Integrating New York’s Healthy Neighborhoods Program into Housing Rehabilitation: Initial Lessons from the ROC HOME Study

by Katrina Smith Korfmacher and Becca Lauzon, University of Rochester

Promoting healthy homes requires thinking about housing and humans; however, many programs focus just on one or the other. We asked: Can programs that provide grants to fix up homes do more to engage residents and ensure they have the knowledge, skills, and tools for keeping their homes healthy? And can this help promote families’ health after the contractors leave?

In the ROC HOME study, we studied what happens when resident engagement is included in healthy homes renovation programs. The ROC HOME study worked with owner-occupant families participating in Rochester’s HUD-funded healthy homes housing grant program between 2020 and 2025. The study was co-led by Dr. Robin Dodson of the Silent Spring Institute and our team at the University of Rochester, partnered with the City of Rochester, Rochester Energy Efficiency and Weatherization (RENEW), and the National Center for Healthy Housing (NCHH). The study was supported by HUD’s Healthy Homes Technical Studies program, the National Institute of Environmental Health Sciences, and the Konar Foundation.

Government, private, and community programs spend millions each year on grant programs to make homes healthier and safer. Decades of research by NCHH and others show that these repairs can have long-term effects on reducing hazards, particularly lead hazards, and improving residents’ health (Dixon et al., 2012; Clark et al., 2011). The ROC HOME team wondered whether housing repair programs could also reduce other kinds of contaminants in dust—like asthma triggers, pesticides, and plastic chemicals—and whether engaging residents with education and basic supplies could magnify these programs’ effects.

When we were designing the ROC HOME study, we needed to find a model for how to engage with residents in a low-cost, simple, and effective way. We wanted this “resident engagement intervention” to be replicable, so that if it worked it could be readily integrated into housing rehabilitation programs in other states or even nationally. Luckily, we didn’t have to look any farther than New York State’s Healthy Neighborhoods Program (HNP).

Since 1985, the HNP has helped tens of thousands of families. The HNP operates in 17 counties and New York City. It varies according to local needs, but the basic idea is the same: Families in high-risk areas can sign up for home visits to receive educational materials, referrals to local resources, and low-cost healthy home supplies. HNP home visitors engage with residents to help them reduce home hazards through safer cleaning, integrated pest management, reduced chemicals use, improved ventilation, and home maintenance (furnace filter replacement, et cetera). The per-visit cost of this program is low, visits are short, and they can be carried out by home visitors with a wide range of training and skills. Many HNP home visitors come from the communities they serve. And… it works! The HNP program has been found to be effective in reducing home hazards and extremely cost effective, particularly for asthma prevention (Gomez et al., 2017; Reddy et al., 2017; Reddy et al., 2017).

Dr. Katrina Korfmacher interviews a ROC HOME study participant.

The HNP is based on a checklist that supports a dialogue between the resident and home visitor focused on the hazards of greatest concern to each family. ROC HOME built on this model by adding questions about other contaminants of particular concern for children’s health, like phthalates, pesticides, and fragrance chemicals. For example, we added questions about the use of air fresheners, some of which can be a source of endocrine-disrupting chemicals in household dust. We used this “HNP+” survey as the foundation for engaging residents in ROC HOME.

The ROC HOME study visited participants’ homes multiple times to collect dust samples and conduct the HNP+ survey. We also provided a “healthy home kit” that included safer cleaning supplies, dryer balls to replace scented dryer sheets, a hygrometer for tracking humidity, and a HEPA-filtered vacuum cleaner. Many of the HNP+ questions relate to physical home conditions, while others relate to behaviors and choices about consumer products like cleaners, air fresheners, and pesticides.

Dr. Katrina Korfmacher delivers a healthy home kit for the ROC HOME study in 2021.

