Radon, smoking, and lung cancer: the need to refocus radon control policy

Radiation Detection-CD/DVD, Glass, and Emerging Materials for Radon Exposure Assessment

This review aimed to explore advances in radon detection methods, emphasizing cost-effectiveness and accessible techniques such as CDs, DVDs, and glass-based detectors. In this review, we compared traditional methods like alpha track detectors and continuous radon monitors with emerging innovations that leverage polycarbonate material and IoT-integrated systems. Our evaluation of the synthesis suggests that CDs and DVDs provide scalable solutions for long-term radon monitoring, while glass-based detectors like CR-39 offer high sensitivity for epidemiological studies. The integration of IoT and AI technologies further enhances real-time radon monitoring, paving the way for precise, scalable, and affordable radon mitigation strategies. This work highlights the importance of low-cost, innovative approaches in reducing radon-related lung cancer risks and informs future research on optimizing the technologies for diverse environments.

Short-Term vs. Long-Term: A Critical Review of Indoor Radon Measurement Techniques

Radon is a known carcinogen, and the accurate assessment of indoor levels is essential for effective mitigation strategies. While long-term testing provides the most reliable data, short-term testing (STT) offers a quicker and more cost-effective alternative. This review evaluated the accuracy of STT in predicting annual radon averages and compared testing strategies in Europe (where long-term measurements are common) and the United States (where STT is prevalent). Twenty (20) studies were systematically identified through searches in scientific databases and the grey literature, focusing on STT accuracy and radon management. This review revealed several factors that influence the accuracy of STT. Most studies recommended a minimum four-day test for initial screening, but accuracy varied with radon levels. For low levels (<75 Bq/m3), a one-week STT achieved high confidence (>95%) in predicting annual averages. However, accuracy decreased for moderate levels (approximately 50% success rate), necessitating confirmation with longer testing periods (3 months). High radon levels made STT unsuitable due to significant fluctuations. Seasonality also played a role, with winter months providing a more representative picture of annual radon averages. STT was found to be a useful method for screening low-risk areas with low radon concentrations. However, its limitations were evident in moderate- and high-level scenarios. While a minimum of four days was recommended, longer testing periods (3 months or more) were crucial for achieving reliable results, particularly in areas with potential for elevated radon exposure. This review suggests the need for further research to explore the possibility of harmonizing radon testing protocols between Europe and the United States.

Short Communication: Radon testing via a state tobacco quitline

Objective

Exposure to radon gas at home is the second largest cause of lung cancer after smoking and dramatically increases smokers' risk of lung cancer. State tobacco quitlines are uniquely positioned to inform smokers about radon, yet, to our knowledge, none does so. We explored the feasibility of introducing free radon tests via the tobacco quitline in North Dakota, a state with one of the highest radon levels in the U.S.

Methods

Five hundred consecutive callers to the ND Quits Tobacco quitline from February 2021 to February 2023 were invited to complete a brief radon questionnaire and receive a free radon test kit. Radon tests were bar-coded so that the return rate of the tests and the radon levels could be determined.

Results

Two hundred fifty-one (51 %) callers completed the questionnaire and seventy-five radon tests were successfully returned to the laboratory. More than one third of the test results were ≥ 4.0 pCi/L, the action level recommended by the EPA. Only 1 in 5 participants reported knowing that radon caused lung cancer.

Conclusion

Radon knowledge among ND smokers is poor. Radon test distribution via quitlines is feasible and may be a valuable addition to quitline services, particularly in states with high radon levels.

Radon and lung cancer: Current status and future prospects

Beyond tobacco smoking, radon takes its place as the second most significant contributor to lung cancer, excluding hereditary and other biologically related factors. Radon and its byproducts play a pivotal role in exposing humans to elevated levels of natural radiation. Approximately 10-20 % of lung cancer cases worldwide can be attributed to radon exposure, leading to between 3 % and 20 % of all lung cancer-related deaths. Nevertheless, a knowledge gap persists regarding the association between radon and lung cancer, impeding radon risk reduction initiatives globally. This review presents a comprehensive overview of the current state of research in epidemiology, cell biology, dosimetry, and risk modeling concerning radon exposure and its relevance to lung cancer. It also delves into methods for measuring radon concentrations, monitoring radon risk zones, and identifying priorities for future research.

Vaping, Environmental Toxicants Exposure, and Lung Cancer Risk

Lung cancer (LC) is the second-most prevalent tumor worldwide. According to the most recent GLOBOCAN data, over 2.2 million LC cases were reported in 2020, with an estimated new death incident of 1,796,144 lung cancer cases. Genetic, lifestyle, and environmental exposure play an important role as risk factors for LC. E-cigarette, or vaping, products (EVPs) use has been dramatically increasing world-wide. There is growing concern that EVPs consumption may increase the risk of LC because EVPs contain several proven carcinogenic compounds. However, the relationship between EVPs and LC is not well established. E-cigarette contains nicotine derivatives (e.g., nitrosnornicotine, nitrosamine ketone), heavy metals (including organometal compounds), polycyclic aromatic hydrocarbons, and flavorings (aldehydes and complex organics). Several environmental toxicants have been proven to contribute to LC. Proven and plausible environmental carcinogens could be physical (ionizing and non-ionizing radiation), chemicals (such as asbestos, formaldehyde, and dioxins), and heavy metals (such as cobalt, arsenic, cadmium, chromium, and nickel). Air pollution, especially particulate matter (PM) emitted from vehicles and industrial exhausts, is linked with LC. Although extensive environmental exposure prevention policies and smoking reduction strategies have been adopted globally, the dangers remain. Combined, both EVPs and toxic environmental exposures may demonstrate significant synergistic oncogenicity. This review aims to analyze the current publications on the importance of the relationship between EVPs consumption and environmental toxicants in the pathogenesis of LC.

The occurrence of bone and joint cancers and their association with rural living and radon exposure in Iowa

Primary bone and joint cancers are rare and understudied, yet these neoplasms are difficult to treat and impact all age groups. To explore the long-term changes in the occurrence of bone and joint cancers, patients diagnosed with these neoplasms between 1975 and 2016 were identified in the Surveillance Epidemiology and End Results of the National Cancer Institute of the USA. The age-adjusted incidence (AAIR) and mortality (AAMR) rates were calculated for three decades and compared to AAIR and AAMR in years 1975-1984. By using the population-based cancer registries of the USA, Iowa was identified as a state with increased cases of bone and joint malignancies. The bone and joint cancer cases in Iowa were correlated with the percentage of rural population, the average farmland size, or the residential radon levels. Results demonstrated that the mean AAIR of bone and joint cancers for US female and male patients (< 50 years of age) increased from 0.57 (95% C.I. 0.55-0.63) and 0.76 (95% C.I. 0.69-0.82) for years 1975-1984 to 0.71 (95% C.I. 0.66-0.76) and 0.94 (95% C.I. 0.87-1.07) for years 2005-2014, respectively. The increase in bone and joint cancer cases in Iowa positively correlated with the percentage rural population (R = 0.222, P < 0.02), and the average farmland size (R = 0.236, P < 0.02) but not the radon levels (R = - 0.038, P < 0.7). The findings revealed that patients younger than 50 years of age and those who resided in rural areas and engaged in farming were more likely to be diagnosed with primary bone and joint cancers.

