Healthy Homes Specialist Credential
Study Guide
KEEP CONFIDENTIAL
Prepared by the National Center for Healthy Housing
January 24, 2012
www.nchh.org/Training/Healthy-Homes-Specialist-Credential.aspx
Building a healthy home environment for all children
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Health Homes Specialist Credential
Study Guide
This Study Guide is designed to prepare a health or a housing professional to become a Healthy Homes
Specialist. While it will help prepare the professional to pass the Healthy Homes Specialist Credential
examination, it covers more topics than may be on the exam. Where not otherwise noted, the material comes
from the HUD/CDC Healthy Homes Reference Manual and the Essentials for Healthy Homes Practitioners
training course. Visit www.nchh.org/Training/Healthy-Homes-Specialist-Credential.aspx for more information on
the credential and the references.
For more information on the study guide, contact Susan Aceti at 443.539.4153 or [email protected].
Table of Contents
Section
I.
Institute of Medicine Reports
A.
IOM Clearing the Air Report in 2000
B.
IOM Damp Indoor Spaces and Health Report in 2004
II.
American Housing Survey
III.
Healthy People 2010 Goals
IV.
Seven Principles for Healthy Homes
V.
Keep It Contaminant-Free
A.
Hazards Posed by Common Household Contaminants
B.
Federal Requirements Regarding Common Household Contaminants
C.
Renovation Work Practice Requirements for Asbestos and LeadBased Paint
D.
Control Methods for Specific Contaminants
VI.
Keep It Pest-Free
A.
Pest Characteristics
B.
Pest Control Options
C.
Additional Pest Control Questions
D.
HUD Integrated Pest Management Guidance
VII.
Keep It Dry
A.
Materials of Construction
B.
Preventing Moisture Problems
VIII.
Keep It Ventilated
A. Humidity and Relative Humidity
B. Air Movement and Filtration
C. Sources of Contaminants
IX.
Keep It Safe
X.
Keep It Clean
XI.
Keep It Maintained
XII.
Water and Wastewater
XIII.
Laws and Codes
XIV.
Acronyms
National Center for Healthy Housing
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Health Homes Specialist Credential
Study Guide
I.
Institute of Medicine Reports
The 2000 and 2004 Institute of Medicine (IOM) Reports are the most authoritative source for the
connection between health and housing. These documents are the foundation for healthy homes.
A.
IOM Clearing the Air Report in 2000
Asthma is a critical health problem closely connected with hazards in the home. A Healthy Homes
Specialist needs to know what biological and chemical agents have sufficient evidence of an
association or causal relationship to the development or exacerbation of asthma. While it is
helpful to know the strength of the evidence, it is most important to distinguish it from the agents
for which there is only limited or suggestive evidence of an association. The IOM Clearing the Air
report is the most authoritative statement on the connection. Note that this report is more than 10
years old. More recent research has found associations for certain agents, but the IOM has not
updated its report.
Write the agents determined by the IOM to have sufficient evidence of an association or causal
relationship to asthma into the appropriate column in the table below. Use the agents listed below
as a reminder. Agents may be repeated in both columns. No need to write in the agents with only
limited or suggestive evidence of an association. Where an agent is limited to certain conditions,
note those limitations.
Go to http://www.nchh.org/LinkClick.aspx?fileticket=Rlb8SSGdT6s%3d&tabid=457 for the
answers.
Agents:
Birds (Domestic)
Cat
Cockroaches
Dog
Environmental Tobacco Smoke
Formaldehyde
Fragrances
Fungi or Molds
House Dust Mite
Houseplants
Insects Other than Cockroaches
Mice
Nitrogen Oxides
Rats
Pesticides
Volatile Organic Compounds.
Limitations:
In Preschool- Aged Children
High-Level Exposures
What is the difference between exacerbation and development of asthma? Which is more
significant?
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B.
IOM Damp Indoor Spaces and Health Report in 2004
A damp indoor environment is a common problem in housing. Dampness comes from a wide
variety of sources and can result in many problems including mold, cockroaches and rodents. A
Healthy Homes Specialist needs to know which health outcomes have sufficient evidence of an
association or causal relationship to damp indoor environmental when mold is or is not present.
While it is helpful to know the strength of the evidence, a Specialist must be able to distinguish
health outcomes with sufficient evidence from those with only limited or suggestive evidence of
an association. The IOM Damp Indoor Spaces and Health report is the most authoritative
statement on the connection. Please note that this report is more than four years old. More recent
research may have found additional or stronger associations for certain health outcomes but the
IOM has not updated its report.
Write the health outcomes determined by the IOM to have sufficient evidence of an association or
causal relationship to damp indoor environments into the appropriate column in the table below.
Use the health outcomes listed below as a reminder. Health outcomes may be repeated in both
columns. No need to write in the health outcomes with only limited or suggestive evidence of an
association. Go to http://www.nchh.org/LinkClick.aspx?fileticket=Rlb8SSGdT6s%3d&tabid=457
for the answers.
Health Outcomes:
Asthma development
Asthma symptoms in sensitized persons
Cancer
Cough
Dyspnea/Shortness of breath
Fatigue
Hypersensitivity pneumonitis in susceptible persons
Lower respiratory illness in otherwise healthy children
Neuropsychiatric symptoms
Reproductive effects
Skin symptoms
Upper respiratory tract symptoms
Wheeze
What is a damp indoor environment?
What are likely outcomes of damp indoor spaces?
