The relationship between housing conditions and health has been documented for centuries (Krieger & Higgins, 2002; Mood, 1993). Home-based health hazards are heavily researched due to their contributions to the development or exacerbation of asthma, as well as increased risks for unintentional injuries in the home (DiGuiseppi, Jacobs, Phelan, Mickalide, & Ormandy, 2010; Jacobs et al., 2010; Kanchongkittiphon, Mendell, Gaffin, Wang, & Phipatanakul, 2015). Further, the high prevalence of poor conditions in renter-occupied units (ROUs) intensifies these negative housing and health associations. According to the 2013 American Housing Survey (AHS) conducted by the U.S. Census Bureau (2016a), 35.6% of occupied units are estimated to be ROUs. Furthermore, 9.1% of ROUs were reported to have moderate to severe physical problems, which is 3 times higher than was reported by their owner-occupied counterparts (U.S. Census Bureau, 2016b). The differences between the quality of housing stock of ROUs versus owner-occupied units creates a disparity that cannot be overlooked by the public health community.
We spend the majority of our time indoors, so it is especially meaningful to improve the indoor home environment (Baker, Keall, Au, & Howden-Chapman, 2007). The public health community responded to the need to address housing-related health concerns by publishing The Surgeon General's Call to Action to Promote Healthy Homes (2009), which declared that healthy housing would consider characteristics such as "structural and safety aspects of the home (i.e., how the home is designed, constructed, and maintained; its physical characteristics; and the presence or absence of safety devices), quality of indoor air and water, and the presence or absence of chemicals" (p. vii).
This call to action became a starting point for public health agencies to increase efforts placed on housing that supports health. Since then, the U.S. Department of Housing and Urban Development (HUD) has also adopted a Health in All Policies approach to encourage health as the foundation of housing policy (Bostic, Thornton, Rudd, & Sternthal, 2012, p. 2,130).
The Southern Nevada Health District (SNHD) recognized the deficiencies in renter-occupied housing quality and created the Clark County Landlord-Tenant Hotline in May 2011. The hotline has become a tool used by the local community to address concerns about habitability issues encountered by occupants of ROUs. Clark County, Nevada, contains a greater percentage of renter-occupied housing units (46.9% versus 35.6%) compared with the U.S. as a whole. For the first time in 2013, AHS included the Las Vegas, Nevada, metropolitan area, providing an additional picture of the housing conditions SNHD already identified as poor. Of the households surveyed in the Las Vegas area, 5.2% of ROUs had moderate to severe physical problems (U.S. Census Bureau, 2016b), almost 6 times higher than owner-occupied units. A vast number of these units are occupied by sensitive populations, including minorities (55% non-White), low income (24% living below poverty), and children (39%) (U.S. Census Bureau, 2016b). In order to confront the knowledge gap in the literature surrounding low-cost interventions for addressing healthy homes issues in ROUs, SNHD partnered with the University of Nevada, Las Vegas (UNLV) to study local ROU housing quality and build local capacity to operate a sustainable program to help address housing issues in rental units.
The purpose of this article is to describe the hotline operations and characterize the pop ulation using the service, the types of housing complaints most frequently reported by ROU residents, and the complaints observed by SNHD environmental health specialists during the Clark County Landlord-Tenant Hotline Study (CCLTHS).
CCLTHS was funded through a HUD Office of Healthy Homes Technical Studies Grant Program from November 2013 through October 2016. The primary purpose of the study was to determine whether a landlord-tenant hotline is an effective method to address home-based hazards (i.e., healthy homes issues) that can adversely impact health, specifically in ROUs. CCLTHS staff took over operation of the hotline in March 2014 and worked in concert with SNHD to respond to local tenants and landlords experiencing habitability issues in their units or properties. Callers to the hotline were instructed to leave a voicemail message with their self-reported complaint(s) and a callback phone number; CCLTHS staff made at least two attempts to return calls during typical business hours.
To each caller they reached, a staff member would explain the Nevada Revised Statute (NRS) Chapter 118A regarding the habitability of a dwelling unit and the written notification process the law entails. The statute (Nevada Revised Statute [section] 118A.380) delineates complaint types as either essential or nonessential services. Essential services include "heat, air-conditioning, running water, hot water, electricity, gas, a functioning door lock, or another essential item or service" (Residential Landlord and Tenant Act, n.d.). Nonessential services include effective waterproofing and weather protection; plumbing facilities; hot and cold water; adequate heating facilities; properly installed and maintained electrical components; an appropriate number of trash receptacles; clean, sanitary buildings and grounds, free of debris, filth, trash, and pests; building components in good repair; and ventilation, air-conditioning, and other facilities in good repair (Nevada Revised Statute [section] 118A.290) (Residential Landlord and Tenant Act, n.d.). Per existing SNHD protocols, attempts are made to collect baseline data from hotline callers, including caller name, ROU address, and the nature of the complaint(s). All complaints were characterized by best fit into the following categories: mold; general maintenance; bed bugs; cockroaches; other insects; heating, ventilation, and air conditioning (HVAC) outage; odor; water outage; sewage; utility outage; rodents; domestic animal; pigeons; hoarder; environmental tobacco smoke; or other.
People who called the hotline from March 17, 2014, through July 1, 2016, and met certain criteria were eligible for consent into CCLTHS as approved by the Institutional...