1. HIPPY for Healthy Homes Project Partners: Alesia Ferguson. Ilias Kavouras, Desiree Burroughsray UAMS College of Public Health, Barbara Gilkey of HIPPY Sponsored by Environmental Protection Agency

2. Delivery Pre-Survey:

3. Outline Pre-survey: Everyone Grant description: Dr. Ferguson Indoor contaminants: Dr. Ferguson – Chemical Hazards Found in Homes: Carbon Monoxide – Biological Hazards Found in Homes: Mold – Physical-Natural Hazards Found in Homes: Radon Ventilation: Dr. Kavouras Fun Exercise-Desiree Burroughsray – What you recall – What’s your opinion – Give us your email, respond to online survey – Arrange training in your region

4. Health effects of an unhealthy home Sickness (varies) Allergies Asthma (15% of children mostly non-Hispanic Blacks) Respiratory illnesses CO poisoning Cancer Gastrointestinal diseases Fatigue

5. Causes and Triggers for Asthma Development of asthmaAsthma “attacks” House dust mites Second(third)-hand tobacco smoke Cockroaches Respiratory Syncytial Virus House dust mites Second(third)-hand tobacco smoke Cockroaches Pets (cats and dogs) Air pollution Fungi and molds Rhinovirus Formaldehyde Fragnances Domestic birds RSV and “pneumoniae” bacteria Clearing the Air: Asthma and Indoor Air Exposures, Institute of Medicine of National Academy of Sciences, 2000, ISBN: 0-309-51861-X; Available online: https://download.nap.edu/catalog.php?record_id=9610https://download.nap.edu/catalog.php?record_id=9610

6. 2011 American Housing Survey Study Out of 131 million units, 81 million built before 1979 (median age:1974) Median sq. footage, 1700 85 million units have central heating 50 million use gas stoves 9 million units say primary source of water is not safe to drink 1.5 million units lacking some or all plumbing facilities 2 million units with severe physical problems (plumbing, heating, electric, upkeep) (4 million moderate Sponsored by HUD and the US Census Bureau

7. Housing Survey Data, in 1000’s Deficiencies NortheastMidwestSouthWest Total (per million units) 21,06625,68242,58425,575 Signs of rats in last 12 months 16178558374 Signs of mice in last 12 months 3,8093,0813,9171,937 Signs of rodents, not sure which kind in last 12 months 8379379153 Signs of cockroaches in last 12 months 1,4457818,3532,578 Holes in floors 273208500192 Open cracks or holes (interior) 1,2851,2522,2871,125 Broken plaster or peeling paint (interior) 629536764440 No electrical wiring 40237622 Exposed wiring 302402694422 Rooms without electric outlets 158132322153

8. Grant objectives Build capacity in the state for education and health protection from hazards in the home. Development of materials for parents and children Training of HIPPY coordinators and home-based outreach educators in 6 regions of the State Address specific hazards of radon, mold and carbon monoxide safety Address other factors in the home that contribute to asthma and other respiratory illnesses Provide simple methods and links to resources to address these hazards

9. ActivitiesFall 2012 Winter 2012 Spring 2013 Sum. 2013 Fall 2013 Winter 2013 Spring 2014 Sum. 2014 Compilation of learning materials, creating of workshop program for coordinators, home- based educators and parents xxx Contribution to resource bookletxxxxxx Workshop and discussion of healthy program with HIPPY coordinators (potential 47) at State conference x X Workshops for home based educators and delivery of pre-post assessments (potential 246) at State conference X x Analysis of pre and post assessments from home-based educators, coordinators and parents Xxxxxx Parent Workshops and Meeting Across State xxxxxxX Communication with Other children programs (share ideas and materials) xx Report of Activities x x x x Grant timeline

10. Objectives  Biological Hazards Found in Homes  Mold  Chemical Hazards Found in Homes  Carbon Monoxide  Physical Hazards Found in Homes  Radon  Ventilation

11. Biologic Pollutants/Hazards Cockroaches House Dust Mites Other Insects Pets Plants Human skin (highest source of bacteria) Mold/Fungi Toxins and Irritants

12. Mold Mold is found in the natural environment: breaks down dead organic matter. Mold reproduces using spores: found in both indoor and outdoor air. In order to survive spores need a surface that has water and a food source. Mold is an immediate problem when it overgrows in the indoor environment.

