Healthy Homes Screening Tool (HHST)

1. Healthy Homes Screening Tool (HHST) We wish to acknowledge the assistance of Jane Nickert from the City of Detroit Department of Health and Wellness Promotion, Robert Scott from MDCH, and many work-study students who helped with this survey.

2. What the HHST Will Do The Healthy Homes Screening Tool (HHST) will: • Examine the health risks in surveyed homes by assessing the presence of a wide range of risk factors that may increase the potential for sickness, injuries, and death among a home’s inhabitants. • Provide a consumer and paraprofessional screening tool as a companion to the Healthy Homes Rating System (HHRS). • Evaluate differences in resident responses regarding health and safety hazards in comparison with actual findings determined through the HHRS.

3. HHST Targets & Versions • The first version of the HHST was used for face-to-face interviews with residents at the door. • The second version of the HHST is being used by non-housing professionals to make observations about the household.* • A third two-page version of the HHST is currently being developed to be used by non-housing professionals and paraprofessionals to make observations within the home. *Residents are being given the option of allowing non-housing professionals into the home to make observations or to complete the survey by a face-to-face interview at the door.

4. HHST vs. HHRS • The HHST is a screening tool intended for use within households by paraprofessionals and others. • The HHRS is “a system of assessment… of hazards and the potential effect of conditions” to be used by trained housing professionals. [1] [1] Healthy Homes Rating System – Operating Guidance

5. Healthy Homes Risks Asthma/Allergy • In homes where allergens are present, including dust mites, cockroaches, mold, furry pets, tobacco smoke, air fresheners, and certain chemicals, “children may experience severe and frequent asthma attacks from high airborne concentrations of these allergens”.[1] Moisture/Water Damage • Moisture and water damage can cause mold and fungus growth, leading to the development of asthma and allergies and triggering “allergic symptoms such as rhinitis, conjunctivitis, eczema, cough and wheeze”. [2] Lead • Lead-based materials, such as lead-based paint and water pipes, can cause lead poisoning and have “toxic effects on the nervous system, cognitive development and blood production”. [2] [1] National Institute of Environmental Health Sciences - www.niehs.nih.gov/airborne/asthma.html [2] Healthy Homes Rating System – Operating Guidance

6. Healthy Homes Risks Housing Characteristics: House • Overall housing conditions such as excess noise, risk of entry by intruders, lack of adequate living space, improper food preparation appliances and lack of proper personal hygiene and sanitation facilities can have multiple negative physical and psychological impacts on residents. Housing Characteristics: Stairs • Falling on stairs can be caused by poor structural condition, inadequate lighting and absence of handrails, leading to “bruising, fractures, head, brain and spinal injuries” and even death. [1] Housing Characteristics: Bath • Falls within a bath can be caused by lack of slip-proof surfaces and grab bars, often resulting in “cuts or lacerations, swelling or bruising, or fractures”. [1] Housing Characteristics: Fire/Electrical • Smoke detectors, fire extinguishers, multiple exits and fire exit strategies can help to reduce the risk of death by burns or gas or smoke inhalation in the case of a fire. • Exposed wiring and improperly vented appliances can increase the risk of fire and electrical shock. [1] Healthy Homes Rating System – Operating Guidance

7. Healthy Homes Risks Carbon Monoxide • Improperly vented gas appliances such as dryers and stoves can lead to increased levels of carbon monoxide, leading to “headaches, dizziness, weakness, nausea, confusion”, disorientation, fatigue, and even “unconsciousness and death”. [1] Poisoning: Other • Substances such as medication, pesticides, cleaning products and others can be potentially hazardous to children especially if stored in accessible locations. Radon • Significant exposure to ionizing radiation can “damage DNA and cause genetic mutation”. [1] Because radon is a gas, it can leak into homes through the basement or crawl space, cracks in concrete floors and walls, floor drains and sump holes, or through well water. The Environmental Protection Agency (EPA) estimates that radon is the number one cause of lung cancer in non-smokers, responsible for as many as 21,000 cancer deaths each year. The combination of smoking and the presence of radon in the home can significantly increase the risk of lung cancer. [1] Healthy Homes Rating System – Operating Guidance

8. HHST Target Area Working from west to east, the northernmost boundary from Linwood to Woodward is Webb/Woodland.  From Woodward to Oakland it is Holbrook, and from Oakland to I-75 it is Clay. Working from north to south, the easternmost boundary from Atkinson to Holbrook is Woodward. From Holbrook to Clay, it is Oakland, and from Clay to Mack it is I-75.  The southernmost border, from west to east, is West Grand Blvd between Linwood and 14th.  From 14th to Rosa Parks Blvd, it is I-94.  Between Rosa Parks Blvd and Trumbull, it is Grand River, and between Trumbull and I-75 it is Mack/Martin Luther King Blvd.  Between Atkinson and West Grand Blvd, the westernmost boundary is Linwood.  Between West Grand Blvd and I-94, it is 14th, and between I-94 and Grand River, it is Rosa Parks Blvd.

