Dual home screening and tailored environmental feedback to reduce radon and secondhand smoke: an exploratory study.

Author:Hahn, Ellen J.
Position::ADVANCEMENT OF THE SCIENCE
 
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Introduction

Lung cancer is the second most commonly diagnosed cancer and has the highest mortality rate of all cancers (National Cancer Institute, 2007). Radon is a leading preventable cause of lung cancer, second only to smoking (U.S. Department of Health and Human Services [HHS], 2005), and accounts for about 10% of all lung cancer cases each year in the U.S. (Committee on Health Risks of Exposure to Radon [BEIR VI], National Research Council, 1999). The U.S. Environmental Protection Agency (U.S. EPA) estimates that 1 in 15 homes in the U.S. tests positive for radon at or above the U.S. EPA action level of 4 picocuries per liter (pCi/L) (HHS, 2005). Secondhand smoke (SHS) is the third leading preventable cause of lung cancer, responsible for an estimated 3,000 lung cancer deaths per year among nonsmokers (HHS, 2006). The combination of firsthand smoke and SHS and radon exposure increases the risk of lung cancer nearly 10-fold (U.S. Environmental Protection Agency [U.S. EPA], 2004). Interestingly, households with smokers are less likely to test for radon than those without smokers (Centers for Disease Control and Prevention, 1999), despite the fact that smokers are at greater risk for developing lung cancer from radon exposure than never-smokers (Bonner et al., 2006; Lagarde et al., 2001). Although the perceived risk from smoking and SHS is high (Rayens et al., 2007), less is known about the combined perceived risks of these two environmental exposures (Hampson, Andrews, Lee, Lichtenstein, & Barckley, 2000).

Our exploratory study aims were to 1) describe the feasibility of a brief, tailored dual home screening and environmental feedback intervention (FRESH; Freedom from Radon Exposure and Smoking in the Home) to assess and reduce radon and SHS exposure; 2) examine changes in risk perception and health actions following FRESH; and 3) assess differences in parents' perceived risk of lung cancer and synergistic risk perception (SHS x radon) between those with and without home smoking at baseline. First, we hypothesized that parents would have greater perceived risk of lung cancer and synergistic risk (SHS x radon) post-intervention. Second, those with home smoking would be less likely to take action to reduce exposure to radon and SHS than those without smoker(s)/smoking in the home. Third, we hypothesized that home smoking would be associated with perceived risk of lung cancer and synergistic risk at baseline.

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Exposure to radon, a colorless, odorless, radioactive gas that forms from the decomposition of uranium in the ground, is associated with an estimated 15,400 to 21,800 lung cancer cases in the U.S. each year (Committee on Health Risks of Exposure to Radon [BEIR VI], National Research Council, 1999). Radon can be detected with a simple, commercially available test; however, the proportion of people who have tested is low (Wang, Ju, Stark, & Teresi, 2000). If high levels of radon are found, properly installed mitigation systems reduce the risk of exposure.

SHS, a major source of indoor air pollution, causes coronary heart disease, lung cancer, asthma, and sudden infant death syndrome (HHS, 2010). The home is the primary source of SHS for children and a major source of SHS exposure for adults (HHS, 2006).

If exposed to 4 pCi/L of radon over a lifetime, 7 per 1,000 of those who never smoked would develop lung cancer compared to 62 of 1,000 smokers who would develop lung cancer (U.S. EPA, 2004). Despite the synergistic risk of radon and tobacco smoke, smokers are less likely than nonsmokers to engage in protective radon behaviors (Hampson, Andrews, Barckley, Lichtenstein, & Lee, 2006).

Our study was guided by the Teachable Moment Model (McBride, Emmons, & Lipkus, 2003), positing that a health event (i.e., feedback on home radon and SHS levels) serves as a cue to perceive a health threat that can motivate an individual to reduce the threat (McBride et al., 2003; Figure 1). Using tailored environmental feedback may be one way to create teachable moments by generating heightened receptivity to behavior change (Law son & Flocke, 2009).

Methods

Design and Sample

The exploratory study was a quasi-experimental, pre-post design with quota sampling to ensure that 60% of participants would be in the home smoking group. The participants were parents or primary caregivers of children recruited from a pediatric practice during an office visit. To be eligible for the study, participants had to own their homes, have access to a telephone, and never have tested for radon. Once the quota of those without smokers in the home was reached, participants were eligible only if they had a smoker in the home. Participants completed the baseline survey on a laptop computer while in the physician's office at the time of recruitment. After completing the baseline survey, participants were asked to colocate a radon and an airborne nicotine sampler in their homes for 72 hours. The two-month post-intervention surveys were completed online. The study was approved by the University of Kentucky Medical institutional review board.

Intervention

The brief, tailored environmental feedback intervention, FRESH, was designed to create a teachable moment for lung cancer risk reduction by motivating participants to simultaneously test their homes for radon and SHS and delivering a tailored environmental feedback intervention. After receiving the test results (4-8 weeks post-testing), trained research staff with educational preparation in nursing and health...

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