the standards are adopted and DHS creates a brochure. City attorneys, as well as code enforcement and public health officials, are authorized to enforce the Act, which has gone largely unimplemented due to lack of funding. In New York State, two bills have been introduced that mirror the California Act.

See Action Agenda for more information about legislation and regulations.

Sources and Additional Information:

Affordable Comfort – www.affordablecomfort.org

Building Science Corporation – www.buildingscience.com/

Canada Mortgage and Housing Corporation – www.cmhc-schl.gc.ca

Environmental Health Watch, Moisture Audit of Residential Structures – www.ehw.org/Healthy_House/HH_Moist_Audit.htm

Environmental Protection Agency, Mold Remediation in Schools and Commercial Buildings – www.epa.gov/iaq/molds/images/moldremediation.pdf

T. Platts-Mills, J. Vaughan, M. Carter, and J. Woodfolk, Journal of Allergy and Clinical Immunology, “The Role of Intervention in Established Allergy: Avoidance of Indoor Allergens in the Treatment of Chronic Allergic Diseases,” pp. 787-804 (November 2000).

US Dept. of Housing and Urban Development, Healthy Homes Issues: Mold, External Review Draft, Version 2, October 2, 2001 – www.hud.gov/offices/lead/hhi/Mold_v2_12-01.pdf

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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

Health insurance coverage and access to preventive care play a major role in determining health outcomes. Uninsured persons are less likely to seek routine care and may postpone or decline to seek treatment for health problems. According to a report by the Henry J. Kaiser Family Foundation, minority Americans are at least twice as likely to be uninsured than whites, due to disparities in private insurance coverage. At the same time, minorities are more likely than whites to be insured under Medicaid, which provides health coverage for low-income Americans.

Although insurance coverage improves access to health care, minority children have less access to primary medical care than white children, even after accounting for differences in insurance coverage, according to the Kaiser Family Foundation Report. Minority children are less likely to have a usual source of medical care or a specific doctor and are less likely than white children to seek care for symptoms warranting medical attention. Inadequate routine and preventive care increases a child’s incidence and burden of disease.

Childhood Lead Poisoning

Over the past 20 years, childhood lead poisoning has declined dramatically in the United States due to bans on lead in gasoline, paint, food cans, and other consumer products. However, lead poisoning is still an important health problem, affecting an estimated 310,000 (1.6 percent) children ages 1-5, according to analysis of data from the National Health and Nutrition Examination Surveys (NHANES), released by the Centers for Disease Control and Prevention. As the numbers of lead-poisoned children have declined, the disparities of the disease have become more pronounced.

While lead poisoning crosses all socioeconomic, geographic, and racial boundaries, the burden of this disease falls disproportionately on low-income families and families of color living in older, poorly maintained housing. For example, in the U.S., African-American children are at two times greater risk than whites, according to the most recent data available on the disparities of the disease.

For a fact sheet explaining this prevalence and disparity data, click here.

Asthma

The prevalence of asthma in the United States has increased dramatically over recent decades, affecting all racial, ethnic, and age groups. The risk for asthma appears to be more closely correlated with socioeconomic status than race. However, even after accounting for socioeconomic differences, African-American children are twice as likely to have asthma and six times more likely to die from it than white children, according to a Kaiser Family Foundation Report.

In a continuing study, researchers at the Harlem Hospital Center, Harlem Children’s Zone, and the Mailman School of Public Health have found that 25 percent of Harlem children tested have asthma, the highest rate ever documented in this country. For Hispanics, prevalence rates are mixed. For example, the Institute of Medicine reports that Mexican-American children living in the Southwest have some of the lowest rates of asthma in the country, while Puerto Rican children living on the East Coast have some of the highest asthma rates.

Hospitalization for asthma generally is avoidable if the disease is well managed. In urban, low-income, and minority areas, increases in asthma hospitalization and mortality rates are especially pronounced. Poverty, substandard housing, inadequate access to health care, lack of education, and failure to adequately control asthma with medication all contribute to asthma episodes and deaths.

