Evidence

The National Center for Healthy Housing (NCHH) conducts research on key aspects of childhood lead poisoning and lead hazard control and reducing exposure to allergens and other residential hazards. The results have been used to shape federal and state regulations.

The research agenda at NCHH is organized around these guiding principles:

1. Discover and/or verify the varied links and interactions between housing and health.
2. Discover and/or verify housing interventions that support and/or improve health.
3. Provide the evidence base for new guidelines, regulatory standards, and legislation.
4. Standardize and improve methods of detecting and controlling housing-related health hazards.
5. Present findings in varied formats, including but not limited to peer-reviewed scientific literature, conference presentations, and the popular press.
6. Continue efforts to combat childhood lead poisoning by ensuring policies are practical and scientifically valid.

Housing and community conditions have a major impact on health. The research resources provided here are designed to help you find the evidence-based information you need to support health and housing interventions and programs in your community. In addition to these resources, please see NCHH’s extensive resources library.

Housing Interventions to Improve Health

A Systematic Review of Housing Interventions and Health: Introduction, Methods, and Summary Findings
This article reviews evidence on the effectiveness of specific housing interventions to improve health. Studies were categorized according to the type of intervention, how and where it was delivered, and its target population. A description of the project’s research methods and summary findings are provided along with companion articles and resources, which provide greater details about the reviewed housing interventions. NCHH also provides a report version (listed directly below) of the same findings. [url, pdf; Journal of Public Health Management & Practice, 2010]

Housing Interventions and Health: A Review of the Evidence
This report, assessing the impact of housing interventions on health, is based on an exhaustive review of scientific literature on housing and neighborhood-level interventions to improve housing. The review was conducted by a panel of health and housing experts who employed two broad categories of evidence, clinical and environmental or housing measures, to make their determination about the efficacy of the intervention. Findings ranged from sufficient evidence of effectiveness to no evidence or ineffective, with results indicating that specific housing interventions can improve certain health outcomes. [pdf; NCHH, 2009]

Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions – Children and Adolescents with Asthma
Based on a review of 23 studies, the Community Preventive Services Task Force recommends the use of home-based multitrigger, multicomponent interventions with an environmental focus for children and adolescents with asthma. The recommendations are based on strong evidence of effectiveness in improving asthma symptoms and reducing the number of school days missed due to asthma. The task force found that home-based multitrigger, multicomponent interventions with a combination of minor or moderate environmental remediation with an educational component provides good value for the money invested. [url; Community Preventive Services Task Force]

Housing and Community Interventions to Improve Health

The Community Guide
This website provides findings and systematic reviews from the U.S. Department of Health and Human Services’ Community Preventive Services Task Force (CPSTF). The Community Preventative Services Task Force develops recommendations and determines evidence gaps to help inform federal, state, and local health practitioners. The Community Guide focuses on interventions to improve community health and well-being: which interventions have worked, target populations, and potential costs and benefits. The site features extensive information on health issues ranging from diabetes to health equity to nutrition. Its tool box provides a collection of public health materials to help users assess and carry out evidence-based public health strategies and interventions. The tool box includes case studies, fact sheets, evaluations, templates, and other materials that public health practitioners can adapt to help them plan and design effective interventions. [url; CPSTF]

CDC Community Health Improvement Navigator
This interactive database of inventions allows users to specify a variety of filters (such as populations, risks, and types) to search for reports related to specified factors. Studies and reports fall under four action areas: socioeconomic factors, physical environment, health behaviors, and clinical care. [url; CDC]

Housing Quality and Health

State of Healthy Housing
This biennial report issued by NCHH assesses the health of housing using 20 key factors from the 54 communities sampled by the American Housing Survey (AHS). Local communities could create their own assessment of housing quality using similar housing quality characteristics; e.g., interior and exterior leaks, signs of pests, and other factors collected by local public health and code enforcement agencies. [url; NCHH, 2020]

Housing Code Violation Density Associated with Emergency Department and Hospital Use by Children with Asthma
Local agencies that enforce housing policies can partner with the healthcare system to target pediatric asthma care. Code enforcement agencies have data that can help pinpoint potential clusters of high asthma morbidity. This study assesses whether the density of housing code violations in census tracts and relevant violations (such as the presence of mold or cockroaches) was associated with population-level asthma morbidity. The study found that increased density in housing code violations was associated with population-level morbidity independent of poverty. [url; ResearchGate, 2014]

San Francisco Children Living in Redeveloped Public Housing Used Acute Services Less than Children in Older Public Housing
Poor housing quality is a predictor of poor health and developmental problems in low-income children. This report examined the association between public housing and recurring pediatric emergency and urgent care hospital visits. It was found that children living in non-redeveloped public housing were more likely to have one or more repeat visits within one year for acute healthcare services, compared to children who lived in redeveloped HOPE VI housing. No differences in repeat visits was found between children in redeveloped HOPE VI housing and in nonpublic housing. [url; ResearchGate, 2014]

Best Practices for Effecting the Rehabilitation of Affordable Housing
Rehabilitating and maintaining our aging housing stock is one key mechanism to help meet the nation’s affordable housing needs. However, renovating affordable housing is fraught with institutional and regulatory barriers. The existing stock varies greatly in condition and age, making the rehab process far less predictable and, often, more challenging than new construction. This report from HUD examines potential solutions to some of the major barriers encountered with urban rehab projects and offers a set of practices that have successfully overcome challenges throughout every stage of the rehabilitation. [pdf; HUD, 2006]

Improving Health of Housing in South King County
This paper, prepared for the Housing Development Consortium of Seattle King-County (HDC), examines policies to improve health and housing quality in South King County, WA. The authors conducted a national literature review to determine best practices to address unhealthy housing and interviewed key officials and stakeholders from cities in South King County to better understand local programs and their effectiveness. Based on their finding, the authors developed a set of best practices which they recommended be implemented in South King County to improve housing conditions and related health outcomes. [pdf; Housing Consortium, 2015]

CDC Lead Poisoning and Healthy Homes Publications
The CDC site provides access to data and surveillance reports, as well as a range of CDC-sponsored research publications related to lead hazards and healthy homes. [url; CDC]

HUD Office of Lead Hazard Control and Healthy Homes (OLHCHH)
The OLHCHH site focuses specifically on interventions and programs to improve the quality of housing, especially for vulnerable populations. Available resources include access to healthy homes videos, upcoming events, and key technical studies. [url; OHLCHH]

Green Building and Health

Green & Healthy Homes Initiative (GHHI)
The Green & Healthy Homes Initiative (GHHI), directed by the Coalition to End Childhood Lead Poisoning (Coalition), addresses the health and energy efficiency needs of a home through holistic intervention models. The initiative is a national effort to integrate lead hazard control, healthy homes and weatherization, and energy efficiency work. GHHI’s site features key information about what makes a home green and healthy, and links to resources for homeowners and policymakers about major health hazards that can be found in homes, ranging from asbestos to pests.

Health Outcomes and Green Renovation of Affordable Housing
This article discusses an NCHH study that examined the health impact of green building renovation on residents living in a multifamily property in southwest Minnesota. The researchers found significant health improvements following low-income housing renovation that complied with green standards and recommended that all green building standards include health requirements. Additionally, they found that collaboration of housing, public health, and environmental health professionals through integrated design holds promise for improved health, quality of life, building operation, and energy conservation.

Green Rehabilitation of Elder Apartment Treatments (GREAT)
The GREAT study was one of the nation’s first examinations of the health outcomes among older Americans following rehabilitation using green healthy housing methods. The study hypothesized that public housing renovated using green healthy housing standards could improve the mental and physical health of residents. Evaluation activities included development of assessment protocols, data entry and analysis, execution of quality assurance activities; and completion of evaluation reports. Green renovations such as improved ventilation, moisture and mold reduction, and various safety measures resulted in improved mental and general physical health, prevented falls, and reduced exposure to tobacco smoke. [url; NCHH, 2013]

