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Integrated pest management in multi-story public housing for the elderly in Houston, Texas

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INTEGRATED PEST MANAGEMENT IN MULTI-STORY PUBLIC HOUSING FOR
THE ELDERLY IN HOUSTON, TEXAS
By
NANCY MANNING CRIDER, MS
APPROVED:
LUISA FRANZINI, PHD
LINDA E. LLOYD, PHD
MARY ANN SMITH, PHD
DEAN, THE UNIVERSITY OF TEXAS
SCHOOL OF PUBLIC HEALTH
Template designed by Dr. David Ramsey.
Copyright
By
Nancy Manning Crider, MS, DrPH
2010
Template designed by Dr. David Ramsey.
INTEGRATED PEST MANAGEMENT IN MULTI-STORY PUBLIC HOUSING FOR
THE ELDERLY IN HOUSTON, TEXAS
By
NANCY MANNING CRIDER, MS
DISSERTATION
Presented to the Faculty of The University of Texas
School of Public Health
in Partial Fulfillment
of the Requirements
for the Degree of
DOCTOR OF PUBLIC HEALTH
THE UNIVERSITY OF TEXAS
SCHOOL OF PUBLIC HEALTH
Houston, Texas
August, 2010
UMI Number: 3413257
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DEDICATION
This dissertation is dedicated to my husband Ron, my daughters Katie and Becca, my
sister Bea and my friend Nan.
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ACKNOWLEDGEMENTS
I would like to acknowledge the assistance and support of Tom Neltner, Dion Lerman,
Allison Taisey, Changlu Wang, Monica Clark, Rosalia Guerrero-Luera, Brenda Reyes, Aster
Tesfai, Horace Allison, Denise Schroeder, Manuel Morales, Ann Davison, Brandon
Kimmins, Michael Phillips, Brad and Eva Prather, Karen and Joe Robertson, Carol Galeener,
“Chip” Carson”, Linda Lloyd, Luisa Franzini and Mary Ann Smith.
I would like to thank the National Center for Healthy Housing for providing the glue
traps to determine the extent and location of cockroach infestation in the study property and
for providing the training materials for the IPM course that was presented to the Houston
Housing Authority management and staff.
I would also like to thank the Northeastern IPM Center located at Cornell University for
covering the expenses for the instructor to present the targeted IPM education program “IPM
in Multi-Family Housing” to the Houston Housing Authority management and staff.
Template designed by Dr. David Ramsey.
INTEGRATED PEST MANAGEMENT IN MULTI-STORY PUBLIC HOUSING FOR THE
ELDERLY IN HOUSTON, TEXAS
Nancy Manning Crider, MS, DrPH
The University of Texas
School of Public Health, 2010
Dissertation Advisor: Luisa Franzini, PhD
Integrated pest management is a viable alternative to traditional pest control methods. A
paired sample design was utilized to measure the effect of IPM education on the number of
cockroaches in a 200 unit, seven story public housing building for the elderly in Houston, TX.
Glue traps were placed in 71 randomly selected apartments (5traps/unit) and left in place for
two nights. Baseline cockroach counts were shared with the property manager,
maintenance/janitorial staff, service coordinator, pest control professional and tenant
representatives at the end of a one day “Integrated Pest Management in Multi-Family
Housing” training course.
There was a significant decrease in the average number of cockroaches after IPM education
and implementation of IPM principles (P < 0.0003). Positive changes in behavior by
members of the IPM team and changes in the housing authority operational plan were also
found. Paired t-tests comparing the difference between mean cockroach counts at baseline and
follow-up by location within the apartment all demonstrated a significant decrease in the
number of cockroaches.
Results supported the premise that IPM education and the implementation of IPM principles
are effective measures to change pest control behaviors and control cockroaches. Cockroach
Template designed by Dr. David Ramsey.
infestations in multi-story housing are not solely determined by the actions of individual
tenants. The actions of other residents, property managers and pest control professionals are
also important factors in pest control.
Findings support the implementation of IPM education and the adoption of IPM practices by
public housing authorities. This study adds to existing evidence that clear communication of
policies, a team approach and a commitment to ongoing inspection and monitoring of pests
combined with corrective action to eliminate food, water and harborage and the judicial use of
low risk pesticides have the potential to improve the living conditions of elderly residents
living in public housing.
Template designed by Dr. David Ramsey.
TABLE OF CONTENTS
List of Tables ............................................................................................................................. i List of Figures ........................................................................................................................... ii List of Appendices ................................................................................................................... iii Introduction ................................................................................................................................1 Statement of the Problem ...............................................................................................1 Review of the Literature ............................................................................................................8 Housing and Health........................................................................................................8 Public Housing in the United States ..............................................................................8 Cockroaches and Cockroach Allergens .......................................................................11 Cockroach Infestations and Pesticide Use ...................................................................17 Integrated Pest Management (IPM) .............................................................................21 Cockroach Sampling and Monitoring ..........................................................................27 IPM Training and Education ........................................................................................28 Methods....................................................................................................................................30 Study Design ................................................................................................................30 Sample Design .............................................................................................................30 Sampling Universe; Sampling Frame; Study Unit...........................................31 Sampling Design ..............................................................................................31 Sample Size ......................................................................................................32 Intervention .................................................................................................................32 Data Collection ............................................................................................................33 Data Preparation...........................................................................................................35 Quantitative Analysis Plan...........................................................................................37 Qualitative Analysis Plan.............................................................................................38 Results ......................................................................................................................................40 Conclusions ..............................................................................................................................51 Appendices ...............................................................................................................................58 References ................................................................................................................................85 Template designed by Dr. David Ramsey.
LIST OF TABLES
Table 1: Summary Statistics Baseline Compared to Follow-up ..............................................40 Table 2: Number & Percentage of Cockroaches by Trap Location: Baseline vs Followup ................................................................................................................................41 Table 3: Paired t-tests Difference between Baseline and Follow up by Location ...................43 Table 4: Cockroach Counts in Laundry and Trash Rooms Baseline vs Follow-up .................44 Table 5: One way ANOVA by Level Baseline vs Follow-up .................................................45 Table 6: One way ANOVA by Wing Baseline vs Follow-up ..................................................46 Table 7: One-way ANOVA by Level by Wing Baseline vs Follow-up ..................................47 i
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LIST OF FIGURES
Figure 1: Number of Cockroaches by Location Baseline compared to Follow-up .................41 Figure 2: Categorization of Cockroach Infestation Baseline compared to Follow-up ............42 ii
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LIST OF APPENDICES Appendix A: CEHRC Cockroach Sampling Checklist and Sampling Instructions .................59 Appendix B: CEHRC Cockroach Report ................................................................................67 Appendix C: Notice to Resident ..............................................................................................69 Appendix D: Floor Plan of Multi-Story Public Housing Apartment Building ........................72 Appendix E: Letter of Permission............................................................................................75 Appendix F: Verbal Consent Script .........................................................................................77 Appendix G: Follow-up Survey Questionnaire .......................................................................79 Appendix H: Summary of Baseline Unit Cockroach Reports .................................................81 iii
INTRODUCTION
Statement of the Problem
The problem under consideration is the effect of targeted Integrated Pest Management
(IPM) education on the control of cockroaches in multi-story public housing for the elderly in
Houston, Texas.
Overview
The connection between housing and health is not new. In the 1800s, public health
reformers in America and Europe identified environmental and housing conditions as the
source of infectious diseases i.e. cholera, tuberculosis and typhus. This recognition led to
improved sanitation and slum clearance. Florence Nightingale, (Nightingale, 1992) cited by
National Center for Healthy Housing, wrote, “the connection between health and the
dwelling of the population is one of the most important that exists”. In 1937, the American
Public Health Association formed the Committee on Hygiene and Health and published a
report “Basic Principles of Healthy Housing”. That same year, in the midst of the Great
Depression, the U.S. Congress passed the 1937 Housing Act that initiated the development of
public housing in the United States.(Harris County Housing Authority, 2008; Houston
Housing Authority, 2010; San Diego Housing Commission; Stoloff, 2004; Texas Low
Income Housing Information Services, 1998) The goal of the act was to provide decent, safe
and sanity living conditions for low income families; however, by the mid-1950s the flight to
the suburbs left high concentrations of low income minorities in run down, inner-city
properties infested with rodents and cockroaches.(Stoloff, 2004; Texas Low Income Housing
Information Services, 1998)
1
The presence of cockroaches in public housing, long considered an undesirable fact of life
for occupants of these affordable properties, has now become a recognized health hazard.
The Institute of Medicine Report (IOM 2000), Clearing the Air: Asthma and Indoor Air
Exposures, determined that cockroaches, in addition to being an unwelcome nuisance that
contaminate food, dishes and counter tops with Salmonella and other harmful bacteria, also
exacerbate or cause allergies and asthma in sensitive individuals and cause asthma in preschool aged children. (Institute of Medicine, 2000)
The Third National Health and Nutrition Examination Survey (NHANES: CDC 19881994) estimated that 43% of individuals in the U.S., ages 6-59 years are allergic to at least
one indoor allergen. (Arbes et al., 2005) Twenty-six percent (26%) of these individuals are
sensitive to German cockroach allergen. (Arbes et al., 2005) A number of researchers have
demonstrated that cockroach frass (droppings, shed skins and remains of dead cockroaches)
found in household dust is the source of these potent allergens. Chew et al., (2006) reported
that 93% of the 321 New York City public housing apartments studied, including families
(221 apartments) and elderly (100 apartments), had at least one dust sample with detectable
levels of Cockroach allergen (Bla g 2). (G. L. Chew et al., 2006) Rauh et al., (2002) found a
significant association between housing disrepair and the concentration of cockroach allergen
independent of income level. (Rauh & Chew, 2002a; Rauh & Chew, 2002b) It has been well
documented that children living in public housing have high exposure and sensitization to
cockroach allergen and these individuals exhibit a high incidence of asthma, acute morbidity
and increased utilization of healthcare resources. (Gelber et al., 1993; Rosenstreich et al.,
May 8, 1997)
2
While all age, race and ethnic groups suffer with asthma, low income and minority
populations experience a significantly increased burden of disease, morbidity and medical
utilization, as evidenced by higher rates of emergency room visits, hospital admissions and
fatalities. (Akinbami, ) Compared to whites, African Americans (AA) have 3 times the rate
of hospitalization for asthma and the highest rates occur among AA and Hispanics living in
the poorest neighborhoods. Vulnerable populations include not only young children but also
the elderly who may spend up to 80 percent of their time indoors. (Klepeis et al., 2001). CDC
estimates that 28.4 million individuals are affected by asthma (Centers for Disease Control
and Prevention) and that the health care related costs exceed $19.7 billion. (National
Institutes of Health, National Heart, Lung and Blood Institute, 2007)
In addition to the health hazards directly caused by cockroaches, unresolved cockroach
infestations promote the unnecessary and inappropriate use of and exposure to toxic
pesticides. According to the EPA, 75 percent of U.S. households used at least one pesticide
product indoors during the past year and 80 percent of most people's exposure to pesticides
occurs indoors. Studies have demonstrated levels of about a dozen frequently used organic
pollutants to be 2 to 5 times higher inside homes than outside, regardless of whether the
homes were located in rural or highly industrial areas (U.S. Environmental Protection
Agency and the United States Consumer Product Safety Commission, Office of Radiation
and Indoor Air, April 1995) The effect of pesticides in humans can be acute or chronic
ranging from minor irritations to severe neurological damage.
