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thank you for coming hello everyone i'm jonathan lynch i am the deputy associate director for communication with the division of environmental health science and practice in the national center for environmental health at the centers for disease control and prevention i'd like to welcome you to today's eh nexus webinar for radon awareness week all participants joining us today are in listen only mode closed captions are available for this webinar next slide please today's eh nexus webinar will be available to view on demand a few days after the webinar you can find the video recording of today's webinar at the cdc eh nexus webpage and next slide please you can see here from the logistics that if you have a question to ask you can press the q a button and put your questions in there we have a lot of content today so we may not be able to get to all questions but uh please ask them anyway it's good information for our panel of experts um next slide please okay i would now like to welcome our presenters for the webinar we are pleased to have three presenters today dr salome alfie is a senior service fellow in the radiation studies section division of environmental health science and practice in the national center for environmental health at cdc our second presenter is dr thomas golden dr golden is an epidemic intelligence service officer in the office on smoking and health also at cdc and our final presenter is dr bill field dr field is a professor emeritus at the university of iowa's college of public health with appointments in the department of occupational and environmental health and the department of epidemiology next slide please before we go to our presenters we're going to start with a video that illustrates why we should all take steps to reduce the amount of radon that we are exposed to [Music] my name is jackie nixon and i am 73 years old and i am a cancer survivor i always was one that was big on exercising uh eating right so my health was perfect i did never had the flu in my life i got one cold maybe a year um i couldn't ask for more the indication that i noticed something wrong was when i was singing and for example if i can if i sing a note and you have so many beats to hold that note i would get like half of the way and i'd lose air and later on it became apparent that part of the reason was lung cancer the first thought was oh my god i'm going to die i did think about you know things i might have done in the past that might have caused it but bottom line is is that i i never smoked a day in my life i had the surgery and i was home for seven months once i was able to go back out again i went to a meeting and there was a gentleman there there was a home inspector did you ever hear a braid on it i don't i can't explain it to you but for some reason i immediately knew that was it i took my own money and i got the highest level monitors and i asked my neighbors because you have to test at the lower levels so we tested the building and rose's apartment came out to 18 picocuries the government-level epa level guideline is for echocards [Music] i said well i know what i can do and i decided that i was going to start my own advocacy just basically start telling people i think in specifically in jackie's case i mean she was diagnosed with lung cancer in 2015 and that was in a very rapidly changing era for radon and lung cancer had she been diagnosed in 2000 we would have never even thought of her cases radon related and so the timing of the two her diagnosis and the the growth in knowledge sort of coincided and and as time went by in jackie's case as as the years went by um she became like a healthcare hero and she helped educate you know people around her the general public but also me you know because then i thought well this is real pay attention to your health period do not ignore things radon affects your lungs you may not have any symptoms zero symptoms so test your house radon and know your numbers [Music] [Music] great thank you um so now we're going to turn it over to dr salome alfie dr selma alfie please proceed thank you jonathan and boy what a powerful video could you please put the next slide uh jackie mentioned quite a few things on her video so what i'd like to do is cover some of the radon basics in my presentation next please and i want to get started with this little video and then i'll go into more details home is our place of rest gathering working learning and growing we take care of our homes and the people inside them and our homes protect us but the environmental protection agency estimates that one in 15 homes have high radon levels radon is a gas that you cannot see smell or taste radon is the second leading cause of lung cancer in the u.s you can test your home for radon using a radon test kit call your state radon office for information on testing there are many ways to reduce radon levels in your home if it is high call your state radon office for help test your home take action learn more thank you okay please put the next slide okay so we we already started talking quite a bit about radon and i want to break down into some important pieces for example what is radon radon is an odorless and invisible radioactive gas that comes naturally from rocks soil water when you're in an outdoor environment the levels of radon are very low and generally are not considered harmful however when radon gets into homes or building through small cracks or holes it can build up to higher levels and when we breathe in high rate on levels over long periods of time it can cause lung cancer radon is the second leading cause of lung cancer in the united states after smoking next please this graphic here illustrates how radon can get into the home if you can see on the bottom uh there's radon and ground water you move up is radon in bedrock radon in soil and you see the various pathways that can get into the home for example through construction joints gaps around service pipes cavities and cracks inside walls if you have a sump pump in your home a private well in some areas if they have high radon through the groundwater supplies etc