In an inner-city asthma study supported by the National Institute of Allergy and Infectious Diseases (NIAID), researchers found that asthma was more severe in children who experienced significant barriers to accessing medical care. The NIAID study also found that when a nurse practitioner assisted high-risk children and their families in managing the child’s condition and instituting environmental controls, such as the removal of cockroach allergen from their homes, children experienced a 30 percent decrease in asthma-related hospitalizations and unscheduled doctor and emergency room visits. This study indicates that by addressing asthma triggers in the home and taking aggressive action to ensure that inner-city children adequately manage the disease, the disparities in hospitalizations and deaths caused by asthma can be reduced.

Cancer

Minority populations are both more likely to develop cancer and more likely to die from the disease than whites. African-American men, for example, are 20 percent more likely to get cancer than white men, according to the American Cancer Society. Some specific forms of cancer affect minorities at rates several times higher than the national average.

Ethnic minorities also experience poorer cancer survival rates than whites. Like most diseases, cancer treatment is more effective if begun early in the course of the disease. If preventive medical care is inadequate, cancer is more likely to be diagnosed at a later stage, when options for treatment are more limited and the odds for survival reduced. According to the American Cancer Society, cancer mortality rates are 40 percent higher for African-American men than white men.

Many of the differences in cancer incidence and mortality rates likely are due to socioeconomic factors rather than race or ethnicity. Socioeconomic status bears upon education, occupation, health insurance, income level, and living conditions to a greater extent than race. Each of these factors in turn impacts a person’s risk of developing and surviving cancer.

Eliminating Health Disparities

Efforts to eliminate health disparities are underway both nationally and locally. The nation’s Healthy People 2010 agenda seeks to identify the most significant preventable threats to health and establish national goals to reduce them. The second of the program’s two overarching goals is to eliminate health disparities that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

The National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, has developed a number of grant programs to document health disparities and arm policy makers with the information needed to reduce them. NIEHS and the National Institute of Allergy and Infectious Diseases have supported several urban asthma studies.

The U.S. Department of Health and Human Services created an Office of Minority Health in 1985, and the Centers for Disease Control and Prevention created a similar office in 1988. Many states also have created offices addressing minority health. The HHS OMH funds health projects conducted by minority community and national organizations, maintains minority health consultants in HHS Regional Offices, and operates a Resource Center on minority health issues. This Office also overseas the Healthy Community Innovation Initiative, a program designed to prevent asthma and other diseases through community services, with special attention to eliminating health disparities. The National Institutes of Health also has a National Center on Minority Health and Health Disparities to coordinate research, training, and outreach programs surrounding health disparities. Due to the strong link between socioeconomic status and health disparities, programs designed to improve the socioeconomic status of minorities also could help to reduce health disparities.

Addressing health disparities related to hazards in housing requires directing attention and resources to the communities at highest risk. Focusing on properties that pose the greatest health risks, which are overwhelmingly older, low-income, and in substandard condition, will yield the greatest improvement in health outcomes and address the striking health disparities borne by low-income and minority families.

Sources and Additional Information:

Agency for Healthcare Research and Quality – www.ahrq.gov

American Cancer Society, Cancer Facts & Figures for African Americans, 2003-2004 – www.cancer.org/downloads/STT/861403.pdf

National Cancer Institute, Center to Reduce Cancer Health Disparities – http://crchd.nci.nih.gov/

Centers for Disease Control and Prevention, Office of Minority Health – www.cdc.gov/omh/default.htm

Centers for Disease Control and Prevention, Third National Report on Human Exposure to Environmental Chemicals (July 2005)

Health Resources and Services Administration – www.hrsa.gov

Henry J. Kaiser Family Foundation, Key Facts: Race, Ethnicity & Medical Care (1999)

Institute of Medicine, Clearing the Air: Asthma and Indoor Exposures (2000)

National Institute of Allergy and Infectious Diseases – www.niaid.nih.gov/default.htm

Office of Minority Health, U.S. Department of Health and Human Services – www.omhrc.gov

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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.

