Integrated Pest
Management in Multi-story
Public Housing for the
Elderly
Nancy Crider, DrPH
University of Texas Health Science Center – Houston School of Nursing
Acknowledgements
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Tom Neltner
Dr. Chang Lu Wang
Dion Lerman
Allison Taisey
Houston Housing Authority
National Center for Healthy Housing
North East IPM Center
Problem
• The problem under consideration is the
effect of Integrated Pest Management
(IPM) on the control of cockroaches in a
200 unit multi-story apartment building
for the elderly, in Houston, TX, with a
known cockroach infestation
Significance of Study
• Cockroaches long considered an
undesirable fact of life for residents of
public housing are now a recognized
health hazard.
• Previous IPM research primarily children
living in multi-family housing in the North.
• Challenge of maintaining a pest free indoor
environment may be different for the
elderly living in tropical southern climate.
Cockroaches Cause Asthma
• Institute of Medicine Report (2000)
Clearing the Air: Asthma and Indoor Air
Exposures
– Cockroaches cause allergies and asthma in
sensitive individuals
• Third National Health and Nutrition
Examination Survey (NHANES)
– 43% of individuals in the US, ages 6-59 allergic
to at least one indoor allergen
– 26% of these sensitive to German cockroach.
Inner City Asthma Study (1999)
Combination of cockroach sensitization
and exposure are associated with an
increase in clinical symptoms and
increase use of health care system
Cockroach Allergens
• Cockroach “frass” (droppings, shed skins
and remains of dead cockroaches) found in
household dust are the source of potent
allergens. (Bla g1, Bla g2)
• Allergens are proteins and are reported as
units per gram of dust.
– Threshold for sensitization > 2U/g of dust
– Threshold for asthma morbidity > 8U/g
dust
Schal at al (2008)
• Studied the amount of allergen present in
each pellet of cockroach feces
– 1 pellet of cockroach feces = ~1mg;
– 1 mg of feces =500 Units of Bla g1
– 1 female cockroach = 3 mg feces per day
– 1 day = ~1500 Units of Bla g 1
Chew et al (2006)
• 93% of the 321 NYC public housing units
had detectable levels of CR allergen.
– (90% > 1U/g ; 71% > 8U/g)
• 37% of households had at least on resident
with asthma.
• Higher asthma prevalence and morbidity
compared to national average.
– (26%) of children <18 years
– (20%) of all adults
Cohn et al (2006)
• Elevated concentrations of cockroach
allergens more prevalent in
– High-rise apartments
– Urban areas
– Multi-family units
– Pre-1940 housing
– Low income households.
Cohn et al (2006) continued
• Odds ratio (OR) for elevated concentrations
of Bla g1 consistently increased with
reported presence of cockroaches and
more recent observation of cockroaches.
– 100% of tenants reporting >50
cockroaches/day had Bla g1 levels >8U/g (OR
599)
– 77% who reported sightings in the last week
had Bla g1 levels >2U/g (OR 8.3); 53% had
levels >8U/g (OR 222.9)
Other Studies
• Curtain-Brosnan et al found reports of
roaches by parents were associated
with clinically relevant levels of Bla g1;
however negative reports were not
sufficient evidence of low CR allergen
exposure
• Johns et al (2000) 20% of homes with
no reported infestation had significant
levels of Bla g1
Wang et al (2006)
• Reported the higher the cockroach count
the higher the concentration of Bla g1 and
Bla g2 cockroach allergen.
• Bla g1 concentrations >8U/g of dust were
found with a moderate cockroach
infestation (10 CR/trap/night)
Lewis et al (2003)
• Found higher prevalence and asthma
morbidity in woman sensitized to
cockroach allergen and even higher in
those sensitized and exposed to high
levels of cockroaches.
• Those sensitized and exposed to
concentrations >2U/g were 3X more
likely to have been treated in hospital
emergency departments and use steroids
Lewis et al (2003) continued
• When adjusted for poverty and race the
association between cockroaches and
asthma persisted
• After allowing for effect of cockroaches
the effect of race and poverty lost
significance.
Arbes et al (2004)
• Found that cockroach allergens Bla g1
and Bla g2 present in low income
housing could be reduced through a
combined intervention program that
included occupant education,
insecticide use and professional
cleaning.
Integrated Pest Management (IPM)
• A team approach designed to control
pests by eliminating food, water and
harborage
• Involves inspection, identification,
maintenance, monitoring, and action
• Requires education and behavior
change
• Can dramatically reduce both pesticide
use and numbers of pests.
