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Introducing NCHH's Healthy Housing Fact Sheets: EPA Region 1

Think about your home community. What makes it special? What specific challenges does it face? I’m sure, if given the chance, we could all go on at length about the individuality in the places we live and work. Those of us doing policy work at national organizations spend much of our time focused on the big picture, but the healthy housing needs of each state are unique and varied. We are far more effective as an advocacy community when we remember to take advantage of the perspective and challenges each state brings.

That’s why the National Center for Healthy Housing has created 53 state healthy housing profiles – including the District of Columbia and an overview of the whole U.S. – for use by policy makers and advocates across the country. Each fact sheet offers eight statistics about the healthy housing situation in each state, covering topics including asthma prevalence and financial burden, childhood lead poisoning numbers and age of housing, radon levels, carbon monoxide fatalities, and unintentional falls among older adults. The fact sheets also tell you which of 11 programs at CDCHUD, and EPA are currently funding your state efforts. Most information was found from federal or state governments, and each fact is hyperlinked back to the source material.

EPA Region 1

Throughout 2018, we’re posting highlights of our state fact sheets by EPA region, one region per month. In January, we’re starting off with EPA Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

  • It’s well known among the healthy housing community that the Northeast typically has older housing stock than other parts of the country, and that is one of the first things that sticks out among these six states. Between 55% and 73% of housing in each state was built before lead paint was outlawed in 1978; 20-30% was built before 1940.
  • In 2015, the combined regional total of blood lead level tests over 5 µg/dL, the CDC action level, was 9,148. Forty percent (40%) of New Hampshire children are estimated to have had elevated blood lead levels at some point in their lives.
  • The region also shares high predicted and tested radon levels. In Connecticut, one in five homes has elevated radon; in Maine and New Hampshire, this number is nearly one in three. An estimated 628 cases of radon-related lung cancer occur in Massachusetts each year.
  • Rhode Island has the highest proportion of residents 85 and older in the U.S. at 15.8%, and nearly one in four Rhode Islanders are over 65. Risk of falling is a particular healthy housing issue for older adults. For example, hospital charges for unintentional falls among older adults totaled over $630 million in Massachusetts in 2010.
  • Another medical expense that has proved costly to the region is emergency asthma treatment. In 2014, Connecticut spent $135 million on acute care where asthma was the primary diagnosis; in 2012, Rhode Island spent $21 million on asthma hospitalizations.
  • The region also boasts some healthy housing milestones. Vermont was the first state to lower its definition of elevated blood lead levels to 5 µg/dL. This legislation was passed in 2008.
  • Maine was one of 14 states and localities that benefited from the additional funding for CDC’s Lead Poisoning Prevention program passed in December 2016.

Other NCHH Resources

NCHH’s state fact sheets will be updated annually with current information. For questions or comments, please email Laura Fudala at


Sarah Goodwin joined NCHH as a Policy Analyst in June 2017. She previously served NCHH as a policy intern, helping to establish and run the Find It, Fix It, Fund It lead action drive and its work groups. She holds a Bachelor of Arts degree in Interdisciplinary Studies: Communications, Legal Institutions, Economics, and Government from American University.

Are You Decking the Halls with Asthma and Allergy Triggers?

For many, the sight and smell of the Christmas tree is just the thing to put them in the holiday mood – tiny lights peppering a fir, pine, or spruce like hundreds of stars and ornaments that spark decades of wonderful memories. The crisp scent of your tree somehow makes the house smell fresh and clean. As you carefully decorate your home for the holidays, you’re probably spending considerable time making your home a safe, welcoming place for your family and friends to gather. But, at the risk of sounding like a humbug, we want to share some not-so-merry information about the holiday season. Studies have revealed a rise in hospital visits for asthma and other respiratory issues around Christmas, and your holiday decorations – including that beautiful tree that you've just erected in the corner – could be responsible.  As you plan your holiday gatherings, consider ways that you can reduce asthma and allergy triggers in your home.   

