Creating and Maintaining Healthy Home Environments

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1 Creating and Maintaining Healthy Home Environments Jacquelyn Menghrajani, MPH, CPH Region 9 Children's Environmental Health Coordinator Mariela Lopez, MPH Region 9 Asthma Coordinator

The connection between health and dwelling is one of the

- Florence Nightingale A healthy home is a home sited,

2 The connection between health and dwelling is one of the most important that exists. - Florence Nightingale A healthy home is a home sited, designed, built, maintained, and renovated in ways that support the health of its residents. - The Surgeon General s Call to Action to Promote Healthy Homes, 2009 Images source: U.S. Department of Health and Human Services, The Surgeon General s Call to Action to Promote Healthy Homes. Office of the Surgeon General.

3 Overview Children s vulnerability to environmental hazards Asthma Healthy Homes Overview Keep It Ventilated Keep It Pest-Free Keep It Safe Keep It Contaminant-Free Resources

4 4 Learning Objectives Name at least two Principles of Health Housing and actions that can be taken to implement them. Describe at least two ways to prevent exposure to lead and environmental asthma triggers.

5 Why Children are Vulnerable to Environmental Hazards

Children are NOT little adults Children are often

adults because of: Unique activity patterns and

Windows of susceptibility during early life stages.

6 Children are NOT little adults Children are often more vulnerable to environmental hazards than adults because of: Unique activity patterns and behaviors. Windows of susceptibility during early life stages. Physiological differences. Children also depend on adults to ensure that their environment is safe. 6

7 Environments Influence Outcomes Educational, social, and financial impacts Increased risk of adverse health outcomes Environmental exposures 7

8 Asthma 101 Mariela Lopez, Regional Asthma Coordinator Air Toxics, Radiation, and Indoor Air Office (ATRIA)

9 Asthma Burden in the U.S. Cost of Asthma Nationwide: $56 Billion Annually

10 Poor and Minority Children Have a Greater Asthma Burden

11 What does the Region 9 Asthma Program Do? Develop partnerships Build capacity through outreach, training, and education Provide technical assistance Collaborate with other EPA programs Creating and Promoting Healthier Environments for Asthmatics Conduct regional research projects

13 EPA is not in this Alone EPA works with HUD and CDC to eliminate the disparities of asthma.

14 Asthma Straw Challenge 1. Grab Straw 2. Seal lips around straw 3. Hold your nose 4. Only breathe through the straw

15 Asthma Myths People with asthma should not exercise You ll outgrow asthma Rescue medicine will cure asthma Asthma is easy to diagnose/treat ALL asthma is the same

16 What is Asthma?

17 Definition Asthma (AZ-ma) is a chronic (longterm) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.

18 What makes asthma symptoms worse or causes an attack?

19 Environmental Triggers Triggers are things in the environment (indoor and outdoor) that can cause asthma symptoms, cause an episode or attack, or just make asthma worse ALLERGEN IRRITANT Will affect people that are allergic to a specific thing(s) Will affect everyone at a certain dose

20 Examples of Triggers Combustion by Products: Particles and gases that are formed when fuel is burned. Where do we find these? Gas cooking appliances, fireplaces, woodstoves, candles, incense, and unvented kerosene and gas space heaters.

21 Examples of Triggers Pests Cockroaches Body parts and droppings. Rodents Fur, skin flakes, and urine Where do we find these? Areas with food and water such as kitchens, bathrooms, and basements.

22 Examples of Triggers Pets with fur: Fur, skin flakes, and saliva. Where do we find these? Throughout entire home

Examples of Triggers Dust Mites Body parts and

Dust mites are too small to be seen with the

23 Examples of Triggers Dust Mites Body parts and droppings. Where do we find these? Mattresses, bedding, carpeting, curtains, upholstered furniture, and stuffed toys. Dust mites are too small to be seen with the naked eye. They can survive in a range of climates, but they prefer high humidity.

