Health of Homes, Arkansas
Assessing the Health of Homes in the Central Little Rock Neighborhood of Arkansas
Ferguson, Alesia, Ph.D. and Welker, Leah, M.P.H.
Alesia Ferguson, Associate Professor
University of Arkansas for Medical Sciences
Environmental and Occupational Health Department
4031 West Markham, Slot 820, Little Rock, Arkansas 72207
Phone: (501) 526-6662 Fax: (501) 526-6750
Leah Welker, Industrial Hygiene Officer
University of Arkansas for Medical Sciences
Occupational Safety and Health, Campus Operations
4031 West Markham, Slot 617, Little Rock, Arkansas 72207
Phone: (501) 686-5543 Fax: (501) 526-6750
Abstract
The quality of the indoor air has received greater consideration in the last decade as Americans spend more time indoors and researchers become more aware of the influence of poor indoor air quality on adverse health outcomes. Since 1998, when the U.S. Department of Housing and Urban Development (HUD) received funds to develop and implement research programs and projects to address research on housing and health, there has been a wealth of useful information and tools developed. This paper presents the assessment of 10 homes in the Central Little Rock Neighborhood of Arkansas, using survey tools adapted from The Healthy Homes Initiative (HHI) and other health agencies to primarily focus on the quality of the indoor air. Results are also presented from measurements taken in the home for indicators of air quality (e.g., VOCs, particulate and humidity levels). Mold, ventilation related deficiencies, and high levels of air particulates relative to the outdoors were the predominant findings in the ten homes. In addition, many behavioral actions were found that could potentially influence the quality of the indoor environment.
Key Words: Indoor Air Quality, Healthy Homes, Ventilation Deficiencies, Seven Healthy Home Principles
Introduction and Background
Americans spend more time indoors in more air tightened homes, and are therefore potentially exposed to a greater concentration of contaminants. The age of electronics and the internet has resulted in children, in particular, spending less time playing and visiting the outdoors. With concerns on energy efficiency, homes are tightened to prevent heat or cold loss. If homes are over tightened and poorly ventilated, contaminates generated in the indoor environment can build up to unsafe exposure levels. Health effects caused from exposure to contaminants are extremely variable based on exposure duration, range of exposure(s), and susceptibility of the individual exposed (Rushton and Elliot, 2003). Residential exposures are likely to be chronic low-level exposures which create non-specific symptoms rather than clearly defined health outcomes making it difficult to establish cause and effect. However, it is well understood that common indoor pollutants, such as: second-hand smoke, combustion pollutants, volatile organic chemicals (VOCs), and various allergens like mold, pet dander, and dust mites can, at the least, exacerbate common health conditions such as asthma (Akinbami and Schoendorf, 2002; Breysse et al., 2004).
Today, public health agencies are faced with growing concerns of health inequalities as it relates to the disproportionate distribution of substandard housing in low-income populations and related health outcomes. Poor housing conditions are associated with a wide range of health conditions, such as: respiratory infections, asthma, lead poisoning, injuries, cardiovascular disease, cancer, and mental health disorders (Commission of the European Communities, 1991; Henry et al., 2006). Individuals with low socioeconomic standards (SES) are more likely to live in substandard housing due to lack of knowledge on the influence of housing and health and lack of resources to maintain and improve conditions in the home (Krieger and Higgins, 2002). Oftentimes, the poor live in poorly maintained rental properties. In general, researchers suspect that racial and ethnic groups have higher morbidity and mortality prevalence that correlates with issues of segregation, and the resulting substandard housing, poor urban air quality, poor indoor air quality, inadequate medical care, and other social factors (Morello-Frosh and Lopez, 2006). Asthma and its relationship to the indoor air has become of greater interest due to its rising incidence rates. Today, over 25 million Americans suffer from asthma (i.e., 8% adults, over 9% of children), with the burden borne by racial and ethnic groups (Asthma and Allergy Foundation of America, 2013). Poor quality housing and its influence on health needs to become an integral part of the discussion as we examine the social, economic, and cultural factors affecting health (Fuller-Thompson et al., 2000).
