The Healthy Homes Screening Tool (HHST) is being tested by the Wayne State University Center for Urban Studies as a tool to examine the health risks in homes. This screening tool is intended to help non-housing professionals to provide a first indication of the extent of risks that tend to increase sickness, injuries, and death among inhabitants of the home.  The first version of this survey was administered on paper, either during a face-to-face interview or completed by the resident and returned by mail.  If a resident was unable to participate in a face-to-face interview the survey was then administered by an interview over the phone.  A total of 519 households in a central city neighborhood of Detroit were surveyed using the first version of the HHST.  Below are five graphs from the preliminary analysis of the HHST indicating some of the greatest health risks within homes surveyed. We are now improving this instrument and preparing to test the reliability and validity of that version. In the long range we expect that the HHST may indicate when a more thorough examination of housing risks must be completed using the HUD-sponsored Healthy Homes Rating System.

The households surveyed within Detroit showed elevated  rates  of asthma diagnosis among both adults and children.  Of the 516 households that responded, 28.1% reported an adult in the household had been told they had asthma. Nearly a quarter (23.1%) of the 368 households that answered the question reported that children (under 18) had been told by a doctor or other medical professional that they had asthma.  Chronic breathing problems were also reported in children in 21.6% of all households surveyed.  In the state of Michigan in 2007 the Michigan Department of Community Health reported a statewide prevalence of asthma at 9.5%.

Certain household allergens such as dust mites, cockroaches, mold, furry pets, tobacco smoke, and certain chemicals may potentially trigger or increase the severity and frequency of asthma attacks.  Volatile organic compounds (VOCs), which can be found in air fresheners, candles, plug-ins and incense, may also increase the severity and frequency of these attacks.  The HHST found that 43.5% of households included at least one person who smoked.  The survey also found 54.8% of households used candles, 46.3% used plug-in air fresheners, and 37.8% used incense.  These conditions may contribute to the high proportion of households reporting asthma and chronic breathing problems.

A large proportion of homes surveyed, 39.1%, reported water had leaked into their home from the outdoors in the last 12 months, excluding plumbing or other inside leaks.  Such water leaks can cause dampness and high humidity, leading to an increase in dust mites, mold, and fungal growth.  These conditions can cause an increase in both the prevalence and severity of allergy and asthma symptoms.  The population most affected by these conditions is children under 14 years of age, according to the Department of Housing and Urban Development, Healthy Homes Rating System – Operating Guidance.  This high proportion of water leaks from outdoors likely contributes to the high proportions of asthma reports demonstrated in the graphs above.

Lead is a heavy metal that can cause lead poisoning and have “toxic effects on the nervous system, cognitive development and blood production.”  The population most severely affected by lead is children under 6 years of age, according to the Department of Housing and Urban Development, Healthy Homes Rating System – Operating Guidance.  Lead was commonly used in household paint until it was banned in 1978.  Of the households in Detroit, 87.3% were built before 1978, meaning a majority of these homes likely contain lead-based paint.  When this paint chips or peels, it becomes easy for children to ingest, causing irreversible damage to their cognitive development.  Lead also has a sweet taste, encouraging children to ingest the toxic substance.  Having your home tested for lead and regularly having your children tested for lead poisoning is recommended if your home was built prior to 1978.

Chipping or peeling paint was visible in 60.4% of the homes surveyed with the HHST, the vast majority of which were built prior to 1978. However, only 44.3% of homes had been tested for lead, and only 50% of households had their children tested for lead poisoning.

Home fires kill many people in Detroit and Michigan every year as well as injuring people through burns and smoke or gas inhalation.  Ensuring there is a working smoke detector present on every level and in every sleeping area of a home can help make sure residents are alerted in time to safely escape.  However, 29% of homes surveyed did not have a smoke detector on every level and in every sleeping area.  Sleeping with a bedroom door closed will also delay the spread of fire and smoke into a bedroom, allowing extra time to escape. However, only 46.2% of homes surveyed reported using this practice.  Making sure exits from the building are accessible in the event of a fire and having fire extinguishers present and readily accessible for use are also important fire safety practices and were largely reported to be followed among those surveyed.

