Abstract
This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs.
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References
The Doc4Kids Project. Not safe at home: How America's housing crisis threatens the health of its children. Boston Medical Center and Children's Hospital, Boston, MA, February 1998. Available at:http://www.bmc.org/program/doc4kids/index.html.url. Accessed October 29, 1999.
Lowry S: An introduction to housing and health.BMJ. 1989;299:1261–1262.
Kasl SV. Quality of the residential environment, health, and well-being.Bull NY Acad Med. 1990;66:479–490.
World Health Organization.Health Principals of Housing. Geneva: World Health Organization; 1989.
APHA Program Area Committee on Housing and Health, 1968. Basic health principles of housing and its environment.Am J Public Health. 1969;59:841–851.
Bureau of Census.American Housing Survey for the United States in 1995, Current Housing Reports H150/95RV. Washington, DC: US Department of Commerce; 1997. Available at:http://www.census.gov/prod/2/constr/h150/h15095rv.pdf.url. Accessed October 29, 1999.
Smith SJ. Health status and the housing system.Soc Sci Med. 1990;31:753–762.
Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: control of infectious diseases.MMWR Morb Mortal Wkly Rep. 1999;48:621–629.
Link B, Susser E, Steve A, Phelan J, Moore R, Struening E. Lifetime and five-year prevalence of homelessness in the United States.Am J Public Health. 1994;84:1907–1912.
Lowry S. Health and homelessness.BMJ. 1990;300:32–34.
Efron D, Sewell JR, Horn M, Jewell F. Children in homeless families in Melbourne: health status and use of health services.Med J Aust. 1996;165(11–12):630–633.
Weinreb L, Goldberg R, Bassuk E, Perloff J. Determinants of health and service use patterns in homeless and low-income housed children.Pediatrics. 1998;102:554–562.
Bassuk EL, Weinreb LF, Buckner JC, Browne A, Salomon A, Bassuk SS. The characteristics and needs of sheltered homeless and low-income housed mothers.JAMA. 1996;276:640–646.
National Safety Council.Accident Facts—1998 Edition. Itasca, IL: National Safety Council; 1998.
Lowry S. Accidents at home.Br Med J. 1990;300:104–106.
Centers for Disease Control and Prevention. Deaths resulting from residential fires and the prevalence of smoke alarms—United States, 1991–1995.MMWR Morb Mortal Wkly Rep. 1998;47:803–806.
Marshall SW, Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts JD. Fatal residential fires: who dies and who survives?JAMA. 1998;279(20):1633–1637.
Sharp GB, Carter MA. Prevalence of smoke detectors and safe tap water temperatures among welfare recipients in Memphis, Tennessee.J Community Health. 1992;17:351–365.
Mallonee S, Istre GR, Rosenberg M et al. Surveillance and prevention of residential-fire injuries.N Engl J Med. 1996;335(1):27–31.
Schwarz DF, Grisso JA, Miles C, Homes JH, Sutton RL. An injury prevention program in an urban African-American community.Am J Public Health. 1993;83:675–680.
Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomized controlled trials.BMJ. 1996;312:29–33.
Pirkle JL, Brody DJ, Gunter EW et al. The decline in blood lead levels in the United States—the National Health and Nutrition Examination Surveys.JAMA. 1994;272:284–291.
Centers for Disease Control and Prevention. Blood lead levels—United States, 1991–1994.MMWR Morb Mortal Wkly Rep. 1997;46:141–146.
Centers for Disease Control and Prevention. Preventing lead poisoning in young children. Atlanta, GA: Center for Disease Control and Prevention.
US Department of Housing and Urban Development.Comprehensive and Workable Plan for the Abatement of Lead-Based Paint in Privately Owned Housing, Report to Congress. Washington, DC: Office of Policy Development and Research; 1990.
US Environmental Protection Agency.Distribution of Soil Lead in the Nations' Housing Stock. Washington, DC: Office of Pollution Prevention and Toxics; 1996. Report no. EPA 747-R-96-003.
Bornschein RL, Succop P, Kraft KM, Clark CS, Peace B, Hammond PB. Exterior surface dust lead, interior house dust lead and childhood lead exposure in an urban environment. In Hemphill DD, ed.Trace Substances in Environmental Health, 20. Proceedings of University of Missouri's 20th Annual Conference, June 1986. Columbia, MO: University of Missouri; 1987:322–332.
Lanphear BP, Roghmann KJ. Pathways of lead exposure in urban children.Environ Res. 1997;74(1):67–73.
Lanphear BP, Weitzman M, Winter NL et al. Lead-contaminated house dust and urban children's blood lead levels.Am J Public Health. 1996;86:1416–1421.
Lanphear BP, Matte TD, Rogers J et al. The contribution of lead-contaminated house dust and residential soil to children's blood lead levels.Environ Res. 1998;79:51–68.
US Department of Housing and Urban Development.Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing. Washington, DC: HUD, 1995.
Pirkle JL, Kaufmann RB, Brody DJ, Hickman T, Gunter EW, Paschal DC. Exposure of the US population to lead, 1991–1994.Environ Health Perspect. 1998;106:745–750.
