It is the rare article on radon that has no errors. For example, all the subatomic and macro physics are unfamiliar enough to most people that errors even by people you'd hope would know better are common. And many people interviewed are one-day-training-experts and not professional speakers so a reality is that thoughts can come out poorly, or that they're simply mistaken, not to mention that some essential phrase might have gotten edited out by someone who's also not an expert on radon.

So over the years, I've become philosophical about things, and I'm now accustomed to looking at whether an article is a net positive, not whether it is free of mistakes. In my opinion, there are enough statements in this presentation that are useful and accurate--e.g., "You can’t see it and can’t smell it but radon gas can seep into your home and greatly increase your risk for lung cancer. It's a real threat for those of us here in the Tennessee Valley and the only way to know you have it, is to test your home."--that I'm willing to grant that the piece is a net positive, despite the cringe moments and even the occasional egregious mistake. My hope is that with good information available otherwise and with proper training, certification and oversight of radon professionals, the public will eventually get the straight story even if they were initially misled on some points by a three-minute news item.

↪Brian R Gaulke et al.

Looking at the survey results for why people did not take steps to mitigate ...
• Did not consider their radon levels were particularly high (35% of respondents)
• Concern about the cost of mitigation (18% of respondents)
• Did not yet find the time to mitigate (8%)
• Lack of information or didn’t know what to do to reduce their radon levels (8%)
... I think that Brian is right in that those who would say, "'I haven't gotten sick yet' etc." are probably buried among that 35% group--and I suspect even among the latter groups.

But I have these additional thoughts about that list of four reasons.
- The great thing, the advantage of having this list, is not only that one knows better what the barriers are, but also, with a little thought, that they are all to some extent Addressable. I believe that improved public health education and creative thinking can help make progress on all of these barriers. That is the good news. In reverse order...
• Lack of information / didn't know what to do: Establish/improve avenues for brief, clear communication on this matter (e.g., "three simple steps"), referring people to a trusted neutral financially-disinterested source, when initial radon results are above the action level.
• Not yet find time: To the extent this is not just a "convenient reason to give," be sure to communicate somehow--at least in FAQ pages--what time commitment is necessary here. It strikes me that the biggest issue is the matter of what time investment is required to research what needs to be done, who is qualified to do it, how much it will cost, etc. To the extent that process can be facilitated collaboratively among all qualified radon testing and mitigation firms, and with government support, this could alleviate a lot of the misgivings people feel as they get into something that is a complete mystery to them.
• Concern about cost: This requires a little more research: Is it that people know the costs and still have concerns? Or is it that they have little idea of the true costs, and armed with what "horror stories" they may have heard, are simply fearing the unknown? (To be sure, this is tied into the risk-cost-benefit analysis people do that I address in the next bullet.) The solution will depend on the source of this concern. While it may hoped that external sources of funding may yet be created to assist in mitigation subsidies for low-income households, the issue for many people could be addressed by a mixture of messaging around the idea of what cost range is expected, comparing this with routine expenses, etc., and perhaps offering ways to help people "divide and conquer" by paying in installments, some before the work and some after, if the full amount doesn't fit their budget.
• Didn't consider levels particularly high: Again, this is a big category and could benefit from drilling down a little. For example, what levels would they consider high enough and why? People are notoriously irrational about assessing and comparing levels of risk, so we have to recognize that and work with that reality. Even for things like cigarette smoking, which kills far more people than radon, and failure to use seat belts, it has taken years to adjust social norms to recognize these as risky enough to change behaviors. As we all know, radon exposure gives no sensations, and produces no immediate symptoms, so it is easy for people to regard their levels as "not particularly high." (After all, if not with full awareness, they at least subconsciously feel that if radon were elevated, they Would somehow sense it or feel symptoms.) This state of affairs is a call for clear, consistent, repeated education, not only about radon, but also about what levels of exposure warrant mitigation--even though essentially NO level of radon is detectable by senses or by immediate symptoms. And even though cause-effect in any Particular case cannot be shown, the stories of people who got lung cancer even at those "not particularly high" levels of exposure need to be told as well.