A combination of measures is often most effective in reducing exposure to dust mite allergens. Because dust mites thrive in the bedroom, this is a good place to begin interventions. One important strategy for controlling dust mites includes reducing moisture and maintaining a low relative humidity in the home, although it may not be feasible to completely eliminate dust mites from homes in moderately humid climates. In addition to killing dust mites, steps should be taken to reduce exposure to dust mite waste products. Weekly hot-water (minimum 130ºF) laundering of bedding (including sheets, bedcovers, and blankets) will kill dust mites and reduce allergen levels. Covering pillows and mattresses with allergen-impermeable covers will contain dust mites and their waste products and reduce exposure to dust mite allergen. Additional measures include washing stuffed toys and vacuuming and steam cleaning carpets.

Sources and Additional Information:

Asthma and Allergy Foundation of America – www.aafa.org

T. Platts-Mills, J. Vaughan, M. Carter, and J. Woodfolk, Journal of Allergy and Clinical Immunology, “The Role of Intervention in Established Allergy: Avoidance of Indoor Allergens in the Treatment of Chronic Allergic Diseases,” pp. 787-804 (November 2000).

University of Nebraska Cooperative Extension In Lancaster County, “House Dust Mites,” – http://lancaster.unl.edu/enviro/pest/resources/DustMites311.shtml

P. Vojta, S. Randels, J. Stout, M. Muilenbert, H. Burge, H. Lynn, H. Mitchell, G. O’Connor, and D. Zeldin, Environmental Health Perspectives, “Effects of Physical Interventions on House Dust Mite Allergen Levels in Carpet, Bed, and Upholstery Dust in Low-Income, Urban Homes,” 815-819 (August 2001) – http://ehp.niehs.nih.gov/docs/2001/109p815-819vojta/abstract.html

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Essential Maintenance Practices

The concept of “essential maintenance practices” (EMPs) was developed to deal with lead-based paint in older housing in recognition that “an ounce of prevention is worth a pound of cure.” While some homes need dedicated “lead abatement projects” by certified contractors, in most cases, hazards can be avoided in the first place through good maintenance and common sense safeguards. Some EMPs are specific to lead safety, such as avoiding paint removal practices that generate and spread dangerous lead dust. Others address conditions that can cause multiple problems. For example, water leaks, water damage, and excessive moisture can encourage the growth of mold, mildew, and pests, which can cause asthma and other health problems, in addition to causing paint to deteriorate. Periodic visual inspections can identify clues to and causes of water leaks and moisture problems so that low-cost repairs “nip problems in the bud.” The concept of “enlightened maintenance practices” is at the foundation of healthy homes. The EPA/HUD five-hour training course in lead-safe work practices (LSWP) offers a model for conveying practical information to existing trades and can benefit all those whose work encounters painted surfaces in older housing.

Essential Maintenance Practices to Reduce Lead Hazards

In 1995, a broad-based national task force chartered by Congress reached almost unanimous consensus on recommendations for controlling lead-based paint hazards in private housing. As part of its comprehensive recommendations, Putting the Pieces Together: Controlling Lead Hazards in the Nation’s Housing (July 1995), the Task Force on Lead-Based Paint Hazard Reduction and Financing called for six Essential Maintenance Practices by owners of pre-1978 rental properties that may contain lead-based paint. These Essential Maintenance Practices are relatively inexpensive initial steps property owners need to take to reduce the chances that hazards will develop, avoid the inadvertent creation of hazards, and provide an early warning system to alert owners to deteriorating paint.

It is important to understand that Essential Maintenance Practices are a “floor,” not a “ceiling,” as these practices were not designed to control lead hazards in units that are judged to be higher-risk based on their age or condition (e.g., construction before 1950, extensive deteriorated paint, deferred maintenance, etc.).

Essential Maintenance Practices for Property Owners

1. Use safe work practices during work that disturbs paint that may contain lead to avoid creating lead-based paint hazards. Do not use unsafe paint removal practices, including:

  • Open flame burning;
  • Power sanding or sandblasting (unless a special vacuum attachment is used to contain dust);
  • Water blasting; and
  • Dry scraping more than a de minimis surface area (for example, more than one square foot per room).

