Radon, an invisible killer in Canadian homes: perceptions of Ottawa-Gatineau residents

Using the precaution adoption process model and the health belief model to understand radon testing and mitigation: a pre-post quasi-experimental study

BACKGROUND

Despite being the leading cause of lung cancer for non-smokers, few Canadians take action to test for and mitigate radon. This study's aim was twofold: (1) to investigate predictors of radon testing and mitigation using the Precaution Adoption Process Model (PAPM) and Health Belief Model (HBM); and (2) to assess the impact on beliefs of receiving radon results above health guidelines.

METHODS

A convenience sample within Southeastern Ontario households was recruited to test their homes for radon (N = 1,566) for a pre-post quasi-experimental study. Prior to testing, participants were surveyed on risk factors and HBM constructs. All participants whose homes tested above the World Health Organization's radon guideline (N = 527) were surveyed after receiving their results and followed for up to 2 years after. Participants were classified into PAPM stages and regression analyses were conducted to determine predictors between different stages (from deciding to test onwards). Paired bivariate analyses compared responses before and after receiving results.

RESULTS

Perceived benefits from mitigating was associated with progressing through all stages in the study's scope. Perceived susceptibility to and severity of illness and perceptions of cost and time to mitigate were associated with progression through some PAPM stages. Homes with smokers or individuals under 18 were associated with not progressing through some stages. Home radon level was associated with mitigation. Attitudes towards many HBM constructs significantly decreased after receiving a high radon result.

CONCLUSIONS

Public health interventions should target specific radon beliefs and stages to ensure households test and mitigate for radon.

Characterization of Colorado residents and radon reduction behaviors through latent class analysis and path models

Radon is a naturally occurring radioactive gas that enters homes through cracks in the foundation where accumulated levels can cause lung cancer. Within the United States (U.S.), state level radon reduction strategies rely on education and outreach to motivate people to test and mitigate their home. Only about 5% of the housing units in Colorado, U.S. have been tested for radon. This study looks at the 2012 Behavioral Risk Factors Surveillance System (BRFSS) in Colorado to identify distinct groups of people using Latent Class Analysis, and compares radon awareness, testing, and mitigation to understand underlying differences of radon reduction behaviors using path models. Five classes were identified: 1) Wealthy Young Families, 2) Older Singles, 3) Empty Nesters, 4) Smokers, and 5) Struggling Young Families. Significant differences in responses to radon survey questions existed across groups in which Struggling Young Families were the least likely to be aware of radon, have tested their home for radon, and have their home mitigated. Average radon awareness, testing, and mitigation appeared to be influenced by financial stress. Results from this study can be used to tailor future radon interventions and policy initiatives to enhance equity of radon reduction behaviors including legal framework to ensure radon mitigation takes place in rental properties.

Residents' perception and worldview about radon control policy in Canada: A pro-equity social justice lens

Radon is a potent indoor air pollutant, especially in radon prone areas and in countries with long winters. As the second top lung carcinogen, radon is disproportionately affecting certain population subgroups. While many provinces have taken sporadic actions, the equity issue has remained unaddressed across all policy measures. Attempts to enforce radon guidelines and enact building regulations without considering residents' views have proved ineffective. Research linking residents' radon risk perception and worldviews regarding radon control policy is lacking in Canada. We applied mixed (quantitative and qualitative) methods in a pro-equity social justice lens to examine the variations in residents' risk perception, access to risk communication messages, and worldviews about risk management across the sociodemographic strata. Triangulation of the quantitative and qualitative findings strengthened the evidence base to identify challenges and potential solutions in addressing the health risk through upstream policy actions. Enacting radon control policy requires actions from all levels of governments and relevant stakeholders to ensure equal opportunities for all residents to take the preventive and adaptive measures. Small sample size limited the scope of findings for generalization. Future studies can examine the differential impacts of radon health risk as are determined by various sociodemographic variables in a representative national cohort.

The efficacy of public health information for encouraging radon gas awareness and testing varies by audience age, sex and profession

Radioactive radon inhalation is a leading cause of lung cancer and underlies an ongoing public health crisis. Radon exposure prevention strategies typically begin by informing populations about health effects, and their initial efficacy is measured by how well and how fast information convinces individuals to test properties. This communication process is rarely individualized, and there is little understanding if messages impact diverse demographics equally. Here, we explored how 2,390 people interested in radon testing differed in their reaction to radon's public health information and their subsequent decision to test. Only 20% were prompted to radon test after 1 encounter with awareness information, while 65% required 2-5 encounters over several months, and 15% needed 6 to > 10 encounters over many years. People who most delayed testing were more likely to be men or involved in engineering, architecture, real estate and/or physical science-related professions. Social pressures were not a major factor influencing radon testing. People who were the least worried about radon health risks were older and/or men, while negative emotional responses to awareness information were reported more by younger people, women and/or parents. This highlights the importance of developing targeted demographic messaging to create effective radon exposure prevention strategies.