The U.S. Department for Housing and Urban Development (HUD) has promoted the use
of Integrated Pest Management (IPM) for several decades; however, it still does not require
3
Public Housing Authorities to adopt IPM by regulation. In May 2007, HUD issued a
Guidance Notice on IPM to inform Public Housing Authorities (HA) about reference
materials for voluntary implementation of IPM in HA properties. (U.S. Department of
Housing and Urban Development Office of Public and Indian Housing) In 2008, the Houston
Housing Authority (HHA) adopted an IPM policy and piloted a 1-day integrated pest
management training session in a multi-story apartment building for the elderly with a long
standing cockroach infestation. (Personal communication with Horace Allison, Senior Vice
President, HHA). The goal of IPM, according to the EPA, “is to manage pest damage by the
most economical means and with the least possible hazard to people, property and the
environment”. (U.S. Department of Housing and Urban Development Office of Public and
Indian Housing)
To date most of the research and published literature on the efficacy and cost effectiveness
of IPM in public housing has focused on multi-family housing in Northern cities i.e. Boston
and New York. These large metropolitan areas located in the North Eastern United States
have distinct seasons and a less humid environment compared to the sub-tropical climate
experienced by Houston and other South Central cities located on the Gulf Coast. Most prior
studies have addressed the problem of cockroach infestation in public housing with
significant numbers of children. Little work has been done in public housing with
predominantly elderly populations. The challenge of maintaining a pest free indoor
environment in elderly housing may be different than the challenges found in multi-family
developments as a result of loss of function associated with the normal aging process and the
impact of chronic disease. According to the 1995 American Housing Survey (AHS)
4
approximately 14% of elderly individuals report a personal limitation, a mobility limitation
or the use or need of assistance. The most frequently reported limitations are mobility, doing
housework, cooking/food preparation, bathing and accessing the bathroom. (Newman, 2003)
This study extended the research on IPM in public housing by evaluating the impact of
targeted IPM education and the implementation of IPM principles in a multi-story apartment
building for the elderly in a Houston, Texas. The setting for this study was a two hundred
(200) unit, seven (7) story apartment building for the elderly, owned by the Houston Housing
Authority (HHA), with a known cockroach infestation. To determine a baseline cockroach
count and estimate the extent of cockroach infestation in the study property, glue traps were
placed by the Texas Healthy Homes Training Center on behalf of the Houston Housing
Authority, prior to the educational intervention. Baseline and follow-up cockroach counts
were collected following the Community Environmental Health Resource Center (CEHRC)
Cockroach Sampling Instructions (Appendix A).(Alliance for Healthy Homes) The Houston
Housing Authority gave permission to use the de-identified data for this study. The CEHRC
sampling procedure has been demonstrated as a valid approach to cockroach sampling
(Hynes et al., 2004; C. Wang & Bennett, 2009; C. Wang & Bennett, 2006) The current study
used the CEHRC guidelines categorizing the extent of infestation as a proxy for dust
sampling of cockroach allergen in the environment.
The results of this study are intended for use by public housing authorities, HUD planners,
property managers and legislators to improve the living conditions of low income families,
seniors and individuals with disabilities who reside in public housing. Specifically, the
results of this study demonstrated that cost effective training approaches and pest control
5
interventions that result in a change from traditional pest management behaviors to a more
integrated pest management approach. Ultimately, the widespread use of IPM will improve
the health and quality of life of residents living in public housing by eliminating cockroach
infestations and decreasing the use of toxic pesticides in the indoor environment.
It is anticipated that environmental education targeted to residents of multi-family housing
and the introduction of Integrated Pest Management by public housing authorities will
decrease cockroach infestations and exposure to cockroach allergens known to cause and
exacerbate asthma in susceptible individuals. In the long term, it is anticipated that IPM
education and the implementation of IPM principles will reduce health disparities, decrease
the health care costs and increase the number of symptom free days for those suffering the
burden of cockroach associated disease.
Study Objectives
1. To determine if targeted Integrated Pest Management (IPM) education decreased the
number of cockroaches, in a 7-story apartment building for the elderly in Houston, Texas.
Baseline cockroach counts were compared to follow-up counts to determine the impact of
the targeted IPM training.
Null Hypothesis: There is no difference in the number of cockroaches after the
implementation of IPM compared to baseline data.
Working Hypothesis: There is a difference in the number of cockroaches after the
implementation of IPM compared to baseline data.
2. To determine if targeted Integrated Pest Management (IPM) education changed the pest
control practices and policies of the Houston Housing Authority.
6
The property manager, maintenance/janitorial staff, service coordinator and the pest control
professional were asked to describe what if any changes they have made since receiving the
IPM training.
The HHA annual plan and the pest control contract were reviewed to determine if any
changes were made based on the knowledge gained from the targeted training.
7
REVIEW OF THE LITERATURE
Housing and Health
Housing has long been recognized as a determinant of health. In the 1800s, public health
reformers such as Florence Nightingale led the effort to improve sanitation in hospitals,
military barracks and housing with the goal of eliminating environmental conditions known
to cause disease in humans. (Nightingale, 1992)(Harris County Housing Authority, 2008;
Houston Housing Authority, 2010; San Diego Housing Commission; Stoloff, 2004; Texas
Low Income Housing Information Services, 1998) In 1937, the American Public Health
Association formed the Committee on Hygiene and Health and published a report “Basic
Principles of Healthy Housing”. (Harris County Housing Authority, 2008; Houston Housing
Authority, 2010; San Diego Housing Commission; Stoloff, 2004; Texas Low Income
Housing Information Services, 1998) In recent years there has been growing awareness about
the social determinants of health including housing and the increasing body of evidence
associating housing quality not only with injuries and infectious disease but also with poor
nutrition, mental illness and chronic disease.(Hood, May 2005; Jacobs, 2004; Korfmacher,
2005; Krieger & Higgins, 2002) In 2005, the U.S. Surgeon General issued a “call for action
to improve the health of Americans by improving the indoor environment”. (Hood, May
2005)
Public Housing in the United States
Public housing in the United States was established in the 1930s during the Great
Depression in response to the deplorable housing conditions in the slums and the increasing
number of unemployed. The aim of the 1937 Housing Act was to provide decent, safe and
8
sanitary living conditions for low income families. Large scale construction of high rise
buildings dominated public housing in urban areas of the United States during the 1950s and
resulted in an urban subculture known as “the projects”. Post World War II demand for
housing and changes in federal policy lead to the flight to the suburbs and subsequently high
concentrations of very low-income minority families became the norm in the inner city
projects. Unfortunately, due to limited financing, not all properties were well maintained.
This lead to the deterioration of many affordable housing units and the rise of many of the
problems and negative stereotypes commonly associated with public housing, including
crime, substandard housing and pest infestation. (San Diego Housing Commission; Stoloff,
2004) “Public housing and urban planning once closely aligned have drifted apart”. (Hood,
May 2005)
Over the past seventy years, more than 1 million Texans have lived in public housing. For
many residents, affordable public housing is the only thing between them and homelessness.
The majority of public housing developments in Texas are more than thirty years old; many
need major repair and modernization. Most developments were built in low income,
minority neighborhoods and contributed to the concentration of poor and minority families in
public housing. (Texas Low Income Housing Information Services)
The Houston Housing Authority (HHA), initiated in 1938 in response to the 1937 Housing
Act, currently serves more than 60,000 low income individuals. As of 2009, the HHA owned
twenty-three properties (19 multi-family developments and 4 elderly apartment units)
including >4000 rental units and 200 single family homes. Eighty-two (82) percent of the
tenants are minorities, of these seventy-six (76) percent are African American. Other
9
demographics indicate twenty-two (22) percent are >62 years of age and twenty-six (26)
percent of those with disabilities are over 62 years. The Housing Operations Department is
responsible for resident services, maintenance and safety. (Houston Housing Authority) Day
to day operations of HHA developments, including pest management, unit turnover and
routine maintenance, is subcontracted to local property management companies with
substantial experience managing affordable HUD housing units. (Personal communication
with HHA, Vice President Operations)
The U.S. Housing and Urban Development (HUD), Real Estate Assessment Center
(REAC) measures the effectiveness of Public Housing Agencies nationwide. There are four
components to the REAC assessments; physical inspections, financial submissions,
management operation certifications and resident satisfaction surveys. To ensure that
families have housing that is decent, safe, sanitary and in good repair REAC conducts
approximately 20,000 physical inspections on properties each year. The 2004, REAC Survey
found that more than half of the public housing residents who responded to the survey
reported insects and rodents inside their apartments. (U.S. Department of Housing and Urban
Development Office of Public and Indian Housing) Additionally, almost 10% of the residents
said that rodents or insects were always a problem. (2006 REAC - How the RASS Measures
Up). (U.S. Department of Housing and Urban Development Office of Public and Indian
Housing) Housing authorities are rated as high (90-100), standard (75-89.9) or
troubled/substandard (<75) based on a composite score. Some housing authorities score
much worse than others. In the first year of the REAC survey, 36% of PHAs scored high,
10
42% standard and 22% substandard/troubled. In 2008, the HHA was rated as a high
performer. (Houston Housing Authority, 2010)
Cockroaches and Cockroach Allergens
There are many species of cockroaches however, only a few species, German, American,
Oriental and Brown-banded, are found indoors. (Eggleston & Arruda, 2001)Cockroaches are
nocturnal insects that hide during the day and are active at night. The number of cockroaches
that people see is small in comparison to the entire population. If a tenant sees a cockroach
during the day it is usually a sign of a major infestation. Cockroaches have three stages of
life: egg, nymph and adult. Adult cockroaches lay between 16-50 eggs in egg cases that they
carry until shortly before the nymphs are ready to hatch. (Eggleston & Arruda, 2001) The
German cockroach, the most common indoor species, likes a warm humid environment.
They generally inhabit kitchens and bathrooms and are found in cracks and crevices, around
plumbing fixtures, in cupboards and drawers and around stoves and refrigerators. When
infestations are severe they are found in other areas inside a house or apartment.
Cockroaches migrate easily in multi-family housing via plumbing and electrical connections.