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Study Guide
II.
American Housing Survey
A Healthy Homes Specialist must know the basic characteristics of housing including common problems,
and be able to identify important relationships between those characteristics. The American Housing
Survey (AHS) is the most authoritative and comprehensive collection of that information. The AHS is
funded by the U.S. Department of Housing and Urban Development (HUD) and administered by the U.S.
Census Bureau to take a snapshot at the housing conditions in a community. The Census Bureau
conducts a national survey every two years and large metropolitan statistical areas (MSAs) periodically.
NCHH identified the housing characteristics most relevant to healthy housing and summarized them in
various reports at a table. Go to http://www.nchh.org/Portals/0/Contents/AHS_National_2007_Full_12-3008.pdf to locate the table with the data. Write in the answers from the table.
1.8 million
4.0 million
5.8 million
17.5%
10.3%
7.9%
0.7%
5.5%
71.7%
19.8%
1.1%
62.9%
51.4%
21.3%
52.5%
69.7%
# of homes with severe physical problems (note that units are thousands of homes)
# of homes with moderate physical problems
# of homes with either severe or moderate problems
% of homes with exterior physical problems
% of homes with exterior water leakage in past 12 months
% of homes with interior water leakage in past 12 months
% of homes with signs of rats in past 3 months
% of homes with signs of mice in past 3 months
% of rental homes built before 1980
% of homes with a septic tank, cesspool, or chemical toilet
% of homes with fuel-burning room heaters without a flue as main heating equipment
% of homes with gas-fired warm-air furnaces
% of homes with piped gas for water heating
% of homes with piped gas for clothes dryer
% of homes with residents with severe problems rating home 8 to 10 with 10 as best
% of homes with severe problems due to lack of some or all plumbing facilities
Check the most common cause of each type of problem.
Ext. water leakage
Walls or window
problems
Basement
problems
Roof problems
Other/Unknown
Int. water leakage
Leaking pipes
Broken fixtures
Broken water
heater
Other/Unknown
Severe Physical Prob.
Plumbing
Heating
Electric
Upkeep
Moderate Physical Prob,
Plumbing
Heating (close)
Upkeep (close)
Kitchen
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Health Homes Specialist Credential
Study Guide
III.
Healthy People 2010 Goals
A Healthy Homes Specialist needs to know the top priorities for healthy homes. The U.S. Department of Health
and Human Services (HHS) established the United States’ top priorities in its Healthy People 2010 program.
The program established measureable objectives for the United States to achieve by the year 2010. Seven
objectives directly relate to housing improvements that will benefit health. HHS is planning to update these
objectives in its Healthy People 2020 program. For more information, see www.healthypeople.gov/.
Checkmark the seven housing-related health objectives set by the Healthy People 2010 program. Go to
http://www.nchh.org/LinkClick.aspx?fileticket=Rlb8SSGdT6s%3d&tabid=457 and scroll to pages 8-10 for the
answers.
____ Eliminate elevated blood lead levels in children.
____ Reduce pesticide exposures that result in visits to a health care facility.
____ Reduce cockroaches from low-income multi-family housing.
____ Reduce indoor allergen levels.
____ Increase the proportion of persons who live in homes tested for radon concentrations.
____ Reduce the number of homes with more than 4 picocuries per liter of radon in their air.
____ Increase the number of new homes constructed to be radon resistant.
____ Eliminate the use of asbestos in building materials that can become friable.
____ Increase the proportion of persons living in pre-1950s housing that has been tested for the presence of
lead-based paint.
____ Reduce the number of homes with interior or exterior water leakage.
____ Reduce the proportion of occupied housing units that have moderate or severe physical problems from
6.5% to 3.1%.
____ Reduce the number of homes with deteriorated lead-based paint.
IV.
Seven Principles for Healthy Homes
The National Center for Healthy Housing has established seven principles for healthy homes. These seven
principles provide a structure to understand the approaches to prevent and correct conditions in housing that
can make a home unsafe or unhealthy. A Healthy Homes Specialist needs to know these principles.
Write down the seven principles. Go to http://nchh.org/what-we-do/Healthy-Homes-Principles.aspx for the
answers.
1. ________________________
4. ________________________
7. ________________________
2. ________________________
5. ________________________
V.
3. ________________________
6. ________________________
Keep It Contaminant-Free
A.
Hazards Posed by Common Household Contaminants
A Healthy Homes Specialist needs to understand the nature of the hazards posed by common contaminants in
the home. The following was developed from the HUD/CDC Healthy Homes Reference Manual and associated
resources. Go to http://www.nchh.org/LinkClick.aspx?fileticket=xOmexR94oew%3d&tabid=506 in Table 1 for
information.
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Health Homes Specialist Credential
Study Guide
Fill in each of the four columns for each of the contaminants in the left column. Consider typical exposures that
a resident would encounter in a home. Primary routes of exposure would be: inhalation, ingestion, skin contact,
or injection (such as splinters). For the last column, identify which of the seven principles (i.e., Keep It Dry,
Clean, Ventilated, Pest-Free, Safe, Contaminant-Free, and Maintained) that will have a significant benefit
reducing the hazards posed by the contaminant.
