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Chu MT, Fenelon A, Rodriguez J, Zota AR, Adamkiewicz G. Development of a multidimensional housing and environmental quality index (HEQI): application to the American Housing Survey. Environ Health 2022; 21:56. [PMID: 35606753 PMCID: PMC9128206 DOI: 10.1186/s12940-022-00866-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/11/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Substandard housing conditions and hazardous indoor environmental exposures contribute to significant morbidity and mortality worldwide. Housing indices that capture the multiple dimensions of healthy housing are important for tracking conditions and identifying vulnerable households. However, most indices focus on physical deficiencies and repair costs and omit indoor environmental exposures, as few national data sources routinely collect this information. METHODS We developed a multidimensional Housing and Environmental Quality Index (HEQI) based on the World Health Organization's Housing and Health Guidelines and applied it to the 2019 American Housing Survey (AHS). The HEQI consisted of ten domains associated with poor health: household fuel combustion, dampness and mold, pests and allergens, lead paint risk, high indoor temperatures, low indoor temperatures, household crowding, injury hazards, inadequate water and sanitation, and ventilation. We evaluated the validity and performance of the HEQI against three housing characteristics (i.e., year built, monthly rent costs, unit satisfaction rating) and two established indices (i.e., Adequacy Index, Poor Quality Index). RESULTS Approximately 79% (92 million) of U.S. households reported at least one HEQI domain associated with poor health (mean per household: 1.3; range: 0,8). Prevalent domains included household fuel combustion (61.4%), dampness and mold (15.9%), inadequate water and sanitation (14.3%), and injury hazards (11.9%). Pests and allergens, low indoor temperatures, and injury hazards were consistently associated with older homes, lower rent costs, and lower unit satisfaction. Compared to established housing indices, the HEQI captured four new environmental domains which enabled the identification of 57.7 million (63%) more households with environmental risk factors like mold, cockroaches, crowding, household fuel combustion, and higher building leakage. CONCLUSIONS Indoor environmental exposures are prevalent in U.S. households and not well-captured by existing housing indices. The HEQI is a multidimensional tool that can be used to monitor indoor environmental exposures and housing quality trends in the U.S. Some domains, including radon, pesticides, asbestos, noise, and housing accessibility could not be assessed due to the lack of available data in the AHS. The mounting evidence linking residential environmental exposures with adverse health outcomes underscore the need for this data in the AHS and other national surveys.
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Affiliation(s)
- MyDzung T Chu
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Andrew Fenelon
- School of Public Policy and Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Judith Rodriguez
- Department of Architecture, Harvard University Graduate School of Design, Cambridge, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ami R Zota
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Gary Adamkiewicz
- Department of Architecture, Harvard University Graduate School of Design, Cambridge, MA, USA
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Fabian MP, Lee SK, Underhill LJ, Vermeer K, Adamkiewicz G, Levy JI. Modeling Environmental Tobacco Smoke (ETS) Infiltration in Low-Income Multifamily Housing before and after Building Energy Retrofits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030327. [PMID: 26999174 PMCID: PMC4808990 DOI: 10.3390/ijerph13030327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
Secondhand exposure to environmental tobacco smoke (ETS) in multifamily housing remains a health concern despite strong recommendations to implement non-smoking policies. Multiple studies have documented exposure to ETS in non-smoking units located in buildings with smoking units. However, characterizing the magnitude of ETS infiltration or measuring the impact of building interventions or resident behavior on ETS is challenging due to the complexities of multifamily buildings, which include variable resident behaviors and complex airflows between numerous shared compartments (e.g., adjacent apartments, common hallways, elevators, heating, ventilating and air conditioning (HVAC) systems, stack effect). In this study, building simulation models were used to characterize changes in ETS infiltration in a low income, multifamily apartment building in Boston which underwent extensive building renovations targeting energy savings. Results suggest that exterior wall air sealing can lead to increases in ETS infiltration across apartments, while compartmentalization can reduce infiltration. The magnitude and direction of ETS infiltration depends on apartment characteristics, including construction (i.e., level and number of exterior walls), resident behavior (e.g., window opening, operation of localized exhaust fans), and seasonality. Although overall ETS concentrations and infiltration were reduced post energy-related building retrofits, these trends were not generalizable to all building units. Whole building smoke-free policies are the best approach to eliminate exposure to ETS in multifamily housing.