Use good work practices and take precautions to prevent the spread of lead dust (for example, limit access to the work area to workers only; cover the work area with six mil polyethylene plastic or equivalent; protect workers; protect occupants’ belongings by covering or removing them from the work area; wet painted surfaces before disturbing; and wet debris before sweeping).

Perform specialized cleaning of the work area upon completion of work using methods designed to remove lead-contaminated dust.

2. Perform visual examinations for deteriorating paint (unless the paint is found not to be LBP):

  • At unit turnover; and
  • Every 12 months (unless the tenant refuses entry).

3. Promptly and safely repair deteriorated paint and the cause of the deterioration. If more than a de minimis amount of paint (for example, more than one square foot per room) has deteriorated (unless the paint is found not to be LBP):

  • Follow Essential Maintenance Practice #1 (above) when repairing the surface.
  • Diagnose and correct any physical conditions causing the paint deterioration (for example, structural and moisture problems causing substrate failure or conditions causing painted surfaces to be crushed).
  • When there is extensive paint deterioration (for example, more than five square feet per room), the procedures for dust testing after Standard Treatments apply.

4. Provide generic LBP hazard information to tenants per Title X, including the EPA-developed educational pamphlet and any information available about LBP or LBP hazards specific to the unit.

5. Post written notice to tenants asking tenants to report deteriorating paint and informing them whom to contact. Promptly respond to tenants’ reports and correct deteriorating paint, with accelerated response in units occupied by a child under age six or a pregnant woman. In no case should owners take longer than 30 days to respond. Do not retaliate against tenants who report deteriorating paint.

6. Train maintenance staff. At a minimum, maintenance supervisors need to complete a training course based on the HUD/EPA operations and maintenance/interim control activities curriculum. The maintenance supervisor must ensure that workers either take the training course or have a clear understanding of LBP hazards, unsafe practices, occupant protection, and dust cleanup methods (by such means as on-the-job training and video instruction). The maintenance supervisor needs to provide adequate oversight of workers who have not taken the training course.

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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:

  • Indoor contaminants. These include chemicals used in the construction or renovation of buildings (e.g., glues, off-gassing from carpets, emissions from particle board, cleaning compounds). In addition, appliances that burn gas can produce particulates and carbon monoxide. Incomplete combustion and poor ventilation of these appliances (cook stoves, gas furnaces, gas boilers, and gas water heaters) can contribute to indoor contaminants. Gas cook tops should be used with fans that send exhaust outside. Gas-fired heating appliances should be sealed and power-vented systems installed to remove products of incomplete combustion. Wood-burning stoves can also create particulates and must be vented outside.
  • Outdoor contaminants. Outdoor particulates can be drawn inside when the heating or cooling system draws air into a home. Particulates and allergens found in outdoor air can be asthma triggers. Filtering incoming air for HVAC systems effectively filters particulates. Experts recommend using filters with a MERV 6-8, but higher MERV levels trap smaller particles and generally are more appropriate for those with allergies or where the indoor environment has a high concentration of mold spores, dust particles, or other allergens.

Two types of ventilation can help control harmful air contaminants and humidity: spot ventilation and dilution ventilation. Spot ventilation draws air from a particular location (e.g., bathroom, kitchen) and exhausts it to the outside. Dilution ventilation address low-level contamination throughout the home.

Spot Ventilation. Exterior exhaust fans should be installed in all bathrooms and kitchens. These fans remove humidity and carbon monoxide. The most effective fans are quiet and durable. Use fans that operate at one sone or less and exhaust to the outdoors. Fans equipped with timers or de-humidistat controls are useful to ensure the fans run for a sufficient period of time. A good rule of thumb is to run a bathroom fan for about 45 minutes after a shower.