Contaminant
Asbestos
Hazards Posed by Common Household Contaminants
Primary Health
Common Sources
Primary Routes
Impact
in Home
of Exposure
 Lung cancer
 Insulation/
 Inhalation of
Vermiculite
fibers from
 Asbestosis
deteriorated,
(scar tissue buildup  Floor tiles
damaged, or
in lung)
 Sheet vinyl flooring
disturbed
 Mesothelioma
 Cement shingles
material. The
(cancer of the lining
or roofing
material needs to
of chest and
 Plaster and joint
be friable. See
abdomen)
compound
definition below.
 Gaskets
 Skin cancer
Arsenic
Carbon
Monoxide
Cockroaches
Formaldehyde
Lead
Mercury
 Chromated Copper
Arsenate (CCA)
treated lumber
(produced before
2004) (e.g., in
wooden decks and
playsets)
 Private wells (in
some locations)
 Combustion
appliances
 Attached garage
 Walls, cavities,
and other places to
hide
 Death
 Central nervous
system damage
 Asthma
 Allergies
 Stomach illness
 Communicable
disease
 Respiratory irritation  Glues
and sensitization
 Pressed wood
 Nasal cancer
products
 Nervous system/
brain damage
 Learning,
behavioral
problems
 Cancer
 High blood pressure
 Nervous system/
brain damage
National Center for Healthy Housing
Relevant
“Keep Its”
Maintained
Contaminant-Free
Dry
Clean
Maintained
 Ingestion of
drinking water and Safe
residue from
wood or soil
 Splinters
 Inhalation
 Inhalation
 Ingestion
Ventilated
Maintained
Clean
Pest-Free
Clean
Dry
Maintained
 Inhalation
Contaminant-Free
Ventilated
 Deteriorated paint
 Lead in soil and
dust
 Lead in water
 Some consumer
products
 Ingestion
 Inhalation of dust
from renovation,
or disturbing leadbased paint.
Maintained
Clean
Dry
Contaminant-Free
 Fluorescent lamps
 Thermometers
 Switches
 Inhalation
Maintained
Ventilated
Clean
Contaminant-Free
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Contaminant
Mold
Nitrogen Oxides
Pesticides
Radon
Rodents
Sewer Gas
Volatile
Organics
(VOCs)
Hazards Posed by Common Household Contaminants
Primary Health
Common Sources
Primary Routes
Impact
in Home
of Exposure
 Asthma
 Damp indoor
 Inhalation
environments
 Hypersensitivity
 Ingestion
pneumonitis
 Water-damaged
materials
 Coughing/
wheezing
 Upper respiratory
tract symptoms
 Combustion
 Inhalation
 Asthma
appliances
exacerbation
 Current use
 Inhalation
 Depends on
pesticide used,
 Residue from past  Ingestion
often nervous
use
 Dermal
system
 Soil, clay, or rock
 Inhalation
 Lung cancer
from around and
underneath
foundation
 Walls, cavities,
 Inhalation
 Asthma (mice)
crawlspaces, and
 Ingestion
 Infectious disease
other places to
 Bites
 Bites
hide
 Fire and explosion  Broken sewers
 Inhalation
 Central nervous
 Empty drain traps
system damage
 Respiratory system
damage
 Depends on
 Air fresheners
 Inhalation
chemical; often
 Glues & building
 Ingestion
nervous system
materials
damage
 Sprays and
 Can be poisoning
coatings
hazard
 Household
cleaners
Relevant
“Keep Its”
Dry
Maintained
Clean
Ventilated
Ventilated
Maintained
Pest-Free
Contaminant-Free
Maintained
Ventilated
Ventilated
Contaminant-Free
Maintained
Dry
Pest-Free
Maintained
Dry
Clean
Maintained
Ventilated
Contaminant-Free
Safe
Ventilated
Notes:
 Only some common household contaminants with significant potential hazards are listed.
 Contaminants are sorted alphabetically.
 Primary health impact is based on hazard posed by contaminant in common household settings.
 “Keep Its” refers to the Seven Principles of Healthy Housing.
 “Keep Its” are listed by their importance to addressing hazard.
 “Friable” means that the material, when dry, may be crumbled, pulverized, or reduced to powder by hand
pressure, and includes previously nonfriable material after such previously nonfriable material becomes
damaged to the extent that, when dry, it may be crumbled, pulverized, or reduced to powder by hand
pressure. 40 CFR 763.83.
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Health Homes Specialist Credential
Study Guide
Federal Requirements for Homes Regarding Common Household Contaminants
A Healthy Homes Specialist needs to understand the regulatory programs to protect residents from the hazards
posed by common contaminants in the home. The following was developed from the HUD/CDC Healthy Homes
Reference Manual and associated resources.
Go to http://www.nchh.org/LinkClick.aspx?fileticket=xOmexR94oew%3d&tabid=506 in Table 2 (scroll to page
3) for information.
Fill in each of the five columns for each of the contaminants in the left column. Describe requirements that apply
to homes. Identify the nature and extent of state requirements and whether they are part of an EPA program.
Federal Requirements for Homes Regarding Common Household Contaminants
Contaminant
Asbestos
Arsenic
Carbon
Monoxide
Cockroaches
Formaldehyde
Lead
Sale or Use
EPA banned
sale in
textured paint,
patching/joint
compounds,
and thermal
systems
insulation in
1977. Note:
EPA-banned
sale in most
products
reversed by
court in 1991.
EPA banned
CCA lumber
production in
2004.
Not applicable.
In-Home
Hazard Level
Disclosure
to Resident
EPA – Friable
asbestos
containing
material
confirmed by lab
to be asbestos.
None.
None.
None.
None.
Some states set
standards in soil.
None.