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Affiliation(s)
- Maria Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
| | - Sharon Kitman Lee
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
| | - Lindsay Jean Underhill
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
| | - Kimberly Vermeer
- Urban Habitat Initiatives Inc., 328A Tremont Street, Boston, MA 02116, USA.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
| | - Jonathan Ian Levy
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
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Okoli CTC, Khara M. Correlates of secondhand tobacco smoke exposure among individuals with a history of substance use and/or psychiatric disorders participating in a tobacco treatment program in Vancouver, Canada. Community Ment Health J 2014; 50:729-36. [PMID: 24337583 DOI: 10.1007/s10597-013-9691-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 12/09/2013] [Indexed: 11/25/2022]
Abstract
Individuals with substance use (SUD) and/or psychiatric disorders (PD) are disproportionately affected by tobacco use; yet, little is known about secondhand tobacco smoke (SHS) exposure in these populations. An analysis of existing data examined SHS exposure among 497 smokers in community clinics in Vancouver, Canada. Seventy-percent of the participants reported SHS exposure. In sex-stratified multivariate logistic regression analyses correlates of SHS exposure among women were not having a history of using evidence-based smoking cessation treatment and using a single substance (as compared to a polysubstance use history); whereas among men, a history of a respiratory illness and higher nicotine dependence were associated with SHS exposure. Despite limitations about the measures of SHS exposure used in the study, these findings suggest a need to further determine the risks associated with SHS exposure and tobacco use among individuals with SUD and/or PD within mental health and addictions treatment settings.
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Affiliation(s)
- Chizimuzo T C Okoli
- University of Kentucky College of Nursing, 315 College of Nursing Building, Lexington, KY, 40536-0232, USA,
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Fabian MP, Stout NK, Adamkiewicz G, Geggel A, Ren C, Sandel M, Levy JI. The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model. Environ Health 2012; 11:66. [PMID: 22989068 PMCID: PMC3527278 DOI: 10.1186/1476-069x-11-66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 09/06/2012] [Indexed: 05/19/2023]
Abstract
BACKGROUND In the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date. METHODS We designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold. RESULTS Model design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates. CONCLUSIONS We describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.
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Affiliation(s)
- M Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Amelia Geggel
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Cizao Ren
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Megan Sandel
- Department of General Pediatrics, Boston Medical University School of Medicine, Boston, MA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
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Fabian P, Adamkiewicz G, Levy JI. Simulating indoor concentrations of NO(2) and PM(2.5) in multifamily housing for use in health-based intervention modeling. INDOOR AIR 2012; 22:12-23. [PMID: 21913994 PMCID: PMC3248980 DOI: 10.1111/j.1600-0668.2011.00742.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
UNLABELLED Residents of low-income multifamily housing can have elevated exposures to multiple environmental pollutants known to influence asthma. Simulation models can characterize the health implications of changing indoor concentrations, but quantifying the influence of interventions on concentrations is challenging given complex airflow and source characteristics. In this study, we simulated concentrations in a prototype multifamily building using CONTAM, a multizone airflow and contaminant transport program. Contaminants modeled included PM(2.5) and NO(2) , and parameters included stove use, presence and operability of exhaust fans, smoking, unit level, and building leakiness. We developed regression models to explain variability in CONTAM outputs for individual sources, in a manner that could be utilized in simulation modeling of health outcomes. To evaluate our models, we generated a database of 1000 simulated households with characteristics consistent with Boston public housing developments and residents and compared the predicted levels of NO(2) and PM(2.5) and their correlates with the literature. Our analyses demonstrated that CONTAM outputs could be readily explained by available parameters (R(2) between 0.89 and 0.98 across models), but that one-compartment box models would mischaracterize concentrations and source contributions. Our study quantifies the key drivers for indoor concentrations in multifamily housing and helps to identify opportunities for interventions. PRACTICAL IMPLICATIONS Many low-income urban asthmatics live in multifamily housing that may be amenable to ventilation-related interventions such as weatherization or air sealing, wall and ceiling hole repairs, and exhaust fan installation or repair, but such interventions must be designed carefully given their cost and their offsetting effects on energy savings as well as indoor and outdoor pollutants. We developed models to take into account the complex behavior of airflow patterns in multifamily buildings, which can be used to identify and evaluate environmental and non-environmental interventions targeting indoor air pollutants which can trigger asthma exacerbations.
