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THE INTEGRATED PEST MANAGEMENT INTENSITY IMPACT STUDY (IPMIIS)A Closer Look at Mental Health, Asthma, Housing and the Way We Manage Pests.
Alan Fossa & John Kane
May 29th , 2014
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HEALTH & HOUSING
Housing, a key social determinant of healthWell documented in literature Housing influences a variety of health
outcomes Respiratory health, Neurodevelopment etc… literature (Evans 2003)
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MENTAL HEALTH & HOUSING
What about mental health? Documented links between housing and
mental health Somewhat limited body of research
Why do we need to take a closer look? Significant upward trends in mental health
measures Disparities in these measures across housing
type
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MENTAL HEALTH & HOUSING
Methodologically limited body of work (Evans, 2000) Cross-sectional design, non-standardized outcome measurement…
How are we looking at housing quality?Physical structure, building codes, major health threats (lead, asbestos etc…)
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MENTAL HEALTH & HOUSING
Persistent sadness among adults 7.2% in 2005 and 9.4% in 2010 (BBRFS
2005,2010) 16.9% in public housing vs. 7.6% in non-public,
non-subsidized housing (BBRFS 2010)
Persistent anxiety among adults 12.0% in 2005 and 17.3% in 2010 (BBRFS
2005,2010) 19.5% in public housing vs. 16.3% in non-public,
non-subsidized housing (BBRFS 2010)
Similar trend among youth (YRBS, 2005, 2013)
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Pests are a major problem in urban housing 85.2% child’s rooms, detectable roach
allergens (NCICAS, 1997)
42% Homes in Boston with detectable mouse allergens (Phipatanakul, 2000)
Inequities in pest problems 71% Reported infestation in public housing
vs. 22% in non-public housing (Wang, et. al., 2008)
> 50% public housing residents reported problems with pests indoors (National Center for Healthy Housing, 2008)
HOUSING QUALITY-PESTS
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ASTHMA & HOUSING
Disparities in asthma burdens
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ASTHMA & HOUSING
Roaches and rodents are a major factor in housing-asthma relationshipAllergens from both pests are proven asthma triggers (National Center for Healthy Housing, 2009)
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PEST MANAGEMENT AND HEALTH
Direct relationship between pest management and healthPesticide exposure and other dangers Good pest management Improved health
Indirect relationship between pest management and healthGood pest management Reduction in
Pests Improved health
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PEST MANAGEMENT AND HEALTH
How are we looking at housing quality?Physical structure, building codes, major
health threats (lead, asbestos, etc…)
A pest free environment is a component of quality housing Should be reflected in research tools
What is good pest management?
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INTEGRATED PEST MANAGEMENT (IPM)
Alternative to traditionally ineffective methods
Major Focuses Restricted access to food, water and shelter Prevention and education Structural integrity Sanitation Conservative application of pesticides
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IPM AT BOSTON HOUSING AUTHORITY
•Largest housing authority in New England•Largest property owner in Boston•10% of Boston residents in BHA housing
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IPM AT BOSTON HOUSING AUTHORITYThree main pests: Cockroaches Rodents Bedbugs
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IPM AT BOSTON HOUSING AUTHORITY
Evolution of Pest Control at BHA: 1982 – bug crew 1995 – outside contractors “flushouts” 2001 – listening tour
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IPM AT BOSTON HOUSING AUTHORITYHealthy Public Housing Initiative: Indoor Air Quality Resident
Health Various methods researched Recommendation: Integrated Pest
Management (IPM)
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IPM AT BOSTON HOUSING AUTHORITYHealthy Pest Free Housing Initiative: Implement IPM at 15 developments over 3
years Community Health Advocates Institutionalize Evaluate continually
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IPM AT BOSTON HOUSING AUTHORITYCost Benefit Analysis: $4.63 to $7.09 = +$2.46 Decrease pest infestations, pest work orders,
pesticide use, stress, losses from REAC scores, HID complaints, court cases
Increase or Improve quality of life, sense of health, job satisfaction, staff time, and achieve high performer status
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IPMIIS
Pest Management
Asthma
Mental Health
General HealthHousing
Cost
Pest Infestation
Pesticide Exposure
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IPMIIS GOALS
Develop a tool for classifying pest management of a housing authority into 3 categories.
