Radon Risk Communication Research: Practical Lessons

Those responsible for state and local radon programs often express frustration about the small share of homes that have been tested for radon, and the small share of those with high readings that have been mitigated. There are now a number of completed studies that have examined how well alternative ways of communicating about radon risk have accomplished the goals of motivating appropriate testing and mitigation. This paper summarizes the research results that are most crucial for planning and implementing effective radon risk communication programs. We identify six reasons why people do not respond to radon as a serious threat and provide some remedies suggested by radon studies.     

Communicating the risk from radon.

A prominent television station developed a special series of newscasts and public service announcements about radon. This was combined with their advertising of the availability of reduced-price radon test kits in a local supermarket chain. The large number of test kits sold was a success from a marketing perspective, but not from a public health perspective--especially because of the very small share of high readings that were mitigated. In contrast, a study of housing sales showed a much higher testing rate and corresponding mitigation when risk communication accompanied the housing transaction, rather than being directed toward the general public. This paper examines the relative effectiveness of these alternative approaches to radon risk communication, emphasizing the implications for developing and implementing radon programs.     

Effect modification of ambient particle mortality by radon: A time series analysis in 108 U.S. cities

Numerous studies have reported a positive association between ambient fine particles and daily mortality, but little is known about the particle properties or environmental factors that may contribute to these effects. This study assessed potential modification of radon on PM_2.5 (particulate matter with an aerodynamic diameter <2.5 μm)-associated daily mortality in 108 U.S. cities using a two-stage statistical approach. First, city- and season-specific PM_2.5 mortality risks were estimated using over-dispersed Poisson regression models. These PM_2.5 effect estimates were then regressed against mean city-level residential radon concentrations to estimate overall PM_2.5 effects and potential modification by radon. Radon exposure estimates based on measured short-term basement concentrations and modeled long-term living-area concentrations were both assessed. Exposure to PM_2.5 was associated with total, cardiovascular, and respiratory mortality in both the spring and the fall. In addition, higher mean city-level radon concentrations increased PM_2.5-associated mortality in the spring and fall. For example, a 10 µg/m³ increase in PM_2.5 in the spring at the 10th percentile of city-averaged short-term radon concentrations (21.1 Bq/m³) was associated with a 1.92% increase in total mortality (95% CI: 1.29, 2.55), whereas the same PM_2.5 exposure at the 90th radon percentile (234.2 Bq/m³) was associated with a 3.73% increase in total mortality (95% CI: 2.87, 4.59). Results were robust to adjustment for spatial confounders, including average planetary boundary height, population age, percent poverty and tobacco use. While additional research is necessary, this study suggests that radon enhances PM_2.5 mortality. This is of significant regulatory importance, as effective regulation should consider the increased risk for particle mortality in cities with higher radon levels.

Implications: In this large national study, city-averaged indoor radon concentration was a significant effect modifier of PM_2.5-associated total, cardiovascular, and respiratory mortality risk in the spring and fall. These results suggest that radon may enhance PM_2.5-associated mortality. In addition, local radon concentrations partially explain the significant variability in PM_2.5 effect estimates across U.S. cities, noted in this and previous studies. Although the concept of PM as a vector for radon progeny is feasible, additional research is needed on the noncancer health effects of radon and its potential interaction with PM. Future air quality regulations may need to consider the increased risk for particle mortality in cities with higher radon levels.     

EPA’s Perspective on Risks from Residential Radon Exposure

Indoor radon has been judged to be the most serious environmental carcinogen which the EPA must address for the general public. The optimal strategy for dealing with this problem depends on the magnitude of the risk, how the risk is distributed within the population, as well as the effectiveness and costs of mitigation measures. Based on current exposure and risk estimates, radon exposure in single-family houses may be a causal factor in roughly 20,000 lung cancer fatalities per year. Most of these projected fatalities are attributable to exposures in houses with average or moderately elevated radon levels (below 10 pCi/L). Hence to appreciably reduce radon-induced lung cancers, remediation efforts must include houses not highly elevated in radon. From either an individual risk or a cost-benefit standpoint, reduction of a few pCi/L per home appears to be justified. The optimal strategy for dealing with the indoor radon problem depends on the magnitude of the risk per unit exposure, the distribution of exposures in houses, and the effectiveness and costs of mitigation. EPA’s current views with respect to these factors and the associated uncertainties are discussed.     

A two-year study of seasonal indoor radon variations in southern Maryland

The concentrations of indoor radon in the basements of homes located in southern Maryland average about 1.3 times the first floor radon concentrations. Particular geological units tend to be associated with higher indoor radon. In the study area, homes underlain by phyllite were mostly above 4 pCi/liter (the US Environmental Protection Agency 'action level'). Comparative studies between indoor radon and total-gamma aeroradioactivity show that aeroradioactivity can be accurately used to estimate community radon hazards. When combined, geology and aero radioactivity can be used to identify problem homes.     

