Healthy Homes Program Research Articles

Establishing a Virtual Home Assessment Program: from Concept to Implementation as a Result of the COVID-19 Pandemic.

Environmental home assessments have traditionally been performed in-person at the homes of Children's Mercy Kansas City patients. The COVID-19 pandemic brought many challenges to the way patients interact with their healthcare providers, including home visiting programs. Reaching out to patients with high-risk asthma and immunocompromised health was still needed, despite the pandemic. This project's purpose was to develop a virtual (telemedicine) healthy home assessment protocol that would continue to meet patients' needs during the isolation resulting from the pandemic. This is a newly developing approach to performing home environmental assessments with limited published research. Research on the effective use of telemedicine as an alternative to in-person clinic visits has shown that for some health conditions telemedicine represents a useful technique to engage with patients and caregivers. For some conditions, like pediatric asthma, it provides a similar level of efficacy in disease management while providing a more efficient form of interaction. This article describes the development and delivery process, timelines of caregiver interaction, and guidelines for performing virtual home assessments. It summarizes the challenges and benefits of using a virtual process for delivering home assessment services for asthma and allergy patients. Overall, caregivers indicated they found the use of virtual technology had significant benefits for them including their personal comfort and the time efficiency gained by using virtual visits to interact with Healthy Homes Program staff.

Gauging and Responding to the Need for Home Repair Assistance in Delaware.

We review the extent of the need for home repair assistance for low-income homeowners in Delaware, and steps being taken to address this need. Delaware contains an estimated 25,000 homes owned by low-income households that need repair, of which an estimated 5,000 are in substandard condition. There is an estimated $96 million total cost associated with this home repair need, with eighty percent of this cost ($76 million) coming from the twenty percent (5,000) of these homes that are in substandard condition. In order to address this need for repair assistance, Delaware's three Habitat for Humanity organizations have designed the Statewide Healthy Homes Program, which centers on the intersection of health and housing. The vision of the Habitat for Humanity Statewide Healthy Homes Program is to increase capacity for home repair assistance across Delaware. Additionally, the program seeks to include partnerships with healthcare providers to ensure a holistic approach to home repairs, improving each resident's quality of life.

Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial

IntroductionThe evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health...

The U.S. Department of Housing and Urban Development BUILD Las Vegas 2019 Event: Lessons Learned in Public Health Community Engagement.

The U.S. Department of Housing and Urban Development (HUD) BUILD Las Vegas 2019 event brought together Las Vegas Lead Hazard Control and Healthy Homes Program (LVLHCHHP) staff, community leaders, and volunteers from multiple organizations for a neighborhood clean-up and community resource fair in a low-income, historic west Las Vegas neighborhood. In preparation for the event, LVLHCHHP staff encountered a lack of published guidance regarding past BUILD events or planning of community-based public health events. To address this gap in the literature, this brief report offers lessons learned from the process of planning and evaluating the HUD BUILD Las Vegas 2019 event. These include taking early planning measures, centering the focus on community needs, and forming strategic partnerships, which can provide a valuable foundation for future events that want to integrate community engagement with public health.