Christmas Trees and Wreaths 

Did you know that live trees could increase the risk of wheezing, persistent cough, and allergic sensitization in infants? A study, performed by staff at the SUNY Upstate Medical University, supported by the Children’s Environmental Health Centers of New York, and published in the Annals of Allergy, Asthma & Immunology, looked into the connection between epidemic peaks in respiratory illness the weeks before and the week after December 25 in children and adults.
The study found that Christmas trees, including their needles and bark, from a range of species, carried about 50 types of mold, two-thirds of which could lead to shortness of breath, watery eyes, sinus congestion, feelings of fatigue, and problems sleeping. Some of the molds identified can lead to long-term lung problems and conditions, such as bronchitis and pneumonia. Mold spores occur naturally, but the spores thrive in warm conditions, such as your living room. Plus, as the tree decays, the number of airborne mold spores increases dramatically. 

Artificial trees that have been stored improperly can also be a trigger. While in storage, they can accumulate significant amounts of mold spores, dust, and other irritants. 

Other Holiday Triggers  

Other holiday decorations can also trigger asthma attacks and allergies. Here are some of the most common seasonal indoor allergy triggers to avoid:

  • Candles and fragrances – seasonal scents and the warm glow of candles make them a popular choice during the holidays. The fragrances and soot given off by candles can trigger sensitivity in people with allergies or asthma. Besides creating a health hazard, the soot, small particles from paraffin wax, can damage your computers and other electrical appliances.
  • Wood-burning fireplaces – a cozy fire is welcome on a cold winter day; however, a wood-burning fireplace could also be a source for allergy and asthma triggers

Here are some tips to protect your home and family from allergy and asthma triggers during the holidays: 

  • Hose down your tree and let it dry before you bring it inside, whether it’s a fresh-cut variety or you’re getting your artificial tree out of storage. 
  • Remove a live tree soon after Christmas Day. 
  • Have your fireplace and chimney inspected and cleaned every year by a professional. 
  • Instead of a fireplace screen, opt for a fireplace with an insert or a retrofit
  • Avoid using sprays or scented candles with strong fragrances. 
  • Avoid paraffin candles. They’re a petroleum byproduct and release gaseous pollutants, volatile organic compounds (VOCs), and particulate matter into the air.
Don’t mistake us for Ebenezer Scrooge! It's just that we love the holidays and want to ensure that everyone in your family can enjoy them to the fullest. And you can with some minor modifications to your already thorough holiday preparations. We wish you a safe and healthy holiday season from our NCHH family to yours!

More Resources

EPA Burn Wise Program for Wood Burning – Tip Sheets
Environmental Health and Safety - Fire Prevention Guidelines for Tree Safety
University of Illinois Extension – Christmas Tree Selection and Care
Cleveland Clinic – Best Ways to Prevent Air Pollution
NCHH – Ensuring Asthma-Safe Homes 
Center for Excellence in Children’s Environmental Health – Healthy Home, Home Hazards: Mold
Preventative Medicine Reports – Health and societal effects from exposure to fragranced consumer products.

Why I Support NCHH

As we enter into a season of Thanksgiving, I wanted to share my appreciation for work and the people of the National Center for Healthy Housing.

First, a little background on me: I’m, well, the background. Chances are, we haven’t met. You haven’t seen me at any conferences nor have you heard me speak on any panels. You haven’t read about my research; I haven’t published any. Really, unless you’ve been to our offices, you wouldn’t know I worked here at all. That’s by design. You see, serving others has been at the heart of my career in nonprofit management. As the middle child of two pastors, I grew up watching my parents tirelessly serve others. At an early age, I found myself wondering, “Who takes care of the people who take care of everyone else?” With this ever-present question in mind, I’ve built my career in an attempt to answer it. I decided that I would be that resource. Supporting the work of great leaders and great companies is my way of serving the world.

The National Center for Healthy Housing (NCHH) is one of those great companies. NCHH is the preeminent national nonprofit dedicated to securing healthy homes for all. Since 1992, NCHH has served as a highly regarded and credible change agent, successfully integrating healthy housing advocacy, research, and capacity building under one roof to reduce health disparities nationwide. I support the NCHH team and, by extension, the healthy housing movement, in an administrative capacity. 