A Mixed Methods Population Health Approach to Explore Radon-Induced Lung Cancer Risk Perception in Canada

BACKGROUND

Radon is a predominant indoor air pollutant and second leading cause of lung cancer in radon-prone areas. Despite the gravity of the health risk, residents in Canada have inadequate perception and taken minimal protective actions. Better perception of a risk motivates people to take preventive measures. Scholarship about radon health risk perception is lacking in Canada. We applied a mixed methods population health approach to explore the determinants shaping perception and actions of a resident population in Canada.

METHODS

We conducted mixed surveys (n = 557) and qualitative bilingual interviews (n = 35) with both homeowners and tenants of Ottawa-Gatineau areas. The study explored residents' risk perception and adaptations factors. Descriptive, correlational and regression analyses described and established associations between quantitative variables. Thematic, inductive analyses identified themes in the qualitative data. A mixed methods analysis triangulated both results to draw a holistic perception of the health risk.

RESULTS

Residents' quantitative perceptions of radon health risk, smoking at home, synergistic risk perception, social influence and care for family were associated significantly with their intention to test for radon levels in their home, actual testing and mitigation. These results were explained further with the qualitative findings. Residents who had dual cognitive and emotional awareness of the risk were motivated enough to take preventive actions. Caring for family, knowing others who contracted lung cancer and financial capability were enablers, whereas lack of awareness and homeownership, cost of mitigation and stigma were obstacles to preventive actions. We also explored the dual subjective and objective aspects of risk perception that are influenced by micro- and macro-level determinants.

CONCLUSIONS

Inducing protective action to reduce risk requires comprehensive population-level interventions considering dual perceptions of the risk that can modify the risk determinants. Future research can explore the dual aspects of risk perception and unequal distribution of the risk factors.

Communicating radon risk via a smartphone app: a pilot intervention study

Background

Residential radon is a major preventable cause of lung cancer. However, prevention requires radon testing and it has proven very challenging to motivate individuals to test their homes for hazards like radon that are invisible and whose health effects occur after a long latency following exposure. Novel approaches to radon communication are urgently needed.

Methods

We created a novel radon-education app for smartphones and examined its effectiveness in increasing radon knowledge and radon testing. We studied radon knowledge and attitudes and behavior relevant to radon testing before and after app use.

Results

Ninety-seven undergraduates installed the app on their smartphones and used it for a month. App use resulted in higher scores in the domains of radon knowledge (p < .001); self-efficacy (p < .001), and response efficacy (p < .001). Twenty-three participants (24%) used the app to obtain a free radon test kit. Self-efficacy (p < .05) and response efficacy (p < .01) were positive predictors of ordering a test kit. The test process completion rate (the fraction of participants who ordered test kits, used them to test their houses and sent the kits to the lab) was 9%.

Conclusions

A smartphone app is a promising venue for communicating radon risk and for stimulating radon testing. Future interventions designed to increase actual test kit use are required to maximize the benefit of the app.

Residents' perceptions of radon health risks: a qualitative study

BACKGROUND

Radon is a high impact environmental pollutant and is the second leading cause of lung cancer in Canada. Building design, extended winter, and geographical location expose residents of Ottawa-Gatineau (the national capital region in Canada) to an increased risk. It is surprising that residents have an inadequate awareness of the risk - despite its gravity - and have taken minimum preventive actions. This study explores perceptions of radon health risk and examines the factors that enable and hinder the adoption of preventive measures among Ottawa-Gatineau residents.

METHODS

We conducted semi-structured interviews with 35 residents with varying educational and income levels to inquire about their knowledge and perception of radon, and to explore their views of enablers and obstacles to taking action to reduce radon risks. Thematic, inductive data analysis was undertaken.

RESULTS

The results indicate that: 1) Residents obtained information on radon from various sources that include the media, their education or occupation, their social network, and home renovation events. Limited references were made to the National Radon Program responsible for testing for radon and informing residents. 2) Awareness of radon risk varied, and the knowledge retained by some residents is insufficient to adequately protect their health. 3) Enablers for taking protective action included: having an understanding of the risk along with health consciousness; caring for family and children; knowing others who had contracted lung cancer and having financial resources. Obstacles consisted of: lack of awareness; cost; lack of home ownership; and potential difficulty in selling the house. 4) Residents attributed primary responsibility to public agencies for disseminating information, and incentivizing or mandating action through more stringent regulation.

CONCLUSION

Risk perceptions are subjective, and are influenced by micro and macro level factors. Inducing protective action to reduce risk requires comprehensive interventions taking into account the dual cognitive and emotional aspects of risk perception. Future research may explore the dual aspects of risk perception and examine the contents of the risk communication message. Policy should address the responsibility of both governments and residents in tackling the issue.