Adult cockroaches are able to fit in cracks about 1/16th of an inch, therefore, any small gap or
hole provides prime harborage. (J. Hahn & Ascerno, 2005)
Cockroaches, besides being a nuisance and known carriers of over forty different
pathogens including pneumonia, food poisoning, salmonella, E-coli and typhoid (J. Hahn &
Ascerno, 2005; Hu & Appel, May 3, 2003) (World Health Organization WHO), also produce
potent allergens known to cause or exacerbate asthma and allergies in susceptible
individuals. (Institute of Medicine, 2000)(National Institute of Environmental Health
11
Sciences )(NIH 2007). Asthma, a chronic inflammatory disease of the airways, is a major
public health issue. Although research has indicated that there are both genetic and
environmental components involved in the development of asthma, there is currently no cure
for the disease. However, it is widely accepted that asthma symptoms can be mitigated by
controlling environmental triggers including pet dander, dust mites, environmental tobacco
smoke, fungi/molds, mice dander and cockroach allergens. (Institute of Medicine, 2000)
(NIH 2007).
Cockroach allergens are proteins found in cockroach saliva and frass (droppings, shed
skins and remains of dead cockroaches) that become incorporated into household dust. The
German cockroach (Blattella Germanica), the species most frequently responsible for
infestations in public housing, produces potent and persistent Bla g 1 and Bla g 2 allergens
that are carried on large dust particles. Allergen concentration is reported as units of Bla g1
or Bla g2 per gram of dust (U/g). The accepted threshold for human sensitization to these
allergens is two (2) U/g of dust. The asthma morbidity threshold is 8 U/g of dust. (Eggleston
et al. 1998; Rosenstreich et al. 1997; Gelber et al. 1993).
Cockroach allergen has been clearly identified as a risk factor for asthma and some
researchers have determined that the level of cockroach allergen in homes is predictive of
allergic sensitization and asthma morbidity. (Arruda et al. 2001; Cohn 2006; Eggleston et al.
1998; Rosenstreich et al. 1997; Sarpong et al. 1997; Gelber et al. 1993;). Cockroach frass is
the source of these potent and persistent allergens. Schal et al. (2008) studied the amount of
allergen present in each pellet of cockroach feces and reported the following results:
1 pellet of cockroach feces = ~1mg;
12
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.
Cohn et al. (2006) reported that evidence of cockroach activity (droppings, shed skins) is a
very strong predictor of cockroach allergen levels. The researchers found elevated
concentrations of allergens were more prevalent in high-rise apartments, urban areas, multifamily units, pre-1940 housing and low income households (< $20,000). The presence of
cockroach allergen, however, was not restricted to low income households. Seven percent
(7%) of households with incomes >$60,000 reported Bla g1 levels >2 U/g of dust. Cohn et al
found the Odds Ratio (OR) for elevated concentrations of Bla g1 consistently increased with
the reported presence of cockroaches and with more recent observation of cockroaches.
Eighty-six percent (86%) of the residents reporting problems with cockroaches had
detectable levels of Bla g1 at one or more sites. (58 % >2U/g, OR 4.62; 38% >8U/g, OR
65.47). One hundred percent (100%) of those reporting >50 cockroaches per day had Bla g1
levels >8U/g (OR 599). Five to 50 Cockroaches per day was also a strong predictor of high
allergen levels (96% >2U/g, OR 8.9; 63% >8 U/g, OR 208. More recent observations of
roaches also predicted the level of Bla g1 in the apartment. Seventy-seven point nine percent
(77.9 %) of the residents reporting sightings in the past week had Bla g1 levels >2 U/g (OR
8.3); 58.7% had levels >8U/g (OR 222.9).
Wang, et al. (2007) interviewed residents and inspected the apartments of 358 randomly
selected Gary Housing Authority units in Gary Indiana. Seventy-one percent (71%) reported
problems with pests and 42% reported that a resident with asthma resided in the apartment.
13
Physical inspection of these units found 81 % were infested by cockroaches, mice, ants,
spiders or flies; 49 % were infested with German cockroaches (especially in the kitchen);
36% of the units were infested with mice and this finding was associated with the diagnosis
of asthma; and 26% were infested by the Oriental cockroach. Only 22 % of tenants (35 of
159) with cockroach infestations reported the problem to management. Despite the low
reporting of the problem 72% of the Gary apartments had evidence of pesticide use and 80%
reported using pesticides to control cockroaches, however, the pesticides were not always
fresh or used properly. Despite the heavy use and reliance on pesticides the researchers found
that cockroach control was poor. Dust samples taken in 101 apartments found Bla g1
allergens in 98% of the kitchen dust samples. One third of the dust samples reveled Bla g1
levels >8 U/g and cockroaches were captured on glue traps in 85 % of the apartments.
(NCHH Case study; C. Wang & Bennett, 2006)
Based on positive skin test rates the Third National Health and Nutrition Examination
Survey (NHANES: CDC 1988-1994) estimated that 43% of individuals in the U.S., ages 659 years are allergic to at least one indoor allergen. Twenty-six percent (26%) of these
individuals are sensitive to German cockroach allergen. (Arbes et al. 2005). The National
Cooperative Inner-City Asthma Study (NCICAS) found 37% of children with asthma are
sensitized to cockroach allergens (Gergen et al., 1999). Goldstein et al. (1987) found
evidence of cockroach allergen in 85% of the 400 inner city homes that were tested.
Eggleston (2003) suggested that exposure to cockroach allergens is likely to occur through
direct contact with bedding in a manner similar to dust mite exposure.
14
Chew et al (2006) reported that 93% of the 321 New York City public housing apartments
studied, including families (221 apartments) and elderly (100 apartments), had at least one
dust sample with detectable levels of Cockroach allergen (Bla g 2). Ninety percent (90%) of
the apartments had Bla g2 levels >1 U/g of dust and seventy-one percent (71%) were >8 U/g
of dust. (G. L. Chew et al., 2006) Others have reported that approximately 20% to 48% of
homes without visible evidence of cockroaches contain detectable cockroach allergen in dust
samples. (G. L. Chew et al., 1998; Gelber et al., 1993; Institute of Medicine, 2000; Pollart et
al., February 1991). Matsui et al., (2003) found that cockroach allergens in suburban,
Baltimore households is more common than previously thought. (Matsui, Wood,
Kanchanaraska, Curtin-Brosnan, & Eggleston, July 2003)
Direct measurement of indoor allergens is not always feasible, especially in the inner city.
Rauh et al. (2002) found a highly significant correlation between self report of cockroach
sighting and allergy levels in dust in bedrooms (r = 0.522, p <0.001) and kitchens (r=0.665,
p<0.001). (Rauh & Chew, 2002a; Rauh & Chew, 2002b) Curtain-Brosnan et al. (CurtinBrosnan et al., Nov 2008)found reports of cockroaches by parents were associated with
clinically relevant levels of Bla g 1, and concluded that parent reporting of pests and pets
may be sufficient to recommend environmental control practices for sensitized children.
Consistent with other researchers (G. L. Chew et al., 1998; Gelber et al., 1993; Pollart et al.,
February 1991) Curtain-Brosnan also found that negative reports of pest infestations are not
sufficient evidence of low pest allergen exposure.(Curtin-Brosnan et al. 517-523) Chew
concluded that exposure to cockroach allergen can occur even when no signs of cockroaches
have been reported. (G. L. Chew et al., 1998)
15
Chew et al (2006) found a high asthma prevalence and morbidity in their study of families
and elderly living in New York City public housing. (G. L. Chew et al., 2006) Thirty-seven
(37%) percent of households had a least one resident with asthma. 159 (22%) of all residents
had a diagnosis of asthma by a physician. Fifty-three children, 26% of children <18 years and
105 adults, 20% of all adults in the study had asthma compared to ~8.2 % prevalence in the
United States in 2007. (Texas BRFSS)
A prospective longitudinal study conducted by Lewis et al. (2002) reported that the
prevalence of doctor diagnosed asthma (86%) and asthma morbidity (52%) was more
common in women sensitized to cockroach allergen and even higher in those sensitized and
exposed to high levels of cockroaches. Furthermore, those sensitized and exposed to
cockroach Bla g 1 or Bla g2 levels >2 U/g were three times more likely to have been treated
in a hospital emergency room and use steroids to treat their asthma than those who were not
sensitized . When adjusted for poverty and race the association between cockroaches and
asthma persisted. However, in the multivariate model, after allowing for the effect of
cockroaches the effect of race and poverty on asthma morbidity lost statistical significance
suggesting that it is the effect of cockroaches that contributes to the socio-economic disparity
in asthma morbidity not the reverse. This prospective study also found that in those
individuals who were not sensitized to cockroach allergens there was no difference in asthma
prevalence between those with high or low allergen exposure. (Lewis, Weiss, Platts-Mills,
Burge, & and Gold, 2002). These findings were consistent with the Inner City Asthma Study
(Gergen, Mortimer, & Eggleston, 1999) and other case-control studies including Gelber et al.
(1993) that demonstrated the combination of cockroach sensitization and exposure are
16
associated with an increase in clinical symptoms and an increase use of the health care
system.
Rauh et al. (2002) studied the type and extent of common disrepairs i.e. cracks and holes,
leaky pipes, unrepaired water damage and inadequate and/or intermittent heating and
electricity found that the distribution of cockroach allergen is significantly influenced by the
physical characteristics of the built environment. Sixty-eight (68) percent of the participants
reported the presence of cockroaches and the proportion of those reporting cockroaches and
the levels of Bla g2 allergen increased significantly with the degree of disrepair. Sixty-four
(64) percent of the kitchens and 30% of the beds had Bla g2 levels >2U/g. Forty-four (44)
percent of the kitchens and 10% of the beds had Bla g2 levels >8U/g. The relationship
remained after adjusting for income, ethnicity and pest control methods. (Rauh & Chew,
2002a)
Cockroach Infestations and Pesticide Use
In addition to the health hazards directly caused by cockroaches, unresolved cockroach
infestations promote the unnecessary and inappropriate use of and exposure to toxic
pesticides. Pesticides can cause both immediate and long term health effects. Some are
known to cause cancer and other chemical agents can exacerbate asthma and allergies.
Depending on the pesticide the impact may be mild and treatable to debilitating or fatal.
(National Pesticide Telecommunications Network) Children, elderly and those with breathing
problems and chronic lung disease such as chronic obstructive pulmonary disease (COPD)
and emphysema are most at risk. (U.S. Environmental Protection Agency) According to the
EPA, 75 percent of U.S. households used at least one pesticide product indoors during the
17
past year and 80 percent of most people's exposure to pesticides occurs indoors. (US
Environmental Protection Agency) Other studies found measurable levels of up to a dozen
pesticides in the air inside homes. (U.S. Environmental Protection Agency) EPA's Total
Exposure Assessment Methodology (TEAM) studies demonstrated levels of about a dozen
frequently used organic pollutants to be 2 to 5 times higher inside homes than outside,
regardless of whether the homes were located in rural or highly industrial areas (U.S.