next please you may or may not be aware that one out of 15 homes has high rate on levels ing to data from the environmental protection agency next please so how do you know if your home is high then radon levels well the one way to to know is to test like i said you can't smell it you can't taste it you can't see it but there is a way that you can test for it you can contact your state rate on office to get a test kit or you can purchase it at a hardware store or you can even get it online a jackie in her video she mentioned a pico curious per liter that is the unit that is used to measure radon levels and the epa has an action level of four picogears per liter so if your test shows that the radon levels are above four picocures per liter or if you want to reduce the levels in your home even if they're below four you can contact your state rate on office and they will help you find a qualified or state certified rate on contractor in your area that can fix your home because the good news is that a high rate on levels are fixable however it takes technical knowledge and special skills so we really recommend that you rely on a qualified professional for these repairs and once you do repair we recommend that you test again to make sure that the repairs indeed reduce the radon levels next please now how do you know when to test your home well certainly if it's never been tested or you don't know the levels it's possible that whoever lived in the home before tested but did not provide you any results so it's a good idea to test if you don't know the levels a lot of people test when they're preparing to buy or sell a home also before or after doing any renovations especially if you are making any repairs to reduce radon levels like i said in the previous slide once you make a repair you want to make sure that the levels have been reduced and if you make any lifestyle changes in the home that would cause someone for example to spend more time in the basement in a home office or a playroom or whatever if you have an unfinished basement and you finish it you want to make sure you test to make sure the levels are still below the action level next please uh there's certain ways certainly you can do it yourself like i mentioned before you can purchase a radon test kit from a hardware store from online you can go and test your home or office and then you can send the test kit to an approved laboratory and they will send you the results on what your radon levels are next please now once you get your results it can be either higher than four between two and four or lower than two picocures per liter and there are different things that you can do if the levels are higher than four we'd recommend that uh if you use a short term test that you take a second test and do the average you can contact the licensed professional to a radon reduction system if the average of the two turn short-term tests is higher than four picocurie all their results from any long term are also higher than four now the long term test is a test that you can place your detector anytime between three months to a year and that will give you a more accurate um description or depiction of the levels in your home it is important that you retest a few months if you fix your home to make sure that the system is working properly if the levels are between two and four picocures per liter we suggest considering installing a radon reduction system and make sure you re-test a few months after your home is fixed again to see if the levels were reduced if the levels are less than two there's no action needed you can test your home again again if you change areas at your home if you finish a basement or you are in another part of the house that you weren't using before next please now when we talk about fixing your home we talked about installing a radon mitigation system again we suggest that you contact your state rate on office and there are radon programs in every state in the country and or you can contact the epa national radar proficiency program and they have listing of qualified professionals that can fix your home again we highly recommend that you use people that are certified to do radon mitigation and there are several methods one that is proven to reduce radon levels is called a soil depreciation system and that method uses a vent pipe that captures the radon gas coming from the ground and routes it outside the home as you can see in this picture there's a fan and is venting out to the top of above the house next slide please there are other things that you can do to reduce your levels you can see all the foundation cracks and other openings that also will help make this system more effective and cost efficient and of course different homes may need different designs so it's very important that when you select a contractor that they look at your home and give you a specific design for your house and again we suggest that you test your home after installing the system to make sure it works and consider re-testing every couple years or if you do any remodeling next please there are no known safe levels of radon but even if your levels are not above four you can still take actions to keep the radon levels low of course you can open windows and using fans that approach works but it sees on all there are many areas in the country that you cannot keep your windows open for more than a couple of months at a time so it's a short-term strategy again sealing cracks in floors and with plaster caulk or other materials and again if you do any of those things make sure you retest next please radon in schools like homes schools can also have high rate on levels it's very important that you ask if your school has been tested for radon if the school has not been tested there are certified professional testing services or school personnel that can test the school for radon but it's also very important that you contact your state radon program before doing any school testing because some states have restrictions on who may conduct the test next please now did you know about the combination of radon and smoking the risk of increasing lung cancer from radon and the