Healthy home environment assessments

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-MHE, Kearney 2014). Programs typically focus on improving asthma management via low cost changes such as improved ventilation, integrated pest management (IPM), 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 (Campbell 2015*, Krieger 2015*).

Expected Beneficial Outcomes (Rated)

  • Reduced exposure to allergens

  • Reduced hospital utilization

  • Improved health outcomes

Other Potential Beneficial Outcomes

  • Improved asthma management

  • Improved quality of life

  • Improved indoor air quality

Evidence of Effectiveness

There is strong evidence that healthy home environment assessments encourage household behaviors that reduce asthma triggers and exposure to allergens (Uchima 2019*, Welker 2018*, LeCann 2017, Jassal 2013*), decrease use of urgent care and related health care costs (Welker 2018*, Jassal 2013*, Gomez 2017*, Turcotte 2018*, Campbell 2015*, Kearney 2014), and improve health outcomes (Uchima 2019*, Welker 2018*, Campbell 2015*, Jassal 2013*, Krieger 2015*).

Healthy home environment assessments conducted by community health workers (CHWs) or trained asthma outreach workers reduce children’s allergy and asthma symptoms, use of asthma medications, and asthma-related hospital visits (Welker 2018*), and may also reduce the number of asthma-related doctor’s appointments (Mankikar 2016). Programs have been shown to improve asthma self-management, increase the number of asthma symptom free days (Uchima 2019*, Turcotte 2018*, Kearney 2014, Kapheim 2015*, Margellos-Anast 2012*), and can reduce activity restrictions for asthmatic children (Uchima 2019*). Programs improve quality of life (Uchima 2019*, Turcotte 2018*, Kearney 2014, Kapheim 2015*, Margellos-Anast 2012*) and reduce school and work absences for asthmatic children and their caregivers (Uchima 2019*).

Healthy home environment assessment programs benefit adults and children with asthma in urban and rural areas (Gomez 2017*) and reduce racial and ethnic disparities in health outcomes among children with asthma (Uchima 2019*). Such programs increase the use of air filters, improve allergy and asthma symptoms, and reduce exposure to secondhand smoke (SHS) for urban, minority children from low income families (Welker 2018*), as well as for asthmatic adults and children in lower quality housing (Krieger 2015*, Campbell 2015*). Programs have also been shown to improve home air quality and reduce urgent care admissions for minority and disadvantaged families in rural areas (Kearney 2014, Postma 2011).

Healthy home environment assessments improve user comfort, including temperature and humidity, and may reduce the presence of molds (LeCann 2017). Programs can increase knowledge of home hazards and reduce them, including basement, roof, and plumbing leaks, particularly if program methods and materials are sensitive to low literacy levels and cultural differences among participants (Mankikar 2016).

Economic evaluations indicate healthy home environment assessments achieve high cost savings largely due to averted urgent care clinic visits, emergency room visits, and hospitalizations (Uchima 2019*, Jassal 2013*, Gomez 2017*, Kearney 2014, Margellos-Anast 2012*). Low-intensity, healthy home environment assessment programs for people with asthma show greater cost reductions when services are targeted to those with the worst controlled asthma, including children and adults in rural and urban settings (Gomez 2017*).

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 (Campbell 2015*, 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 (ECAPP, Kearney 2014). The Minnesota Department of Health’s Asthma Program offers training, resources, and mentoring for local public health agencies interested in delivering asthma home-based services, including environmental assessments (MN DOH-Asthma toolkit).

Implementation Resources

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

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.

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.

LHS - Local Housing Solutions (LHS). To enhance local affordability and foster inclusive communities. New York University, Furman Center and Abt Associates, Inc.

MN DOH-Asthma toolkit - Minnesota Department of Health (MN DOH). Asthma home-based services toolkit.

Citations - Evidence

* Journal subscription may be required for access.

Uchima 2019* - Uchima O, Sentell T, Dela Cruz MR, Braun KL. Community health workers in pediatric asthma education programs in the United States: A systematic literature review. Children’s Health Care. 2019;48(2):215-243.

Welker 2018* - Welker K, Nabors L, Lang M, Bernstein J. Educational and home-environment asthma interventions for children in urban, low-income, minority families. Journal of Asthma. 2018;55(12):1301-1314.

LeCann 2017 - Le Cann P, Paulus H, Glorennec P, et al. Home environmental interventions for the prevention or control of allergic and respiratory diseases: What really works. Journal of Allergy and Clinical Immunology: In Practice. 2017;5(1):66-79.

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.

Gomez 2017* - Gomez M, Reddy AL, Dixon SL, Wilson J, Jacobs DE. 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. 2017;23(2):229-238.

Turcotte 2018* - Turcotte DA, Chaves E, Gore R, Adejumo KL, Woskie S. The impact of housing type on low-income asthmatic children receiving multifaceted home interventions. Public Health. 2018;164:107-114.

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.

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.

Mankikar 2016 - Mankikar D, Campbell C, Greenberg R. Evaluation of a home-based environmental and educational intervention to improve health in vulnerable households: Southeastern Pennsylvania lead and healthy homes program. International Journal of Environmental Research and Public Health. 2016;13(9):1-15.

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.

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.

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.

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.

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.

ECAPP - Eastern Carolina Asthma Prevention Program (ECAPP). Reduce asthma attacks, emergency department visits and asthma hospitalizations among rural, low income families with children with asthma.

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.

MN DOH-Asthma toolkit - Minnesota Department of Health (MN DOH). Asthma home-based services toolkit.

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