The Environmental Health Assessment List (HEAL) is an instrument designed by the Tacoma-Pierce County Health Department (TPCHD) for identifying hazards in the home environment. The HEAL consists of two major parts: the survey and the home action plan. The survey comprises a few sections including dust and lead control, moisture problems, indoor air quality, and so on. The questionnaire is designed in a way that each answer and assessment result is correlated with a particular action step, based on which a person can easily see what immediate solution every identified problem may have. Moreover, the answers are ranked on the concern level scale that includes lower, medium, and higher levels. Thus, after the competition of the survey, it becomes clear what areas should be prioritized and intervened first.
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The main objective of TPCHD is to “enhance personal and community health through innovative programs and information” (TPCHD, n.d.a, para. 1). Along with illness prevention and control, TPCHD focuses on environmental health. As stated by Friis (2012) “the environment is intimately connected with human health, illness, and mortality: some estimates place the toll of the world’s deaths caused by environmental factors at 40%” (p. 5). Considering that people spend the largest portion of the lifetime in their houses, it is vital to ensure that the home environment is safe. Unfortunately, it is often hard to detect any environmental hazards because chemicals and other detrimental agents are usually beyond the ability of human senses to detect (TPCHD, n.d.b). It is possible to say that the HEAL provides all the necessary information to drive environmental improvements at home and can be of help for both the professionals and the households.
Selected Home Environment
The selected home environment is located in a relatively new two-storied building constructed in the 1990’s at 7300 Dixon Street, Forest Park, Illinois. The house is situated in the quiet and green sleeping quarters surrounded by sidewalks and driveways. No factories, auto body shops, airports, bus and rail stations, as well as gas stations are anywhere nearby the building. It is located more than five blocks away from the most proximate busy street. No excess radioactivity was reported in the neighborhood in the past. The calm and homely atmosphere was one of the major motivations for moving to this area.
The home itself is a one-bedroom apartment, in which two persons live on a permanent basis. Along with a living room and a bedroom, there is a small kitchen and a bathroom. The apartment has three windows in total. Overall, it is spacious, well-lit, and not exposed to disturbing sources of noise.
In general, the building characteristics are associated with a low level of concern. It was constructed after 1978, which means that lead-based paint was not used there. Remodeling and paint removal is not planned for the nearest future and, within a few past years, nobody removed the external paint. The only area of medium concern is the level of temperature maintained in the apartment during the heating season. It usually ranges on the scale from 68F to 75F, which means the indoor temperature may help control moisture but reduces energy efficiency.
No significant risks are identified in the house surroundings. There are no nearby sources of smoke or major sources of air pollution such as highways, gas stations, etc. However, minor pollution comes from the driveways and parking lots as many neighbors have cars.
Dust and Lead Control
As stated by the United States Environmental Protection Agency (EPA, 2017), lead paint is present in millions of homes, especially those built before 1978. Lead dust often gets on various surfaces and objects that people touch. Moreover, it can enter the air during vacuuming or sweeping. As it was mentioned above, lead paint was not used in the selected home environment. Additionally, all painted surfaces are well-maintained in the house − there is no peeling or flaking.
The largest part of the living space is not carpeted. Thus, dust is easy to remove and clean. There are some small area rugs. However, since none of the family members has asthma, they do not pose a significant risk to health. A high-quality doormat is present at the main door as well. It helps control the track-in of dust. Moreover, to keep the living area clean, the family members remove shoes at the entrance. The only major area of concern is that the home is vacuumed only once a month. It may be thus suggested to increase the frequency of vacuuming to lower the risks.
Indoor dampness and mold are common problems for households across the globe. In cold climates, the prevalence of indoor mold equals 5–10%, while in moderate and warm climates it is 10–30% (Quansah, Jaakkola, Hugg, Heikkinen, & Jaakkola, 2012). The selected home environment is prone to the occurrence of mold as well. It means that there are risks for the development of chronic respiratory conditions such as asthma (Quansah et al., 2012). The family attempts to control the problem through regular and efficient ventilation of the kitchen and bathroom. The use of permeable materials (e.g., carpets) in these living areas is avoided. However, the refrigerator coils are rarely cleaned. It is recommended to do it more frequently because the evaporator coil can become fouled by mold spores and other contaminants that can reduce the quality of indoor air.
In recent years, there were no problems with the sewage or drainage in the building. However, about two years ago, one of the neighbors who live above had his apartment flooded. As a result, the floor in their place was completely damaged. Nevertheless, there were no visible signs of damage to the ceiling in the selected home. The neighbor removed the damaged material right after the incident.
Forest Park, IL, is categorized as the Radon Zone 3, which indicates an average indoor radon level of less than 2 pCi/L (“Map of radon zones,” 2017). The level of radon pollution in the area is below the level recommended by the EPA. Nevertheless, it is not known whether some particular materials that may contain high concentrations of radium were used throughout the house construction. Since radon is formed during the decay of radium in soil and rocks, the use of such materials as by-product phosphogypsum may be detrimental to health.
Overall, the quality of indoor air in the apartment is associated with a low level of concern as the windows frequently remain open. Indoor air pollution is also reduced because kerosene heaters and wood stoves are not used in the house. The family members only use the electric stove, so there is no exposure to smoke.