risk of increasing lung cancer with radon and smoking is 10 times higher so if you live in a high in a home with high rate on levels if you're a smoker it raises your risk by a factor of 10. next please now the epa or environmental protection agency and the surgeon general's office estimate that radon is responsible for approximately more than 21 000 lung cancer deaths each year in the u.s the radioactive particles that are a product of the decay of radon gas they can get trapped in your lungs of course it takes many years for lung cancer to develop and most people like jackie you know you don't have any symptoms until lung cancer is advanced and at that point it may be much harder to treat these are some of the reasons why it's important to take steps to reduce radon exposure throughout your life by testing and knowing your levels and fixing your home if you have elevated rhino levels next please uh some of the factors that increase your risk of getting lung cancer from radon include again living in or working in a building that has high radon levels having high radon levels in the part of the homework building when you spend the most time smoking cigarettes as i mentioned currently or in the past and also burning wood coal or other substances that add particle to the air and currently there's no conclusive data that show whether children are at a greater risk than adults from radon next please i want to just show you we have a little calendar here this week we're kicking off radon awareness week and this seminar is actually the kickoff event we will have different themes every day and we will invite you to join uh our radon awareness week by going onto our website and i'll show you the link in the next slide but monday we'll focus about getting the facts as today tomorrow learning the risk wednesday exploring data and resources thursday keeping school safe and friday talking to your patients that's gear more towards the health care providers we encourage you to check out our website and share with your family and friends next please and here is the link where we have additional information where we have the video clips when we have the testimonial and some additional resources if you go to cdc.gov radon and thank you very much for your attention and i'll turn this over to dr golden next please good afternoon thank you so much adella for that excellent presentation providing us with some very useful and beneficial information about radon and about radon detection as was mentioned at the outset of this presentation or at the outset of this webinar rather my name is dr thomas golden i'm an epidemic intelligence service officer at the us centers for disease control and prevention i work in the office on smoking and health where a lot of my research focuses on tobacco use and tobacco cessation particularly in the clinical context as it pertains to primary care physicians i'm a family doctor by training and i'm very excited to talk to all of you today about radon and cigarette smoking could you please advance to the next slide so the title of this talk is radon and cigarette smoke exposure a dangerous combination as was mentioned i'm dr golden i'm an eis officer at cdc and i'm also a lieutenant commander in the united states public health service please advance to the next slide thank you here we have just a brief overview of what we'll be discussing today i'll start off with a talk about radon and smoking and thanks to adela's fine presentation we already have a lot of background information on radon what it is where it comes from and what the potential harmful effects of it can be i'll delve into a little bit more detail about how smoking can potentiate and exacerbate some of those detrimental health effects in the second part of my talk i'll discuss secondhand smoke and how that is its own unique environmental health exposure particularly as pertains lung cancer risk and then finally i'll close with things we can do tangibly to reduce our risk of lung cancer and other health risks posed by exposure to cigarette smoke please advance to the next slide so again to start i'm going to discuss the additive effects of radon and smoking next slide please so lung cancer is the leading cause of cancer death in the united states and the leading causes of lung cancer as we've mentioned before throughout this session thus far are number one cigarette smoking and it's attendant secondhand smoke exposure and then the second most common cause of lung cancer after exposure to cigarette smoke is radon and just to really drive this point home smoking and radon exposure each increase the risk of lung cancer and the combination of those two things increases that risk even more they have a an additive effect advance to the next slide please thank you radon can cause lung cancer in anyone regardless of whether or not that person used to smoke or currently smoked as we saw in our introductory video and again studies have demonstrated a combined effect between smoking and radon for lung cancer risk the national cancer center excuse me the national cancer institute estimates that around 90 percent of radon related lung cancer deaths occur among people who smoke are used to smoke so to kind of tease that out a little bit while radon is an independent risk factor for lung cancer it's even when combined with cigarette smoke the risk of lung cancer increases even further next slide please now we'll move on to the second part of this presentation where i'll talk a little bit about another environmental exposure that can cause multiple health problems in addition to lung cancer and that's something i'm sure many of us are familiar with or at least have heard about secondhand smoke next slide please to begin this section i'll just define what exactly it is i mean when i say secondhand spoke and put briefly it's the combination of smoke created by smoking cigarettes smokes created in two different ways via this mechanism side stream smoke which comes from the burning end of a combustible tobacco product combustible tobacco products include many different things but the most commonly used product in the united states and around the world