My role is behind the scenes. I’m not on the Hill advocating to ensure that the FY18 budget contains the necessary resources to address and prevent childhood lead poisoning like our policy team. (I work on employee benefit packages.) The producers of critically acclaimed television and news outlets haven’t lined up to interview me, as they have our chief scientist. I certainly haven’t invented a protocol like the Healthy Home Checkup by Healthy Housing Solutions, Inc. ®, which was designed to identify potential health and safety problems of homes before they can cause injury or health issues. (My greatest invention this year was the employee handbook.) I haven’t spoken to a panel of mayors about code enforcement as done by our deputy director. I don’t travel the country leading the movement, nor do I educate healthy housing practitioners about the importance of home-based asthma care programs alongside our executive director. The entire team here works hard every day to deliver the best tools, data, policies, and best practices to empower healthy housing professionals to do their work. I simply support the people who do these wonderful things. I’d like to think that I take care of them while they take care of everyone else.

We’ve had a busy year. Originally created to help the victims of hurricanes Katrina and Rita, our flood guide, Creating a Healthy Home: A Field Guide for Cleanup of Flooded Homeshas been a valuable resource to those who are working to rebuild their homes and their lives after hurricanes Harvey and Irma.

The mini-grants we provided to several communities this year have helped hundreds of parents, teachers, and community leaders increase their understanding of lead poisoning prevention. Because of their education, many of these folks now know how to talk to their government representatives about these important issues.

NCHH was featured on the cover of the Journal of Public Health Management and Practice this year. We helped to summarize the health and cost benefits of the New York State Healthy Neighborhoods Program. This partnership and program are helping many people with asthma achieve better health, while also saving money and improving household conditions.

Our Aging Gracefully project is helping 142 low-income elders remain safely in their cherished homes as long as possible. Ms. Reed, a retired educator from Greensboro, NC, wrote us a beautiful note expressing her gratitude. She spoke genuinely about the home upgrades she received through our program having a “profound impact” on her quality of life as an independent senior living in her own home.

NCHH, as a member of the Health Impact Project team, contributed to 10 Policies to Prevent and Respond to Childhood Lead Exposure. The report highlights activities such as removing leaded drinking water service lines and eradicating lead paint hazards from the homes of children born in 2018, would protect more than 661,000 children and yield $6.2 billion in future benefits.

NCHH has had a great 25th year. We believe that through partnerships, community-based research, and advocacy, we can all work together to reduce health disparities and lift up communities through improvements in health, education, and productivity. As a movement, we’re all doing a fantastic job. We do important work and we have the privilege of dedicating our lives to the service of others.

Our funders, partners, friends, and supporters make our work at NCHH possible. During this Thanksgiving season, I’d like to say that I am thankful for YOU. Whether you are leading the movement with us or quietly support the healthy housing movement, from one “behind the scenes” person to another, thank you for your support. It’s clear to me that you support NCHH for the same reasons that I do. First, because you believe in service. Additionally, you and I know that it feels good to give. Most importantly, you and I support NCHH because we believe that everyone should have a safe and healthy place to call home. We believe in this work. We believe that together, we can secure healthy homes for all. 

A great way to support the healthy homes movement is by participating with NCHH in #GivingTuesday. The Tuesday after Thanksgiving, Giving Tuesday is a movement to create an international day of giving at the beginning of the holiday season. Giving to NCHH on #GivingTuesday is the perfect time to remember that you and I don’t give to NCHH, we give through it. Our monetary gifts allow these folks to continue the great work that they’ve been doing for the last 25 years. I hope you’ll continue to join me in supporting this cause and this organization. Donate today.

A Shower of Benefits: Drinking Water and Healthy Housing

The American Public Health Association today hosts a Twitter chat on “What's in Your Water: The State of Water and Our Health” (#SafeWater). The state of the nation’s infrastructure that delivers drinking water to our homes is nothing short of appalling, with Flint being only the tip of the iceberg. It’s outdated, and like much of our roads, bridges, electrical grid and housing stock, it’s seriously underfunded and ill-maintained, causing high healthcare costs and needless suffering. At best, this is penny-wise and pound-foolish; at worst, it’s criminally negligent. Just today, Pew Charitable Trusts, Robert Wood Johnson Foundation, NCHH, and others released a major new report showing that the benefits of lead poisoning prevention far outweigh the costs.

The nation still has no health-based standard for lead in drinking water, and protocols for sampling for lead in water are all over the place and hard to interpret. The only real standard that does exist is designed to determine how well corrosion control treatments are working, not whether health is being adequately protected. The same is true for other contaminants, like PFAS/PFOS/PFOAs (e.g., perfluorooctanoic acid [PFOA], perfluorooctane sulfonate [PFOS], and other perfluoroalkyl substances [PFASs], which are chemicals used for stain-resistance, Teflon coatings for frying pans, and other purposes. We hear of outbreaks of legionella and other diseases related to poor water treatment standards.

