Boston Healthy Homes and Schools Collaborative (BHHSC) is a program of Health Resources in action. BHHSCs work focuses on health conditions directly related to environmental hazards – specifically asthma and lead poisoning. We provide information, training, and other resources to family childcare providers to promote healthy home daycares. Who We Are Our mission is to promote healthy homes, schools, and childcare facilities in Boston, and enhance the well-being of individuals who live, work, and play in them.
Some of Our Members: Boston Department of Neighborhood Development Boston Public Health Commission Clean Water Action Boston Medical Center Dorchester Environmental Health Coalition MA Coalition for Occupational Safety and Health Massachusetts Department of Public Health Boston Tenants Organization Massachusetts Affordable Housing Alliance Childrens Hospital US Environmental Protection Agency Urban Edge
BHHSC is a Community Resource Conducts trainings and educational sessions for parents, property owners, and childcare providers Provide information and referrals on questions from parents, property owners and local organizations Creates a presence in the community through collaboration, attending community events, partnerships with youth organizations and local universities Convenes interested organizations to coordinate work
What Hazards Exist in the Home? What comes to mind when you think of hazards to health and safety in a home?
What Health Risks are related to the Home Hazards?
Potential Health Effects of Poor Quality Indoor Environment Asthma Triggers Secondhand smoke Pests Mold/Moisture Dust mites Pet dander Chemicals/pesticides Poisoning Carbon monoxide Lead paint Chemicals/pesticides Respiratory and IAQ Effects Building and Household Products Chemicals Injury/Death Falls Fire/electrical CO Carcinogens Radon gas Chemicals/pesticides Wood smoke Developmental delays Lead paint Chemicals/pesticides Multiple Drinking water contamination
Creating a Healthy Home The Seven Principles of a Healthy Home 1.Dry – Damp houses attract mold and other asthma triggers 2.Clean – Clean homes reduce pests and other health risks 3.Pest-Free – Exposure to pests like cockroaches and mice can worsen asthma and cause other health problems. Pesticides are also dangerous to childrens health. 4.Safe – Most injuries occur at home and are usually falls, burns, and poisonings.
Creating a Healthy Home The Seven Principles of a Healthy Home 5.Contaminant-Free – Contaminants in the home include lead, tobacco smoke, and pesticides. 6.Ventilated – Increasing fresh air in the home can improve indoor air quality. 7.Maintained – Poorly maintained homes are at risk of pests, moisture, and other health risks.
Healthy Homes in Boston? What do healthy homes issues look like in Boston? Two major healthy homes issues that Boston residents are faced with are: 1.Lead poisoning 2.Asthma
What is Lead Poisoning? Lead is a heavy metal that was used in paint, gasoline, and other things Young children can become lead poisoned when they swallow or breathe something that contains lead. It is also dangerous for pregnant women. There may be no visible symptoms of lead poisoning at the time of exposure so children should have their blood tested
In New England, lead based paint is the primary source of poisoning. Most homes built before 1978 have lead based paint, and homes built before 1950 are likely to contain even more lead. What is Lead Poisoning? No. 1 Source is Lead Paint Dust
Sources of Lead Poisoning? Most lead poisoned children were exposed by inhaling lead paint dust Children breathe in lead paint dust in the summer when windows are opened and closed frequently, and also when there are home renovations being done
Other Sources of Lead Some plastic toy components and toy jewelry imported from China have tested high for lead levels Tap water: Lead gets into water from leaded pipes, lead solder used to connect water pipes, and some brass faucets Certain candies and spices from other countries
Effects at low levels: Slower development Learning and behavioral problems Reduced motor skills Effects at high levels: In addition to effects listed above, high levels of lead can result in seizures or a coma and can be potentially lethal Health Effects of Lead Lead poisoning is measured by the number of micrograms per deciliter in the blood – called elevated blood lead levels.