The Healthy Homes Program Initiative (HHI) was established in 1998, and thereafter, many government, state, and local agencies have collaborated to provide training, outreach, and education programs that promote health and safety within the home environment (HUD, 1991). Additionally, many homes assessment tools/checklists have been developed to help the researcher/assessor identify defencencies in homes that lead to potential hazards and accumulation of harmful contaminants (CDC, 2010b). These assessment tools are applicable and amendable for diverse indoor environments and assist in minimizing chronic exposures to indoor pollutants and other safety hazards in the home. The U.S. Department of Housing and Urban Development (HUD), the Center for Disease Control and Prevention (CDC), the National Center for Healthy Housing (NCHH), and the Environmental Protection Agency (EPA) all have reference guides for addressing specific contaminants in homes and the quality of the indoor air. In addition, these guides also address the benefit of quantitative data, in which measurements give a definitive result for the quality of the air.
The NCHH has established seven well known principles for addressing the health of a home. These include keeping a home dry, clean, pest free, contaminant free, ventilated, maintained, and safe (NCHH, 2008). These principles provide simple and key messages for homeowners to improve the condition of the home. Many of these principles are interrelated and affect the quality of the indoor air. Keeping a home properly ventilated, for example, contributes to a contaminant environment. The American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) also develops guidelines for air quality and emphasizes that the most important factor for improving indoor air quality is ventilation (ASHRAE, 2010). Increasing ventilation with fans, properly functioning and maintained heating, ventilation and air conditioning (HVAC) systems, bathroom exhausts, and opening windows reduces the accumulation of indoor air pollutants in the home.
The Pilot Project reported here was conducted in a low socioeconomic community of Little Rock considered the Downtown, Oak Forest, and West Little Rock areas of Pulaski County (i.e., zip codes 72204 and 72206). Table 1 has some demographics for the zip codes, the county in which the zip codes are located, and the State. The State of Arkansas is very rural, except for a few urban areas, such as Pulaski County (the city of Little Rock can be found here) and Washington County (the city of Fayetteville can be found here). The study area has some revitalization, with wealthier families and business moving in over the last decade. However, this area is still considered relatively poor compared with the rest of metropolitan Little Rock and has a high percent of African Americans. This area has a significant number of homes built before 1979; greater than 72% for the 72206 zip code, and greater than 90% for the 72204 zip code which includes a portion of the downtown area of Little Rock.
The pilot study was designed to identify common hazards related to indoor air quality and for the researchers to develop simple and cost effective healthy home interventions that could be shared with the resident. Assessment tools developed by various agencies were tailored to focus on typical indoor air pollutants and factors influencing the indoor air. The project and its survey instruments were approved by the UAMS Institutional Review Board (IRB) in May, 2012. Consent forms were developed to outline project purpose and procedures for participants, and a simple post survey was created and used as an additional assessment and post-evaluation tool.
Table 1: Demographical Information for Community, County and State
(U.S. Census Bureau, 2010)
Demographic data (2010 unless otherwise indicated / 72204 zip code / 72206 zip code / Pulaski County (2009 data) / Arkansas StatePopulation / 32,505 / 25,624 / 382,748 / 3,915,918
% Non-Hispanic Blacks to Non-Hispanic Whites / 22.4 to 71.9 / 50.5 to 47.2 / 34.8 to 55.3 / 15.3 to 74.5
Population Density per square mile / 2, 129 / 240 / 495 / 56
Adjusted Median Household Income / 31,250 / 37,627 / 41,591 / 40,149
Average Age (years) / 32.6 / 40.7 / 36 / 37.3
Residents with income below the poverty level in 2010 (%) / 17.3 / 20.8 / 16.9 (8.6 for whites and 29 for Blacks / 18.4
Median house/condo value / 85,600 / 86,100 / 131, 900 / 105,100
% Homes Built Before 1979 / >90 / >72 / >61 / 50
Average Household Size / 2.4 / 2.5 / 2.4 / 2.5
Medium number of rooms in house or condos / 5.8 / 6.0 / 5.9 / 5.9
Percent Renters (5) / 45 / 34 / 39 / 33
Methods
Ten homes were assessed between June and September 2012 with the use of 2 surveys instruments and air sampling measurements in the home. Residents were recruited through the Arkansas Community Organization where a presentation was made at their monthly meeting describing project goals and benefits. Members were invited to participate and put their contact information on a form for the researcher to call and schedule an appointment for the home assessment. The first survey instrument was a resident survey, completed by the resident in about 15 minutes with help from the researcher, and contained 28 questions designed to address some behavioral patterns, information on the structural characteristics of the home, and any previous or current problems within the home. Questions on the structural characteristics included: age of home, types of appliances used, structural condition, types of ventilation used, frequency of filter change, general maintenance, previous test for lead and/or radon, functioning smoke and carbon monoxide alarms, and chemical storage location.
