The Integrated Pest Management Intensity Impact Study (IPMIIS)

1. The Integrated Pest Management Intensity Impact Study (IPMIIS) A Closer Look at Mental Health, Asthma, Housing and the Way We Manage Pests. Alan Fossa & John Kane May 29th , 2014

2. Health & Housing • Housing, a key social determinant of health • Well documented in literature • Housing influences a variety of health outcomes • Respiratory health, Neurodevelopment etc… literature (Evans 2003)

3. Mental Health & Housing What about mental health? • Documented links between housing and mental health • Somewhat limited body of research Why do we need to take a closer look? • Significant upward trends in mental health measures • Disparities in these measures across housing type

4. Mental Health & Housing • Methodologically limited body of work (Evans, 2000) • Cross-sectional design, non-standardized outcome measurement… • How are we looking at housing quality? • Physical structure, building codes, major health threats (lead, asbestos etc…)

5. Mental Health & Housing • Persistent sadness among adults • 7.2% in 2005 and9.4% in 2010 (BBRFS 2005,2010) • 16.9% in public housing vs. 7.6% in non-public, non-subsidized housing (BBRFS 2010) • Persistent anxiety among adults • 12.0% in 2005 and17.3% in 2010 (BBRFS 2005,2010) • 19.5% in public housing vs. 16.3% in non-public, non-subsidized housing (BBRFS 2010) • Similar trend among youth (YRBS, 2005, 2013)

6. Housing Quality-Pests • Pests are a major problem in urban housing • 85.2% child’s rooms, detectable roach allergens (NCICAS, 1997) • 42% Homes in Boston with detectable mouse allergens (Phipatanakul, 2000) • Inequities in pest problems • 71% Reported infestation in public housing vs. 22% in non-public housing (Wang, et. al., 2008) • > 50% public housing residents reported problems with pests indoors (National Center for Healthy Housing, 2008)

7. Asthma & Housing • Disparities in asthma burdens

8. Asthma & Housing • Roaches and rodents are a major factor in housing-asthma relationship • Allergens from both pests are proven asthma triggers (National Center for Healthy Housing, 2009)

9. Pest Management and Health • Direct relationship between pest management and health • Pesticide exposure and other dangers • Good pest management  Improved health • Indirect relationship between pest management and health • Good pest management  Reduction in Pests  Improved health

10. Pest Management and Health • How are we looking at housing quality? • Physical structure, building codes, major health threats (lead, asbestos, etc…) • A pest free environment is a component of quality housing • Should be reflected in research tools • What is good pest management?

11. Integrated Pest Management (IPM) • Alternative to traditionally ineffective methods • Major Focuses • Restricted access to food, water and shelter • Prevention and education • Structural integrity • Sanitation • Conservative application of pesticides

12. IPM at Boston Housing Authority • Largest housing authority in New England • Largest property owner in Boston • 10% of Boston residents in BHA housing

13. IPM at Boston Housing Authority Three main pests: • Cockroaches • Rodents • Bedbugs

14. IPM at Boston Housing Authority Evolution of Pest Control at BHA: • 1982 – bug crew • 1995 – outside contractors “flushouts” • 2001 – listening tour

15. IPM at Boston Housing Authority Healthy Public Housing Initiative: • Indoor Air Quality Resident Health • Various methods researched • Recommendation: Integrated Pest Management (IPM)

16. IPM at Boston Housing Authority Healthy Pest Free Housing Initiative: • Implement IPM at 15 developments over 3 years • Community Health Advocates • Institutionalize • Evaluate continually

17. IPM at Boston Housing Authority Cost Benefit Analysis: • $4.63 to $7.09 = +$2.46 • Decrease pest infestations, pest work orders, pesticide use, stress, losses from REAC scores, HID complaints, court cases • Increase or Improve quality of life, sense of health, job satisfaction, staff time, and achieve high performer status

18. Pest Management Asthma Cost IPMIIS Housing General Health Mental Health Pest Infestation Pesticide Exposure

19. IPMIIS Goals • Develop a tool for classifying pest management of a housing authority into 3 categories. High Intensity IPM Traditional Pest Management Low Intensity IPM

20. IPMIIS Goals • Investigate the effect of IPM intensity on general health, mental health and asthma in residents Mental Health IPM Intensity General Health Asthma