Patterns of indoor radon concentrations, radon-hazard potential, and radon testing on a small geographic scale in Utah

INTRODUCTION

Currently, there are no publicly-available estimates of indoor radon concentration at scales smaller than the county. Radon-hazard potential soil maps that reflect underlying geologic factors can be created at small geographic scale and linked to residential and census data. We determined the association between residential radon tests and high radon-hazard potential soil at the residential and block group levels using a large Utah-based dataset. We also identified characteristics of block groups with limited tests in the dataset.

METHODS

We geocoded a dataset of residential radon tests obtained from 2001 to 2017 by a statewide educational program. We linked each location to maps of radon-hazard potential soil, the Environmental Protection Agency's (EPA) county radon zones. We also calculated the number of tests conducted in each block group and linked block groups to demographic data from the 2020 United States census. Log-linear and logistic models identified the association between residential home test results and 1) radon-hazard potential soil of each residence, 2) percent of residences on high radon-hazard potential soils in block groups, and 3) EPA's radon zones. We compared demographic characteristics among block groups with ≥5 or <5 residential tests in our dataset.

RESULTS

Approximately 42% of homes in the dataset tested ≥4 pCi/L. We found significant positive associations for residential radon test results with 1) residential location on high radon-hazard potential soil and 2) block groups with >0% of residences on high radon-hazard potential soil. EPA radon zones were not associated with residential test results. Block groups with <5 tests had higher than the statewide median percentage of Hispanic residents (OR = 2.46, 95% CI = 1.89-3.21) and were located in rural counties.

DISCUSSION

Radon-hazard potential soil has a significant association with residential home radon tests. More efforts are needed to improve radon testing in block groups that are rural and have greater percentages of racial minorities.

Lung cancer as adverse health effect by indoor radon exposure in China from 2000 to 2020: A systematic review and meta-analysis

Indoor radon exposure is thought to be associated with adverse health effect as lung cancer. Lung cancer incidences in China have been the highest worldwide during the past two decades. It is important to quantitively address indoor radon exposure and its health effect, especially in countries like China. In this paper, we have conducted a meta-analysis based on indoor radon and its health effect studies from a systematic review between 2000 and 2020. A total of 8 studies were included for lung cancer. We found that the relative risk (RR) was 1.01 (95% CI: 1.01-1.02) per 10 Bq/m³ increase of indoor radon for lung cancer in China. The subgroup analysis found no significant difference between the conclusions from the studies from China and other regions. The health effect of indoor radon exposure is relatively consistent for the low-exposure and high-exposure groups in the subgroup analysis. With a better understanding of exposure level of indoor radon, the outcomes and conclusions of this study will provide supports for next phase of researches on estimation of environmental burden of disease by indoor radon exposures in countries like China.

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.

Neighborhood characteristics of low radon testing activities: A longitudinal study in Atlanta, Georgia, United States

Radon testing remains low even nationwide although its exposure is the leading cause of lung cancer among non-smokers. Little has been done to examine the neighborhood characteristics with low testing prevalence. This study investigated the associations between indoor radon testing and neighborhood characteristics in an urban environment with the highest Radon potential. A total of 25 years (1990-2015) of radon tests (n = 6355) were pooled from public and private sources in DeKalb County, Georgia, United States. Neighborhoods were characterized using racial residential segregation for African Amercians in addition to other social indicators. The associations between neighborhood characteristics and radon testing rates were evaluated using Ordinary Least Squares and Spatial Regression Models, respectively. Results show that the testing rates were lower than 6.5% over the 25 years. Summers followed by early springs experienced more tests than the other seasons. Areas of low testing rates (≤1.55%) spatially matches the mostly segregated neighborhoods. Residential segregation expanded in the 25 years and was significantly correlated (P value < 0.05) with low testing rates, even after other social indicators were controlled. Associations with the other social indicators, such as income or education, were weaker. Concertedly identifying the culturally relevant interventions in segregated communities is necessary to reduce and eliminate threats from environmental radon.

Interventions to promote home radon testing: A randomized clinical trial of a smartphone app vs. printed brochures

Radon is a preventable cause of lung cancer, but the percentage of homes tested for radon is low. We previously developed a smartphone app that informs users about radon and allows them to request a free radon test. Here we conducted a randomized, controlled trial comparing the radon app versus printed brochures on radon knowledge, attitudes, and behaviors, including the proportion of participants requesting radon tests. Participants (N = 138) were undergraduates at a midwestern university. Data were analyzed by t-tests, general linear models, and logistic regression. App users showed significantly greater increases in radon knowledge (p = 0.010) and self-efficacy (p < 0.001) and requested tests three times more often than brochure recipients (41.4% vs. 13.2%, p < 0.001). However, the rate of test usage in each condition was low, ~3%. In conclusion, the radon app markedly outperformed brochures in increasing knowledge and requests for radon tests. Future work should focus on methods to increase test usage.

The Effect of the Coal Industry on Indoor Radon Concentrations in eMalahleni, Mpumalanga Province of South Africa

ABSTRACT

South Africa has rich coal deposits concentrated in the northeast of the country, and as a result, most of the country's coal mining is located in this region. Two of the principal coalfields exploited are the Witbank and Highveld coalfields, located in the Mpumalanga province. Coal contains trace quantities of the naturally occurring radionuclides whose mass concentration can be enhanced by anthropogenic activity. The radioactive fallout from these activities could lead to elevated radon concentrations indoors. Two towns, Secunda and eMalahleni, were identified due to their proximity to coal-based industries. A previous study investigated whether these industries caused elevated radon levels in Secunda homes but found a lower-than-expected average concentration of 76.4 ± 7.6 Bq m-3. This was attributed to either the prevailing wind depositing the radioactive fallout to neighboring towns, such as eMalahleni, or the type of industrial activity. This paper builds on this study by investigating whether elevated radon levels are found in homes in eMalahleni. Measurements were performed in 22 homes during December 2019, and the average indoor radon concentration was calculated as 122.1 ± 8.5 Bq m-3. The cause of these elevated levels was then investigated, and it was found that even though the coal industry contributes to elevated radon levels, the town's underlying geology seems to be the primary contributor.

Molecular target therapeutics of EGF-TKI and downstream signaling pathways in non-small cell lung cancers

Lung carcinoma (LC) is the third most common cancer diagnosis and accounted for the most cancer-related mortality worldwide in 2018. Based on the type of cells from which it originates, LC is commonly classified into non-small cell lung cancers (NSCLC) and small cell lung cancers (SCLC). NSCLC account for the majority of LC and can be further categories into adenocarcinoma, large cell carcinoma, and squamous cell carcinoma. Accurate classification of LC is critical for its adequate treatment and therapeutic outcome. Since NSCLC express more epidermal growth factor receptor (EGFR) with activation mutations, targeted therapy EGFR-tyrosine kinase inhibitors (TKIs) have been considered as primary option of NSCLC patients with activation EGFR mutation. In this review, we present the genetic alterations, reported mutations in EGFR, and TKIs treatment in NSCLC patients with an emphasis on the downstream signaling pathways in NSCLC progression. Among the signaling pathways identified, mitogen activation protein kinase (MAPK), known also as extracellular signal-regulated protein kinase (Erk) pathway, is the most investigated among the related pathways. EGFR activation leads to the autophosphorylation of its kinase domain and subsequent activation of Ras, phosphorylation of Raf and MEK1/2, and the activation of ERK1/2. Phosphatidylinositol 3-kinase (PI3K)/Akt is another signal pathway that regulates cell cycle and has been linked to NSCLC progression. Currently, three generations of EGFR TKIs have been developed as a first-line treatment of NSCLC patients with EGFR activation and mutation in which these treatment options will be further discussed in this review. The Supplementary Appendix for this article is available at http://links.lww.com/JCMA/A138.

High-efficiency radon adsorption by nickel nanoparticles supported on activated carbon

Nickel nanoparticles supported on AC (Ni/AC) composites, combining abundant micropores with open metal sites, are rationally designed for adsorbing Rn.

Status of radon exposure in Bangladeshi locations and dwellings

Potentially higher cancer risk due to exposure from natural background radiation was indicated for the Bangladeshi population by estimations based on the countrywide study. Several regions with elevated natural background exhibited higher soil radium and thorium contents than the world average. Being the decay products of these radioactive elements, natural radon isotopes could constitute environmental risk factors for internal radiation exposure to the lungs of people living in these areas. Although lung cancer is one of the most prevalent types of cancer in Bangladesh, its status and features are still unclear. To clarify the present status of one of the potential risk factors for lung cancer in the country, this review intends to ascertain the countrywide radon exposure, and its pathways by types of local dwelling and by regions, which would provide an indication of the internal exposures in areas of elevated natural background radiation and radionuclides of soil as well as an understanding of the preliminary contribution of environmental radon on the country's lung cancer prevalence. In this review, countrywide monitored air radon exposures for Bangladeshi dwellings and workplaces are organized from peer-reviewed published papers. Radon has been identified as one of influential sources of radiation dose in Bangladesh with its higher radon exhalation and emanation rate from soil. A novel nationwide depiction of the overall assessed indoor and soil radon levels for Bangladesh has been made through radiation maps. This would be helpful for designing future systematic radon/radiological monitoring and research on the country's lung cancer prevalence.

Characteristics and Behaviors Among a Representative Sample of New Jersey Adults Practicing Environmental Risk-Reduction Behaviors

CONTEXT

Environmental exposure to groundwater contamination from agricultural runoff, chemical pollution, or geology and indoor air hazards from misuse of consumer products or naturally occurring radon contributes to adverse health outcomes. Individuals can reduce exposure to environmental hazards by practicing risk-reduction behaviors.

OBJECTIVE

To characterize the demographic and behavioral characteristics of the population practicing environmental risk-reduction behaviors in order to identify gaps in current prevention outreach efforts.

DESIGN

The New Jersey Behavioral Risk Factor Survey captures data on self-reported environmental risk-reduction behaviors and health-promoting behaviors (cancer screenings, vaccinations, smoking). To account for complex survey data, weighted analyses were performed in SAS v9.4.

SETTING

New Jersey, 2014-2015.

PARTICIPANTS

The New Jersey Behavioral Risk Factor Survey is an ongoing telephone health survey of NJ residents. About 1000 NJ residents are selected randomly each month to derive statewide representative prevalence estimates.

MAIN OUTCOME MEASURES

Self-reported private well testing, radon screening, and carbon monoxide (CO) detector ownership.

RESULTS

Statewide prevalence of the practice of environmental risk-reduction practices includes 56.6% for private well testing, 44.3% for radon screening, and 86.1% for CO detector ownership. A larger percentage of individuals who are white or Asian, college-educated, earn more than $50 000, and own their homes reported CO detector ownership and radon screening. Age was the only demographic factor associated with private well testing. Screening for radon and CO detector ownership was positively associated with receiving an influenza shot, colonoscopy, aerobic exercise, and positive self-reported health and not smoking.

CONCLUSIONS

There is a need to improve rates of environmental risk-reduction behaviors and reduce disparities in the practice of these behaviors through efforts to increase awareness. Public health officials should target outreach to specific populations that do not practice risk-reduction behaviors.

Designing an Indoor Radon Risk Exposure Indicator (IRREI): An Evaluation Tool for Risk Management and Communication in the IoT Age

The explosive data growth in the current information age requires consistent new methodologies harmonized with the new IoT era for data analysis in a space-time context. Moreover, intuitive data visualization is a central feature in exploring, interpreting, and extracting specific insights for subsequent numerical data representation. This integrated process is normally based on the definition of relevant metrics and specific performance indicators, both computed upon continuous real-time data, considering the specificities of a particular application case for data validation. This article presents an IoT-oriented evaluation tool for Radon Risk Management (RRM), based on the design of a simple and intuitive Indoor Radon Risk Exposure Indicator (IRREI), specifically tailored to be used as a decision-making aid tool for building owners, building designers, and buildings managers, or simply as an alert flag for the problem awareness of ordinary citizens. The proposed methodology was designed for graphic representation aligned with the requirements of the current IoT age, i.e., the methodology is robust enough for continuous data collection with specific Spatio-temporal attributes and, therefore, a set of adequate Radon risk-related metrics can be extracted and proposed. Metrics are summarized considering the application case, taken as a case study for data validation, by including relevant variables to frame the study, such as the regulatory International Commission on Radiological Protection (ICRP) dosimetric limits, building occupancy (spatial dimension), and occupants' exposure periods (temporal dimension). This work has the following main contributions: (1) providing a historical perspective regarding RRM indicator evolution along time; (2) outlining both the formulation and the validation of the proposed IRREI indicator; (3) implementing an IoT-oriented methodology for an RRM indicator; and (4) a discussion on Radon risk public perception, undertaken based on the results obtained after assessment of the IRREI indicator by applying a screening questionnaire with a total of 873 valid answers.

Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy

Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.

Vaping and lung cancer - A review of current data and recommendations

OBJECTIVES

Lung cancer is the most common cause of cancer mortality worldwide and, while tobacco smoke remains the primary cause, there is increasing concern that vaping and E-cigarette use may also increase lung cancer risk. This review concentrates on the current data, scholarship and active foci of research regarding potential cancer risk and oncogenic mechanisms of vaping and lung cancer.

MATERIALS AND METHODS

We performed a literature review of current and historical publications on lung cancer oncogenesis, vaping device/e-liquid contents and daughter products, molecular oncogenic mechanisms and the fundamental, potentially oncogenic, effects of electronic cigarette smoke/e-liquid products.

RESULTS

E-cigarette devices and vaping fluids demonstrably contain a series of both definite and probable oncogens including nicotine derivatives (e.g. nitrosnornicotine, nitrosamine ketone), polycyclic aromatic hydrocarbons, heavy metals (including organometal compounds) and aldehydes/other complex organic compounds. These arise both as constituents of the e-liquid (with many aldehydes and other complex organics used as flavourings) and as a result of pyrolysis/complex organic reactions in the electronic cigarette device (including unequivocal carcinogens such as formaldehyde - formed from pyrolysis of glycerol). Various studies demonstrate in vitro transforming and cytotoxic activity of these derivatives. E-cigarette device use has been significantly increasing - particularly amongst the younger cohort and non-smokers; thus, this is an area of significant concern for the future.

CONCLUSION

Although research remains somewhat equivocal, there is clear reason for concern regarding the potential oncogenicity of E-Cigarettes/E-Liquids with a strong basic and molecular science basis. Given lag times (extrapolating from tobacco smoke data) of perhaps 20 years, this may have significant future public health implications. Thus, the authors feel further study in this field is strongly warranted and consideration should be made for tighter control and regulation of these products.

Design and Development of a New Methodology Based on Expert Systems Applied to the Prevention of Indoor Radon Gas Exposition Risks

Exposure to high concentration levels of radon gas constitutes a major health hazard, being nowadays the second-leading cause of lung cancer after smoking. Facing this situation, the last years have seen a clear trend towards the search for methodologies that allow an efficient prevention of the potential risks derived from the presence of harmful radon gas concentration levels in buildings. With that, it is intended to establish preventive and corrective actions that might help to reduce the impact of radon exposure on people, especially in places where workers and external users must stay for long periods of time, as it may be the case of healthcare buildings. In this paper, a new methodology is developed and applied to the prevention of the risks derived from the exposure to radon gas in indoor spaces. Such methodology is grounded in the concurrent use of expert systems and regression trees that allows producing a diagram with recommendations associated to the exposure risk. The presented methodology has been implemented by means of a software application that supports the definition of the expert systems and the regression algorithm. Finally, after proving its applicability with a case study and discussing its contributions, it may be claimed that the benefits of the new methodology might lead on to an innovation in this field of study.

Estimating the disease burden of lung cancer attributable to residential radon exposure in Korea during 2006-2015: A socio-economic approach

Estimating the lung cancer disease burden can provide evidence for public health practitioners, researchers, and policymakers. This study uses claim data from lung cancer patients for 2006-2015 from the Korean National Health Insurance Service to estimate the lung cancer burdens attributable to residential radon in Korea using disability-adjusted life years (DALY) and patients' annual economic burden with societal perspectives using the cost-of-illness (COI) method. The number of patients increased during our study period (from 35,866 to 59,168). The disease burden and that attributable to residential radon, respectively, increased from 517.57 to 695.74 and 64.62 (95%; CIs 61.33-67.69) to 86.99 (95%; CIs 82.7-91.1) DALYs per 100,000 patients. The percentage of years lost due to disability among the DALY doubled from 8% to 17%. The cost for all the patients was US$2.33 billion, with US$292 (95%; CIs 278-306) million attributable to residential radon. During the last decade, the lung cancer disease burden increased by 1.34 times, with a doubled percentage of non-fatal burden and average annual growth rate of 9.5% of the total cost. Hence, the burden and cost of lung cancer in Korean provinces have been steadily increasing. The findings could be used as input data for future cost-effectiveness analysis of policies regarding radon reduction.

Radon-The Element of Risk. The Impact of Radon Exposure on Human Health

Lung cancer is a heterogeneous group of diseases with multifactorial aetiology. Smoking has been undeniably recognized as the main aetiological factor in lung cancer, but it should be emphasized that it is not the only factor. It is worth noting that a number of nonsmokers also develop this disease. Radon exposure is the second greatest risk factor for lung cancer among smokers-after smoking-and the first one for nonsmokers. The knowledge about this element amongst specialist oncologists and pulmonologists seems to be very superficial. We discuss the impact of radon on human health, with particular emphasis on respiratory diseases, including lung cancer. A better understanding of the problem will increase the chance of reducing the impact of radon exposure on public health and may contribute to more effective prevention of a number of lung diseases.

Identifying indoor radon sources in Pa Miang, Chiang Mai, Thailand

Radon is the leading source of lung cancer mortality after smoking in Chiang Mai, Thailand. Finding a source of carcinogens is one of the important measures for preventing the cancer risk for this region. Specific sites at Pa Miang, Doi Saket have the highest incidences of lung cancer and have a combination of factors that influence indoor radon concentration. Our study identified the sources of indoor radon within several houses. The results indicate that geological and topographic characteristics, including active faults and mountain terraces, are the main sources of indoor radon, especially for wooden houses. Besides building materials, the design of the houses, ventilation conditions, and lifestyle choices are all factors influencing indoor radon concentrations and its associated risk. Although radon levels (29–101 Bq m⁻³) and total indoor annual effective doses (0.9–3.8 mSv year⁻¹) received from all sources at these sites have shown no significant health risk due to radon exposure , this investigation will be useful as a starting point to guide strategies to respond and prevent the risk of lung cancer, especially in Chiang Mai.

Environmental Risk Factors: The role of oncology nurses in assessing and reducing the risk for exposure

BACKGROUND

The multifaceted origins of cancer are related to the dynamic interface between the human body and the environment. It is estimated that as many as 60% of cancers arise from environmental exposures.

OBJECTIVES

This article describes potential risks for exposure to radon, arsenic, pesticides, and antineoplastic agents, which can lead to the development of cancer.

METHODS

The authors performed a review of the literature on environmental exposures and their relationship to the development of cancer.

FINDINGS

Environmental factors are abundant in the home, workplace, and environment. Nurses can lead campaigns to educate the public about environmental risk factors and their effects on the development of cancer.

