Columbia County Healthy Neighborhoods Program

The Columbia County Healthy Neighborhoods Program (HNP) provides free in-home health and safety assessments for asthma, indoor air quality, lead, fire safety, and other environmental health hazards for individuals living in Columbia County. There are absolutely no requirements to sign up and all are strongly encourages to participate.

The HNP follows guidelines developed by an expert panel convened by the National Heart, Lung, and Blood Institute of the National Institutes of Health. The program targets housing in high-risk areas that are identified using housing, health, and socioeconomic indicators from census and surveillance data. The HNP uses a combination of door-to-door canvassing and referrals to reach residents in these high-risk areas. During a visit, an outreach worker provides education (written and verbal), referrals and products to help residents correct or reduce housing hazards.

The Healthy Neighborhoods program seeks to reduce housing related illness and injury through prevention and education.

In the past five years, the HNP visited 31,000 homes with 85,000 residents, and provided the asthma intervention to 11,000 adults and children with asthma. The assessments created a valuable data set about the health effects of housing hazards.

In one study [1], residents with asthma were recruited through 3 mechanisms:
1. door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings
2. referrals from community partners (REFERRED), 573 residents in 307 dwellings
3. referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings.

The analysis compared improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated. Results showed that after HNP staff visited the homes, there were significant improvements in the physical conditions of the home, as well as better self-management of asthma, improved health care access, and a decrease in asthma morbidity outcomes, including a decrease in the number of asthma attacks and hospitalizations due to asthma.

In the TARGETED group before the HNP intervention, only 19% of people with poorly controlled asthma knew their personal asthma triggers, 6% knew how to avoid their triggers, and 17% used a peak flow meter to manage their asthma. At a return visit 3-6 months later, 100% knew their triggers and how to avoid them, and 85% were using a peak flow meter to help manage their symptoms. Children also missed fewer days of school or daycare after the HNP visit; in the 3 months leading up to the first HNP visit, the children with poorly controlled asthma had missed 5.8 days of school or daycare. After the intervention, they had missed only 2 days in the previous 3 months.

A second study [2] analyzed the cost-benefits of the program. The study looked at one thousand households with 550 children and 731 adults with active asthma, and at 791 households with 448 children and 551 adults with asthma events in the previous year.

For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311.

A third study [3] evaluated the impact of the HNP on 6,436 dwellings that received an initial visit followed by a return visit (out of 28,491 homes that received an initial visit). The majority of residents were low-income renters and lived in buildings built before 1950.

Among the homes that were revisited, there were significant improvements in the conditions assessed for tobacco control, fire safety, lead poisoning prevention, indoor air quality, and other hazards (including pests and mold). There was a significant reduction in the number of hazards per home (2.8 to 1.5; P < .001), but homes were not hazard-free at the revisit.

In the revisited dwellings, the most prevalent conditions at the initial visits were a missing CO detector (68%), missing smoke detectors (40%), smoking in the home (39%), odors of chemicals or scented products (24%), ineffective cleaning/dust accumulation (17%), rodents (14%), and significant clutter (13%). 27% of homes were built before 1978 and had a lead paint hazard inside or outside the home. Among conditions included in the home hazard score, all but chemical smells were significantly improved after the interventions (P < .05). The highest percentages of improved homes were for missing smoke detectors (95%), missing CO detectors (76%), malfunctioning appliances (68%), blocked exits (67%), rodents (65%), cockroaches (58%), leaks (54%), electrical hazards (54%), and mold (53%).

[1] An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children. Reddy, Amanda L. MS; Gomez, Marta MS; Dixon, Sherry L. PhD.
[2] A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program. Gomez, Marta MS; Reddy, Amanda L. MS; Dixon, Sherry L. PhD; Wilson, Jonathan MPH; Jacobs, David E. PhD, CIH.
[3] The New York State Healthy Neighborhoods Program: Findings From an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program. Reddy, Amanda L. MS; Gomez, Marta MS; Dixon, Sherry L. PhD.