Dilution Ventilation. Dilution ventilation addresses the entire living space. Air changes (exchanging indoor air with outdoor air) and air cleaning help determine the effectiveness of dilution. Air changes result from a combination of natural ventilation (infiltration; leakage; windows) and mechanical (controlled) ventilation. Air cleaning occurs when particulates are filtered and when air is dehumidified to remove moisture. The goal is to provide sufficient changes to ensure a healthy environment. There are several types of heating and cooling systems with filtration that can be installed to accomplish this. A common element necessary in all systems is duct sealing, particularly on the return side (side drawing in the air). The Air Conditioning Contractors Association (ACCA) provides guidance on duct sealing in its Manual D: Duct Design.

Sizing HVAC Systems

It is important not to oversize a system. Oversizing can contribute to poor air distribution and insufficient dehumidification, creating an environment that promotes mold growth. Oversized heating systems can “short cycle,” meaning that the system does not run long enough to turn the fan on for a sufficient period to distribute new air. Systems that short cycle during air conditioning will deliver cold air in short bursts but not necessarily dehumidify the air. The resulting cold, clammy environment can encourage mold growth. Some contractors oversize HVAC systems to compensate for duct leakage and to minimize complaints about heating or cooling delivery. The ACCA provides guidance on system sizing in its Manual J.

HVAC Systems Can Contribute to Air Quality Problems

HVAC systems can also exacerbate indoor air quality problems. The HVAC system may be contaminated (because of mold in duct lining or bacteria on coil or filters, for example), and the system may spread these pollutants throughout the home. Second, the HVAC duct distribution system can spread pollutants from one portion of the home to another. Regular maintenance and duct sealing can help minimize these problems.

Sources and Additional Information:

Air Conditioning Contractors Association (ACCA) – www.acca.org

American Society of Heating and Refrigerating and Air Conditioning Engineers, Inc – www.ashrae.org

Building Science Corporation – www.buildingscience.com/resources/mechanical/default.htm

Home Energy Magazine – http://homeenergy.org

Minnesota State Regulations – Ventilation – http://www.revisor.leg.state.mn.us/arule/7672/1000.html

Washington State Regulations – Ventilation – www.doh.wa.gov/hsqa/fsl/CRS/resources.htm

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Cockroaches

Cockroaches in homes are a health hazard to many children and families because of the risks cockroach antigens pose to asthma sufferers. Traditionally, cockroaches were controlled because they are offensive, leave behind an awful smell, and cause gastrointestinal and respiratory illness. However, research shows that cockroach debris (old shells, saliva, body parts, and droppings) triggers asthma attacks in people who are sensitized to cockroach antigen (proteins found in the debris). In homes where several allergens are present, including dust mites, mold, furry pets, tobacco smoke, and certain chemicals, children may experience severe and frequent asthma attacks from high airborne concentrations of these allergens.

Any home with food or moisture can have cockroaches. Kitchens and bathrooms typically have the highest number of cockroaches due to the presence of food products and moisture from plumbing fixtures. Apartment buildings often have the worst infestations. The goal is to keep cockroaches out of the home and to eliminate existing pests. Reaching this goal is not always easy, especially in multi-unit housing that is already infested. For most apartment buildings, the landlord must take a building-wide approach to controlling these pests. Moreover, a coordinated effort by the landlord and all tenants is required to eliminate cockroaches.

Integrated pest management techniques that control cockroaches through moisture control and other interventions can also help to minimize exposure to other environmental hazards, including lead and mold. Moisture from leaky roofs, plumbing fixtures, spills, damp areas in the kitchen and bathroom, and other sources should be minimized, along with access to food, accumulation of trash, and holes and cracks in the walls. Safe and effective pest management techniques must be utilized, as some chemicals used to treat pests are toxic, may exacerbate asthma symptoms, and are not successful at ridding homes of cockroaches.

Because children spend more time indoors, allergens found in homes and other buildings pose a significant health risk for asthma sufferers. With asthma rates growing at a startling rate, the hazard posed by the presence of any cockroaches must be addressed.