Carbon monoxide is a toxic gas that, at high concentrations, can cause “headaches, dizziness, weakness, nausea, confusion”, disorientation, fatigue, and even “unconsciousness and death.”  Due to the fact it is both colorless and odorless, a working carbon monoxide detector is one of the few ways to detect a leak besides physical symptoms just mentioned.  Common sources of carbon monoxide include improperly vented gas, oil, or solid fuel burning appliances such as dryers and stoves.

Of the 515 homes that responded to the above question in the survey, 81.6% reported they had gas appliances such as a stove or dryer, but 27.6% reported the appliance was not vented to the outside . Only 38.1% of households surveyed reported having a carbon monoxide detector in their home.

The United States Centers for Disease Control and Prevention (CDC) committed to the goal of eliminating blood lead levels of greater than 10 micrograms of lead per deciliter of blood (10 µg/dl) by 2020 and recommends public health actions at levels above 5µg/dl (see the CDC Lead Home Page). While lead poisoning has few physical symptoms, it can result in learning and behavioral disabilities. Children between the ages of six months and 3 years are at the greatest risk because they have a high degree of exposure to lead in household dust due to normal hand-to-mouth activity. Their developing nervous system is at heightened vulnerability to lead toxicity.

This chart shows the number of children (under 6 years old) newly identified with blood lead levels at or above 10 µg/dl over the past 14 years. This chart demonstrates a mostly steady decline in lead poisoning cases over the past 14 years. The small spike in 2001 and 2002 can be attributed to a new Medicaid policy enacted that required testing of blood lead levels among children considered to be at a high risk for lead poisoning. In 1998 9.7 percent (4,846 children) of children under the age of 6 in Detroit had blood lead levels at or above 10 µg/dl; in 2001 that decreased to 5.5 percent (3,236). High risks of lead poisoning can be typically be attributed to areas with lower income housing and homes that were built before 1978. Medicaid considers all children living in the City of Detroit to be at high risk for lead poisoning.

This map shows the locations of lead poisoning cases for children under 6 that were identified in Detroit it 2011. The green dots represent residences of children with blood lead levels between 10 to 19 µg/dL and the red dots are more severe  lead poisoning cases (20 to 99 µg/dL). Lead poisoning cases were recorded throughout most of Detroit, though there was a concentration in the center of the city (older housing) and on its East side.

The above map shows the number of lead poisoning incidences per address/home in the City of Detroit. The yellow dots show that there are 4,610 homes in the city with two occurrences per home; these are the most frequent. However, the blue dots, which show  three to five or six to nine occurrences per home, cover more of the map because of the higher number of people affected. There was one home in the southwest portion of the city that had 17 lead poisoning cases, according to the map.

The above chart shows the number of Michigan children under the age of 6 whose blood lead levels were tested over the past 14 years. The steady increase in the number of children tested can be at least partially attributed to Medicaid requirements.  The total number of children tested increased from 73,643 in 1998 to 151,867 in 2011. Most of this increase was due to children receiving Medicaid: in 1998, approximately 57 percent of the children tested were receiving Medicaid; in 2011, 76 percent were.

This chart shows the percentage of Michigan children under 6, of those who were tested, who had elevated blood lead levels over the past 14 years. As depicted in the orange line, nearly 10 percent of children tested had blood lead levels of at least 10 µg/dL in 1998. In 2011, less than 1 percent of children tested had levels of at least 10 µg/dL. The middle line (brown) represents more severe cases (at least 15 µg/dL) and the red line represents the most severe (at least 20 µg/dL). The decline in lead poisoning cases among all three categories can be attributed, directly and indirectly, to increases in testing among high risk children, increases in vacancy among the oldest, most dangerous and hazardous housing stock, and targeted lead poisoning prevention and case management.