healthy homes screening tool (hhst)

Healthy Homes Screening Tool (HHST)

12012

We wish to acknowledge the assistance of Jane Nickert from the City of Detroit Department of Health and Wellness Promotion, Robert Scott from MDCH, and many work-study students who helped with this survey.

What the HHST Will DoThe Healthy Homes Screening Tool (HHST) will:

• Examine the health risks in surveyed homes by assessing the presence of a wide range of risk factors that may increase the potential for sickness, injuries, and death among a home’s inhabitants.

• Provide a consumer and paraprofessional screening tool as a companion to the Healthy Homes Rating System (HHRS).

• Evaluate differences in resident responses regarding health and safety hazards in comparison with actual findings determined through the HHRS.

2012 2

HHST Targets & Versions• The first version of the HHST was used for face-to-face

interviews with residents at the door.

• The second version of the HHST is being used by non-housing professionals to make observations about the household.*

• A third two-page version of the HHST is currently being developed to be used by non-housing professionals and paraprofessionals to make observations within the home.

*Residents are being given the option of allowing non-housing professionals into the home to make observations or to complete the survey by a face-to-face interview at the door.

2012 3

HHST vs. HHRS• The HHST is a screening tool intended for use

within households by paraprofessionals and

others.

• The HHRS is “a system of assessment… of

hazards and the potential effect of conditions”

to be used by trained housing professionals. [1]

2012 4

[1] Healthy Homes Rating System – Operating Guidance

Healthy Homes RisksAsthma/Allergy

• In homes where allergens are present, including dust mites, cockroaches, mold, furry pets,

tobacco smoke, air fresheners, and certain chemicals, “children may experience severe and

frequent asthma attacks from high airborne concentrations of these allergens”. [1]

Moisture/Water Damage

• Moisture and water damage can cause mold and fungus growth, leading to the development

of asthma and allergies and triggering “allergic symptoms such as rhinitis, conjunctivitis,

eczema, cough and wheeze”. [2]

Lead

• Lead-based materials, such as lead-based paint and water pipes, can cause lead poisoning

and have “toxic effects on the nervous system, cognitive development and blood production”.

[2]

2012 5

[1] National Institute of Environmental Health Sciences - www.niehs.nih.gov/airborne/asthma.html[2] Healthy Homes Rating System – Operating Guidance

http://www.niehs.nih.gov/airborne/asthma.html

Healthy Homes RisksHousing Characteristics: House

• Overall housing conditions such as excess noise, risk of entry by intruders, lack of adequate living space, improper food preparation appliances and lack of proper personal hygiene and sanitation facilities can have multiple negative physical and psychological impacts on residents.

Housing Characteristics: Stairs

• Falling on stairs can be caused by poor structural condition, inadequate lighting and absence of handrails, leading to “bruising, fractures, head, brain and spinal injuries” and even death. [1]

Housing Characteristics: Bath

• Falls within a bath can be caused by lack of slip-proof surfaces and grab bars, often resulting in “cuts or lacerations, swelling or bruising, or fractures”. [1]

Housing Characteristics: Fire/Electrical

• Smoke detectors, fire extinguishers, multiple exits and fire exit strategies can help to reduce the risk of

death by burns or gas or smoke inhalation in the case of a fire.

• Exposed wiring and improperly vented appliances can increase the risk of fire and electrical shock.

2012 6


Healthy Homes RisksCarbon Monoxide

• Improperly vented gas appliances such as dryers and stoves can lead to increased levels of carbon

monoxide, leading to “headaches, dizziness, weakness, nausea, confusion”, disorientation, fatigue, and

even “unconsciousness and death”. [1]

Poisoning: Other

• Substances such as medication, pesticides, cleaning products and others can be potentially hazardous to

children especially if stored in accessible locations.

Radon

• Significant exposure to ionizing radiation can “damage DNA and cause genetic mutation”. [1] Because radon

is a gas, it can leak into homes through the basement or crawl space, cracks in concrete floors and walls,

floor drains and sump holes, or through well water. The Environmental Protection Agency (EPA) estimates

that radon is the number one cause of lung cancer in non-smokers, responsible for as many as 21,000

cancer deaths each year. The combination of smoking and the presence of radon in the home can

significantly increase the risk of lung cancer.

2012 7


2012 8

Working from west to east, the northernmost boundary from Linwood to Woodward is Webb/Woodland. From Woodward to Oakland it is Holbrook, and from Oakland to I-75 it is Clay.

