1. Radon in Your Home: It’s in Your Hands
A Presentation for Fairfax County, Virginia Residents
Heather Heisterkamp, MPH student
Walden University
PUBH
Instructor: Dr. Rebecca Heick
Spring, 2010
Hello, my name is Heather Heisterkamp and I’m glad to have the opportunity to speak with you about the important topic of the presence of radon in your community and in your homes. One objective of this presentation is to educate the residents of Fairfax County, Virginia about the nature of radon, its associated health effects, and the public health significance of radon. My ultimate goal in delivering this presentation is to motivate homeowners to take simple steps to reduce their exposure to radon. It’s up to you to take matters into your own hands.

2. Did you know? Radon is a cause of lung cancer.
No federal regulations or standards to test or limit radon exist for places of residence.
Radon is easy to fix through personal preventative measures.
Did you know that scientific studies support radon as one cause of lung cancer? Did you know that, to date, there are no federal requirements or standards for homes to reduce radon levels to a specified safe limit? Did you know that radon can easily be reduced in your home, decreasing your chances for lung cancer, and assuring the safety of loved ones in the home (EPA, 2010)?
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

3. Objectives What is radon? Public health significance
Current control measures
Barriers to radon reduction
How can the public protect themselves?
Additional resources
My goal today is to present, in an easy-to-understand format, how community members and homeowners can protect themselves from radon. I will define radon; explain the health effects associated with radon exposure; discuss what is currently being done on a federal, state, and local level to control radon exposure; present obstacles and barriers to improve control; and most importantly, equip you with the tools and resources to take matters into your own hands and protect yourselves, family members, and community. I will provide additional resources at the end of this presentation for your to reference and learn more about radon on your own. Let’s get started.

4. What is Radon?
What is radon and how does it affect our homes?

5. Characteristics Natural gas
Released from breakdown of uranium and thorium found in rocks, soil, or water
Released in air, groundwater, and surface water
Colorless with no taste or smell (ATSDR, 2008)
Variable from month to month and day to day (NCI, 2004)
Measured as pico Curies per Liter (pCi/L) of air
Average indoor level is 1.3 pCi/L; average outdoor level is .4 pCi/L
No safe level of exposure (EPA, 2010)
Radon is a natural gas that is released from the breakdown of uranium and thorium. Uranium and thorium are elements found in the earth and water. Once released, radon particles enter the air, groundwater and surface water where people can inhale or ingest these particles. Radon is undetectable by the human senses; you can not taste or smell it, and it is not visible (ATSDR, 2008). Radon is affected by barometric pressure and precipitation and its levels vary from month to month and even day to day. Radon is measured as pico Curies per Liter of air. So you have a frame of reference, the average indoor level is 1.3 pCI/L while the average outdoor level is .4 pCi.L There is no known safe level of exposure. In other words, scientists do not know if people are safe at any level (EPA, 2010).
Department of Health and Human Services, Agency for Toxic Substances & Disease Registry. (2008). ToxFAQs for radon (CAS#: ). Retrieved April 17, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from

6. Sources Air Water Mines Residential homes Commercial buildings Offices
Schools
Radon is found inside and outside. It is in air, water, mines, homes, commercial and office buildings, and schools. Lower levels of radon are present in the air and water since particles can diffuse into the atmosphere. Higher levels are present in confined spaces such as mines, homes, and buildings (ATSDR, 2008).
Department of Health and Human Services, Agency for Toxic Substances & Disease Registry. (2008). ToxFAQs for radon (CAS#: ). Retrieved April 17, 2010 from