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Affiliation(s)
- Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., T4W, Boston, MA 02118
- Department of Environmental Health, Harvard School of Public Health, 4 Floor Landmark Center West, 401 Park Drive, Boston, MA 02115
- Corresponding author, , Tel: 617-638-4731, FAX: 617-638-4857
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard School of Public Health, 4 Floor Landmark Center West, 401 Park Drive, Boston, MA 02115
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., T4W, Boston, MA 02118
- Department of Environmental Health, Harvard School of Public Health, 4 Floor Landmark Center West, 401 Park Drive, Boston, MA 02115
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Gentner NJ, Weber LP. Secondhand tobacco smoke, arterial stiffness, and altered circadian blood pressure patterns are associated with lung inflammation and oxidative stress in rats. Am J Physiol Heart Circ Physiol 2011; 302:H818-25. [PMID: 22140051 DOI: 10.1152/ajpheart.00852.2011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic smoking and secondhand tobacco smoke exposure are major risk factors for cardiovascular disease that are known to adversely alter the structural and mechanical properties of arteries. The objective of this study was to determine the effects of subchronic secondhand tobacco smoke exposure on circadian blood pressure patterns, arterial stiffness, and possible sources of oxidative stress in conscious, unsedated radiotelemetry-implanted rats. Pulse wave change in pressure over time (dP/dt) was used an indicator of arterial stiffness and was compared with both structural (wall thickness) and functional (nitric oxide production and bioactivity and endothelin-1 levels) features of the arterial wall. In addition, histology of lung, heart, and liver was examined as well as pulmonary and hepatic detoxifying enzyme activity (cytochrome P450, specifically CYP1A1). Subchronic secondhand tobacco smoke exposure altered the circadian pattern of heart rate and blood pressure, with a loss in the normal dipping pattern of blood pressure during sleep. Secondhand tobacco smoke exposure also increased pulse wave dP/dt in the absence of any structural modifications in the arterial wall. Furthermore, although nitric oxide production and endothelin-1 levels were not altered by secondhand tobacco smoke, there was increased inactivation of nitric oxide as indicated by peroxynitrite production. Increased lung neutrophils or pulmonary CYP1A1 may be responsible for the increase in oxidative stress in rats exposed to secondhand tobacco smoke. In turn, this may be related to the observed failure of blood pressure to dip during periods of sleep and a possible increase in arterial stiffness.
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Affiliation(s)
- Nicole J Gentner
- Toxicology Graduate Program, University of Saskatchewan, Saskatoon,Saskatchewan, Canada
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Zartarian VG, Schultz BD, Barzyk TM, Smuts M, Hammond DM, Medina-Vera M, Geller AM. The Environmental Protection Agency's Community-Focused Exposure and Risk Screening Tool (C-FERST) and its potential use for environmental justice efforts. Am J Public Health 2011; 101 Suppl 1:S286-94. [PMID: 22021316 DOI: 10.2105/ajph.2010.300087] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our primary objective was to provide higher quality, more accessible science to address challenges of characterizing local-scale exposures and risks for enhanced community-based assessments and environmental decision-making. METHODS After identifying community needs, priority environmental issues, and current tools, we designed and populated the Community-Focused Exposure and Risk Screening Tool (C-FERST) in collaboration with stakeholders, following a set of defined principles, and considered it in the context of environmental justice. RESULTS C-FERST is a geographic information system and resource access Web tool under development for supporting multimedia community assessments. Community-level exposure and risk research is being conducted to address specific local issues through case studies. CONCLUSIONS C-FERST can be applied to support environmental justice efforts. It incorporates research to develop community-level data and modeled estimates for priority environmental issues, and other relevant information identified by communities. Initial case studies are under way to refine and test the tool to expand its applicability and transferability. Opportunities exist for scientists to address the many research needs in characterizing local cumulative exposures and risks and for community partners to apply and refine C-FERST.
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Affiliation(s)
- Valerie G Zartarian
- Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC 27711, USA.
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