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Region 1: EPA New England

Healthy Communities Grants

The Asthma Team at the EPA in Region 1 has been able to fund various projects and programs that focus on asthma and indoor air quality issues through the Healthy Communities Grant Program. For more information on the Healthy Communities Grant Program please go to Region 1's Health Communities Grants Program website.

For more funding resources, please refer to our grant resources page.

The following is a sample of the type of asthma and indoor air quality projects the asthma team values and has funded through the Healthy Communities Grant Program over the last few years.

New England

Health Resources in Action’s Asthma Regional Council of New England (2010-2012)
Promoting Best Practices in Asthma Management

Summary: Adult and childhood asthma is a growing epidemic, with approximately 9.1% of children and 7.3% of adults in the U.S. alone with the disease. With appropriate proactive asthma care, nearly all hospitalizations, along with other urgent care and emergency room visits can be avoided. The Asthma Region Council (ARC) is a coalition of nearly 75 governmental, academic, health, and community organizations across New England that seeks to tackle environmental contributors to pediatric and adult asthma, with a special focus on the most sensitive and vulnerable populations. This project seeks to reduce health disparities, and promote environmental justice and health and safety of low-income and minority populations in New England by increasing the availability of asthma services. Project activities include analyzing billing codes and their impact on the delivery of recommended asthma services, hosting training sessions regarding the billing code analysis, disseminating e-newsletters and updating resources on the ARCs website, hosting a region-wide ARC Council meeting, hosting conference calls with the NE Asthma Programs, and hosting several ARC Advisory Committee meetings.

Measurable Results: Creation of report on billing codes; Number of attendees at training sessions; Number of newsletters produced; Size of email distribution list, Number of website hits; Number of attendees at ARC meetings; Number of conference calls hosted.

Partners: New England State Asthma Programs, ARC Advisory Council

Health Resources in Action (New England-wide, 2007-2008)
Improving Asthma Environmental Management through Health Care Policy Change

Summary: Health Resources in Action's Asthma Regional Council (ARC) is a coalition of government, community, academic and health organizations that seek to address disproportionate asthma burdens across New England. The project emphasized the preventative aspects of asthma by focusing on environmental contributors that exacerbate or cause asthma. ARC improved health outcomes for low-income asthmatic children by increasing the supply and demand of home-based environmental education and services through the health sector. The ARC educated and worked with health plans and other payers across the region to encourage them to pay for and engage in best practices for asthma care. ARC also assisted state Asthma Managers in select New England Departments of Health develop strategies to increase the financial sustainability and availability of these services by changing health care payment and asthma service policies in their respective states. ARC promoted Integrated Pest Management (IPM) in the home and developed a companion IPM guide for health plans. The project brought Medicaid managed care plans and hospital Medical Directors, serving low income residents together to share the information about IPM and best practices for asthma management. ARC continues to sponsor one annual meeting that addresses the objectives laid out in ARC's strategic planning session that state officials and academic or community organizations attend. The ARC publishes updated information about asthma and funding opportunities on its website, and prints biannual editions of its newsletter that is disseminated to more than 300 individuals and organizations throughout the region.

Measures of Success: Two newsletters were published that highlight activities that address environmental aspects of asthma in the region. The newsletters reached 300 stakeholders and covered a number of asthma related stories, successes and plans. An annual Asthma Regional Council meeting was held and consisted of presentation by a number of model regional Healthy Homes programs. ARC's newly-created Strategic Plan was also presented at the meeting. The Strategic Plan had four focus areas: Healthy Homes, Improving Asthma Management, Indoor/Ambient Air and Asthma Surveillance. Twenty pediatricians, occupational therapists, internal medicine doctors and asthma nurses from the public and private sectors attended a meeting put on by ARC and the University of Massachusetts-Lowell to create an "Asthma Provider Consensus Statement" that outlines the ways in which the health sector must work together to align payments with the delivery of best practices and services for improved asthma care, especially with low income patients. Two state Asthma Managers were recruited to coordinate a new subcommittee consisting of the six state Asthma Managers and Asthma Epidemiologists; the new subcommittee held two meetings. Nearly 100 health providers, payers, and government officials attended a symposium that informed the participants of updated best practices for delivering asthma care to low-income, high-risk populations. ARC also developed Simple Steps to an Asthma Friendly Home a checklist to help patients with asthma rid their homes of asthma triggers and maintained the ARC website.

Partners: Federal, state and local governments as well as community based organizations, health and academia

Health Resources in Action (New England-wide, 2006-2007)
Improving Asthma Data & Outcomes in New England

Summary: Health Resources in Action's Asthma Regional Council (ARC) brings together leaders from the environmental, education, public health, community development, and housing fields to identify priorities and work towards a reduction in asthma and its effects on children and families. ARC reinforced its established role by convening council meetings and producing a newsletter to report on progress in target areas. In addition, ARC worked to develop a region-wide policy report on improved data mining strategies to better understand asthma prevalence. ARC also initiated a business case study for documenting the value of comprehensive asthma education and trigger reduction to become a reimbursable medical service. ARC continues to work with diverse partners to identify best practices, lessons learned, and to provide a forum for insightful dialogue about asthma issues in New England.

Measures of Success: ARC produced the winter edition of Innovations, ARC's newsletter that highlights model regional activities that address environmental aspects of asthma and mailed it to over 300 recipients. ARC conducted interviews with the five state Asthma Managers to determine how ARC and the EPA Region 1 office could better assist them in their positions and presented the results at an ARC meeting where federal officials and nearly 50 state agency representatives attended. ARC members participated in a two-day conference on Integrated Pest Management (IPM) for residential settings; at the conference ARC presented the preliminary Business Case and how it could be used to promote IPM in low income housing. During the project, a sixteen-page report entitled Accessing Public and Private Health Care data to Promote Population Health at the State Level was completed. A Case for Smoke-free Housing, a second published report, included regional successes as well as information from across the country. ARC collaborated with the Boston Area Tobacco Coalition and conducted 69 low income housing tenant evaluations to better understand attitudes on and exposure to secondhand smoke and to evaluate support for (or lack of) no-smoking policies. A third published report, Investing in Best Practices for Asthma: A Business Case for Education and Environmental Interventions advocates for health care coverage of asthma best practices and was featured at national EPA meetings. Half of the new Strategic Plan was completed by the project's end.