21. IPMIIS Goals • Demonstrate longitudinal relationships between IPM, asthma and pest infestation Asthma Symptoms Time IPM Intensity Time Pest Infestation

22. IPMIIS Goals • Demonstrate longitudinal relationships between IPM, pest infestation and asthma • Demonstration a longitudinal relationship between IPM and pesticide residues IPM Intensity Pesticide Residues Time Pest Infestation Time Asthma

23. IPMIIS Goals • Limited cost-effectivness analysis IPM Intensity Time Healthcare Utilization (Asthma) Time $

24. IPMIIS Methods • Enrollment • Cross-sectional and Follow-up • Even across IPM stratum • Study teams • CBPR Based (Community Member and Graduate Student) • Data collection • Observation • Surveys • Sample collection • Pesticides • Allergens

25. IPMIIS Methods IPMIIS 16 Developments Cross-Sectional 460 Households Longitudinal 89 Households (Asthmatic Participants)

26. IPMIIS Methods • Determination of IPM Intensity Levels • Data sources: IPM logs, pest control contracts and work orders • Metrics: • % Units inspected • % Units with evidence of pest infestation (focus units) • % Focus units not followed up • 3 Year average work order prevalence • Contract lapses • Kellogg site • Active tenant coordinator

27. IPMIIS Methods • Field Work & Data Collection:

28. IPMIIS Methods • Participant Surveys Collected information on: • Demographics (income, age, sex, etc…) • Self-reported Health (CESD, PSS, Physical health, etc…) • Self-reported pest infestation (experience with pests, etc…) • Asthma outcomes and related health info (ARQL and ACT) • Self-reported pest management (personal management and development management, etc…)

29. IPMIIS Methods • Unit Observations Collected Information On: • Objective pest infestation (actual pests, droppings and other signs, etc…) • Objective factors associated with pest infestation (poor sanitation, structural damage, etc…) • Evidence of pest management (traps, gels, plugged up holes, etc…) • Environmental Sampling (kitchen) • Pesticide Sampling • Allergen Sampling (mouse and roach)

32. IPMIIS Methods • CBPR Component • Comprehensive involvement • Study Design • Execution • Interpretation and dissemination of results • Collaboration with community based organizations (Committee for Boston Public Housing and BHA) • Study team (one community advocate and one graduate student)

33. Preliminary data • Approximately 37% of residents reported the presence of cockroaches in their home and 32.2% reported rodents • Of 460 enrolled participants, 74% werefemale and 52.6% identified themselves asHispanic or Latino • Our study population had a median CESD score of 11 and a mean PSS score of 4.8 • Focus on the association between mental health symptoms, pest infestation, and pest management practices using logistic regression and multi-level regression techniques

34. What now? • Last field visit on December 25, 2013 • Construction of Cleaned Analytic Datasets • Work with collaborators at Boston University and Harvard University • Further develop and execute analysis plan

35. Acknowledgements Snehal Shah Margaret Reid Mae Bennett-Fripp Gary Adamkiewicz John Levy Lori Luce Special Thanks U. S. Department of Housing and Urban Development HUD Assistance Grant MALHH0193-09 Committee for Boston Public Housing National Healthy Homes Conference

36. References • Evans, G.W., The built environment and mental health. J Urban Health, 2003. 80(4): p. 536-55. • Boston Behavioral Risk Factor Survey (2005, 2006, 2008 and 2010), Boston Public Health Commission • Youth Risk Behavior Survey (2005, 2007, 2009, 2011 and 2013), Centers for Disease Control and Prevention • Evans, G.W., et al., Housing quality and mental health. J Consult ClinPsychol, 2000. 68(3): p. 526-30. • Phipatanakul, W., et al., Effect of environmental intervention on mouse allergen levels in homes of inner-city Boston children with asthma. Ann Allergy Asthma Immunol, 2004. 92(4): p. 420-5. • Phipatanakul, W., et al., Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. J Allergy ClinImmunol, 2000. 106(6): p. 1070-4.

37. References • Wang, C., M.M. Abou El-Nour, and G.W. Bennett, Survey of pest infestation, asthma, and allergy in low-income housing. J Community Health, 2008. 33(1): p. 31-9. • Integrated Pest Management Interventions for Healthier Homes:Pests Persist in Federally Subsidized Housing. 2008, National Center for Healthy Housing.

38. Thank you!