The second survey was a visual survey used to identify housing hazards, such as physical condition, types of combustion appliances, and obvious home hygiene-related behaviors (e.g., chemical storage, cleanliness, use of candles, and obvious signs of pets or pests). The walk-though visual inspection was conducted by the researcher and contained 45 reference items and took approximately 60 to 90 minutes. It also included a visual assessment for mold by looking for any obvious sight and/or smell indications of a problem. No assessment for mold was conducted in the crawl space or roof of the homes.
Finally, environmental sampling was used to detect and quantify the concentration of key contaminants or indicators of air quality in the home. Temperature, humidity, carbon monoxide, carbon dioxide, Volatile Organic Compounds (VOCs), and air particulates were sampled. All samples were recorded with date and time and plotted on a generalized floor plan of the home for reference. Factors that could potentially influence reading were recorded (e.g., recently cleaned, pets, cooking). In addition, swab tests were conducted in 6 key areas (i.e., doors and windows) using the Lead Check swabs. Environmental sampling and survey completion lasted 2-3 hours in each home and occurred between 3:30 pm to 6:00 pm. An initial radon test was completed on two homes with results of 0.9 and 3 pCi/L. The home with the 3 pCi/L was measured in a half basement with poor ventilation and possible cracks allowing seepage from the soil. It was recommended to the resident to increase ventilation. This was the only home in the study with a basement. Based on these initial findings and the fact that central Arkansas is not at risk for high radon level based on the EPA Radon map, no further radon test was conducted. Pulaski County, the study area, has a predicted average indoor radon screening level less than 2 pCi/L, and this is considered a low level at which mitigation is not needed (City-Data, 2013). Radon is identified as a key contaminat in many homes across the country and is the second largest contributor to lung cancer following cigarrete smoke (EPA, 2013).
Measurements for temperature, humidity, carbon monoxide, and carbon dioxide were taken in each room of the home. The MultiRae Plus photo-ionization detector (PID) was used to actively measure airborne concentrations of volatile organic chemicals (VOCs). The MultiRae measures concentration levels by internally collecting and recording samples every 30 seconds. The number of samples taken was contingent upon the number of rooms per home. The TSI Q-Trak was used to measure carbon monoxide, carbon dioxide, temperature, and humidity. With the use of TRAKPRO software, the data is stored and results are loaded to computer. The Fluke 983 Particulate Counter was used to measure airborne particles in each room and simultaneously measured and displayed six channels of particle size distribution and their concentration in counts per liter; 0.3µm, 0.5µm, 1.0µm, 2.0µm, 5.0µm, and 10.0µm. Sampling inside the home began in the basement, if one was present, otherwise sampling began on the ground level of the home. A comparative sample was collected outside the home to determine background levels.
ResultS and Discussion:
i. Home Characteristics, Temperature, Humidity, CO2, and CO Results
As homes age, there is greater risk for structural deficiencies and improperly functioning appliances, if poorly maintained. In addition, if a home is built before 1978, there is a chance lead based paint will be found on various surfaces and building materials. The average age of the homes in this study was fifty-seven years old, with the age of the oldest being 1930 and the newest being 1998. In this study, nine residences were single family homes and one was a townhouse. All ten respondents were African American females. This is not surprising as women are more likely to attend community meetings and be more concerned about the home environment, even on behalf of their male counterparts. There were 9 homeowners and one renter. The square footage of a home can contribute to the concentration of exposure. Generally, a larger home will have lower concentrations of contaminates due to a greater volume. There must still be adequate ventilation to filter contaminates out of the air depending on the mass of contaminants generated. The average square footage for the ten homes was 1362 sq. ft., with the smallest being 988 and the largest being 2379 sq. ft.