Environmental Protection Agency and the United States Consumer Product Safety
Commission, Office of Radiation and Indoor Air (6604J) 39). Julien et al. (2008) investigated
the magnitude and distribution of pyrethroid and organophosphate pesticide loadings in
public housing in Boston, Massachusetts. At least six pesticides were detected in kitchen
floor wipes in the majority of the homes (range 3-8). Permethrin and chlorpyrifos were
found in 100% of the study homes. Diazinon, cypermethrin and cyfluthrin were found in
98%, 90% and 71% of the homes respectively. (Julien et al. 167-174). Chew et al. (2006)
investigated the determinants of cockroach exposure in New York City public housing and
found 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) (Chew et al. 502-513).
Detection of several banned or restricted use pesticides in some public housing units,
underscore the need for integrated pest management strategies that embrace the safe and
judicious use of pest control products. (Julien et al. 167-174) In addition, awareness of the
hazards and proper use of pesticides including total release foggers need to be better
communicated. To reduce the risk of pesticide related health effects, integrated pest
18
management strategies that eliminate pests’ access to food, water, and shelter need to be
promoted and adopted. (Centers for Disease Control and Prevention (CDC) 1125-1129)
The U.S. Department for Housing and Urban Development (HUD) has promoted the use
of Integrated Pest Management (IPM) for several decades. In the late 1990s the United States
Department of Health and Human Services began to target efforts at identifying and reducing
the causes of asthma. (U.S. Department of Health and Human Services) The Environmental
Protection Agency (EPA) has a priority objective to increase the number of asthmatics taking
actions to reduce exposure to environmental triggers and low income individuals have been
identified as a priority group. (U.S. Environmental Protection Agency)
In September of 2004, the Attorney Generals for the states of New York, Connecticut,
Illinois, Wisconsin, New Mexico and the U.S. Virgin Islands filed suits against the United
States Department of Housing and Urban Development (HUD) (Connecticut Attorney
General) for violation of the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA)
(U.S. Environmental Protection Agency) and failure to promote Integrated Pest Management
through regulation and procurement. The suit, brought on behalf of public housing residents,
sought an injunction requiring HUD to amend its regulations to require the adoption and
implementation of IPM as part of the annual operational plan required of each public housing
authority (PHA). The attorneys argued that IPM protects residents from both the adverse
health effects of cockroaches and mice and the unnecessary use of pesticides to control
infestations. They further argued that human exposure to pesticides is a serious health hazard
noting that organophosphates are particularly toxic and that pesticides i.e. pyrethrins are
allergens that can exacerbate asthma attacks. (Connecticut Attorney General)
19
In 2007, public housing tenants in Toronto, Canada brought a class action suit against the
Toronto Community Housing Corporation and the city and province of Toronto to force the
housing authority to make basic repairs to address the most common tenant complaints
including water damage and pest infestations by cockroaches, mice, rodents and bedbugs.
(Smith) The Star Bulletin (May 7, 2008), reported that the State of Hawaii Department of
Health in partnership with the Hawaii Public Housing Authority introduced a “Catch a
Roach” campaign at a 375 unit public housing complex. The goal of the project was to
decrease preventable asthma complications that result in costly hospitalizations and
emergency room visits. Residents received glue traps and brochures about the dangers of
cockroaches and how to combat them. According to the Hawaii State Health Department,
about 50% of residents who have asthma are allergic to cockroaches. (State of Hawaii
Department of Health)
While the U.S. Department for Housing and Urban Development (HUD) has promoted the
use of Integrated Pest Management (IPM) for several decades it still does not require Public
Housing Authorities to adopt IPM by regulation. In 1995, Maintenance Guidebook Seven
that included reference materials on IPM was distributed to all public housing authorities. In
2006, HUD issued a Guidance Notice on IPM to inform housing authorities (HA) about
Guidebook Seven and additional reference materials for voluntary implementation of IPM in
their properties. The Guidance was revised in 2007 and reissued again in 2008. According
to the HUD Guidance Notice (US Department of Housing and Urban Development Office of
Public and Indian Housing Notice PIH 2007-12 (HA)) IPM:
20
•
“Offers the potential efficacy of pest elimination while protecting the health of
residents and staff.”
•
“Will extend the useful life of property and, thereby, generate significant savings
that offset costs of the pest control operations.”
•
“Methods are effective in preventing moisture intrusion and accumulation.”
Integrated Pest Management (IPM)
The goal of IPM, according to the Environmental Protection Agency (EPA), “is to
manage pest damage by the most economical means and with the least possible hazard to
people, property and the environment”. (US Department of Housing and Urban
Development Office of Public and Indian Housing Notice PIH 2007-12 (HA)) IPM is aimed
at preventing pests and is more sustainable than the use of pesticides alone. IPM is a team
approach designed to eliminate food, water and harborage for pests. It involves inspection,
monitoring and identification of pests, and action by team members based on established
action thresholds. (U.S. Environmental Protection Agency, September 10, 2009) IPM also
requires education and behavior change by property management and staff, pest control
professionals and tenants. (U.S. Environmental Protection Agency) IPM can make dramatic
reductions in both pesticide use and numbers of pests. By coordinating responsibilities and
relying on products and practices that work together IPM minimizes exposure and provides
longer lasting control. IPM makes better use of limited resources, reduces complaints and in
the long run lowers pest control costs. (D. M. Miller, ; D. M. Miller & Meek, 2004; National
Center for Healthy Housing, ; C. Wang & Bennett, 2009)
21
The HUD Guidance describes the following components of an effective IPM program : 1.
Communicate Policies; 2. Identify Problems; 3.Monitor and Track Pest activity ; 4. Set
Thresholds for Action; 5. Improve Non-Pesticide control methods; 6. Prevent Pest Entry and
Movement; 7. Educate Residents and Update Leases; 8. Enforce Lease; 9. Use Pesticides
Only When Necessary; 10. Post Signs regarding pesticide usage. (U.S. Department of
Housing and Urban Development Office of Public and Indian Housing)
Key principles of IPM include: 1. Monitoring pest infestations with sticky traps; 2.
Blocking pest entryways and harborage; 3. Eliminating food and water sources; and 4.
Applying low-risk pesticides only as needed to address identified problems. (Boston Housing
Authority; Malone, February 2008) Non-chemical methods to control cockroaches include
education, sanitation, vacuuming, trapping and maintenance to eliminate and seal harborages.
(C. Wang & Bennett, February 2006; C. Wang & Bennett, 2006)
Numerous studies have shown that the implementation of IPM can decrease the number of
cockroaches, cockroach allergens and improve the quality of life for tenants. Kass et al.,
(August 2009) implemented a building wide IPM intervention in New York City that
included a single visit by a team of pest control technicians. The New York City Housing
Authority (NYCHA) recruited and trained 9 tenants as pest control technicians. Researchers
interviewed tenants, collected dust samples and placed cockroach monitoring devices (glue
traps) before and after the IPM intervention. IPM teams cleaned kitchen cabinets, stoves,
refrigerators, floors and countertops and bathroom floors and counters; they sealed cracks
and crevices and applied boric acid and cockroach baits and gels. The intervention team also
provided cleaning supplies and garbage cans to tenants and told them to use storage
22
containers and dispose to garbage frequently. Residents were also asked not to use Tempo®
(a readily available insecticide powder that is illegal for consumer use), Chinese chalk (a
cockroach chalk available in some local ethnic shops that is illegal for in the U.S.) or
aerosol/spray pesticides. The number of trapped cockroaches in IPM kitchens versus control
apartments (1.0 reference) was 0.57 at three months and 0.86 at six months. Subjective
sightings of cockroaches by tenants in IPM versus control apartments (1.0 reference) at 3
months and 6 months were 0.44 and 0.55 respectively. The odds of reducing the number of
trapped cockroaches in IPM apartments by 25% and 50% after 3 months were 3.1 and 2.7
times the odds in control apartments. Similarly, IPM was associated with lower allergen
levels per gram of dust in kitchens and beds at 6 months. The residents’ use of pesticides in
IPM apartments also decreased. At baseline 18% of IPM apartments reported using Tempo®
or Chinese chalk compared to 8% of control apartments. At 6 months only 2% of the IPM
apartments reported using these pesticides (a 10 fold drop) whereas usage in control
apartments dropped to 5% (half of previous levels). The use of aerosol sprays and foggers
dropped 63% at baseline to 37% at follow-up in the IPM apartments compared to 53% at
baseline and 59% at follow-up in control units. Residents in IPM apartments also reported
more positive feelings about NYCHA building services at follow-up than controls. (Kass et
al., August 2009)
Chew et al. (2006) concluded that high levels of cockroach allergens are determined not
only by how an individual resident controls pests but also how other residents, property
managers and landlords mitigate environmental conditions that promote infestations. Sever
et al. (Sever et al.) and Sarpong et al (Sarpong, Wood, & Eggleston, 1996) demonstrated that
23
cockroach control alone can significantly reduce cockroach allergens in homes. Sarpong
demonstrated that Bla g2 levels in settled dust samples were decreased after extermination
and vacuuming. Greene and Breisch found that the use of cockroach baits dramatically
reduced the use of liquid insecticide. They also found that the use of baits to control
infestations resulted in a 93.1% drop in the number of cockroach complaints. (Greene, Albert
and Breisch, Nancy L.)
Eggleston et al. (1999) tested allergen abatement that included two cycles of cleaning
followed by professional pest control treatments to 13 families in inner-city homes in
Baltimore. (Eggleston et al., October 1999) All homes reported cockroaches; however,
cockroaches were only captured in 10 homes. Within two months 8 of the 10 had no captured
cockroaches, another decreased from 63 to 3 trapped roaches. The tenth home increased from
44 to 63 cockroaches at 2 months and remained high until month 6. At month 8 this home
captured 4 cockroaches. Allergen levels dropped in all the apartments however, the
relationship between extermination and allergen levels was mixed with allergen levels
dropping more in some partially exterminated apartments than those with complete
extermination of cockroaches. Eggleston concluded that cockroach allergens are more stable
than animal (cat) allergens that tend to fall rapidly within 6 months after the animal is
removed. The difference may be due to the fact that cockroach allergen is found in the
insect’s secretions and feces. Also residual allergen may be hidden in small cracks and
crevices that are difficult to clean but may still enter the home environment. (Eggleston et al.,
October 1999).
24
Arbes et al. (S. J. Arbes et al., August 2003) examined the method for abatement of Bla g1
cockroach allergen in low-income urban homes. The intervention consisted of occupant
education, placement of bait stations and professional cleaning. Bla g1 levels decreased from
633 to 24U/g on kitchen floors (96% reduction), from 25 to 4.3 u/g on living room
floors/sofas (83% reduction), 46 to 7.3 on bedroom floors (84% reduction) and 6.1 to 1.0 in
bedroom beds (84% reduction). All decreases were significant (p < .01) except the bedroom
floor (p = 06). The bed allergen level was decreased below the 2U/g sensitization level and
the bedroom and living room floor/sofa were decreased below the asthma morbidity
threshold (8U/g). Arbes et al. (S. J. Arbes et al., January 2004)continued this studied and
found that the decreased cockroach allergen levels were sustained at month twelve with
insecticide application alone. Arbes also reported that control homes in the first 6 months of
the study were provided with insecticide baits for months 6-12. No other intervention was
conducted in either arm. Surprisingly, the cross over controls reported significant decreases
in Bla g1 and Bla g2 cockroach allergens from month 6-12 and at month 12, there was no
significant difference in Bla g1 concentrations in intervention compared to cross-over control
homes (p>.64). This finding contradicts earlier studies that concluded allergen abatement
programs in inner-city homes should include professional control of cockroaches,
professional cleaning and home repair. (S. J. Arbes et al., August 2003) Arbes conducted a
third randomized study to determine if cockroach elimination alone is enough to decrease
cockroach allergens and if it matters who is doing the extermination (university
entomologists vs. commercial pest control professionals).(Arbes S.J. et al, 2004; S. J. J.