Good to read Brian and Shawn's discussion. I do agree that better average post-mitigation results should not be the only metric for success. The number and fraction of homes mitigated that are in need of it are important as well. Likewise, the effectiveness of any program in ensuring long-term reliability is also critical. To speak in "bottom line" terms, what approach maximizes the number of lives saved over the long term?

While I agree that the real estate transaction provides a "great opportunity to educate and to perform testing and mitigation," I am happy with any social norm of attitudes and practices that accomplishes the same thing. IF people can widely accept and carry out testing, mitigation, and regular retesting and maintenance, outside of the real estate transaction process, what could be wrong with that? It's just that the occasion of taking occupancy in a new building is such a logical juncture for intervention, it seems to me it would be a shame not to take advantage of it.

A great audience to address, Bill. Thanks for continuing the reminders..

Don't get your hopes up too soon for radon-detecting plants.
The mechanism discussed is one that operates at a chemical level that requires a certain concentration of target substance in order to produce a detectable signal, even when amplified as discussed. On the other hand, radon and its progeny, even in a "problem house," would be present at extremely small concentrations when considered from a chemical perspective--many orders of magnitude smaller than the bacterial metabolites that have been detected. And while the kind of chemical damage caused by radon/progeny in cells may be something that could be looked at, many potential chemical markers for that aren't specific to radon. The author writes, "If they can figure out how houseplants respond to other threats, such as radon..." but I'm afraid this may be spitballing, at least where radon is concerned, leading me to think that that is a very big "If".
I doubt that radon testing professionals are likely to be replaced by genetically engineered tobacco plants anytime soon.

While I think we can agree that each individual's case is different, and that for responses specific to an individual, health concerns are properly brought to that person's physician(s), there are nevertheless some things that can be said in response to Doug Stoll's question:

1) Smoking has many different adverse outcomes whose rates of risk after smoking cessation behave differently. For example, though some of the data might have been refined by more recent studies, the website https://whyquit.com/whyquit/A_Benefits_Time_Table.html gives at least an idea of how these rates of improvement differ depending on the health outcome studied. Be careful to avoid saying that "in a year or so" someone is healed from the adverse effects of smoking -- or of radon.

2) With respect to the risk of lung cancer after smoking cessation, there are numerous studies out there, but here is an article--not necessarily the best or most recent, but accessible to most readerships--that shows how lung cancer risk both drops but remains higher than a never-smoker's risk for a long time after quitting: https://www.health.harvard.edu/newsletter_article/cigarettes-the-lung-cancer-risk-lingers

3) I am not aware if clinical studies specifically addressing the behavior of the lung cancer risk curve after reducing radon exposure have been done. However, I understand (e.g., from BEIR VI, etc.) there are reasons to believe (and I defer to those more expert than me to elaborate) that lung cancer risk over time after radon exposure reduction would show some characteristics similar to its behavior after smoking cessation.

4) In other words, though the lung cancer risk would not reduce to the level of a person never-exposed-to-high-levels-of-radon, substantial reductions in that person's risk would be expected to occur over time.

5) Of course, there is never any guarantee regarding the outcome for any particular person.

Congratulations on CRCPD's release of this long-awaited successor to the quarter-century-old Physician's Guide to Radon. Thanks to the U.S. EPA (and to the American taxpayer, of course) for supporting development of the guide, with its broader and appropriate emphasis on the role of all health care providers in health communication and cancer prevention. And especially, thanks to Dr. Bill Field, not only for his perseverance in drafting the guide, and for his collegial approach in working with many diverse collaborators, but also for his championing of its adoption by and dissemination through as many professional health avenues as possible.

I encourage everyone, particularly when questions arise about the state of the medical science regarding radon, and about what health care providers should know and do, to be sure to distribute this guide far and wide. This is an achievement that should not be underestimated.

http://www.radonleaders.org/resources/reducingtheriskfromradon

Hi Tony,
There are folks more qualified than I to respond here, but my take on this is along the following lines:
As an analogy, your question is rather like asking what is the best causation study for smoking and lung cancer after the 1964 Surgeon General's report. To be sure, the science has progressed in many ways since then, but once something has been conclusively demonstrated, there's not really such a strong scientific need to demonstrate it again.
But there is clearly social and public health value in re-making the case from time-to-time. Unfortunately, the resources needed to go through the kind of major exercise that the National Academy of Sciences did under an EPA grant 20 years ago are not so readily come by, so I can't point to any single new review that has the singular weight that BEIR VI did in its time.
Of course, you are aware of EPA's 2003 Assessment of Risks from Radon in Homes. And US Surgeon General Carmona issued a prominent National Health Advisory on radon in 2005. In 2006, the NAS also put out a more general review of Health Risks from Exposure to Low Levels of Ionizing Radiation (BEIR VII), but radon was not a big focus of that report.
International publications such as the United Nations Committee on the Effects of Atomic Radiation (UNSCEAR) series of reports on "Effects of ionizing radiation" (including ... 2006, 2008, 2012, 2013, 2016) keep track of current science but these are not on the radar for most, and their content is beyond most readerships. The World Health Organization's 2009 Handbook on Indoor Radon is probably the best known international document summarizing the science and policy perspectives on radon for a more lay readership, but even then you're quite likely to encounter a lack of awareness about this publication. Other documents you could refer people to include ICRP's Publication 115 (2010) that adjusts the risk coefficient upward, and of course the Health Physics Society's 2009 revised (be sure you aren't looking at the 1990 version) position statement on radon.
Nevertheless, for purposes of having material that summarizes the science cogently, I do routinely suggest that people review the materials (available on www.radonleaders.org ) from Dr. Bill Field and Dr. Jay Lubin--their papers and presentation before the President's Cancer Panel (2008). Anyone who wants to read more, such as the analyses on the pooled radon epidemiological studies, can follow the references therein.

Such a scientist. Such a soul. In your grief, Rick, may you also feel blessed. You've reminded us of how much we unknowingly stand upon the shoulders of giants.

This is indeed a tragic loss. My condolences to Dr. Kotrappa's family and to everyone at Rad-Elec. I'm sure Rick brought a smile to many with his "understatement" sentence. I do want to give a testimonial to Paul in that no opportunity to be of service was too small for him to undertake: He was of notable assistance to my son when he was doing a Rn/Tn science project when he was in high school.

Your point is well taken. Sorry I was in a hurry and leapt to reply before appreciating that. Of course, your list of passive measures undertaken by Wx people is significantly deficient compared to RRNC.

Other than what the Wx folks may be doing within their means to address the problem, I would expect that currently there is little appetite among mitigators for encouraging doing radon mitigation via passive measures. I imagine most of the science on the inadequacy of those (e.g., not "sealing alone" for "mitigation effectiveness") is from the '80s and '90s, and that is now considered a settled issue. Maybe those studies can be dug up and "average reduction fraction effectiveness" can also be looked at.

I would like to contrast the two statements:

First Dick's: "My personal experience over 29 years of mitigating radon in homes is that passive measures by themselves do not have a significant effect on building radon levels unless the starting point is already close to 4.0 pCi/l, and I'm prepared to tell them that."

Then from the Ft. Collins study: "We found that RRNC reduces radon by an average of 49%, which confirms the findings of similar studies in other part of the nation. We further found that the number of homes above 4 pCi/l dropped from 83% with the radon system disabled [capped] to 40% with the radon system enabled [uncapped]."

It would be interesting to compare Dick's capped/uncapped data with the Ft. Collins dataset.