9. Smoking n=301 n=23 n=371 n=22 n=1 n=0 Completed outside house by interview Completed in house by site visitor

10. Smoking n=160 n=5 n=69 n=9 n=3 n=23 n=1 n=13 n=3 n=0 n=0 n=1 n=1 n=0 Completed in house by site visitor Completed outside house by interview

11. Fire/Burns n=52 n=534 n=164 n=6 n=1 n=2 n=34 n=387 n=23 n=299 n=2 n=11 n=34 n=335 n=19 n=338 n=1 n=4 Completed in house by site visitor Completed outside house by interview

12. Fire/Burns n=670 n=57 n=26 n=1 n=0 n=0 n=121 n=39 n=63 n=14 n=4 n=0 Completed outside house by interview Completed in house by site visitor

13. Fire/Burns n=278 n=25 n=429 n=33 n=2 n=1 Completed in house by site visitor Completed outside house by interview

14. Fire/Burns n=13 n=35 n=11 n=42 n=9 n=22 Completed in house by site visitor Completed outside house by interview

15. Poisoning n=556 n=38 n=515 n=36 n=433 n=32 n=506 n=33 Completed in house by site visitor Completed outside house by interview

16. Falls n=55 n=607 n=98 n=2 n=0 n=1 n=54 n=553 n=151 n=4 n=0 n=1 n=57 n=625 n=83 n=1 n=0 n=0 Completed in house by site visitor Completed outside house by interview

17. Falls n=15 n=158 n=41 n=551 n=0 n=1 n=31 n=341 n=25 n=367 n=0 n=1 Completed in house by site visitor Completed outside house by interview

18. Asthma/Allergies n=100 n=9 n=27 n=381 n=6 n=0 n=18 n=197 n=41 n=502 n=8 n=0 n=18 n=103 n=40 n=352 n=0 n=2 Completed in house by site visitor Completed outside house by interview

19. Asthma/Allergies n=14 n=126 n=10 n=71 n=2 n=48 n=4 n=28 Completed outside house by interview Completed in house by site visitor

20. Asthma/Allergies n=239 n=12 n=141 n=14 n=11 n=0 Completed outside house by interview Completed in house by site visitor

21. Asthma/Allergies n=396 n=40 n=287 n=28 n=305 n=27 Completed outside house by interview Completed in house by site visitor

22. Asthma/Allergies n=654 n=50 n=558 n=45 n=125 n=44 Completed outside house by interview Completed in house by site visitor

23. Mold/Water Damage n=20 n=265 n=38 n=441 n=1 n=2 n=22 n=225 n=34 n=477 n=3 n=5 Completed in house by site visitor Completed outside house by interview

24. Mold/Water Damage n=116 n=20 n=33 n=555 n=1 n=3 n=28 n=13 n=38 n=158 n=3 n=5 Completed outside house by interview Completed in house by site visitor

25. Pests n=172 n=23 n=25 n=196 n=8 n=42 n=6 n=36 Completed in house by site visitor Completed outside house by interview

26. Pests n=11 n=181 n=27 n=217 n=0 n=2 Completed in house by site visitor Completed outside house by interview

27. Lead Poisoning n=200 n=13 n=206 n=19 n=1 n=12 n=417 n=34 n=287 n=25 n=2 n=0 n=600 n=37 n=8 n=35 n=9 n=22 Completed in house by site visitor Completed outside house by interview

28. Entry by Intruders n=162 n=50 n=28 n=9 n=161 n=48 n=34 n=10 Completed outside house by interview Completed in house by site visitor

29. Carbon Monoxide n=25 n=283 n=33 n=404 n=276 n=24 n=51 n=4 Completed in house by site visitor Completed outside house by interview

30. Carbon Monoxide n=5 n=162 n=0 n=15 n=64 n=5 n=21 n=3 n=9 n=0 n=1 n=3 n=1 n=2 n=0 n=1 n=0 n=1 Completed in house by site visitor Completed outside house by interview

31. Carbon Monoxide n=105 n=15 n=572 n=44 n=5 n=0 n=17 n=5 n=166 n=53 n=2 n=0 n=360 n=25 n=19 n=252 n=1 n=0 Completed outside house by interview Completed in house by site visitor

32. Radiation n=39 n=114 n=19 n=73 n=1 n=6 n=0 n=15 n=17 n=283 n=11 n=38 Completed in house by site visitor Completed outside house by interview

33. Crowding & Space n=149 n=45 n=43 n=14 n=126 n=38 n=46 n=14 n=135 n=39 n=25 n=10 Completed outside house by interview Completed in house by site visitor

34. Crowding & Space n=165 n=46 n=25 n=8 n=67 n=22 n=120 n=32 n=186 n=58 n=1 n=8 n=106 n=35 n=84 n=22 Completed outside house by interview Completed in house by site visitor

35. Noise n=48 n=151 n=10 n=42 Completed in house by site visitor Completed outside house by interview

36. Food Safety n=189 n=58 n=159 n=53 n=187 n=58 n=190 n=59 Completed outside house by interview Completed in house by site visitor

37. Water Supply n=194 n=59 n=0 n=1 n=192 n=58 n=1 n=2 Completed outside house by interview Completed in house by site visitor

38. Electrical Hazards n=603 n=49 n=100 n=9 n=1 n=1 Completed outside house by interview Completed in house by site visitor

39. Electrical Hazards n=18 n=61 n=41 n=130 n=0 n=2 Completed in house by site visitor Completed outside house by interview

40. Next Steps • The Center is in the process of piloting a grant from MDCH to work with health professionals and others to prepare a one-page version of the HHST, pilot it, and identify steps for its implementation as part of regular home visitation processes.

41. Center for Urban Studies Lyke Thompson Director (313) 577-5209 ad5122@wayne.edu Ramona Washington Research Assistant (313) 577-0979 r.r.washington@wayne.edu Angie Sarb Research Assistant (313) 993-8045 angela.sarb@wayne.edu