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Barbara L. Brenner,¹ Steven Markowitz,² Maribel Rivera,^1,3 Harry Romero,³ Matthew Weeks,⁴ Elizabeth Sanchez,³ Elena Deych,¹ Anjali Garg,¹ James Godbold,¹ Mary S. Wolff,¹ Philip J. Landrigan,¹ and Gertrud Berkowitz¹

¹Department of Community and Preventive Medicine, Mount Sinai Medical Center, New York, New York, USA; ²Center for the Biology of Natural Systems, Queens College, City University of New York, New York, USA; ³Boriken Neighborhood Health Center, New York, New York; USA; ⁴Settlement Health, New York, New York, USA

Abstract
Pesticides, applied in large quantities in urban communities to control cockroaches, pose potential threats to health, especially to children, who have proportionately greater exposures and unique, developmentally determined vulnerabilities. Integrated pest management (IPM) relies on nonchemical tools--cleaning of food residues, removal of potential nutrients, and sealing cracks and crevices. Least toxic pesticides are used sparingly. To evaluate IPM's effectiveness, the Mount Sinai Children's Environmental Health and Disease Prevention Research Center, in partnership with two community health centers in East Harlem, New York City (NY, USA) , undertook a prospective intervention trial. Families (n = 131) enrolled when mothers came to the centers for prenatal care. Household cockroach infestation was measured by glue traps at baseline and 6 months afterward. The intervention group received individually tailored IPM education, repairs, least-toxic pest control application, and supplies, with biweekly pest monitoring for 2 months and monthly for 4 months. The control group, residing in East Harlem and demographically and socioeconomically similar to the intervention group, received an injury prevention intervention. The proportion of intervention households with cockroaches declined significantly after 6 months (from 80.5 to 39.0%) . Control group levels were essentially unchanged (from 78.1 to 81.3%) . The cost, including repairs, of individually tailored IPM was equal to or lower than traditional chemically based pest control. These findings demonstrate that individually tailored IPM can be successful and cost-effective in an urban community. Key words: children's environmental health, cockroach, community intervention trial, integrated pest management, pesticides, urban built environment. Environ Health Perspect 111:1649-1653 (2003) . doi:10.1289/ehp.6069 available via http://dx.doi.org/ [Online 2 July 2003]