7. Radon in Homes Levels highest in Reach multiple floors up
sealed homes
basements
first floors
homes built over uranium rich soil
Reach multiple floors up
Varies between homes next door (NCI, 2004)
Well water and groundwater contribute 1-2% of radon into air
Worldwide, 50% of radon exposure comes from homes (EPA, 2010).
Radon is a particular threat in homes because people spend a lot of time in these confined spaces. Tightly sealed homes or homes built over uranium rich soil have the highest levels. Radon levels are also found in basements and first floors and can reach multiple floors up. Radon levels can even vary between homes directly next to each other. So your neighbor’s house may have a very low level, but your home may have a very high level (NCI, 2004). Radon can enter the home through drinking water. Well water and ground water contribute 1-2% of radon into air within the home. Worldwide, 50% of radon exposure comes from homes (EPA, 2010).
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

8. Public Health Significance
So how does radon affect us all? What is the public health significance?

9. Radon and Lung Cancer
WHO, EPA and National Academy of Sciences declare radon a public health threat
Lung cancer
Direct link between radon exposure and lung cancer
The World Health Organization (WHO), National Academy of Sciences, and the Environmental Protection Agency (EPA) recognize radon as a public health threat. Research has demonstrated a direct link between lung cancer and radon (EPA, 2010).
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from

10. Radon and Lung Cancer Cont.
Radon causes 15,000-20,000 lung cancer deaths per year in the U.S.
Worldwide, 15% of lung cancer cases due to radon exposure
Smoking may be a contributing factor
Children are not at increased risk (EPA, 2010)
Radioactive particles damage cells in lungs (NCI, 2004)
Longer exposure associated with increased risk
Medical tests do not detect exposure (ATSDR, 2008)
So let’s talk more specifically about radon and lung cancer. Radon causes 15,000 to 20,000 lung cancer deaths per year making it the second leading cause of lung cancer deaths. Worldwide, 15% of lung cancer cases result from radon exposure. Although radon associated lung cancer occurs in smokers and non-smokers, people who smoke have a significantly greater chance of developing lung cancer. Notably, children have not been found to be more susceptible (EPA, 2010). Radioactive particles, released from the breakdown of radon, damage the cells in the lungs (NCI, 2004). Longer exposure is associated with increased risk. Unfortunately, there are no medical tests to detect exposure or predict health outcomes (ATSDR, 2008).
Department of Health and Human Services, Agency for Toxic Substances & Disease Registry. (2008). ToxFAQs for radon (CAS#: ). Retrieved April 17, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from

11. Research Studies
CDC and EPA research radon and health risks (CDC, 2007)
Association between radon and lung cancer
Initial studies with miners (NCI, 2004)
North American Residential Radon Studies and European Residential Radon Studies (EPA, 2010)
Tom Kelly, Director of EPA’s Indoor Environments Division: “These findings effectively end any doubts about the risks to Americans of having radon in their homes” (as cited in EPA, 2010, Health Effects)
Research studies have been instrumental in determining the association between lung cancer and radon. They are critical to understanding the potential impact of radon and support policies and recommendations to keep people healthy. The Centers for Disease Control and Prevention (CDC) works with the EPA and other organizations to understand the health risks associated with radon exposure (CDC, 2007). As I mentioned in the previous slide, lung cancer is the only know health effect supported by evidence to be caused from radon. Initial studies involved miners and demonstrated an association between radon exposure and lung cancer. Further studies linked radon exposure in homes to lung cancer (NCI, 2004). The North American Residential Radon Studies and European Residential Radon Studies demonstrated a direct link between radon exposure and lung cancer. Further, these studies showed that even low levels of radon can lead to lung cancer. Do you remember I mentioned there is no know safe level of radon exposure? In regards to these studies, Tom Kelly, Director of the EPA’s Indoor Environments Division made the following statement: “These findings effectively end any doubts about the risks to Americans of having radon in their homes” (as cited in EPA, 2010, Health Effects).
Centers for Disease Control and Prevention, National Center for Environmental Health. (2007). Radon research. Retrieved April 16, 2010 from
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

12. Current Controls
So what is currently being done to protect us from this threat? What are the current controls in place?

