The Indoor Radiological Problem in Perspective

Measures to tighten homes to conserve energy, as are being encouraged and subsidized by federal and state governments, may reduce air infiltration by 20% or more. Standard prudent risk-assessment methodologies predict that, due to increased levels of indoor radon caused by this reduction in ventilation, the added lifetime lung cancer risk to members of the public is of order 200/million people exposed. In situations where the radon source term is unusually high, or extreme reductions in ventilation are made, the added risk can be more than an order of magnitude greater. While these imputed risks are far outside the range that is normally tolerated, no systematic efforts are in progress to mitigate or limit the risk in any way. Furthermore, efforts to determine better the variations in radon source term and the health effects of indoor radon are being deemphasized. The technical background is presented in some detail, and implications with regard to management of risks to the public are discussed.     

Uncertainty and Variability Analysis in Multiplicative Risk Models

Currently, there is a trend away from the use of single (often conservative) estimates of risk to summarize the results of risk analyses in favor of stochastic methods which provide a more complete characterization of risk. The use of such stochastic methods leads to a distribution of possible values of risk, taking into account both uncertainty and variability in all of the factors affecting risk. In this article, we propose a general framework for the analysis of uncertainty and variability for use in the commonly encountered case of multiplicative risk models, in which risk may be expressed as a product of two or more risk factors. Our analytical methods facilitate the evaluation of overall uncertainty and variability in risk assessment, as well as the contributions of individual risk factors to both uncertainty and variability which is cumbersome using Monte Carlo methods. The use of these methods is illustrated in the analysis of potential cancer risks due to the ingestion of radon in drinking water.     

Awareness and Perceptions of the Risks of Exposure to Indoor Radon: A Population‐Based Approach to Evaluate a Radon Awareness and Testing Campaign in England and Wales

The current study aimed to evaluate the locally directed radon roll‐out program that was conducted between 2001 and 2005 in England and Wales to increase radon awareness and testing rates. A representative sample of 1,578 residents aged 16 and older were interviewed who lived in radon‐affected areas of 15 local authorities in England and Wales that were eligible for participation in the program. The study systematically sampled across participating and nonparticipating local authorities, “actionable” and “nonactionable” radon‐affected areas, and geographic regions with different campaign histories (Wales, Southwest England, and the rest of England). As a multistage sampling strategy was used, the data were analyzed from a multilevel perspective. This study found that participants living in participating local authorities had higher levels of awareness and were more likely to have tested their home for radon than participants living in nonparticipating local authorities. Similar results were found for participants living in “actionable” areas as compared to those living in “nonactionable” radon‐affected areas. The study further found that radon awareness and testing rates were the highest in Southwest England and the lowest in Wales. This study suggests that the radon roll‐out program has been effective in raising awareness and testing rates, and that ongoing domestic radon campaigns in Southwest England may have raised radon awareness and testing in these areas, showing important reinforcement effects of multiple risk communication campaigns.     

Modeling Lung Carcinogenesis in Radon‐Exposed Miner Cohorts: Accounting for Missing Information on Smoking

Epidemiological miner cohort data used to estimate lung cancer risks related to occupational radon exposure often lack cohort‐wide information on exposure to tobacco smoke, a potential confounder and important effect modifier. We have developed a method to project data on smoking habits from a case‐control study onto an entire cohort by means of a Monte Carlo resampling technique. As a proof of principle, this method is tested on a subcohort of 35,084 former uranium miners employed at the WISMUT company (Germany), with 461 lung cancer deaths in the follow‐up period 1955–1998. After applying the proposed imputation technique, a biologically‐based carcinogenesis model is employed to analyze the cohort's lung cancer mortality data. A sensitivity analysis based on a set of 200 independent projections with subsequent model analyses yields narrow distributions of the free model parameters, indicating that parameter values are relatively stable and independent of individual projections. This technique thus offers a possibility to account for unknown smoking habits, enabling us to unravel risks related to radon, to smoking, and to the combination of both.     

Effect of Risk Ladder Format on Risk Perception in High- and Low-Numerate Individuals

Utilizing a random sample from the general population ( N = 257), we examined the effect of the radon risk ladder on risk perception, as qualified by respondents' numeracy. The radon risk ladder provides comparative risk information about the radon equivalent of smoking risk. We compared a risk ladder providing smoking risk information with a risk ladder not providing this information. A 2 (numeracy; high, low) × 3 (risk level; high, medium, low) × 2 (smoking risk comparison: with/without) between subjects experimental design was used. A significant ( p < 0.045) three-way interaction between format, risk level, and numeracy was identified. Participants with low numeracy skills, as well as participants with high numeracy skills, generally distinguished between low, medium, and high risk levels when the risk ladder with comparative smoking risk information was presented. When the risk ladder without the comparative information about the smoking risk was presented, low-numerate individuals differentiated between risk levels to a much lesser extent than high-numerate individuals did. These results provide empirical evidence that the risk ladder can be a useful tool in enabling people to interpret various risk levels. Additionally, these results allow us to conclude that providing comparative information within a risk ladder is particularly helpful to the understanding of different risk levels by people with low numeracy skills.     