Partners: Federal, state and local governments as well as community based organizations, health and academia


Connecticut Coalition for Environmental Justice (2010-2012)
Showcase Showdown with Asthma

Summary: Twenty percent of city residents suffer from asthma in some neighborhoods of Bridgeport, Connecticut. Those rates are more than twice the national average and three times the state average. Bridgeport also has the third highest number of people hospitalized for asthma in the state of Connecticut. Connecticut Coalition for Environmental Justice works to promote fair and meaningful involvement of Connecticuts urban residents in environmental policies that effect where they live, play, and work by providing education to the community and promoting individual, corporate, and governmental responsibility toward Connecticuts city environments. This project seeks to motivate Bridgeport residents to be more aware of environments that trigger asthma and lead poisoning, to engage in proper asthma self-management, and to help themselves, neighbors, and families seek medical treatment for asthma or lead poisoning. Activities include hosting an asthma community fair, convening city organizations working on asthma and lead poisoning prevention to develop a Healthy Homes program, and promoting the implementation of Tools for Schools in the Bridgeport Public Schools.

Measurable Results: Number of families participating in the Healthy Homes program; Number of community residents educated through asthma fair, Number of schools implementing Tools for Schools

Partners: Bridgeport Asthma Council, Bridgeport Health Department, Bridgeport Lead Free Families, Bridgeport Neighborhood Trust, Connecticut Department of Public Health

Ledge Light Health District (New London County, 2008-2009)
Comprehensive Asthma Intervention Plan

Summary: The Ledge Light Health District's Comprehensive Asthma Intervention Project is an evidence based asthma self-management program with home education and comprehensive home intervention to identify and address asthma triggers. Children receive education and outreach in the home environment that will carry over into the child's school environment. In addition, the Coaches and Asthma program provides coaches with training on asthma and environmental health.

Measures of Success: As of March 2009, six clients received home visits, four were children. The AIRS program was adapted for one family who elected to receive follow-up from the child's school nurse instead of a home visit. The nurse reported being pleased with her progress. New London County Asthma Action Partnership (NLCAAP) continues to hold quarterly meetings where they share ideas on asthma awareness and promotional activities. Four people joined the NLCAAP bringing the total roster to 32 members. NLCAAP has participated in four outreach programs including an AIRS training for the Bridgeport Health Department, attending TVCCA Family Fun Night where NLCAAP had the opportunity to talk with over 400 families about asthma, promoting AIRS and smoking cessation at Electric Boat "House Calls," and planning an asthma program targeting recreational baseball coaches. Project staff attended six meetings/workshops to increase education on asthma programs and ideas to improve program effectiveness.

Partners: New London County Asthma Action Partnership (NLCAAP), Uncas Health District

Connecticut Coalition for Environmental Justice (Bridgeport, 2007-2009)
Healthy Indoors/AIRS

Summary: The Connecticut Coalition for Environmental Justice (CCEJ) is a nonprofit organization founded in 1998 with a mission to improve urban environmental health through education and changes in policy and to promote individual, corporate and government responsibility to protect the environment. In 2006, CCEJ efforts were expanded to create the Fairfield County Environmental Justice Network to serve the needs of residents in Bridgeport, CT. Bridgeport has nearly double the state average rate of asthma related hospitalization and more than two times the number of emergency room visits due to asthma attacks than the state average. The Healthy Indoor/AIRS project addresses asthma and indoor environmental quality by educating local residents on asthma signs, symptoms and triggers, conducting targeted home visits to assess risk, reducing exposure to health hazards, and building healthier indoor environments. This project relies on the design of the Asthma Indoor Risk Strategies (AIRS), a validated program from the Connecticut Department of Public Health which follows the National Heart, Lung and Blood Institute guidelines for diagnosis and management of asthma. By applying proven methods, this project reduces in-home exposure to toxics which leads to indoor health improvement. The project focuses on reducing exposures to asthmatic health hazards including mold, pesticides, volatile organic compounds, insecticides, and lead.

Measures of Success: As of March 2009, CCEJ hired a new program nurse who was trained in Putting on AIRS. The program nurse designed a flyer and brochure to promote and advertise the program as well as spoke about Healthy Indoors/AIRS plans and strategies with a member of the Bridgeport Health Department.

Partners: Bridgeport Asthma Council and Bridgeport Department of Healthy and Social Services

Connecticut Department of Public Health (Hartford, 2007-2009)
Connecticut School Indoor Environmental Resource Team (CSIERT)-Sustaining EPA's Tools for Schools

Summary: This project provides Tools for Schools (TfS) training for Connecticut schools in the large cities of Stamford, Hartford, New Haven, the Connecticut Technical High School system and other small to moderate-sized cities. Initiatives include creating and providing new training workshops for custodians in several districts, holding refresher courses for schools already participating in the program, assisting school districts to implement a Cleaning for Health greencleaning program, supporting TfS team fall kick-off meetings at member schools, and completing and maintaining the Connecticut Tools for Schools website for students, staff, families, and administrators.

Measures of Success: As of June 2009, buy-in presentations were given to school district executive staff at Waterbury, Portland and Region 12. A first training workshop was conducted in the New Haven School District (four schools), Bridgeport School District (six schools), Region 4 (five schools) and two vocational-technical high schools. A second training was completed in Region 4 (five schools) and Bridgeport (six schools). An "Advanced TfS for Custodians" workshop was conducted in New Haven. Sterling (one school), Ledyard (six schools), South Windsor (seven schools), Montville (five schools), Old Saybrook (four schools), Mansfield (four schools), Thomaston (three schools) and New Fairfield (one school) received a refresher training course. Bullard Havens Technical High School and Windham Technical High School implemented the program in May 2009. The new green cleaning consultation service and kick-off meetings were announced via e-mail to 145 district coordinators and 775 team coordinators. Green cleaning consultations were conducted for Hebron, New Hartford/Region 7, Region 14, New Haven, Ellis Technical High School, New Fairfield, Madison and Bridgeport. The CSIERT website was created and introduced via email; TfS partners were urged to participate in the new online forum.

