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Healthy home environment assessments

Evidence Rating

Scientifically Supported

Health Factors

Healthy home environment assessments engage home visitors, often community health workers (CHWs), similarly trained asthma outreach workers, other professionals, paraprofessionals, or volunteers to assess and remediate environmental health risks within the home (, ALA-MHEKearney 2014). Programs typically focus on improving asthma management via low cost changes such as improved ventilation, integrated pest management, and other forms of allergen control. Programs may also provide low emission vacuums, allergen-impermeable bedding covers, air filters, cleaning supplies, and supplies for roach abatement ().

Expected Beneficial Outcomes (Rated)

  • Reduced exposure to allergens

  • Reduced hospital utilization

Other Potential Beneficial Outcomes

  • Improved asthma management

  • Improved quality of life

  • Improved indoor air quality

  • Improved health outcomes

Evidence of Effectiveness

There is strong evidence that healthy home environment assessments encourage household behaviors that reduce asthma triggers and exposure to allergens (, , , , , Hoppin 2006) and decrease use of urgent care and related health care costs (, , Kearney 2014, , ). Additional evidence is needed to confirm long-term effects on health outcomes (, , ).

Healthy home environment assessments conducted by community health workers (CHWs) or trained asthma outreach workers have been shown to improve asthma self-management, increase the number of asthma symptom free days, and improve quality of life for participating children and their caregivers (, Kearney 2014, , ). Such interventions can also improve asthma symptoms for those living in lower quality housing (Hoppin 2006, , ).

Available research suggests that healthy home environment assessment programs are more frequently established in urban areas (Postma 2011). However, such programs have also been shown to improve home air quality and reduce urgent care admissions for minority and disadvantaged families in rural areas (Postma 2011, Kearney 2014). A study of the Home-Based Asthma Support and Education (HomeBASE) program indicates increases in the number of symptom free days and improvements in quality of life for participants of various racial and ethnic backgrounds, genders, ages, and levels of asthma control ().

Economic evaluations indicate healthy home environment assessments achieve high cost savings largely due to averted urgent care clinic visits, emergency room visits, and hospitalizations (, , Kearney 2014, ).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

Healthy home environment assessments are in place throughout the country. For example, Seattle, Washington’s King County Asthma Program, Healthy Homes, engages community health workers (CHWs) to conduct home visits focused on controlling asthma (, Seattle-Asthma program). The Master Home Environmentalist Program (MHEP) launched by Washington’s American Lung Association, trains volunteers to identify health hazards in the home (e.g. dust, lead, household chemicals, mold and other air pollutants), use low cost methods to reduce risks, and train families to improve their home environments (ALA-MHE).

The Eastern Carolina Asthma Prevention Program’s Asthma Case Managers (ACM) provide education and resources to control asthma and allergen triggers in the home, largely to low income families with children (Kearney 2014).

Implementation Resources

Clean Air-HEAL - Clean Air for Kids Partnership. Directions for the do-it-yourself home environmental assessment list (HEAL).

ACEEE-SmarterHouse - American Council for an Energy-Efficient Economy (ACEEE). SmarterHouse: an up-to-date guide on energy savings in the home.

ALA-MHE - American Lung Association (ALA). The Master Home Environmentalist (MHE) Program.

WAC - Children's Health Alliance of Wisconsin. Wisconsin Asthma Coalition (WAC). Home Walkthrough Program: report and checklist to identify low and no-cost solutions to asthma triggers.

Citations - Evidence

* Journal subscription may be required for access.

Hoppin 2006 - Hoppin P, Jacobs M, Ribble M. Enhancing asthma management using in-home environmental interventions: A review of public health department programs. Dorchester: Asthma Regional Council of New England (ARC); 2006.

Postma 2011 - Postma JM, Smalley K, Ybarra V, Kieckhefer G. The feasibility and acceptability of a home-visitation, asthma education program in a rural, latino/a population. Journal of Asthma. 2011;48(2):139-46.

Primomo 2006* - Primomo J, Johnston S, DiBiase F, Nodolf J, Noren L. Evaluation of a community-based outreach worker program for children with asthma. Public Health Nursing. 2006;23(3):234-41.

Campbell 2015* - Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for Medicaid-enrolled children with asthma: Effects on asthma outcomes and costs. American Journal of Public Health. 2015;105(11):2366-2372.

Jassal 2013* - Jassal MS, Diette GB, Dowdy DW. Cost-consequence analysis of multimodal interventions with environmental components for pediatric asthma in the state of Maryland. Journal of Asthma. 2013;50(6):672-680.

Kapheim 2015* - Kapheim MG, Ramsay J, Schwindt T, Hunt BR, Margellos-Anast H. Utilizing the community health worker model to communicate strategies for asthma self-management and self-advocacy among public housing residents. Journal of Communication in Healthcare: Strategies, Media and Engagement in Global Health. 2015;8(2):95-105.

Krieger 2015* - Krieger J, Song L, Philby M. Community health worker home visits for adults with uncontrolled asthma: The HomeBASE trial randomized clinical trial. JAMA Internal Medicine. 2015;175(1):109-117.

Margellos-Anast 2012* - Margellos-Anast H, Gutierrez MA, Whitman S. Improving asthma management among African-American children via a community health worker model: Findings from a Chicago-based pilot intervention. Journal of Asthma. 2012;49(4):380-389.

Kearney 2014 - Kearney GD, Johnson LC, Xu X, et al. Eastern Carolina Asthma Prevention Program (ECAPP): An environmental intervention study among rural and underserved children with asthma in Eastern North Carolina. Environmental Health Insights. 2014;8:27-37.

Citations - Implementation Examples

* Journal subscription may be required for access.

Campbell 2015* - Campbell JD, Brooks M, Hosokawa P, et al. Community health worker home visits for Medicaid-enrolled children with asthma: Effects on asthma outcomes and costs. American Journal of Public Health. 2015;105(11):2366-2372.

Kearney 2014 - Kearney GD, Johnson LC, Xu X, et al. Eastern Carolina Asthma Prevention Program (ECAPP): An environmental intervention study among rural and underserved children with asthma in Eastern North Carolina. Environmental Health Insights. 2014;8:27-37.

Seattle-Asthma program - Public Health: Seattle & King County. Guidelines to Practice (G2P): Reducing Asthma Health Disparities through Guideline Implementation. Program works with clinics, health plans, and with patients in their homes to improve asthma care of children and adults.

ALA-MHE - American Lung Association (ALA). The Master Home Environmentalist (MHE) Program.

Date Last Updated

Jul 27, 2016