Hazardous Household Products
Hazardous household products include chlorine-based cleaners, auto products, plastic glue, oil-based paints, as well as pesticides. In the selected home environment, only a few such products are used once or several times per year and pesticides are never used. The family pays significant attention to the way these products are stored. For instance, inflammable materials are never kept close to the sources of heat, while toxic agents are kept away from food, etc. Based on this, the level of concern in this category is low. However, no particular precautions are taken when those products are used. To avoid harm due to inhaling toxic chemicals, etc., it is recommended to make use of the outdoors or in the room with open windows.
To a large extent, the home environment is safe and favorable. There are no significant sources of chemical and physical pollution both outdoors and indoors. However, some areas require improvements. The actions for the elimination of existing moisture problems and enhancement of dust control will be discussed in this part of the paper.
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The main identified moisture problems are as follows: sometimes the signs of mold growth appear, and some places in the home have a musty odor. As stated by Nevalainen, Täubel, and Hyvärinen (2015), “mold growth in a building acts as a source of indoor pollutants, such as spores, cells, fragments of hyphae and spores, and microbial metabolites” (p. 132). Although fungi are universal and appear everywhere, the growth of mold due to dampness is not regarded as a “normal” source of fungi due to its association with multiple adverse health effects (Nevalainen et al., 2015, p. 132). Therefore, it is essential to reduce excess moisture in the home to minimize biological pollution.
According to the action plan solutions outlined in the HEAL, to address moisture problems, one needs to minimize water producing activities and reduce kitchen and bathroom humidity. Additionally, if mold is present, it is recommended to clean it up with a chlorine bleach solution. According to the World Health Organization (2009), “ventilation (outdoor airflow into a building) must be adequate to remove and dilute pollutants and humidity generated indoors, although the first alternative for improving indoor air quality should be control of pollutant sources” (p. 41). Thus, it is better to start with the removal of mold signs and cleaning of possible sources of mold spores including rugs, carpets, refrigerator coils, drip pans, etc. Only then, it will be adequate to proceed to the improvement of the ventilation system.
Although in the home, the windows remain open almost all the time, the signs of mold indicate that natural ventilation may not be enough. The mechanical ventilation system must be improved. Currently, the bathroom and the kitchen are mechanically vented. However, Luengas et al. (2015) note that over time, mechanical filters can become saturated with particles and, as a result, the pressure loss increases in them. It leads to decreased particle removal efficiency. Thus, old filters must be replaced to be able to reduce humidity effectively.
The second of the identified issues are related to dust control and can be eliminated through increased frequency of vacuuming. As stated by Portnoy et al. (2013), excess exposure to dust mites provokes the risk of dust sensitization, which consequently leads to the development of asthma. It means the frequent vacuuming is a must. In the home, the rooms are usually cleaned with an upright vacuum cleaner. To ensure the best results, its belt and bag should be checked for damages regularly. Weekly cleaning is necessary because mite allergens are highly stable for long periods. According to Portnoy et al. (2013), it means that “even if the mites are killed, occupants will continue to have exposure to mite allergens and other immunomodulators such as chitin from their exoskeletons” (p. 476). Since it is impossible to remove carpeting, furniture, and mattresses entirely, the researchers recommend abating the number of dust mites by using highly-efficient vacuum cleaners (Portnoy et al., 2013). Additionally, since pillow encasings and bedclothes can serve as barriers between sleepers and mite allergens, bedding should be washed on a regular basis as well. In this way, it is possible to say that regular vacuuming and cleaning with other tools have immunoprotective functions.
Every human interacts with his or her environment constantly. As stated by the Office of Disease Prevention and Health Promotion (ODPHP, 2017), these interactions largely affect the quality of life, life expectancy, and health disparities. Since people spend most of their time at home, it is essential to control all the physical, chemical, and biological factors that can impact their health adversely. The assessment of the home environment is especially critical for individuals associated with various health risks (ODPHP, 2017).
The results of the given assessment project reveal that the HEAL is an effective tool for the identification of different environmental hazards in homes and neighborhoods. The guidelines provided by TPCHD are simple to use and understand so even non-professionals can easily handle the assessment and intervention design process. In the analyzed home environment, the major areas of concern were the humidity level and dust control. Although these issues are usually paid less attention compared to such problems as exposure to toxicants, etc., the literature review findings demonstrated that excess exposure to moisture-associated fungi and dust mites increases the risk for the development of chronic respiratory conditions and immune system deficiencies. Therefore, it is essential to manage environmental concerns promptly, and it is possible to say that the HEAL can substantially facilitate this process.
Friis, R. H. (2012). Essentials of environmental health. Sudbury, MA: Jones & Bartlett Learning.
Luengas, A., Barona, A., Hort, C., Gallastegui, G., Platel, V., & Elias, A. (2015). A review of indoor air treatment technologies. Reviews In Environmental Science & Biotechnology, 14(3), 499-522. Web.
Nevalainen, A., Täubel, M., & Hyvärinen, A. (2015). Indoor fungi: Companions and contaminants. Indoor Air, 25(2), 125-156. Web.
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Quansah, R., Jaakkola, M. S., Hugg, T. T., Heikkinen, S. A. M., & Jaakkola, J. J. K. (2012). Residential dampness and molds and the risk of developing asthma: A systematic review and meta-analysis. PLoS ONE, 7(11), e47526. Web.
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