The Healthy Homes and Neighbourhoods Integrated Care Initiative

Introduction: Sydney Local Health District undertook a collaborative planning process for vulnerable families in 2013 and 2014. In late 2014 the District successfully tendered for an integrated care initiative for vulnerable families – Healthy Homes and Neighbourhoods, which was implemented in July 2015. Practice Change Implemented: The initiative involved system redesign and commitment from health, education, social care, local government, primary-care and non-Government partners. The model included: shared intake, care-coordination, family group conferencing, wrap-around delivery models, place-based service hubs, general practice engagement and support, and population-based health improvement initiatiave. Aim and Theory of Change: The intervention aims to break intergenerational cycles of disadvantage, psychological trauma, poor parenting and poor health outcomes. A complex Theory of Change ToC was developed, that in summary, would: 1 engage, empower and support families; and 2 develop and strengthen the service system through a collaborative co-design process. Targeted Population and Stakeholders: The initiative is intended for vulnerable families with complex health and social care needs who have one or more dependent children unborn through to 17 years where their complex health needs are impacting on their capacity to parent effectively and participate in their community. The Stakeholders included: the local primary health network PHN, statutory child protection agency, housing department, schools, early childhood education and care providers, local government, and non-Government organisations working with complex families. Time Line: Implementation in July 2015, reviewed 2016 and secured recurrent funding July 2017. Highlights: The initiative has the following key features: Multiple core and non-core agencies working together over a sustained period of time i.e. 5 years with families with complex health and social needs All the needs of families are in scope for the intervention, including housing, employment, income support and legal advice Use of evidence informed integrated care methods by service partners, including family case conferencing, and “wrap around” care delivery Encouraging families to have a “health home” for all their health needs and supporting them to move from dependency to independence Supporting general practice providers to care for families that are often seen to be “too difficult” Development and implementation of shared assessment tools and referral criteria Implementation of family assessment and engagement tools that can be used over the long-term to monitor the health and wellbeing of family members Transferability: The integrated care model uses design elements that were adapted from other international projects and which can be implemented in other health and social care settings. The model may also be transferable to other vulnerable population groups including aged care. Conclusions: The development of a trusting relationship between HHAN care coordinators, service providers and their clients has been an integral component of the success of the Healthy Homes and Neighbourhoods Program. Discussion: The HHAN initiative demonstrates the benefits of integrating services with the social care, education and local government sectors to address the social determinants of health as they affect families Lessons Learned: The development of trust between agencies, clinicians and patients is essential for the development and implantation of integrated care initiatives

Integrated Care across Health District Boundaries

The Healthy Homes and Neighbourhoods (HHAN) Program provides long term care coordination to families with complex health and social needs, in the Sydney Local Health District (SLHD). Referral during the antenatal period is the preferred pathway, aiming to ensure complex families have support for themselves and their child, commencing in the period prior to birth. Previous geospatial mapping has identified two areas of clustered disadvantage within SLHD. Following identification of reduced attendance at one of two SLHD antenatal clinics, a HHAN care coordinator established communications with two hospitals in adjoining health districts to discover patterns of attendance for “out of area” pregnant women. Reasons for attendance at these “out of area” antenatal clinics is uncertain at this stage, but Local Government has identified gaps in public transport to the secondary SLHD hospital. Further research into cross boundary hospital attendance will be undertaken. By attending the adjacent Local Health District’s psychosocial meetings, HHAN aims to identify and engage with vulnerable women and their families, living with SLHD, but attending “out of area” health services. Engagement with adjoining health districts helps to integrate health and social care services beyond our local health district borders, which is vital for families living within previously identified areas of disadvantage. This initiative targeted pregnant women, and their families, with complex health and social needs residing in SLHD who were utilising antenatal health services outside SLHD boundaries. Engagement with health and social care providers across local health district boundaries is essential as HHAN aims to ensure vulnerable women and their families are not “falling through the cracks”. This presentation will focus on the initial collaboration between nurses/midwives and social workers, based in bordering health districts with the common aim of providing client focused support. Attendance at adjacent health district psychosocial meeting commenced in July 2017, following a period of discussion between health districts to acknowledge the identified gap in SLHD antenatal attendance and recognition of cross boundary health utilisation. Ongoing collaboration is planned to allow for seamless referral into the HHAN program and other health and social care services. Inter-Health District Care Coordination is a developing area within Australian public health. This Sydney-based, high-risk, antenatal pathway demonstrates to health care providers and their consumers that flexible support is possible across health boundaries. Interdisciplinary, cross health district collaboration is an essential current and future pathway to improve outcomes in the most vulnerable members of our population. The development of a trusting relationship between HHAN care coordinators, service providers and their clients has been an integral component of the success of the Healthy Homes and Neighbourhoods Program. This inter-health district liaison is enhancing communication and planning across health borders. Challenging and supporting health and social care partners to think and act outside their geographical boundaries is essential for ongoing change in these sectors, as we put the consumer and their complex lives at the forefront of our care. Whilst change is challenging, collaboration between health service providers is one step towards providing timely, integrated supportive care for vulnerable families.

The New York State Healthy Neighborhoods Program: Findings From an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program.