13. Federal Controls No federal requirements or standards for radon
Education
CDC’s “A Citizen’s Guide to Radon” manual (CDC, 2007)
Radon Reduction Act (PL )
Assist states
Update Citizen’s Guide
Perform studies
Recommendations
Fix radon levels when they are between 2pCi/L and 4pCi/L (EPA, 2010)
Although radon is a recognized public health threat, currently, there are no laws that require radon to be kept at certain levels in homes even when buying or selling a home. In the 1980s, the CDC developed “A Citizen’s Guide to Radon” in an effort to raise awareness and educate people about the threat of radon. This guide is still circulating today (CDC, 2007). In 1988 congress added some provisions to the Indoor Radon Abatement to the Toxic Substances Control Act that funded the EPA’s radon programs. This amendment, through the Radon Reduction Act (PL ), provided assistance to states and required the EPA to update the Citizen’s Guide and conduct studies on radon levels in certain facilities. In the absence of federal regulations, the EPA has made recommendations. Homeowners are encouraged to test their homes up to the third floor and reduce radon levels, through mitigation services, when radon levels reach 4pCi/L and preferably at 2pCi/L (EPA, 2010).
Centers for Disease Control and Prevention, National Center for Environmental Health. (2007). Radon research. Retrieved April 16, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

14. State Controls Multimedia Mitigation Programs
Indoor air programs
Maintain air levels at 4,000 pCi/L (0.4pCi/L in air)
Community water supply programs
Maintain water levels at 300 pCi/L (0.03 pCi/L in air)
Although there are no federal regulations, state programs play a role in reducing radon levels. In accord with the Safe Drinking Water Act, the EPA has proposed to reduce radon in indoor air and water. Through the Multimedia Mitigation Programs, states will have the power to lower indoor air radon levels by encouraging homeowners to fix their homes or build homes that are radon resistant. States may also decide to reduce levels in the water by requiring suppliers to keep radon levels below 4,000 pCi/L. This amount of radon would only release 0.4pCi/L of radon into the air. States have another option to alter radon levels through the community water supply by reducing radon levels in drinking water to 300 pCi/L. This will contribute about 0.03 pCi/L of radon into the air (EPA, 2010)
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

15. Radon Zones
One way the EPA works to help national, state, and local efforts in understanding and reducing radon is by designating radon zones. Also, these zones help groups in developing radon resistant building codes. Each of the 3,141 counties in the U.S., defined by their radon potential, are assigned to a radon zone. Zone one is “highest potential”, Zone 2 is “moderate potential” and Zone 3 is “low potential”. However, elevated levels occur in all three zones (EPA, 2010).
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from

16. Radon in Fairfax County
Conducted by Fairfax County Health Department
Yellow = low radon potential (14% were above 4 pCi/L)
Red = high radon potential (44% were above 4 pCi/L)
Similarly, a radon potential map has been developed for Fairfax County. The yellow areas indicate low potential and the red areas indicate high radon potential. Importantly, radon levels above 4pCi/L were found in both low and high potential areas. Fourteen percent of homes surveyed in the low radon potential area had radon levels above 4pCi/L and 44% of homes surveyed in the high radon potential area had levels above the recommended limit (Fairfax County Health Department, 2010).
Fairfax County Department of Health. (2010). Radon air quality. Retrieved April 17, 2010 from

17. Fairfax County Program
Public Health Services goal: 40% of homes tested in U.S.
Virginia Department of Health’s Indoor Radon Program
Provides education information
Listing of certified professionals
In addition to federal and state, locals efforts are underway to reduce radon in homes. While, the Public Health Services’ goal is to have 40% of homes in the U.S. tested, the CDC admits more public awareness and interventions will be needed to reach this goal. To support this goal, the Virginia Department of Health administers the Indoor Radon Program. Funded by the EPA, this program provides information for the general public and maintains a list of certified professionals for testing and mitigation (VDH, 2010).
Virginia Department of Health, Office of Epidemiology, Radiological Health Programs. (2010). Indoor radon program. Retrieved April 17, 2010 from

