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June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. De

Long term follow-up of home environmental remediation for mold & moisture. June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. Dearborn. Long term follow-up of home environmental remediation for mold & moisture.

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June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. De

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  1. Long term follow-up of home environmental remediation for mold & moisture June 22, 2011 Ellen M. Wells, Matt Berges, Stephen Vesper, Iwona Yike, H. Lester Kirchner, Stuart Greenberg, Dorr G. Dearborn

  2. Long term follow-up of home environmental remediation for mold & moisture Ellen M. Wells1, Matt Berges2, Stephen Vesper3, Iwona Yike1, H. Lester Kirchner4, Stuart Greenberg2, Dorr G. Dearborn1 1: Swetland Center for Environmental Health, CWRU School of Medicine; Cleveland, OH 2: Environmental Health Watch; Cleveland, OH 3: US Environmental Protection Agency; Cincinnati, OH 4: Geisinger Medical Center, Danville, PA • PRESENTATION OUTLINE • Background • UMMP • UMMP II • Conclusions

  3. Urban Mold and Moisture Project II • PARTNERS • Swetland Center for Environmental Health, CWRU School of Medicine, grantee • Environmental Health Watch • University Hospitals • Cuyahoga County Board of Health • US Environmental Protection Agency • Cuyahoga County Department of Development • FUNDERS • HUD Office of Healthy Homes and Lead Control • US Environmental Protection Agency

  4. BACKGROUND

  5. Moisture in the home Extent of the issue www.ehw.org • At least 20% of U.S. buildings have signs of dampness • Moisture is more likely with • Overcrowding • Insufficient heating, ventilation, and insulation • A Cleveland Perspective • Older housing stock • High poverty levels For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, 2004

  6. Moisture in the home Connection with health • Consequences of excess moisture • Leads to microbial growth (mold) • Initiates chemical or biological degradation of materials • Encourages presence of pests • Presence of dampness is considered to be a risk factor for asthma and respiratory disease For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, 2004

  7. Fungi (i.e., mold) • Ubiquitous eukaryotic organisms • Hundreds of different species • Growth limited by temperature, nutrients, moisture • Health effects include • Infections, allergies, toxicities • Health effects may arise from • Viable (live), or nonviable (dead) or fragments of organisms For more information, see: Guidelines for Indoor Air Quality: Dampness and Mould, World Health Organization, 2009; Damp Indoor Spaces and Health, Institute of Medicine, 2004

  8. URBAN MOLD & MOISTURE PROGRAM

  9. Leaks Cooking, Bathing, Watering Plants, Breathing,Washing Surface water Air From Soil Groundwater Urban Mold & Moisture Program Will reduction of moisture in homes improve homes and health? • Components of the program • Visual inspections of homes • Homes sampled for mold • Moisture reduction interventions • Monitoring respiratory health

  10. Urban Mold & Moisture Program Moisture intervention goals • Repair the “Cleveland drop” • Flash the soil to the house • Treat the porch like a roof • Eliminate sub-slab duct and heating systems • Disconnect and redirect downspouts • Reduce moisture in crawlspaces • Correct negative grade at foundation • Remove debris in basements • Vent clothes dryer to exterior • Occupant education

  11. Urban Mold & Moisture Program A subset of the program where families had asthmatic children • Randomized controlled trial • Eligibility criteria • Children hospitalized for asthma within the past year • Mold visible in the home • All children (n=62) had medical care optimized • Roughly half (n=29) of the homes were remediated • Children assessed at 6 and12 months • Homes reassessed at 12 months For more information, see: Kercsmar et al. 2006. Environmental Health Perspectives 114(8):1574-1580.

  12. Urban Mold & Moisture Program Outcomes from asthma study • Significant decrease in symptom days (p = 0.004) after repairs • Lower rate of ER visits and hospitalizations • Remediation group: 1 of 29 • Control group: 11 of 33, p = 0. 003). For more information, see: Kercsmar et al. 2006. Environmental Health Perspectives 114(8):1574-1580.

  13. URBAN MOLD & MOISTURE PROGRAM ii

  14. Urban Mold and Moisture Project II Are home moisture interventions effective 5 to 8 years later? • Sustainability/maintenance of housing improvements • Do these interventions need to be modified? • Home visual inspections to identify mold • Sampling for mold and moisture • Maintenance of respiratory symptom improvements

  15. UMMP II • 104 homes renovated in 2000-5 • 44 (42%) visited in 2008-9 • 28 (63.6%) with original families • 16 (36.4%) with new families • Data collected at the visits • Visual inspection for mold • Dust sampling for mold • Occupant questionnaire • Visual assessment of interventions

  16. Housing interventions Interventions still in working order • Repair of the “Cleveland drop” • Did not require maintenance • All were still in place and functional • Eliminate sub-slab duct work • Concrete in holes in duct work, new furnace • All were still in place and functional For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch, www.ehw.org

  17. Housing interventions Functional, but some improvements needed • Flash the soil to the house • Poor implementation can exacerbate problem • Flat trenches, rubber ending near foundation • Treat the porch like a roof • Temperature gradients may still cause moisture • Reduce moisture in crawl spaces • Use of plastic may trap water from other sources • Including ‘rat slabs’ could help prevent pests • Correct negative grade at foundation • Not every grade was completely corrected • Maintenance also needed to maintain these For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch, www.ehw.org

  18. Housing interventions Post-intervention events contributed to failure • Disconnection, redirection of downspouts • Most common problem • Not maintained, occasionally missing • Some implementations exacerbate problem • Location can be a problem for other activities • Remove debris from basement • Staff occasionally not allowed into basement • Several basements still had debris • Vent clothing dryer to outside • Common for the vent to become disconnected • In some cases this was intentional For more information, see: “Moisture Control in Older Housing: Observations of a Five Year Follow Up”, Environmental Health Watch, www.ehw.org

  19. Visual inspections for mold

  20. Symptom questionnaires • Given to families with a new infant, mold in the home • Baseline, 1 year and 5-8 years following remediation • Limited to those who had not moved 5-8 years later (n=56) • General symptoms • Several symptoms decreased at 1 year, but not 5-8 years later • Respiratory symptoms • Most significantly improved at 1 year, but no significant improvement from baseline at 5-8 years • ‘A lot of mucus of phlegm’, ‘shortness of breath or rapid breathing’ showed significant improvement at 5-8 years (v. baseline)

  21. Asthma exacerbations • Repeated interviews among 26 families with interventions • 16 had moved, 10 had not moved • Exacerbation = ER visit or hospitalization • Among those who had moved • 6 out of 16 children (37.5%) had a total of 10 exacerbations • Among those who had not moved • 2 out of 10 children (20.5%) had a total of 3 exacerbations

  22. Analysis of mold in dust • QPCR analysis of 33 mold species in homes of asthmatic children

  23. conclusions

  24. Conclusions, part 1 There are long term benefits to moisture interventions; however, maintenance continues to be an issue • Sustainability of housing interventions • Overall these houses remain in better condition • Consider interventions not requiring maintenance even if more cost • Education regarding the purpose, maintenance of interventions • Occurrence of self-reported respiratory symptoms • In most cases, a decline at 1 year was not maintained

  25. Conclusions, part 2 • Asthma exacerbations among those in renovated homes • Fewer exacerbations among those still in renovated homes compared to those who moved • Presence of mold in homes of asthmatics • A few species had lower concentrations • Many species increased in concentrations compared to baseline or just post clearance

  26. Acknowledgements • Jodi Lavrich • Mia Gelles • Debrah Muhammad • Margaret Pizzi • Akbar Tyler

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