There has been solid evidence demonstrating a strong link between housing (and home environment) and its impact on health. All facets of the residence have been shown to have an impact on health for those who dwell within: everything from basic air and water quality, materials used to build and treat the structures, to the physical surroundings nearby as with an industrial complex or a lush farm field using herbicides (Carozza, Elgethun, & Whitworth, 2008; Centers for Disease Control and Prevention, 2005; Chevier, Eskenzi, Bradman, Fenster, & Barr, 2007). The importance of healthy homes and the concern for reducing hazards that impact health were again brought to the national stage with the 2009 release of the surgeon general's call to address home hazards and their impact on the health of all Americans (U.S. Department of Health and Human Services, 2009). This report provided a summary of information regarding the well-documented links to the impact these hazards have on the health of people of all ages, particularly those most vulnerable such as the very young, pregnant women, or older adults.
During this same year, Marion County Public Health Department (MCPHD) in Indianapolis, Indiana, was awarded a Healthy Homes Demonstration Grant Program in April 2009 by the U.S. Department of Housing and Urban Development (HUD). This funding was targeted to support activities addressing health and safety hazards in privately owned rental and owner-occupied homes with low- and very low-income residents living in the Martindale-Brightwood neighborhood, an urban community in Indianapolis. This area has an extensive history of heavy industry and lead smelting throughout the past 60 years.
One portion of this grant is being used to fund institutional review board (IRB)approved research conducted by the Lead Safe and Healthy Homes Department of MCPHD for a 36-month period. This study, "The Healthy Homes Demonstration Project--Phase I," examines the effects of providing cost-effective preventive measures in correcting residential safety hazards that produce disease and injuries in low-income populations.
A long-term goal of this study is to identify and promote cost-effective prevention measures to correct multiple residential safety hazards that produce disease and injuries in sensitive subgroups who may occupy low-income or substandard housing. The sensitive subgroups identified along with the heads of households are children, pregnant women, older adults, and people with disabilities. To date, of the 452 housing units and heads of households targeted, 220 have been enrolled and have received systematic healthy homes assessments, personalized plans of care, and moderate nonstructural modifications. These interventions included: older adult or handicapped accessibility, asthma trigger remediation, mold inspection and referrals, structural lead and blood lead testing and referrals for pregnant women and children 6 years of age and under, radon testing and referrals, and other nonstructural modifications and health referrals.
Final results are pending with the completion of the final phase of recruitment and implementation of interventions and data analysis. The development and implementation of this study has presented unique challenges and positive outcomes for MCPHD, study participants, and community stakeholders. Our guest commentary presents insight into some of the benefits and rewards of implementing a successful study-process, as well as the challenges in implementing a community-based research study for the first time in a preexisting Lead Safe and Healthy Homes program.
Characteristics of the Targeted Area, Participants, and Their Homes