1. Barcey T. Levy, Cynthia Wolff, Jeanette Daly, Yinghui Xu, Lori Heeren, Paul Niles, Heather Morehead October 11, 2013 Iowa Cancer Summit University of Iowa Departments of Family Medicine and Epidemiology Akron Mercy Medicine Clinic, Akron, Iowa

2. Background Radon is a colorless, tasteless, radioactive gas produced from the decay of naturally occurring uranium, thorium, and radium in the soil. The gas enters buildings and decay products are breathed in. High radon levels are present in homes throughout Iowa, unless steps are taken to prevent it. Radon is the second leading cause of lung cancer overall, estimated to cause 15,000 to 22,000 deaths nationally.

3. How does radon get into your home? Radon gas rises up through the soil and is pulled into a house or building. It enters a home or building through cracks in the foundation, construction joints, gaps around service pipes or wires, and sump pits. It doesn’t matter what type of foundation your home has—basement, crawl space, slab—your home could have high levels of radon.

4. EPA Map of Radon Zones

5. Methods Cynthia Wolff, MD, in Akron, Iowa became very interested in radon after hearing some talks at the Iowa Cancer Summit. She teamed up with Barcey Levy to write a proposal to the Iowa Cancer Consortium that was funded. Dr. Wolff and her office agreed to hand out radon kits to patients. Kits were obtained from Air Chek, Inc., Mills River, NC. Medical office staff kept a list of kit numbers and which patients had them. Dr. Wolff also agreed to hold forums describing the dangers of radon and the importance of testing homes for radon. Individuals taking kits filled out a one-page questionnaire.

6. Methods (cont’d) The investigator developed questionnaire asked about: the age of their home years lived there whether they had ever tested for radon whether they had radon mitigation in the past type of heating whether their home is well-insulated demographics

7. Methods (cont’d) The University of Iowa and the Akron Mercy Medical Clinic IRBs approved this research. Data from the questionnaires were double-entered and verified. This information was linked with the radon result. If a kit was handed out and not returned, Dr. Wolff’s office called the subject to remind them to do the radon testing. Descriptive statistics and association tests of radon levels with home characteristics and income level were done using SAS.

8. Results Over 14 educational community presentations were held with over 400 individuals attending. A total of 746 radon kits were handed out, with 397 radon results received (53.2% return rate). 364 kits gave a valid test result (91.7%). 346 radon results were valid and could be matched with a questionnaire. Mean radon results were 10.1 pCi/L (SD 8.5). Of the 8 radon values above 30 pCi/L, the mean was 45.5 pCi/L.

9. Results 82% of homes had radon results of 4 pCi/L or higher. 4 pCi/L is the Environmental Protection Agency action level. The mean age of the homes was 54.0 years (SD 36.2). The most common types of heating were gas (62%), followed by electric (25%), with geothermal (5%) and wood (4%) much less common. 76% considered their home to be well-insulated.

10. Results 16% had tested their homes previously. The mean level of radon was 13.9 (SD 8.7) pCi/L (for those who could remember what their previous results were). Mean age of subjects was 55.3 years (SD 15.2 years). 42% reported an income level below $50,000. There were no significant differences in radon level by type of home heating or income level. Well-insulated homes had a significantly higher radon levels than those that were less well- insulated (10.8 vs. 8.2 pCi/L, p<.007)

11. Discussion Consistent with other studies in Iowa, over 80% of homes tested had radon levels for which re-testing or mitigation would be recommended. Homes that were well insulated had higher radon levels than homes that were not. Over 50% of radon kits were returned. There was no charge to patients for the kits. Having a nominal charge might have helped with the return rate.

12. Discussion Nearly 92% of individuals had a valid radon test result, indicating that nearly all were able to write clearly and follow the instructions. Dr. Wolff and her staff conducted over 14 forums which reached over 400 individuals. They set up agreements with banks for low- interest loans for radon mitigation and compiled a list of certified radon mitigators.

13. Limitations Kits were handed out by a very enthusiastic and dedicated office staff and this might be difficult to replicate in other office settings. All questionnaire information from individuals taking kits was self-reported. There was no attempt made to verify the accuracy of the information.

14. Conclusion Over 80% of homes tested had elevated radon levels. As with other types of public health testing, testing can lead to results which need follow-up and for which additional costs are incurred. This is balanced by the known effects of radon, which is estimated to cause 400 deaths each year in Iowa. This project provides an excellent example of community engagement and University outreach.

15. Dr. Wolff and her Staff

16. Acknowledgement Iowa Cancer Consortium Iowa Department of Public Health NCI 1 RC4 CA153493-01 Akron Mercy Medical Clinic The University of Iowa Departments of Family Medicine and Epidemiology

17. It could save you or a loved one’s life!