Arbes, 2006) All homes in the third study were multi-family apartments in a metropolitan
25
area of North Carolina and all homes had 50-1000 trapped cockroaches at baseline. At 12
months the university arm had significant reductions in allergen levels at all locations within
the apartment while the commercial arm never significantly beat the controls. Arbes et al
concluded that the differences in reduction of allergen levels between university
entomologists and the independent pest control operator were dependent on the schedule and
intensity of pest control treatments, the use of traps to monitor cockroach infestations and the
insecticides used to treat infestations (baits vs. sprays). (S. J. J. Arbes, 2006; Schal, 2008;
Sever et al.) Arbes, et al. also concluded that cockroach reductions alone can achieve large
reductions in cockroach allergen and suggested that if cockroach reduction alone, without
professional cleaning, could decrease allergen levels low enough to have a clinical benefit
and improve asthma morbidity there could be a large cost savings in public health programs
to designed to decrease exposure to Bla g1 and Bla g2 allergens. (S. J. J. Arbes, 2006)
Subsequent work by Sever (Sever et al.) and Schal (2008)concluded that cockroach
reductions alone can achieve large reductions in cockroach allergen without professional
cleaning. Schal and Sever also reported better results when the entire home was treated
versus just the kitchen and bathroom. (Schal, 2008; Sever et al.)
Environmental Health Watch (EHW) conducted a study to determine the efficacy of IPM
in low-income housing in Cleveland, Ohio. (Greenberg, November 2003) The goal of the
intervention was “Precision targeted IPM”. EHW modified standard IPM strategy by
utilizing monitoring traps to determine detailed spatial analysis of pest harborages and
feeding sites to facilitate the placement of pesticides. EHW also used a heat gun in
combination with a vacuum cleaner during inspections to flush cockroaches from hiding
26
areas not normally targeted by pest control technicians. Greenberg described how the
effectiveness of flushing and vacuuming encouraged residents to participate in the IPM
program. (Greenberg, 2004; National Center for Health Housing, )
Cockroach Sampling and Monitoring
Placement of glue traps is a well established method to monitor cockroach infestations, to
determine spatial distribution and to evaluate the effectiveness of cockroach control
programs. (Kaakeh & Bennett, August 1997; C. Wang & Bennett, February 2006; C. Wang
& Bennett, 2006)The Community Environmental Health Resource Center (CEHRC)
Cockroach Sampling Instructions/Procedure (Appendix A) developed by the Alliance for
Healthy Housing (Alliance for Healthy Homes) utilizes the placement of glue traps to
determine the presence and estimate the extent of cockroach infestations. Glue traps, simple
strips of cardboard treated with non-toxic, sticky glue adhesive, come in many different
shapes and sizes. When left out overnight in areas that provide food, water and harborage to
cockroaches i.e. kitchens and bathrooms glue traps are an effective method to identify and
monitor pest infestations. (Alliance for Healthy Homes) The CEHRC sampling procedure has
been successfully employed by a number of researchers to monitor and categorize cockroach
infestations (Wang and Bennett 879-885; Levy et al. 2191-2203).
The CEHRC sampling procedure is considered a valid approach to cockroach sampling.
Wang et al 2006 utilized the CEHRC sampling procedure and reported that the higher the
cockroach count the higher the concentration of Bla g1 and Bla g2 cockroach allergen.
(Wang and Bennett 879-885) CERCH guidelines categorize the extent of infestation based on
the number of cockroaches trapped from none to extremely high. A moderate infestation is
27
categorized as more than 10 cockroaches per trap per night. (Alliance for Healthy Homes)
Wang 2006 found the presence of more than 10 cockroaches resulted in a concentration of
>8 Units of Bla g allergen per gram of dust. This study will use cockroach counts, collected
per the CEHRC sampling procedure, as a proxy for dust sampling of cockroach allergen in
the environment.
IPM Training and Education
Hynes’ (2004) research into the connection between asthma and cockroaches in public
housing led to the development of the Healthy Pest-Free Housing Initiative (HPFHI), which
works with the Boston Housing Authority (BHA) to help reduce cockroaches and other pests
in Boston public housing. The initiative’s integrated pest management (IPM) program
educates residents on such things as home cleanliness and safe use of pesticides. The
program includes a core group of peer educators who live in public housing and help
maintain the IPM efforts by assisting their neighbors and spreading the word within the
public housing communities. (Boston Housing Authority; D. Hahn, ; Hynes et al., 2004;
National Center for Healthy Housing, ) The Boston program offers a “pesticide buyback”
twice a year to allow residents the opportunity to trade unused pesticides for safer products.
The project has also changed pest control contract specifications (Altman, December 2007;
Hynes et al., 2004) and instead of routinely spraying pesticides in the entire complex the pest
control company now inspects and monitors pest activity and only treats apartments with
documented infestations. Additionally, prevention is emphasized and control methods are
tailored to the structural differences of individual developments. (Auman-Bauer, 2008) John
Kane, IPM Coordinator and planner for the Boston Housing Authority, reports a 75 %
28
reduction in work orders dealing with pests since the project began and a huge increase in the
quality of life for residents and staff. The initial costs of the Boston IPM pilot program in
Year 1 were more than four times higher ($17,808) than the traditional pest control program
($6,819); however, by the third year program costs ($6,644) were essentially the same as the
traditional program with much better results. (Boston Housing Authority) Gail Livingston,
Director of Operations and Property Management Boston Housing Authority stated “We do
IPM because it is the right thing to do and because it works. Allowing our residents to live in
a pest-free home is a basic service as well as a huge quality of life issue.”(Altman, December
2007)
Based on the results of the Boston Housing Authority Initiative, a targeted 1-day IPM
training course, “Integrated Pest Management in Multi-family Housing”, was developed as a
joint effort by the USDA Cooperative Extension Service, the United States Department of
Housing and Urban Development (HUD), the Environmental Protection Association (EPA)
and the National Center for Healthy Housing (NCHH). This training program, run by the
Northeastern IPM Center through a Housing and Urban Development (HUD) and U.S.
Department of Agriculture (USDA-CSREES) interagency agreement is intended for
conventional public housing authorities (PHAs) across the US, but can apply to other
affordable housing contexts as well. Now available through the Northeastern IPM Center and
the National Center for Healthy Housing to training partners across the United States,
“Integrated Pest Management in Multi-family Housing” was the educational intervention in
the current study. (National Center for Healthy Housing; Northeastern Integrated Pest
Management Center)
29
METHODS
Study Design
An analytical study design was utilized.
Sample Design
A paired sample design was utilized to measure the effect of IPM education on the
number of cockroaches present in the study property. The paired sample design was
selected because it allows each apartment to serve as its own control. Each data point in the
baseline sample was compared to a corresponding data point in the follow-up sample. The
use of a paired sample design was chosen because it is more definitive than an independent
sample design since most of the confounding factors i.e. physical structure and location of
the property; property management, maintenance, janitorial and pest control practices; tenant
housekeeping practices and tenant characteristics including disability, limited mobility and
decreased vision, present at the baseline measurement were also present at the follow-up
measurement; therefore, the confounders present in the sample will not influence the
comparison of the two measurements. Conversely, an independent sample design would help
rule out other possible causes for a decrease in the number of cockroaches however, the
findings would only be suggestive, because the confounding factors previously identified
(building location, physical condition of the structure, property and pest management
practices and tenant mix and characteristics) that might be present in the two independent
samples could cause an apparent difference when there is no difference.
30
Sampling Universe; Sampling Frame; Study Unit
The sampling universe was all apartments located in multi-story public housing
for the elderly in the United States. The sampling frame used to draw the study
sample consisted of all 200 apartments of the seven story public housing apartment
for the elderly operated by the Houston Housing Authority (HHA) at 6000 Telephone
Rd, Houston, TX. The ultimate study units were individual apartments randomly
selected from the Telephone Rd property. Cockroach counts, previously obtained by
the HHA, were analyzed to evaluate the effectiveness of the targeted IPM education
intervention.
Sampling Design
A random sampling design was utilized in this study. Specifically, the sampling
units (apartments) were selected using a systematic, random sampling approach. To
assure that all levels and wings of the apartment building had an equal chance of
being selected for the study sample, a random starting point was chosen on each level
of the building by pointing to a unit on the building floor plan (Appendix D).
Beginning at the random starting point (apartment) on each level the researcher exited
the apartment, turned right and sampled every third apartment. Every third apartment
on each floor was sampled to assure that apartments in all three wings and all seven
levels of the building were represented in the study. This approach was chosen
because cockroaches like to live in warm, dark cracks and spaces within and between
apartments and are able to travel between apartments via common walls and ceilings.
(Eggleston & Arruda, 2001; J. Hahn & Ascerno, 2005) Consequently, sampling the
31
number of cockroaches in every third apartment minimizes the chance of missing a
pest infestation. This systematic, stratified approach also increases precision and
decreases variable error. In addition to the apartments selected as sample units, the
common laundry and trash chute rooms on each level of the multi-story building were
sampled. The decision to include common areas in the sample was made since these
areas are frequently recognized sources of cockroach infestations in public housing.
(Boston Housing Authority)
Sample Size
A study sample of seventy- three (73) apartments was selected from the sampling
frame. Based on the experience of other researchers working with the Boston
Housing Authority to implement IPM, a medium effect size of 50% was expected. A
10% non response rate, defined as the inability to access an apartment in the selected
sample, was anticipated. Assuming a 95% confidence interval (alpha =.05) the
estimated power of this sample size is >90%.
GROUP COMPARISON
(TWO GROUPS)
Ho: μ1=μ2
enter estimated standard deviation
enter estimate for μ1
20
24
enter estimate for μ2
enter Z for Confidence Interval
enter Z for Power
compute sample size formula
12
1.96
1.282
58
Intervention
In July 2008, 43 participants, representing twenty one different properties owned by the
Houston Housing Authority, attended a 2-day “Essentials for Healthy Homes Practitioner”
32
course, developed by the National Center for Healthy Housing. After this introductory
training the study building, with a known cockroach infestation problem, was selected by the
HHA as a “demonstration property” to implement an Integrated Pest Management program.
In October 2008, property management personnel, building maintenance/janitorial staff,
the service coordinator (social worker) and tenants from the study property attended a
targeted, one day Integrated Pest Management training course. The one day course,
“Integrated Pest Management in Multi-family Housing”, developed as a joint effort by the
USDA Cooperative Extension Service, the United States Department of Housing and Urban
Development (HUD), the Environmental Protection Association (EPA) and the National
Center for Healthy Housing (NCHH), was held onsite in the community room at the study
property. The course was presented by a member of the curriculum development team from
the University of Pennsylvania, Philadelphia, PA. Content included a visual survey and
inspection of the exterior of the building as well as an interior inspection of both an occupied
and unoccupied apartment. Baseline cockroach counts obtained from glue trap monitoring
were shared with the property manager, pest control operator, building maintenance and
janitorial staff, the service coordinator (Social Worker) and tenant representatives.
Data Collection
Cockroaches collected in October 2008 and March 2009, by the Texas Healthy Homes
Training Center on behalf of the Houston Housing Authority, were utilized for this study.
Permission to analyze these de-identified cockroach samples was obtained from the President
of the Houston Housing Authority (Appendix E).
33
The Community Environmental Health Resource Center (CEHRC) Cockroach sampling
instructions (Appendix A) (Alliance for Healthy Homes) were utilized to collect baseline and
follow up cockroach counts. To assure consistency of trap placement, increase data
reliability and decrease survey error, project staff received training prior to sampling.
CEHRC sampling guidelines and instructions were reviewed with all individuals selected to
place and retrieve glue traps. Placement of glue traps was demonstrated in a pilot apartment
identified for training that is not included in the random sample. Training data collectors
prior to the placement of monitoring traps and providing an opportunity to demonstrate their
ability to assemble and accurately place the glue traps increases the reliability and validity of
the data by decreasing the variability among data collectors. Additionally, using the same
individuals to collect both baseline and follow-up data controls variability and increases the
test-retest reliability.
Victor® glue traps were used to collect cockroaches in the sample units. Five glue traps
were set in each apartment and remained in place for two (2) nights. Per HHA lease
agreements management is permitted to enter tenant apartments, for pest control, with prior
notice. A notice was distributed to residents 48 hours prior to placement of glue traps.
(Appendix C). The five glue traps were placed in each unit as follows: two (2) in the kitchen
(#1 by the refrigerator; #2 by the stove); #3 in the bathroom on the floor behind toilet; #4 in
the bedroom under head of bed and #5 the living room behind sofa. An alternate living room
location was utilized in several units due to excessive furniture/clutter and lack of
accessibility to the sofa. An additional, sixth, glue trap was placed in the second bedroom of
each two bedroom apartment in the sample. Residents who were at home when the traps
34
were placed were instructed not to remove traps, avoid sweeping/mopping around traps and
not to leave food or water out over night. Glue traps were left in place for two nights.
Cockroach traps were collected and placed in pre-labeled zip lock sandwich bags. To contain
the cockroaches and prevent inaccurate cockroach counts each glue trap was sealed in an
individual bag. All the traps from each unit were placed in a second larger zip lock bag. The
unit samples were collected by floor and placed in a carry bag.
Data Preparation
Glue traps were labeled with a four digit code. The first digit, 1-7, identified the level in
the building; the second two digits, 01-37, the unit and the fourth digit, 1-5, the placement
location in the unit. Glue traps were coded based on placement in each unit as follows: #1 in
the kitchen by the refrigerator; #2 in the kitchen by the stove; #3 in the bathroom on the floor
behind toilet; #4 in the bedroom under head of bed and #5 the living room behind sofa.
Cockroaches were counted by trap and a “Cockroach Report” (Appendix B) was
completed for each unit. Unit cockroach counts were used to determine the level of
cockroach infestation. The level of infestation for each unit was categorized by number of
trapped cockroaches per CEHRC decision guidelines. (Appendix A).
Category
Cockroaches Trapped
None Trapped
No cockroaches on any trap
Low
One to ten total
Moderate
More than ten cockroaches total but less than ten
cockroaches per trap per night
High
Between ten and 25 cockroaches per trap per night
Extremely High
More than 25 cockroaches per trap per night
35
Data from the individual Cockroach Reports was entered into a summary table. The
accuracy of cockroach counts and categorizations on the summary table were verified and
transcribed into Excel® spread sheet. Once transcribed, the data were checked for
transcription errors and corrected as indicated to assure accuracy.
Missing data points were omitted from statistical analysis. If one or more glue traps were
retrieved from an apartment the unit remained in the study and the cockroach counts were
included in the data analysis. If not all of the glue traps were retrieved, then the
categorization of cockroach infestation in the sample unit was calculated based on the total
number of cockroaches trapped divided by the number of returned traps divided by the
number of nights the traps were in place. For example, the total number of cockroaches
trapped (25) divided by the number of traps retrieved (1) divided by the number of nights
traps were placed (2) equals 12.5/trap/night. Based on the CEHRC decision guidelines, the
infestation in this circumstance would be categorized as High. A total of four apartments
whose tenants refused placement of glue traps (2) or where no traps were returned (2) were
excluded from statistical analysis.
Using the building floor plan (Appendix D), the three wings of the building were
identified as Wing A, Wing B and Wing C. The levels of the building were identified as 1 -7.
The wings are divided by a common elevator lobby. Each level except the first floor has
access to the trash chute that is located in an enclosed room behind the elevator shaft and a
laundry room across from the enclosed trash room. Level 1 has two wings with apartments.
The third wing on this level is occupied by common areas including the kitchen, dining
room, boiler room and trash chute. Levels 2-7 have three wings that are occupied by tenants.
36
Quantitative Analysis Plan
STATA® statistical software package was used for data analysis. Baseline and follow-up
data were analyzed separately and the two samples were compared. Descriptive statistics
were used to organize and display the data and determine the mean, range, standard error and
standard deviation of the baseline and follow up data. Sample units (apartments) were sorted
by the number of cockroaches trapped (from high to low) and the data were examined for
patterns (clusters) of moderate, high or extremely high cockroach infestation by location
within the building or by proximity to one another.
Sample units were sorted by floor and by wing by the number of cockroaches trapped
(from high to low). Descriptive statistics were used to organize and display the data by level
and by wing. Analysis of variance (ANOVA) by building level stratified by wing was
carried out to determine if there is a statistical difference in infestation between levels and/or
wings of the building. It was anticipated that the lower floor(s) of the building were more
likely to show evidence of cockroach infestation due to their proximity to outside
landscaping and the number of entry doors. It was also anticipated that apartments located
above or adjacent to common areas i.e. the trash chute, community rooms (kitchen and
dining) and the boiler room are more likely to have cockroach infestations than those located
a greater distance from these locations. (Altman, December 2007; Bryks, 1999; Livingston,
Kane, & Luce, 2008)
The number of trapped roaches by trap location (1=kitchen refrigerator, 2=kitchen sink,
3=bathroom, 4=bedroom, 5=living room, 6=second bedroom/other) was also analyzed.
ANOVA by trap location was performed to determine if there is a statistical difference
37
between glue trap locations within an apartment. Based on the literature, it was anticipated
that there would be a different level of cockroach infestation between trap locations within
each apartment. Specifically, it was hypothesized that cockroaches were more likely to be
trapped in the kitchen and bathroom compared to the bedroom and living room. (Eggleston &
Arruda, 2001; Kass et al., August 2009)
Paired t-tests comparing baseline glue trap cockroach counts with follow up cockroach
counts were performed to evaluate the effectiveness of the targeted IPM training and to test
the null hypothesis, there is no significant difference in the number of cockroaches after the
implementation of IPM compared to baseline. The sample size was greater than 30 therefore
a normal distribution can be assumed.
Qualitative Analysis Plan
The behavioral response of training participants was determined by obtaining feedback
on the implementation of IPM practices including challenges, successes, outcomes,
remaining issues. Comments regarding changes in pest control practices and the perceived
effectiveness of implementing IPM were obtained from the property manager,
maintenance/janitorial staff and service coordinator (Social Worker). Verbal consent
(Appendix F) was obtained prior to interview. Responses were recorded by job title. Names
of individual staff members remained confidential. Staff members were asked to describe
what if any changes they have made since receiving the IPM training. (Appendix G).
Housing Authority administrative staff was asked the following questions to determine if
there were any modifications to the operating plan or pest control practices as the result of
the training.
38
•
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?
Pest control records were reviewed to determine if any changes were made in the use
of pesticides subsequent to the IPM intervention. The study property pest control
contract and the publicly available HHA annual plan were also examined to determine if
either document had been modified as a result of the knowledge gained from the IPM
training. Tenants were not individually surveyed before or after the IPM training. A
decrease in the number of cockroaches served as a proxy for tenant satisfaction.
39
RESULTS
Five (5) days prior to the Integrated Pest Management in Multi-Family Housing training,
three hundred fifty-five (355) glue traps were placed in 71 of the 73 randomly selected units
(5 traps/unit) to establish a baseline cockroach count. Traps were left in place for two nights.
Two tenants refused trap placement and were omitted from the study. Two other tenants
discarded the glue traps before they could be retrieved. Since baseline counts were missing
for these two apartments they were also omitted from the study. Cockroach counts from the
remaining 69 apartments were analyzed. Summary statistics are reported below in Table 1.
Table 1: Summary Statistics Baseline Compared to Follow-up
Variable
Observations
Mean
Range
0 – 572
Std
Error
13.04
Std
Deviation
107.54
Baseline
Total
Followup Total
69
53.92
69
8.44
0 – 144
2.73
22.49
95% Confidence Interval
27.89
79.95
2.99
13.88
The majority of the cockroaches at baseline and follow up were collected in the kitchen,
adjacent to the refrigerator and stove. The remaining cockroaches were collected in the
bathroom, the bedroom under the head of the bed and the living room. Results are displayed
below in Table 2 and Figure 1.
40
Table 2: Number & Percentage of Cockroaches by Trap Location: Baseline vs Follow-up
Location of Trap Total # of Cockroaches
Trapped by Location
Baseline
Follow-up
Percentage of Cockroaches
Trapped by Location
Baseline
Follow-up
Refrigerator
1448
145
40%
25%
Stove
890
124
25%
22%
Bathroom
443
146
12%
25%
Bedroom (under
the head of bed)
Living Room
587
92
16%
16%
263
68
7%
12%
Figure 1: Number of Cockroaches by Location Baseline compared to Follow-up
41
The number of apartments with extremely high (>25 cockroaches/trap/night), high
(>10cockroaches /trap/night) and moderate (more than 10 total but< 10 cockroaches
/trap/night) levels of infestation demonstrated a decrease at follow-up compared to baseline.
Conversely, the number of apartments with no infestation showed an increase at follow-up
compared to baseline. The number of apartments with low infestations (1-10 cockroaches
total) remained about the same at follow-up compared to baseline. Results are shown in
Figure 2.