Sources and Additional Information:

Beyond Pesticides – Integrated pest management to control cockroaches – www.beyondpesticides.org/alternatives/factsheets/COCKROACH%20CONTROL.pdf and www.beyondpesticides.org/infoservices/pesticidesandyou/Winter%2001-02/Good%20Riddance%20to%20Roaches.pdf

Environmental Health Watch – www.ehw.org/Asthma/ASTH_Cockroach_Control.htm

National Institute of Environmental Health Sciences – www.niehs.nih.gov/airborne/prevent/roach.html

US Environmental Protection Agency – www.epa.gov/iaq/asthma/pests.html

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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

The main indoor cause of carbon monoxide poisoning are combustion appliances (those which burn fuels for warmth, cooking, or decorative purposes), such as furnaces, space heaters, gas ranges, gas water heaters, and fireplaces. The most serious effects of carbon monoxide in the home occur in the winter when homes are closed up more tightly. If combustion appliances are used properly and are well maintained, the amount of carbon monoxide produced is not usually hazardous to human health. However, if appliances are used incorrectly or vented improperly, the levels of carbon monoxide indoors can become dangerous.

Vented appliances are designed to be used with a pipe, chimney, duct, or other device that sends the pollutants outside the home. If a vent is blocked, leaking, or improperly installed, the appliance can release a large amount of combustion pollutants, including carbon monoxide, directly into the home. Unvented appliances do not have a pipe, chimney, or other duct to carry the pollutants outside the home, and therefore disperse carbon monoxide and other pollutants throughout the home.

Other sources of indoor carbon monoxide include: cars in attached garages, especially when the engine is being warmed up; gas stoves (with a flame that burns yellow); furnaces with cracked heat exchangers or leaking chimneys that leak gases into the ventilation system; house fires; and non-electric space heaters used indoors without enough fresh air. Outdoor sources of carbon monoxide include vehicle exhaust, industrial processes, and fuel combustion in incinerators and boilers.

Reducing Exposure to Carbon Monoxide

Properly selecting, installing, inspecting, and maintaining appliances in the home can reduce the risk of exposure to dangerous levels of carbon monoxide. Good ventilation in the home is also critical to preventing hazardous levels of carbon monoxide. Because carbon monoxide is impossible to see or smell, a carbon monoxide detector or alarm is the only way to determine one’s exposure.

Sources and Additional Information:

American Lung Association – Carbon Monoxide, February 2000 – www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35370

American Lung Association – Carbon Monoxide Fact Sheet, May 2004- www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35375

American National Standards Institute (ANSI), American Society of Heating, Refrigeration, and Air-Conditioning Engineers (ASHRAE), Ventilation for Acceptable Indoor Air Quality, Standard 62-2001, ISSN 1041-2336

Canada Department of National Health and Welfare – Exposure Guidelines for Residential Indoor Air Quality, Ottawa. April 1987.

Consumer Product Safety Commission – Carbon Monoxide Detectors Can Save Lives, Document #5010 – www.cpsc.gov/cpscpub/pubs/5010.html

Consumer Product Safety Commission – Carbon Monoxide Questions and Answers, Document #466 – www.cpsc.gov/cpscpub/pubs/466.html

Consumer Product Safety Commission – Non-Fire Carbon Monoxide Deaths and Injuries Associated with the Use of Consumer Products, Annual Estimates, October 2000 – www.cpsc.gov/LIBRARY/co00.pdf

Consumer Product Safety Commission, U.S. Environmental Protection Agency, and American Lung Association – What You Should Know About Combustion Appliances and Indoor Air Pollution, Document #452 – www.epa.gov/iaq/pubs/combust.html

Drs. Thom, Penn, Ischiropoulos, and Xu, University of Pennsylvania Medical Center – New Mechanism To Explain Carbon Monoxide Poisoning Identified, September 27, 1997 – www.sciencedaily.com/releases/1997/09/970927111303.htm

US Centers for Disease Control and Prevention – Carbon Monoxide Fact Sheet – www.cdc.gov/co/faqs.htm