24 Examples of Triggers Secondhand Smoke Mix of smoke from the burning end of a cigarette, pipe or cigar and the smoke exhaled by a smoker Where do we find these? Anywhere smoking is allowed

25 Examples of Triggers Mold Mold growth, including spores and odors. Where do we find these? Often found in areas with more moisture such as kitchens, bathrooms, and basements. There are many types of mold and they can be found in any climate.

26 Examples of Triggers Volatile Organic Compounds (VOCs) Chemical vapors that come from household items. Where do we find these? Products such as cleaning agents, deodorizers, air fresheners, perfumes, paints, nail polish, and nail polish remover.

27 What can we do? 1. Talk to your doctor 2. Get an Asthma Action Plan 3. Reduce Exposure to Triggers: Control animal allergens. Don t let kids sleep with stuffed toys and wash toys in HOT water 1X per week. Control pest allergens. Clean up mold and control moisture. Control sources of indoor air pollutants. Reduce exposure to dust mites. Reduce use of harsh chemicals.

28 Healthy Homes Overview

29 What is Healthy Homes? A holistic approach to addressing health and safety hazards in homes. Mold Allergens Indoor Air Pollution Lead Carbon monoxide Pesticides Radon Home safety

30 Keep It Dry Keep It Well-Ventilated Keep It Thermally Controlled Keep It Pest-Free Keep It Safe Keep It Contaminant- Free Keep it Maintained Keep It Clean

31 Keep It Ventilated

32 Why do we need proper ventilation? Proper ventilation plays an important role in health. If we do not ventilate, then we can see higher rates of: Common Colds Flu Pnuemonia Bronchitis (which can all lead to missed school and work days) Necessary to remove humidity and dilute or remove contaminants Local exhaust ventilation (cook tops/bathrooms) remove contaminants from point sources

33 Keep It Pest-Free Use Integrated Pest Management Practices

34 Why Keep It Pest-Free? Pests, their dander, and their excrement function as allergens that can trigger asthma. Adverse health effects of pesticide exposure may range from mild symptoms to more serious health conditions depending on the pesticide and amount and frequency of exposure. Acute exposure to pesticides may lead to short-term effects Headaches Dizziness Muscle twitching Weakness Tingling sensations Nausea Long-term exposure to pesticides may lead to serious health effects Birth defects Learning disabilities Behavioral changes Organ damage Cancer Asthma symptoms 34

Tips to Prevent Pest Problems Keep pests out by eliminating entry points. Remove food and water. Keep food in sealed containers. Keep kitchen and dining areas clean.

35 Tips to Prevent Pest Problems Keep pests out by eliminating entry points. Remove food and water. Keep food in sealed containers. Keep kitchen and dining areas clean. Keep lids on waste bins. Fix and prevent leaks. Eliminate clutter. Monitor for pests. Treat existing pest problems

Tips to Address Pest Problems Preventing pest problems is best! Try non-chemical methods first. If pesticides are needed to address a pest problem: Choose the least toxic pesticide available.

36 Tips to Address Pest Problems Preventing pest problems is best! Try non-chemical methods first. If pesticides are needed to address a pest problem: Choose the least toxic pesticide available. Use baits or crack/crevice treatments instead of spray, if possible. Read and follow directions on the label carefully. Keep children and pets away from areas where pesticides are being applied and store out of their reach. Keep pesticides in original containers. Never use outdoor pesticides indoors. Never use illegal pesticides, such as tres pasitos. 36

37 Keep It Contaminant-Free

38 Common Environmental Hazards Found in Homes Radon Asbestos Volatile Organic Compounds Carbon Monoxide Lead Mercury Pesticides

39 Common Environmental Hazards Found in Homes Radon Asbestos Volatile Organic Compounds Carbon Monoxide Lead Mercury Pesticides

40 Why Keep It Contaminant Free? Volatile organic compounds (VOCs) can be found in many household products, such as cleaners, air fresheners, paint, and wood polish. VOCs can result in various health effects, such as headaches, dizziness, fatigue, and irritation. Some VOCs can increase the risk of cancer.

difficulties, lower intelligence, hyperactivity, and hearing problems.