Figure 2: Categorization of Cockroach Infestation Baseline compared to Follow-up
Paired t-tests comparing the difference between mean cockroach counts at baseline and
follow-up by location were all significant: total, kitchen, refrigerator, stove, bathroom,
bedroom and living room. Results are reported below in Table 3.
42
Table 3: Paired t-tests difference between baseline and follow up by 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
Total # Cockroaches/unit
45.48529
t=3.6229, 67df, Pr(T>t) = 0.0003
Laundry rooms had low or no cockroach infestations at both baseline and follow-up. Glue
traps placed behind the washing machine in the laundry room on levels 2-7 captured a total
of two cockroaches at baseline and one cockroach at follow-up. Six of the seven trash rooms
had low or no cockroach infestations at baseline (1 -5 cockroaches). One trash room had a
high infestation (42 cockroaches) at baseline which was nonexistent at follow up. Traps
placed next to the trash chute in the trash rooms on level 2-7 at baseline captured a total of 52
cockroaches. None were trapped at follow-up. See results in Table 4.
43
Table 4: Cockroach Counts in Laundry and Trash Rooms Baseline vs Follow-up
Level *
Laundry
Trash Rooms
*No laundry or
trash chute on
level 1
2
Baseline
Follow-up
Baseline
Follow-up
0
0
0
0
3
0
1
3
4
1
0
42
5
0
0
5
6
1
0
1
Not retrieved
Room clean
Not retrieved
Room clean
Not retrieved
Room clean
0
7
0
0
1
0
A one-way ANOVA was performed to test the null hypothesis there is no difference in
cockroach infestation among levels of the building. The researcher anticipated that the
number of cockroaches would be greater on the ground level than on the upper floors of the
multi-story apartment building. There was no significant difference in the number of
cockroaches per unit between levels of the multi-story apartment building at baseline or at
follow-up. Based on this result, the null hypothesis that there is no significant difference in
the number of cockroaches between levels was supported and the alternate hypothesis that
there are significantly more cockroaches in apartments located on the ground level was
rejected. Results of one way ANOVA by level are shown in Table 5.
44
Table 5: One way ANOVA by Level Baseline vs Follow-up
Level
1
Mean number of cockroaches
by apartment at baseline
F= 0.77; Prob > F = 0.59
2
Mean number of cockroaches
by apartment at follow-up
F = 0.77; Prob > F = 0.59
2
2
53
20
3
31
5
4
92
8
5
56
13
6
42
2
7
85
8
Total
53
8
A one way ANOVA was performed to test the null hypothesis that there is no difference
in the numbers of cockroaches by wing of the building. Based on the findings of the Boston
Housing Authority it was anticipated that greater numbers of cockroaches would be present
in the wing directly over the boiler room and adjacent to the trash chute. A significant
difference in cockroach counts between wings was found at baseline. Based on this result,
the null hypothesis that there is no significant difference in the number of cockroaches
between wings was rejected in favor of the alternate hypothesis that there are significantly
more cockroaches in apartments located in Wing C, adjacent to the trash chute and above
common areas and the boiler room, than in Wings A or B. There was no significant
difference between wings of the building after the intervention. The loss of significance at
follow-up supports the hypothesis that IPM education and the implementation of IPM
45
principles are effective means to change the behavior of maintenance staff, pest control
professionals and tenants. Results are displayed in Table 6 below. Furthermore, a one-way
ANOVA of the difference in mean cockroach counts by wing revealed a significant
difference in the improvement between wings (Table 6). This finding suggests that the
impact of training on behavior had a greater impact on decreasing the number of cockroaches
present in the wing over the boiler room and common areas.
Table 6: One way ANOVA by Wing Baseline vs Follow-up
21.89
Mean number of
cockroaches by
apartment at followup
F = 0.19; Prob > F =
0.82
10.04
Mean difference in
number of
cockroaches by
apartment
F = 5.52; Prob > F =
0.0061
11.85
B
36.6
8.94
27.71
C
101.79
6.13
95.66
Total
53.32
8.44
45.48
Wing
Mean number of
cockroaches by
apartment at baseline
F = 4.26; Prob > F =
0.02
A
A one-way ANOVA by level by wing revealed a significant difference between wings on
level 5 of the apartment building at baseline. There was no significant difference between
wings by level at follow-up. Results are shown below in Table 7. Review of the baseline
findings by unit location suggests that this finding may be associated with a cluster of
neighboring apartments connected by a common ceiling. Two adjacent apartments were
categorized as having a high level of infestation (between 10 and 25 cockroaches per trap per
46
night) at baseline. At follow-up both apartments had fewer cockroaches (88 and 13 compared
to 208 and 117) and were categorized as having moderate levels of infestation.
Table 7: One-way ANOVA by Level by Wing Baseline vs Follow-up
Wing
A
Mean difference in number
of cockroaches by apartment
at Baseline Level 5
F = 8.03; Prob > F = 0.002
29
Mean difference in number
of cockroaches by apartment
at Follow-up Level 5
F = 3.88; Prob > F = 0.08
2
B
163
51
C
20
2
Total
56
13
Changes in Behavior and Operating Procedures
Following the October 2008 training the property manager and housing authority staff, in
conjunction with the pest control professional, developed an Integrated Pest Management
plan for the study building. Utilizing the baseline glue trap data (Appendix H), IPM training
content and specific technical pest control recommendations provided during and following
the training by the USDA Northeast IPM Center and the Texas Healthy Homes Training
Center the HHA team worked together to implement the IPM plan. Elements of the IPM plan
instituted at the study property included deep cleaning of a select number of apartments with
extremely high cockroach infestations, repair of plumbing leaks and more frequent removal
of trash from the barrels at the base of the trash chute. The plan also included the introduction
47
of bait stations and gel bait and closer attention to and enforcement of tenant lease provisions
regarding cleanliness and sanitation of apartments.
The Service Coordinator (social worker), assigned to the study property reviewed the
baseline findings and identified apartments occupied by tenants with limited mobility, vision
or disability that needed assistance to perform the activities required to eliminate or mitigate
cockroach infestations in their apartment. The Service Coordinator assisted these tenants to
apply for personal and domestic help. The social worker also secured social worker interns
from local universities and utilized volunteers from community based organizations to assist
a select group of tenants to implement IPM controls in their apartments.
Subsequent to the IPM educational session and the implementation of the IPM program at
the study building the pest control contractor modified his approach to pest control.
Specifically, in addition to the monthly treatment of kitchens and bathrooms with boric acid,
he began treating bedrooms and living rooms where there was monitoring evidence of an
infestation. The pest control operator also agreed to use gel bait instead of or in addition to
boric acid in apartments where boric acid alone had not been effective. At the request of the
property manager and tenants, the pest control professional now uses gel bait and bait
stations (in addition to or in lieu of boric acid) to control cockroaches. In the months
following the IPM training, the pest control operator also utilized the technical expertise of
the USDA Cooperative Extension Service Northeast IPM Center personnel.
Prior to the IPM training the boiler room and maintenance shop, including the collection
barrel at the base of the trash chute, were not being treated for cockroach infestations. After
attending the training the lead maintenance staff began placing bait stations in these areas.
48
At follow up, maintenance and janitorial staff reported seeing fewer cockroaches in these
areas. This action on the part of the maintenance staff is believed to be the primary reason
that there was a significant decrease in cockroach infestations in Wing C (the wing over the
boiler room and common areas) at follow-up compared to baseline.
Despite the positive behavioral changes demonstrated after the training by the pest control
professionals and the maintenance staff, neither housing authority personnel nor pest control
staff have implemented routine glue trap monitoring to identify and respond to cockroach
infestations. Additionally, the pest control contract has not been revised to include IPM
specifications.
In 2008, after the IPM training program, the Houston Housing Authority (HHA) adopted
an IPM policy and amended the annual operational plan to include a section on IPM.
Documents confirming this action are available for public view on the HHA website. The
maintenance section of the adopted operational plan includes a section on IPM and
incorporates the 7 Steps to Healthy Housing. The revised HHA plan also requires property
managers to perform quarterly housekeeping inspections for all rental properties owned by
the housing authority. During follow-up conversations, the property manager of the study
property confirmed that quarterly inspections are now being completed and that there is
greater attention to tenant lease provisions regarding cleanliness and sanitation.
In the fall of 2009, nine months after the follow-up monitoring at the study
“demonstration” property, the HHA requested assistance from the Texas Public Health
Training Center to implement an Integrated Pest Management program at another multi-story
49
apartment building for the elderly with a known cockroach infestation. The initial training
for the staff and tenants of the second building was completed in February 2010.
50
CONCLUSIONS
Integrated pest management education and the adoption of IPM strategies is a viable
alternative to traditional pest control methods employed to combat cockroach infestations.
The results of the current 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). Positive changes in behavior by members of the IPM team and changes in the
HHA annual operational plan were also found.
Baseline and follow-up results in the current study determined that the kitchen and
bathroom account for 99% of the total cockroach infestations in the sample. These findings
are consistent with other research studies that identified the kitchen and bathroom as major
sources of infestation due to the accessibility of food, water and harborage (Eggleston 2001;
Wang 2007; Arbes 2003; Kass et al 2009; Chew 2006).
Similar to the Boston Housing Authority reports, the current study found significantly
more cockroaches in apartments that were located above the boiler room and common areas.
Specifically, Wing C located above the boiler room had significantly higher cockroach
counts at baseline that disappeared at follow-up. The loss of significance at follow-up
suggests that the IPM education program was effective and that there was a change in the
behavior by the maintenance staff and pest control professionals. Additionally, the one-way
ANOVA of the difference in mean cockroach counts by wing showed a significant difference
in the improvement between wings A, B and C. The finding that Wing C improved more
than Wing A or B suggests that the positive impact of training on behavior had a greater
51
impact on decreasing the number of cockroaches present in the wing over the boiler room
and common areas.
One unexpected result in the current study was that there was no significant difference in
cockroach infestations among levels of the building. The researcher anticipated that the
number of cockroaches would be greater on the ground level than on the upper floors of the
multi-story apartment building; however, there was no significant difference in the number of
cockroaches per unit between levels of the multi-story apartment building at baseline or at
follow-up. This unexpected result appears to be due to the segregation of tenants with
“providers” who assist with activities of daily living (ADLs) including cooking and cleaning
on the ground floor. The difference in sanitation is thought to be the primary reason for the
absence of a significant difference in cockroach counts between levels. Also, the current
study did not find significant cockroach infestations in laundry rooms. In the current study
laundry rooms were very clean and essentially free from cockroach infestations both at
baseline and follow-up. Additionally, with the exception of one trash room at baseline, the
current study did not identify any major cockroach infestations in the trash chute rooms.
The decrease number of cockroaches at follow-up and the loss of significance by wing on
Level 5 after the intervention demonstrates how adjacent apartments connected by common
walls and ceilings, the built environment, can impact the spread of cockroach infestations.