A physiologically based assessment of human exposure to radon released from groundwater

Most of the indoor radon comes directly from the soil beneath the foundation of a basement. Recently, radon from groundwater was found to make some contribution to the total inhalation risk associated with radon in indoor air. This study presents a realistic exposure assessment of a human to indoor radon released from groundwater. First, the prediction of indoor radon concentration released from groundwater was based on a three-compartment model that was developed to describe the transfer and distribution of the radon released from groundwater in a house through showers, washing clothes, and flushing toilets. Second, a physiologically based pharmacokinetic (PBPK) model for inhaled radon was developed and used to estimate tissue group concentrations in a human body. The PBPK model provides reasonable predictions of uptake, excretion, and distribution of retained radon among tissue groups in the body. Hence, the approach using the PBPK model combined with realistic indoor exposure scenarios predicts the radon concentrations in tissue groups in the body associated with the indoor radon pollution. The results obtained from the study will help increase the quantitative understanding of the risk assessment issues associated with the indoor radon released from the groundwater.     

The Value of Monitoring for Radon in the Home: A Decision Analysis

In light of the recent publicity about the adverse health effects of radon gas, many citizens and government officials are considering whether or not to monitor for radon in homes. This paper presents a formal decision analysis of the monitoring dilemma from the perspective of hypothesized homeowners. The analysis considers the costs of radon monitoring and control, the carcinogenic risks of radon exposure, the demographics of household size, and a hypothetical homeowner's knowledge of radon exposure levels—with and without the benefit of specific monitoring data. Since monitoring every home in the United States would be quite expensive, the analysis reveals some more efficient monitoring strategies that might be employed by citizens and government officials. While the paper presents a new analytic perspective in the monitoring problem, the results should not be considered definitive. Further study is necessary to clarify precisely what is known about radon exposure, health effects, and control strategies.     

Analysis of radon origin by backward atmospheric transport modelling

This work shows how ambient radon concentrations measured at Cabauw station in central Netherlands are influenced by transport from different regions under typical transport conditions occurring during April and November, 2007 by means of atmospheric Lagrangian particle dispersion modelling in a receptor-oriented approach. Four specific regions have been isolated to assess their contribution to the modelled radon ambient concentrations at Cabauw, and two different radon flux assumptions. Westerly flows coming from the ocean are poor in radon and do not increase radon air concentrations unless there is some fetch over the British Isles. Continental transport, mainly from eastern and southern Europe, significantly increases radon background concentrations, reaching increments of 3 Bq m^?3. A constant 0.66 atoms cm^?2 s^?1 radon flux over land and zero over water bodies is a good approximation for the source term in order to study regional contributions and modulation of the radon background.     

Accuracy and Precision of Home Radon Monitoring and the Effectiveness of EPA Monitoring Guidelines

EPA has provided guidelines to homeowners for monitoring and mitigating radon in the home. The effectiveness of these guidelines is dependent, in part, on the accuracy and precision of monitoring methods. This paper proposes a model for radon monitoring accuracy and precision based upon a review of the monitoring literature. The model is then used to quantify the extent of potential misclassification of homes by radon level from the application of EPA guidelines.

Short-term monitoring performed in the basement during winter produced conservative (higher than actual) radon estimates, on average. For homes with annual concentrations of 4 pCi/L, approximately 30 percent will still have short-term results under 4 pCi/L. Underestimation of radon levels is cut by 50 percent or more by the use of monitors on first floor and basement (confirmatory monitoring) as opposed to monitoring the basement alone (screening monitoring). However, following the screening/confirmatory monitoring sequence suggested by EPA increases underestimation at radon levels under 8 pCi/L. The model was found to be sensitive to a number of the assumptions made, and specific follow-up studies are suggested.     

The carcinogenic risk of some organic vapors indoors: A theoretical survey

This exploratory report examines the risk of selected organic air pollutants measured in homes in the United States and the Netherlands. After several theoretical assumptions, estimates are made for the carcinogenic potency of each chemical; combined with the exposure measurements these give estimates of cancer risk. These estimates are compared with risks of these same pollutants outdoors and in drinking water and also with other well known indoor air pollutants: cigarette smoke, radon gas and formaldehyde. These comparisons indicate priorities for action. Some suggestions are made for future studies.     