None.
Some states require
alarms. IRC
requires alarm when
getting permit.
None.
None.
CPSC – Alarm
sounds at lifethreatening
conditions.
Note: Alarm not
federally
required.
Not applicable. HUD HQS –
Free of
infestation
HUD sets
None.
standards on
wood products
in
manufactured
housing.
CPSC
EPA
 Banned sale  Deteriorated
National Center for Healthy Housing
HUD requires
warning in
manufactured
housing.
EPA/HUD
required for:
Renovation
Work Practices
State
Requirements
 Most states adopt
 EPA requires
work practices if EPA work
practices and
renovation of
professional
housing with
licensing
more than four
standards.
units per
building.
 Some states
require disclosure.
 EPA requires
work practices if
any demolition.
 OSHA requires
work practices.
IPMC and some
states prohibit
infestation and set
cleanup standards.
OSHA has
California sets
exposure limits
standards on wood
and requires
products in use
controls and work except manufactured
practices.
housing.
 EPA requires:
o Pre-
 IPMC and some
states prohibit
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Federal Requirements for Homes Regarding Common Household Contaminants
Contaminant
Mercury
In-Home
Disclosure
Hazard Level
to Resident
or
lead-based
 Pre-1978
application in paint.
Housing sale
new paint
or lease.
 High levels of
after 1977.
lead in dust or  Contractors
 Strictly
soil.
must give
limited lead
See Table 3.
prein children’s  No imminent &
renovation
products
notice for
substantial
after
endangerment. work in Pre2/10/2009
1978
Note: HUD
structures.
requires testing
in federallyassisted
housing. CPSC
requires testing
after 2/10/10.
Sale or Use
CPSC banned
sale in interior
latex paint.
Not applicable.
None.
None.
None.
None.
Mold
Nitrogen Oxides
Pesticides
Radon
Rodents
Renovation
State
Work Practices
Requirements
renovation
deteriorated paint.
notification.
 Most states adopt
o Lead-safe
EPA work
work
practices and
practices
professional
(effective
licensing
4/22/10).
standards.
 HUD requires
 Some states
work practices
require more.
on subsidized
property
 OSHA requires
work practices.
None.
Some states ban
mercury in some
products.
None.
Some states require
cleanup and
licensing.
None.
None.
All required by
Many states require
EPA to follow
licensing of
label. Most states professionals. Some
license
states restrict use.
contractors using
pesticides.
None.
Some states require
testing, licensing,
and remediation.
Not applicable
None.
EPA bans sale EPA – Depends
or use of
on pesticide.
unregistered
pesticides.
None.
None.
Not applicable. Recommended
action level of 4
picocuries per
liter of air.
Not applicable. HUD HQS –
Free of
infestation.
None.
None.
None.
Not applicable.
None.
None.
None.
None.
HUD HQS –
Free of
pollutants in air
at levels that
threaten health.
None.
None.
Sewer Gas
Volatile Organic
(VOCs)
National Center for Healthy Housing
IPMC and some
states prohibit
infestation and set
cleanup standards.
IPMC and some
states require drain
traps to have water.
Unknown.
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Renovation Work Practice Requirements for Asbestos and Lead-Based Paint
Only lead-based paint and asbestos have federal requirements for specific work practices in housing. A Healthy
Homes Specialist needs to know the key elements of the federal requirements for these contaminants. Go to
http://www.nchh.org/LinkClick.aspx?fileticket=xOmexR94oew%3d&tabid=506 in Table 3, page 5 for
information.
Fill in each of the three columns for each of the contaminants in the left column. Describe requirements that
apply to homes.
Lead-Based Paint Renovation Work Practices
Trigger for
Agency
Clearance Testing
Professional Licensing
Requirements
Rule
EPA LPB
Independent risk
Abatement –
 Dust Sampling Technician – Conducts
Activities
permanent
assessor or
clearance.
- 40 CFR
elimination of leadinspector must
 Inspector – Determines if paint is lead745
based paint hazards confirm levels less
based paint. Conducts clearance. Note that
Subpart L,
but not renovation.
than:
a lead-based paint inspection determines
8/29/1996
Pre-renovation
 40 µg/ft2 on floors;
where there is lead-based paint on a
notice to EPA (or
building component.
 250 µg/ft2 on
authorized state).
window sills;
 Risk Assessor – Evaluates lead-based
paint hazards and recommends corrections.
 400 µg/ft2 in
Conducts clearance.
window trough (if
present in
 Abatement Contractor, Supervisor, and
contained work
Worker – Conduct abatement.
area);
HUD LeadSafe
Housing
– 24 CFR
Part 35
- 9/6/1996
None unless abatement required, but HUD
requires training for:
 Supervisor and worker completes HUDapproved lead-safe work practices course;
or
 Supervisor completes Abatement
Supervisor course and trains workers.
Federal subsidized
housing disturbing
more than:
 2 ft2 per interior
room;
 20 ft2 in exterior; or
 10% of
component;
of paint in pre-1978
housing.
EPA
Renovation,
Repair, and
Painting
– 40 CFR
745.80 to
745.91
- 4/22/2010
 Certified Renovation Firm with Certified
Renovator
Renovation –
Disturbing more
than:
 6 ft2 per interior
room,
 20 ft2 in exterior; or
 Window
replacement or
paint demolition.
of paint in pre-1978
housing occurring
over 30-day period.