A growing evidence base suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation. To evaluate the impact of a large-scale, multisite, state-funded healthy homes program. Homes in high-risk neighborhoods of 13 counties funded under the New York State Healthy Neighborhoods Program (NYS HNP) from 2008 to 2012. A total of 28 491 homes received an initial visit and 6436 dwellings received a revisit (follow-up assessment 3 to 6 months after the intervention). A majority of residents are low-income renters living in buildings built prior to 1950. The NYS HNP is a low-intensity healthy homes program. Participating homes undergo a visual assessment to identify potential environmental health and safety hazards, and interventions (education, referrals, and products) are provided to address any hazards identified during the visit. The proportion of homes affected by several types of housing hazards, improvement in hazards among revisited homes, and the change in the overall number of hazards per home were assessed. 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. This evaluation suggests that a comprehensive, low-intensity healthy housing approach can produce short-term impacts with public health significance. This evaluation provides information about hazards that are common, easily assessed, and easily corrected or improved, which may be of use to a variety of programs that already provide in-home services and are seeking to expand the scope of their visits or to inform the development of new programs.

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. 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. Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

DNA methylation levels associated with race and childhood asthma severity

ABSTRACTObjective: Asthma is a common chronic childhood disease worldwide. Socioeconomic status, genetic predisposition and environmental factors contribute to its incidence and severity. A disproportionate number of children with asthma are economically disadvantaged and live in substandard housing with potential indoor environmental exposures such as cockroaches, dust mites, rodents and molds. These exposures may manifest through epigenetic mechanisms that can lead to changes in relevant gene expression. We examined the association of global DNA methylation levels with socioeconomic status, asthma severity and race/ethnicity. Methods: We measured global DNA methylation in peripheral blood of children with asthma enrolled in the Kansas City Safe and Healthy Homes Program. Inclusion criteria included residing in the same home for a minimum of 4 days per week and total family income of less than 80% of the Kansas City median family income. DNA methylation levels were quantified by an immunoassay that assessed the percentage of 5-methylcytosine. Results: Our results indicate that overall, African American children had higher levels of global DNA methylation than children of other races/ethnicities (p = 0.029). This difference was more pronounced when socioeconomic status and asthma severity were coupled with race/ethnicity (p = 0.042) where low-income, African American children with persistent asthma had significantly elevated methylation levels relative to other races/ethnicities in the same context (p = 0.006, Hedges g = 1.14). Conclusion: Our study demonstrates a significant interaction effect among global DNA methylation levels, asthma severity, race/ethnicity, and socioeconomic status.

Health Hazards in the Home: An Assessment of a Southern Nevada Community.

As a sub-grantee of a Department of Housing and Urban Development (HUD) Lead Hazard Control and Healthy Homes Program, the University of Nevada, Las Vegas' Department of Environmental and Occupational Health performed lead and Healthy Homes investigations and collected data regarding conditions in the home environment in Henderson, Nevada. The purpose of this research is to characterize housing conditions in southern Nevada, compare data to census data, and to highlight the health outcomes associated with adverse housing conditions. Visual home assessments were conducted in 106 homes in southern Nevada, and specific hazards were characterized using the Healthy Homes Rating System. The results were then compared, when possible, to American Housing Survey (AHS) data for the Las Vegas metropolitan area. Lead, domestic hygiene, carbon monoxide, damp and mold, excess cold and heat, and structural collapse were the most frequently identified hazards, found in at least 101 (90%) of participant households. Median household income of program participants was half (50%) that of the surrounding zip code, which was expected, as classification as "low-income" by HUD standards was a requirement for participation. Our data indicated that the AHS data may not be representative of very low income housing in southern Nevada and may underreport actual conditions. In-home inspections performed by trained personnel provide a more accurate picture of conditions than the self-report method used by the AHS. In addition, we recommend the development of a standardized Healthy Homes visual assessment tool to allow for the comparison of housing conditions between communities.

Detection of allergen sources in the homes of sensitized children.

To identify the presence of environmental factors linked to the onset of allergies and asthma in the homes of children participating in an early detection program that were identified with sensitivity to common allergens in the region of Sonora, Mexico. A walkthrough assessment was carried out in the homes of sensitized children; the research tools were the questionnaire and environmental checklist proposed by the Lowell Healthy Homes Program of the University of Massachusetts-Lowell. The results showed the presence of environmental allergen sources, to which most of the children in the study are sensitized, as well as the environmental conditions and habits that determine the quality of the indoor air of the households, were both related to triggering allergies and asthma in this population. A statistically significant association was found between the visual observation of dust inside homes and the sensitivity of children to dust mites. Dust found inside the home was the most relevant environmental factor related to positive cases of IgE in children. Early detection of allergies in children in the study and the methodology used in this investigation provided a useful framework for the design of plans and intervention alternatives in these homes to prevent the development of allergies and asthma panorama. These plans should be designed with a multidisciplinary approach to impact social, environmental and economic benefits in the family, improving the living conditions of the study population and contributing to the sustainable development goals of the United Nations for 2030.

Evaluation of a Home-Based Environmental and Educational Intervention to Improve Health in Vulnerable Households: Southeastern Pennsylvania Lead and Healthy Homes Program.

This evaluation examined whether participation in a home-based environmental educational intervention would reduce exposure to health and safety hazards and asthma-related medical visits. The home intervention program focused on vulnerable, low-income households, where children had asthma, were at risk for lead poisoning, or faced multiple unsafe housing conditions. Home visitors conducted two home visits, two months apart, consisting of an environmental home assessment, Healthy Homes education, and distribution of Healthy Homes supplies. Measured outcomes included changes in participant knowledge and awareness of environmental home-based hazards, rate of children’s asthma-related medical use, and the presence of asthma triggers and safety hazards. Analysis of 2013–2014 baseline and post-intervention program data for a cohort of 150 families revealed a significantly lower three-month rate (p < 0.05) of children’s asthma-related doctor visits and hospital admissions at program completion. In addition, there were significantly reduced reports of the presence of home-based hazards, including basement or roof leaks (p = 0.011), plumbing leaks (p = 0.019), and use of an oven to heat the home (p < 0.001). Participants’ pre- and post- test scores showed significant improvement (p < 0.05) in knowledge and awareness of home hazards. Comprehensive home interventions may effectively reduce environmental home hazards and improve the health of asthmatic children in the short term.

Federal Enactment of Healthy Homes Legislation in the United States to Improve Public Health.

Not all homes across America are “healthy” homes. This contributes to the poor health of Americans and exacerbates existing health conditions costing millions each year in health-care cost. Newer research is being conducted into strategies to alleviate biological, chemical, and physical hazards in the home, and various programs exist to assist the homeowner in making improvements in the quality of their home. Not every homeowner or renter nationwide or within community localities has access to these strategies or programs that could potentially improve their home environment and therefore the health of their family. The objective of this article is to propose elements of a policy to address this inconsistency and variation. This proposal centers around the federal enactment of a national policy demanding that each state implements a healthy homes program tailored to fit their specific state housing and health needs. Members of Congress from States that have successfully implemented healthy home programs should champion this policy. Organizations that recognize the impact of housing on health should support the development of a national healthy homes strategy. This article will discuss the need, outcomes, stakeholders, and minimum requirements of such a policy.

The Lingering Life of Lead Pollution: An Environmental Justice Challenge for Indiana

exposure in children has drastically decreased but the statement above remains true—Black children continue to have substantially higher blood lead levels than their white counterparts even when socioeconomic variables are accounted for. Indiana is no exception. African Americans and Hispanics continue to show higher rates of elevated blood lead levels than their white counterparts in Indiana. 4 Indiana has adopted the Lead and Healthy Homes Program. Its purpose is to 5

HIPPY for Healthy Home Program: Results of Pre and Post Surveys Addressing Indoor Air Quality Contaminants in Arkansas Homes

Background: HIPPY for Healthy Homes is a collaborative program between the University of Arkansas for Medical Sciences’ College of Public Health and the parent involvement, school readiness program called Home Instruction for Parents of Preschool Youngsters (HIPPY) to build capacity for education and knowledge on key hazards in the home. Methods: Radon, mould, carbon monoxide and indoor irritants for respiratory illnesses (e.g., asthma) and allergies, were identified as important hazards in the home to be addressed by the Arkansas HIPPY program. Program implementation with HIPPY involved an in-class training program for HIPPY coordinators and home-based educators (HBCs and HBEs), development of materials (e.g., brochures, website), and an outreach format to best implement the program. The four-hour in-class training for the HBCs and HBEs combined PowerPoint presentations and group activities, and in the one year training period reached 151 HIPPY HBEs and HBEs in six regions of the State of Arkansas. An online version of the training was later developed for sustained implementation of the program by giving new HIPPY educators the opportunity to learn about these hazards and share with their parents. Results: This paper reports on the methodologies of the HIPPY for Healthy Homes program and results from a pre- and post-assessments delivered during the in-class training to evaluate knowledge on the key home hazards presented and effectiveness of the training at increasing knowledge for 151 HBEs and HBCs. Potential impact of project methodology on parents in the program receiving and understanding the information and ultimately changing behavior is based on a brief follow-up post assessment of 47 HBEs and HBCs. Conclusion: This program can offer a useful methodological approach to reach families associated with home based educational program in order to educate them on important home hazards. Areas for improvement and expansion exist.

Homes of low-income minority families with asthmatic children have increased condition issues.

The home is increasingly associated with asthma. It acts both as a reservoir of asthma triggers and as a refuge from seasonal outdoor allergen exposure. Racial/ethnic minority families with low incomes tend to reside in neighborhoods with low housing quality. These families also have higher rates of asthma. This study explores the hypothesis that black and Latino urban households with asthmatic children experienced more home mechanical, structural condition-related areas of concern than white households with asthmatic children. Participant families (n = 140) took part in the Kansas City Safe and Healthy Homes Program, had at least one asthmatic child, and met income qualifications of no more than 80% of local median income; many were below 50%. Families self-identified their race. Homes were assessed by environmental health professionals using a standard set of criteria and a specific set of on-site and laboratory sampling and analyses. Homes were given a score for areas of concern between 0 (best) and 53 (worst). The study population self-identified as black (46%), non-Latino white (26%), Latino (14.3%), and other (12.9%). Mean number of areas of concern were 18.7 in Latino homes, 17.8 in black homes, 13.3 in other homes, and 13.2 in white homes. Latino and black homes had significantly more areas of concern. White families were also more likely to be in the upper portion of the income. In this set of 140 low-income homes with an asthmatic child, households of minority individuals had more areas of condition concerns and generally lower income than other families.

Internal transcribed spacer rRNA gene sequencing analysis of fungal diversity in Kansas City indoor environments

Compared to traditional methods of fungal exposure assessment, molecular methods have provided new insight into the richness of fungal communities present in both indoor and outdoor environments. In this study, we describe the diversity of fungi in the homes of asthmatic children located in Kansas City. Fungal diversity was determined by sequencing the internal transcribed spacer (ITS) regions of ribosomal RNA derived from fungi collected in air and dust samples from 31 homes participating in the Kansas City Safe and Healthy Homes Program (KCSHHP). Sequencing results were then compared to data obtained using viable and non-viable fungal exposure assessment methods. ITS clone libraries were predominantly derived from the phylum Ascomycota in both air (68%) and dust (92%) samples and followed by the Basidiomycota and Zygomycota. The majority of Ascomycota clones belonged to four orders including the Pleosporales, Eurotiales, Capnodiales, and Dothideales. ITS sequencing revealed the presence of a number of rarely documented fungal species placed in the Pleosporales. Several species placed in the Basidiomycota were detected in ITS clone libraries but not by viable or non-viable methods. The prevalence of organizational taxonomic units (OTUs) was significantly higher in air than in dust samples (p < 0.0001); however, no differences between OTUs in air samples collected in the subjects' room and basement were observed. These sequencing results demonstrate a much broader diversity of Ascomycota and Basidiomycota communities in KCSHHP indoor environments than previously estimated using traditional methods of assessment.