is cigarettes and secondhand smoke also constitutes mainstream smoke breathed out by the person who is smoking secondhand smoke contains more than 7 000 chemicals hundreds of which are toxic and 70 of which are known to cause cancer advance to the next slide please kind of emphasize why this is so important the u.s surgeon general has concluded that there is no safe level of secondhand smoke exposure secondhand smoke exposure alone can cause lung cancer results from a study from several years ago in 2014 that was conducted in spain suggested that a combination of secondhand smoke so among people who don't smoke themselves but are who are regularly exposed to secondhand smoke the combination of that and radon does lead to an increased risk of lung cancer so that additive effect of radon and smoking exists not just for those who smoke themselves but for those who are regularly exposed to second-hand smoke next slide please so who's harmed by secondhand smoke really anyone who's exposed to it even for a brief period of time secondhand smoke can cause health problems in children and adults and it can even be deadly each year in the united states second-hand smoke exposure contributes to approximately 400 000 deaths in infants and about 41 000 deaths among adults who do not themselves smoke and since 1964 about 2.5 million people who don't smoke have died from health problems caused by second-hand smoke exposure i think this slide is really helpful because in a systems-based approach it's illustrative of all the myriad ways secondhand smoke exposure can negatively impact people's health and i like how it's broken up into both children and adults so among children a lot of ear infections are actually correlated with secondhand smoke exposure secondhand smoke exposure can also cause respiratory problems impaired lung function anyone who works in an inpatient clinical capacity would be able to attest to the degree to which second hand smoke exposure causes asthma exacerbations in young children and there is a correlation between secondhand smoke exposure and sids or sudden infant death syndrome and among adults secondhand smoke exposure is correlated with stroke with nasal irritation of course with lung cancer the main focus of this discussion but also coronary heart disease and low birth rate in pregnant women next slide please now moving on to the final part of this presentation i'll discuss tangible things we can do to reduce risk adella very comprehensively discussed some ways we can reduce the risk of our exposure to radon i'm going to focus a little bit more on ways we can reduce our risk of exposure to both second-hand smoke and smoke from combustible tobacco products next slide please so cur of course the most important thing a person can do to lower his or her risk of lung cancer from smoking is quitting smoking in my clinical practice when i'm meeting with a patient who smokes the first thing i always say when we're doing kind of a an overall wellness visit or a preventive health check is that the most important thing you can do for your health is to stop smoking quitting smoking lowers the risk for lung cancer obviously but many other adverse health outcomes including cardiovascular disease other lung diseases that aren't cancer and many other kinds of cancer in fact quitting smoking is really hard anyone who's worked in a clinical practice or who has tried to quit smoking himself knows how hard it can be but there are lots of resources that can help tobacco use disorder is a substance use disorder and like other substance use disorders there are evidence-based treatments to help with cessation in fact there are a number of fda approved evidence-based medications that can help with smoking cessation and a conversation with a primary care physician can lead you to ways that might help using these medications as part of a comprehensive cessation plan you can further reduce the risk of lung cancer posed to you and your family by testing and protecting your home from radon next slide please the only effective way to completely eliminate involuntary exposure to secondhand smoke is to eliminate smoking in all indoor areas continued efforts to promote implementation of state-wide and local comprehensive smoke-free laws are critical to protect non-smokers from this preventable health hazard in the places where they live work and gather the number of states that enacted statewide comprehensive smoke-free policies such as no smoking allowed in work sites restaurants or bars increased pretty dramatically from just one state in 2000 to 36 states in 2020 but despite this progress 40 percent of the american population is not covered by these comprehensive laws while some states might not have statewide regulations substantive progress has been made adopting comprehensive smoke-free laws at the local level smoke-free rules and cars and homes can also protect people particularly particularly the most vulnerable such as children obviously the change in that map on the left from 2000 to the map on the right in 2020 is encouraging but we can clearly see there remains work to be done next slide please and i'll close with just what i hope are some key takeaways from this conversation smoking and radon exposure each increased the risk of lung cancer as we touched on in that first section and the combination of those two things increases the risk even more reducing radon exposure can reduce the risk of lung cancer in everyone including those who currently formerly or never smoked you can protect yourself and your family by quitting smoking and testing your home for radon and secondhand smoke exposure increases the risk of lung cancer secondhand smoke along with radon exposure increases this risk even more next slide please thank you very much for your time i hope that you have found this presentation informative and interesting and i will hand it off to dr bill field thank you again okay it's great to have be with you and uh enjoyed the first two presentations the next slide please so what i want to talk uh for the remaining minutes that we have is about a a new guide that we developed for healthcare providers to learn a bit about radon and to help provide guidance for their clinics and the patients that they see next slide please when we think about educating the public about radox you can see in this graphic here there's lots of different ways to help educate the public through health insurers through building codes through school officials teachers real estate agents but one of the most persuasive ways to educate public is through medical providers very often medical providers are the only scientists that a member of the public will see and they have a lot of trusted medical providers so we thought this was a really important avenue to help educate the public thanks a lot please so if you search radon and physicians over the past couple years put in those two terms what pops up is a guide that the epa developed many years ago back in 1993 and when we did our focus groups for the health care providers this was a guide that benign was still using as reference information so we thought it really needed to update it next slide so through funding from the council radiation control program directors these are the folks in all the different states that that promote the guidance for radiation exposure within their state or usually that at the different health departments and uh they formed a group called council radiation control program directors an excellent group so they're the ones that funded the update of this guide and what's really funding that they received from the u.s epa so it's really an update of uh funds that they have to develop an updated guide and this guy was developed right through focus groups that i i established different parts different regions of the united states met with several times developed a guy went back and got feedback and the input that we received was primarily from physicians physicians assistant nurse practitioners and other members of the nursing staff next slide one of the and i want to talk rather than just i'm going to be going over some of the content of the guy but i really want to talk about some radon misperceptions that a lot of healthcare providers had and i think members of the general public have as well uh providers often state it as compared to the number of deaths caused by smoking radon's very pretty insignificant why are we worrying about radon when we have say 140 000 people died here from lung cancer related to smoking and if you look at it from that perspective pretty much all the other causes of cancer or cancer mortality it looks pretty small when you compare it to lung cancer here's colon and rectums 53. so if you get down some of the other calls like esophageal or urinary bladder why don't we worry about urinary bladder cancer look at what's caused by lung and bronchitis or from cigarette smoking and the high rate of lung and bronchus but i think the wrong wrong comparison if we look at the number of cancer deaths radon this lung cancer as mentioned before it's about 21 000 each year which if it was treated as his own disease category be one of the top 10 leading causes of cancer death in the united states so if you look at from that perspective you can see really important uh important cause of cancer death next slide another misperception is most people most healthcare providers thought that radon was caused from the radon gas when it's actually caused by the radon decay products inhalation on these radon decay pods to being deposited on the pulmonary epithelium and then further decaying producing genetic defects next slide please so as uh radon decasic the case in a series of radioactive particles these are solid particles that when inhaled uh get deposited in the lung and two of them in particular polonium-218 and 214 undergo further decay by alpha decay and that causes a lot of radiogenic harm to the lung from these exposures so three of these radon decay products and we want to re-highlight that in the guide next slide please and as you can see these alpha particles from these radon decay products they cause double strand dna breaks which can happen directly because these alpha particles are they're very large they impact a lot of energy over a short distance uh can really damage dna they can also produce free radical formation and the free radicals can also damage the dna and initiate the lung cancer next slide please another perception was that mortality risk estimates for radon were based on old minor studies you heard the number 21 000. that was really the central estimate from an epa document 20 or so years ago and that was solely based on minor studies next slide please so these minor studies as you can see here were performed all over the world so these are folks that work underground hard rock mining uranium mining and they go in and they assess what their radon concentrations are actually the decay products in these mines and then they look at the adverse health outcomes related so they were these were done over the world and these findings showed that as the radon exposure right on decay product the slow exposure increased the lung cancer risk increased so they interpolated when i say they the epa interpolated this risk back to what someone would get in their home and that's where the 21 000 came up with so it was an interpretation or an extrapolation from higher exposures next slide but what we know now and which a lot of health care providers didn't know that there were also direct studies done people with lung cancer in their home so we did a study for example in iowa where we identify people with lung cancer and we match them to controls and then we measure the radon in the house of people with lung cancer and compare that to the people without lung cancer to come up with risk estimates so this is the sort of technical summary of what the different studies have found and when you on the left column it's all these different studies european north american chinese combined so in north america we had studies before in the united states and canada and then europe there are numerous studies performed and we pulled the data so we took the original data from the studies and we did a re-analysis and how you can interpret this for the primary