US Environmental Protection Agency – Sources of Indoor Air Pollution, Carbon Monoxide, February 2003 – www.epa.gov/iaq/co.html

World Health Organization, Report on a WHO meeting, August 21-24, 1984, Indoor Air Quality Research. EURO Reports and Studies 103, Regional Office for Europe, Copenhagen, Denmark, 1986

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Asbestos

Asbestos is the general name used to describe several types of fibrous minerals. These minerals occur naturally and have been mined since the late 1800s for use in modern commercial industries. As asbestos fibers are strong, heat resistant, chemical resistant, and useful in providing heat insulation, their most common uses include addition to building products, insulation materials, and products intended for use in high friction areas (e.g. vehicle brake parts). Although there are six types of asbestos, the most common type found in buildings is chrysotile, also known as white asbestos. The US Environmental Protection Agency (EPA) estimates that approximately 90-95 percent of all asbestos contained in buildings throughout the United States is chrysotile.Asbestos is a known carcinogen, and inhalation of asbestos fibers is known to cause respiratory problems and lung diseases such as asbestosis, mesothelioma, and lung cancer. Asbestosis is a lung disease in which inhaled fibers become stuck in the lung tissue, eventually causing scarring. Mesothelioma is a cancer of the membranes lining the chest and lung cavity and/or the abdominal cavity. Lung cancer is cancer of the lung tissue itself. A combination of smoking and asbestos exposure is known to greatly increase an individual’s risk of lung cancer. All three of these diseases experience delayed development and the diseases may not manifest for 10-40 years after the initial asbestos exposure. Further, there is some indication that exposure to asbestos through inhalation and possibly ingestion may also be related to other cancers of the respiratory and gastrointestinal tracts. For information on other cancer risks in the home environment, please see Cancer Risks.

In the home environment, asbestos can be found in numerous locations. Some of the most common areas are floor and ceiling tiles, plasters, insulations, adhesives, wallboard, joint compound, roofing materials, fireproofing materials, and cement products. Asbestos materials in the piping that transports drinking water can also be another source of exposure. Asbestos that is intact, undisturbed, and in overall good condition does not necessarily pose a problem to human health. Deterioration and damage releases fibers into the air. Asbestos fibers can enter the home environment as a result of infiltration of airborne asbestos from mines or factories; improper renovation or demolition of a building containing asbestos; and dust brought home on the skin or clothing of individuals exposed at work.

The federal government recognizes asbestos as a health hazard and treats asbestos as a regulated substance. However, the use of asbestos is not banned. Various voluntary agreements have been reached with manufacturers to eliminate the use of asbestos in some materials (i.e. crayons and liners for hand-held hairdryers). Additionally, the Consumer Product Safety Commission (CPSC) enacted a policy in 1986 which required the labeling of all consumer products that contain intentionally added asbestos and are likely to release fibers under reasonable conditions of handling and use. In 1989, EPA established a ban on all new uses of asbestos but allowed for the continuation of uses established before this date. The majority of this ban was stopped from taking effect by a 1991 ruling from the U.S. Court of Appeals. Today, EPA encourages people to inquire about the presence of asbestos in a product from its dealers, suppliers, and manufacturers and suggests laboratory testing in some instances.

It is not possible to unquestionably determine if a material contains asbestos without performing laboratory tests. However, materials labeled as containing asbestos and materials suspected as such should be monitored in the home to prevent potential exposure. In general, if the known or suspected asbestos-containing material is in good condition, it is usually best to leave it alone. The material should be checked regularly for signs of deterioration and/or damage without disturbing it. A professional is needed to remove or repair asbestos-containing materials that are damaged or will be disturbed during a home improvement project.

Sources and Additional Information:

Agency for Toxic Substances and Disease Registry (ATSDR) – ToxFAQ for Asbestos – www.atsdr.cdc.gov/tfacts61.html

American Lung Association – www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35368

CPSC, EPA, and American Lung Association – Asbestos in the Home – www.cpsc.gov/cpscpub/pubs/453.html

Environmental Protection Agency – www.epa.gov/asbestos

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