Authors: Karen M. Butler, DNP, RN Whitney Hiner, BSN, RN Monica Mundy, MPH Renee Fox, MS

1. Authors: Karen M. Butler, DNP, RN Whitney Hiner, BSN, RN Monica Mundy, MPH Renee Fox, MS Amanda Wiggins, PhD Kathy Rademacher, BA Ellen J. Hahn, PhD, RN, FAAN

2. Who We Are • Vision: All people will have access to clean air and live in healthy environments. • Mission: To promote lung health and healthy environments to achieve health equity through: • research • community outreach and empowerment • advocacy and policy development • access to health services

3. Background • In 2014, 215,951 people in the U.S. were diagnosed with lung cancer. • Radon, a colorless, odorless radioactive gas, is the second leading cause of lung cancer. • More radon-related lung cancers occur in individuals with a history of smoking. • It is estimated that the combination of first or secondhand smoke and radon exposure increases the risk of lung cancer nearly tenfold. • Although radon is a leading cause of lung cancer, there is little to no evidence in the literature showing the effects of radon exposure on respiratory symptoms.

4. Purpose and Hypothesis • To explore the association between exposure to radon and air nicotine in the home, smoke-free home policies, and respiratory symptoms among healthy adults, controlling for COPD, smoking status, and smoking in the home. • Current smokers, those with high radon and air nicotine in the home, and those with limited to no rules about home smoking would report more respiratory symptoms.

5. Methods • Short-term radon test kits (free) • Passive air nicotine samplers (free) • Self-reported 3-item respiratory symptom scale • Add-on pilot study of homeowners enrolled in larger RCT • Four groups based on their end-of-parent study home test results • High radon/High SHS • Low radon/High SHS • High radon/Low SHS • Low radon/Low SHS

6. Measures and Procedures • AirChek short-term radon test kit • Radon levels > 4 pCi/L = high • Passive air nicotine sampler (Johns Hopkins Environmental Health Lab) • Air nicotine levels > 0.1 mg/m3 = high • Self-reported 3-item respiratory symptom scale • Cough • Fatigue • Spitting up blood • Logistic regression examined associations between exposure to radon, air nicotine and self-reporting any respiratory symptoms • Data analysis using SAS version 9.4 with an alpha level of .05 throughout.

7. Demographic and Home Characteristics of the Study Sample (N=71)

8. Results • Home radon levels ranged from 0.3 pCi/L to 21.8 pCi/L; home air nicotine levels ranged from 0.005 mg/m3 to 6.535 mg/m3. • Of the 71 participants, 27 homes tested high for radon and 44 homes tested high for air nicotine. • Nearly 4 of 10 participants reported experiencing at least one respiratory symptom in the last month. • Those with high radon levels were 5.6 times more likely to report experiencing at least one respiratory symptoms than those with low radon, controlling for other variables.

9. Percentage reporting respiratory symptoms in the past month by high and low radon and secondhand smoke levels in the home

10. Predictors of self-reported respiratory symptoms, controlling for smoking status, smoking in the home, and COPD

11. Discussion • Those with high radon levels were more likely to report experiencing at least one respiratory symptoms than those with low radon. • The public is generally unaware of the increased risk of lung cancer related to radon exposure, with smokers more at risk for radon-induced lung cancer. • More research is needed to examine the association between radon exposure, reported respiratory symptoms, and other lung diseases.

12. Conclusions • Exposure to radon in the home was associated with self-reported respiratory symptoms. • Reducing radon exposure could have important respiratory health and public health benefits. • Providing radon awareness education with healthcare providers, especially those with specialization in pulmonology is needed. • Adding radon testing to screening practices in primary care is warranted.

13. FREE Radon Continuing Education Convenient, online platform 3 CE hours • Lung cancer risks • Laws and policies to reduce risk • Communicating health risks • Answering FAQs • Strategies to increase testing www.breathe.uky.edu

14. Acknowledgment UK Markey Cancer Center Support Grant (CCSG) provided funding for this study.

15. WHO WE ARE AND WHAT WE DO: The American Association of Radon Scientists and Technologists (AARST) Foundation provides educational, scientific, charitable and literary resources relating to radon science and radon (radiation) risk reduction for the benefit of the American public and professionals engaged in radon research, education and radiation risk reduction. The Foundation is organized exclusively for educational, scientific, charitable and literary purposes under section 501 (c)(3) of the Internal Revenue Code. The Foundation supports radon related research, standards, and environmental justice to financially assist those that are unable to take action to test for and reduce elevated radon levels when discovered. The Foundation’s board is comprised of professionals from the entire spectrum of the radon community including business and education professions and environmental agencies. Email: info@AARSTFoundation.org Website: aarstfoundation.org Follow us on Facebook: AARST Foundation

16. Presenting Author: Karen M. Butler, DNP, RN Professor Assistant Dean of Academic Operations Co-Director, Radon Policy Division, BREATHE University of Kentucky College of Nursing Karen.Butler@uky.edu www.breathe.edu Questions?