Partners: Connecticut Indoor Environment Resource Team. Members include: Connecticut Departments of Public Health, Education, and Environmental Protection; Connecticut Education Association; American Lung Association of Connecticut; University of Connecticut School of Medicine; Yale University; Connecticut Department of Labor Occupational Safety program; Connecticut Parent Teacher Association; Connecticut Foundation for Environmentally Safe Schools

Connecticut Department of Public Health (Waterbury and Meriden, 2007-2009)
Putting on AIRS

Summary: The Connecticut Department of Public Health (CTDPH) adopted a regional asthma approach and encouraged its 10 regions to implement an asthma intervention. Putting on AIRS (Asthma Indoor Risk Strategy) is a comprehensive home education and environmental intervention program administered by a nurse, public health educator and a town sanitarian. This grant enables two large urban cities, Waterbury and Meriden to implement the already established asthma intervention program. The program provides cleaner indoor air and asthma self-management training to asthmatic patients in order to prevent asthmatic events and therefore decrease emergency department (ED) visits, hospitalizations and absenteeism from school or work. CTDPH will evaluate the impact of conducting AIRS at a statewide level and conduct a cost benefit analysis of implementation costs versus cost savings from declining ED visits, physician visits, and hospitalizations.

Measures of Success: As of June 2009, seven urban areas have implemented the Putting on AIRS program and provide data to CTDPH for analysis. Waterbury has received a total of 41 referrals. To date, 15 home visits have been completed with 4 more scheduled. Evaluations of the program have resulted in positive parent feedback. Collaboration and continued communication with school nurses has proven to be an excellent source of referrals. In May, the Waterbury AIRS program participated in Asthma Awareness Month activities including a Waterbury Health Department open house, meeting attendance, posted information on community bulletin boards and distribution of educational materials to residents. The CTDPH continues to support and motivate Meriden to get involved in the asthma region and to implement an AIRS program.

Partners: Ledge Light Health District, Waterbury Health Department, Meriden Health Department, Naugatuck Valley, Meriden, Waterbury and Bridgeport Asthma Coalitions, and CT EJ Network and HUSKY A (Medicaid)

Bridgeport Community Health Center (Stamford, 2004-2009)
Development of a Community Based Asthma Network for Community Environmental Education

Summary: Development of a Community Based Asthma Network for Community Environmental Education, educates children, families and immigrants of low socio-economic status about indoor asthma triggers through a coordinated community-based approach. The project is implemented by the BCHC through the Stamford Community Health Center in partnership with the City of Stamford Department of Health and Social Services Division of Environmental Health's A Breath of Fresh Air program. The project addresses the microenvironments of children, specifically the home and day care centers, by educating children, families and caregivers on recognizing and reducing indoor environment asthma triggers. The project intervention provides the following: peak flows, spirometers, medication education and therapy, asthma action plans developed with parents and the patient, culturally appropriate patient education, and asthma inhalers for low income families who are uninsurable (e.g. immigrants).

Measures of Success: As of March 2009, project successes include the hiring of a consultant to help establish the Stamford Pediatric Asthma Network (SPAN). The consultant has been successful in convening monthly asthma meetings with good attendance for SPAN. The Stamford Advocate printed an article on asthma and the Asthma Management Program. In March, 2009 four parents of children with asthma joined the Network. Currently, the Network is focused on developing and implementing Memorandums of Understanding (MOU) that center on referrals to the Center's Asthma Program. The MOUs are targeted to the City of Stamford Health Department School Nurse Program and the Children's Learning Center. A total of 537 encounters have been completed at the Asthma Clinic in Stamford. The program provided asthma education to 629 children and families (157% of project goal).

Partners: Stamford Community Health Center, City of Stamford Department of Health and Social Services Division of Environmental Health

Ledge Light Health District (New London County, 2007-2008)
New London County Asthma Action Partnership

Summary: Putting on AIRS is a home-based program that takes a clinical and sanitarian approach to demonstrate the importance of addressing both the environmental and medical/health components for optimal asthma management. New London County Asthma Action Partnership (NLCAAP) expanded Putting on AIRS and EPA's Tools for Schools programs to reach the uninsured and patients in emergency rooms or hospitalized for asthma related complications. The project addressed asthma in the county's most vulnerable populations and integrated individual programs into one campaign. The program provided effective asthma management programs through schools, health care settings, and in-home assessments to the target population of low-income children living with asthma; the project also strengthened and broadened the NLCAAP. The Partnership improved asthma self-regulation through coordination of medical care, patient education, and manipulation of the indoor environment. By empowering individuals to take control of their chronic disease, the program's vigorous disease management practices positively affected the overall health and well-being of those living with asthma and reduced asthma related emergency room visits and absenteeism.

Measures of Success: The AIRS program representatives visited 34 clients at home. The most common reported environmental trigger was mold; secondhand cigarette smoke was also an issue. As a result of AIRS visits four clients moved out of unsuitable housing, and others learned that proper house keeping will reduce asthma triggers and have requested a HEPA filtered vacuum from social workers. NLCAAP continues to have quarterly meetings and during the project recruited five new members. A three hour workshop was held for nurses; 23 nurses attended. A test assessing knowledge of asthma was given to each nurse before and after the workshop; average test scores went from 76% before the workshop to 96% after. The workshop received positive participant feedback. A panel on Tools for Schools had 25 attendees from ten schools; the information learned at this panel had potential to better the indoor air quality for 3,600 students plus faculty and staff. In total, asthma educational workshop attendees included 23 school nurses, 22 sanitarians, 25 school representatives and 55 coaches. Most referrals for the AIRS program continued to come from physicians and the NLCAAP learned that without physician involvement, it is difficult to get people interested in home visits.

Partners: The New London county Asthma Action Partnership, Connecticut Department of Public Health (CTDPH), Ledge Light Health District (LLHD), Uncas Health District, William W. Backus Hospital, Lawrence and Memorial Hospital, Child and Family Agency, Nurses from School Districts, and municipalities, Pulmonologists, Pediatricians, and Pharmacists; American Lung Association, Visiting Nurses Association, and Tribal Nations.

Ledge Light Health District (New London County, 2005-2007)
Asthma: Putting on AIRS Project

Summary: Asthma: Putting on AIRS Project created a county-wide cooperative and integrated infrastructure of health care professionals, schools, parents, and those living with asthma by incorporating the northern tier of the county into an existing partnership of towns working to address childhood asthma. The program introduced the implementation of multiple programs such as EPA's Tools for Schools, Putting on AIRS, and Open Airways to address the burden of asthma. Best practices were applied to outcome-based Asthma Management Programs targeting children, un/under-insured, and minority populations through schools, health care settings, and in-home assessments.