Farfel MR, Chisholm JJ, Rohde CA. The longer-term effectiveness of residential lead paint abatement.Environ Res. 1994;66:217–221.
Environmental Protection Agency.Lead-Based Paint Abatement and Repair and Maintenance Study in Baltimore: Findings Based on Two Years of Follow-Up. Washington, DC: EPA; 1997. EPA no. 747-R-97-005.
National Center for Lead-Safe Housing.Evaluation of the HUD Lead-Based Paint Hazard Control Grant Program. Fifth Interim Report. Columbia, MD: National Center for Lead-Safe Housing; February 1998.
Staes C, Matte T, Copley CG, Flanders D, Binder S. Retrospective study of the impact of lead-based paint hazard remediation on children's blood lead levels, St. Louis.Am J Epidemiol. 1994;139:1016–1026.
Farfel MR, Chisolm JJ. Health and environmental outcomes of traditional and modified practices for abatement of residential lead-based paint.Am J Public Health. 1990;80:1240–1245.
Amitai Y, Graef JW, Brown MJ et al. Hazards of “deleading” homes of children with lead poisoning.Am J Disabl Child. 1987;141:758–760.
Swindell SL, Charney E, Brown MJ, Delaney J. Home abatement and blood lead changes in children with class III lead poisoning.Clin Pediatr. 1994;33:536–541.
Ashengrau A, Beiser A, Bellinger D, Copenhafer D, Weitzman M. Residential lead-based-paint hazard remediation and soil lead abatement: their impact among children with mildly elevated blood lead levels.Am J Public Health. 1997;87:1698–1702.
Rhoads GG, Ettinger AS, Weisel CP et al. The effect of dust lead control on blood lead in toddlers: a randomized trial.Pediatrics. 1999;103(3):551–555.
Weitzman M, Ashengrau A, Bellinger D, Jones R, Hamlin JS, Beiser A. Lead-contaminated soil abatement and urban children's blood lead.JAMA. 1993;269:1647–1654.
Farrell KP, Brophy MC, Chisholm JJ Jr, Rohde CA, Strauss WJ. Soil lead abatement and children's blood lead levels in an urban setting.Am J Public Health. 1998;88:1837–1839.
Environmental Protection Agency.Urban Soil Lead Abatement Demonstration Project. Volume 4: Cincinnati Report. Washington, DC: EPA; 1993. Report no. EPA 600/AP93/001d.
Mannino DM, Homa DM, Pertowski CA et al. Surveillance for asthma—United States, 1960–1995.MMWR Morb Mortal Wkly Rep CDC Surveill Summ. 1998 Apr 24;47(1):1–27.
Platts-Mills TAE, Vervloet D, Thomas WR, Aalberse RC, Chapman MD. Indoor allergens and asthma: report of the third international workshop.Am J Allergy Clin Immunol. 1997;100:S2-S24.
Rosenstreich DL, Eggleston P, Kattan M et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.N Engl J Med. 1997;336:1356–1363.
Bierman CW. Environmental control of asthma.Immunol Allergy Clin North Am. 1996;16:753–764.
Platts-Mills TA. The role of allergens in allergic airway disease.J Allergy Clin Immunol. 1998;101:S364-S366.
Murray AB, Ferguson AC. Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy. A controlled trial.Pediatrics. 1983;71:418–422.
Gergen PJ, Mortimer KM, Eggleston PA et al. Results of the National Cooperative Inner-City Asthma study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes.J Allergy Clin Immunol. 1999;103:501–506.
Verhoeff AP, Burge HA. Health risk assessment of fungi in home environments.Ann Allergy Asthma Immunol. 1997;78:544–556.
Nikulin M, Reijuka K, Jarvis BB, Veijalainen P, Hintikka EL. Effects of intranasal exposure to spores orStachybotrys atra in mice.Fund Appl Toxicol. 1997;35:182–188.
American Academy of Pediatrics Committee on Environmental Health. Toxic effects of indoor molds.Pediatrics. 1998;101:712–714.
Montana E, Etzel RA, Horgan TE, Dearborn DG. Environmental risk factors associated with pediatric idiopathic pulmonary hemorrhage and hemosiderosis in a Cleveland community.Pediatrics [serial on-line]. 1997;99(1). Available at:http://www.pediatrics. org/cgi/content/full/99/1/e5.url. Accessed October 29, 1999.
Sudakin DL. Toxigenic fungi in a water-damaged building: an intervention study.Am J Ind Med. 1998;34:183–190.
Brunekreef B, Dockery DW, Speizer FE et al. Home dampness and respiratory morbidity in children.Am Rev Respir Dis. 1989;140:1363–1367.
Wickman J, Nordvall SL, Pershagen G et al. House dust mite sensitization in children and residential characteristics in a temperate region.J Allergy Clin Immunol. 1991;88:89–95.
Verhoff AP, van Strien RT, Van Wijnen JH, Brunekreef B. Damp housing and childhood respiratory symptoms: the role of sensitization to dust mites and molds.Am J Epidemiol. 1995;141:103–110.
