DEVELOPING CAPACITY IN ENVIRONMENTAL HEALTH …...tribal clinics. Implement at 3 other tribal communities in WA and OR. National Institutes of Health Native American Research Centers

DEVELOPING CAPACITY IN ENVIRONMENTAL HEALTH

&INDOOR AIR QUALITY PROGRAMS

2019 EPA TRIBAL ENVIRONMENTAL LEADERS’ SUMMIT

PORTLAND, OR

CELESTE L. DAVIS, REHS, MPH

NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD

SOCIO-ECOLOGICAL MODEL OF HEALTH

State & National

Community

Organizational

Interpersonal

Individual

• INDIVIDUAL: AGE, SEX, GENETICS, BEHAVIORS, KNOWLEDGE

• INTERPERSONAL: FAMILY & FRIENDS SUPPORT, KNOWLEDGE, BELIEFS, HEALTH HABITS/BEHAVIORS, JOB/FINANCES, STRESS

• ORGANIZATIONAL: SCHOOL, WORK, CHURCH, INTERACTIONS WITH

• COMMUNITY: SOCIAL SERVICES & SUPPORTS, ACCESS TO HEALTH CARE, HOUSING & BUILT ENVIRONMENT, NATURAL ENVIRONMENT, SAFETY

• STATE & NATIONAL/PUBLIC POLICY: POLICIES & LAWS

PUBLIC HEALTH APPROACH TO IAQ – APPLICATION TO ASTHMA MANAGEMENT

1. STEP 1. DEFINE & MONITOR THE PROBLEM

2. STEP 2. IDENTIFY RISK & PROTECTIVE FACTORS

3. STEP 3. DEVELOP & TEST PREVENTION OR INTERVENTION STRATEGIES

4. STEP 4. ASSURE WIDESPREAD ADOPTION

PH APPROACH STEP 1: DEFINE & MONITOR THE PROBLEM

Guiding Questions Potential Sources of Data

How many people have asthma? What age groups? How severe – hospitalizations, deaths….?

IHS or Tribal Health Clinic; Tribal Epidemiology Centers, State Health Department, behavioral surveys

When and where are the cases of asthma occurring? Use health data to develop a map – Housing Department, Planning Department, GIS program; Environmental Health Data: air quality monitoring; school IAQ inspections; other surveys

PH APPROACH STEP 2: IDENTIFY RISK & PROTECTIVE FACTORS

Guiding Questions Potential Sources of Data

What are the risk factors that lead to poorly controlled asthma?

IHS, CDC;; clinical practice standard from medical organizations; environmental health leaders

What are protective factors?

PH APPROACH STEP 3: DEVELOP & TEST INTERVENTION STRATEGIES

Guiding Questions Potential Sources of Data

Are there existing, effective strategies based on bestavailable evidence?

IHS, CDC; The Community Guide; Scientific research and peer reviewed journals; clinical practice

standards; environmental health best practices

If none exist, what resources do I need to develop a new strategy based on what was learned in steps one and two?

Where can I find research partners to help evaluatethe selected strategy?

Is the strategy effective – did it do what was intended?

PH APPROACH STEP 4: ASSURE WIDESPREAD ADOPTION

Guiding Questions Potential Sources of Data

Who would benefit from this strategy (parents, educators, policy makers, etc.)?

IHS, CDC; The Community Guide; National Implementation Research Network -

http://www.fpg.unc.edu/~nirn/; University of Kansas Community Toolbox -

http://ctb.ku.edu/en/default.aspx

How do I get this strategy to the people who need it?

Where can I find assistance and support for implementing an effective strategy and on-going monitoring and evaluation of the strategy?

Where can I find model policies or codes?

IMPLEMENTING ENVIRONMENTAL HEALTH IAQ PROGRAMS

In WA, hospitalization due

to asthma is

more likely for native patients vs. white

patients

WA Comprehensive Hospital Abstract System, 2012-13, corrected for AI/AN misclassification by the IDEA-NW Project.

UNPUBLISHED. PLEASE DO NOT DISTRIBUTE.

REDUCING INDOOR AIR POLLUTANTS IMPROVES ASTHMA

TRIBAL PROGRAMS

• Continue work with IHS funds, referrals from pharmacy for home visits

• Continuing and expanding

Yakama Nation IHS Clinic

• Goal of reaching 10-12 pediatric patients• Building referral system and forms to institutionalize• Staff undergoing formal training

Tulalip Tribes –GAP Funded

YAKAMA NATION & IHS ASTHMA PILOT

• Clinic & pharmacy referrals to IHS Environmental Health Officer through electronic health record, 25 home visits

• 72% of patients made environmental or habit modifications • 47% patients decreased use of asthma rescue medication• Urgent Care visits reduced from 53% to 12%• Emergency Room visits decreased from 47% to 18% • 90% of patients went from reporting asthma as being not-well

controlled, to well controlled

NW PORTLAND

AREA INDIAN HEALTH BOARD

Project Aims

Measure impacts of

combined clinic and home visit

program.

Document protocols and practices.

Develop training materials for other

tribal clinics.

Implement at 3 other tribal

communities in WA and OR.

National Institutes of Health Native American Research Centers for Health

IHS SERVICE MODEL FOR ASTHMA MANAGEMENT

INTAKE & RISK ASSESSMENT

COMPREHENSIVE ASSESSMENT & SERVICE

HEALTHY HOMES VISIT

• REFERRALHOSPITALIZATION OR ED VISIT

• REFERRALPRIMARY CARE VISIT

PHARMACY CONSULT

HEALTHY HOME VISIT

EH, EP/IAQ, Nurse, CHW

SUMMARY

• WE SPEND UP TO 90% OF OUR TIME INDOORS• HOME, SCHOOL, WORK…

• INDOOR AIR QUALITY IS AFFECTED BY OUTDOOR POLLUTANTS & INDOOR CONTAMINANTS• TRAFFIC & INDUSTRY, COMBUSTION SOURCES, EMISSIONS FROM FURNISHINGS, PETS & PESTS, HOUSEHOLD CLEANING PRODUCTS,

BEHAVIORS & HOBBIES, DAMPNESS & MOLD

• HUMAN EXPOSURE CAN LEAD TO DISEASE OR POOR HEALTH MANAGEMENT• ASTHMA, ALLERGIC RHINITIS, RESPIRATORY INFECTIONS

• EXPOSURE & DISEASE CAN BE PREVENTED AND CONTROLLED

• EFFECTIVE IAQ MONITORING PROGRAMS – PROACTIVE OR COMPLAINT-DRIVEN

• HEALTH CARE REFERRALS TO EH FOR IAQ ASSESSMENT (SUSCEPTIBLE INDIVIDUALS OR CASES)

• EDUCATION FOR PARENTS, SCHOOL STAFF, WORKPLACE OCCUPANTS

• POLICIES THAT PROMOTE HEALTH – INDOOR SMOKING BANS OR DISTANCE REQUIREMENTS, HOUSING CODES

THANK YOU!

•MY CONTACT INFO:

• CELESTE L. DAVIS

• [email protected]

• NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD