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Self-Reported Health Outcomes Associated With Green-Renovated Public Housing Among Primarily Elderly Residents

Breysse, Jill MHS, CIH; Dixon, Sherry L. PhD; Jacobs, David E. PhD, CIH; Lopez, Jorge BS; Weber, William MArch

Journal of Public Health Management and Practice: July/August 2015 - Volume 21 - Issue 4 - p 355–367
doi: 10.1097/PHH.0000000000000199
Original Articles

Objectives: Assess the benefits of green renovation on self-reported health of primarily elderly residents of a low-income public housing apartment building.

Design and Setting: Using questions from the Medicare Health Outcomes Survey, we interviewed residents at baseline and 1 year after green renovation of their 101-unit building in Mankato, Minnesota, comparing self-reported mental and physical health outcomes of 2 sets of residents (all-ages: median, 66 years, n = 40; elder: median, 72 years, n = 22) with outcomes for 2 same-aged low-income Minnesota comparison groups taken from Medicare Health Outcomes Survey participants (n = 40 and 572, respectively).

Participants: Study group: Mankato apartment building residents.

Interventions: Green renovation including building envelope restoration; new heating, electrical, and ventilation systems; air sealing; new insulation and exterior cladding; window replacement; Energy-Star fixtures and appliances; asbestos and mold abatement; apartment gut retrofits; low volatile organic chemical and moisture-resistant materials; exercise enhancements; and indoor no-smoking policy.

Main Outcome Measures: Self-reported health status including Activities of Daily Living and Veteran's Rand 12 (VR-12) survey results; housing condition visual assessment; indoor environmental sampling; and building performance testing.

Results: The all-ages study group's mental health improved significantly more than the comparison group's mental health on the basis of mean number of good mental health days in the past month (P = .026) and mean VR-12 mental component score (P = .023). Sixteen percent fewer all-ages study group people versus 8% more comparison group people reported falls (P = .055). The elder study group's 9% improvement in general physical health was not statistically significantly better than the elder comparison group's decline (6%) (P = 0.094). Significantly fewer people in the all-ages group reported smoke in their apartments because of tobacco products (20% vs 0%, P = .005), likely reflecting the new no-smoking policy.

Conclusions: Green healthy housing renovation may result in improved mental and general physical health, prevented falls, and reduced exposure to tobacco smoke.

This study aimed at investigating the impact of green low-income housing renovation on physical safety and on the physical and mental health of primarily elder residents.

National Center for Healthy Housing, Columbia, Maryland (Ms Breysse and Drs Dixon and Jacobs); Southwest Minnesota Housing Partnership, Slayton (Mr Lopez); and University of Minnesota Center for Sustainable Building Research, College of Design, Minneapolis (Mr Weber).

Correspondence: Jill Breysse, MHS, CIH, National Center for Healthy Housing, 10320 Little Patuxent Parkway, Ste 500, Columbia, MD 21044 (

Renovations were funded by the American Recovery and Reinvestment Act through a U.S. Department of Housing and Urban Development (HUD) Competitive Capital grant, the MN Department of Employment and Economic Development, as well as the Mankato Economic Development Authority, Southwest MN Housing Partnership, and Greater MN Housing Fund. This study was funded by the HUD Office of Lead Hazard Control and Healthy Homes, grant #MDLHH0201-09. The green charrette was funded by Blue Cross and Blue Shield of Minnesota Foundation. The authors thank personnel at the Mankato Economic Development Authority and the Minnesota Valley Council of Governors for facilitating data collection, Patrick Smith at the University of Minnesota for helping collect and evaluate environmental data, Questions and Solutions Engineering for building performance testing, and Dorr Dearborn for comments on an earlier version of this article. The substance and findings of this work are dedicated to the public. The authors are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the US government.

The Veterans RAND 12-Item Health Survey was developed from the Veterans RAND 36-Item Health Survey, which was developed and modified from the original RAND version of the 36-Item Health Survey version 1.0 (also known as the “MOS SF-36”). We complied with the uses of the Rand 36-Item Health Survey listed in

The authors declare no conflicts of interest.

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