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Welcome. This website provides detailed information about a health study that examines the link between enhancing indoor air quality and reducing childhood asthma symptoms and other health issues. This study is formally called the Housing and Energy Attributes Linked To Health through Retrofits, or “HEALTH-R.”
The study recruitment has been extended, and will continue until all spaces are taken. Applications are reviewed in the order in which they are received.
HEALTH-R will focus on children with asthma who live in single-family homes or townhomes.
Asthma attacks and asthma symptoms are typically caused by the body’s reaction to asthma triggers. Pollen, dust mites, pests, mold spores, pet dander, and cigarette smoke are examples of triggers. Many triggers are always present in the home in low amounts. But when the amount or concentration of a trigger gets too large, it can trigger asthma symptoms or asthma attacks.
Previous studies have shown that asthma attacks and asthma symptoms can be reduced by avoiding asthma triggers.
This study examines a new approach for removing certain asthma triggers from the home. This new approach will make modifications to the building structure and to the heating, ventilation and cooling systems in the home based on current industry best practices. This study will test whether these modifications enhance quality of life for children with asthma living in modified homes.
The purpose of the study is to learn more about your family’s health and indoor environmental quality over two years – 1 year before housing improvements take place and one year after improvements take place. We will compare these results to homes that did not get the improvements over the same time frame. The study will also look to see how the improvements hold up over time and will quantify any energy savings.
We use the term, “enhance indoor air quality” to describe home improvements that are designed to help reduce triggers. Triggers can be brought in from the outside (such a pollen or dust particles that come in from open doors and windows), or they can be created when people or pets do things inside the house (such as burning candles, shedding hair, or smoking), or they can be created because the house is a good environment for them to grow (such as dust mites or mold that grow in high-humidity environments).
The Building Performance Institute (BPI), the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), and the Air Conditioning Contractors of America (ACCA) have developed building standards that define high quality building practices, which includes methods to enhance indoor air quality. These standards have influenced the “Breathe Easy Home Indoor Air Quality System” that will be tested in this study. This system includes the best-in-class methods in the residential energy efficiency industry and the residential heating, ventilation and air conditioning industry.
When comparing a typical older home with a home that meets the Breathe Easy Home Indoor Air Quality System guidelines, some or all of the following measures would typically be installed:
• Air Sealing and Insulation
• Duct Sealing
• Duct Design Modifications
• Fresh Air Ventilation
• Whole Home Air Filtration
• Humidity Control Devices
To find out more about the solution, click here. To find out why we believe the solution is likely to work, click here. Since every house is different, and results may vary, we need to evaluate the results scientifically to determine if they work as expected.
If you are selected to participate in the study, some houses will receive the intervention with asthma education, and some houses will have asthma education only, depending on random selection. If your home is not selected for the enhanced indoor air quality improvements, you will have the option of purchasing them at a substantial discount after the study is completed.
The study is being managed by the National Center for Healthy Housing (NCHH), a non-profit research and policy organization. Ecobeco LLC (ecobeco), a Rockville, MD-based Home Performance with ENERGY STAR® contractor specializing in home modifications to improve energy efficiency and indoor air quality has been retained as the general contractor. The “Breathe Easy Home Indoor Air Quality System” guideline is created and maintained by Breathe Easy Home, a Rockville, MD-based non-profit.
The study has been approved by the Chesapeake Institutional Review Board. The study design was reviewed by an expert advisory panel including Dr. Daniel Ein, Professor and Director of Allergy & Asthma Center at George Washington University, Dr. Janet Phoenix, Assistant Professor at the George Washington School of Public Health, Dr. Elizabeth Matsui, Associate Professor of Pediatrics at the Johns Hopkins Children’s Center, Brett Singer, Researcher at Lawrence Berkeley National Laboratory, and Paul Francisco, Researcher at the Illinois Sustainable Technology Center and current Chair of the ASHRAE 62.2 standards committee.
• Your child must have asthma that has been diagnosed by a doctor and not well controlled as determined by a standard Asthma Control Test.
• The child must be between the ages of 5 and 16, and must be living full time in the home.
• All participating families must live in single-family or townhomes with exactly one forced air system. We are unable to accept applications from apartments or condominiums, or from homes with multiple forced air systems.
• You have lived in your home for one year, and you plan to stay in your residence through the end of 2017.
• The home must be a non-smoking one.
• Your child must be covered through private medical insurance (for example, coverage provided by your employer, or coverage purchased through the Maryland Health Connection Exchange). We are unable to accept children covered by Medicaid or the Children’s Health Insurance Program (CHIP).
• You live in Baltimore City, or Anne Arundel, Baltimore, Howard, Montgomery, or Prince George's Counties, or you live in Washington, D.C. (the District of Columbia)
• No new major home renovation or expansion projects during the study period.
You will receive an answer within a few business days. The selection process will happen in four phases on a rolling basis. First, we will read your application. Second, we will arrange for a comprehensive Home Energy Audit and Ventilation Assessment, which is a 4-hour visit to your home to perform a detailed inspection of your home and its HVAC equipment, and to determine the scope of work needed to bring your home into compliance with the Breathe Easy Home Indoor Air Quality System guideline. Third, we will randomly assign your home to either the study group or a control group. Fourth, we will arrange for a researcher to visit your home to determine if your child is eligible. If you satisfy the criteria for all four phases of the application process, we will offer you a spot on the trial.
All participants will be selected on a rolling basis. We will visit your home to conduct an interview and collect some air and dust samples before any changes are made to your home. Selected homes will be slotted into a 1 week period during the Summer of 2016 for the modifications to occur. Every 3-4 months for 1 year, you will be visited by a researcher to conduct a health interview, and to perform air quality measurements.
To participate in the study, we will ask you to provide a copy of your insurance card, and documentation from your child’s doctor of a diagnosis of asthma. Additionally, during the Comprehensive Energy Audit, and at the conclusion of the 1 year, we will ask for a copy of your electric and gas utility bills to determine the energy impact of the modifications.
• You and your children may or may not benefit from being in this study. The benefit to participating is that you will receive education about avoiding asthma triggers and things you can do to make your housing conditions support your health. You will also receive all environmental sampling results. This study will help the study staff to learn more about whether improved housing ventilation helps to improve indoor environmental quality and reduce health problems, especially asthma, in the home. This can help other people across the country.
• While all the technologies in this study are commercially available, and all the work is being done to published industry standards, the results of the interventions have not been scientifically evaluated. Thus, we cannot be sure what the outcome of this study will be. The intervention could help your child feel better, it could have no effect, or it could make your child feel worse compared to children in the “control” group.
• This study will make some modifications to your home that cannot be undone by the study contractors if you are not satisfied with the results. We will explain the modifications to you in detail and will ask you to agree to the modifications before construction begins.
• In addition to making permanent structural changes, we will install advanced controls and filtration systems that work best when they are professionally maintained, and when filter media is replaced according to manufacturer recommendations. During the study period, we will provide maintenance and filters at no cost. After the study period, you will need to maintain your equipment or hire an HVAC contractor to maintain your equipment.
• Depending on the equipment installed in your home, the equipment will have a limited life span, and will need to be repaired or replaced over time. The equipment will be warrantied during the study period by our HVAC contractor. After the study period, you will be responsible for obtaining warranty service, and for repairs and replacement that occur outside warranty.
• Participating in this study may uncover new medical issues. The study cannot provide any medical care for your household or your child, but you are free to provide the results of the testing in your home to your family physician.
• We will keep all your information confidential and protected, but there is a slight risk that some of your personal information could be accidentally released. We will take steps to keep your personal information secure.
To compensate you for your time, we will pay you $50 or $100 for each phase of the study that you complete, up to $350. We will review the detailed compensation plan with you before you are enrolled in the study.
There is no cost or fee to apply for the study. During the study, if you are in the intervention group, you should be aware of two costs. First, the installed home improvements are consistent with best practices in the Energy Efficiency industry, and should lower the costs to heat and cool your home. However, best practices in the Indoor Air Quality industry typically consume additional energy to run fans and provide filtration. Therefore, we are unable to determine if your energy bills will be more or less than you have had in the past. Second, at the end of the study, you will need to purchase the installed home improvements for $100. NCHH will explain to you how this purchase works during the enrollment process.
Yes. You are free to not enroll in the study at any time. At the conclusion of the selection process, we will share with you the results of your Breathe Easy Home Assessment if you received an assessment. If you are selected for the intervention group, we will share with you the modifications that will be done to your home, and the detailed schedule for construction and follow-up visits. You can then decide to accept or decline to enroll in the study. If you are not able to sign the Research Study Consent document, or you are not able to sign the ecobeco Home Improvement contract, you will not be able to participate in the study.
All information provided by study participants will be kept private and will not be provided to any third parties except in aggregate, and with no personally identifiable information, or as required by law.
Yes. ecobeco will work with interested families who are enrolled in the study intervention group to document their stories through photos and video and audio recordings to provide a personal keepsake and to provide educational opportunities for other families to learn about their participation in this study. Video or audio recordings are completely voluntary, and we will ask you for written permission before making any recordings.
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