Rosenstreich DL, Eggleston P, Kattan M et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma.N Engl J Med. 1997;336:1356–1363.
Rao CY, Burge HA, Chang JCS. Review of quantitative standards and guidelines for fungi in indoor air.J Air Waste Manag Assoc. 1996;46:899–908.
Centers for Disease Control and Prevention. Rat-bite fever—New Mexico, 1996.MMWR Morb Mortal Wkly Rep. 1998;113:89–91.
Vinetz JM, Glass GE, Flexner CE, Mueller P, Kaslow DC. Sporadic urban leptospirosis.Ann Intern Med. 1996;125:794–798.
Smith RP Jr, Rand PW, Lacombe EH, et al. Norway rats as reservoir hosts for Lyme disease spirochetes on Monhegan Island, Maine.J Infect Dis. 1993;168:687–691.
Coombe N, Marr JS. Rat bites support need for in-home control: an epidemiologic study of rat bites in New York City, 1974–1978.J Environ Health. 1980;42:321–326.
Cloarec A, Rivault C, Fontaine F, Le Guyader A. Cockroaches as carriers of bacteria in multi-family dwellings.Epidemiol Infect. 1992;109:483–490.
Fotedar R, Nayar E, Samantray JC et al. Cockroaches as vectors of pathogenic bacteria.J Commun Dis 1989;21:318–322.
Landrigan PJ, Claudio L, Markowitz SB et al. Pesticides and inner-city children: exposures, risks, and prevention.Environ Health Perspect. 1999;107:431–437.
Gurunathan S, Robson M, Freeman N et al. Accumulation of chlorpyrifos on residential surfaces and toys accessible to children.Environ Health Perspect. 1998;106:9–16.
Davis DL, Ahmed AK. Exposures from indoor spraying of chlorpyrifos pose greater health risks to children than currently estimated.Environ Health Perspect. 1998;106:299–301.
Chanda SM, Pope CN. Neurochemical and neurobehavioral effects of repeated gestational exposure to chlorpyrifos in maternal and developing rats.Pharmacol Biochem Behav. 1996;53:771–776.
Huss K, Rand C, Butz AM et al. Home environmental risk factors in urban minority children.Ann Allergy. 1994;72:173–177.
Samet JM, Spengler JD. Indoor air pollution. In Rom WN, ed.Environmental and Occupational Medicine. 2nd ed, Boston: Little Brown and Company; 1992.
Centers for Disease Control and Prevention. Unintentional carbon monoxide poisonings in residential settings—Connecticut, November 1993–March 1994.MMWR Morb Mortal Wkly Rep. 1995;44:765–767.
American Thoracic Society. Achieving healthy indoor air. Report of the ATS Workshop: Sante Fe, New Mexico, November 16–19, 1995.Am J Respir Crit Care Med. 1997;156:S33-S64.
National Academy of Sciences. Biological effects of ionizing radiation (BEIR) VI report: the health effects of exposure to indoor radon. Executive summary. Available at: http://www.epa.gov/iaq/radon/beiriv1.html. Accessed October 29, 1999.
Centers for Disease Control and Prevention. Radon testing of households with a residential smoker—United States, 1993–1994.MMWR Morb Mortal Wkly Rep. 1999;48:683–686.
Morrison Hershfeld Limited.Moldy Houses: Why They Are and Why We Care, Report to Canada Mortgage and Housing. Ottowa, Ontario, Canada: Morrison Hershfield Limited; 1995.
Roscoe RJ, Gittleman JL, Deddens JA, Petersen MR, Halperin WE. Blood lead levels among children of lead-exposed workers: a meta-analysis.Am J Ind Med. 1999;36:475–481.
US Department of Housing and Urban Development, Office of Lead Hazard Control. The Healthy Homes Initiative: a preliminary plan. April 1999. Available at: http://www.hud.gov:80/lea/HHIFull.pdf. Accessed October 29, 1999.
US Department of Housing and Urban Development. Community Development Block Grant (CDBG) Entitlement Communities Program. Available at: http://www.hud.gov/progdesc/cdbgent.html. Accessed October 18, 1999.
US Department of Housing and Urban Development. HUD's Budget. Available at: http://www.hud.gov/budget.html. Accessed October 29, 1999.
Lead-Based Paint Hazard Reduction and Financing Task Force.Putting the Pieces Together: Controlling Lead Hazards in the Nation's Housing. Washington, DC: US Department of Housing and Urban Development; 1995. Publication no. HUD-1547-LBP.
Gulson BL, Gray B, Mahaffey KR et al. Comparison of the rates of exchange of lead in the blood of newly born infants and their mothers with lead from their current environment.J Lab Clin Med. 1999;133:171–178.
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The views expressed in this article are those of the authors and do not necessarily reflect official policies of the US Centers for Disease Control and Prevention or the US Department of Housing and Urban Development.
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Matte, T.D., Jacobs, D.E. Housing and health—Current issues and implications for research and programs. J Urban Health 77, 7–25 (2000). https://doi.org/10.1007/BF02350959
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DOI: https://doi.org/10.1007/BF02350959