Cigarette and Hookah Smoking in Adolescent Students using World Health Organization Questionnaire Global Youth Tobacco Survey (GYTS): A Pilot Study in Varamin City, Iran in 2016

BACKGROUND AND OBJECTIVES

Clues show that a large number of toxic agents, including carcinogenic, heavy metals, other particles, and high levels of nicotine, are effectively delivered through cigarette and hookah smoking. A pilot study was carried out in Varamin city, Iran in 2016 aimed to determine status of cigarette and hookah smoking in adolescent students using, Global Youth Tobacco Survey (GYTS) questionnaire.

METHODS

It was a cross-sectional study. At the first, of 63 Varamin city schools' using cluster sampling, 48 schools were considered as primary clusters and 4 schools were selected randomly as sample clusters and students with 7, 8 and 9 years of education were studied. The total number of registered students was 1,108 and 1,075 responded to the study questionnaire. The main tool for collecting information used in this study was the GYTS questionnaire developed by the World Health Organization, was completed by subjects.

RESULTS

Totally, 479 (44.6%) students were boys and 596 (55.4%) were girls. Of 1,075 subjects the number of students at 7, 8 and 9 years education was 369 (34.3%), 362 (33.7%) and 344 (32.0%) respectively. The cigarette and hookah smoking using experience among the population was 9.2% and 25.5 respectively. Regarding the averages of the total score, although students have a relatively good attitude and specially behavioral intention (72% and 88% of the total score respectively), but only 47% of the total knowledge score by boys and 51% by girls, shows the average level of students' awareness related the undesirable effects of smoking.

CONCLUSIONS

Considering that one out of four students experienced cigarette and hookah smoking. Nearly half of the students are exposed to cigarette smoke at home or outdoors. The state of cigarette and hookah smoking in the country is alarming among school students.

Challenging the concept of de novo acute myeloid leukemia: Environmental and occupational leukemogens hiding in our midst

Myeloid neoplasms like acute myeloid leukemia (AML) originate from genomic disruption, usually in a multi-step fashion. Hematopoietic stem/progenitor cell acquisition of abnormalities in vital cellular processes, when coupled with intrinsic factors such as germline predisposition or extrinsic factors such as the marrow microenvironment or environmental agents, can lead to requisite pre-leukemic clonal selection, expansion and evolution. Several of these entities have been invoked as "leukemogens." The known leukemogens are numerous and are found in the therapeutic, occupational and ambient environments, however they are often difficult to implicate for individual patients. Patients treated with particular chemotherapeutic agents or radiotherapy accept a calculated risk of therapy-related AML. Occupational exposures to benzene, dioxins, formaldehyde, electromagnetic and particle radiation have been associated with an increased risk of AML. Although regulatory agencies have established acceptable exposure limits in the workplace, accidental exposures and even ambient exposures to leukemogens are possible. It is plausible that inescapable exposure to non-anthropogenic ambient leukemogens may be responsible for many cases of non-inherited de novo AML. In this review, we discuss the current understanding of leukemogens as they relate to AML, assess to what extent the term "de novo" leukemia is meaningful, and describe the potential to identify and characterize new leukemogens.

Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer

The incidence of most cancers increases with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. The prevention and identification of cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This first of a two-part review addresses special considerations regarding cancer prevention for adults aged 65 and older. Screening decisions and the impact of limited life expectancy and an older adult's ability to tolerate cancer treatment are also addressed. Guidance is provided regarding the prevention and early identification of lung, colorectal, bladder, and kidney cancer in older adults. The prevention of breast, prostate, and female urogenital cancers are addressed in Part 2. J Am Geriatr Soc 68:2399-2406, 2020.

Synergistic ideas in oncology: prospects for practical implementation

The review is devoted to the analysis of the problem of synergistic ideas application in oncology after simultaneous combined application of agents. An example of the determination and quantification of the synergistic enhancement ratio is presented. It is emphasized that independent addition is determined by product of probabilities of the effects induced by each agent applied separately. Elevated temperatures synergistically enhance the lethal effect of ionizing radiation and chemical compounds used in the treatment of cancer. Analyzing the dependence of the synergistic effect on the acting temperature after its simultaneous application with ionizing radiation or cisplatin, the existence of an optimal temperature ensuring the greatest synergistic interaction was shown for cultured mammalian and yeast cells. The universal regularities of the manifestation of synergism, independent on the agents, biological objects and tests used, are noted. The greatest synergy is observed with the simultaneous application of agents. The synergism recorded as a result of the combined effects of two factors is observed only with a certain ratio of the effects induced by each agent. Synergism depends on the intensity of the factors used — the current temperature, the dose rate of ionizing radiation or the concentration of chemical agents. These universal patterns have been demonstrated for proand eukaryotic cells, including oncological origin. The existence of universal patterns of synergism indicates the need to develop a new paradigm and theoretical model of synergism, which should take into account the identified patterns. An original biophysical concept of synergistic interaction is proposed. Concrete results are presented that demonstrate the possible ways of using the ideas of synergism in oncology by achieving the greatest synergistic enhancement ratio for the combined effects of various physical and chemical agents. It is concluded that the knowledge and the application of the ideas and general patterns of synergy described in this paper can be useful for specialists using the simultaneous action of various agents to optimize combined treatment methods in modern oncology.

An examination of radon awareness, risk communication, and radon risk reduction in a Hispanic community

Purpose: Radiation risk communication is a critical component of radiation protection and the public's understanding of radiation risks and benefits. Risk communication becomes even more complicated when considering cultural and language differences. In the US, many diverse communities face risk communication challenges. We obtained radon testing data to evaluate patterns of radon testing in Allentown, the third largest city in Pennsylvania. Radon exposure is the second leading cause of lung cancer after smoking and is associated with over 21,000 lung cancer deaths in the US annually. It is estimated that 1 in every 15 homes in the US has elevated radon levels above the recommended action level set by the US Environmental Protection Agency. Allentown has some of the highest reported levels of indoor radon in the country, yet only a small portion of the population has tested their homes. This is true particularly among self-identified Hispanics, who make up nearly half of the city's population. This study seeks to (1) characterize the difference in testing rates between self-identified Hispanics and non-Hispanics in Allentown, (2) quantify the level of radon awareness and knowledge, (3) identify potential obstacles to radon testing among the Allentown population that self-identifies as Hispanic, and (4) determine whether more effective risk communication is needed.Method: Radon test results in Allentown were analyzed to better understand the nature of radon testing. To evaluate radon awareness and knowledge, a cross-sectional study was conducted using a face-to-face survey. This data was informative in assessing testing and mitigation practices, ethnicity, income level, age, education level, homeowner status, zip code and primary language.Results: Ethnicity was an independent predictor of radon awareness and knowledge. Statistically significant differences were found between the number of self-identified Hispanics (39%) and non-Hispanics (84%) who indicated that they had ever heard of radon; 13% of Hispanics and 49% of non-Hispanics knew that they lived in an area with typically high radon levels. There was a statistically significant association between self-reported ethnicity and radon testing with non-Hispanics (43%) more likely to test their homes for radon than Hispanics (32%).Conclusion: Individual and community understanding of the risks of exposure to radiation sources such as radon is dependent upon communication that informs and spurs appropriate action. This study demonstrates the need for culturally appropriate radon risk communication strategies targeted to a Hispanic population. Successful communication will raise awareness and knowledge that can lead to better public health protection.

Radon exposure is rising steadily within the modern North American residential environment, and is increasingly uniform across seasons

Human-made buildings can artificially concentrate radioactive radon gas of geologic origin, exposing occupants to harmful alpha particle radiation emissions that damage DNA and increase lung cancer risk. We examined how North American residential radon exposure varies by modern environmental design, occupant behaviour and season. 11,727 residential buildings were radon-tested using multiple approaches coupled to geologic, geographic, architectural, seasonal and behavioural data with quality controls. Regional residences contained 108 Bq/m³ geometric mean radon (min < 15 Bq/m³; max 7,199 Bq/m³), with 17.8% ≥ 200 Bq/m³. Pairwise analysis reveals that short term radon tests, despite wide usage, display limited value for establishing dosimetry, with precision being strongly influenced by time of year. Regression analyses indicates that the modern North American Prairie residential environment displays exceptionally high and worsening radon exposure, with more recent construction year, greater square footage, fewer storeys, greater ceiling height, and reduced window opening behaviour all associated with increased radon. Remarkably, multiple test approaches reveal minimal winter-to-summer radon variation in almost half of properties, with the remainder having either higher winter or higher summer radon. This challenges the utility of seasonal correction values for establishing dosimetry in risk estimations, and suggests that radon-attributable cancers are being underestimated.

Predictors and Spatial Variation of Radon Testing in Illinois, 2005-2012

CONTEXT

Radon is the second leading cause of lung cancer, but exposure can be reduced through testing one's home and mitigating if levels are high.

OBJECTIVE

To determine what factors predict radon testing and to identify, through spatial analysis, areas in Illinois with lower or higher than expected testing rates.

DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOMES

An ecological study design was used to evaluate data on radon tests performed in Illinois by a licensed professional or a home radon test kit analyzed by a state-approved laboratory between 2005 and 2012. Zip code-level rates of testing per 1000 occupied residences were calculated for all testing methods combined and for licensed professional testing and home kit testing separately. The following zip code-level factors associated with radon testing were considered: Environmental Protection Agency (EPA) radon zones (ie, categorization of areas by predicted radon risk), socioeconomic characteristics, homeowner occupancy, and rurality. Univariate and multivariable incidence rate ratios were calculated to examine what factors were associated with each testing type. Hotspot analysis was performed to identify zip codes with lower than expected and higher than expected testing rates (ie, "coldspots" and "hotspots," respectively).

RESULTS

Radon testing rates varied across EPA zone, socioeconomic characteristics, and level of rurality. In multivariable analysis, EPA zone, education, and median household income positively predicted all testing types combined. Median home value was associated with licensed testing, whereas rurality was negatively associated with licensed testing. Owner occupancy positively predicted home kit testing. Between 19.6% and 31.1% of zip codes were coldspots for radon testing rates, dependent upon testing type. Coldspots of all testing method rates were concentrated in the southern part of the state.

CONCLUSION

Public health professionals can benefit from understanding what area-level factors predict radon testing and what geographic areas may under-utilize testing. Such information can aid the development of geographically targeted, cost-effective interventions that increase radon testing and subsequently reduce lung cancer risk.

IDENTIFICATION OF NOVEL BIOMARKERS FOR LUNG CANCER RISK IN HIGH LEVELS OF RADON BY PROTEOMICS: A PILOT STUDY

Radon is the second most important risk factor for lung cancer after tobacco smoking. In Chiang Mai, Thailand, the values of indoor radon activity concentrations are considerably higher than global average values and it is a highest level among East Asian countries. The aim of our study is to identify novel biomarkers for lung cancer risk in high radon areas using a proteomic approach. In our transitional study, a total of 81 participants of non-smokers were examined, consist of 25 lung cancer patients (LC), 16 healthy controls from low levels of natural radiation areas (LLNRA) and 40 healthy controls from high levels of natural radiation areas (HLNRA). The results showed that a total of 799 differentially expressed proteins were identified. Among these, a total of 25 proteins were observed in both LC and HLNRA, but not in LINRA. Owing to the results obtained from this study, we also point out the research direction regarding the validation of some new candidate protein as a biomarker to screen population with high risk for lung cancer in the area with high levels of radon.

Genomic Instability and Carcinogenesis of Heavy Charged Particles Radiation: Clinical and Environmental Implications

One of the uses of ionizing radiation is in cancer treatment. The use of heavy charged particles for treatment has been introduced in recent decades because of their priority for deposition of radiation energy in the tumor, via the Bragg peak phenomenon. In addition to medical implications, exposure to heavy charged particles is a crucial issue for environmental and space radiobiology. Ionizing radiation is one of the most powerful clastogenic and carcinogenic agents. Studies have shown that although both low and high linear energy transfer (LET) radiations are carcinogenic, their risks are different. Molecular studies have also shown that although heavy charged particles mainly induce DNA damage directly, they may be more potent inducer of endogenous generation of free radicals compared to the low LET gamma or X-rays. It seems that the severity of genotoxicity for non-irradiated bystander cells is potentiated as the quality of radiation increases. However, this is not true in all situations. Evidence suggests the involvement of some mechanisms such as upregulation of pro-oxidant enzymes and change in the methylation of DNA in the development of genomic instability and carcinogenesis. This review aimed to report important issues for genotoxicity of carcinogenic effects of heavy charged particles. Furthermore, we tried to explain some mechanisms that may be involved in cancer development following exposure to heavy charged particles.

Confluent impact of housing and geology on indoor radon concentrations in Atlanta, Georgia, United States

Radon is a naturally released radioactive carcinogenic gas. To estimate radon exposure, studies have examined various risk factors, but limited information exists pertaining to the confluent impact of housing characteristics and geology. This study evaluated the efficacy of housing and geological characteristics to predict radon risk in DeKalb County, Georgia, USA. Four major types of data were used: (1) three databases of indoor radon concentrations (n = 6757); (2) geologic maps of rock types and fault zones; (3) a database of 402 in situ measurements of gamma emissions, and (4) two databases of housing characteristics. The Getis-Ord method was used to delineate hot spots of radon concentrations. Empirical Bayesian Kriging was used to predict gamma radiation at each radon test site. Chi-square tests, bivariate correlation coefficients, and logistic regression were used to examine the impact of geological and housing factors on radon. The results showed that indoor radon levels were more likely to exceed the action level-4 pCi/L (148 Bq/m³) designated by the U.S. Environmental Protection Agency-in fault zones, were significantly positively correlated to gamma readings, but significantly negatively related to the presence of a crawlspace foundation and its combination with a slab. The findings suggest that fault mapping and in situ gamma ray measurements, coupled with analysis of foundation types and delineation of hot spots, may be used to prioritize areas for radon screening.

Radon in Schools: A Brief Review of State Laws and Regulations in the United States

Exposure to Radon, a colorless, naturally occurring radioactive gas, is one of leading causes of lung cancer, and may pose a significant long-term risk for school age children. We examined the regulations and statutes in each US state related to radon in schools to delineate key features of policies and discrepancies among states that may have public health implications. Search terms such as "radon", "school", "mitigation", "certification", "licensing", and "radon resistant new construction" were used to scan current statutes from each state legislature's website and regulations from official state government websites for relevant regulatory and statutory requirements concerning radon in schools. State regulations related to the testing, mitigation, and public dissemination of radon levels in schools are inconsistent and the lack of nationwide indoor radon policy for schools may result in unacceptably high radon exposure levels in some US schools. We highlight the features and discrepancies of state laws and regulations concerning radon in schools, and offer several constructive means to reduce risks associated with radon exposure in school children.

Short Telomere Length as a Biomarker Risk of Lung Cancer Development Induced by High Radon Levels: A Pilot Study

Long-term exposure to radon has been determined to be the second leading cause of lung cancer after tobacco smoking. However, an in-depth study of this topic has not been explicitly carried out in Chiang Mai (Thailand). This paper presents the results of an indoor radon level measurement campaign in dwellings of Chiang Mai using total of 110 detectors (CR-39) during one year. The results show that the average radon levels varied from 35 to 219 Bq/m³, with an overall average of 57 Bq/m³. The finding also shows that the average value is higher than the global average value of 39 Bq/m³. In addition, to examine the cause of lung cancer development among people with risk of chronic exposure to radon during their lifetime, 35 non-smoker lung cancer patients and 33 healthy nonsmokers were analyzed for telomere length. As expected, telomere length was significantly shorter in lung cancer patients than in healthy nonsmokers. Among healthy nonsmokers, the telomere length was significantly shorter in a high radon group than in an unaffected low radon group. To the best of our knowledge, our research provides the first attempt in describing the shortened telomeres in areas with high levels of environmental radon that might be related to lung cancer development.

Perceived Synergistic Risk for Lung Cancer After Environmental Report-Back Study on Home Exposure to Tobacco Smoke and Radon

Purpose:

To examine the short-term impact of a personalized environmental report-back intervention to reduce home exposure to tobacco smoke and radon on perception of synergistic risk for lung cancer. Radon-induced lung cancer is more common among those exposed to tobacco smoke.

Design:

Randomized controlled trial.

Setting:

Primary care clinics and a pharmacy waiting area at a University Medical Center in the Southeastern United States and community events.

Participants:

Five hundred sixty adult homeowners and renters (3-month follow-up, n = 334).

Intervention:

Personalized environmental report back.

Measures:

Single-item synergistic risk perception measure using 5-point Likert-type scale.

Analysis:

Change in synergistic risk from baseline to 3 months was evaluated using a generalized estimating equation model containing main effects of treatment group and time. Covariates in the model included age, gender, education, and home smoking status.

Results:

For treatment and control groups combined, there was a significant increase in perception of synergistic risk from baseline to 3 months, but the study groups did not differ. There was no association between perceived synergistic risk and whether or not there were smokers at home.

Conclusion:

Learning about combined risks for lung cancer, with or without dual home screening for secondhand smoke and radon and environmental report-back, may enhance perceived risk for combined environmental exposures. Evaluation of perceived synergistic risk with a single item is a study limitation.

The Disease Burden of Lung Cancer Attributable to Residential Radon Exposure in Korean Homes

BACKGROUND

Residential radon exposure is known to be an important risk factor for the development of lung cancer. The objective of this study was to calculate the disease burden of lung cancer attributable to residential radon exposure in Korea.

METHODS

We calculated the national exposure level using Korean national radon survey data from 2011 to 2014, and house structure distribution data from each administrative region. Using the exposure-risk function, the population attributable fraction (PAF) was calculated and applied to calculate the disease burden for lung cancer attributable to residential radon exposure.

RESULTS

Residential radon exposure levels were the highest, at 116.4 ± 50.4 Bq/m³ (annual mean radon concentration ± standard deviation) in detached houses, followed by 74.1 ± 30.0 Bq/m³ in the multi-family dwellings, and 55.9 ± 21.1 Bq/m³ in apartments. The PAF for lung cancer, due to long-term radon exposure in Korean homes, was 6.6% and 4.7% in men and women, respectively. The total disease burden of lung cancer attributable to residential radon exposure was 14,866 years of life lost (YLL) and 1,586 years lost due to disability (YLD) in 2013. Overall, 1,039 deaths occurred due to residential radon exposure, of which 828 were in men and 211 in women.

CONCLUSION

The smoking rate of men in Korea exceeded 70% in the 1990s, and is still near 40%. Although the size of the effect varies depending on the estimation method, it is a critical aspect as a risk factor of lung cancer because of the synergistic relationship between smoking and radon exposure. Because the Korean society is rapidly aging, population who were formerly heavy-smokers are entering a high-risk age of lung cancer. Therefore, it is necessary to inform the public about the health benefits of reduced radon exposure and to strengthen the risk communication.

Assessing cancer risk factors faced by an Ancestral Puebloan population in the North American Southwest

Ancestral Puebloan people in the North American Southwest suffered high rates of disease, poor health, and early age-at-death. Four individuals with skeletal expressions of cancer were found in a pre-Columbian population in the Taos Valley - Reports of malignant neoplasms in the archaeological record are uncommon and their presence in four of 82 individuals is a high occurrence. This study continues Whitley and Boyer's (2012) research testing whether concentrations of ionizing radiation were sufficiently high to induce cancer and related health issues. Access to a preserved and partly reconstructed subterranean pit structure inhabited between AD 1120 and 1170, allows us to test radon concentrations in a residential dwelling. This study found radon occurring in high levels, 19.4-20.3 pCi/L (717.8-751.1 Bq/m3) within the structure. Epidemiological reports are inconsistent when linking specific cancers and radon exposure. However, this study can control for many of the confounding factors plaguing other studies, provide unique data that have the potential to initiate dialogue on the etiology of neoplastic disease in the American Southwest, and add new dimensions to the study of the living conditions and health of the Ancestral Puebloans and their descendants.

