NEHA October 2022 Journal of Environmental Health

October 2022 • Journal of Environmental Health 25 abilities attributed to childhood lead poisoning cases have been reduced. Lead and healthy homes hazards are systematically identified in program-qualified housing by grantee personnel before remediation plans are developed and implemented. Assessment approaches include environmental sampling, building performance testing, resident interviews, and visual assessment. In 2018, the City of Las Vegas Oce of Community Services, with the University of Nevada, Las Vegas as a subgrantee, was awarded a HUD Lead Hazard Control and Healthy Homes Grant. Known as the Las Vegas Lead Hazard Control and Healthy Homes Program (Las Vegas LHCHHP), the initiative enrolled 62 homes through March 2020. Demographics and Housing Characteristics of Las Vegas According to the U.S. Census Bureau (2021) and the City of Las Vegas 2015–2020 Consolidated Plan, Las Vegas is home to >645,000 residents and is the most densely populated city in Nevada. In terms of race and origin, 58.5% of Las Vegas residents identify as White, 33.2% identify as Hispanic or Latino, 12.1% identify as Black or African American, 6.7% identify as Asian, 1.0% identify as American Indian and Alaska Native, <1.0% identify as Native Hawaiian and Other Pacific Islander, and 8.2% report being two or more races (U.S. Census Bureau, 2021). Of 211,690 households within the city limits, 81,930 (39%) reported having an income <80% of the area median income (City of Las Vegas, 2015). According to City of Las Vegas 2015–2020 Consolidated Plan estimates, there are similar numbers of owner- and renter-occupied housing units built before 1980 (26,529 and 26,585, respectively). Over 50% of both owner- and renter-occupied housing had children present in the home. Approximately 30% of Las Vegas households faced housing issues including substandard housing conditions, overcrowding, and housing cost burden in 2015. Nearly 1,800 households reported issues with plumbing or kitchen facilities. Overcrowding, defined as having 1.01–1.50 persons per room, was identified in 4,180 renter-occupied households and 1,195 owner-occupied households; severe overcrowding, defined as ≥1.51 individuals per room, was identified in 240 owner-occupied households and 1,970 renter-occupied households. Housing cost burden of >50% of household income was reported by 18,760 renter-occupied households and 15,675 owner-occupied households, and there were 1,775 renter-occupied households and 910 owner-occupied households that were zero- or negative-income (City of Las Vegas, 2015). Study Contributions As the first HUD-funded Lead Hazard Control and Healthy Homes Grant within the city limits of Las Vegas, the Las Vegas LHCHHP was able to provide updated and more detailed information about the quality of qualified low-income housing stock in Las Vegas. The analysis of program findings here also o¢ers additional insight into the types and locations of lead-based paint and other health and safety hazards throughout the participating homes. Methods Recruitment Methods The Las Vegas LHCHHP was restricted to homes within Las Vegas city limits, with priority given to homes with children <5 years. We used a variety of recruitment methods to spread program awareness and enroll participants into the program, including doorto-door canvassing of target ZIP Codes (i.e., 89101, 89106, 89107, and 89108), posting on the City of Las Vegas website, news media outlets, community outreach events, and mailing letters to homeowners. The primary and most e¢ective recruitment method was the mailing of letters to homeowners and property owners. Participants interested in the program completed a prequalification intake form to determine initial eligibility based on their estimated household income, construction year of their home, location, and if they had a pregnant individual and/or any children <6 years living in or visiting the home frequently. If a participant prequalified for the program based on this information, an application would be mailed, emailed, or dropped o¢ at their home, depending on the occupant’s preference. Program sta¢ were then readily available to address any questions, concerns, or scheduling requests for application processing appointments. All study activities, including the consent process, were approved by the University of Nevada, Las Vegas Institutional Review Board (Protocol #1128104). Enrollment Requirements To be enrolled in the program, the housing unit had to be a permanent structure within the City of Las Vegas and built prior to 1978, as verified by the Clark County Assessor’s records. For an owner-occupied home, the household had to have a pregnant individual or a child <6 years who lived in or visited the home frequently. Verification of each child’s age (e.g., birth certificate, immunization record, or visiting child form), applicant’s identification (e.g., driver’s license or passport), and income verification of all occupants ≥18 years (e.g., recent pay stubs, Social Security income statements, unemployment benefits) were required. Applicants also had to provide evidence of homeowners or renters insurance where applicable, and they had to acknowledge receipt and understanding of the U.S. Environmental Protection Agency’s Renovate Right educational brochure regarding safe renovation procedures in pre-1978 housing. Complete applications with agreement to the Las Vegas LHCHHP terms and conditions were required to qualify. Applicants living in rental properties also needed to provide a copy of their rental agreement as well as identification for all persons on that agreement. Rental properties were not required to have a child <6 years and/or a pregnant individual living there, but the property owner did have to agree to rent their home for 3 years to a low-income family. Once the application and all required documents were obtained, the final qualification for the program was based on calculation of the household’s total income by household size using HUD income standards. Lead Inspection and Risk Assessment Once a participant qualified for the program, a lead inspection and risk assessment (LIRA) was scheduled. This surface-by-surface inspection of all interior and exterior painted surfaces involved testing with a Viken Pb200i portable X-ray fluorescence (XRF) analyzer. Inspection is conducted by lead risk assessor sta¢ who are certified by the U.S. Environmental Protection Agency. Dust and soil sampling were also conducted in addition to an inspection of the building conditions. HUD standards were used to identify hazards from lead dust and soil sampling results once they were analyzed by a laboratory that was accredited by the National Lead Laboratory Accreditation Program. Once deteriorated