National Center for Healthy Housing
Independent risk
assessor, inspector,
or dust sampling
technician must
confirm levels less
than:
 40 µg/ft2 on floors;
 250 µg/ft2 on
window sills; and
 400 µg/ft2 in
window trough (if
present in
contained work
area).
 Certified
renovation
conducting postcleaning
verification by
comparing wipes
to card.
 Option for
independent
clearance testing
per HUD, state, or
local rule.
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Agency
Rule
EPA
NESHAP
– 40 CFR
61.145
- 1990




Notes:







Asbestos Renovation Work Practices
Trigger for
Professional Licensing
Requirements
Disturbing more
Inspector – Determines if material
than:
contains asbestos.
 260 ft on pipes;
Management Planner – Determines if
material contains asbestos. Evaluates
 160 ft2 on other
hazards and recommends corrections.
components; or
Project Designer – Designs renovation
 35 ft3 removed.
to comply with requirements.
of friable asbestoscontaining material
Abatement Contractor, Supervisor,
in calendar year.
and Worker – Conduct abatement.
Pre-renovation
Supervisor required by OSHA on large
notice to EPA (or
projects. OSHA requires Operations and
authorized state).
Maintenance.
Clearance Testing
Zero visible
emissions to the
outside air from
transport or disposal
of asbestos waste.
CFR = Code of Federal Regulations
EPA = U.S. Environmental Protection Agency
ft2 = Square Feet
HUD = U.S. Department of Housing and Urban Development
LBP = Lead-Based Paint
NESHAP = National Emission Standard for Hazardous Air Pollutants
µg/ft2 = micrograms of lead per square foot of horizontal surface.
B.
Control Methods for Specific Contaminants
A Healthy Homes Specialist needs to know some basic information about the specific contaminants.
Provide short answers to the following questions:
1.
Where is lead-based paint most likely to be found in homes?
2.
Why are children at greater risk of lead hazards?
3.
If you find something that may contain asbestos in good condition, what should you do?
4.
Vermiculite contains what chemical that could cause harm to human health?
5.
Who can measure radon and how can it be measured?
6.
What methods are used to control radon in homes?
7.
What is the difference between an active and passive radon control system?
8.
How much do radon control systems cost?
9.
Where should CO alarms be placed in a home?
10.
Is it possible to know that there is a CO problem without the use of an alarm or detector?
11.
If you find mold, the first step is to do what?
12.
What should be done with a couch that has extensive mold contamination?
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VI.
A.
Keep It Pest-Free
Pest Characteristics
A Healthy Homes Specialist needs to know the significant household pests and how to control them.
Checkmark the characteristics that describe the five most significant pests. A characteristic may apply
to more than one or none of the pests. Check all that apply.
Characteristic of the pests
Rat
Mouse
Cockroach
Bedbug
Flies
Which prefers to come out at night (nocturnal)?
Which prefers to live in walls?
Which will come in from outside on its own?
Which is/are likely to be carried into a home?
Which can get in through a ¼” hole?
Which draws human blood?
Which relies on blood to survive?
Which is/are likely to trigger an asthma attack?
Which carry diseases that humans can get?
Which can be eliminated from multi-family
housing?
Which adult is the smallest?
Which likes pet food?
Which likes water damage in a wall?
Sealing holes in exterior walls and windows best
control which pests?
Sanitation best controls which pests?
Which should be tolerated in a home?
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B.
Pest Control Options
A Healthy Homes Specialist needs to know when and how to apply common pesticides to recognize
when there are problems.
Checkmark the characteristics that describe the four most common pesticides and application methods
for cockroaches. Check all that apply.
Broadcast
Spray
Pest control options
Fogger
Boric
Acid
Bait
Station
Which best controls cockroaches?
Which can chase cockroaches away but they may
return?
Which shouldn’t be used with baits?
What are people likely to come into contact with
after use?
Which is especially useful at unit turnover?
Which must not be used around food?
Which are less effective around food?
Which works best with good housekeeping?
Which should not be used to control cockroaches?
C.
Additional Pest Control Questions
A Healthy Homes Specialist needs to understand some additional pests and pesticide issues.
Provide brief answers to each of the following questions.
1.
What are key signs of a termite problem?
2.
After cockroach problems have been eliminated, what should be done to remove cockroach
allergens?
3.
What is the most effective way to control mosquitoes?
4.
What is the most effective way to control houseflies?
5.
When building a home, what type of construction practice can help minimize termite
infestations?
6.
To eliminate a rat nesting area, firewood should be stored how high off the ground?
7.
When is it appropriate to use a rodenticide?
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D.
HUD IPM Guidance
Beyond knowing the pests and the control options, a Healthy Homes Specialist needs to understand
how to put the pieces together into what is known as an “integrated pest management” or “IPM”
program. While only voluntary, HUD’s “Guidance on Integrated Pest Management” is the most
authoritative statement on the issue. HUD first published the guidance in February 2006, made
revisions in May 2007, and renewed it in May 2008. For the May 2007 version, go to
http://www.nchh.org/LinkClick.aspx?fileticket=gLGGTTxngDk%3d&tabid=506. The HUD Guidance sets
a goal for an IPM program and identifies the ten essential elements of an effective IPM program.
Mark the statement that best describes the goal of an IPM program as defined by EPA and HUD:
____
____
____
____
Protect public health by eliminating pests without the use of pesticides.
Manage pest damage by the most economical means with the least possible hazard to people,
property, and the environment.