Seasonal variation of indoor radon in dwellings of Malwa region, Punjab

Indoor radon measurements in 105 dwellings belonging to 21 villages of Muktsar and Ferozepur districts of Malwa region, Punjab, have been carried out, using LR-115 type II cellulose nitrate films in the bare mode. The annual average indoor radon value in the study area varies from 76.25 to 145.50 Bq m⁻³, which is well within the recommended action level [ICRP, 1993. Protection against radon at home and work. Annals of ICRP, ICRP Publication, p. 65]. Seasonal variation of indoor radon shows high values in winter and low values in summer. The winter/summer ratio of radon concentration has been computed for all 105 dwellings. The winter/summer ratio of indoor radon ranges from 0.84 to 1.89 with an average of 1.46. The indoor radon values obtained in the present investigation are more than the world average of 40 Bq m⁻³     

Predicting Radon Testing Among University Employees

Abstract

To determine covariates of radon testing behavior, we surveyed by mail a random sample of all Boston University employees (N = 915) six to nine months after they had been informed of the availability of radon testing services through the University's medical center. The response rate was 58%. Analysis suggests blue collar workers were underrepresented within the response rate. Slightly more than half of the respondents (51%) were men. The majority (69%) were under the age of 45. Twenty-seven percent of the respondents (N = 143) had tested their homes for radon. Bivariate analysis revealed important differences between radon testers and nontesters. Testers were 12 times more likely to be home owners than renters (p = 0.00), and were more knowledgeable about radon's characteristics and testing procedures (p = 0.00). Testers were more likely to view radon as a serious problem (p = 0.00), to consider radon testing efficacious (p = 0.00), and to consider themselves susceptible to exposure (p = 0.00). Testers were also less likely to perceive barriers to radon testing. We used logistic regression to compare the usefulness of the Health Belief Model and the Diffusion of Innovations Model in predicting radon testing. We concluded that the knowledge deficits and barriers to radon testing identified in this study should be targeted in radon educational interventions.     

Radon versus other lung cancer risk factors: How accurate are the attribution estimates?

This notebook paper provides a brief overview of attribution estimates for some key lung cancer risk factors, focusing on indoor radon gas exposure in the U.S., UK, and Canada. Tobacco smoking represents the primary cause of lung cancer worldwide. Radon is regarded as the second leading lung cancer risk factor in the U.S. and Canada. It can be observed, however, that the reported estimates appear not to add up to the maximum cumulative attribution of 100%.

Implications: Limitations and uncertainties associated with published epidemiological studies and the observed lack of consistency in lung cancer attribution estimates for radon and other non-smoking lung cancer risk factors should be taken into consideration by policy makers in setting population health protection priorities.     

Reducing the Risks from Radon

The U.S. Environmental Protection Agency estimates that residential radon levels in the United States lead to approximately 13,600 lung cancer deaths per year. To address this problem, the Agency has identified three program initiatives that can provide substantial reductions in the public’s risks: (1) public information activities that urge the public to test for radon and reduce elevated concentrations in existing homes, (2) new construction standards to reduce radon entry, and (3) radon testing and mitigation during real estate transactions. This paper analyzes the costs and risk reductions that could result from the implementation of these major initiatives, showing how all three elements cost-effectively protect the public’s health.     

Sample Design Considerations for Indoor Air Exposure Surveys

Concern about the potential for indoor air pollution has prompted recent surveys of radon and NO₂ concentrations In homes and personal exposure studies of volatile organics, carbon monoxide and pesticides, to name a few. The statistical problems in designing sample surveys that measure the physical environment are diverse and more complicated than those encountered in traditional surveys of human attitudes and attributes. This paper addresses issues encountered when designing indoor air quality (IAQ) studies. General statistical concepts related to target population definition, frame creation, and sample selection for area household surveys and telephone surveys are presented. The implications of different measurement approaches are discussed, and response rate considerations are described.     

Thoron in the Environment

Thoron (²²⁰Rn), an isotope of the radon family, is produced in the earth’s crust at a rate comparable to that of common radon (²²²Rn). Thoron’s average activity concentration in soil gas and ground-level outside air is comparable to that of radon. Recent data from Europe and the United States indicate that in terms of the energy of the alpha particle decays of thoron’s progeny, its concentration in indoor air is significant, typically about half that due to radon progeny. This paper reviews current knowledge about thoron and its progeny in the outdoor and indoor environments and discusses issues involved in assessing whether or not it is a significant indoor pollutant.     

Numerical simulations of radon as an in situ partitioning tracer for quantifying NAPL contamination using push-pull tests