41 Why Keep It Contaminant Free? Lead is a very toxic metal that has been used in lead-based paint, old water pipes and plumbing fixtures, and other products. Low levels of lead in the blood of children may result in behavioral problems, learning difficulties, lower intelligence, hyperactivity, and hearing problems. Exposure to lead during pregnancy can increase the risk of miscarriage, cause a baby to be born too early or too small, and harm the developing brain, kidneys, and nervous system.

Why Keep It Contaminant Free? Carbon monoxide (CO) is produced when fuel is burned in cars, trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces.

42 Why Keep It Contaminant Free? Carbon monoxide (CO) is produced when fuel is burned in cars, trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces. CO is an odorless, colorless, and toxic gas that can cause: Fatigue Confusion Headaches Nausea Death at very high levels

consumer products such as batteries, light bulbs, thermometers, and skin

Mercury can harm the brain, heart, kidneys, lungs, and immune system of

43 Why Keep It Contaminant Free? Mercury is very toxic and can be found in contaminated fish and shellfish and consumer products such as batteries, light bulbs, thermometers, and skin lightening creams. Mercury can harm the brain, heart, kidneys, lungs, and immune system of people of all ages. Exposure during pregnancy can harm the developing nervous system affecting a child s ability to think and learn

Tips to Keep It Contaminant-Free Cleaning and Other Household Products Consider purchasing and using less toxic household products. Increase ventilation when using products that emit VOCs.

44 Tips to Keep It Contaminant-Free Cleaning and Other Household Products Consider purchasing and using less toxic household products. Increase ventilation when using products that emit VOCs. Use household products according to manufacturer's directions. Buy in quantities that you will use. Keep children and pets away when using products that emit VOCs and store out of reach.

Tips to Keep It Contaminant-Free Cleaning and Maintenance Clean and dust regularly using wet cleaning techniques. Use a vacuum with a HEPA filter.

45 Tips to Keep It Contaminant-Free Cleaning and Maintenance Clean and dust regularly using wet cleaning techniques. Use a vacuum with a HEPA filter. Have a trained professional inspect, clean and tune-up central heating system (furnaces, flues and chimneys) annually. Repair any leaks promptly. Install CO detectors and check them according to manufacturer s directions. Properly dispose of mercury-containing products and use EPA or ATSDR tips to clean up mercury spills carefully. Maintain HVAC system and change filters regularly

46 Tips to Keep It Contaminant-Free Consumer Products Avoid cooking or storing food and

purposes. Do no use remedies that often contain lead, such as greta and azarcon.

Do not let children put jewelry, charms, or metal items in their mouths.

46 46 Tips to Keep It Contaminant-Free Consumer Products Avoid cooking or storing food and liquids in lead crystal, lead-glazed pottery or porcelain, and products made for decorative purposes. Do no use remedies that often contain lead, such as greta and azarcon. Do not use personal care products that may contain lead or mercury. Do not let children put jewelry, charms, or metal items in their mouths. Regularly check the Consumer Product Safety Commission Recall List: Regularly check the FDA recall list:

Check and maintain all painted surfaces (inside and outside) to prevent paint

47 47 Tips to Keep It Contaminant-Free Cleaning and Maintenance If your home was built before 1978: Be aware of lead-based paint and lead dust. Check and maintain all painted surfaces (inside and outside) to prevent paint deterioration. Hire a Lead-Safe Certified contractor for renovations. Do not let children chew window sills.

48 Tips to Keep It Contaminant-Free Drinking Water Use only cold water for drinking, cooking, and making infant formula. If you suspect lead or other contaminants may be in your water, use filtered water or bottled water for drinking, cooking, and making infant formula. Also, have your water tested. Questions? Contact your water purveyor, local health department or the EPA Safe Drinking Water Hotline ( ).