Controlling pests using pesticides as the last resort.
Using the least toxic pesticide with the lowest exposure to public health and the environment.
Which of the following activities would be consistent with the ten elements of an effective IPM program?
Check all that apply.
Setting a zero-tolerance goal for pests, such as cockroaches, bedbugs, rats, and mice.
Sealing holes and cracks around doors and windows.
Requiring residents to get permission to use pesticides, especially sprays and foggers.
Enforcing lease provisions prohibiting housekeeping and sanitation problems.
Removing shrubs and ground cover that are close to the building.
Requiring pest management professionals to notify residents before using pesticides.
Prohibiting the use of all pesticides.
Monitoring for cockroaches with glue traps around interior trash and food handling areas.
Using gels and bait stations for cockroaches and ants.
Educating resident leaders so they can educate their peers and report problems.
Tracking pest complaints.
Prohibiting the routine use of pesticide sprays.
Provide brief answers to each of the following questions:
1.
Does HUD’s IPM Guidance prohibit the use of specific pesticides?
2.
According to HUD’s IPM Guidance a successful IPM program will result in what outcome?
3.
What are the three resident responsibilities that HUD’s IPM Guidance requires in leases?
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Health Homes Specialist Credential
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VII.
Keep It Dry
In addition to the materials covered in the previous section, the Healthy Homes Specialist needs to understand
how to keep a home dry, especially the materials used to accomplish that goal and how to prevent moisture
problems.
A.
Materials of Construction
Provide brief answers to each of the following questions:
B.
1.
Why is drywall now used more commonly than plaster and lath?
2.
What is the primary function of brick on the outside of a home?
3.
Can moisture penetrate a concrete wall? If yes, why?
4.
What does a crack in the basement wall that runs to the edge or corner indicate?
5.
Why are finished basements susceptible to moisture problems?
6.
What material is used to make a footer or footing? Why?
Preventing Moisture Problems
Provide brief answers to each of the following questions:
1.
What are useful strategies to prevent moisture in the ground from entering a crawl space?
2.
Should the temperature in an unfinished attic be closer to the outside temperature or inside?
3.
What is flashing on roofs and roof penetrations like chimneys and skylights designed to do?
4.
How are typical roofs designed to allow them to breathe?
5.
How does water vapor enter a home?
6.
What is ice-damming on a roof and how can it be prevented?
7.
What hazards are associated with high humidity?
VIII.
Keep It Ventilated
In addition to the materials covered in the previous sections, the Healthy Homes Specialist needs to understand
how to keep a home ventilated, including controlling humidity.
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Health Homes Specialist Credential
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A.
Humidity and Relative Humidity
For each question below, check the appropriate limit.
0%
Relative Humidity
30%
50%
70%
100%
What is the minimum and maximum humidity that most
people are comfortable at?
What humidity causes water to condense on surfaces
that are the same temperature as the air?
What humidity are people likely to experience chapped
lips and irritated sinuses?
What humidity is virtually impossible to achieve?
Above what humidity level encourages the growth of dust
mites?
Provide brief answers to each of the following questions:
1.
If the temperature drops, what happens to the relative humidity?
2.
B.
Does air conditioning reduce the amount of water in the air (relative humidity)? If so, how?
Air Movement and Filtration
Provide brief answers to each of the following questions:
C.
1.
What is the stack effect and how does it work in a two-story home?
2.
What is the most common system for rating furnace filters and what is the minimum rating
recommended for filtering air in heating/cooling systems?
3.
What is the national standard by the American Society of Heating, Refrigeration, and Air
Conditioning Engineers for ventilation in buildings of fewer than four stories?
Sources of Contaminants
Checkmark all that apply.
Gas Stove/
Oven
Electric
Stove/
Oven
Bathroom
Shower
Gas
Water
Heater
Gas Dryer
Gas
Space
Heater
Which can generate
dangerous levels of
these contaminants?
Carbon monoxide
Nitrogen dioxide /
oxides
Humidity
According to the
International Property
Maintenance Code:
Which must be
exhausted outside?
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Which may be
exhausted into an
attic?
Which needs no
exhaust if a nearby
window can be
opened?
Provide brief answers to each of the following questions:
1.
What color should the flame be of a properly functioning gas appliance?
2.
What is the significance of a yellow flame?
3.
What are the common problems that you should watch out for in exhaust ductwork from a gasfired clothes dryer?
4.
What is sealed combustion for a warm-air furnace? Why is it better than traditional combustion?
5.
How does a gas furnace keep dangerous gas from combustion out of the air recirculating in a
home?
6.
When spot- or point-source exhaust (such as a kitchen or bathroom fan) is used, how does air
get into the home to replace the amount exhausted?
IX.
Keep It Safe
In addition to the materials covered in the previous sections, the Healthy Homes Specialist needs to understand
how to keep a home safe.
Provide brief answers to each of the following questions:
1.
According to the Home Safety Council, in 1998, what is the top cause of unintentional deaths in
homes?
2.
Handrails are required if there are how many steps?
3.
If an overhead garage door is hard to open, what should you do?
4.
What does a GFCI stand for and where should it be used?
5.
On a cleaning chemical label, what is the difference between a “corrosive” and an “irritant”?
6.
While labels should always be followed, which label must be followed by a user – even a consumer –
on penalty of law?
X.
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Keep It Clean
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Health Homes Specialist Credential
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In addition to the materials covered in the previous sections, the Healthy Homes Specialist needs to understand
how to keep a home ventilated, including controlling humidity.