Measures of Success: The home based program worked with a total of 94 clients. Within those clients, 51 home visits were made. Researchers concluded that dust and high humidity levels (mostly due to water damage) were the primary asthma triggers in clients' homes. Secondhand smoke was a factor in one-third cases. After six months of participating in the AIRS program, there was a 30.36% reduction in asthma related emergency department visits, a 73.21% decrease in unscheduled, asthma related doctor visits, and a 23.21% decrease in days absent from school or work due to asthma. A test of asthma knowledge was given prior to AIRS visits and again after the visit to evaluate changes in client knowledge level. Before the visit, 30.91% of clients got all five questions correct, and at the close of the visit, 67.27% got all correct answers. Tools for Schools was implemented in 48 schools, but at the time of project completion schools varied in degree of TfS participation.

Partners: Child and Family Agency of SECT, Mashentucket Pequot Tribal Nations, Uncas Health District, Visiting Nurses Association of SE CT


Maine Indoor Air Quality Council (2010-2012)
Weatherization Plus Health: Ensuring Healthy Indoor Air Quality During Low-Income Weatherization & Energy Retrofits

Summary: Weatherization efforts in Maine limit their scope to the reduction of unplanned air leakage and improving the thermal performance of the building envelope. These same weatherization efforts can adversely impact the indoor air quality in a home, creating conditions that put occupant health at risk, especially if the occupant is a child, is elderly, or suffers from asthma. The Maine Indoor Air Quality Council is a nonprofit organization whose mission is to promote quality of life through improved indoor environments. In 2009, they developed a draft Protocol and companion checklist to assist weatherization professionals in evaluating homes for indoor air quality problems prior to weatherization, correcting IAQ problems as part of the project, and preventing the creation of IAQ problems where none previously existed. This project seeks to field test the protocol and checklist in 50% of the low-income weatherization projects in Aroostook and Waldo Counties, with the goal of developing a workable model. Use of the protocol is expected to achieve healthy, energy efficient, more affordable housing for disadvantaged populations in Maine. Project activities include creating a webinar and training Aroostook and Waldo County personnel, field testing while implementing the protocols in 50% of projects, revising the protocols/checklist based on the results of the field tests and data analysis, and developing a strategic plan for future protocol/checklist implementation by MaineHousing.

Measurable Results: Number of webinars held; Number of weatherization personnel trained; Number of projects implementing the protocol; Collection of health, building, and cost data.

Partners: MaineHousing, Aroostook County Community Action Program, Waldo County Community Action Program, Maine Radon Section, Maine Department of Environmental Protection, Maine Asthma Council

The Houlton Band of Maliseet Indians (Littleton, 2008-2011)
Asthma Health Homes Initiative

Summary: The Asthma Healthy Homes (AHH) Initiative develops and delivers a comprehensive asthma intervention program to include training, outreach and education on environmental trigger identification and avoidance techniques and asthma self-management to ensure healthy home for children and families of the Houlton Band of Maliseet Indians (HBMI) tribe in Maine. The project improves the environmental conditions, health, and quality of life for at least 20 Maliseet children and adults with asthma by supporting in-home education and intervention. The project evaluated the Ledge Light Tribal Putting on AIRS materials for adaptation.

Measures of Success: The AHH Initiative has contracted with Houlton Regional Hospital (HRH) to deliver four asthma trainings conducted by an HRH Asthma Educator. The first training is for HBMI staff, the second for community members, the third for SAD #29 personnel, and the final training is for local area health providers. AHH Initiative met twice with SAD #29 School Health Advisory Subcommittee to discuss asthma educational needs and plan for the community event and with the Maine Center for Disease Control and Prevention Asthma Program Director to explore partnership opportunities with the Maine Asthma Council. AHH Initiative continues to work on developing a culturally appropriate Education/Outreach program and evaluation instruments to use at AHH Initiative asthma education programs.

City of Portland (Portland, Lewiston, & Bangor, 2007-2008)
Smoke Free Housing in Maine

Summary: There are nearly 380,000 people who rent units in multi-unit housing or own/manage a multi-unit building in the state of Maine. The Smoke-Free Housing Coalition of Maine, comprised of over fifty public health advocates, tenants, landlords, property managers and environmental health professionals, is dedicated to reducing the number of residents in multi-unit housing who are involuntarily exposed to environmental tobacco smoke (ETS) through education, advocacy, and policy change. The Coalition's Smoke Free Housing in Maine project increased the percentage of public housing authorities who implemented smoke-free policies in their housing units, worked with major newspapers in the three largest urban areas of Maine to add a smoke-free icon to each of their smoke-free apartment listings to make identifying smoke-free properties easy for tenants, collaborated with housing departments at five of Maine's major universities to promote smoke-free housing, educated and empowered students to advocate against environmental tobacco smoke exposure in their rental units, implemented the EPA Smoke-Free Homes Pledge program, created and distributed a culturally appropriate, multilingual tenant fact sheet to individuals in Maine's urban communities (Portland, Lewiston, and Bangor), and provided technical assistance to tenants and landlords throughout the state. The Coalition continued to build strong communication lines with the public, broaden awareness, and further decrease the number of families exposed to ETS in multi-unit buildings.

Measures of Success: Eighteen (72%) of Maine public and tribal housing authorities adopted a smoke-free policy in at least one of their buildings accounting for over 3,500 units and 6,200 tenants. The accomplishment included the nation's first tribal housing authority with a smoke-free policy, Pleasant Point Passamaquoddy Reservation Housing Authority, which adopted a policy in a 60-unit family development. The Sun-Journal added a smoke-free icon to housing ads placed that wish to designate units as smoke-free. In addition, the Sun-Journal, Advertiser-Democrat and the Rumford Falls Time added "is this a smoke-free unit?" to their list of standard questions for landlords who call to list apartments in the papers or online. Eight universities in Maine participated in efforts to educate and empower students on smoke-free housing. The Coalition collected 1,524 smoke-free home pledges from parents, grandparents and caregivers throughout the State of Maine.