Working from north to south, the easternmost boundary from Atkinson to Holbrook is Woodward. From Holbrook to Clay, it is Oakland, and from Clay to Mack it is I-75.

The southernmost border, from west to east, is West Grand Blvd between Linwood and 14th. From 14th to Rosa Parks Blvd, it is I-94. Between Rosa Parks Blvd and Trumbull, it is Grand River, and between Trumbull and I-75 it is Mack/Martin Luther King Blvd.

Between Atkinson and West Grand Blvd, the westernmost boundary is Linwood. Between West Grand Blvd and I-94, it is 14th, and between I-94 and Grand River, it is Rosa Parks Blvd.

HHST Target Area

Smoking

2012 9

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.2%

55.1%

44.7%

Does anyone in your home smoke?

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.0%

48.9%

51.1%

Does anyone in your home smoke?

Completed in house by site visitor Completed outside house by interview

n=23

n=22

n=301

n=371

n=1 n=0

Smoking

2012 10

10

6

5

4

3

2

1

0% 20% 40% 60% 80% 100%

5%

0%

0%

5%

16%

47%

26%

Number of people who smoke

10

6

5

4

3

2

1

0% 20% 40% 60% 80% 100%

0.0%

0.4%

1.1%

4.8%

8.6%

25.7%

59.5%

Number of people who smoke


n=160

n=69

n=23

n=13

n=3

n=1

n=5

n=9

n=3

n=1

n=1

n=0

n=0

n=0

Fire/Burns

2012 11

Does your family sleep with the bedroom doors closed?

Is a fire extinguisher present?

Are smoke detectors present in your home?

0% 50% 100%

1.8%

3.4%

1.7%

35.2%

39.0%

10.2%

63.0%

57.6%

88.1%

YesNoDon't Know

Does your family sleep with the bedroom doors closed?

Is a fire extinguisher present?

Are smoke detectors present in your home?

0%20%

40%60%

80%100%

0.6%

1.6%

0.3%

49.9%

42.9%

23.4%

49.5%

55.5%

76.3%

YesNoDon't Know


n=52

n=6

n=1

n=34

n=23

n=2

n=34

n=19

n=1

n=534

n=164

n=2

n=387

n=299

n=11

n=335

n=338

n=4

Fire/Burns

2012 12

Has everyone in your house-hold discussed how to get out

in case of a fire?

Are there multiple exits from the building in the event of a

fire?

0% 20% 40% 60% 80% 100%

0%

0%

26%

2%

74%

98%

YesNoDon't Know

Has everyone in your household discussed how to get out in case of a fire?

Are there multiple exits from the building in the event of a fire?

2.1%

0.0%

33.5%

3.7%

64.4%

96.3%

YesNoDon't Know


n=670

n=26

n=121

n=63

n=4

n=57

n=1

n=39

n=14

n=0 n=0

n=0

Fire/Burns

2012 13

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

1.7%

55.9%

42.4%

Do you use any appliances other than a furnace to provide heat? (wood

stove, fireplace, space heater)

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.3%

60.5%

39.2%

Do you use any appliances other than a furnace to provide heat? (wood

stove, fireplace, space heater)


n=278

n=429

n=2

n=25

n=33

n=1

Fire/Burns

2012 14

Pipework between Radiators

Pipework that serve hot water to taps and water tanks

Radiators

0%20%

40%60%

80%100%

24.3%

25.0%

30.2%

Are the following hot surfaces acces-sible to children?

Yes

Pipework between Radiators

Pipework that serve hot water to taps and water tanks

Radiators

0%20%

40%60%

80%100%

17.2%

27.8%

25.2%

Are the following hot surfaces acces-sible to children?

Yes


n=13

n=11

n=9

n=35

n=42

n=22

Poisoning

2012 15

Pesticides

Garden Supplies

Cleaning Products

Medications

0% 20% 40% 60% 80% 100%

75%

74%

73%

78%

Are the following items stored out of the reach of children?

Yes

Pesticides

Garden Supplies

Cleaning Products

Medications

0% 20% 40% 60% 80% 100%

84.8%

82.5%

82.4%

89.0%

Are the following items stored out of the reach of children?

Yes


n=556

n=515

n=433

n=506

n=38

n=36

n=32

n=33

Falls

2012 16

Do you have working lights above or near all stariways?

Are there handrails present in all stairways?

Are all stairs in good condition?

0%

0%

0%

2%

7%

4%

98%

93%

96%

YesNoDon't Know

Do you have working lights above or near all stariways?

Are there handrails present in all stairways?

Are all stairs in good condition?

