1. Sarah E. Kercsmar, PhD Jennifer Mason, AAS Sarah Adkins, MS Susan Westneat, MA Mary Kay Rayens, PhD Heather Robertson, MPA Ellen J. Hahn, DNS, RN University of Kentucky College of Nursing Clean Indoor Air Partnership October 19, 2010

2.  Kentucky Radon Program  Protect Services, Inc.  Illinois Radon Professionals

3.  Funding from Tobacco Policy Change: A Collaborative for Healthier Communities and States, a national initiative of The Robert Wood Johnson Foundation (ID #64496) Photo credits: NKU Documentary Photography Class, Spring 2009

5.  Explore the feasibility of conducting a population-based Test and Win contest to promote home radon testing and mitigation  Test the effects of a Test and Win contest on radon testing and mitigation behaviors  Examine the sociodemographic factors affecting home radon levels and mitigation behaviors  Investigate mitigation behaviors and attitudes toward radon among those with high radon levels.

6.  Lung cancer is the second most commonly diagnosed cancer and has the highest mortality rate of all cancers.  Radon is the second leading cause of lung cancer.  Radon is responsible for 15,000 to 21,000 lung cancer deaths every year. About 2,900 of these deaths occur among people who have never smoked.

7.  Based on a previous Test and Win conducted in Illinois in the Spring of 2009, we hypothesized that at least 50% of registrants would test and return their kits.  What are the characteristics of Test and Win Contest participants who decided to test their homes for radon?  What factors are associated with radon levels and mitigation behaviors?

8.  Population-based trial; one group quasi- experimental design  Adult homeowners recruited via print ads, fliers, and earned TV media  NKY homeowners enrolled in study to test their homes (pre-survey; online or phone)  Chance of winning free radon mitigation (5 homes with highest levels)  Homeowners whose home tested above the EPA action level received follow-up information on remediation to reduce their risk of lung cancer  6-month post-survey with homeowners who tested high for radon

9.  If radon levels were at or above the EPA action level but they were not selected for the free mitigation, they were responsible for the cost of mitigation (optional but encouraged, and not part of study).  Kentucky law requires that when you sell your home, you must disclose to the seller that you have tested for radon.  The benefits of assessing the home for radon and receiving information about lung cancer risk and how to reduce that risk outweigh the risks of breach of confidentiality and cost of mitigation.

10.  October 19: Registration began during Radon Action Week.  October 30: Registrations accepted no later than 5:00PM EDT  November 4: Free test kits mailed to participating homes (email or phone reminders to return kit).  November 13: All test kits postmarked no later than November 13.  December 15: All winners contacted. In the event of a tie, winners were randomly chosen from eligible contestants with the same radon level.

11.  300 expressed interest in the Contest.  193 (64%) eligible Northern Kentucky residents from Boone, Kenton, and Campbell counties completed the initial survey.  55% of the 193 eligible residents lived in Boone County, 17% in Campbell County, and 27% in Kenton County.  All eligible residents received a short term radon test kit to place in their homes and return to be analyzed.

12.  50% male  96% Caucasian  83% married  48% had minor child(ren) in the home  20% were smokers and/or lived with a smoker  Length of time lived in the home = 1 week to 36 years (M = 10.3 years, SD = 9.3)  Homes were built from 1908-2009 (age of home M = 24.7 years, SD = 23.7)

13.  Hypothesis: At least 50% of registrants would test and return their kits.  68% of the test kits were returned and readable.

14. Note: Testing status was not related to: age, gender, race, employment status, smoking status, or family diagnosis of lung cancer. VariableTestersNon-testersP-value Age of house Married At most high school education House on walkout Smoker in home Smoking allowed in home Diagnosis of lung cancer (self) M = 24.7 83% 6% 60% 13% 8% 0% M = 42.2 68% 16% 40% 25% 18% 3%.0005.02.03.009.04.03 Table. Demographic Comparisons of Testers and Non-testers

15.  What factors are associated with radon levels?  Radon levels ranged from 0.5 to 49.3 pCi/L.  57% of the homes that returned readable kits tested at or above the Environmental Protection Agency action level of 4.0 pCi/L.  Homes with basements had higher radon levels than those without.

16.  The five highest radon levels that were eligible for the free radon mitigation system were:  49.3  17.4  15.0  13.9  13.5

17.  Timeline for publicity  TV coverage was crucial  Importance of protocol about how to handle calls/emails about results  Helpful to send out all test kits on the same day and give a short time frame for return  Winners’ reception was good for PR and to hear their stories

19.  74 participants from the original study were invited to participate in the follow-up; 50% did (n=37).  All were non-smokers  72% reported increased knowledge about radon and motivation to remediate  21% had a family member with lung cancer. AND…..

20. 36% HAD MITIGATED! (including 10 additional homeowners who did not “win” the contest.)

22.  Those with a smoker in the home had significantly lower levels of radon in their houses than those without. Among those with smoking in home, 76% had radon levels less than 4, while among nonsmokers, only 39% had radon levels below this cutoff (p =.003 for comparison) Average radon level

23.  79 homeowners who were in the original study were invited to participate in the second follow-up.  To be included, they either had to be under the EPA action level (4.0 pCi/L) or have at least 1 self-reported smoker in their home.  48 homeowners enrolled in the second follow-up.  Placed both a short-term and a long-term test in their homes.  Will compare results of the two tests.

24.  Repeat the study in a rural county in Kentucky.  Focus on message design (both pre- and post- contest).

25.  The Contest approach is an effective way to increase home testing for radon and mitigation.  Risk factors for not testing include: less education, having an older home, having a home with an interior access basement, having smokers in the house, allowing smoking in the home, and having been diagnosed with lung cancer.  Lung cancer is almost totally preventable by eliminating firsthand and secondhand smoking and radon exposure.

26. For more information… contact Sarah Kercsmar, PhD at scave2@email.uky.edu or 859-261-1721. scave2@email.uky.edu