Partners: Smoke-Free Housing Coalition of Maine, Maine Indoor Air Quality Council, Healthy Androscoggin, Partnership for A Tobacco-Free Maine, City of Portland Minority Health Program, Healthy Portland, Maine Coalition on Smoking or Health, Bangor Regional Partners for Health; and Partnership for a Healthy Community.

Maine Indoor Air Quality Council (Statewide, 2006-2008)
Tribal Housing Construction for Indoor Air Quality: Ventilating New and Existing Homes

Summary: The State of Maine does not require municipalities or tribal communities to adhere to a residential building code, so the Maine Indoor Air Quality Council (MIAQC) addressed this concern through trainings for construction professionals on air quality and ventilation problems. The MIAQC provided a half-day training to private construction contractors entitled "Ventilating New and Existing Homes" on critical housing construction practices to control indoor air quality pollutants that can affect occupant health. The Tribal Housing Construction for Indoor Air Quality modified and expanded this training to reach in-state affordable housing construction professionals including Habitat for Humanity, tribal contractors and those working in Native American tribal members housing. This effort helped improve the quality of the indoor environment in new and existing tribal homes.

Measures of Success: Three trainings on indoor air quality issues and ventilation techniques were provided to over 100 affordable housing professionals, volunteers and product suppliers who live and/or work in at-risk tribal communities in Maine.

Partners: Indian Health Service: Native American Tribes in Penobscot, Aroostock, and Washington Counties


JSI Research & Training Institute (2010-2012)
Casas Sanad Ninos Sanos

Summary: Childrens health is particularly at risk from exposures inside their homes. The majority of Lawrences housing consists of wood frame multiple family dwellings built in the early 1900s. Multiple families occupy units originally built for single families and 68% of the housing stock is rental property, limiting the control that renters have over their indoor environments. JSI Research & Training Institute is a nonprofit organization whose mission is to improve the health of underserved populations. This project seeks to build the capacity of the Centro de Apoyo Familiar (CAF) and the Asociacion de Ministros Evangelicos de Lawrence (AMEDAL) to engage and support Lawrences Latino residents in identifying, understanding, and taking action to reduce environmental health threats to children. Project activities include developing training programs for CAF, modifying a training program for community residents, assembling a library of environmental health information (asthma, lead poisoning, and household pesticides and chemicals), and conducting home assessments.

Measurable Results: Number of trainings held, Number of people trained; Amount of environmental health materials in English and Spanish; Number of home assessments; Number of action plans established; Number of volunteers taking action to reduce environmental exposures

Partners: Centro de Apoyo Familiar, Center of Assistance to Families, Asociacion de Ministros Evangelicos de Lawrence

Massachusetts Coalition for Occupational Safety & Health (2010-2012)
Asthma Prevention through Healthy Schools Initiative

Summary: Many Massachusetts schools suffer from lack of maintenance causing inadequate ventilation, moisture and mold problems, and pest infestations. Poor building conditions can affect the learning opportunities and work environments of our children and school staff. Environmental asthma triggers, respiratory illnesses and other serious health conditions are increasingly associated with the school environment. The Massachusetts Coalition for Occupational Safety and Health is a nonprofit membership organization that promotes healthy workplaces and communities in eastern Massachusetts through education, coalition building, and advocacy. This project seeks to build on the achievements of year one through the engagement of the Greater Brockton Asthma Coalition and statewide stakeholders to (1) expand upon the knowledge, resources, and relationships developed to reduce asthma and improve asthma management and (2) utilize useful tools developed to promote concrete actions including investigating and eliminating environmental triggers in schools and homes and documenting the lessons and strategies across communities to expand institutional and community capacities to achieve environmental health. Activities include engaging Greater Brockton stakeholders and the Healthy Schools committee to promote policies and practices recommended in year one, forming new school Environmental Wellness Teams, introducing the Easy Breathing Program at 2 health centers in New Bedford and Brockton, recruiting families to participate in the Healthy Homes Program, and increasing the effectiveness and engagement of stakeholder participation from urban communities.

Measurable Results: Number of meetings; Number of school Environmental Wellness Teams formed; Number of medical providers, clinic staff, and school nurses introduced to the Easy Breathing Program; Number of families participating in Healthy Homes Program

Partners: Massachusetts Asthma Advocacy Partnership (MAAP), Self Help Inc./Greater Brockton Asthma Coalition (GBAC), Brockton Education Association (BEA)

Health Department, Town of Wareham (Wareham, 2006-2010)
Smoke-Free Homes Campaign

Summary: Smoke-free homes can reduce exposure to indoor toxics and improve the indoor environment air quality. This project trains staff and partners to involve their clients in a smoke-free pledge campaign, which provides smokers with a Smoke-Free Homes kit in English, Spanish, or Portuguese. The Health Department conducts a focus group to discuss the challenges of and barriers to keeping a home smoke-free and implements a town media campaign that includes posters, press releases, and town bus advertisements to raise public awareness about Smoke-Free Homes and other available resources.

Measures of Success: As of February of 2009, Town of Wareham residents have signed 275 smoke-free home pledges. Researchers continue to replenish educational materials to participating staff and promote smoke-free homes through posters, fact sheets and public services announcements played on local cable television. Participating teachers and staff continue to take pledges and follow-up with families who opted not to sign pledge forms.

Partners: Cape Cod Child Development Program (Wareham Head Start), Wareham Child Care, Little Peoples' College, Wareham Women and Infant Care Program

Pioneer Valley Asthma Coalition (Springfield, 2008-2009)
Building Asthma Safe Environments

Summary: The Pioneer Valley Asthma Coalition's Building Asthma Safe Environments project works with health care providers to promote asthma self-management and integrate evidence based Healthy Homes principles into existing asthma management services. This project trains community health workers and nurses about methods of identification, remediation and prevention of environmental exposures in the home that trigger asthma. In addition, the project identifies families with physician diagnosed asthma who could benefit from home visits and a series of follow-up visits.

Measures of Success: As of March 2009, the Pioneer Valley Asthma Coalition developed and conducted a evaluated knowledge on asthma needs, environmental factors in the home that trigger asthma, methods of remediation based on Healthy Homes principles and local resources to address these issues. The information was collected and incorporated into the community health care worker training. Training was lead by a representative from the Community Asthma Program based out of Brigham and Women's Hospital and held in February, 2009. Twenty-eight community health care workers attended the training session. Community health workers, nurses and team managers will implement the intervention beginning May 1, 2009.

