Working Toward a Healthier Home

1. Working Toward a Healthier Home Information for Parents and Childcare Educators

2. Introduction

3. Our mission is to promote healthy homes, schools, and childcare facilities in Boston, and enhance the well-being of individuals who live, work, and play in them. Who We Are Boston Healthy Homes and Schools Collaborative (BHHSC) is a program of Health Resources in action. BHHSC’s work focuses on health conditions directly related to environmental hazards – specifically asthma and lead poisoning. We provide information, training, and other resources to family childcare providers to promote healthy home daycares.

4. Boston Tenants Organization Massachusetts Affordable Housing Alliance Massachusetts Department of Public Health Children’s Hospital US Environmental Protection Agency Urban Edge Some of Our Members: MA Coalition for Occupational Safety and Health Boston Department of Neighborhood Development Boston Public Health Commission Clean Water Action Boston Medical Center Dorchester Environmental Health Coalition

5. Conducts trainings and educational sessions for parents, property owners, and childcare providers Provide information and referrals on questions from parents, property owners and local organizations Convenes interested organizations to coordinate work BHHSC is a Community Resource Creates a presence in the community through collaboration, attending community events, partnerships with youth organizations and local universities

6. Healthy Homes Concepts

7. What Hazards Exist in the Home? What comes to mind when you think of hazards to health and safety in a home?

8. What Health Risks are related to the Home Hazards?

9. Potential Health Effects of Poor Quality Indoor Environment • Asthma Triggers • Secondhand smoke • Pests • Mold/Moisture • Dust mites • Pet dander • Chemicals/pesticides • Poisoning • Carbon monoxide • Lead paint • Chemicals/pesticides • Respiratory and IAQ Effects • Building and Household Products • Chemicals • Injury/Death • Falls • Fire/electrical • CO • Carcinogens • Radon gas • Chemicals/pesticides • Wood smoke • Developmental delays • Lead paint • Chemicals/pesticides • Multiple • Drinking water contamination

10. Creating a Healthy HomeThe Seven Principles of a Healthy Home Dry – Damp houses attract mold and other asthma triggers Clean – Clean homes reduce pests and other health risks Pest-Free – Exposure to pests like cockroaches and mice can worsen asthma and cause other health problems. Pesticides are also dangerous to children’s health. Safe – Most injuries occur at home and are usually falls, burns, and poisonings.

11. Creating a Healthy HomeThe Seven Principles of a Healthy Home 5. Contaminant-Free – Contaminants in the home include lead, tobacco smoke, and pesticides. 6. Ventilated – Increasing fresh air in the home can improve indoor air quality. 7. Maintained – Poorly maintained homes are at risk of pests, moisture, and other health risks.

12. Healthy Homes in Boston? • What do healthy homes issues look like in Boston? • Two major healthy homes issues that Boston residents are faced with are: • Lead poisoning • Asthma

13. Lead Poisoning Basics

14. What is Lead Poisoning? • Lead is a heavy metal that was used in paint, gasoline, and other things • Young children can become lead poisoned when they swallow or breathe something that contains lead. It is also dangerous for pregnant women. • There may be no visible symptoms of lead poisoning at the time of exposure so children should have their blood tested

15. What is Lead Poisoning? No. 1 Source is Lead Paint Dust In New England, lead based paint is the primary source of poisoning. Most homes built before 1978 have lead based paint, and homes built before 1950 are likely to contain even more lead.

16. Sources of Lead Poisoning? • Most lead poisoned children were exposed by inhaling lead paint dust • Children breathe in lead paint dust in the summer when windows are opened and closed frequently, and also when there are home renovations being done

17. Other Sources of Lead Certain candies and spices from other countries Some plastic toy components and toy jewelry imported from China have tested high for lead levels Tap water: Lead gets into water from leaded pipes, lead solder used to connect water pipes, and some brass faucets

18. Health Effects of Lead Lead poisoning is measured by the number of micrograms per deciliter in the blood – called elevated blood lead levels. • Effects at low levels: • Slower development • Learning and behavioral problems • Reduced motor skills Effects at high levels: In addition to effects listed above, high levels of lead can result in seizures or a coma and can be potentially lethal

