FRESH: Freedom from Radon Exposure and Smoking in the Home

Ellen J. Hahn, PhD, RN, FAANCollege of Nursing Clean Indoor Air PartnershipUniversity of Kentucky

DisclosureDisclosureThe project described is supported

by Award Number R01ES021502-03 (9/1/12-5/31/17) from the National Institute of Environmental Health Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Environmental Health Sciences or the National Institutes of Health.

In Memoriam….”I just did not In Memoriam….”I just did not know”know”

Lois, a never smoker, died from radon-induced lung cancer, September 2013

Clean Indoor Air PartnershipOur MissionTo reduce tobacco use and exposure to secondhand smoke and radon through research, community engagement, and policy surveillance and development in treatment and prevention.

www.ciap.uky.edu Find kysmokefree on twitter and facebook

FRESHFRESH

Freedom fromRadon Exposure andSmoking in theHomeCan Dual Home Screening Reduce Exposure?

Tobacco Smoke◦ 85% lung cancer cases

caused by tobacco smoke.

◦ 3,000 lung cancer deaths per year among nonsmokers from secondhand smoke

Radon◦ 20,000 lung cancer

deaths per year from radon exposure (only 2,100-2,900 among never smokers)

◦ Of those exposed to at least 4 pCi/L of radon, the risk of developing lung cancer is estimated at 62/1,000 for smokers and 7/1,000 for nonsmokers.

◦ Most never smokers with lung cancer are women.

Tobacco, Radon, & Lung Cancer

Soil gas infiltration primary source of indoor radon exposure.

Most radon-induced lung cancers are associated with low to moderate radon concentrations.

When radon gas is inhaled, alpha particles are emitted by the radon decay products (Po and Pb), leading to significant DNA damage.

Radon decay products create Pb-210, a semi-stable isotope of lead (half-life 22 yrs)

Radon and Lung Cancer

Purposes of the StudyPurposes of the StudyTest the effects of FRESH on:

(a) home exposure to SHS and radon and the likelihood of taking action among homeowners.

(b) Teachable Moment psychosocial factors

Examine the differential effects of home smoking on taking action.

Explore impact of FRESH on rentersIdentify factors associated with use

of monetary incentive for radon mitigation (simulated tax credit)

Create a Teachable Create a Teachable Moment!Moment!

Adapted from the Teachable Moment model (McBride et al., 2003)

FRESH: Dual Home FRESH: Dual Home Screening for Lung Screening for Lung Cancer PreventionCancer Prevention Pilot Funding from Markey

Cancer Center/KLCRP, UK College of Nursing, UK Got Grants Program

Brief, home screening and environmental feedback intervention (FRESH)

50 parents recruited in pediatrician’s office and received free home radon and air nicotine kits.

2-month follow up survey

National Institute of Environmental Health Sciences (NIEHS)

National Institute of General Medical Sciences (NIGMS)

R01ES021502-03 (9/1/12-5/31/17)

Hahn, E.J., Rayens, M.K., Kercsmar, S.E., Adkins, S.M., Wright, A.P., Robertson, H.E., Rinker, G. (2014). Dual home screening and tailored environmental feedback to reduce radon and secondhand smoke: An exploratory study. Journal of Environmental Health, 76(6):156-61.

Study DesignStudy Design

RCT with stratified sampling to ensure equal proportion of those exposed to SHS in the home

Recruit homeowners (n = 520) and renters (n = 46) at UK Family Medicine Clinic & Pharmacy

Baseline electronic survey ($10)Intervention

Free home test kits for radon and SHS Environmental feedback intervention post-

results (8-10 weeks post-enrollment)Follow up online surveys to assess behavior

change (3-9-15 mos; $20-$30-$40)17-month home testing

Dual Home ScreeningDual Home Screening

Radon Test Kit Secondhand Smoke Test Kit

Environmental Feedback InterventionTailored based on one of four conditions

◦ high radon/high SHS (radon = > 4 pCi/L; SHS = > 0.1 μg/m3)◦ high radon/low SHS◦ low radon/high SHS◦ low radon/low SHS

Brief problem solving via phone◦ Readiness stage assessment, stage-tailored queries to

enhance self-efficacy, motivation, & behavior change◦ Follow-up queries using 5Rs Relevance, Risks,