Partners: BMC Heath Net Plan, Baycare Health Partners

Massachusetts Coalition of Occupational Safety & Health (Statewide, 2007-2008)
Asthma Prevention through Healthy Schools

Summary: The Asthma Prevention through Healthy Schools initiative complements Massachusetts Coalition of Occupational Safety & Health's (MassCOSH) mission to develop the capacity of low-income communities to achieve a healthy environment at work and home. MassCOSH shared current successes and new approaches on green cleaning, Integrated Pest Management, and school environmental committees with stakeholders in Brockton, Fall River, New Bedford, and Springfield. MassCOSH partnered with eight Boston schools that have high asthma rates; together they developed a pilot program to integrate environmental assessments and Boston Public School policies into the school's Whole School Improvement Plan (WSIP). The program also encouraged parents and teachers to engage in their school's environmental efforts and become leaders in promoting city-wide policies that integrate school environmental efforts into the WSIP. Using lessons learned from Boston's pilot program, other communities gained knowledge and skills to engage in Healthy Schools environmental initiatives and to strengthen their ability to establish or expand local asthma coalitions.

Measures of Success: As of June 2008, four environmental committee leaders were trained to coordinate environmental assessments and action plans in four schools. Action plans have been completed. MassCOSH and Boston Public School's School Wellness Council worked together to finalize goals and objectives. MassCOSH also collaborated with Boston Healthy Schools Taskforce at a quarterly meeting and had sub-committee meetings on Integrated Pest Management, school chemicals and school environmental assessments to promote key environmental policies/procedures. In fall of 2007, all schools without vacuums were provided backpack vacuum cleaners. Training was conducted for 2 parent asthma leaders to be healthy school advocates, and 10 parent asthma leaders were trained on environmental problems such as mold, pests and other asthma triggers. Four parent asthma leaders have staffed information booths where they distributed a factsheet and/or conducted parent interviews on classroom conditions and asthma triggers. An article was printed in the April issue of the BTU newspaper on school environmental action which was distributed to over 5,000 members. Forty parents attended a Boston Urban Asthma Coalition parent advocate meeting at the Umana Barnes Middle School. Sixty teachers attended a MassCOSH, Pioneer Valley Asthma Coalition and the Massachusetts Teacher Association sponsored indoor air quality conference that included a workshop on health and safety committees and how to conduct a school walkthrough. MassCOSH worked with a MAAP Steering Committee which launched a statewide advocacy platform to reduce asthma rates. Sixty coalition members from across the state attended the MAAP Summit where the keynote presentation was on BUAC Healthy Schools model. A Platform of priority issues was finalized for the MAAP Healthy Schools Committee.

Partners: Massachusetts Asthma Advocacy Partnership, Boston Asthma Initiative, Boston Public Schools, Boston Public Health Commission, School Staff Unions

Lexington Public Schools (Lexington, 2006-2007)
Healthy Schools: Inside and Out Automated Training and Mentoring Program

Summary: The project improved indoor air quality in all Lexington Public Schools (LPS) by implementing Tools for Schools (TfS) training, improving indoor air quality procedures, and implementing an indoor air quality monitoring and reporting system. The project developed a paperless, automated TfS system to increase the program's efficiency, sustainability, and accessibility of data for patrons.

Measures of Success: LPS developed an automated TfS system to serve nine schools, 6,300 students, and 1,000 employees. A PowerPoint training and other communication tools were given to school staff in order to educate them on indoor air quality issues; 750 LPS staff participated in training and implementation of TfS. Stand for Children taught community members of the TfS initiative. In addition to staff education, changes were made in school procedures including the following: filter replacement, timely disposal of chemicals, recycling, use of green products, and anti-idling. The Lexington Green Pages website was developed to provide students, parents and staff with a list of environmentally savvy and cost-efficient companies compatible with TfS goals and objectives. A presentation about the basic TfS automated program was given to 14 communities. A five year Indoor Air Quality Assessment Schedule for school use was submitted to the EPA for possible integration into TfS. A pilot program is to be used by 600 Connecticut schools.

Partners: Stand for Children, Lexington Education Association, Town of Lexington

Center for Health and Human Services, Inc (New Bedford and Fall River, 2005-2007)
Smoke-Free Homes Campaign

Summary: Over a two year period, the campaign collaborated with six early childhood partner organizations to get families with smokers and children ages five or under in the home to sign a pledge form to keep the home smoke-free and subsequently, protect their child(ren) against exposure to secondhand smoke. Those families that signed the pledge form received a Smoke-Free Homes kit (available in English, Portuguese, and Spanish) and families who did not, were sent informational fact sheets about the harmful effects of secondhand smoke exposure. In addition, a media campaign was implemented that included ads placed on the interior and exterior of city buses and posters distributed throughout the community.

Measures of Success: A total of 187 teachers were trained to participate in the Smoke-Free Homes Campaign; 1300 Smoke-Free Home kits were assembled and nearly all were delivered to participating organizations. In total, 928 smoke-free home pledges (twice the original project goal) were collected.

Partners: New Bedford Head Start, Fall River Head Start, Northstar Learning Center/New Bedford, Little People's College/New Bedford, John E. Boyd Center for Child Care & Development/Fall River, and the Massachusetts Department of Public Health Tobacco Control Program.

New Hampshire

Breathe New Hampshire, (Statewide, 2008-2010)
Tools for Schools Plus: Healthy Schools, Healthy Children, Health Minds

Summary: Breathe New Hampshire and its partners are using EPA's Tools for Schools (TfS) to provide four school districts in the State of New Hampshire training on school building indoor air quality. In addition, Breath New Hampshire is implementing other activities including anti-idling, high performance design, green cleaning and asthma education to improve the quality of the indoor air environment in New Hampshire schools.

Measures of Success: As of March 2009, Breathe New Hampshire and partners met with 10-15 school administrators, staff, facility members, schools nurses and other school representatives from SAU 13 (Freedom, Madison, Tamworth) to discuss TfS implementation. Asthma Management Training was presented to SAU 13 where TfS checklists were distributed to school personnel. Asthma training was also presented at Lamprey River Elementary in Raymond. Plans for training and implementation in other schools continue.