Some Criteria for Evaluating Risk Messages

Seven criteria are presented for use in evaluating communications designed to explain the magnitude of a risk. The criteria are: (1) comprehension (Does the audience understand the content of the communication?); (2) agreement (Does the audience agree with the recommendation or interpretation contained in the message?); (3) dose-response consistency (Do people facing a higher dose of a hazard perceive the risk as greater and/or show a greater readiness to take action than people exposed to a lower dose of this hazard?); (4) hazard-response consistency (Do people facing a hazard that is higher in risk perceive the risk as greater and/or show a greater readiness to take action than people exposed to a hazard that is lower in risk?); (5) uniformity (Do audience members exposed to the same level of risk tend to have the same responses to this risk?); (6) audience evaluation (Does the audience judge the message to have been helpful, accurate, clear, etc.?); and (7) types of communication failures (When different types of failures are possible, are the failures that occur generally of the more acceptable variety?). Each of these criteria is illustrated with data collected in a test of message formats designed to explain the risk presented by radon gas in a home.     

The Interplay of Science, Values, and Experiences Among Scientists Asked to Evaluate the Hazards of Dioxin, Radon, and Environmental Tobacco Smoke

To investigate the extent to which personal values and experiences among scientists might affect their assessment of risks from dioxin, radon, and environmental tobacco smoke (ETS), we conducted an experiment through a telephone survey of 1461 epidemiologists, toxicologists, physicians, and general scientists. Each participant was read a vignette designed to reflect the mainstream scientific thinking on one of the three substances. For half of the participants (group A) the substance was named. For the other half (group B), the substance was not named but was identified only as Substance X, Y, or Z. Knowing the name of the substance had little effect on the scientists' evaluation of dioxin, although those who knew the substance to be dioxin were more likely to rate the substance as a serious environmental health hazard (51% vs. 42%, p = 0.062). For radon, those who knew the substance by name were significantly more likely to consider it an environmental health hazard than were those who knew it as substance Z (91% vs. 78%, p less than 0.001). Participants who knew they were being asked about ETS rather than substance X were significantly more likely to consider the substance an environmental health hazard (88% vs. 66%, p less than 0.001), to consider the substance a serious environmental health hazard (70% vs. 33%, p less than 0.001), to believe that background exposure required public health intervention (85% vs. 41%, p less than 0.001), and to believe that above-background exposure required public health intervention (90% vs. 74%, p less than 0.001). These findings suggest that values and experiences may be influencing health risk assessments for these substances, and indicate the need for more study of this phenomenon.     

Protective Responses to Household Risk: A Case Study of Radon Mitigation

This study analyzes the effectiveness of a mass-media radon information and testing campaign conducted in the Washington, D.C. area in the winter of 1988. Although an impressive number of test kits (approximately 100,000) were sold, the ultimate mitigation rates resulting from the campaign were extremely low. Analyses show that low mitigation rates cannot be explained by postulating that people's responses to radon are insensitive to the level of objective risk. They may instead be due to characteristics of the protective response required to reduce radon risk. Radon may be thought of as one of a family of household risks which have risk response profiles that make them particularly difficult for people to manage and remediate. Traditional information campaigns for such risks are likely to be ineffective; instead, they may require regulatory strategies or programs which provide active guidance and assistance.     

Lay Understanding of Synergistic Risk: The Case of Radon and Cigarette Smoking

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants ( N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards ( p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.     

Modeling the Modification of the Risk of Radon-Induced Lung Cancer by Environmental Tobacco Smoke

The presence of environmental tobacco smoke (ETS) in homes has been implicated in the causation of lung cancer. While of interest in its own right, ETS also influences the risk imposed by radon and its decay products. The interaction between radon progeny and ETS alters the exposure, intake, uptake, biokinetics, dosimetry, and radiobiology of those progeny. The present paper details model predictions of the various influences of ETS on these factors in the U.S. population and provides estimates of the resulting change in the risk from average levels of radon progeny. It is predicted that the presence of ETS produces a very small (perhaps unmeasurable) increase in the risk of radiation-induced tracheobronchial cancer in homes with initially very high particle concentrations for both active and never-smokers, but significantly lowers the risk in homes with initially lower particle concentrations for both groups when generation 4 of the lung is considered the target site. For generation 16, the presence of ETS generally increases the radon-induced risk of lung cancer, although the increase should be unmeasurable at high initial particle concentrations. The net effect of ETS on human health is suggested to be a complicated function of the initial housing conditions, the concentration of particles introduced by smoking, the target generation considered, and the smoking status of exposed populations. This situation precludes any simple statements concerning the role of ETS in governing the incidence of lung cancer in a population.