0.0%

0.1%

0.1%

11.7%

21.4%

13.9%

88.3%

78.4%

86.0%

YesNoDon't Know


n=55

n=2

n=54

n=4

n=57

n=1

n=607

n=98

n=1

n=553

n=151

n=1

n=625

n=83

n=0

n=0

n=0

n=0

Falls

2012 17

Is there a slip-proof surface in bathtub and/or showers?

Are grab bars present in bathtub(s) and/or showers?

0%20%

40%60%

80%100%

0%

0%

45%

73%

55%

27%

YesNoDon't Know

Is there a slip-proof surface in bathtub and/or showers?

Are grab bars present in bathtub(s) and/or showers?

0%20%

40%60%

80%100%

0.1%

0.1%

51.8%

77.6%

48.1%

22.3%

YesNoDon't Know


n=341

n=367

n=1

n=158

n=551

n=1

n=31

n=25

n=15

n=41

n=0

n=0

Asthma/Allergies

2012 18

Do any of the persons living here have chronic problems breathing?

Have any adults living here been told by a doctor or other medical professional that they have asthma?

Have any persons living here (under 18) been told by a doctor or other medical professional that they have asthma?

0%

0%

0%

69%

69%

71%

31%

31%

24%

YesNoDon't Know

Do any of the persons living here have chronic problems breathing?

Have any adults living here been told by a doctor or other medical professional that they have asthma?

Have any persons living here (under 18) been told by a doctor or other medical professional that they have asthma?

0.4%

1.1%

1.2%

77.0%

71.0%

78.2%

22.5%

27.9%

20.5%

YesNoDon't Know


n=9

n=27

n=18

n=41

n=18

n=40

n=100

n=381

n=6

n=197

n=502

n=8

n=103

n=352

n=2

n=0

n=0

n=0

Asthma/Allergies

2012 19

Alot

A Moderate Amount

A Little

Not at All

0% 20% 40% 60% 80% 100%

13.3%

6.7%

33.3%

46.7%

Would you say [this person] limits [his/her] usual activities due to

asthma?

Alot

A Moderate Amount

A Little

Not at All

0% 20% 40% 60% 80% 100%

10.3%

17.6%

26.0%

46.2%

Would you say [this person] limits [his/her] usual activities due to

asthma?


n=126

n=71

n=48

n=28

n=14

n=10

n=2

n=4

Asthma/Allergies

2012 20

Birds

Cats

Dogs

0% 20% 40% 60% 80% 100%

0.0%

23.7%

21.1%

Do you have any of the following pets living in your home?

Yes

Birds

Cats

Dogs

0% 20% 40% 60% 80% 100%

1.6%

20.3%

34.0%

Do you have any of the following pets living in your home?

Yes


n=12

n=14

n=239

n=141

n=11 n=0

Asthma/Allergies

2012 21

Plug-Ins

Incense

Candles

0% 20% 40% 60% 80% 100%

45.8%

47.5%

67.8%

Do you use the following air freshener products in your home?

Yes

Plug-Ins

Incense

Candles

0% 20% 40% 60% 80% 100%

43.5%

40.9%

56.2%

Do you use the following air freshener products in your home?

Yes


n=396

n=287

n=305

n=40

n=28

n=27

Asthma/Allergies

2012 22

Pine-Sol

Lysol

Bleach

0% 20% 40% 60% 80% 100%

74.6%

76.3%

84.8%

Do you use the following cleaning products in your home?

Yes

Pine-Sol

Lysol

Bleach

0% 20% 40% 60% 80% 100%

65.8%

79.1%

91.9%

Do you use the following cleaning products in your home?

Yes


n=50

n=45

n=44

n=654

n=558

n=125

Mold/Water Damage

2012 23

Have there been water leaks in the house from INSIDE the building in the past year?

Has water leaked into your home from outdoors in the past year? (exclude plumbing or other inside leaks)

5.1%

1.7%

57.6%

64.4%

37.3%

33.9%

YesNoDon't Know

Have there been water leaks in the house from INSIDE the building in the past year?

Has water leaked into your home from outdoors in the past year? (exclude plumbing or other inside leaks)

0.7%

0.3%

67.5%

62.3%

31.8%

37.4%

YesNoDon't Know


n=20

n=38

n=1

n=22

n=34

n=3

n=265

n=441

n=2

n=225

n=477

n=5

Mold/Water Damage

2012 24

Have you smelled mold in your home?

Have you seen mold in your home?

0%20%

40%60%

80%100%

5.6%

1.8%

70.4%

61.1%

24.1%

37.0%

YesNoDon't Know

Have you smelled mold in your home?

Have you seen mold in your home?

0%20%

40%60%

80%100%

2.6%

0.4%

82.7%

82.3%

14.7%

17.2%

YesNoDon't Know


n=116

n=555

n=3

n=28

n=158

n=5

n=20

n=33

n=1

n=13

n=38

n=3

Pests

2012 25

Cockroaches

Bed Bugs

Insects

Mice/Rats

0% 20% 40% 60% 80% 100%

10.2%

13.6%

42.4%

39.7%

Is there visible evidence of the follow-ing in or around your home?

Yes

Cockroaches

Bed Bugs

Insects

Mice/Rats

0% 20% 40% 60% 80% 100%

5.1%

6.0%

27.9%

24.3%

Is there visible evidence of the follow-ing in or around your home?

Yes


n=23

n=25

n=8

n=6

n=172

n=196

n=42

n=36

Pests

2012 26

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.0%

71.1%

29.0%

If yes to any of the above, do you use pesticides to get rid of or prevent

them?

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.5%

54.3%

45.3%

If yes to any of the above, do you use pesticides to get rid of or prevent

them?


n=181

n=217

n=2

n=11

n=27

n=0

Lead Poisoning

2012 27

Was your house built before 1978?

Is there chipping or peeling paint inside or outside of your home?

(If children present) Have your children been tested for lead poisoning?

16.7%

0.0%

3.0%

14.8%

42.4%

57.6%

68.5%

57.6%

39.4%

YesNoDon't Know

Was your house built before 1978?

Is there chipping or peeling paint inside or outside of your home?

(If children present) Have your children been tested for lead poisoning?

3.4%

0.3%

2.9%

5.3%

40.7%

49.3%

91.3%

59.1%

47.9%

YesNoDon't Know


n=200

n=206

n=12

n=417

n=287

n=2

n=600

n=35

n=22

n=13

n=19

n=1

n=34

n=25

n=37

n=8

n=9

n=0

Entry by Intruders

2012 28

Do you have deadbolts on all your external doors?

Do all your windows have locks?

0%20%

40%60%

80%100%

17.2%

15.3%

82.8%

84.8%

YesNo

Do you have deadbolts on all your external doors?

Do all your windows have locks?

0%20%

40%60%

80%100%

17.4%

14.5%

82.6%

83.9%

YesNo


n=162

n=28

n=161

n=34

n=50

n=9

n=48

n=10

Carbon Monoxide

2012 29

Are they working?

Do you have a carbon monoxide detector in your home?

0%20%

40%60%

80%100%

14.3%

55.9%

85.7%

42.4%

YesNo

Are they working?

Do you have a carbon monoxide detector in your home?

0%20%

40%60%

80%100%

15.6%

58.8%

84.4%

41.2%

YesNo


n=25

n=33

n=24

n=4

n=283

n=404

n=276

n=51

Carbon Monoxide

2012 30

10

7

6

5

4

3

2

1

0

0% 20% 40% 60% 80% 100%

0.4%

0.4%

0.8%

1.1%

3.4%

7.8%

23.9%

60.5%

1.9%

How many? (Carbon Monoxide De-tectors)

10

7

6

5

4

3

2

1

0

0% 20% 40% 60% 80% 100%

0%

0%

4%

4%

0%

12%

20%

60%

0%

How many? (Carbon Monoxide De-tectors)


n=5

n=162

n=64

n=21

n=9

n=3

n=2

n=1

n=1

n=15

n=5

n=3

n=1

n=1

n=0

n=0

n=0

n=0

Was your furnace inspected in the past year?

Is an unvented gas fireplace used in the home?

Is an unvented gas stove used in the home?

0%20%

40%60%

80%100%

2%

0%

0%

42%

91%

75%

56%

9%

25%

YesNoDon't Know

Carbon Monoxide

2012 31

Was your furnace inspected in the past year?

Is an unvented gas fireplace used in the home?

Is an unvented gas stove used in the home?

0%20%

40%60%

80%100%

0.0%

1.1%

0.7%

41.2%

89.7%

83.9%

58.8%

9.2%

15.4%

YesNoDon't Know


n=15

n=44

n=5

n=53

n=25

n=19

n=1

n=105

n=572

n=5

n=17

n=166

n=2

n=360

n=252

n=0

n=0

n=0

Radiation

2012 32

Has any work been done on your home to reduce the level of radon?

Do you know what radon is?

0%20%

40%60%

80%100%

39.3%

1.7%

60.7%

32.2%

0.0%

66.1%

YesNoDon't Know

Has any work been done on your home to reduce the level of radon?

Do you know what radon is?

0%20%

40%60%

80%100%

11.3%

3.1%

84.2%

37.8%

4.5%

59.1%

YesNoDon't Know


n=39

n=19

n=1

n=17

n=11

n=114

n=73

n=6

n=15

n=283

n=38

n=0

Crowding & Space

2012 33

Is the space visible from the home?

Is it fenced in or well-guarded?

Does your home include a recreation space?

0%20%

40%60%

80%100%

20.4%

26.9%

23.7%

79.6%

73.1%

76.3%

YesNo

Is the space visible from the home?

Is it fenced in or well-guarded?

Does your home include a recreation space?

0%20%

40%60%

80%100%

15.6%

26.7%

22.4%

84.4%

73.3%

77.6%

YesNo


n=149

n=43

n=126

n=46

n=135

n=25

n=45

n=14

n=38

n=14

n=39

n=10

Crowding & Space

2012 34

Do all bathroom doors have locks?

Are all bathroom doors working?

Do all bedroom doors have locks?

Are all bedroom doors working?

0% 20% 40% 60% 80% 100%

38.6%

1.7%

59.3%

14.8%

61.4%

98.3%

40.7%

85.2%

YesNo

Do all bathroom doors have locks?

Are all bathroom doors working?

Do all bedroom doors have locks?

Are all bedroom doors working?

0% 20% 40% 60% 80% 100%

44.2%

4.1%

64.2%

13.2%

55.8%

95.9%

35.8%

86.8%

YesNo


n=165 n=46

n=8n=25

n=67

n=120

n=186

n=8

n=106

n=84

n=22

n=32

n=58

n=1

n=35

n=22

Noise

2012 35

No

Yes

0% 20% 40% 60% 80% 100%

17.2%

82.8%

Is your home located near an airport, major highway, or train station?

No

Yes

0% 20% 40% 60% 80% 100%

21.8%

78.2%

Is your home located near an airport, major highway, or train station?


n=48

n=10

n=151

n=42

Food Safety

2012 36

Sink

Oven

Freezer

Refrigerator

0% 20% 40% 60% 80% 100%

100.0%

98.3%

93.0%

100.0%

Does your kitchen include the follow-ing appliances/amenities?

Yes

Sink

Oven

Freezer

Refrigerator

0% 20% 40% 60% 80% 100%

98.4%

97.9%

84.1%

98.4%

Does your kitchen include the follow-ing appliances/amenities?

Yes


n=189 n=58

n=53

n=58

n=59

n=159

n=187

n=190

Water Supply

2012 37

Are both hot and cold water options available?

Does your home have running water?

0%20%

40%60%

80%100%

1.7%

0.0%

98.3%

100.0%

YesNo

Are both hot and cold water options available?

Does your home have running water?

0%20%

40%60%

80%100%

1.0%

0.5%

99.0%

99.5%

YesNo


n=194

n=192

n=2

n=1

n=59

n=58

n=1

n=0

Electrical Hazards

2012 38

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

1.7%

15.3%

83.1%

Is all the wiring in the finished areas of your home concealed either in walls or

behind metal coverings?

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.1%

14.2%

85.7%

Is all the wiring in the finished areas of your home concealed either in walls or

behind metal coverings?


n=49

n=9

n=1

n=603

n=100

n=1

Electrical Hazards

2012 39

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

1.0%

67.4%

31.6%

Have you experienced any problems with your major appliances (stove, furnace, etc.) over the past year?

Don't Know

No

Yes

0% 20% 40% 60% 80% 100%

0.0%

69.5%

30.5%

Have you experienced any problems with your major appliances (stove, furnace, etc.) over the past year?


n=18

n=41

n=61

n=130

n=2 n=0

Next Steps• The Center is in the process of piloting a grant

from MDCH to work with health professionals and others to prepare a one-page version of the HHST, pilot it, and identify steps for its implementation as part of regular home visitation processes.

2012 40

2012 41

Center for Urban Studies

Lyke ThompsonDirector(313) [email protected]

Ramona WashingtonResearch Assistant(313) [email protected]

Angie SarbResearch Assistant(313) [email protected]

healthy homes screening tool (hhst)

Documents

homes inhabitants

surveyed homes

hhrsthe hhst

nonhousing professionals

trained housing professionals

hhst targets versionsthe

nervous system

system of assessment