Partners: NH Coalition for Occupational Safety and Health, DES, LGC

City of Manchester Department of Health (Manchester, 2007-2009)
Multilingual Asthma Education & Outreach Program

Summary: The City of Manchester's Department of Health (MDH), in collaboration with key community partners, developed the Multilingual Asthma Education & Outreach Program to reach multilingual families with asthma education and outreach services conducted in the home. The project provides education to increase patient and caregiver understanding of asthma as a chronic disease, improve self-management skills through the proper use of asthma medications and/or devices, develop and implement Asthma Action Plans, and identify and eliminate environmental asthma triggers in the home, including exposure to environmental tobacco smoke. The program combats the most common barriers to asthma management and control, including issues related to access to care and environmental concerns in the home.

Measures of Success: As of March 2009, selection criteria for new referral sources had been reviewed to ensure appropriate referrals are made. The project continues to work with local hospitals and health providers to streamline the referral process and to establish a liaison who can serve as the primary contact for the asthma case management program. Approximately 20 families participated in a Parent/Guardian Asthma Education Night held at a local elementary school. Outreach to other organizations such as WIC and The Way Home continue to promote program efforts. Two new peer educators were trained. Peer educators have made contact with eight clients to promote asthma education; seven initial intake visits/calls were made. Seven clients have been educated on asthma symptoms, triggers, early warning signs, how to properly use medications and the importance of adhering to medicine schedules. Compliant clients received a nebulizer, appropriate sized mask, a spacer, dust mite covers (pillow and mattress), and green cleaning products to help improve asthma management. Two clients have received instruction on how to use a peak flow meter. Four clients have asthma action plans, and six clients have received follow-up visits. One client who does not receive visits is closely followed by his primary care physician (PCP). Three clients who smoke have made commitments to quit smoking inside the home. Six clients' information has been shared with their PCP and evaluation or feedback for all clients continues as appropriate. Meetings and trainings to keep staff informed continue, and one presentation on the program has been given.

Partners: City of Manchester Department of Health (Division of Chronic Disease Prevention and Neighborhood Health; Division of Environmental Health; Division of School Health); American Lung Association of NH; BRING IT Program; Catholic Medical Center; Child Health Services; Fun Nights; Latin American Center; NH Minority Health Coalition; The Way Home, and Women, Infants and Children Nutrition Program.

Good Beginnings of Sullivan County (Sullivan County, 2006-2008)
Asthma Interventions for Sullivan County Children

Summary: Good Beginnings provided health education and support to parents aimed to ensure the healthy development of children and families in Sullivan County. The Asthma Interventions project improved asthma patient self-management by giving nurses and families the knowledge and ability to reduce and control exposure to environmental asthma triggers in the home. The project provided training to community physicians and childcare providers in asthma trigger reduction and elimination. Training improved indoor environmental conditions and reduced the severity and frequency of asthma attacks in target areas. Good Beginnings also designed and deployed a local media campaign that included radio public service announcements, flyers, newsletters, monthly e-mails, and quarterly public access TV programs to reach Sullivan County residents.

Measures of Success: Nurses and home visit staff were trained in asthma pathophysiology, asthma triggers and motivational interviewing during the first six months of this project. Knowledge assessment tests went from an average of 58% correct before training to an average of 76% correct after training. A participating doctor met one on one with parent educators as requested throughout the project. At total of 152 children were screened for asthma and 40 (26%) were diagnosed with the disease. Of the 152 children, 139 (91%) were under the age of six. Due to difficulty recruiting for home visits, only 10 out of the 33 families with at least one asthmatic child received a home environmental assessment. When conducting home visits, staff used the EPA Environmental Checklist. At each assessment, parents received written and verbal information about housekeeping practices that will minimize asthma triggers, mold removal and prevention, smoking cessation (if needed), and were given a reusable microfiber cleaning cloth, a children's book about asthma and an allergen proof pillow encasing. The project also sponsored two outreach events targeted at health care professionals and seven targeting the community. Good Beginnings found that multidisciplinary approaches (for example, an approach that includes a medical provider, school and home visitor) are most effective.

Partners: Sullivan County Tobacco Prevention and Control Coalition, Claremont-Newport Healthy Homes

Rhode Island

Southern Rhode Island Area Health Education Center (Newport, 2007-2009)
Healthy Residents, Healthy Homes

Summary: The Southern Rhode Island Area Health Education Center (SRI/AHEC) served as the fiscal agency for this project which was managed by the East Bay Community Action program. The Healthy Residents, Healthy Homes project continued activities to assess, understand, and reduce asthma and environmental health issues facing residents in public housing. The project supported and assembled an active workgroup on resident health and environmental quality in Newport public housing, developed and expanded a tool to assess current environmental conditions and asthma burden in public housing units, established Healthy Homes Response Teams to connect families to appropriate resources and promote better environmental practices in Newport public housing units, and encouraged use of the Healthy Residents, Healthy Homes model in other Rhode Island cities. The project incorporated these tools and practices into the regular procedures and operations of the Newport Housing Authority to service public housing residents.

Measures of Success: SRI/AHEC representatives continue to refer residents who smoke to smoking cessation programs and to work with Newport Housing Authority to promote smoke-free housing and green cleaning. Two tenants have been trained as Resident Champions and are assisting in recruiting units for the program. Thirty-nine new families were enrolled in the program to bring the total number of families to 64. Of the 64 enrolled families, 24 are residents from the Donavan, Pond, and Earl Ave units where elderly and disabled residents live. Data was collected on 66 units and 180 individuals at baseline and 6 month follow-up. Of this population, 52 adults (53%) and 33 children (44%) had asthma. In baseline and six month follow-up evaluations of adults and children with asthma, asthma symptoms were significantly reduced. There was a 35% decrease in the number of adults who had asthma symptoms 3 or more times per week, and an 11% increase in the percentage of children who reported they no longer had asthma symptoms. There was a 16% decrease in adults who reported that asthma symptoms interrupted their sleep at least once a week, and a 10% increase in the percentage of adults who reported that asthma no longer interrupted their sleep. In children, there was a 14% increase in those who said asthma no longer woke them at night. Results also showed that 23% fewer adults had to use relief medication for asthma symptoms every day. There was an increase of 8% in adults and 22% in children who did not have to use relief medication for an entire week. Finally, there was a 12% increase in adults and an 8% increase in children who reported that they were in control of their asthma. Environmental conditions were also improved as a result of the intervention. There was a 12% decrease in homes with evidence of mold, a 9% reduction in water leaks, a 3% decline in pest problems (only 1.5% reported pest problems at 6 months), and a 5% decrease in musty odors in the home.