19. Long Term Effects of Lead Poisoning Recent Studies Lead and SAT Scores There is a strong relationship between SAT scores and blood lead levels. One study found that as children’s blood lead levels rose, SAT scores dropped, and vice versa. http://www.usatoday.com/news/education/2009-02-02-lead-SAT_N.htm Lead and Violent Crime Another study found that even low levels of lead can cause or lead to permanent brain damage and a higher chance of being arrested, particularly for violent crimes. http://articles.latimes.com/2008/may/28/science/sci-lead28

20. Preventing Lead Poisoning Urgent Lead Hazards

21. Preventing Lead Poisoning The number one way to protect a child: MAKE SURE THE HOME IS CERTIFIED LEAD SAFE A house is ‘lead safe’ if it has been inspected and received a ‘letter of lead paint compliance’ from the MA Dept of Public Health. You can find out the ‘lead status’ of houses online for free.

22. Prevention Lead Poisoning The MA Lead Law • A home with a child under the age of 6 living there must be certified deleaded (lead safe) according to MA state law. • It is ILLEGALfor a landlord to refuse to rent to someone because they have a child under age 6. • It is the property owner’s responsibilityto pay for a lead inspection and deleading if there is a young child living at the house.

23. Renovate Right

24. Renovate Right Regulation on Lead Safe Work Practices The Environmental Protection Agency recently created a rule requiring ‘lead safe work practices’ while contractors are doing renovation, plumbing, and painting work. This should prevent lead dust from contaminating the living area. This is called the Renovation Repair and Painting Rule.

25. Renovate Right Regulation on Lead Safe Work Practices • Took effect on April 22, 2010 • Affects renovation, repair, or painting work on child-occupied facilities built before 1978, including family childcare providers • Rule applies if disturbing 6 sq ft of painted surface on inside, or 20 sq ft of paint on the exterior

26. Renovate Right Regulations How to Comply What must a Childcare Educator do? • Ask to see the contractor’s Renovation, Repair, and Painting training certification. • Make sure the contractor provides you with a copy of the Renovate Right booklet • Provide renovation notification to families of the children at your childcare • You should provide a copy of the Renovate Right booklet to all parents

27. Renovate Right Regulation Lead Safe Work Practices What are lead safe work practices? Make sure contractors do the following things in order to keep your home free from lead contamination: • Contain the work area: cover furniture and floors, seal doorways leading into the work area • Minimize dust: spray or mist water on paint before scraping, use power tools with an attached filter to catch dust

28. Pay Attention! Renovate Right Regulation How to Comply 3) Clean up thoroughly: contractors should clean daily with a wet mop and rinse water. Use a HEPA vacuum Follow the contractors’ progress to make sure they are working safely. Ask them questions if you are concerned about something you see. Many contractors will do better quality work if they know you are educated about lead safe work practices – so show them you know what you’re talking about!

29. Asthma Basics

30. What is Asthma? Asthma is a chronic respiratory disease and is the most common childhood chronic disease in the country. • Cannot be cured but it can be controlled • Produces recurring episodes of breathing problems • Can be potentially life-threatening • In Boston, young children are more likely to be hospitalized from asthma than other age groups

31. Who Gets Asthma? Asthma can affect anyone, but young children are especially at risk. Children are also more likely to need to go to the emergency room. • Risk Factors for Asthma: • Obesity • Family history of asthma • Allergies • Exposure to allergens like dust mites and second hand smoke

32. Undiagnosed Asthma One tricky thing about asthma is that it often is undiagnosed. Understanding the causes and symptoms of asthma are important so the disease can be properly diagnosed, controlled, and treated.

33. How Asthma Affects the Lungs An asthma attack occurs when: • Bands around the airways in the • lungs tighten and the airways swell • There is extra mucus in the lungs This causes the airways to get smaller and it is more difficult for air to pass through.