Lead and SAT Scores There is a strong relationship between SAT scores and blood lead levels. One study found that as childrens blood lead levels rose, SAT scores dropped, and vice versa. http://www.usatoday.com/news/education/2009-02-02-lead-SAT_N.htm Lead and Violent Crime Another study found that even low levels of lead can cause or lead to permanent brain damage and a higher chance of being arrested, particularly for violent crimes. http://articles.latimes.com/2008/may/28/science/sci-lead28 Long Term Effects of Lead Poisoning Recent Studies
The number one way to protect a child: MAKE SURE THE HOME IS CERTIFIED LEAD SAFE A house is lead safe if it has been inspected and received a letter of lead paint compliance from the MA Dept of Public Health. You can find out the lead status of houses online for free. Preventing Lead Poisoning
A home with a child under the age of 6 living there must be certified deleaded (lead safe) according to MA state law. It is ILLEGAL for a landlord to refuse to rent to someone because they have a child under age 6. It is the property owners responsibility to pay for a lead inspection and deleading if there is a young child living at the house. Prevention Lead Poisoning The MA Lead Law
Renovate Right Regulation on Lead Safe Work Practices The Environmental Protection Agency recently created a rule requiring lead safe work practices while contractors are doing renovation, plumbing, and painting work. This should prevent lead dust from contaminating the living area. This is called the Renovation Repair and Painting Rule.
Renovate Right Regulation on Lead Safe Work Practices Took effect on April 22, 2010 Affects renovation, repair, or painting work on child-occupied facilities built before 1978, including family childcare providers Rule applies if disturbing 6 sq ft of painted surface on inside, or 20 sq ft of paint on the exterior
Renovate Right Regulations How to Comply What must a Childcare Educator do? Ask to see the contractors Renovation, Repair, and Painting training certification. Make sure the contractor provides you with a copy of the Renovate Right booklet Provide renovation notification to families of the children at your childcare You should provide a copy of the Renovate Right booklet to all parents
Renovate Right Regulation Lead Safe Work Practices What are lead safe work practices? Make sure contractors do the following things in order to keep your home free from lead contamination: 1)Contain the work area: cover furniture and floors, seal doorways leading into the work area 2)Minimize dust: spray or mist water on paint before scraping, use power tools with an attached filter to catch dust
Renovate Right Regulation How to Comply 3) Clean up thoroughly: contractors should clean daily with a wet mop and rinse water. Use a HEPA vacuum Pay Attention! Follow the contractors progress to make sure they are working safely. Ask them questions if you are concerned about something you see. Many contractors will do better quality work if they know you are educated about lead safe work practices – so show them you know what youre talking about!
What is Asthma? Cannot be cured but it can be controlled Produces recurring episodes of breathing problems Can be potentially life-threatening In Boston, young children are more likely to be hospitalized from asthma than other age groups Asthma is a chronic respiratory disease and is the most common childhood chronic disease in the country.
Risk Factors for Asthma: Obesity Family history of asthma Allergies Exposure to allergens like dust mites and second hand smoke Who Gets Asthma? Asthma can affect anyone, but young children are especially at risk. Children are also more likely to need to go to the emergency room.
Understanding the causes and symptoms of asthma are important so the disease can be properly diagnosed, controlled, and treated. Undiagnosed Asthma One tricky thing about asthma is that it often is undiagnosed.
How Asthma Affects the Lungs An asthma attack occurs when: This causes the airways to get smaller and it is more difficult for air to pass through. Bands around the airways in the lungs tighten and the airways swell There is extra mucus in the lungs
Asthma Symptoms Symptoms of asthma include: Wheezing Coughing Shortness of breath Chest Tightness
In-Home Asthma Triggers Many people with asthma also have allergies to these same triggers. Dust and dust mites Pests, like cockroaches Allergens, mold, chemicals or pet dander Secondhand Smoke To control asthma, it is important to know what things in the home may trigger an attack.