analysis for europe there's about an eight point four percent increase and now i'm talking about increases i'm talking about at uh 2.7 which is the world health organization guidance for radon so these we're seeing statistically significant significant increases below the epa's action level for north america was 11 chinese study 13.3 and if you ingest it and use better exposure data where you have more a capture further back in a person's history uh the risk estimates go go up because you're getting this less misclassification of exposure but overall you can see there's this this isn't the significant increase even at protracted exposures at 2.75 carries per liter next slide please the other focus group find that we weren't too surprised about was that a few providers received any training about risk posed by protracted rate on decay product exposure and they didn't see many chapters and textbooks or review articles about the subject and in fact a lot of healthcare providers coming out now they don't get that much background on environmental causes of cancer in general so we've really made an effort over the past 10 years to increase the number of publications and highlight these different environmental carcinogens in textbooks next slide please these are just a few that we were able to get published and other colleagues are continuing to work on uh getting more information and getting this communicated to the different agencies and different universities that do training uh the one in the bottom right hand corner is parks occupational lung disorder book and this is the primary text that's used uh to train pulmonary physicians so we're getting more and more publications in the in the literature getting more information for healthcare providers but it's going to be an ongoing uh ongoing effort to try to increase uh information for providers next slide so here's the the um the guide here's the link to it but if you just search epa radon and health the epa has a link to it on their their main radon and health webpage so you can go there and really see it so i'm going to just sort of describe some of the highlights of it right now to the next slide please so here's the different chapters we have what is radon some basic information how's it there in the home talk about radon decay products the number and public health impact this the combined effects smoking radon it's not just additive it's it's synergistic so it's not multiplicative effect but it's more than additive radon health risk for individuals have never smoked there's about 20 000 people getting lung cancer every year that's never smoked uh the science behind the risk estimates right on testing rather than reduction sample guidance for healthcare settings the role healthcare providers have been reducing the burden and really importantly educational resources where's the science to back up the information that we have in the document and then interventions to reduce radar-related lung cancer next slide please so we have time for questions i'm going to go through some of these uh a little bit faster but i hope you have an opportunity to go and actually look at the guide so we have uh updated information on there but how it gets in the home next slide please uh updated table of risk and i think a table like this it's it's really kind of nice to look at the the risk for never smokers uh and they've never spoken for someone that's never smoked 100 cigarettes in their lifetime uh current smokers and you can see the increased risk uh for uh radon induced lung cancer if you that you look down to the bottom the risk for living in a home for a long duration at the ep's action level is about seven and a thousand and for smokers is about 62 and a thousand and if you compare that to the risk that epa sets their carcinogen standards at more like one in a hundred thousand if we retreated radon like we treated the carcinogens that epa regulates we'd have to reduce outdoor air radon concentration so it's a very a significant environment of one carcinogen next slide please one of the other items one of the things that we noticed in the focus groups was physicians were very aware of the new lung cancer screening guidelines so if you have a certain amount for a certain age and you have a certain cumulative exposure to tobacco you can get lung cancer screening low dose ct lung cancer screening then it's covered by medicare and most insurance agencies the nice thing about this is that if someone calls in and they're not eligible for this screening it's really a learning opportunity it's a teachable moment where you can instruct people about other causes of lung cancer because they're already calling in they're concerned about their other risks so here's an opportunity for them to to uh really reach out and teach them uh provide smoking cessation information and then test for radon next slide and i'm just going through these uh pretty quickly they're on the on the guide so i i would very urge you so we thought this section was very important science behind the risk estimates next slide uh radon testing what's resources for how you do radon testing how do you do radon reduction next slide sample guides for use in healthcare settings a lot of healthcare providers said this would really be helpful to them what kind of guidance should we use next slide please and then one of the critical aspects if we can get incorporated into healthcare settings and into uh intakes when a patient comes in you know how much uh are you smoking do you wear your seatbelt um have you tested your home for radon and then have information there if they haven't where they can get either free kit or a reduced price kit or access to that but we we've uh i think so far i've talked about 40 or 50 different practices that have used this and it's been a very successful next slide and then providing educational resources so we can in the guide we can only give summary information but where what was the scientific basis for what we put in the guide so we have a lot of educational resources next slide and then interventions reduce the radon related lung cancers and just some different innovations um that we