Provide brief answers to each of the following questions:
1.
What does HEPA stand for?
2.
What are the merits of each of the following cleaning strategies?
3.

Smooth, hard, and nonabsorbent surfaces.

Taking off shoes when entering home.

Vacuum.
What features would you look for in a vacuum?
For the contaminants listed below, checkmark which of the following can have the hazards they pose effectively
controlled through cleaning.
____
____
____
____
____
____
____
Asbestos
Arsenic
Carbon Monoxide
Cockroach
Formaldehyde
Lead
Mercury
____
____
____
____
____
____
____
Mold
Nitrogen Oxides
Pesticides
Radon
Rodents
Sewer Gas
Volatile Organic Compounds
Which of the following principles of healthy housing benefit significantly from “Keeping It Clean”?
____ Dry
____ Ventilated
____ Pest-Free
____ Safe
____ Contaminate-Free
____ Maintained
XI.
Keep It Maintained
In addition to the materials covered in the previous sections, the Healthy Homes Specialist needs to understand
how to keep a home maintained.
Provide brief answers to each of the following questions:
1.
Identify three maintenance tasks the NCHH Healthy Homes Maintenance Checklist recommends be
performed by professionals.
2.
What is the primary feature of housing codes?
For the contaminants listed below, checkmark which of the following can have the hazards they pose controlled
effectively through a preventive maintenance.
____
Asbestos
National Center for Healthy Housing
____
Arsenic
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____
____
____
____
____
____
Carbon Monoxide
Cockroach
Formaldehyde
Lead
Mercury
Mold
____
____
____
____
____
____
Nitrogen Oxides
Pesticides
Radon
Rodents
Sewer Gas
Volatile Organic Compounds
Which of the following principles of healthy housing benefit significantly from “Keeping It Maintained”?
____ Dry
____ Safe
____ Ventilated
____ Contaminate-Free
____ Pest-Free
____ Clean
XII.
Water and Wastewater
In addition to the materials covered in the previous sections, the Healthy Homes Specialist needs to understand
how to handle water and wastewater to avoid contaminants.
Provide brief answers to each of the following questions:
1.
What are the sources of sewer gas and how can they be controlled?
2.
Where is a P-trap used?
3.
What is the purpose of a P-trap?
4.
What is the purpose of a septic tank?
5.
Why is chlorine used to disinfect drinking water?
6.
What conditions can pose risks for water wells?
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Health Homes Specialist Credential
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XIII.
Laws and Codes
In addition to the materials covered in the previous section, the Healthy Homes Specialist needs to understand
the basics on the International Code Council’s model codes for housing. Go to www.iccsafe.org or
http://www.nchh.org/Training/HealthyHomesTrainingCenter/TrainingCourses/CodeInspectionforHealthierHomes
/StateHousingCodes.aspx for more information.
Checkmark all of the codes that affirmatively answer the question below.
Question
What applies to keep existing homes in good condition?
IEBC
IBC
Model Code
IRC
IPMC
IZC
What applies to a new ten-story apartment building?
What applies to new single-family housing?
What determines what type of building may be built?
What requires that foundation walls be kept free of open
cracks and breaks?
What determines how major renovations in existing homes
should be completed?
What sets minimum standards for the conditions of all
homes?
What are a few key healthy homes requirements in the IPMC?
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XIV.
Acronyms
AHS
American Housing Survey Data
CDC
U.S. Centers for Disease Control and Prevention
EPA
U.S. Environmental Protection Agency
GFCI
Ground Fault Circuit Interrupter
HEPA
High Efficiency Particulate Air
HHS
U.S. Department of Health and Human Services
HUD
U.S. Department of Housing and Urban Development
IBC
International Building Code
ICC
International Code Council
IEBC
International Existing Building Code
IRC
International Residential Code
IPMC
International Property Maintenance Code
IZC
International Zoning Code
IOM
Institute of Medicine
IPM
Integrated Pest Management
IPMC
International Property Maintenance Code
IRC
International Residential Code
LBP
Lead-Based Paint
NCHH
National Center for Healthy Housing
VOC
Volatile Organic Compounds
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Summary of Two Key Institute of Medicine Reports Regarding
Asthma, Indoor Air Quality, Damp Indoor Spaces, and Mold
Association Between Biological and Chemical Exposures in the Home and
Development of Asthma in Sensitive
Exacerbation of Asthma in Sensitive
Individuals
Individuals
Biological Agents
Chemical Agents
Biological Agents
Sufficient Evidence of a Causal Relationship
No agents met this
x House dust mite
x Cat
definition
x Cockroach
x House dust mite
Sufficient Evidence of an Association
No agents met
x ETS (in preschoolx Dog
this definition
aged children)
x Fungi or molds
x Rhinovirus
Limited or Suggestive Evidence of an Association
No agents met
x Cockroach (in preschoolx Domestic birds
this definition
aged children)
x Chlamydia pneumoniae
x Respiratory Syncytial Virus
x Mycoplasma pneumoniae
x Respiratory Syncytial Virus
x
x
x
x
x
x
x
x
x
x
x
Inadequate or Insufficient Evidence to Determine
Whether or Not an Association Exists
Cat, Dog, Domestic Birds
x Nitrogen oxides
x Rodents (as pets or feral
animals)
Rodents
x Pesticides
x Chlamydia trachomatis
Cockroaches (except for
x Plasticizers
x Endotoxins
preschool-aged children)
x Volatile organic
Endotoxins
x Houseplants
compounds (VOCs)
Fungi or molds
x Pollen exposure in indoor
x Formaldehyde
environments
x Fragrances
Chlamydia pneumoniae
x Insects other than
x ETS (in older
Mycoplasma pneumoniae
Cockroaches
children and adults)
Chlamydia trachomatis
Houseplants
Pollen
Limited or Suggestive Evidence of No Association
No agents met
No agents met
Rhinovirus (adults)
this definition
this definition
Chemical Agents
x ETS (in preschoolaged children)
x Nitrogen oxides
(high-level
exposures)1
x ETS (in school
aged and older
children, & adults)
x Formaldehyde
x Fragrances
x Pesticides
x Plasticizers
x Volatile organic
compounds
(VOCs)
No agents met
this definition
Source: National Academies Press, 2000. Clearing the Air: Asthma and Indoor Air Exposures. Executive Summary
Institute of Medicine. ISBN 0-309-06496-1 See www.nap.edu/books/0309064961/html/.