I will leave aside for purposes of this reply the question of how many of the passive systems Dick ran across were properly installed in the first place. But I do want to say that if we limit our discussion to properly installed RRNC systems, some distinction needs to clearly be made:

- It's one thing to define effectiveness as "getting radon levels down to below a threshold" such as the EPA Action Level of 4 pCi/L. And certainly, I think we all agree that RRNC is not expected to be uniformly "effective" in that respect. That kind of effectiveness is a proper metric to evaluate active systems, but isn't a standard that it's fair to hold passive systems to.

- But it's something else entirely if one of the metrics with which to look at passive systems is how effective it is at reducing radon levels, independent of whether the levels are reduced enough to be less than the Action Level. By this measure, the Ft. Collins reduction of 49% is a gratifying result, and the conditions under which it was achieved should be replicated elsewhere--so long as all parties understand that this kind of effectiveness is NOT the last word on radon reduction in a dwelling.

My point is to encourage Dick not to undersell the "average reduction fraction effectiveness" of properly done RRNC when discussing Rn with Wx people, even as he is clear with them that RRNC is not to be relied upon to achieve "mitigation effectiveness."

I scrutinized more closely, and actually, there ARE two hidden mentions, but neither in a context that'll do much good.

If one gives the architect the benefit of the doubt, then there appears to be a desire to include in the plans "something for radon" he/she knows should be there. This suggests another angle from which to approach the problem:
Clearly the architect thought he or she learned somewhere that "typical 2-inch radon pipe" was what was called for. Perhaps this is an honest if well-intentioned mistake. Therefore, perhaps some outreach to the American Institute of Architects (AIA) regarding education on key features of good RRNC might be a way to get conscientious architects to include RRNC properly into building plans. Then if this feature is already shown correctly (i.e., the right size, materials, location, etc.) directly on the plans, would builders be more likely to follow that?
(Of course, I still agree that the best way to get RRNC installed correctly is to require professional certified radon tradespeople to do it.)

Within the range of uncertainty, "8" and "half a pack [=10]" cigarettes are basically the same number.
If you think the cigarette comparison is the best way to communicate to your audience, I wouldn't have a real objection to that so long as you do your best to be clear, using understandable language, that
a) you are talking about the U.S. average excess lung cancer risk only (cigarette smoking also being responsible for more non-cancer deaths than cancer deaths);
b) the risk from radon is much greater for people with a history of smoking than it is for people who are lifelong never-smokers;
c) anyone with lungs can get lung cancer, so radon increases never-smokers' lung cancer risks too;
d) no one deserves lung cancer.

Health communication depends on where one's audience is, what they know already, what they think they know (but inaccurately), and what they can be taught that will motivate change in behavior. There is an inherent conflict between a) presenting information tuned to an audience's capabilities and limitations, and b) knowing what detailed information exists and how the more scientifically minded might prefer to see it. All public health communicators need to navigate this. Too simplified, and you misrepresent reality; too complex, and you go above the heads of your listeners.

For your background, but not necessarily for display to some audiences, I've attached some images I've drafted to approximate the relative risks for U.S. average indoor radon and for the 4 pCi/L action level, for different US populations, so one can see how the relative risk model of lung cancer induction plays out. I do point out that the last graph shows risk of lifetime exposure only AT the Action Level. If long-term exposures are much higher, risk of death from lung cancer due to radon would be correspondingly greater.

I stress that I am happy to have epidemiologists review and refine this draft. Please note also that these are based on EPA's central estimates of risk, and that actual risks might be higher or lower.

Sam cites a very well respected study. And although the conclusion "There was a significant positive linear trend in COPD mortality with increasing categories of radon concentrations (p<0.05)" is striking, it is important to recognize that this is just one study, and that this simple association does NOT constitute proof of a causal association. I would counsel practitioners to be careful not to make excessive claims here. The authors are clear that "Further research is needed to confirm this finding and to better understand possible complex inter-relationships between radon, COPD and lung cancer."

