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Moving Into Green Healthy Housing

Jacobs, David E. PhD, CIH; Ahonen, Emily PhD; Dixon, Sherry L. PhD; Dorevitch, Samuel MD, MPH; Breysse, Jill MHS, CIH; Smith, Janet PhD; Evens, Anne PhD; Dobrez, Doborah PhD; Isaacson, Marjie PhD; Murphy, Colin MS; Conroy, Lorraine PhD; Levavi, Peter JD, MPP

Journal of Public Health Management and Practice: July/August 2015 - Volume 21 - Issue 4 - p 345–354
doi: 10.1097/PHH.0000000000000047
Original Articles

Background: Green building systems have proliferated but health outcomes and associated costs and benefits remain poorly understood.

Objective: To compare health before and after families moved into new green healthy housing with a control group in traditionally repaired housing.

Design and Setting: Mixed methods study in 3 Chicago housing developments.

Participants: Public housing and low-income subsidized households (n = 325 apartments with 803 individuals).

Main Outcome Measures: Self-reported health status, visual assessment of housing condition, indoor air sampling, and Medicaid expenditure and diagnostic data. Medicaid expenditures and International Classification of Diseases, Ninth Revision codes were modeled using a generalized linear model with γ distribution and log-link.

Results: Housing conditions and self-reported physical and mental health improved significantly in the green healthy housing study group compared with both the control group and the dilapidated public housing from which the residents moved, as did hay fever, headaches, sinusitis, angina, and respiratory allergy. Asthma severity measured by self-reported lost school/work days, disturbed sleep, and symptoms improved significantly, as did sadness, nervousness, restlessness, and child behavior. Medicaid data in this exploratory study were inconclusive and inconsistent with self-reported health outcomes and visual assessment data on housing quality but hold promise for future investigation. Possible sources of bias in the Medicaid data include older age in the study group, changes in Medicaid eligibility over time, controlling for Medicaid costs in an urban area, and the increased stress associated with moving, even if the move is into better housing.

Conclusion: The mixed method approach employed here describes the complex relationships among self-reported health, housing conditions, environmental measures, and clinical data. Housing conditions and self-reported physical and mental health improved in green healthy housing. Health care cost savings in Medicaid due to improved housing could not be quantified here but hold promise for future investigations with larger cohorts over a longer follow-up period.

This study aims at comparing health before and after families moved into new green healthy housing with a control group in traditionally repaired housing.

University of Illinois at Chicago (Drs Jacobs, Ahonen, Dorevitch, Smith, Evens, Dobrez, and Conroy and Mr Murphy); National Center for Healthy Housing, Columbia, Maryland (Drs Jacobs and Dixon and Ms Breysse); Center for Neighborhood Technology Energy, Chicago, Illinois (Drs Evens and Isaacson); and Brinshore Michaels Development, Northbrook, Illinois (Mr Levavi).

Correspondence: David E. Jacobs, PhD, CIH, Environmental and Occupational Health Sciences Division School of Public Health, University of Illinois at Chicago, MC 922, 2121 W Taylor St, Chicago, IL 60612 (

Jacobs is principal investigator; Ahonen is project manager; Evens, Dobrez, Dorevitch, and Smith are coinvestigators/data collectors/analysts; Dixon is statistician; Breysse is quality control officer; Conroy and Murphy did air sampling; Isaacson led the community-based participatory research aspect of the project; Levavi designed and identified housing; and all participated in writing and reviewing the manuscript.

Thanks to Eugene Pinzer at HUD, Geraldine Walton, Denita Miller, Jacqueline Owens, Mary White, Tracy Frazier (community residents who all collected visual assessment data), Amy Mucha, Preethi Pratap, Tom Donlan, the Illinois Department of Health and Family Services and Kathleen Staley, Lisa Young, Louise Dooley, Theresa Olison, Amanda Escobar-Gramigna, and Angela Reese. A special thanks goes to the many residents who participated in the study. This project was funded by the U.S. Department of Housing and Urban Development, Office of Healthy Homes and Lead Hazard Control, grant # ILLHH0191-08, supported by the American Recovery and Investment Act, but does not reflect the views of the Government.

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The authors declare no conflicts of interest, except Jacobs who is both an employee of the National Center for Healthy Housing and an unpaid adjunct associate professor at the University of Illinois; he has an approved conflict of interest management plan in place.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.