Tips to Keep It Contaminant-Free Hobbies and

49 Tips to Keep It Contaminant-Free Hobbies and Jobs Shower and change clothes before entering your vehicle or coming home. Launder work and hobby clothes separately from the rest of your family's clothes. Keep all work and hobby materials away from living areas. Keep shoes outside. 49

Additional Tips Remove all shoes or wipe off shoes before entering.

Ensure a healthy diet high in iron, calcium, and vitamin C.

50 Additional Tips Remove all shoes or wipe off shoes before entering. Wash children's hands often, especially before eating and sleeping, and after playing outside. Wash children s bottles, pacifiers, toys, and stuffed animals often. Ensure a healthy diet high in iron, calcium, and vitamin C. Avoid eating seafood that has high levels of mercury or other contaminants. Keep children from eating soil. Be aware of nearby industrial or clean up activities. 50

51 Keep It Safe

52 Safety Issues Falls Poisonings Drownings Choking/ Suffocation Firearm accidents 52

53 Prevent injuries and accidental poisonings Good lighting prevent trips and falls Use railing in stairways Install grab bars in showers if necessary Ensure rugs are not loose Install CO and fire detectors Never use diesel generators indoors Always keep medications and household chemicals away from children s reach Always keep pesticides and cleaners in original containers and use as directed Only buy what you need to avoid having unnecessary chemicals in the home Secure tall bookcases and shelves to walls to avoid accidents (if children climb on them or if there is an earthquake) 53

Follow labels and instructions carefully when using pesticides or other chemicals.

54 Tips to Keep It Safe Keep medications and household chemicals away from children s reach. Use childproof locks on cabinets. Do not leave medications and household chemicals lying around the home. Keep pesticides and cleaners in original containers. Follow labels and instructions carefully when using pesticides or other chemicals. Keep children and pets away from areas where pesticides and chemicals are being used. Only buy what you need to avoid having unnecessary chemicals in the home. 54

55 Resources and Wrap Up Technical Assistance Educational Materials Seminars 55

56 Childhood Lead Poisoning Prevention Programs Asthma Programs Healthy Homes Programs IPM Programs State and Local Health and Environmental Agencies

57 57 U.S. Department of Housing and Urban Development Healthy Homes App

U.S. Environmental Protection Agency www.epa.

58 U.S. Environmental Protection Agency

59 U.S. Environmental Protection Agency

60 Centers for Disease Control and Prevention (CDC) 60

61 National Pesticide Information Center Website: npic.orst.edu Phone number:

62 U.S. EPA Safer Choice Program 62

63 National Lead Information Center Safe Drinking Water Hotline U.S. Environmental Protection Agency 63

64 U.S. Food and Drug Administration 64

65 Consumer Product Safety Commission

FDA/EPA Fish Advice and Local Fish Advisories oehha.ca.gov/fish/advisories www.

66 FDA/EPA Fish Advice and Local Fish Advisories oehha.ca.gov/fish/advisories 66

67 California Poison Control Center 67

Network of health professionals with children s environmental health expertise Provide training and

68 Pediatric Environmental Health Specialty Units (PEHSU) Jointly supported by the EPA and ATSDR for more than 15 years. Network of health professionals with children s environmental health expertise Provide training and serve as a resource to physicians, parents, and others with questions about children s symptoms that may be related to environmental exposures Western States PEHSU wspehsu.ucsf.edu 68

69 THANK YOU! Jacquelyn Menghrajani Mariela Lopez

ADVANCING THE CONVERSATION ON HEALTHY HOMES

ADVANCING THE CONVERSATION ON HEALTHY HOMES Mariela Lopez, MPH Regional Asthma Coordinator Jacquelyn Menghrajani, MPH, CPH Regional Children's Environmental Health Coordinator Overview Why are we here?