think the healthcare providers can use and and they found that this was very helpful this resource next slide uh availability of the guide at this link but if you just type in breathing easier dot info that's a good way to get access but right if you just go to the if you search radon health epa there should be a link link there as well next slide so next steps are when we're developing cme right now for the reading the healthcare provider's guide and we have a series of videos for healthcare providers at the breathing easier site that we hope to transfer over to bergen offering cmes for physicians as well as nurses next slide so i went through them uh pretty quickly but i thought it was important to lead time for questions but this is the information uh that you can reach me and feel free to reach out contact me directly if you have questions hopefully this is just the beginning of our week our relationship about radon and if i could be a resource for you or provide slides for any work that you're doing please feel free to contact me i'll turn it back to jonathan for now thank you thank you for that bill um so when we conduct these webinars we acquire questions from multiple sources and multiple sources and i encourage our viewers here for future eh next each nexus webinars to send us questions in advance we will those are ones we can think through carefully and we can we can um give some priority too and so we have questions both gathered in advance and we have questions here as well the first question um and some of these might revisit topics we covered a little bit but it helps emphasize some of the important points that we've covered um what is epa's action level for radon and what does that that phrase action level mean to the general public adele do you want to take that one sure the epa action level is four picocuries per liter and that is an action uh that's a level that's achievable with current technology uh that was determined uh many years ago uh in some instances you can go much lower but uh it is recognized that uh it's it's achievable to get down to four picocures per liter and i would just say it the four is not four on the scale of one to ten we've seen radon levels across the country and the hundreds and even thousands uh of picocures per liter the good news is that with the radon mitigation system it can be reduced to less than four picocures per liter and i think that will be the take-home message we even seen very complicated homes with very creative contractors that were able to reduce the levels to weigh below four and they and the epa notes that that four doesn't mean it's a safe level um that they they recommend taking action below four if you can do that if it's below two and four uh they recommend uh retesting and taking action if you can that makes sense and that's true of many toxins right it's not is that they all of a sudden become harmless exactly that's right jonathan i'd like to just clarify i think i probably was misunderstood we don't have webinars every day we will have outreach activities every day based on the topic and if you go to our website there will be different uh postings and there will be facebook postings and twitter and things like that but it's today is the only day that we have the webinar and i apologize if that didn't come across correctly thank you okay thank you for the clarification um i do have a quick follow-up question if you know somebody who lives in an area that has you know often is noted for having higher radon areas if there are zones like that how would you encourage them to um to really go out and get tested because i think it's sometimes it's hard to motivate people to want to take that action well i can say that uh based on experience um working at a state that did a lot of radon testing uh radon levels vary every home could be different so it's very important that people test their home um how do you encourage them and how do you know if you're in a high risk area all most states i believe in the epa also has a map of radon levels based on actual measurements that have been done since the 1980s the cdc has the environmental public health tracking data that also shows data i believe up to 2017 where radon levels are indicated so that will give you a good indication of whether you're on a high risk or not so high risk but each house is different whether it's a no home or a new home whether it's drafty or sealed the only way to know if you have a problem is this to test and testing is very easy it's relatively inexpensive it you can do a do-it-yourself home test kit and send it to the laboratory and get your results when you get your results uh you can call your state rate on program and they'll help you interpret and help direct you if you need to do something to lower it i just knowing that this is something that's certainly preventable that you can do something to fix it i think that to me that will be a good motivator what i always tell people is think about it when you go to sell your home you probably will have to test it and when you test it if you have high radon concentrations you'll probably have to fix it so why not uh why not test it now take care of the problem so that you can benefit from the reduction and radon exposure that you have over time other people it depends who you talk to other people are motivated by it is a covered expense under flexible spending accounts so that's a motivation for some people other people they won't test for themselves but their tests for their children so we've had a bunch of different pilot studies where we've we've given radon test kits for in the newborn kit that goes home with the mother so as i showed in that first map i think there's a lot of different ways that you have to try to educate the public but as we learn through covet sometimes it's not always fruitful and i would just add a lot of states have free test kits available or very uh reduced costs again the the test kits are not expensive but you can even get it cheaper or free through some state or county programs so we suggest you contact and there will be the the resources that will be on the slide contact the conference