Goal of IPM
• The goal of IPM as defined by the
Environmental Protection Agency (EPA) is
to control pests by the most economical
long term means with the least possible
hazard to people, property, and the
environment.
HUD Promotes IPM
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HUD has promoted IPM for decades
Issued Maintenance Guidebook in 1995
Issued Voluntary Guidance in 2006
Revised Guidance in 2007, 2008, 2009
and 2011.
• Funded IPM & Healthy Homes Training
Pests and Pesticides
• Unresolved cockroach
infestations promote
the inappropriate use of
toxic pesticides.
• 75% of US households
used pesticide indoors
during the past year.
• 80% of most people’s
exposure occurs inside
Pesticide Use
• According to the EPA, the concentration
of 12 frequently used organic pollutants
is 2-5X higher inside homes regardless
of rural or urban location
• Chew et al. (2006) reported that the use
of low-toxicity pesticides was less
common in buildings occupied by senior
citizens compared to family units (80%
vs 91%; p=.003)
Methods
• Cockroach counts, used as a proxy for
Bla g1 and Blag2 cockroach allergen.
dust sampling
• Paired sample design – each unit
served as its own control
• Systematic random sample – random
starting point on each level, turn right
and sample every third apartment
Data Collection
• The Community
Environmental Health
Resource Center
(CEHRC) Sampling
Procedures used to
determine/categorize
extent of infestation
• Maintenance staff
trained to place glue
traps for monitoring
Data Collection
(355) glue traps were
placed in 71 of the 73
randomly selected
units (5 traps/unit).
• Traps were in place
for 2 nights. Units
were categorized by
level of infestation
Intervention
• 2- day “Essentials for Healthy
Homes Practitioners”
• 1-day “Integrated Pest
Management in Multi-Family
Housing”
• Baseline counts shared at
end of training.
• Property manager and team
developed IPM plan with
support of researcher
Data Analysis
• STATA statistical software package was used
to analyze baseline and follow-up counts.
• Paired t-tests completed to determine if there
was a significant decrease in the number of
cockroaches after the IPM training compared
to baseline.
• ANOVA by building level stratified by wing
completed to determine if there was a
statistical difference between levels and/or
wings of the building
Results
Results
Results
Paired t-tests by trap location
Location of Trap
Difference
Paired t-test Results
(all significant)
Kitchen
31.587302
t = 3.3781, 58 df, Pr(T > t) = 0.0007
Refrigerator
20.18462
t = 3.6698, 60 df, Pr(T > t) = 0.0003
Stove
11.652918
t=2.8996, 63 df, Pr(T > t) = 0.0026
Bathroom
5.053504
t = 1.7810, 60 df, Pr(T > t) = 0.0400
Bedroom (head of bed)
7.524009
t=2.6168, 62df, Pr(T > t) = 0.0056
Living Room
2.922348
t=1.8621, 61df, Pr(T > t) = 0.0337
Results
One way ANOVA by wing
Baseline
Follow-up
Mean difference
Wing
Mean # cockroaches
by apartment
F = 4.26;
Prob > F = 0.02
Mean # cockroaches
by apartment
F = 0.19;
Prob > F = 0.82
# cockroaches by
apartment
F = 5.52;
Prob > F = 0.0061
A
21.89
10.04
11.85
B
36.6
8.94
27.71
C
101.79*
6.13
95.66*
Total
53.32
8.44
45.48
Qualitative Analysis
• Feedback from the property manager,
maintenance staff, service coordinator (social
worker), pest control professional and
housing authority administrative staff was
obtained using a structured questionnaire.
– How have your pest control practices changed as a result
of the IPM training?
– Has the pest control contract been modified as a result of
the IPM training?
– Have there been any modifications to the annual operating
plan as a result of the IPM training?
Discussion
• Cockroach infestations in multi-story/
multi-family housing are not solely
determined by the actions of individual
tenants.
• Infestations are at least partially
determined by the built environment, the
physical structure and failure to
maintain the property
Discussion
• IPM education can change behavior
and ultimately decrease pesticide
exposure by controlling cockroach
infestations.
• The challenge of maintaining a pest free
indoor environment may be different for
the elderly due to loss of function
associated with normal aging and the
impact of chronic disease.
Discussion
• Clear communication of policies, a team
approach and commitment of team
members are key components of a
successful IPM plan.
• Resident education is important.
• Leases should include the tenant’s role
in IPM
• Lease enforcement can make a
difference.
Limitations
• Single property & small sample size do
not allow generalization to all public
housing.
• Responsiveness & interest of pest
control professional
• Motivation and commitment of property
manager and staff
• Availability of support staff (Social
Worker) to assist elderly tenants
Recommendations
• Establish an ongoing monitoring system
• Utilize support services to assist residents
who are physically unable to clean or
prepare for treatment by the PCP
• Purchase HEPA vacuum that can be
routinely used by maintenance & janitorial
staff and loaned to tenants
• Identify & train resident “peer” educators to
assist with glue trap monitoring and provide
tenant education and support.
Further Study
• The relationship of cockroach infestation
and exposure to cockroach allergens to
clinical symptoms, the use of steroids to
treat asthma, hospitalizations and
emergency room use are indicated to
determine if the control of cockroaches
using IPM significantly decrease clinical
symptoms and the use of costly health
care resources in the elderly.
Summary of Results
• IPM education, the establishment of a
team approach and the adoption of IPM
strategies provided an effective solution
to a long standing cockroach infestation.
• The study found a significant decrease
in the average number of cockroaches
after IPM education and implementation
of IPM principles at the study property
(P < 0.0003).
Conclusion
• IPM education and the adoption of IPM
strategies offer a viable alternative to
traditional pest control methods
• The adoption of IPM will improve the
living conditions and health status of
elderly residents living in public housing.
• IPM has the potential to decrease
asthma morbidity and the utilization of
expensive health care resources.
References
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Arbes S.J. et al. (2004). Cockroach allergens (bla g 1 and bla g 2) in low income urban housing reduced through a
combined intervention program (occupant education, insecticide application and professional cleaning). Journal of
Allergy and Clinical Immunology, 113, 109.
Chew, G. L., Carlton, E. J., Kass, D., Hernandez, M., Clarke, B., Tiven, J., Garfinkel, R., Nagle, S., & and Evans, D.
(2006). Determinants of cockroach and mouse exposure and associations with asthma in families and elderly
individuals living in new york city public housing. Annals of Allergy, Asthma & Immunology, 97(October), 502-513.
Cohn, R. D., Arbes, S. J., Jaramillo, R., Reid, L. H., & and Zeldin, D. C. (April 2006). National prevalence and
exposure risk for cockroach allergen in U.S. households. Environmental Health Perspectives, 114(4), 522-526.
Crider, N.M., (2010). Integrated pest management in multi-story public housing for the elderly in Houston, Texas.
Unpublished doctoral dissertation, Department of Management, Policy and Community Health, University of Texas
School of Public Health, Houston, TX
Curtin-Brosnan, J., Matsui, E. C., Breysse, P., McCormack, M. C., Hansel, N. N., Tonorezos, E. S., Eggleston, P. A.,
Williams, D. L., & Diette, G. B. (Nov 2008). Parent report of pests and pets and indoor allergen levels in inner-city
homes. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, &
Immunology, 101(5), 517-523.
Eggleston, P. A., Wood, R. A., Rand, C., Nixon, W. J., Chen, P. H., & and Lukk, P. (October 1999). Removal of
cockroach allergen from inner-city homes. Journal of Allergy and Clinical Immunology, 104(4), 842-846.
Gergen, P. J., Mortimer, K. M., & Eggleston, P. A. (1999). Results of the national cooperative inner city asthma study
(NCICAS) environmental intervention to reduce cockroach allergen exposure in inner city homes. Journal of Allergy
and Clinical Immunology, 103, 501-506.
Lewis, S. A., Weiss, S. T., Platts-Mills, T. A. E., Burge, H., & and Gold, D. R. (2002). The role of indoor allergen
senstitization and exposure in causing morbidityt in women with asthma. American Journal of Respiratory and Critical
Care Medicine, 165, 961-966.
Schal, C. (2008). The ABC's of indoor health: Allergens, baits, cockroaches: A tale of cockroach IPM in 2
environments. Translating Healthy Homes Research Teleconference.
Wang, C., & Bennett, G. W. (2006). Comparative study of integrated pest management and baiting for German
cockroach management in public housing. Journal of Economic Entomology, 99(3), 879-885.
Contact Information
Nancy M. Crider, DrPH, MS, RN
Assistant Professor
University of Texas HSC Houston
6901 Bertner Av., Rm 766
Houston, TX 77030
Telephone: 713-500-2074
Email: nancy.m.crider@uth.tmc.edu