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June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. Dearborn Long term follow-up of home.

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Presentation on theme: "June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. Dearborn Long term follow-up of home."— Presentation transcript:

1 June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. Dearborn Long term follow-up of home environmental remediation for mold & moisture

2 PRESENTATION OUTLINE Background UMMP UMMP II Conclusions Ellen M. Wells 1, Matt Berges 2, Stephen Vesper 3, Iwona Yike 1, H. Lester Kirchner 4, Stuart Greenberg 2, Dorr G. Dearborn 1 1: Swetland Center for Environmental Health, CWRU School of Medicine; Cleveland, OH 2: Environmental Health Watch; Cleveland, OH 3: US Environmental Protection Agency; Cincinnati, OH 4: Geisinger Medical Center, Danville, PA

3 Urban Mold and Moisture Project II PARTNERS Swetland Center for Environmental Health, CWRU School of Medicine, grantee Environmental Health Watch University Hospitals Cuyahoga County Board of Health US Environmental Protection Agency Cuyahoga County Department of Development FUNDERS HUD Office of Healthy Homes and Lead Control US Environmental Protection Agency

4 BACKGROUND

5 Moisture in the home At least 20% of U.S. buildings have signs of dampness Moisture is more likely with Overcrowding Insufficient heating, ventilation, and insulation A Cleveland Perspective Older housing stock High poverty levels For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, Extent of the issue

6 Moisture in the home Consequences of excess moisture Leads to microbial growth (mold) Initiates chemical or biological degradation of materials Encourages presence of pests Presence of dampness is considered to be a risk factor for asthma and respiratory disease For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, 2004 Connection with health

7 Fungi (i.e., mold) Ubiquitous eukaryotic organisms Hundreds of different species Growth limited by temperature, nutrients, moisture Health effects include Infections, allergies, toxicities Health effects may arise from Viable (live), or nonviable (dead) or fragments of organisms For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, 2004

8 URBAN MOLD & MOISTURE PROGRAM

9 Urban Mold & Moisture Program Components of the program Visual inspections of homes Homes sampled for mold Moisture reduction interventions Monitoring respiratory health Will reduction of moisture in homes improve homes and health? Leaks Cooking, Bathing, Watering Plants, Breathing, Washing Surface water Groundwater Air From Soil

10 Urban Mold & Moisture Program Repair the “Cleveland drop” Flash the soil to the house Treat the porch like a roof Eliminate sub-slab duct and heating systems Disconnect and redirect downspouts Reduce moisture in crawlspaces Correct negative grade at foundation Remove debris in basements Vent clothes dryer to exterior Occupant education Moisture intervention goals

11 Urban Mold & Moisture Program Randomized controlled trial Eligibility criteria Children hospitalized for asthma within the past year Mold visible in the home All children (n=62) had medical care optimized Roughly half (n=29) of the homes were remediated Children assessed at 6 and12 months Homes reassessed at 12 months For more information, see: Kercsmar et al Environmental Health Perspectives 114(8): A subset of the program where families had asthmatic children

12 Urban Mold & Moisture Program Significant decrease in symptom days ( p = ) after repairs Lower rate of ER visits and hospitalizations Remediation group: 1 of 29 Control group: 11 of 33, p = ). Outcomes from asthma study For more information, see: Kercsmar et al Environmental Health Perspectives 114(8):

13 URBAN MOLD & MOISTURE PROGRAM II

14 Urban Mold and Moisture Project II Sustainability/maintenance of housing improvements Do these interventions need to be modified? Home visual inspections to identify mold Sampling for mold and moisture Maintenance of respiratory symptom improvements Are home moisture interventions effective 5 to 8 years later?

15 UMMP II 104 homes renovated in (42%) visited in (63.6%) with original families 16 (36.4%) with new families Data collected at the visits Visual inspection for mold Dust sampling for mold Occupant questionnaire Visual assessment of interventions

16 Housing interventions Repair of the “Cleveland drop” Did not require maintenance All were still in place and functional Eliminate sub-slab duct work Concrete in holes in duct work, new furnace All were still in place and functional Interventions still in working order For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch,

17 Housing interventions Flash the soil to the house Poor implementation can exacerbate problem Flat trenches, rubber ending near foundation Treat the porch like a roof Temperature gradients may still cause moisture Reduce moisture in crawl spaces Use of plastic may trap water from other sources Including ‘rat slabs’ could help prevent pests Correct negative grade at foundation Not every grade was completely corrected Maintenance also needed to maintain these Functional, but some improvements needed For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch,

18 Housing interventions Disconnection, redirection of downspouts Most common problem Not maintained, occasionally missing Some implementations exacerbate problem Location can be a problem for other activities Remove debris from basement Staff occasionally not allowed into basement Several basements still had debris Vent clothing dryer to outside Common for the vent to become disconnected In some cases this was intentional Post-intervention events contributed to failure For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch,

19 Visual inspections for mold Room5-8 years vs. baseline5-8 years vs. clearance Basement, any surfaceSignificant decrease Basement, celluloseSignificant decrease KitchenSignificant decreaseDecrease BathroomSignificant decreaseDecrease

20 Symptom questionnaires Given to families with a new infant, mold in the home Baseline, 1 year and 5-8 years following remediation Limited to those who had not moved 5-8 years later (n=56) General symptoms Several symptoms decreased at 1 year, but not 5-8 years later Respiratory symptoms Most significantly improved at 1 year, but no significant improvement from baseline at 5-8 years ‘A lot of mucus of phlegm’, ‘shortness of breath or rapid breathing’ showed significant improvement at 5-8 years (v. baseline)

21 Asthma exacerbations Repeated interviews among 26 families with interventions 16 had moved, 10 had not moved Exacerbation = ER visit or hospitalization Among those who had moved 6 out of 16 children (37.5%) had a total of 10 exacerbations Among those who had not moved 2 out of 10 children (20.5%) had a total of 3 exacerbations

22 Analysis of mold in dust QPCR analysis of 33 mold species in homes of asthmatic children BedroomTV/Living room Clearance vs. baselineSignificant decrease (5 spp) 5-8 years vs. clearanceSignificant decrease (3 spp) Significant increase (20 spp) 5-8 years vs. baselineSignificant decrease (1 spp) Significant increase (20 spp)

23 CONCLUSIONS

24 Conclusions, part 1 Sustainability of housing interventions Overall these houses remain in better condition Consider interventions not requiring maintenance even if more cost Education regarding the purpose, maintenance of interventions Occurrence of self-reported respiratory symptoms In most cases, a decline at 1 year was not maintained There are long term benefits to moisture interventions; however, maintenance continues to be an issue

25 Conclusions, part 2 Asthma exacerbations among those in renovated homes Fewer exacerbations among those still in renovated homes compared to those who moved Presence of mold in homes of asthmatics A few species had lower concentrations Many species increased in concentrations compared to baseline or just post clearance

26 Acknowledgements Jodi Lavrich Mia Gelles Debrah Muhammad Margaret Pizzi Akbar Tyler


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