Home, sweet home. For many people, homes are places of refuge and warmth, housing individuals, families and beloved pets. But what if homes also house triggers for one of the most complicated and puzzling public health epidemics to be identified in the past 20 years?

In an ambitious undertaking called the Healthy Public Housing Initiative, HSPH researchers and others are collaborating with Boston’s biggest landlord–the Boston Housing Authority (BHA)–to respond to high levels of asthma in low-income communities. Energy efficiency issues are also being addressed.

The BHA owns approximately 14,500 residences populated by an estimated 26,000 people.

"We have residents who are struggling with issues of asthma," said Kate Bennett of the housing initiative and the BHA. "We would like to understand where there are housing factors present and what the BHA and residents can do to mitigate their effects."

The wide coalition of partners of the housing initiative includes HSPH, Boston Housing Authority, Boston Public Health Commission, Boston University School of Public Health, Committee for Boston Public Housing, Franklin Hill Tenant Task Force, Peregrine Energy Group, South Boston Community Health Center, Tufts University School of Medicine, Urban Habitat Initiatives, and West Broadway Tenant Task Force.

More than 15 million Americans are asthmatic, according to the National Institutes of Health. The prevalence and severity of the disease are disproportionately higher among children and African Americans. Hispanics are also becoming increasingly ill with the disease. People living in low-income and inner-city communities are especially at risk.

In Boston, Roxbury has the highest asthma hospitalization rates, with six to eight times the rate in Back Bay. Dorchester and the South End aren’t far behind, with four and a half to six times the Back Bay rate.

"There is a growing acknowledgment that housing has a lot to do with increasing asthma rates because this is where you find many of the triggers and the sensitizers to the condition," said Jack Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation in the Department of Environmental Health at HSPH, who helps coordinate the housing initiative.

Among the asthma-inducing culprits are dust mites, cockroaches, molds, rodents, pet dander and indoor air pollution. Other stimulants include cigarette smoke, exercise, pollen and hygiene.

In the Healthy Public Housing Initiative, collaborators are attacking as many asthma triggers as feasible.

The plan is to recruit 60 families living in the Franklin Hill public housing development in Dorchester, each of which has an asthmatic child. The study is longitudinal. Surveyors will collect health data from the families before and after improvements are made to housing conditions.

Air quality in each family’s home, as well as allergens and pesticides in house dust, will be measured.

Comprehensive interventions will be put into place. Air filtration systems will be installed. Molds will be removed. Ventilation systems will be upgraded, as well as heating controls. Insulation will be bolstered to deter build up of moisture inside apartments.

Then, asthma symptoms, lung performance, medication, school absences and health care visits will be tracked over several months.

In another program to be incorporated into the housing initiative work, entire buildings in Franklin Hill will be asked to voluntarily enroll in an aggressive pest management program to help rid the sites of rodents and cockroaches.

Education of residents is an important component of the study. Participants will learn about asthma and other health risks, the importance of quitting smoking, possible pet triggers, and ways to use hygiene to minimize asthma attacks, such as cleaning to get rid of mites.

"None of this will ever work if individuals don’t have the knowledge and means to be vigilant of risk factors for themselves," said Spengler.

Kimberley Vermeer of Urban Habitat Initiatives agrees. "This project is about improving the health and well-being of residents while giving them the power to advocate for themselves for safe and decent housing," she said.

Asking public housing residents to be remarkably active in the study was important to the housing initiative collaborators, some of whom are tenant task force members. Interested residents are being formally trained and paid as the study’s "workforce," recruiting neighbors, conducting surveys and taking air measurements that will help form the study’s foundation.

Some residents have already participated in related pilot programs and focus groups to help direct the housing initiative’s work.

Project collaborators will also be monitoring cost/benefit factors of the interventions they introduce.

"It is an ambitious goal, but we want to acknowledge that there are serious health costs as a result of the way we are not investing in public housing," said Vermeer.

The project is attracting considerable good will, said Spengler. The Sharper Image Company has donated more than 60 Ionic Breeze air cleaning devices, and the Simmons Company has donated beds called BodyCare Kids, featuring an allergen-inhibiting fiber named AllerFree.

The Healthy Public Housing Initiative is not only working at Franklin Hill. In another study, collaborators are working at the West Broadway public housing development in South Boston to research the health benefits and costs of improving energy efficiency in residences. Ironically, some measures to bolster energy efficiency may be leading to unexpected health consequences. For example, the installation of airtight windows reduces drafts but also traps possibly poor quality air in apartments.

John Snell of Peregrine Energy and the housing initiative is working to make an energy and water efficiency master plan for BHA housing.

"As energy upgrades in public housing are assessed, we want to make sure that we can integrate energy efficiency without worsening health conditions," he said.

The Healthy Public Housing Initiative emerged from individual projects. The BHA, Vermeer, Spengler and Snell, as well as Pat Hynes of Boston University and Doug Brugge of Tufts University, also members of the housing initiative, were all working on housing and health issues.

The scope of the housing initiative is broad.

"We know what we’re trying to accomplish isn’t easy," said Spengler. "It’s one of the most difficult things I’ve ever done at HSPH, but we hope to help a few people, which may lead to solving more systemic, complicated problems. Here, we have public health, public agencies and private interests working as partners, bridging ideas to truly preventative health measures."

The project is sponsored by the Department of Housing and Urban Development, Jessie B. Cox Charitable Trust and The Boston Foundation.