High Intensity IPM
Low Intensity IPM
Traditional Pest Management
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IPMIIS GOALS
Investigate the effect of IPM intensity on general health, mental health and asthma in residents
IPM Intensity
Mental Health
General Health
Asthma
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IPMIIS GOALS
Demonstrate longitudinal relationships between IPM, asthma and pest infestation
IPM Intensity
Asthma Symptoms
Pest Infestation
Time
Time
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IPMIIS GOALS Demonstrate longitudinal relationships
between IPM, pest infestation and asthmaDemonstration a longitudinal relationship
between IPM and pesticide residues
IPM Intensity
Pest Infestation
Asthma
Time
Time
Pesticide Residues
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IPMIIS GOALS
Limited cost-effectivness analysis
IPM Intensity
Healthcare Utilization (Asthma)
$
Time
Time
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IPMIIS METHODS
Enrollment Cross-sectional and Follow-up Even across IPM stratum
Study teams CBPR Based (Community Member and Graduate
Student) Data collection
Observation Surveys
Sample collection Pesticides Allergens
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IPMIIS METHODS
IPMIIS16 Developments
Cross-Sectional 460 Households
Longitudinal 89 Households (Asthmatic Participants)
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IPMIIS METHODS
Determination of IPM Intensity LevelsData sources: IPM logs, pest control
contracts and work ordersMetrics:
% Units inspected % Units with evidence of pest infestation (focus
units) % Focus units not followed up 3 Year average work order prevalence Contract lapses Kellogg site Active tenant coordinator
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IPMIIS METHODS
Field Work & Data Collection:
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IPMIIS METHODS
Participant Surveys Collected information on:Demographics (income, age, sex, etc…)Self-reported Health (CESD, PSS, Physical
health, etc…)Self-reported pest infestation (experience
with pests, etc…)Asthma outcomes and related health info
(ARQL and ACT) Self-reported pest management (personal
management and development management, etc…)
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IPMIIS METHODS
Unit Observations Collected Information On: Objective pest infestation (actual pests,
droppings and other signs, etc…)Objective factors associated with pest
infestation (poor sanitation, structural damage, etc…)
Evidence of pest management (traps, gels, plugged up holes, etc…)
Environmental Sampling (kitchen)Pesticide Sampling Allergen Sampling (mouse and roach)
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IPMIIS METHODS
CBPR Component Comprehensive involvement
Study DesignExecution Interpretation and dissemination of results
Collaboration with community based organizations (Committee for Boston Public Housing and BHA)
Study team (one community advocate and one graduate student)
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PRELIMINARY DATA Approximately 37% of residents reported the
presence of cockroaches in their home and 32.2% reported rodents
Of 460 enrolled participants, 74% were female and 52.6% identified themselves as Hispanic or Latino
Our study population had a median CESD score of 11 and a mean PSS score of 4.8
Focus on the association between mental health symptoms, pest infestation, and pest management practices using logistic regression and multi-level regression techniques
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WHAT NOW?
Last field visit on December 25, 2013
Construction of Cleaned Analytic Datasets
Work with collaborators at Boston University and Harvard University
Further develop and execute analysis plan
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AcknowledgementsSnehal Shah
Margaret Reid
Mae Bennett-Fripp
Gary Adamkiewicz
John Levy
Lori Luce
Special ThanksU. S. Department of Housing and Urban Development
HUD Assistance Grant MALHH0193-09
Committee for Boston Public Housing
National Healthy Homes Conference
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REFERENCES Evans, G.W., The built environment and mental health. J Urban
Health, 2003. 80(4): p. 536-55. Boston Behavioral Risk Factor Survey (2005, 2006, 2008 and
2010), Boston Public Health Commission Youth Risk Behavior Survey (2005, 2007, 2009, 2011 and 2013),
Centers for Disease Control and Prevention Evans, G.W., et al., Housing quality and mental health. J Consult
Clin Psychol, 2000. 68(3): p. 526-30. Phipatanakul, W., et al., Effect of environmental intervention on
mouse allergen levels in homes of inner-city Boston children with asthma. Ann Allergy Asthma Immunol, 2004. 92(4): p. 420-5.
Phipatanakul, W., et al., Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. J Allergy Clin Immunol, 2000. 106(6): p. 1070-4.
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REFERENCES Wang, C., M.M. Abou El-Nour, and G.W. Bennett, Survey of pest
infestation, asthma, and allergy in low-income housing. J Community Health, 2008. 33(1): p. 31-9.
Integrated Pest Management Interventions for Healthier Homes:Pests Persist in Federally Subsidized Housing. 2008, National Center for Healthy Housing.
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Thank you!