Project Partners: East Bay Community Action Program, Asthma Regional Council of New England, Rhode Island Department of Health, Newport Housing Authority, and Community Asthma Programs of Hasbro Children's Hospital

Hartford Park Residents Association (Providence, 2006-2007)
Hartford Park Asthma Education Project

Summary: The Hartford Park Residents Association (HPRA) serves the residents living in the Providence Housing Authority's Hartford Park development in Providence, RI. Hartford Park Asthma Education Project seeks to increase resident awareness of asthma and asthma triggers in their homes and neighborhood. The project provided residents with a greater understanding of ways to improve indoor air quality and reduce asthma triggers to improve quality of life for people with asthma. The project engaged two residents to serve as full-time community contacts that distributed educational brochures, identified households with asthma sufferers, developed an asthma support group, and identified existing housing apartment conditions and household practices which may contribute to indoor environmental problems. The gathered information served as a foundation to identify common problems and develop asthma management plans for residents. The resident education and training included information on asthma triggers and management techniques to reduce exposure to indoor toxics and other risks.

Measures of Success: The HPRA distributed 24 peak flow meters to Hartford Park residents (13 adult meters, 11 child meters), 500 copies of the Asthma Triggers brochure, and 30 brochures on RI Diesel Pollution Prevention Initiative and Mold in My Home: What Do I Do? at the association's asthma related meetings; 50 brochures were disseminated at a monthly HPRA meeting featuring a speaker from the American Lung Association. Approximately 30 tenants attended a presentation by a member of RI Health Department. A presentation that addressed asthma was given to approximately 30 tenants by a member of the Newport Housing Authority; an educational activity for three children was also provided at the presentation. Twenty-four residents attended a second presentation by a representative of the American Lung Association, and 22 attended an additional presentation by the RI Health Department. Residents tested before and after the presentations showed an improved understanding of asthma as a result of the educational sessions. Eight residents were interviewed about the usefulness of previous asthma education programs and on their knowledge of asthma. Four focus groups were conducted with approximately 30 residents participating in three and 20 residents participating in the fourth. Two of the focus groups were conducted with children. Twenty residents were assessed and results were analyzed to assist in correcting housing conditions. The IPM program was brought to 18 apartments. On average, families saw an 80% reduction in number of roaches in their apartment between January and March 2007. The IPM program treated 32 additional apartments by project completion. Throughout the project, HPRA successfully collaborated with the Providence Housing Authority.

Partners: Providence Housing Authority


Vermont Department of Health (Statewide, 2007-2008)
Vermont Healthy Schools

Summary: The Envision Program partnered with the Vermont Department of Health to implement the Department's Vermont Healthy Schools program in Vermont schools to decrease asthma incidence; the program utilizes EPA's Tools for Schools along with other resources that promote clean indoor environments. The project trained and mentored school indoor air quality teams in the Tools for Schools program, developed environmental management plans and evaluations to reduce asthma triggers, awarded schools with grants to ease implementation costs, and rewarded successful schools with Environmental Health Certificates of Achievement. In addition, the program tested schools for radon and reduced child exposure to diesel exhaust from school bus idling. Efforts to reduce bus idling included: distributing anti-idling signs and assisting schools in anti-idling policy development.

Measures of Success: Fourteen schools were recruited to participate in the program. A cleaning product evaluation was conducted in the schools. During the first school visit with the head custodian, current products that have less-toxic alternatives were identified and practices that reduce the amount of toxic product required were introduced. At a second school visit, within 60 days of the first, members of the administration and VDH discussed findings from the first visit and the Healthy Schools program. Envision partners used the EPA checklist for school walkthroughs. With EPA Healthy Communities and CDC Asthma money, the project granted eight schools funding to assist with program implementation. The VDH and Department of Education distributed 315 no-idling signs to Vermont schools and encouraged them to place the signs in high traffic areas. Along with the signs, schools were provided with a sample anti-idling policy that includes bus idling restrictions. Seven schools were tested for radon during the winter months of the 2007-2008 school year; many other schools showed interest being tested for radon.

Partners: Vermont Department of Health (VDH), Department of Education, Department of Buildings and General Services, Department of Environmental Conservation, Vermont Child Health Improvement Project, Vermont Envision Partnership, Inform Inc, and the Association of Vermont Recyclers, Vermont Child Health Improvement Project, High Performance School Initiative, Prizim, and Inform Inc.

Vermont Department of Health (Statewide, 2006-2007)
Envision Program: Environmental Health in Vermont Schools

Summary: The Vermont Department of Health promotes environmental health in Vermont schools by implementing Tools for Schools and other effective campaigns to improve indoor environment quality. Envision Program: Environmental Health in Vermont Schools provided education and mentorship to indoor air quality control teams that included school staff members, developed environmental management plans and audits for schools to help reduce asthma triggers, and awarded grants to schools to aid in environmental health measure implementation cost. Public schools that met Envision's environmental health standards were awarded the Environmental Health Certificate of Achievement. In addition to these activities, this project also tested a number of schools for radon and launched a school database initiative that uses Healthy SEAT software to measure statewide progress in improving school environmental health.

Measures of Success: As of July 2007, five schools were educated and mentored in Tools for Schools. A total of 20 cleaning product evaluations were conducted in schools. Three schools were awarded grant money to assist with program implementation costs. Participating schools have been encouraged to apply for a Certificate of Achievement. VDH distributed 315 anti-idling signs to Vermont schools along with EPA educational materials. Approximately 20 schools have expressed interest in radon testing, and five have been tested for radon.

Partners: Vermont Department of Education, Vermont Department of Buildings and General Services, Association of Vermont Recyclers, American Lung Association of Vermont, INFORM Strategies for a Better Environment, Vermont Child Health Improvement Program

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