Looks like the conversation is potentially a fun hornet's nest to walk into, so ...

I wanted to give Bill Angell some support. One can see from the risk charts displayed in the 1986 Citizen's Guide and those in EPA's current version, the outcome of concerns that people expressed:
- Regarding smoking, the equivalence was criticized as inappropriate (some even said it was "scare-mongering"), at least in part, because smoking poses many other risks of death than only that due to smoking-induced lung cancer. Others pointed out the need to discuss explicitly the synergism of smoking and radon, and still others the need for the 70 years at 18 hours/day exposure for the equivalence to be drawn, etc. Bill or others may recall other objections at the time.
- Regarding the X-ray comparison, there were concerns among those doing medical radiology that the chart appeared to bring up the risk of death associated with X-rays, but without any context of its medical indications of diagnostic benefits. The quarrel wasn't so much with the arithmetic as it was with the human implications of discussing X-rays in a bad light. Some radiologists felt that there was so much "fear of radiation" on the part of patients that their job was hard enough as it was to convince people to get the X-rays they needed without any bad publicity associated with use of that tool.
- EPA "just looking at things scientifically and trying to motivate people into testing and fixing", had its communication hands slapped, and as a result, you can see that its current risk chart ( https://www.epa.gov/radon/citizens-guide-radon-guide-protecting-yourself-and-your-family-radon ) now uses other, familiar, if less controversial, comparisons based on "data calculated using the Centers for Disease Control and Prevention’s 1999-2001 National Center for Injury Prevention and Control Reports."

I also want to note that the sheet Marcel sent includes the disclaimer:
"This publication was supported by the Nevada Division of Public and Behavioral Health through Grant Number K1-9693515-0 from the U.S. Environmental Protection Agency. Its contents are solely the responsibility of the authors and do not represent the official views of the Nevada Division of Public and Behavioral Health nor the U.S. Environmental Protection Agency."
so I would suggest it not be referred to as an "EPA fact sheet"

Since we can take it as a given that the developers of point-based building criteria want to ensure occupant health, they should recognize the potential scenarios for the positively pressurized side of radon mitigation systems to leak into conditioned space where that might affect occupant health.

If any fan that is ultimately installed should not be placed within conditioned space, builders should not be given points for pre-installing piping that either may make less safely accessed roof-mounted radon fans needed or will simply make the roughed-in piping unusable.

Instead, in such buildings as Sam describes, the proper directions for pre-installing radon piping need to be conveyed to the builders and to their evaluators to avoid this problem.

Have those directions been officially communicated by AARST at least to the directors of the major building programs, such as those that Sam mentions? If so, documentation of such communications could be provided to mitigators called in to activate builder-installed RRNC in such buildings.

I think that the essential question here is:
Is an unoccupied attic conditioned in such a way that air in that space is more likely to find its way into the livable areas of the building than would the air in unoccupied and unconditioned attic spaces in buildings having them?
1) If yes, then the proscription against radon fan installation in such conditioned spaces is well-founded and builders shouldn’t be awarded points for installing roughed-in piping there.
2) If not, then that proscription in this kind of case may need revisiting.

Since such a conditioned attic space is built to be within the same building envelope as the rooms below it, I’ll admit to a gut feeling (without knowing the evidence) that it is probably more likely to communicate with airspace in the rest of the building.

Yours,

Kevin Stewart
Director of Environmental Health
American Lung Association of the Mid-Atlantic

Hi Tony,
The Lung Association uses a front "contact us" page that affords people different options, so they can reply in a manner most comfortable to them: http://www.lung.org/about-us/contact-us.html
The actual form, at http://www.lung.org/about-us/ask-the-american-lung-association/general-questions.html, uses 8 simple fields which people do tend to fill out. Of course, our topic areas are broad enough that a detailed form would probably be unworkable.

Thanks Dallas,
For example, I got no email on your Habitat question because it was a new discussion.