An eye above
If we're looking at the home as a place of health, we want to find out if it is a place of morbidity, too, because certain hazards, especially conditions associated with air quality," said Albert.
Unrecognized environmental hazards like poor indoor air quality, moisture, mold and other fungal species can interfere with pre-existing health conditions or affect the delivery of in-home services.
In a city like Pittsburgh, where outdoor air quality is also a major concern, Albert and his team at the HHL have found a way to incorporate questions about exposure to these hazards into people's access to in-home supportive care. The project was funded through a grant from HUD, the first of its kind awarded to the University, and resulted in the creation of the Healthy Homes Assessment Tool (H-HAT).
"At first, we looked at what environmental hazard assessments were already in place for home- and community-based services," said Meredith Hughes, JD, MPH, assistant professor of health policy and management. "We found that of the tools out there, only 10% had mentions of environmental hazards."
In partnership with the Allegheny County Agency on Aging and others, the team developed H-HAT to assess air quality and suggest mitigation strategies in more than 40 homes in Greater Pittsburgh.
"The residents who took part (in the H-HAT development process) were already receiving services and many had already received elaborate home assessments, but these were limited to accessibility, safety, and maybe heat and temperature," added Albert. "Nobody was looking at PM2.5, mold or carbon monoxide, which all can affect pulmonary or cardiovascular health, especially if someone has other comorbidities."
PM2.5 is particulate matter that is 2.5 micrometers or fewer in diameter. For comparison, a single human hair is 70 micrometers in diameter. PM2.5 are microscopic solids or liquid droplets that are so small they can be inhaled deep into the lungs and cause serious health problems if they enter the bloodstream or brain.
The H-HAT assessment combined policy, environmental health science, and civil and environmental engineering with public health. At first, researchers did a feasibility study, creating a questionnaire that could be easily added to in-home assessments—and easily judged, like seeing mold on a surface—and then compared these reports to sensor readings. Other questions asked about smokers in the home or the use of natural gas for heating and cooking, as well as radon, an odorless and invisible radioactive gas naturally released from rocks, soil, and water, which is more prevalent in Pittsburgh because of its geology.
H-HAT teams were also challenged to find metrics to measure some environmental hazards. For that, they relied on Jemima Ohwobete, MEng, a PhD student in the Department of Civil and Environmental Engineering at Pitt's Swanson School of Engineering.
"We see a lot of cases, especially with older people, where they get sick, go to the hospital, get better and when they come home what made them sick—especially if it's mold or other microbes—is still there," said Ohwobete. "We wanted to find a low-cost consumer home air monitor that was as close to the gold standard as possible and also easy to use and understand."
Ohwobete says much of her work focused on controllable in-home habits that affect air quality like air flow, light and temperature. To test theories and help formulate suggestions after the assessments, researchers used the Healthy Home Lab for just what its name implies, as a laboratory.
"In the home, the more it is or the darker it is, mold loves it," said Ohwobete, who used rooms at the Healthy Home Lab to experiment with how sunlight, ventilation and temperature affected mold growth. She called it a way to experiment in a practical setting outside of a laboratory.