How did we come to this mess? After all, indoor plumbing was installed in housing to help conquer tuberculosis, typhoid, and cholera as part of the sanitation movement—and it worked! But today, the reality is that the failure to invest in infrastructure maintenance and improvements has provided local water authorities with limited options and complex, delicately balanced water chemistry trade-offs. Adding or subtracting one water treatment option often leads to unintended outcomes resulting in dire public health consequences. In a previous blog, "Infrastructure and Mortgages," we wrote that lead in water and housing in general must be part of the nation’s infrastructure rebuilding.

Are we really going to allow our nation to be forced to buy millions of plastic bottles to access drinkable water, instead of a high-quality water supply system? We should also point out that the quality of that bottled water and all those plastic bottles have their own problems and environmental costs.

What does this mean for parents? I recently had the opportunity to sample the water in the home of a friend with a newborn baby. They had previously gut-rehabbed their home and had asked the local water and sewer authority to sample their water for lead content. The results suggested a very low level—but  this was after flushing the system for 5-10 minutes, which means it didn’t determine the presence of a lead service line or lead in solder for copper pipes, and it didn’t reflect the water they actually drank. (Do you know anyone who runs the faucet for five minutes before filling a glass or pot with water?) As part of the rehab, their contractor had replaced the lead service line on their private property but failed to notify the water authority, who would’ve replaced the section on the public side at the same time as the private side was being replaced. The mom and dad thought the problem had been taken care of, but they asked me to check just to be sure. When I sampled the water, I did a first-flush and then, using a back-of-the-envelope calculation, took a second sample after a two-minute flush, which I suspected would be the water that had stayed in the public side of the lead service line overnight. Sure enough, when I got the results back, the second sample was much higher than what the earlier testing had showed. I contacted the local water authority, and they confirmed that they had not replaced their public section of the lead pipe, but they said they would do so after I sent them the results, which I did.

Parents shouldn’t have to put up with such a scattershot, hit-or-miss approach. We have to do better. And we have to put our people back to work with good paying jobs to fix things like this, instead of waiting for children to get sick or overexposed to contaminants. Here’s what needs to happen:

  1. Make drinking water quality a clear part of the healthy homes strategy. There are currently eight key principles for such a home: A healthy home means one that is free of excessive moisture and mold, free of injury hazards, properly ventilated, well-maintained, clean, free of pests, thermally controlled, and free of contaminants. “Free of contaminants” includes a drinking water supply without lead or other contaminants.
  2. Locate exactly where drinking water lead pipes are located using state-of-the-art technologies. (We created technologies to locate lead in paint, and we can do it for water too).
  3. Improve water treatments to minimize lead and other chemicals and contaminants entering the drinking water system.
  4. Implement a long-term plan to replace all lead drinking water pipes
  5. Implement a plan to eliminate other contaminants and biological agents.
  6. Create a health-based exposure standard for lead in water like we have for lead in dust and soil and enforce it. The current EPA maximum contaminant level goals in drinking water for lead is “zero,” which doesn’t help anyone to make real decisions on taking action.
  7. Fund an infrastructure improvement program that includes improving children’s health. (It makes no sense to treat children only after they get sick—that’s expensive and causes needless suffering.)
  8. Ensure that the infrastructure work creates good paying jobs for our people. An estimate suggests that at least 75,000 jobs can be created for lead mitigation alone doing this type of work. 
  9. Implement the recommendations provided in National Environmental Health Partnership Council’s Environmental Health Playbook: Investing in a Robust Environmental Health System.
  10. Implement the National Safe and Healthy Housing Coalition's “Find It, Fix It, Fund It” campaign, which would save billions of dollars and protect our children.

The science is clear, and we must act on what it tells us, not ignore it or create some so-called “alternative facts.” That action must include all of us—parents, citizens, government, private and public entities, foundation, workers, engineers, scientists, and advocates. 