Review of the baseline findings by unit location suggests that this finding may be associated
with a cluster of neighboring apartments connected by a common ceiling. The result also
suggests that the IPM education program was effective and that there was a change in
52
behavior by the maintenance staff, pest control professionals and tenants who occupied these
connected units.
Clear communication of policies, a team approach and commitment of team members are
key components of a successful IPM plan. IPM education helped individuals members of the
IPM team clarify and better understand their role relative to other members of the IPM team.
Once roles are identified it is important that members commit to the pest control plan and are
held accountable for their actions by the property manager. It is also important to educate
residents and to update leases to include the tenant’s role in IPM.
Identification and monitoring of pest problems are two other components of an effective
IPM program. Visual inspection and the use of glue traps are essential to the rapid
identification and mitigation of cockroach infestations. Glue traps, simple strips of cardboard
treated with non-toxic, sticky glue adhesive, come in many different shapes and sizes. When
left out overnight in areas that provide food, water and harborage to cockroaches i.e. kitchens
and bathrooms glue traps are an effective, low cost method to identify and monitor pest
infestations. Establishing baseline cockroach counts and sharing the results with the property
management team, tenant representatives and the pest control contractor inspired corrective
action and commitment to the plan. Follow-up monitoring provided feedback and reinforced
positive behavioral changes. In the absence of baseline data and follow-up monitoring the
response to the IPM training may not have achieved the same significant results. Despite the
positive behavioral changes demonstrated after the training by the pest control professionals
and the maintenance staff, neither housing authority personnel nor pest control staff have
implemented routine glue trap monitoring to identify and respond to cockroach infestations.
53
Additionally, the pest control contract has not been revised to include IPM specifications.
Monitoring is an essential component of IPM and the absence of ongoing monitoring may
result in backsliding of behavior and the reoccurrence of significant cockroach infestations in
the future.
Prior to IPM training, the Property Manager reported a minimal cockroach problem in the
study property. Baseline monitoring identified apartments with previously unknown or
unreported problems. This finding is consistent with the findings of Wang et al (2007) who
found only 22% of tenants with cockroach infestations reported the infestation to
management. This finding also supports the results of Curtain-Brosnan (2008) who
concluded that negative reports of pest infestation are not sufficient evidence of low exposure
to pests and allergens. The current findings also support those of Eggleston (2001) who
reported that the number of cockroaches people see is small in comparison to the entire
population.
Property management and maintenance staff reported that many residents used aerosols
and pump sprayers inside their apartments to control cockroaches. One tenant with a chronic
respiratory condition and an extremely high number of roaches had multiple cans of aerosol
pesticide strategically located throughout his apartment, on the kitchen counter, bathroom
counter, coffee table and bedside stand. This anecdotal finding is consistent with Wang
(2009) who found visible evidence of pesticide use by tenants to control cockroaches and
Chew et al (2006) who reported that the use of low-toxicity pesticides is less common in
buildings occupied by senior citizens compared to family units. The current study supports
the evidence of Wang (2006), Arbes (2003 & 2004), Kass et al (2009) and the Boston
54
Housing Authority (Livingston,2008; Auman-Bauer, 2008) that IPM education can change
behavior and ultimately decrease pesticide exposure by controlling cockroach infestations.
Further study examining the use of pesticides by elderly residents living in public housing is
indicated to determine if unresolved infestations promote the unnecessary and inappropriate
use of toxic pesticides in the built environment and if education can change tenant behavior.
Limitations
The single residence and small sample size of the current study limit the generalization of
study results to the larger population of all the public housing units in the United States. The
single multi-story apartment building may not be representative of all elderly housing units in
the United States and the response to cockroach infestations in family housing units may be
different than that found in elderly housing. Another limitation was the responsiveness and
previous interest in IPM by the pest control contractor who provided services to the study
property. Previous exposure to IPM principles combined with the baseline evidence that
demonstrated lack of cockroach control may have influenced the pest control contractor and
made him more receptive to a change in pest control practices than other contractors with no
knowledge of IPM might have been. A third issue was the motivation and commitment of the
property manager and staff to rid the property of cockroaches. Finally, the availability of
support staff (Social Worker) to assist elderly tenants secure the help they need to maintain
their apartment and independence may not be universally accessible.
Recommendations
HUD regulations currently require PHAs to adopt an IPM policy as part of their annual
operational plan; however, HUD regulations still do not require PHAs to implement IPM in
55
their properties. Regulations should be amended to require IPM specifications in pest control
contracts. The support of the pest control professional is essential to the success of an
integrated pest management plan. The pest control professional providing service to the
study property was knowledgeable about IPM, attended the IPM training and took corrective
action when provided with baseline cockroach counts. However, since not all PCP are as
supportive of IPM, pest control contracts should clearly specify the utilization of IPM
methods to control cockroach and rodent infestations and limit the use of highly toxic
pesticides. At a minimum the contract should require that the PCP provide glue traps to the
PHA to aid in the identification of cockroach infestations and specify the use of less toxic gel
baits before other methods are utilized.
Continuous monitoring could be accomplished by identifying and training resident “peer”
educators to place glue traps, provide tenant education and assist neighbors who are
physically unable to prepare their apartment for treatment by the pest control professional.
This approach has been implemented successfully by both the Boston Housing Authority
(Hynes, 2004; Auman-Bauer, 2008) and the New York City Housing Authority (Kass, 2009).
The availability of a HEPA vacuum that could be loaned to tenants and used by property
maintenance and janitorial staff at apartment turnover would minimize and knockdown
cockroach populations and allergens. This recommendation supports the findings of Kass,
(2009), who reported lower cockroach allergen levels per gram of dust in kitchens and
bedrooms after IPM intervention teams provided cleaning supplies and assisted tenants to
clean their apartments and Sarpong et al (1996), who demonstrated that Bla g2 levels in
settled dust samples were decreased after extermination and vacuuming.
56
Further study to determine the prevalence and morbidity of asthma and other chronic
respiratory diseases in the elderly population living in public housing is warranted. 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.
Cockroach infestations in multi-story, multi-family housing are not solely determined by
the actions of individual tenants. How other residents, property managers, pest control
professionals and landlords/owners control pests and mitigate the conditions that support pest
infestations are also important factors. The recognition that cockroach infestations are at least
partially determined by the built environment, the physical structure and failure to maintain
the property supports the spread of IPM education and the adoption of IPM practices by
public housing authorities aimed at decreasing cockroach infestations, exposure to cockroach
allergens and the inappropriate use of pesticides. Ongoing inspection, monitoring and
identification of pests combined with corrective action by team members to eliminate food,
water and harborage for pests and the judicial use of low risk pesticides only as needed have
the potential to improve the living conditions and health status of elderly residents living in
public housing. Overtime, it is anticipated that the adoption of IPM will decrease health care
costs associated with asthma and the utilization of costly emergency department visits. If the
use of IPM does not correct the situation then as Rauh, et al. (2002) suggested “the role of
public policy, city planning and code enforcement may offer a more structural approach to
public health intervention”.
57
APPENDICES
58
Appendix A: CEHRC Cockroach Sampling Checklist and Sampling Instructions
59
60
61
62
63
64
65
66
Appendix B: CEHRC Cockroach Report
67
68
Appendix C: Notice to Resident
69
Notice to Resident
October 13, 2008 Dear Resident, On October 15‐17, 2008, we will enter your home to inspect for roaches. IT IS NOT NECESSARY TO EMPTY YOUR CABINETS. If you are seeing roaches or other pests, leave a note indicating where. All apartments will be inspected. Five (5) roach traps will be placed in your apartment, in the kitchen, the bathroom and under the bed/sofa. The traps will be removed on October 20‐22, 2008. If you have any questions please call the office. Thank you for your cooperation. Estimado Residente, El 15‐17 de Octubre de 2008, entraremos a inspeccionar par alas cucarachas. NO ES NECESARIO VACIAR SUS GABINETES. Si usted vé cucarachas, deje una nota que indica adonde. Todas los apartamentos necesitan estar inspecionados. Cinco (5) atrapadoras de cucarachas se pondrán en el apartamento en la cocina, el baño y debajo de la cama/sofa. Las atrapadoras se removeran el 20‐22 de Octubre de 2008. Si usted teine alguna pregunta, llame a la oficina. Gracias por su cooperacion. 70
Cockroach Glue Traps
Atrapadoras de Cucarachas
Photo Courtesy of January Jones
Cockroaches on Glue Traps
Photo Courtesy of January Jones (Atrapadoras de Cucarachas)
Bathroom El baño
• Behind toilet
• Under Sink
• In towel closet
Photo courtesy of Changlu Wang, Purdue University
Cockroach Glue Trap along baseboard in bathroom
Kitchen La
Cocina
• On the floor
by the
refrigerator
• On the floor
by the oven
• In the pantry
behind the
food
• Under sink
Other areas
• By washer or
dryer
• Behind bed
(la cama)
• Under couch
(el sofa)
Photo courtesy of Changlu Wang, Purdue University
Cockroach Glue Trap along refrigerator
71
En la cocina
Appendix D: Floor Plan of Multi-Story Public Housing Apartment Building
72
Floor Plan of Multi-Story Public Housing Apartment Building
73
Floor Plan of Multi-Story Public Housing Apartment Building
74
Appendix E: Letter of Permission
75
76
Appendix F: Verbal Consent Script
77
Verbal Consent Script
Hello _______, this is Nancy Crider from the University of Texas School of Public Health.
I’m calling to follow up on the Integrated Pest Management program that you helped to
implement last year at 6000 Telephone Rd. This follow up evaluation is part of my
dissertation for the University of Texas Health Science Center School of Public Health. With
the permission of the Housing Authority I am evaluating the effectiveness of the IPM
Training Program. I would like set up a time to meet with you to ask a few questions about
the impact the training program had on how you and other staff members identify, monitor
and manage cockroach infestations. It will only take 10 – 15 minutes to complete the survey.
This survey is completely voluntary. You don’t have to answer any of the questions if you
don’t want to. Your name will not be identified and your boss will not know how you
answered the questions.
Is this okay with you?
If the participant responds yes, the researcher will continue with response #1. If a negative
response is received #2 will be used.
1. Great! I’d like to set up a time to talk with you privately. The survey can be
completed either in person or by telephone, whichever is most convenient for you.
When is the best time for you?
2. I understand that you prefer not to be interviewed however, your feedback is
important. I want to assure you that the survey will only take a few minutes and you
don’t have to answer any of the questions if you don’t want to. Is this okay with
you?
If the response to #2 is positive an interview will be scheduled. If it is negative the
participant will be thanked for his/her time and the researcher will close the conversation
That’s okay. If you change your mind please let me know. Thank you for your time.
78
Appendix G: Follow-up Survey Questionnaire
79
80
Appendix H: Summary of Baseline Unit Cockroach Reports
81
Summary of Baseline Unit Cockroach Reports (Page 1 of 3)
82
Summary of Baseline Unit Cockroach Reports (Page 2 of 3)
83
Summary of Baseline Unit Cockroach Reports (page 3 of 3)
84
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