34. Asthma Symptoms • Symptoms of asthma include: • Wheezing • Coughing • Shortness of breath • Chest Tightness

35. In-Home Asthma Triggers To control asthma, it is important to know what things in the home may trigger an attack. Pests, like cockroaches Secondhand Smoke Allergens, mold, chemicals or pet dander Dust and dust mites Many people with asthma also have allergies to these same triggers.

36. Environmental Tobacco Smoke Secondhand smoke, also known as environmental tobacco smoke, is the smoke that comes from a cigarette or cigar and the smoke that a smoker breathes out.

37. Environmental Tobacco Smoke • Secondhand smoke is a major health concern because of the many health risks associated with breathing it in: • Asthma attacks/flare-ups and asthma symptomsthat happen more often and are more severe. • New cases of asthma in children who have not shown asthma symptoms in the past.

38. Third-Hand Smoke What is third-hand smoke? Third-hand smoke is a term for the chemicals, gases, and other toxins left behind in hair, carpets, sofas, clothes and other materials long after a cigarette is put out. Why is third-hand smoke a concern? Third-hand smoke can make asthma worse. Babies are also at an increased risk of swallowing or breathing in these toxins because they spend more time closer to floors and other surfaces.

39. Dust and Dust Mites Dust mites are tiny bugs that are too small to see. • Dust mites feed on human skin flakes, which are commonly found in dust, bedding, furniture, stuffed toys, clothes, and other fabrics and fabric-covered items • Breathing in body parts and droppings of dust mites can trigger asthma symptoms. • Dust mite exposure can also increase the risk of a child developing asthma.

40. Pests • Saliva, body parts or droppings from cockroaches, mice, rats, and other pests can trigger asthma symptoms. • Pests can get into homes and cabinets through cracks and openings. • Dirty dishes, crumbs, spills attract them if they aren’t cleaned up quickly.

41. Other Allergens Allergens include mold, pet dander, and chemicals. Mold Grows in wet or moist areas and create spores that can float through the air. Breathing in these spores can trigger asthma symptoms. • Pet dander • Or pet skin flakes, can also float through the air and get stuck in furniture and clothing. Breathing • in pet dander can • trigger asthma • symptoms.

42. Other Allergens Strong household chemicals can irritate airways and trigger asthma symptoms if they are inhaled. These household chemicals are found in cleaning supplies, pesticides, air fresheners, and perfumes. Besides having the ability to trigger asthma and allergies, these chemicals may be toxic, especially for young children.

43. Break

44. Managing Asthma

45. Asthma Action Plans An asthma action plan is a written plan developed by a person who has asthma and his/her doctor to help better control his/her asthma. Parents and child care educators can help control asthma by making sure the child has an asthma action plan. This individualized asthma action plan will help the child care educator know right away how to treat an asthmatic child and what their triggers are.

46. Asthma Action Plans • An asthma action plan is a great tool for: • Assessing a child’s asthma.How bad is the child’s asthma? What are his/her triggers? • Controlling a child’s asthma.Administer the proper medications. Know, reduce, and avoid asthma triggers. • Monitoring a child’s asthma. Know what to do in case of an asthma attack. Keep emergency phone numbers handy

47. Asthma Action Plans

48. Asthma Medications There are two types of asthma medication. In most cases, a child care educator should have reliever medication, and the parent would administer the controller medication at home. Relievers Controllers Used daily to prevent asthma symptoms Reduce irritation, swelling, and mucus that block airways Do NOT provide quick relief for asthma attacks. Examples: Budesonide, Fluticasone, Beclomethasone • Used for fast relief of symptoms. • Relief in 10-20 minutes • Effective for 4-6 hours. • Relax muscles around airways. • Examples: Albuterol, levalbuterol, Proventil, Ventolin, ProAir

49. Administering Asthma Medication If a child in your care has asthma or asthma-like symptoms, it is important to understand how to administer medication. Medication may be given through a nebulizer or an inhaler. Always have a parent or a healthcare professional demonstrate the correct way to administer medication. If using an inhaler, be sure to use a spacer. If using a nebulizer, you’ll need a mask and pump. The resource guide includes step-by-step instructions on how to administer asthma medication.

50. Types of Asthma Medication Source: Neighborhood Health Plan