There is simply no reason to tolerate lead or other contaminants in our drinking water. I’m going back to my friend’s house to see what happens when that pipe gets replaced. But it should never have happened in the first place. And if we eliminate the lead, we eliminate exposures. We’ve taken lead out of food canning, gasoline, new paint, many consumer products, and we have efforts to address lead in existing homes—all of which have succeeded in reducing blood lead levels by more than 90% over the past several decades. But with over half a million children with too much lead, we can and must do better.

Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Helping Older Adults to Age Gracefully in Place

When my mom was in her early seventies, her health began to decline. It seemed like she had appointments with different specialists every other day: endocrinologist, cardiologist, ophthalmologist, podiatrist, dentist, general physician, et cetera, et cetera. I don’t know if she talked to a doctor about her increasing physical weakness, but there didn’t seem to be an appointment for this problem, which rapidly and distressingly worsened. She went from walking on her own to a cane and to a walker, and her frailty sometimes caused her to fall in her own (admittedly cluttered) home. Luckily, these falls did not often land her in the ER; however, they were scary and debilitating, and she became more and more reluctant to venture outside her home, finally no longer even walking to the end of her own short driveway to pick up her mail.
This rather unremarkable story is surely familiar. Frailty, falls, and fear are all too often perceived as a “normal” part of aging. Older adults – particularly those living on a fixed income and dealing with adverse health conditions – may not be able to adequately maintain their homes or move safely within those homes, making falls and unplanned hospitalizations a distinct hazard. Low-income adults are particularly vulnerable to this scenario because they may have even less money and little or no access to needed healthcare. NCHH’s new Aging Gracefully in Place study hopes to demonstrate that this story does not have to be the norm for older adults.

NCHH is collaborating with Johns Hopkins School of Nursing (Hopkins) and organizations in four communities around the country to evaluate the replicability of Hopkins’ “Community Aging in Place, Advancing Better Living for Elders” (CAPABLE) intervention program.Hopkins’ CAPABLE program is a client-centered, home-based, unified set of interventions utilizing an occupational therapist (OT), a registered nurse (RN), and a home improvement professional (see text box) to increase older adults’ mobility and physical function so they can more safely age in place and move more independently both inside and outside their homes.

Archstone Foundation and the Harry and Jeanette Weinberg Foundation are funding the CAPABLE interventions, and the U.S. Department of Housing and Urban Development’s (HUD) Office of Policy Development and Research (PD&R) is funding an evaluation to determine whether the Hopkins’ CAPABLE program improves low-income elders’ physical function and decreases home safety hazards both immediately after CAPABLE interventions are completed and one year after they began.

The three-year Aging Gracefully project is helping these organizations help 142 low-income elders in their communities remain safely in their cherished homes as long as possible. Without a doubt, my mom would have been happier if a program like CAPABLE could have helped her to move confidently in and around the home she’d lived in for almost 50 years. 

Through this formative evaluation, Aging Gracefully is also fostering a learning community among the following four diverse partners to see if Hopkins’ CAPABLE program can be replicated in their communities and to document vital information needed to scale up and sustain the CAPABLE program across the country:
The CAPABLE program has already shown promise in Baltimore, MD (see text box above). The hope is that CAPABLE and other similar programs will ultimately fit within larger efforts, such as the “Well-Home Network.” In collaboration with LeadingAge and Families USA, NCHH is working on a plan to design and implement this national network of housing-based service models (HBSMs) at affordable nonprofit housing organizations to ensure that low-income older adults age successfully in their communities by helping them to achieve better health, well-being, and social engagement while also reducing Medicare and Medicaid costs.

COMMENT: What’s your story? NCHH wants to hear from you. Tell us how a program in your area has or could have benefited your aging parents or relatives. Leave your comment on our Facebook page, or tell your story here

1©2015 Johns Hopkins University. All rights reserved.

Jill Breysse, CIH, Project Manager, has worked for NCHH since 1998. During that time, she has overseen more than 10 healthy homes research studies, analyzing the relationship between green affordable housing renovation and health outcomes and exploring the impact of energy retrofits on both lead poisoning and asthma outcomes. Ms. Breysse has authored several peer-reviewed research articles evaluating healthy homes hazard assessment tools and interventions. Most recently, she was lead author of guidance on conducting health impact assessments for housing decisions and helped to develop the National Healthy Homes Standard, an evidence-based standard of care for existing owner-occupied and rental housing. 

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