1
At concentrations that may occur only when gas appliances are used in poorly ventilated kitchens.
x Sufficient Evidence of a Causal Relationship: Evidence fulfills association criteria and in addition satisfies
criteria regarding the strength of association, biologic gradient (dose-response effect), consistency of association,
biologic plausibility and coherence, and temporality used to assess causality.
x Sufficient Evidence of an Association: Association has been observed in studies in which chance, bias, and
confounding factors can be ruled out with reasonable confidence (e.g. several small bias free studies showing an
association that is consistent in magnitude and direction
x Limited or Suggestive Evidence of an Association: Evidence is suggestive of an association but is limited
because chance, bias, and confounding cannot be ruled out with confidence (e.g. one high quality study shows
association, but results of other studies are inconsistent)
x Inadequate or Insufficient Evidence to Determine Whether or Not an Association Exists: Available studies
are of insufficient quality, consistency, or statistical power to permit a conclusion; or no studies exist
x Limited or Suggestive Evidence of No Association: Several adequate studies are mutually consistent in not
showing an association (but limited to the conditions, level of exposure, and length of observation covered in the
study).
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References - Page 1 of 137
Summary of Two Key Institute of Medicine Reports Regarding
Asthma, Indoor Air Quality, Damp Indoor Spaces, and Mold
Summary of Findings Regarding Association Between Health Outcomes and
Exposure to
Presence of Mold or Other Agents
Damp Indoor Environments
in Damp Indoor Environments
Sufficient Evidence of a Causal Relationship
Sufficient Evidence of an Association
x Upper respiratory (nasal and throat) tract
x Upper respiratory (nasal and throat) tract symptoms
symptoms
x Cough
x Cough .
x Hypersensitivity pneumonitis in susceptible persons
x Wheeze
x Wheeze
x Asthma symptoms in sensitized persons
x Asthma symptoms in sensitized persons
Limited or Suggestive Evidence of an Association
x Dyspnea (shortness of breath)
x Lower respiratory illness in otherwise healthy children
x Lower respiratory illness in otherwise healthy
children
x Asthma development
Inadequate or Insufficient Evidence to Determine
Whether or Not an Association Exists
x Airflow obstruction (in otherwise healthy persons)
x Dyspnea (shortness of breath)
x Skin symptoms
x Skin symptoms
x Mucous membrane irritation syndrome
x Asthma development
x Gastrointestinal tract problems
x Gastrointestinal tract problems
x Chronic obstructive pulmonary disease
x Airflow obstruction (in otherwise healthy persons)
x Fatigue
x Fatigue
x Inhalation fevers (nonoccupational exposures)
x Mucous membrane irritation syndrome
x Neuropsychiatric symptoms
x Neuropsychiatric symptoms
x Lower respiratory illness in otherwise healthy x Chronic obstructive pulmonary disease
adults
x Cancer
x Cancer
x Inhalation fevers (nonoccupational exposures)
x Acute idiopathic pulmonary hemorrhage in infants x Reproductive effects
x Reproductive effects
x Lower respiratory illness in otherwise healthy adults
x Rheumatologic and other immune diseases
x Rheumatologic and other immune diseases
x Acute idiopathic pulmonary hemorrhage in infants
Source: National Academies Press, 2004. Damp Indoor Spaces and Health. Tables ES-1 and ES-2
Institute of Medicine of the National Academies, ISBN 0-309-09246-9.
See www.nap.edu/books/0309091934/html/.
x Sufficient Evidence of a Causal Relationship: Evidence is sufficient to conclude that a causal relationship exists
between the agent and the outcome. That is, the evidence fulfills the criteria for “sufficient evidence of an
association” and, in addition, satisfies the following criteria: strength of association, biologic gradient, consistency of
association, biologic plausibility and coherence, and temporally correct association.
x Sufficient Evidence of an Association: Evidence is sufficient to conclude that there is an association. That is, an
association between the agent and the outcome has been observed in studies in which chance, bias, and
confounding can be ruled out with reasonable confidence.
x Limited or Suggestive Evidence of an Association: Evidence is suggestive of an association between the agent
and the outcome but is limited because chance, bias, and confounding cannot be ruled out with confidence.
x Inadequate or Insufficient Evidence to Determine Whether an Association Exists: The available studies are of
insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence of an association.
Alternatively, no studies exist that examine the relationship.
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References - Page 2 of 137