The New York State Healthy Neighborhoods Program: Articles, Abstracts, and Supplements

Project Funder: U.S. Department of Housing and Urban Development (HUD)

Project Partner: The New York State Department of Health

Project Contact: Amanda Reddy, areddy@nchh.org, 443.539.4152

This page collects materials pertinent to three interrelated research articles stemming from the following research projects:

The New York State Healthy Neighborhoods Program: Findings from an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program
An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children
A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents with Asthma: Findings from the New York State Healthy Neighborhoods Program

Article 1

The New York State Healthy Neighborhoods Program: Findings from an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program

Authors: Amanda L. Reddy, MS, BA; Marta Gomez, MS, BS; Sherry L. Dixon, PhD, MS

Context: A growing evidence base suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation.

Objective: To evaluate the impact of a large-scale, multisite, state-funded healthy homes program.

Setting: Homes in high-risk neighborhoods of 13 counties funded under the New York State Healthy Neighborhoods Program (NYS HNP) from 2008 to 2012.

Participants: A total of 28,491 homes received an initial visit and 6,436 dwellings received a revisit (follow-up assessment 3-6 months post-intervention). A majority of residents are low-income renters living in buildings built prior to 1950.

Intervention: The NYS HNP is a low-intensity healthy homes program. Participating homes undergo a visual assessment to identify potential environmental health and safety hazards, and interventions (education, referrals, and products) are provided to address any hazards identified during the visit.

Main Outcome Measures: The proportion of homes affected by several types of housing hazards, improvement in hazards among revisited homes, and the change in the overall number of hazards per home were assessed.

Results: Among the homes that were revisited, there were significant improvements in tobacco control, fire safety, lead poisoning prevention, indoor air quality, and other hazards (including pests and mold). There was a significant decrease in the number of hazards per home (2.8 to 1.5; P < .001), but homes were not hazard-free at the revisit.

Conclusion: This evaluation suggests that a comprehensive, low-intensity healthy housing approach can produce short- term impacts with public health significance.

Digital Supplements Relating to Article 1

Digital Supplement 1: NYSDOH Healthy Neighborhoods Program and Asthma Forms [pdf]
Digital Supplement 2: Conditions Considered for the Housing Hazard Score [pdf]
Digital Supplement 3: NYSDOH Healthy Neighborhoods Program Scannable Form User Manual [pdf]
Digital Supplement 4: Bivariate Associations Between Pairs of Housing Hazards [pdf]

Article 2

An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children

Authors: Amanda L. Reddy, MS, BA; Marta Gomez, MS, BS; Sherry L. Dixon, PhD, MS

Context: Reducing exposure to environmental triggers is a critical part of asthma management.

Objective: To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies.

Setting: The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors.

Participants: Residents with asthma were recruited through three mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings.

Intervention: The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted three to six months after the initial visit.

Main Outcome Measure(s): The analysis compares improvements across the three groups for measures of asthma self-management, healthcare access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated.

Results: Among 1,465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, healthcare access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and healthcare access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group.

Conclusion: Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to healthcare access and self-management. Healthcare payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

Digital Supplements Relating to Article 2:

Digital Supplement 1: NYSDOH Healthy Neighborhoods Program and Asthma Forms [pdf]
Digital Supplement 2: Prevalence of and Improvement in Asthma Triggers and Trigger Promoting Conditions, by Recruitment Group [pdf]

Article 3

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents with Asthma: Findings from the New York State Healthy Neighborhoods Program

Authors: Marta Gomez, MS, BS; Amanda L. Reddy, MS, BA; Sherry L. Dixon, PhD, MS; Jonathan Wilson; David E. Jacobs, PhD

Context: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few healthcare payers reimburse or provide coverage for these services.

Objective: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program.

Design: Pre- versus post-intervention comparisons of asthma outcomes for visits conducted during 2008-2012.

Setting: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors.

Participants: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year.

Intervention: The program provides home environmental assessments and low-cost interventions to address asthma trigger–promoting conditions and asthma self-management. Conditions are reassessed three to six months after the initial visit.

Main Outcome Measures: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period.

Results: For asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311.

Conclusion: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of healthcare utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale.

Digital Supplement Relating to Article 3: