THE INTEGRATED PEST MANAGEMENT INTENSITY IMPACT STUDY (IPMIIS)A Closer Look at Mental Health, Asthma, Housing and the Way We Manage Pests.

Alan Fossa & John Kane

May 29th , 2014

HEALTH & HOUSING

Housing, a key social determinant of healthWell documented in literature Housing influences a variety of health

outcomes Respiratory health, Neurodevelopment etc… literature (Evans 2003)

MENTAL HEALTH & HOUSING

What about mental health? Documented links between housing and

mental health Somewhat limited body of research

Why do we need to take a closer look? Significant upward trends in mental health

measures Disparities in these measures across housing

type

MENTAL HEALTH & HOUSING

Methodologically limited body of work (Evans, 2000) Cross-sectional design, non-standardized outcome measurement…

How are we looking at housing quality?Physical structure, building codes, major health threats (lead, asbestos etc…)

MENTAL HEALTH & HOUSING

Persistent sadness among adults 7.2% in 2005 and 9.4% in 2010 (BBRFS

2005,2010) 16.9% in public housing vs. 7.6% in non-public,

non-subsidized housing (BBRFS 2010)

Persistent anxiety among adults 12.0% in 2005 and 17.3% in 2010 (BBRFS

2005,2010) 19.5% in public housing vs. 16.3% in non-public,

non-subsidized housing (BBRFS 2010)

Similar trend among youth (YRBS, 2005, 2013)

Pests are a major problem in urban housing 85.2% child’s rooms, detectable roach

allergens (NCICAS, 1997)

42% Homes in Boston with detectable mouse allergens (Phipatanakul, 2000)

Inequities in pest problems 71% Reported infestation in public housing

vs. 22% in non-public housing (Wang, et. al., 2008)

> 50% public housing residents reported problems with pests indoors (National Center for Healthy Housing, 2008)

HOUSING QUALITY-PESTS

ASTHMA & HOUSING

Disparities in asthma burdens

ASTHMA & HOUSING

Roaches and rodents are a major factor in housing-asthma relationshipAllergens from both pests are proven asthma triggers (National Center for Healthy Housing, 2009)

PEST MANAGEMENT AND HEALTH

Direct relationship between pest management and healthPesticide exposure and other dangers Good pest management Improved health

Indirect relationship between pest management and healthGood pest management Reduction in

Pests Improved health

PEST MANAGEMENT AND HEALTH

How are we looking at housing quality?Physical structure, building codes, major

health threats (lead, asbestos, etc…)

A pest free environment is a component of quality housing Should be reflected in research tools

What is good pest management?

INTEGRATED PEST MANAGEMENT (IPM)

Alternative to traditionally ineffective methods

Major Focuses Restricted access to food, water and shelter Prevention and education Structural integrity Sanitation Conservative application of pesticides

IPM AT BOSTON HOUSING AUTHORITY

•Largest housing authority in New England•Largest property owner in Boston•10% of Boston residents in BHA housing

IPM AT BOSTON HOUSING AUTHORITYThree main pests: Cockroaches Rodents Bedbugs

IPM AT BOSTON HOUSING AUTHORITY

Evolution of Pest Control at BHA: 1982 – bug crew 1995 – outside contractors “flushouts” 2001 – listening tour

IPM AT BOSTON HOUSING AUTHORITYHealthy Public Housing Initiative: Indoor Air Quality Resident

Health Various methods researched Recommendation: Integrated Pest

Management (IPM)

IPM AT BOSTON HOUSING AUTHORITYHealthy Pest Free Housing Initiative: Implement IPM at 15 developments over 3

years Community Health Advocates Institutionalize Evaluate continually

IPM AT BOSTON HOUSING AUTHORITYCost Benefit Analysis: $4.63 to $7.09 = +$2.46 Decrease pest infestations, pest work orders,

pesticide use, stress, losses from REAC scores, HID complaints, court cases

Increase or Improve quality of life, sense of health, job satisfaction, staff time, and achieve high performer status

IPMIIS

Pest Management

Asthma

Mental Health

General HealthHousing

Cost

Pest Infestation

Pesticide Exposure

IPMIIS GOALS

Develop a tool for classifying pest management of a housing authority into 3 categories.

High Intensity IPM

Low Intensity IPM

Traditional Pest Management

IPMIIS GOALS

Investigate the effect of IPM intensity on general health, mental health and asthma in residents

IPM Intensity

Mental Health

General Health

Asthma

IPMIIS GOALS

Demonstrate longitudinal relationships between IPM, asthma and pest infestation

IPM Intensity

Asthma Symptoms

Pest Infestation

Time

Time

IPMIIS GOALS Demonstrate longitudinal relationships

between IPM, pest infestation and asthmaDemonstration a longitudinal relationship

between IPM and pesticide residues

IPM Intensity

Pest Infestation

Asthma

Time

Time

Pesticide Residues

IPMIIS GOALS

Limited cost-effectivness analysis

IPM Intensity

Healthcare Utilization (Asthma)

$

Time

Time

IPMIIS METHODS

Enrollment Cross-sectional and Follow-up Even across IPM stratum

Study teams CBPR Based (Community Member and Graduate

Student) Data collection

Observation Surveys

Sample collection Pesticides Allergens

IPMIIS METHODS

IPMIIS16 Developments

Cross-Sectional 460 Households

Longitudinal 89 Households (Asthmatic Participants)

IPMIIS METHODS

Determination of IPM Intensity LevelsData sources: IPM logs, pest control

contracts and work ordersMetrics:

% Units inspected % Units with evidence of pest infestation (focus

units) % Focus units not followed up 3 Year average work order prevalence Contract lapses Kellogg site Active tenant coordinator

IPMIIS METHODS

Field Work & Data Collection:

IPMIIS METHODS

Participant Surveys Collected information on:Demographics (income, age, sex, etc…)Self-reported Health (CESD, PSS, Physical

health, etc…)Self-reported pest infestation (experience

with pests, etc…)Asthma outcomes and related health info

(ARQL and ACT) Self-reported pest management (personal

management and development management, etc…)

IPMIIS METHODS

Unit Observations Collected Information On: Objective pest infestation (actual pests,

droppings and other signs, etc…)Objective factors associated with pest

infestation (poor sanitation, structural damage, etc…)

Evidence of pest management (traps, gels, plugged up holes, etc…)

Environmental Sampling (kitchen)Pesticide Sampling Allergen Sampling (mouse and roach)

IPMIIS METHODS

CBPR Component Comprehensive involvement

Study DesignExecution Interpretation and dissemination of results

Collaboration with community based organizations (Committee for Boston Public Housing and BHA)

Study team (one community advocate and one graduate student)

PRELIMINARY DATA Approximately 37% of residents reported the

presence of cockroaches in their home and 32.2% reported rodents

Of 460 enrolled participants, 74% were female and 52.6% identified themselves as Hispanic or Latino

Our study population had a median CESD score of 11 and a mean PSS score of 4.8

Focus on the association between mental health symptoms, pest infestation, and pest management practices using logistic regression and multi-level regression techniques

WHAT NOW?

Last field visit on December 25, 2013

Construction of Cleaned Analytic Datasets

Work with collaborators at Boston University and Harvard University

Further develop and execute analysis plan

AcknowledgementsSnehal Shah

Margaret Reid

Mae Bennett-Fripp

Gary Adamkiewicz

John Levy

Lori Luce

Special ThanksU. S. Department of Housing and Urban Development

HUD Assistance Grant MALHH0193-09

Committee for Boston Public Housing

National Healthy Homes Conference

REFERENCES Evans, G.W., The built environment and mental health. J Urban

Health, 2003. 80(4): p. 536-55. Boston Behavioral Risk Factor Survey (2005, 2006, 2008 and

2010), Boston Public Health Commission Youth Risk Behavior Survey (2005, 2007, 2009, 2011 and 2013),

Centers for Disease Control and Prevention Evans, G.W., et al., Housing quality and mental health. J Consult

Clin Psychol, 2000. 68(3): p. 526-30. Phipatanakul, W., et al., Effect of environmental intervention on

mouse allergen levels in homes of inner-city Boston children with asthma. Ann Allergy Asthma Immunol, 2004. 92(4): p. 420-5.

Phipatanakul, W., et al., Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study. J Allergy Clin Immunol, 2000. 106(6): p. 1070-4.

REFERENCES Wang, C., M.M. Abou El-Nour, and G.W. Bennett, Survey of pest

infestation, asthma, and allergy in low-income housing. J Community Health, 2008. 33(1): p. 31-9.

Integrated Pest Management Interventions for Healthier Homes:Pests Persist in Federally Subsidized Housing. 2008, National Center for Healthy Housing.

Thank you!