13. Roof leak Mold on crawl space ceiling

14. Mold - Why Today? Always outside “ background ” levels of mold Excessive Building Tightness? – (reduced infiltration, reduced ventilation) Poor construction practices Improper use of building materials More media and public awareness High rates of asthma and allergies

15. Spores (concentration), fragments, proteins Mycotoxins Microbial volatile organic compounds People can react if mold is living or dead Health Effects – People React to:

16. Chemical Pollutants Carbon Monoxide Pesticides Cigarette smoke Lead-Based Paint in old Home Ozone Volatiles (e.g., formaldehyde, sulfides) – From paints, varnishes, waxes, cleaning, disinfecting, degreasing, and hobby products, dry cleaning clothes – Pressed wood products (check ANSI approved products, get laminated or coated ) – Avoid UF glues, lumber or metal

17. Carbon Monoxide Leads to over 500 deaths each year Is released by combustion appliances, cars, and cigarettes Is odorless, colorless, and tasteless Prevents a person’s blood from delivering oxygen to tissue and organs Is often released in high levels unvented space heaters, improperly functioning gas ranges, leaky wood stoves, and back-drafting vented space heaters and furnaces

18. Carbon Monoxide Exposure p. 9 Trainee Resource Book Source: SE Field Guide

19. Carbon Monoxide – Different organizations publish varying maximum exposure limits for CO: OSHA = no more than 50 ppm for 1 hour NIOSH = no more than 35 ppm for 1 hour The U.S. National Ambient Air Quality Standards for CO = 9 ppm for 8 hours and 35 ppm for 1 hour The Consumer Product Safety Commission = levels not to exceed 15 ppm for 1 hour or 25 ppm for 8 hours – Most CO detectors go off when CO levels reach 70 ppm

20. Preventing Carbon Monoxide Poisoning Have gas appliances professionally installed, vented outside, and checked annually for carbon monoxide leaks. Run cars and trucks only outside the garage and away from any openings into the house to prevent carbon monoxide poisoning Never run lawnmowers and other combustion devices inside the garage or near any windows Don ’ t use a gas range or oven for heating because CO can build up quickly inside a home Put carbon monoxide monitors near bedroom(s) and low to the ground

21. Radon Radon is a gas from the earth that can get in through floors and basements, water supply. Cannot see it or smell it. Dust particles are involved Causes cancer, especially in smokers Level between 2-4- pCi/L (picocuries of radon per liter), take some simple steps If levels are above the U.S. Environmental Protection Agency action level 4 pCi/L, install a radon mitigation system, from simple to more complex

23. Controlling Radon We are likely to have low levels here-varies Test your home for radon gas (Home-depot $25- include send off) Mitigation – vapor barrier in crawl space – sealing cracks and leaks (lower level), – house pressurization, soil suction, ventilator – Costs $100 to $10,000 Test your home for radon gas

24. Radon Mitigation

25. Ventilation Open windows in the morning (cool air) (Natural) Air pollution, safety and 1970’s energy crisis – Closed windows, tight buildings/homes Warmer climate and markets promoted mechanical ventilation (A/C) (Mechanical or forced) Ventilation is the process of replacing air to provide high indoor air quality (i.e. replenish oxygen, remove moisture and contaminants).

26. Ventilation today Existing home A/C units “refresh” and circulate existing indoor air using a “filter” to remove air contaminants Easily maintained T and humidity levels Insufficient removal of contaminants Home contaminant levels may be higher than outdoor levels The “cleaning” efficiency of filters depends on their quality and regular replacement and more importantly, they do not remove gases.

27. Steps to improve ventilation If A/C is regularly usedIf A/C is not regularly used Keep a “normal” temperature (winter: 66-70; summer: 80-86). Use high quality filters, inspect and replace them. Open windows for 1-2 hrs/day (in the morning or evening) Open multiple windows for 1-2 hrs/day (in the morning or evening) (screens on windows may be used) Use fans to move air in the home. May use de-humidifiers in humid days Air purifiers (check before you use) Perform regular maintenance and performance testing of the A/C system Perform a thorough home evaluation and fix leaks Perform a thorough home evaluation and improve natural ventilation efficiency

29. Questions?

30. Fun Activities and Post Survey Information – What you recall – What’s your opinion – Give us your email, complete post survey – Arrange training in your region for coordinators and home based educators

31. Fun Activity Microstructures & Designs (small groups -> large groups) Scenario #1 Divide the group into 5 large groups based on each pamphlet/brochure that will be given to families (Healthy Homes, Allergies and Asthma, Mold, Radon and Carbon Monoxide). Have individuals work in pairs from a prompt (What can you do to make a home healthy?) brainstorming ideas for how home based educators can help create a healthier home. What would be the best methods/approaches for engaging families? (5 min) Then have the 5 large groups re-form and discuss their ideas. Each group will present 3 of their best ideas to the large group (5-10min).

32. Second Fun Activity Microstructures & Designs (small groups -> large groups) Scenario#2 Divide the group into 5 large groups based on pamphlet/brochure that will be given to families (Healthy Homes, Allergies and Asthma, Mold, Radon, and Carbon Monoxide). Have individuals work in pairs from a prompt (What are problems you have seen visiting homes? What do you think could be done to make a home healthy?) brainstorming ideas regarding needs that they have identified in the homes they visit. Then have the 5 large groups re-form and discuss their ideas. Are any of the groups ideas included in the tips section of the brochure? Each group will present 3 problems w/ solutions to the large group (5-10min).