title: A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs.
abstract: BACKGROUND
  Although indoor environmental conditions can affect pediatric asthmatic patients, few studies have characterized the effect of building interventions on asthma-related outcomes. Simulation models can evaluate such complex systems but have not been applied in this context.
  
  
  OBJECTIVE
  We sought to evaluate the impact of building interventions on indoor environmental quality and pediatric asthma health care use, and to conduct cost comparisons between intervention and health care costs and energy savings.
  
  
  METHODS
  We applied our previously developed discrete event simulation model (DEM) to simulate the effect of environmental factors, medication compliance, seasonality, and medical history on (1) pollutant concentrations indoors and (2) asthma outcomes in low-income multifamily housing. We estimated health care use and costs at baseline and subsequent to interventions, and then compared health care costs with energy savings and intervention costs.
  
  
  RESULTS
  Interventions, such as integrated pest management and repairing kitchen exhaust fans, led to 7% to 12% reductions in serious asthma events with 1- to 3-year payback periods. Weatherization efforts targeted solely toward tightening a building envelope led to 20% more serious asthma events, but bundling with repairing kitchen exhaust fans and eliminating indoor sources (eg, gas stoves or smokers) mitigated this effect.
  
  
  CONCLUSIONS
  Our pediatric asthma model provides a tool to prioritize individual and bundled building interventions based on their effects on health and costs, highlighting the tradeoffs between weatherization, indoor air quality, and health. Our work bridges the gap between clinical and environmental health sciences by increasing physicians' understanding of the effect that home environmental changes can have on their patients' asthma.
authors.affiliation: Department of Environmental Health, Boston University School of Public Health, Boston, Mass; Department of Environmental Health, Harvard School of Public Health, Boston, Mass. Electronic address: pfabian@bu.edu.
authors.forename: Maria Patricia
authors.initials: MP
authors.lastname: Fabian
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, Mass.
authors.forename: Gary
authors.initials: G
authors.lastname: Adamkiewicz
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
authors.forename: Natasha Kay
authors.initials: NK
authors.lastname: Stout
authors.affiliation: Department of General Pediatrics, Boston Medical University School of Medicine, Boston, Mass.
authors.forename: Megan
authors.initials: M
authors.lastname: Sandel
authors.affiliation: Department of Environmental Health, Boston University School of Public Health, Boston, Mass; Department of Environmental Health, Harvard School of Public Health, Boston, Mass.
authors.forename: Jonathan Ian
authors.initials: JI
authors.lastname: Levy
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects; D016902:Air Pollution, Indoor / Q000009:adverse effects; D001249:Asthma / Q000191:economics / Q000276:immunology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008954:Models, Biological; D052638:Particulate Matter / Q000009:adverse effects; D010571:Pest Control
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Air pollution; DEM; Discrete event simulation model; ED; Emergency department; FEV(1)%; IPM; Integrated pest management; MEPS; Medical Expenditure Panel Survey; NO(2); Nitrogen dioxide; PM(2.5); Particulate matter less than 2.5 μm in diameter; Percent predicted forced expiratory volume in 1 second; allergen; asthma; discrete event simulation; energy savings; green building; housing; indoor air; intervention; lung function
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