Environmental Tobacco Smoke Secondhand smoke, also known as environmental tobacco smoke, is the smoke that comes from a cigarette or cigar and the smoke that a smoker breathes out. According to the Centers for Disease Control, secondhand smoke contains more than 4,000 chemicals At least 250 of these chemicals are known to be harmful More than 50 of these chemicals are known to cause cancer
Environmental Tobacco Smoke Secondhand smoke is a major health concern because of the many health risks associated with breathing it in: o Asthma attacks/flare-ups and asthma symptoms that happen more often and are more severe. o New cases of asthma in children who have not shown asthma symptoms in the past.
Third-Hand Smoke What is third-hand smoke? Third-hand smoke is a term for the chemicals, gases, and other toxins left behind in hair, carpets, sofas, clothes and other materials long after a cigarette is put out. Why is third-hand smoke a concern? Third-hand smoke can make asthma worse. Babies are also at an increased risk of swallowing or breathing in these toxins because they spend more time closer to floors and other surfaces.
Dust and Dust Mites Dust mites are tiny bugs that are too small to see. o Dust mites feed on human skin flakes, which are commonly found in dust, bedding, furniture, stuffed toys, clothes, and other fabrics and fabric-covered items o Breathing in body parts and droppings of dust mites can trigger asthma symptoms. o Dust mite exposure can also increase the risk of a child developing asthma.
Pests Saliva, body parts or droppings from cockroaches, mice, rats, and other pests can trigger asthma symptoms. Pests can get into homes and cabinets through cracks and openings. Dirty dishes, crumbs, spills attract them if they arent cleaned up quickly.
Other Allergens Allergens include mold, pet dander, and chemicals. Mold Grows in wet or moist areas and create spores that can float through the air. Breathing in these spores can trigger asthma symptoms. Pet dander Or pet skin flakes, can also float through the air and get stuck in furniture and clothing. Breathing in pet dander can trigger asthma symptoms.
Other Allergens Strong household chemicals can irritate airways and trigger asthma symptoms if they are inhaled. These household chemicals are found in cleaning supplies, pesticides, air fresheners, and perfumes. Besides having the ability to trigger asthma and allergies, these chemicals may be toxic, especially for young children.
Asthma Action Plans Parents and child care educators can help control asthma by making sure the child has an asthma action plan. This individualized asthma action plan will help the child care educator know right away how to treat an asthmatic child and what their triggers are. An asthma action plan is a written plan developed by a person who has asthma and his/her doctor to help better control his/her asthma.
Asthma Action Plans An asthma action plan is a great tool for: o Assessing a childs asthma. How bad is the childs asthma? What are his/her triggers? o Controlling a childs asthma. Administer the proper medications. Know, reduce, and avoid asthma triggers. o Monitoring a childs asthma. Know what to do in case of an asthma attack. Keep emergency phone numbers handy
Asthma Medications There are two types of asthma medication. In most cases, a child care educator should have reliever medication, and the parent would administer the controller medication at home. Relievers o Used for fast relief of symptoms. Relief in 10-20 minutes o Effective for 4-6 hours. o Relax muscles around airways. o Examples: Albuterol, levalbuterol, Proventil, Ventolin, ProAir Controllers o Used daily to prevent asthma symptoms o Reduce irritation, swelling, and mucus that block airways o Do NOT provide quick relief for asthma attacks. o Examples: Budesonide, Fluticasone, Beclomethasone
Administering Asthma Medication If a child in your care has asthma or asthma-like symptoms, it is important to understand how to administer medication. Medication may be given through a nebulizer or an inhaler. Always have a parent or a healthcare professional demonstrate the correct way to administer medication. If using an inhaler, be sure to use a spacer. If using a nebulizer, youll need a mask and pump. The resource guide includes step-by-step instructions on how to administer asthma medication.
Types of Asthma Medication Source: Neighborhood Health Plan
Providing a Healthy Family Childcare Environment If you take a close look at your home, there are many easy and inexpensive things you can do to make it a healthier learning environment for children in your care.
Air Quality Have a smoke-free home Keeping tobacco products out of the home in the first place is the best way to have a smoke-free home. Consider asking people to smoke outside of your home or vehicle, even at times when children arent there. If you notice smoke drifting in from a neighbors apartment, consider talking to your landlord about creating a smoke free policy for your building. It is completely legal and can save your landlord money. Control Moisture Make sure your home is well- ventilated using fans or open windows. Excess moisture can create mold and mildew growth and mold spores can trigger asthma. If you notice mold or mildew in high moisture areas like the bathroom, try to clean it up as soon as possible.
Preventing Lead Exposure Use cold water Pay attention to paint Make sure your home has no chipping or flaking paint, especially if the house was built before 1978. Scraping or sanding this paint could create a major lead dust hazard. Make sure that the person doing renovations on your home is using lead safe work practices. Older homes may have lead water pipes. Even in newer homes, some brass faucets or plumbing fixtures may contain lead. To avoid lead in your drinking water, let the water run for 30 seconds (until you can feel the water temperature change), and always use cold water for drinking and cooking.
Preventing Lead Exposure Supply a doormat Feed healthy foods Check toys for lead Lead dust in soil can come into the house on peoples shoes. Doormats can help remove dust, dirt, and debris from shoes. This can help keep your home cleaner and healthier. Lead looks like iron and calcium to the body, so look for foods that have iron or calcium. Examples: Beans, spinach, and lean red meats. Sometimes old toys, or toys imported from other countries may contain lead. Check your toys by purchasing a lead testing kit or visit: www.healthytoys.org.
Controlling Dust Use a HEPA vacuum Clean with a damp cloth Clean and wash surfaces with wet wipes or wet towels, not dry ones. This will pick up lead dust (which can cause lead poisoning), pet dander, and other allergens that can trigger asthma symptoms. Rugs and carpets can trap and hold allergens like dust mites, pollen, and pet dander. If you cant remove carpeting, cleaning them regularly and using vacuums with HEPA filters can reduce the amount of allergens in carpeting (and remove lead dust) because it traps very small particles that normal vacuums may not pick up or even spread around.
Pest Prevention Dont feed pests Avoid pesticides Chemical pesticides can make asthma worse and are especially toxic to young children. Instead of pesticides, try to find any holes in the walls/ducts/vents that pests may be using to get in, and use sticky traps or other pest traps rather than pesticides. Remove pests food and water by: 1)Storing food in strong containers that are hard to get into or chew through 2)Washing dirty dishes as soon as possible, and 3)Using trash bins that can be sealed tightly with a lid.
Household Chemicals Use green cleaners Avoid strong scents Green cleaners are alternatives to traditional, chemical cleaners, which can worsen asthma. If you must use bleach, use it only in the recommended concentration – never more.. Examples of Brands: J. R. Watkins, Eco-Me, Shaklee, Seventh Generation, Begleys It is easy and inexpensive to make your own green cleaners using baking soda and vinegar. Try to avoid strong scents, including perfumes, scented candles, and air fresheners. Some people are allergic or sensitive to the chemicals in scented products.
Other Things to Consider Safely dispose of mercury Check for radon Mercury is a heavy metal that can be toxic if ingested. The most common place to find mercury in the home is in compact fluorescent (CFL) light bulbs.. Make sure CFL light bulbs are kept away from children and recycled properly. Many hardware stores (including Home Depot) accept used CFLs, or you can bring them to the citys hazardous waste drop off day. Radon is a radioactive gas that can cause cancer. It comes from the soil and can be found anywhere. You cant see or smell radon in your house, so the only way to know if there is radon is to have your home tested. Radon testing is easy and inexpensive, and tests are available at hardware stores, or by hiring a professional testing company. Radon remediation
Safe and Healthy Family Childcare Certification Program During the Summer of 2012, BHHSC will be launching the Safe and Healthy Family Childcare certification program. This program will recognize family childcare educators who have taken the extra time to create a safe and healthy childcare environment that supports a healthy learning environment for children. Participants will: Receive a Safe and Healthy Family Childcare window decal for their home Certificate Have their name added to the Safe and Healthy Family Childcare list for parents.