18. Controls for New and Existing Homes
Radon Resistant New Construction (RRNC)
Collaboration among EPA, building code organizations, and contractors (Moeller, 2005)
Additional $250-$750
1.5 million radon resistant home
RRNC Directory
States may require disclosure of radon levels (EPA, 2010)
The EPA is also working with contractors and building code organizations to build Radon Resistant New Construction (Moeller, 2005). The additional cost to prevent high levels of radon is negligible, at $250 to $750, compared to fixing the problem once it has occurred. Notably, as of the 1990s, 1.5 million radon resistant homes have been built. Some states have building codes for radon Resistant New Construction. Virginia has a state-wide radon resistant new construction code but jurisdictions within the state are not obligated to adopt them. A radon resistant new construction directory is available to help homebuyers find qualified builders. When buying or selling an existing home, certain states may require sellers to disclose the radon level (EPA, 2010).
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from
Moeller, D. W. (2005). Environmental health (3rd ed.). Boston, MA: Harvard University Press.

19. Barriers to Radon Reduction
So what prevents us from reducing our risk of lung cancer from radon exposure?

20. Barriers to Reduce Radon
Existing programs
Not cost-effective
Universal testing programs
Mitigation upon initial testing (Ford, Kelly, Teutsch, Thacker, & Garge, 1999)
Cost
Average cost of mitigation is $1,200 (Moeller, 2005)
There are several barriers on a societal, community, and individual level to reducing the threat from radon. Existing universal testing program may not be cost-effective. Different approaches that test only higher radon level areas rather than universal testing may be more cost-effective. Another new approach may involve mitigation after the second radon test. This has the potential to still reduce lung cancer cases but at less cost (Ford, Kelly, Teutsch, Thacker, & Garbe, 1999). The cost of fixing the problem may be an obstacle. The cost of mitigation ranges between $800 to $2,500, with the average cost at $1,200 (Moeller, 2005).
Ford, E., Kelly, A., Teutsch, S., Thacker, S., & Garbe, P. (1999). Radon and lung cancer:
A cost-effectiveness analysis. American Journal of Public Health, 89(3), 351–357.
Retrieved from CINAHL Plus with Full Text database.
Moeller, D. W. (2005). Environmental health (3rd ed.). Boston, MA: Harvard University Press.

21. Barriers to Reduce Radon Cont.
Public perception
Not a serious health threat
EPA missed deadline for submitting standards
(EPA, 2010)
Radon in water
No certified laboratories for analysis
No standards (VDH, 2010)
Another barrier, and the purpose of this presentation, is the general perception that radon is not a significant public health threat and that a level of 4.0pCi/L is safe. The EPA missed Congress’ October 2000 deadline to submit the finalized drinking water standard and regulations remain in a proposed stage. Progress on this can be tracked at (EPA, 2010). Also, there are no laboratories certified to test for radon in water. Further, there are no standards for radon in water regardless if its source is from a well or water system. In Virginia, in the few water systems that have been tested, some have demonstrated to exceed the proposed EPA standard (VDH, 2010).
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from
Virginia Department of Health, Office of Epidemiology, Radiological Health Programs. (2010). Indoor radon program. Retrieved April 17, 2010 from

22. What Can You Do?
So what can you do to protect yourself?

23. What Can You Do? Test your current home
Short term (2-90 days)
Long term (more than 90 days)
Better predictor of radon levels (NCI, 2004)
Vent and limit radon from entering house (ATSDR, 2008)
Fix if above 4pCi/L (EPA, 2010)
First, test your current home. Short term tests can range from two to 90 days. Longer term tests are better predictors of radon levels and monitor levels for more than 90 days (NCI, 2004). Ensure proper ventilation in the house and seal cracks and gaps where radon can seep through the foundation (ATSDR, 2008). If radon levels are above 4pCi/L contact a certified mitigation professional and fix your home (EPA, 2010).
Department of Health and Human Services, Agency for Toxic Substances & Disease Registry. (2008). ToxFAQs for radon (CAS#: ). Retrieved April 17, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from

