FRESH: Freedom from Radon Exposure and Smoking in the Home

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FRESH Freedom from Radon Exposure and Smoking
in the Home

• Ellen J. Hahn, PhD, RN, FAAN
• College of Nursing Clean Indoor Air Partnership
• University of Kentucky

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Disclosure

• The 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.

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In Memoriam.I just did not know
Lois, a never smoker, died from radon-induced
lung cancer, September 2013
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Clean Indoor Air Partnership

• Our 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

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FRESH

• Freedom from
• Radon Exposure and
• Smoking in the
• Home

Can Dual Home Screening Reduce Exposure?
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Tobacco, Radon, Lung Cancer

• 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 Smoke
• 85 lung cancer cases caused by tobacco smoke.
• 3,000 lung cancer deaths per year among
  nonsmokers from secondhand smoke

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Radon and 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)

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Purposes of the Study

• Test 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 renters
• Identify factors associated with use of monetary
  incentive for radon mitigation (simulated tax
  credit)

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Create a Teachable Moment!
Adapted from the Teachable Moment model (McBride
et al., 2003)
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FRESH Dual Home Screening for Lung Cancer
Prevention

• National Institute of Environmental Health
  Sciences (NIEHS)
• National Institute of General Medical Sciences
  (NIGMS)
• R01ES021502-03 (9/1/12-5/31/17)

• 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 pediatricians office and
  received free home radon and air nicotine kits.
• 2-month follow up survey

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.
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Study 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

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Dual Home Screening

• Radon Test Kit

• Secondhand Smoke Test Kit

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Environmental Feedback Intervention

• Tailored based on one of four conditions
• high radon/high SHS (radon gt 4 pCi/L SHS gt
  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

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Data Gathering and Keeping Participants Engaged
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Sample Characteristics (N 387)
    Group     Group     Group               p
    Renters (n 47)   Treatment homeowners (n 168)     Control homeowners (n 172)             p
    Mean (SD) range or n ()   Mean (SD) range or n ()   Mean (SD) range or n ()               p
Age   42.5 (14.7) 21-84 53.5 (12.8) 25-81 52.3 (13.0) 24-80 lt.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) lt.001
         
Note. Renter group younger, less likely to be
White, and less educated than both homeowner
groups. Recruitment ongoing through March 2015.
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Percent who Tested at Baseline
Note. Renters and Treatment homeowners were
provided free test kits and paid to test for both
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Median Test Results by Group
    Group     Group     Group     Group     Group     Group               p  
    Renter     Renter     Treatment homeowner     Treatment homeowner     Control homeowner     Control homeowner               p  
    n     Median (IQR) range   n   Median(IQR) range   n   Median (IQR) range             p  
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) lt0.01-11.15 25 0.02 (0.02-0.03) 0.02-11.47 .032
p from Kruskal-Wallis test Note. Controls who
tested had higher radon levels than renters or
treatment homeowner participants. Renters had
higher air nicotine levels than the homeowner
groups.
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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     19.00 11.21     10.63-34.01 4.87-25.80     lt.001 lt.001  
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Preliminary 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.

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Likelihood of Testing

• Participants 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.

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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, everywhere
• Promote Lung Cancer Awareness Month

• Support Local and State Smoke-free Policies
• Promote Home Radon Testing
• Support Radon Policy Change

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Exposure to Radon in Kentucky
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Questions?

• For more information, contact us
• 859-323-4587
• UKFRESH_at_LSV.UKY.EDU