Safe and Healthy Family Childcare Certification Program Requirements: Complete BHHSC Healthy Homes for Family Childcare Educators training Follow at least 15 out of 20 healthy homes activities from the SHFC checklist o These activities are based on the information from the training Have someone who is not a family member or employee sign your application, certifying that you follow the activities Pay the $20 registration fee to cover administration and materials The certification will last for two years.
Scenario 1: Yvette the cleaning machine Yvette is a 40-year-old family childcare educator, a Haitian immigrant who prides herself on her small, spotless apartment. Her home is orderly and "spick and span." Not surprisingly, Yvette even hates the thought of rodents, but she lives next door to an apartment she refers to as a "cockroach hotel." Yvette is thrilled that the childcare regulations require the use of bleach, as she's always been a big fan. She uses the same highly concentrated solution often, and on all surfaces, from the toilet to the changing table to the children's lunch tables. Yvette uses pesticides to keep the neighbor's bugs out of her unit, spraying along the one kitchen wall shared with the adjoining apartment. So far so good – no rodents, and by keeping doors closed, the smell is usually limited to the kitchen. For Yvette, the clean and pest-free space she offers is a major point of pride. Her client parents –mainly from Haiti themselves love and appreciate it too. One recently commented on how clean the house always smells and another noted, "My child could eat off her floors!" Yvette is now expecting a new child to start at her daycare the next week. The child has a serious case of asthma. Yvette knows it will be that much more important to offer a clean and pest-free space. She plans to really give the place a good scrubbing over the weekend. Your tasks are: A. Create a persuasive argument that explains: (1) proper use of bleach and appropriate alternatives to bleach that are safe and as effective (2) alternative actions or products to prevent pests (3) the hazards of bleach and pesticides to individuals with asthma B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.
Scenario 2: Sylvia and her handy husband Sylvia is a good friend who is about to open her own family childcare. She's blessed with a husband who can build and fix almost anything. He'll soon start the work, beginning with replacing some old windows and window frames. She's thrilled that her husband's great work will avoid the huge expense of hiring an outside person. Moreover, his skill and her excellent and thorough cleaning means no need for a government inspector to come into their house to test for lead. Between his hammer and her vacuum cleaner, they are good to go! After the windows are done, Sylvia's husband will start on the old shed in the backyard, converting it into a little playhouse. The work will begin once her daycare is operating, but he plans to do the work only on weekends and, after all, the shed is outdoors.. Your tasks are: A. Create a presentation that explains: (1) lead dust hazards involved in replacing the old windows (2) keeping lead dust confined to work space. (3) safe and effective clean up procedures and equipment (3) why it is important for a government inspector to test for lead. B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.
Scenario 3: Reina's Best Intentions Go up in Smoke Reina has been a family childcare educator for 2 years. Reina is a smoker but would never consider smoking inside her apartment, the middle unit of a triple decker. Rather, she steps outside on the porch to smoke, keeping the door and adjacent windows tightly closed. Reina smokes in her car during the colder months –which are most for her, as a relatively recent immigrant of the Dominican Republic. She only does so on weekends and evenings, so that the car is clear of smoke by the time she picks up children on weekday mornings. After all this care she takes to ensure her young charges are not exposed to her cigarette smoke, she's terribly frustrated with her new neighbor downstairs, who obviously smokes –a lotinside his unit. The smoke seeps through the ceiling and into her apartment all day long. He might as well be smoking his cigarette right in her living room it smells so strongly of tobacco. Your tasks are: A. Create a presentation that explains: (1) hazards of second- and third-hand smoke (2) how Reina could further improve her own smoking-related behaviors to protect the children in her care. (3) how she could approach the problematic situation of the smoking neighbor. B. Create a storyboard for your presentation using information from the slides and your own information, if applicable.
Having a healthy and safe home helps children live healthier and more productive lives. Davida Andelman Project Director, Healthy Homes (617) 279-2240 x 513 email@example.com Elizabeth Tanefis Program Manager 617-279-2240 x530 firstname.lastname@example.org Contact us with questions, concerns or suggestions. Like us on Facebook www.facebook.com/BostonHHSC Visit our Website www.bhhsc.org