Radon and Tobacco Smoke: A Serious Combined Health Risk Monica E. Mundy, MPH University of Kentucky College of Nursing

Tobacco, Radon, & Lung Cancer Tobacco Smoke 85% of lung cancer cases caused by tobacco smoke. Radon Risk of developing lung cancer if you're exposed to radon: smokers 6.2% nonsmokers 0.7% Most never smokers with lung cancer are women. Lung cancer remains the leading cause of cancer death in the U.S. although it is largely preventable by eliminating smoking, and exposure to radon and secondhand smoke. Most people know that exposure to tobacco smoke is a cause of lung cancer. However, an estimated 25% of lung cancer cases globally occur in nonsmokers, resulting in approximately 300,000 deaths every year. The second leading cause of lung cancer among smokers and the leading cause among nonsmokers is radon, causing approximately15,000 to 22,000 U.S. lung cancer deaths annually. 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. More radon-related lung cancers occur in those with a history of smoking. Exposure to both tobacco smoke and radon, or synergistic risk, increases the likelihood of developing lung cancer nearly tenfold, although radon exposure is a risk for both smokers and nonsmokers. Among never smokers, exposure to radon may be more harmful for those exposed to SHS. Most never smokers with lung cancer are women.

A Dangerous Combination! Secondhand Smoke particles linger in the air and are small enough to be inhaled directly into the lungs. Radon byproducts have a static charge and are attracted to secondhand smoke particles in the air. + The combination of radon attached to secondhand smoke particles greatly increases the likelihood of lung cancer.

How should we frame the message about synergistic risk and lung cancer? “Breathing radon is dangerous, but it is more harmful when you also breathe tobacco smoke.” “There are no safe levels of neither radon nor secondhand smoke.” Here are examples of the way you can frame synergistic risk…

SOLUTION

Now is the Time for Local Action! Governor Bevin: “I believe this should be left to local communities to decide” (in response to ‘Do you support a state smoking ban?’) Sydney Murray, 10/27/15, Cincinnati Enquirer Help them know when they are ready to move to the next stage. Making an ask of the policymakers prematurely can lead to an ineffective law or no law Let’s not wait for the state to decide this issue.

Why focus on local laws? Create a climate where advocates can spend 100% of their political capital on local laws Passing smoke-free laws one community at a time bolsters support for a Smoke-free Kentucky (1/3 of Kentuckians covered) Popularity in rural communities Better to focus on local level rather than accept a state law that risks damaging progress to date Discuss explicit or implicit

Smoke-free laws improve health and lower costs, but only if they are comprehensive, or 100%. An effective, or comprehensive, law protects all workers from exposure to secondhand smoke by covering all indoor workplaces and buildings open to the public. Effective laws save lives and save money. We have seen firsthand results in Kentucky! Asthma ER visits ↓22% in Lexington COPD hospitalizations ↓22% in KY communities with comprehensive smoke-free laws 32% reduction in adult smoking since Lexington’s law took effect 16,500 fewer Lexington-Fayette County smokers Impact: $21 Million per YEAR in healthcare cost savings The only way you see these results is by protecting EVERYONE! This means that every workplace, every restaurant, every business is on a equal playing field and covered by the law.

E-cigarettes need to be regulated just like tobacco smoking Emission Pollute the air (ASHRAE & WHO, 2014)

TOBACCO POLICIES RADON POLICIES Tobacco tax Smoke-free laws Funding comprehensive tobacco treatment programs Barrier-free cessation medication coverage RADON POLICIES Mandatory testing of schools and daycares Mandatory radon disclosure at all real estate transactions Required certification for mitigators Mandatory use of Radon Resistant New Construction

Free Radon Continuing Education Course https://ky.train.org/DesktopModules/eLearning/CourseDetails/CourseDetailsForm.aspx?courseId=1056655

University of Kentucky College of Nursing Let’s Work Together to Promote Health & Prosperity for Future Generations Monica E. Mundy Program Coordinator FRESH, BREATHE University of Kentucky College of Nursing Monica.Mundy@uky.edu www.breathe.uky.edu Help communities formulate and reach smoke-free community goals Readiness Assessment Share resources, tools, and strategies that work Help to tailor a strategy for each community’s needs