Indoor Airborne Spore Levels Before and After Healthy Homes Education and Remediation

RationaleAsthmatic children are often sensitization to airborne fungi yet many live in homes containing poor indoor air quality (IAQ). To examine the reduction in airborne spores at the beginning and after 6 months enrolment in a Healthy Homes program the following studies were conducted.MethodsHomes enrolled in this project contained at least one child with asthma. Homes were evaluated for indoor and outdoor environmental conditions related to the maintenance of IAQ at the time of enrolment and after 6 months of participation in a healthy homes program. After enrolment, residents of these homes received education on maintaining a safe and healthy home along with assistance in remediating unsafe or unhealthy IAQ conditions in the home. Air collections were taken using a BioAire™ Model B520 spore trap both before and after education/remediation at two locations outside the home and at 5 locations inside the home. Air collections were evaluated microscopically for commonly identified spores.ResultsResults from the first 10 homes to fully complete the study indicate the major fungal spores present include Cladosporium (before 97% of collections; after 90% of collections); Aspergillus/Penicillium (87%/75%); Alternaria (35%/45%) and Stachybotrys (24%/6%). Overall spore reductions in the child's bedroom for these 10 homes included Stachybotrys (100%), Aspergillus/Penicillium (55%). Mean total indoor spore levels were reduced from 24% of outdoor ambient levels before the healthy homes program to 16% of outdoor ambient levels at completion.ConclusionsHealthy homes education along with remediation for unsafe or unhealthy conditions resulted in substantial reduction in airborne fungal spore exposure. RationaleAsthmatic children are often sensitization to airborne fungi yet many live in homes containing poor indoor air quality (IAQ). To examine the reduction in airborne spores at the beginning and after 6 months enrolment in a Healthy Homes program the following studies were conducted. Asthmatic children are often sensitization to airborne fungi yet many live in homes containing poor indoor air quality (IAQ). To examine the reduction in airborne spores at the beginning and after 6 months enrolment in a Healthy Homes program the following studies were conducted. MethodsHomes enrolled in this project contained at least one child with asthma. Homes were evaluated for indoor and outdoor environmental conditions related to the maintenance of IAQ at the time of enrolment and after 6 months of participation in a healthy homes program. After enrolment, residents of these homes received education on maintaining a safe and healthy home along with assistance in remediating unsafe or unhealthy IAQ conditions in the home. Air collections were taken using a BioAire™ Model B520 spore trap both before and after education/remediation at two locations outside the home and at 5 locations inside the home. Air collections were evaluated microscopically for commonly identified spores. Homes enrolled in this project contained at least one child with asthma. Homes were evaluated for indoor and outdoor environmental conditions related to the maintenance of IAQ at the time of enrolment and after 6 months of participation in a healthy homes program. After enrolment, residents of these homes received education on maintaining a safe and healthy home along with assistance in remediating unsafe or unhealthy IAQ conditions in the home. Air collections were taken using a BioAire™ Model B520 spore trap both before and after education/remediation at two locations outside the home and at 5 locations inside the home. Air collections were evaluated microscopically for commonly identified spores. ResultsResults from the first 10 homes to fully complete the study indicate the major fungal spores present include Cladosporium (before 97% of collections; after 90% of collections); Aspergillus/Penicillium (87%/75%); Alternaria (35%/45%) and Stachybotrys (24%/6%). Overall spore reductions in the child's bedroom for these 10 homes included Stachybotrys (100%), Aspergillus/Penicillium (55%). Mean total indoor spore levels were reduced from 24% of outdoor ambient levels before the healthy homes program to 16% of outdoor ambient levels at completion. Results from the first 10 homes to fully complete the study indicate the major fungal spores present include Cladosporium (before 97% of collections; after 90% of collections); Aspergillus/Penicillium (87%/75%); Alternaria (35%/45%) and Stachybotrys (24%/6%). Overall spore reductions in the child's bedroom for these 10 homes included Stachybotrys (100%), Aspergillus/Penicillium (55%). Mean total indoor spore levels were reduced from 24% of outdoor ambient levels before the healthy homes program to 16% of outdoor ambient levels at completion. ConclusionsHealthy homes education along with remediation for unsafe or unhealthy conditions resulted in substantial reduction in airborne fungal spore exposure. Healthy homes education along with remediation for unsafe or unhealthy conditions resulted in substantial reduction in airborne fungal spore exposure.