Presented here is a reanalysis of results previously presented by [Davis, B.M., Istok, J.D., Semprini, L., 2002. Push-pull partitioning tracer tests using radon-222 to quantify non-aqueous phase liquid contamination. J. Contam. Hydrol. 58, 129-146] of push-pull tests using radon as a naturally occurring partitioning tracer for evaluating NAPL contamination. In a push-pull test where radon-free water and bromide are injected, the presence of NAPL is manifested in greater dispersion of the radon breakthrough curve (BTC) relative to the bromide BTC during the extraction phase as a result of radon partitioning into the NAPL. Laboratory push-pull tests in a dense or DNAPL-contaminated physical aquifer model (PAM) indicated that the previously used modeling approach resulted in an overestimation of the DNAPL (trichloroethene) saturation (S(n)). The numerical simulations presented here investigated the influence of (1) initial radon concentrations, which vary as a function of S(n), and (2) heterogeneity in S(n) distribution within the radius of influence of the push-pull test. The simulations showed that these factors influence radon BTCs and resulting estimates of S(n). A revised method of interpreting radon BTCs is presented here, which takes into account initial radon concentrations and uses non-normalized radon BTCs. This revised method produces greater radon BTC sensitivity at small values of S(n) and was used to re-analyze the results from the PAM push-pull tests reported by Davis et al. The re-analysis resulted in a more accurate estimate of S(n) (1.8%) compared with the previously estimated value (7.4%). The revised method was then applied to results from a push-pull test conducted in a light or LNAPL-contaminated aquifer at a field site, resulting in a more accurate estimate of S(n) (4.1%) compared with a previously estimated value (13.6%). The revised method improves upon the efficacy of the radon push-pull test to estimate NAPL saturations. A limitation of the revised method is that 'background' radon concentrations from a non-contaminated well in the NAPL-contaminated aquifer are needed to accurately estimate NAPL saturation. The method has potential as a means of monitoring the progress of NAPL remediation.     

Annual Average Radon Concentrations in California Residences

A study was conducted to determine the annual average radon concentrations in California residences, to determine the approximate fraction of the California population regularly exposed to radon concentrations of 4 pCI/l or greater, and to the extent possible, to identify regions of differing risk for high radon concentrations within the state. Annual average indoor radon concentrations were measured with passive (alpha track) samplers sent by mail and deployed by home occupants, who also completed questionnaires on building and occupant characteristics. For the 310 residences surveyed, concentrations ranged from 0.10 to 16 pCI/l, with a geometric mean of whole-house (bedroom and living room) average concentrations of 0.85 pCI/l and a geometric standard deviation of 1.91. A total of 88,000 California residences (0.8 percent) were estimated to have radon concentrations exceeding 4 pCI/l. When the state was divided into six zones based on geology, significant differences in geometric mean radon concentrations were found between several of the zones. Zones with high geometric means were the Sierra Nevada mountains, the valleys east of the Sierra Nevada, the central valley (especially the southern portion), and Ventura and Santa Barbara Counties. Zones with low geometric means included most coastal counties and the portion of the state from Los Angeles and San Bernardino Counties south.     

Annual average radon concentrations in California residences.

A study was conducted to determine the annual average radon concentrations in California residences, to determine the approximate fraction of the California population regularly exposed to radon concentrations of 4 pCi/l or greater, and to the extent possible, to identify regions of differing risk for high radon concentrations within the state. Annual average indoor radon concentrations were measured with passive (alpha track) samplers sent by mail and deployed by home occupants, who also completed questionnaires on building and occupant characteristics. For the 310 residences surveyed, concentrations ranged from 0.10 to 16 pCi/l, with a geometric mean of whole-house (bedroom and living room) average concentrations of 0.85 pCi/l and a geometric standard deviation of 1.91. A total of 88,000 California residences (0.8 percent) were estimated to have radon concentrations exceeding 4 pCi/l. When the state was divided into six zones based on geology, significant differences in geometric mean radon concentrations were found between several of the zones. Zones with high geometric means were the Sierra Nevada mountains, the valleys east of the Sierra Nevada, the central valley (especially the southern portion), and Ventura and Santa Barbara Counties. Zones with low geometric means included most coastal counties and the portion of the state from Los Angeles and San Bernardino Counties south.     

Total human exposure: basic concepts, EPA field studies, and future research needs

Historically, environmental regulatory programs designed to protect public health have monitored pollutants only in geophysical carrier media (for example, outdoor air, streams, soil). Field studies have identified a gap between the levels observed in geophysical carrier media and the concentrations with which people actually come into contact: their daily exposures. A new approach--Total Human Exposure (THE)--has evolved to fill this gap and provide the critical data needed for accurately assessing public health risk. The THE approach considers a three-dimensional "bubble" around each person and measures the concentrations of all pollutants contacting that bubble, either through the air, food, water, or skin. Two basic THE approaches have emerged: (1) the direct approach using probability samples of populations and measuring pollutant concentrations in the food eaten, air breathed, water drunk, and skin contacted; and (2) the indirect approach using human activity pattern-exposure models to predict population exposure distributions. Using the direct approach, EPA has conducted over 20 field studies for pollutants representing four groups--volatile organic compounds, carbon monoxide, pesticides, and particles--in 15 cities in 12 states. The indirect modeling approach has been applied to several of these pollutants. Additional research is needed in a great variety of areas. Even from the few projects completed thus far, the THE approach has yielded a rich new data base for risk assessments and has provided many surprises about the relative contribution of various pollutant sources to public health risk.