County-Level Radon and Incidence of Female Thyroid Cancer in Iowa, New Jersey, and Wisconsin, USA

Background: Few studies have investigated the association between radon and thyroid cancer despite the sensitivity of the thyroid gland to radiation. Our goal is to investigate the association between county-level radon and incidence of female thyroid cancer in the US States of Iowa, New Jersey, and Wisconsin. Methods: Thyroid cancer incidence data were provided by individual state cancer registries and span 1990–2013. Radon data come from a publicly available third-party database, AirChek, accessed in 2017. We tabulated the percent of radon above four picocuries per liter and the female thyroid cancer incidence rate in each county. Quantile maps were constructed, and an ordinary least-squares regression model was run using Geoda 1.10.0.8 (Chicago, IL, USA). Results: No association was observed between county-level radon and incidence of female thyroid cancer in any of the States: New Jersey (β = 0.06, p = 0.23); Iowa (β = −0.07, p = 0.07); or Wisconsin (β = −0.01, p = 0.78). A spatial regression model was considered, but the Moran’s I of the residuals from each of the models was not significant, so no spatial term was required. Discussion: In this county-level ecological study across three different States in the US, we did not find an association between elevated radon and thyroid cancer incidence in women. While this ecologic study reports null findings, due to the ecologic fallacy, individual-level studies of this association may still be warranted.

Association of Smoking in the Home With Lung Cancer Worry, Perceived Risk, and Synergistic Risk

PURPOSE/OBJECTIVES

To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk.
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DESIGN

Cross-sectional baseline survey. 
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SETTING

Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center.
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SAMPLE

515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS).
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METHODS

Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home.
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MAIN RESEARCH VARIABLES

Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics.
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FINDINGS

Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept.
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CONCLUSIONS

Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed. 
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IMPLICATIONS FOR NURSING

Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure.

Radon, Secondhand Smoke, and Children in the Home: Creating a Teachable Moment for Lung Cancer Prevention

OBJECTIVE

This study determined whether having minor children in the home was associated with the teachable moment (TM) constructs of lung cancer worry, perceived risk, health-related self-concept, and the novel construct of synergistic risk.

DESIGN AND SAMPLE

Secondary data analysis of baseline data from a randomized controlled trial of an intervention to reduce home exposure to radon and secondhand smoke (SHS). Quota sample of adults recruited at a Central Kentucky academic medical center (N = 556).

MEASURES

Survey items assessed lung cancer worry, perceived risk, synergistic risk perception, and health-related self-concept.

RESULTS

The presence of children in the home was not a significant predictor of any construct needed to create a TM for lung cancer prevention. Individuals with children living in the home were more likely to be younger, a racial/ethnic minority, a current smoker, and live with a smoker compared to those without children in the home.

CONCLUSIONS

There is a critical need to raise parental awareness on child health inequities related to the home exposure to radon and SHS. Public health nurses can create TMs for lung cancer prevention through greater awareness of the risks posed by radon and SHS along with promoting home testing and low-cost resources to reduce risk.

Radon testing in rapid access lung clinics: an opportunity for secondary prevention

BACKGROUND

Radon is a naturally occurring radioactive gas and a level 1 carcinogen. It acts synergistically with cigarette smoke to cause lung cancer. In Ireland, radon is estimated to be associated with 13 % of all lung cancers. Rapid access lung cancer clinics (RALC's) were established in the UK and Ireland to improve lung cancer management outcomes. There has been no attempt to date to provide advice on household radon exposure assessments in this setting.

AIMS

We performed a prospective feasibility study of radon assessment in our RALC to test the hypothesis that patients would avail of this service and that it would provide an opportunity for secondary prevention in at risk persons.

METHODS

We investigated household radon levels in consecutive patients who were newly referred with symptoms of lung cancer to the RALC in Galway University Hospital, Ireland over a 6-month period.

RESULTS

Of 50 patients enrolled, 42 returned valid results. Overall 21 % of patients had radon levels recorded above the national reference level. Only 5 % of patients were aware of the association between radon gas and lung cancer. Smokers were significantly less likely to engage fully in radon testing.

CONCLUSIONS

The development of RALC's offers a novel opportunity to integrate the concepts of radon exposure, cigarette smoking and the development of lung cancer, and to reinforce this message in the minds of at risk patients.

An Exploratory Analysis of Public Awareness and Perception of Ionizing Radiation and Guide to Public Health Practice in Vermont

Exposure to ionizing radiation has potential for acute and chronic health effects. Within the general public of the United States, there may be a discrepancy between perceived and actual health risks. In conjunction with the Vermont Department of Health, a survey designed to assess public perception and knowledge of ionizing radiation was administered at 6 Vermont locations (n = 169). Descriptive and inferential statistical analyses were conducted. Eighty percent of respondents underestimated the contribution of medical imaging tests to total ionizing radiation exposure. Although only thirty-nine percent of participants were confident in their healthcare professional's knowledge of ionizing radiation, most would prefer to receive information from their healthcare professional. Only one-third of individuals who received a medical imaging test in the past year were educated by their healthcare professional about the risks of these tests. Those who tested their home for radon were twice as likely to choose radon as the greatest ionizing radiation risk to self. Although respondents had an above-average education level, there were many misperceptions of actual risks of exposure to ionizing radiation, particularly of medical imaging tests. Educating healthcare professionals would therefore have a profound and positive impact on public understanding of ionizing radiation.

Radon potential, geologic formations, and lung cancer risk

Objective

Exposure to radon is associated with approximately 10% of U.S. lung cancer cases. Geologic rock units have varying concentrations of uranium, producing fluctuating amounts of radon. This exploratory study examined the spatial and statistical associations between radon values and geological formations to illustrate potential population-level lung cancer risk from radon exposure.

Method

This was a secondary data analysis of observed radon values collected in 1987 from homes (N = 309) in Kentucky and geologic rock formation data from the Kentucky Geological Survey. Radon value locations were plotted on digital geologic maps using ArcGIS and linked to specific geologic map units. Each map unit represented a package of different types of rock (e.g., limestone and/or shale). Log-transformed radon values and geologic formation categories were compared using one-way analysis of variance.

Results

Observed radon levels varied significantly by geologic formation category. Of the 14 geologic formation categories in north central Kentucky, four were associated with median radon levels, ranging from 8.10 to 2.75 pCi/L.

Conclusion

Radon potential maps that account for geologic factors and observed radon values may be superior to using observed radon values only. Knowing radon-prone areas could help target population-based lung cancer prevention interventions given the inequities that exist related to radon.

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We examine spatial and statistical associations between radon and rock formations.

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Observed radon levels vary significantly by geologic formation category.

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Four rock types are associated with high radon levels.

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Mapping both rock formations and radon values may be better than radon alone.