FRESH: Freedom from Radon Exposure and Smoking in the Home
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Transcript of FRESH: Freedom from Radon Exposure and Smoking in the Home
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◦[email protected]