24. What Can You Do? Cont. Be smart when buying a new home
Radon mitigation system inspection
Financing from lenders
Build radon resistant homes (RRNC)
Only additional $250 to $750 extra
Contact your State Radon Program
When buying a new home, ensure the inspector uses the radon mitigation system inspection. This checklist promotes testing for radon, verifies existing mitigation systems, and ensure they are working. Financing is also available through certain lenders. When building a new home, work with a growing list of contractors that are certified in radon resistant new construction. Contact your State Radon Program at They are a wealth of information for you (EPA, 2010).
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from

25. Conclusion Radon is a threat No safe level of exposure
EPA recommends action even at 2-4pCi/L (EPA, 2010)
One out of 15 homes in U.S. estimated to exceed recommended limits
Lung cancer deaths reduced 2-4% (NCI, 2004)
Take action!
Radon is real even though we can’t see, smell, or taste it. It has the potential to affect all of us in the places that we would like to think we are the safest. As I have mentioned before, there is no known safe level of exposure. The EPA has even recommended steps be taken at 2-4 pCi/L as a result of finding the average level in homes at 1.3pCi/L. Even at this level, lung cancer deaths have been associated with radon (EPA, 2010). Importantly, one out of every 15 homes in the U.S is estimated to have radon levels that exceed the EPA’s recommended limits. Reducing radon levels in these homes may reduce radon exposure associated lung cancer deaths by 2-4% or 5,000 cases (NCI, 2004). The current forms of federal, state, and local controls are in the form of recommendations and current proposed regulations are still waiting for review and approval. The general public should pay attention to the significance of radon and adhere to these recommendations in light of scientific studies that support the link between radon and lung cancer. The good news is that you can take simple steps in your home to protect yourself. You’ll find additional resources at the end of this presentation for you to read more about radon, testing, mitigation, and local controls. I hope this information was helpful and you feel more knowledgeable about radon and how to protect yourself. Thank you for your time.
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved from
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from

26. References
Centers for Disease Control and Prevention, National Center for Environmental Health. (2007). Radon research. Retrieved April 16, 2010 from
Department of Health and Human Services, Agency for Toxic Substances & Disease Registry. (2008). ToxFAQs for radon
(CAS#: ). Retrieved April 17, 2010 from
Environmental Protection Agency, Air, Indoor Air Quality. (2010). Radon. Retrieved April 17, 2010 from
Fairfax County Department of Health. (2010). Radon air quality. Retrieved April 17, 2010 from
Ford, E., Kelly, A., Teutsch, S., Thacker, S., & Garbe, P. (1999). Radon and lung cancer: A cost-effectiveness analysis. American Journal of Public Health, 89(3), 351–357. Retrieved from CINAHL Plus with Full Text database.
Hogle, W. (2005). Surgeon General releases national health advisory on radon. Clinical Journal of Oncology Nursing, 9(2), 146. Retrieved from CINAHL Plus with Full Text database.
Moeller, D. W. (2005). Environmental health (3rd ed.). Boston, MA: Harvard University Press.
National Cancer Institute. (2004). Radon and cancer: Questions and answers. Retrieved April 15, 2010 from
Virginia Department of Health, Office of Epidemiology, Radiological Health Programs. (2010). Indoor radon program. Retrieved April 17, 2010 from
Here is the full reference list for the citations used in this presentation.

27. Additional Resources General information Radon and lung cancer
EPA:
WHO:
Radon and lung cancer
National Cancer Institute:
Local regulations and standards
Virginia Department of Health:
Fairfax County Health Department:
Testing
The National Environmental Health Association (NEHA) National Radon Proficiency Program:
The National Radon Safety Board (NRSB):
Here are additional resources for you to review if you are interested.