Class Outline 2/19/13 Video Presentation http://www.youtube.com/watch?v=kkgj2vxxezw (10 minute video Ohio State University http://www.youtube.com/watch?v=_mbu8bvkb_u (7.13 mins) http://www.youtube.com/watch?v=hzesuy2x2ww (3.20 mins) Community Based Participatory Model Healthy Public Housing Initiative (HPHI) Lawrence Projects
Cultural Humility vs Cultural Competence Cultural Humility: Life Long Learning & Development, Self Reflection Recognize and Mitigate Power Imbalance Institutional Accountability Cultural Humility: People, Principles & Practices. 30 Minute documentary published 8/2/12 Professor Vivian Chavez, San Francisco State http://www.youtube.com/watch?v=sashlbs1v4w (complete version)
Healthy Public Housing Initiative: Community Based Participatory Research, using IPM Intervention as a case study Rhona Julien, ScD Introduction to Environmental Justice Feb. 19, 2013
Boston Public Housing Boston Public Housing Facts Largest apartment owner in Boston 15,000 units in 68 developments 25,000 residents (10,000 children) Average Income: 17% of Boston-area median < $10,000 for a family of four
Healthy Public Housing Initiative Project goals Improve home environments of residents. Empower residents. Build capacity within city agencies, community organizations and residents. Impact national policy on housing and health.
HPHI Partners Public/Government Boston Housing Authority (BHA) Boston Public Health Commission Universities Boston University School of Public Health Harvard University School of Public Health Tufts University School of Medicine Community Committee for Boston Public Housing, Inc. Franklin Hill Tenant Task Force, Inc. West Broadway Tenant Task Force, Inc. Public Health Initiative, South Boston Community Health Center Residents of BHA developments
HPHI Study Group 3 Boston Housing Authority (BHA) Developments: West Broadway Franklin Hill Washington Beech Recruited 60 households, pediatric asthmatic (4 to 17 yrs) Racial Composition: Hispanic - 65.8% Black - 31.6% Caucasian - 2.6%
HPHI intervention Health data Environmental Measurements Interventions Clinical Asthma case management: training, access to peak flow meters, monthly diaries and maintaining an appropriate medication regimen. Environmental new mattresses, pillow covers, air purifier, plastic ware, minor home improvements, IPM.
Working Definition of IPM Integrated Pest Management (IPM) is an approach to pest control using multiple strategies that emphasize modification of pest environments with the minimum use of pesticides.
IPM Intervention Evaluate Effectiveness: Pre IPM Measurements (Baseline) Housing conditions/housekeeping practices, pest problem, pesticide use, IAQ awareness, pesticide residues IPM Interventions Resident Education Professional House Cleaning Professional Pesticide Treatment Post IPM Measurements (3 months after baseline)
Measurements (pre/post IPM) Home Assessment Pesticide inventory Assessed roach infestation Environmental Measurements
IPM Interventions Professional cleaning: Washing of walls, removal of debris; minor repairs (caulking) HPHI pest contractor apply Crack and Crevice Treatments, e.g., gels and boric acid
Resident Education Monitor home for pest activity Control pest infestation Reduce pesticide use Minimize occupants exposure to pesticides Optimize use of non toxic alternatives Share the results with a friend
Summary of Findings Pre IPM Intervention - Every home had at least 3 pesticides, some as many as 8 some pesticides were banned, RUP - RUP, detected in 70% of homes - Chlorpyrifos found in every home 2 years following withdrawal from sales Post IPM Intervention Resident Education Positive association with reduction in cyfluthrin concentrations (active ingredient for Tempo, restricted use pesticide) Negative association with permethrin reduction, which may be suggestive of pesticide substitution Professional Cleaning Homes with poor housekeeping were higher at baseline and got better reductions Reduction in cockroach infestation
Community Based Participatory Research (CBPR) Researcher - Resource Community Expert CBPR is research that is conducted as an equal partnership between traditionally trained "experts" and members of a community. (Wikipedia)
Challenges to IPM Language and cultural barriers Literacy issues Access to homes Gaining trust Community s Agenda vs Researchers Agenda ( making a difference is great, quantifying the difference is greater!)
Factors that helped overcome barriers
Focus Group Meeting Meetings with residents introduce ourselves, discuss project, to discuss housing hazards
Community Health Advocates (CHAs) Hire & Train: data collection/documentation, peer education, home inspections (e.g., id asthma triggers, pest entryways.)
Meeting with Project Partners Check-ins: what s working, what s not
Community Meetings to Present Study Findings Tempo, RUP used by some families
HPHI Team Theory to practice - findings led to BHA IPM Program, Bodega outreach, pesticide buyback program.
Cultural Humility http://www.youtube.com/watch?v=sashlbs1v4w (complete version - 30 mins)