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DEVELOPING CAPACITY IN ENVIRONMENTAL HEALTH
&INDOOR AIR QUALITY PROGRAMS
2019 EPA TRIBAL ENVIRONMENTAL LEADERS’ SUMMIT
PORTLAND, OR
CELESTE L. DAVIS, REHS, MPH
NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD
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SOCIO-ECOLOGICAL MODEL OF HEALTH
State & National
Community
Organizational
Interpersonal
Individual
• INDIVIDUAL: AGE, SEX, GENETICS, BEHAVIORS, KNOWLEDGE
• INTERPERSONAL: FAMILY & FRIENDS SUPPORT, KNOWLEDGE, BELIEFS, HEALTH HABITS/BEHAVIORS, JOB/FINANCES, STRESS
• ORGANIZATIONAL: SCHOOL, WORK, CHURCH, INTERACTIONS WITH
• COMMUNITY: SOCIAL SERVICES & SUPPORTS, ACCESS TO HEALTH CARE, HOUSING & BUILT ENVIRONMENT, NATURAL ENVIRONMENT, SAFETY
• STATE & NATIONAL/PUBLIC POLICY: POLICIES & LAWS
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PUBLIC HEALTH APPROACH TO IAQ – APPLICATION TO ASTHMA MANAGEMENT
1. STEP 1. DEFINE & MONITOR THE PROBLEM
2. STEP 2. IDENTIFY RISK & PROTECTIVE FACTORS
3. STEP 3. DEVELOP & TEST PREVENTION OR INTERVENTION STRATEGIES
4. STEP 4. ASSURE WIDESPREAD ADOPTION
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PH APPROACH STEP 1: DEFINE & MONITOR THE PROBLEM
Guiding Questions Potential Sources of Data
How many people have asthma? What age groups? How severe – hospitalizations, deaths….?
IHS or Tribal Health Clinic; Tribal Epidemiology Centers, State Health Department, behavioral surveys
When and where are the cases of asthma occurring? Use health data to develop a map – Housing Department, Planning Department, GIS program; Environmental Health Data: air quality monitoring; school IAQ inspections; other surveys
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PH APPROACH STEP 2: IDENTIFY RISK & PROTECTIVE FACTORS
Guiding Questions Potential Sources of Data
What are the risk factors that lead to poorly controlled asthma?
IHS, CDC;; clinical practice standard from medical organizations; environmental health leaders
What are protective factors?
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PH APPROACH STEP 3: DEVELOP & TEST INTERVENTION STRATEGIES
Guiding Questions Potential Sources of Data
Are there existing, effective strategies based on bestavailable evidence?
IHS, CDC; The Community Guide; Scientific research and peer reviewed journals; clinical practice
standards; environmental health best practices
If none exist, what resources do I need to develop a new strategy based on what was learned in steps one and two?
Where can I find research partners to help evaluatethe selected strategy?
Is the strategy effective – did it do what was intended?
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PH APPROACH STEP 4: ASSURE WIDESPREAD ADOPTION
Guiding Questions Potential Sources of Data
Who would benefit from this strategy (parents, educators, policy makers, etc.)?
IHS, CDC; The Community Guide; National Implementation Research Network -
http://www.fpg.unc.edu/~nirn/; University of Kansas Community Toolbox -
http://ctb.ku.edu/en/default.aspx
How do I get this strategy to the people who need it?
Where can I find assistance and support for implementing an effective strategy and on-going monitoring and evaluation of the strategy?
Where can I find model policies or codes?
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IMPLEMENTING ENVIRONMENTAL HEALTH IAQ PROGRAMS
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In WA, hospitalization due
to asthma is
more likely for native patients vs. white
patients
WA Comprehensive Hospital Abstract System, 2012-13, corrected for AI/AN misclassification by the IDEA-NW Project.
UNPUBLISHED. PLEASE DO NOT DISTRIBUTE.
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REDUCING INDOOR AIR POLLUTANTS IMPROVES ASTHMA
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TRIBAL PROGRAMS
• Continue work with IHS funds, referrals from pharmacy for home visits
• Continuing and expanding
Yakama Nation IHS Clinic
• Goal of reaching 10-12 pediatric patients• Building referral system and forms to institutionalize• Staff undergoing formal training
Tulalip Tribes –GAP Funded
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YAKAMA NATION & IHS ASTHMA PILOT
• Clinic & pharmacy referrals to IHS Environmental Health Officer through electronic health record, 25 home visits
• 72% of patients made environmental or habit modifications • 47% patients decreased use of asthma rescue medication• Urgent Care visits reduced from 53% to 12%• Emergency Room visits decreased from 47% to 18% • 90% of patients went from reporting asthma as being not-well
controlled, to well controlled
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NW PORTLAND
AREA INDIAN HEALTH BOARD
Project Aims
Measure impacts of
combined clinic and home visit
program.
Document protocols and practices.
Develop training materials for other
tribal clinics.
Implement at 3 other tribal
communities in WA and OR.
National Institutes of Health Native American Research Centers for Health
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IHS SERVICE MODEL FOR ASTHMA MANAGEMENT
INTAKE & RISK ASSESSMENT
COMPREHENSIVE ASSESSMENT & SERVICE
HEALTHY HOMES VISIT
• REFERRALHOSPITALIZATION OR ED VISIT
• REFERRALPRIMARY CARE VISIT
PHARMACY CONSULT
HEALTHY HOME VISIT
EH, EP/IAQ, Nurse, CHW
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SUMMARY
• WE SPEND UP TO 90% OF OUR TIME INDOORS• HOME, SCHOOL, WORK…
• INDOOR AIR QUALITY IS AFFECTED BY OUTDOOR POLLUTANTS & INDOOR CONTAMINANTS• TRAFFIC & INDUSTRY, COMBUSTION SOURCES, EMISSIONS FROM FURNISHINGS, PETS & PESTS, HOUSEHOLD CLEANING PRODUCTS,
BEHAVIORS & HOBBIES, DAMPNESS & MOLD
• HUMAN EXPOSURE CAN LEAD TO DISEASE OR POOR HEALTH MANAGEMENT• ASTHMA, ALLERGIC RHINITIS, RESPIRATORY INFECTIONS
• EXPOSURE & DISEASE CAN BE PREVENTED AND CONTROLLED
• EFFECTIVE IAQ MONITORING PROGRAMS – PROACTIVE OR COMPLAINT-DRIVEN
• HEALTH CARE REFERRALS TO EH FOR IAQ ASSESSMENT (SUSCEPTIBLE INDIVIDUALS OR CASES)
• EDUCATION FOR PARENTS, SCHOOL STAFF, WORKPLACE OCCUPANTS
• POLICIES THAT PROMOTE HEALTH – INDOOR SMOKING BANS OR DISTANCE REQUIREMENTS, HOUSING CODES
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THANK YOU!
•MY CONTACT INFO:
• CELESTE L. DAVIS
• NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD