Overview
Californians reside in a variety of housing structures, with 66 percent living in a house, 30 living in multi-unit buildings, and almost four percent living in mobile homes. The majority of Californians own their own homes (56 percent) while most of the rest rent (40 percent). African American and Latino populations are more likely to live in multi-unit structures. Overall, Californians with higher incomes tend to live in houses, and Californians with lower incomes tend to live in multi-unit structures.
The physical places where individuals sleep and live may actually present serious health challenges for people with asthma. Frequently, people with asthma are exposed to a variety of asthma triggers at home (Figure 15. Home Asthma Triggers). In general, people who rent and who live in multi-unit buildings have less control over their environments and the triggers impacting their asthma than people who own and live in houses. While asthma triggers are common in most homes, low-income people may be exposed to additional triggers as a result of poor housing conditions.
There are hundreds of excellent programs already in place throughout the state designed to help people with asthma reduce triggers in their home environments. These range from asthma home visitor programs that educate people about strategies they can use to reduce triggers, to important partnerships between code enforcers and health departments that seek to interpret building codes in a more health protective way. For example, smoke-free multi-unit housing is a priority of the CDPH's Tobacco Control Section and their many state and local partners. Nonetheless, greater assistance is needed for many individuals with asthma in resolving indoor environmental issues.
The Homes, Housing, and Institutional Care Settings objectives of the Strategic Plan address the need to greatly minimize asthma exacerbations from residential exposures. One strategy includes research to improve understanding of asthma triggers. Efforts are proposed in the area of building standards, guidelines and model codes. Educating all stakeholders in the housing industry, including tenants, is necessary to identify and reduce potential risks. Greater assistance for individuals with asthma in resolving idoor environmental issues is recommended. Finally, it will be important to address populations living in foster care, group homes, correctional facilities, nursing homes, mental health institutions, and other instituional care settings.
Figure 15. Home Asthma Triggers
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Secondhand smoke
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Indoor mold and moisture
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Consumer products and personal care products with chemical irritants
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Furry and feathered pets
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Dust mites
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Cockroaches and rodents
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Combustion products (NO2)
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Plant pollens
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Cold air
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Roadways, air pollutants, and ozone
- 4C.1. Improve understanding of asthma trigger exposures in home environments and assess effectiveness of exposure reduction interventions, e.g., the problem of secondhand smoke in multi-unit housing environments.
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4C.1.1. Partner with research organizations on studies of asthma trigger sources, building sciences, and housing policy. Identify and assess effective controls and interventions aimed at reducing indoor exposures in the home environment.
4C.1.2. Develop and promote health protective guidance and standards based on assessment of home exposure reduction interventions.
- 4C.2. Develop and promote standards, guidelines and model policies for asthma-safe healthy housing that minimize indoor environmental risk factors that contribute to asthma.
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4C.2.1. Assess existing standards, guidelines, and model policies to determine the adequacy of these standards to address the environmental risk factors in housing that contribute to asthma. Additionally, assess how and to what extent the standards are being enforced at the local level.4C.2.2. Identify, develop and promote new standards or guidelines for the design, construction, renovation, and maintenance of asthma-safe healthy housing.4C.2.3. Develop and promote guidance to reduce exposures to outdoor air pollution in and around housing, including building design practices and technologies to reduce pollutants entering buildings, and land-use planning to further distance residencies from major roadways and stationary sources.4C.2.4. Partner with public and affordable housing to promote and advocate for increasing the number of asthma-friendly housing units available. Consider building support around volunteer local and state policies requiring a certain percentage of public and affordable housing to be asthma-friendly.4C.2.5. Ensure state and local governments have adequate infrastructure and funding for housing code enforcement.
- 4C.3. Educate various stakeholder groups on the importance of reducing indoor environmental risk factors in housing that contribute to asthma.
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4C.3.1. Identify and develop, as needed, educational materials for stakeholders that highlight indoor air quality risk factors and how to reduce these risk factors. Stakeholders include tenants, landlords, property managers, maintenance/facilities personnel, developers, builders, architects, insurers, and lenders (Figure 16. Asthma-friendly Housing Checklist).
4C.3.2. Develop and implement appropriate outreach mechanisms to distribute the material referred to in the previous strategy. This could include trainings and outreach activities to the various stakeholder groups and incentives to public housing programs to distribute materials to their tenants.
Figure 16. Asthma-Friendly Housing Checklist
- Keep the home and car smoke-free
- If an individual is sensitive to a pet, the best treatment is removal of the pet exposure from the home
- Minimize use of cleaners near persons with asthma
- Use heating system with high efficiency filtration; use exhaust fan while cooking
- Monitor use of gas-fired and solid-fuel stoves and hearth appliances
- Cover mattresses and pillows with allergen-proof covers; launder bedding with hot water
- Choose flooring, carpeting, and furnishings that can be effectively cleaned to minimize dust burden
- Limit the number of stuffed toys in child's bed and sleeping area
- Use air conditioning or dehumidifiers in humid areas (i.e., keep relative humidity below 60 percent)
- Repair leaks as soon as possible, and clean-up indoor mold before applying new flooring and wall surfaces
- Use integrated pest management practices; clean-up food crumbs and pest droppings as soon as possible
- Select low-allergen landscaping
- On bad air quality days, limit physical exertion outdoors
- 4C.4. Ensure healthy home environments for people with asthma through augmentation of home assessments, remediation, and legal advocacy.
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4C.4.1. Encourage building inspectors to expand in-home environmental assessment programs for individuals with persistent or high-risk asthma.
4C.4.2. Work with legal groups to increase legal advocacy services and programs for tenants with asthma who live in unhealthy housing conditions.
4C.4.3. Collaborate with physician groups to train medical providers to assist patients with housing requests, such as "physician verification letter."
4C.4.4. Work with planning, building inspection, and other appropriate groups to ensure that laws adequately address environmental asthma risk factors.
- 4C.5. Reduce asthma morbidity and exposures to asthma triggers for people in institutional care settings, such as foster and group homes, prisons, nursing homes, and mental health institutions.
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4C.5.1. Partner with the California Department of Social Services (Foster Care Branch and Community Care Licensing) to provide educational resources to care providers and foster care public health nurses on the recognition, prevention, and management of asthma among children under their care, and on the identification and reduction of indoor air asthma triggers in their institutions. Ensure that children living in foster care are not exposed to secondhand smoke.4C.5.2. Partner with California Department of Corrections and Rehabilitation on the recognition, prevention, and management of asthma among inmates, and on the reduction of indoor triggers in their institutions.4C.5.3. Partner with California Department of Mental Health on the recognition, prevention, and management of asthma among patients, and on the reduction of indoor asthma triggers in their institutions.