The ROC HOME study visited participants’ homes multiple times to collect dust samples and conduct the HNP+ survey. We also provided a “healthy home kit” that included safer cleaning supplies, a hygrometer for tracking humidity, and a HEPA-filtered vacuum cleaner.
We will be learning from the dust samples collected during these home visits for years as we conduct additional analyses. Meanwhile, the HNP+ survey results and participant interviews are already providing insights into how engaging residents through this low-cost intervention could magnify the positive effects of housing grants on residents’ health. Overall, participants reported taking more healthy home actions after participating in the ROC HOME HNP+, such as in the following examples:

• Using doormats, vacuuming at least weekly, and cleaning in ways likely to reduce lead dust.
• Engaging with family members to practice fire drills and remove shoes when entering the house.
• Reducing use of products with harmful chemicals, like scented detergents, dryer sheets, and air fresheners.
• Maintaining their home’s systems in new ways, like changing furnace filters and lowering the hot water temperature to avoid burns and save energy costs.

As with previous studies of New York’s HNP, ROC HOME is showing that low-cost supplies and education can support habits and practices likely to promote a healthy home over the long term.

As we continue to learn more from the ROC HOME data, we hope our findings will improve future healthy home programs by identifying low-intensity approaches that reduce exposure to lead, allergens, pesticides and other chemicals in the home. ROC HOME gives us a chance to explore whether resident engagement can multiply the health benefits of housing interventions. We hope our findings will inform sustainable, cost-effective, community-based integration of resident engagement into housing grant programs, housing and health policies, and other interventions to promote public health.

References

Clark, S., Galke, W., Succop, P., Grote, J., McLaine, P., Wilson, J., Dixon, S., Menrath, W., Roda, S., Chen, M., Bornschein, R., & Jacobs, D. (2011, February). Effects of HUD-supported lead hazard control interventions in housing on children’s blood lead. Environmental Research, 111(2), 301-311. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21183164

Dixon, S. L., Jacobs, D. E., Wilson, J. W., Akoto, J. Y., Nevin, R., & Clark, C. S. (2012, February). Window replacement and residential lead paint hazard control 12 years later. Environmental Research, 113, 14-20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22325333

Gomez, M., Reddy, A. L., Dixon, S. L., Wilson, J., & Jacobs, D. E. (2017, March-April). A cost-benefit analysis of a state-funded healthy homes program for residents with asthma: Findings from the New York State Healthy Neighborhoods Program. Journal of Public Health Management and Practice, 23(2), 229-238. Retrieved from https://www.researchgate.net/publication/312926076_A_Cost-Benefit_Analysis_of_a_State-Funded_Healthy_Homes_Program_for_Residents_With_Asthma_Findings_From_the_New_York_State_Healthy_Neighborhoods_Program

Reddy, A. L., Gomez, M., & Dixon, S. L. (2017, March-April). The New York State Healthy Neighborhoods Program: Findings from an evaluation of a large-scale, multisite, state-funded healthy homes program. Journal of Public Health Management and Practice, 23(2), 210-218. Retrieved from https://www.researchgate.net/publication/312929685_The_New_York_State_Healthy_Neighborhoods_Program_Findings_From_an_Evaluation_of_a_Large-Scale_Multisite_State-Funded_Healthy_Homes_Program

Reddy, A. L., Gomez, M., & Dixon, S. L. (2017, March-April). An evaluation of a state-funded healthy homes intervention on asthma outcomes in adults and children. Journal of Public Health Management and Practice, 23(2), 219-228. Retrieved from https://www.researchgate.net/publication/312926292_An_Evaluation_of_a_State-Funded_Healthy_Homes_Intervention_on_Asthma_Outcomes_in_Adults_and_Children

Katrina Smith Korfmacher, Ph.D, Professor of Environmental Medicine at the University of Rochester, is the author of Bridging Silos: Collaborating for Environmental Health and Justice in Urban Communities, which explores the challenges, successes, and lessons learned about collaboration through three case studies in New York, Minnesota, and California. She loves contra dancing, a social folk dance where someone tells you what to do and makes you dance with every single person in the room.

Becca Lauzon, Ph.D, Research Assistant Professor of Environmental Medicine at the University of Rochester and the program manager for the Community Engagement Core of the Environmental Health Sciences Center, loves to bake and hang out with her two cats.