Rewards, Roadbocks, Repetition◦ Stage-tailored goals and actions to reduce risk

Mailed packet with results and educational materials

Data Gathering and Data Gathering and Keeping Participants Keeping Participants

EngagedEngaged

Sample Characteristics (Sample Characteristics (N N = 387)= 387)

   Group

 

      p

   Renters (n = 47)

 Treatment

homeowners (n = 168)

 

 Control

homeowners(n = 172)

 Mean (SD);

range or n (%)

 Mean (SD); range

or n (%)

 Mean (SD); range

or n (%) 

Age 

42.5 (14.7); 21-84

53.5 (12.8); 25-81 52.3 (13.0); 24-80 <.001

Gender Male Female 

 18 (38.3%)29 (61.7%)

 66 (39.3%)

102 (60.7%)

 58 (33.7%)

114 (66.3%)

.55

Race White Other 

 33 (70.2%)14 (29.8%)

 147 (87.5%)21 (12.5%)

 148 (87.1%)22 (12.9%)

.009

Education Less than college graduate College graduate

 31 (66.0%)

16 (34.0%)

 52 (31.1%)

115 (68.9%)

 42 (24.4%)

130 (75.6%)

<.001

         Note. Renter group younger, less likely to be White, and less educated than both homeowner groups. Recruitment ongoing through March 2015.

Percent who Tested at Percent who Tested at BaselineBaseline

Note. Renters and Treatment homeowners were provided free test kits and paid to test for both

Median Test Results by Median Test Results by GroupGroup   

Group 

      p 

   Renter

 

 Treatment homeowner

 

 Control

homeowner 

 n 

 Median

(IQR); range

 n

 Median(IQR

); range

 n

 Median

(IQR); range

Radon

25 2.40 (0.55-3.30);

0.0-68.0

127 2.30 (0.70-4.55);

0.30-25.20

56 3.55 (1.55-7.80);

0.30-35.00

.018

SHS 26 0.03 (0.02-5.76);

0.02-17.15

123 0.02 (0.02-0.03);<0.01-11.15

25 0.02 (0.02-0.03);

0.02-11.47

.032

p from Kruskal-Wallis testNote. Controls who tested had higher radon levels than renters or treatment homeowner participants. Renters had higher air nicotine levels than the homeowner groups.

Probability of testing at baseline for both radon and secondhand smoke (n = 384)

  Estimated Odds Ratio

(OR)

95% Confidence Interval for OR

p

 Age

 1.02

 1.00-1.04

 .067

 Gender Male vs. Female

  

1.48

  

0.88-2.25

  

.14

 Race: White vs. Other

  

1.11

  

0.55-2.25

  

.78

 Education College graduate vs. Other

  

2.11

  

1.17-3.81

  

.013

 Smoking Smoker vs. Non-smoker

  

1.32

  

0.72-2.41

  

.37

 Group Renter vs. Control Treatment homeowners vs. Control

  

19.0011.21

  

10.63-34.014.87-25.80

  

<.001<.001

 

Preliminary ResultsPreliminary Results

Sample Characteristics:◦Renters were younger, less likely to

be White, and less educated than both homeowner groups.

Test Results:◦Renters had higher air nicotine levels

than either homeowner group.

Likelihood of TestingLikelihood of TestingParticipants with higher education

were more likely to test.Likelihood to test did not vary by

whether or not there was a smoker in the home.

Renters and homeowners were more likely to test for radon and SHS compared to controls. ◦Renters & homeowners were provided

free test kits and were paid to test.

What Can You Do?What Can You Do?Promote Tobacco

Treatment◦ 1-800-QUIT-NOW

Promote Smoke-free Homes & Public Housing◦ At least 30 ft. away from

entryways, doors, windows.Promote Tobacco-free

Campuses◦ All products, all the time,

everywherePromote Lung Cancer

Awareness Month

Support Local and State Smoke-free Policies

Promote Home Radon Testing

Support Radon Policy Change

Exposure to Radon in Exposure to Radon in KentuckyKentucky

Questions?Questions?For more information, contact

us:◦859-323-4587◦UKFRESH@LSV.UKY.EDU