How Healthy Are Green Building Programs?
This NCHH report examines several leading green building programs including Leadership in Energy and Environmental Development in Design (LEED) from the U.S. Green Building Council, Enterprise Community Partners’ Green Communities Criteria, the International Code Council’s (ICC) National Green Building Standard, and the EPA’s Energy Star with Indoor Air Package Pilot to assess how these programs incorporate healthy homes principles and practices into their standards. [pdf; NCHH, 2008]

Building Products and Health

Healthy Building Network (HBN)
HBN focuses on the use of hazardous chemicals in building products and their impact on human health and the environment. The site offers current health reports about particular products commonly used in building production, such as PVC and recycled content materials, and products that impact specific health issues, such as asthma.HBN also sponsors the Pharos Project, an independent, comprehensive database that identifies health hazards associated with building products. Pharos encourages manufacturers to disclose all ingredients in building products; helps architects, designers, and building owners avoid using products that contain harmful chemicals; and creates incentives for product redesign and modification to reduce the impacts of hazardous materials use throughout the life cycle of building products.

• Asthmagens in Building Materials: The Problem & Solutions
  Hundreds of substances can cause the onset of asthma, many of which are common ingredients in building products such as insulation, paints, adhesives, wall panels and floors. This paper identifies asthmagens found in building products, how people can be exposed to them, and what is known and speculated about the impacts of these exposures. [url; HBN, 2014]
• Full Disclosure Required: A Strategy to Prevent Asthma through Building Product Selection
  This exhaustive investigation of asthma-causing chemicals in building materials identifies commonly-used interior building materials likely to contain chemicals that cause the onset of asthma, examines emerging evidence of how early childhood exposures to these chemicals are of particular concern, and looks at how existing indoor air quality programs and green building rating systems do not yet address this growing public health crisis. It also provides clear strategies for preventing building occupant exposures through product disclosure and green chemistry. [url; HBN, 2013]

Health Impact Assessments (HIA)

Health Impact Project
This initiative, created through a collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts, promotes the use of health impact assessments (HIAs) for community development decisions. The site provides access to HIA reports conducted by communities across the county, policy briefs, research, tool kits, and training materials. One of the project’s endeavors is the Collaboration for Green and Healthy Development, a partnership with Enterprise Green Communities (EGC) and the U.S. Green Building Council (USGBC) to streamline comprehensive and systematic considerations of health in the EGC Criteria and the USGBC’s Leadership in Energy and Environmental Design (LEED) certification programs. Although both programs currently include health measures, it is hoped that the collaboration will serve to strengthen and expand the consideration of health. [url; Pew Charitable Trusts]

Social Determinants of Health and Housing and Community Development

A Simplified Framework for Incorporating Health into Community Development Initiatives
This article lays out a simple framework to identify and measure potential health effects, actions to create positive health impacts, and strategies to mitigate potential negative impacts. The framework is drawn from an analysis of health impact assessments and includes four elements: identifying the health status of the target population, considering neighborhood-level health influences, building design features important to health, and incorporating community engagement and capacity-building activities into the initiative. [pdf; Health Affairs, 2015]

Building Healthy Places Initiative
This initiative from the Urban Land Institute (ULI) helps make the link between human health and development. The site provides evidence-supported research and publications to help enhance health outcomes in real estate developments. The site features reports such as America in 2015, a survey of view about housing, transportation, and community; and resources including a Building Healthy Places Toolkit, to help incorporate health into the built environment; as well as a host of other resources and reports to help developers build with health in mind. [url; ULI]

Center on Society and Health (CSH), Virginia Commonwealth University
This academic research center studies the health implications of social factors – such as education, income, housing, and environmental conditions – on neighborhoods and communities. CSH’s work looks at conditions affecting Americans nationwide with a focus on connections between society and health. A few of the CSH’s current projects include the Health Opportunity and Equity (HOPE) Initiative, Bringing Best Practices to Housing Redevelopment, and Mapping Life Expectancy. [url; CSH]

Related

Investigate the Evidence: NCHH’s Research and Reports [url; NCHH]

Last page update: November 24, 2021.