of radiation control program directors to see the rate on contact in your state and they can direct you to whether there are any free test kits or low cost kits great thank you that was really helpful um going to follow up with the go going back to the questions that we gathered ahead of time um what is the average level of radon in homes in the u.s it's about 1.3 pike a carry per liter and outdoors it's about 0.4 pikachus per liter and it's higher inside the home because of reduced like it gathers in the home it doesn't necessarily either right right we used to say that radon is naturally occurring and sort of changed that a while back it's not actually occurring outdoors but the way we build houses tends to trap radon so it's sort of an enhanced type of radiation home and we build homes that are not radar resistant in many cases we don't build homes anymore that have lead paint so we can start building homes that are radar resistant and that's taking place in a lot of regions across the united states now so we have a number of environmental health practitioners and public health personnel who attend our webinars and who watch the recordings and um would it be advisable to consider promoting this kind of content to home builders i assume that's a big part of the industry definitely and i should say that there is a national effort that's the national radon action plan and we have been working to promote radon across all disciplines across all communities and that involves cdc epa and hud along with a lot of associations that have an interest in radon and we have been working together to develop some approaches that we can reach out as many people as possible and promote radon testing and mitigation certainly share the wealth share the word with with your other environmental health providers and we have a lot of resources the epa has a lot of resources hud has a lot of resources other associations like arts and i know i'm putting a lot of acronyms they're available to they they have a lot of very valuable information and they'll be happy to talk to you and help you promote radon another good place for the cancer consortiums associated with the cancer plans cancer centers around the country that's the next another excellent resource um i'm going to pivot off of that to respond to one of the questions that came in live which asked that they will be able to share this webinar and will it be shared afterwards and the answer is yes we will um do everything we need to to get it ready and post the event on the eh nexus website and you'll be able to find it there in a few days and then yes please do share okay i think we have time for one more question um what so bill you talked a lot about what health providers health care providers can do to help reduce the burden of radon-induced lung cancer can you can you emphasize some of what providers can do in terms of communications with their patients right and and this is really important you know so too often i'm seeing that the patients the lung cancer patients are the ones doing the education to their providers and that's how they learn about it but i think the first thing healthcare providers can do is test themselves it's interesting that healthcare providers have some of the highest testing rates so i they have to start out by bottling the behavior themselves and once they model it then they become familiar with how easy it is to do radon testing and how it's really not that difficult to do radon mitigation and in most cases it's not that expensive to do radar mitigation it's typical to uh calls for a typical home repair on a home but what are the things that they can do and and i'm very encouraged that we're seeing more and more uh physicians and and and staff because they're the really the first line people that that see the patients are including a question about radon on their intake information that's a question they ask they follow up with so that's very encouraging the other the other encouraging aspect would be i've seen now more low-dose ct scanning centers ct scanning centers are incorporating radon information when people call in because you can imagine these are people that are concerned about their health most cases they did smoke so they're higher risk so i think that's some of the low-hanging fruit that we have for reaching out to healthcare providers but just getting them to test a lot of times uh gives them incentive to say wow this is so difficult something other people should do and i cannot tell you how many calls i get each month from healthcare providers who they or their wives you know discovered that they have lung cancer never smoked at high rate on their homes and says why don't we know about this well it's not that we're not trying um so i i think that the videos uh like adele showed looking at actual lung cancer survivors and one of the most important things to note real quickly is you can't tell if someone developed lung cancer from radon you can you can if they didn't smoke and they had a hybrid on chances are it was radon you can come up with a probability probability assessment but it's the same can be said for smoking when someone develops lung cancer and they smoke is just assumed it was smoking there's no unique marker for radon due lung cancer or smoking induced lung cancer i think that's important to know okay jonathan i just want to add quickly that the healthcare guy that dr phil mentioned is available on our website and he's also available in spanish so we encourage you to look at it okay thank you and we're we are out of time there were a number of questions that came in that might involve rather complex answers that are better answered with follow-up and so i encourage everyone who asked a question if you want a follow-up please send an email to ehnexis at cdc.gov and we can forward questions on to our panel of experts here and with that thank you dr salome alfie dr golden and dr field for providing our audience with this important information and thank you everyone for joining us for today's eh access webinar if you have additional questions you may email them again to ehnexis cdc.gov and that's it thank you everyone