EPA's Strategy to Reduce Risk of Radon

                             Steve Page, Director, U.S. EPA Radon Division
                    Office of Air and Radiation,  Office of Radiation and Indoor Air
/.   Introduction
    Since the discovery of extremely high radon levels in the
Reading Prong region in 1985, there has been extensive progress
in the nation's program to reduce the risks of indoor radon.
EPA's Radon Program has grown from a handful of researchers
in isolated problem areas to an organized partnership of gov-
ernment agencies and private organizations working together on
numerous fronts. To accommodate this rapid growth and to keep
national radon efforts on track, EPA has continually evaluated
and refined its strategy by adapting to new knowledge, increased
experience, Congressional direction, and changing needs.
    The Indoor Radon Abatement Act of 1988 (IRAA) directed
EPA to undertake a variety of activities to address the growing
public concern over dangers posed by exposure to indoor radon.
Among other requirements, the law directed the Agency to study
radon levels, evaluate mitigation methods, establish proficiency
programs, assist states with program development, develop
training centers, and provide public information.  EPA  has
developed and implemented programs to address each of the key
provisions of this statute.
    This paper presents EPA's broad national strategy to reduce
radon risks. It combines and reinforces EPA's basic foundation,
including its guiding policies and cooperative partnerships, with
an overall management approach and focus for the future.  The
paper starts with an overview that introduces the strategy's four
key elements:  underlying policies and scientific principles, a
decentralized system of states and other partners for targeting the
public, multiple strategies forachieving radon riskreduction, and
a strong focus on five key program priorities. The paper then
discusses each of these elements in more detail and describes how
they interact to guide future efforts and directions of the Agency.

//.  Strategy Overview
    As illustrated in Exhibit 1, EPA's radon strategy consists of
four key elements:
1.   Science and policy that provide the program foundation;
2.  AdecentralizedsystemforinformingthepulAicihatconsists
of multiple, highly respectedorganizations that can deliverradon
messages through established channels to targeted audiences;
3.  A continuum of strategies for reducing radon risks, ranging
from public information efforts that let people make their own
decisions about the need to test and fix their homes to regulatory
approaches that may ultimately requirepeople to take action; and
4.  A strong focus on those strategies that hold the greatest
promise for achieving long term institutional change.
    These four key elements of EPA's strategy Devolved over
time in a chronological order.  The initial emphasis of early
efforts was scientific research on the magnitude andiextent of the
radon problem.mitigationresearch.healthriskreseatchsynthesis,
and development of sound policy guidelines. EPA. then began
development of a unique system for delivering this'information
and recommendations to the public, andjjegan ito explore a
variety of strategies for gettingjhe public to takeaejion. Most
recently.EPAhas consulted with scientists~governmentofficials,~
health organizations, and others'to sharpen its focus on those
strategies which have the greatest potential for reducing radon
     NEHA joins EPA'paftnershfj) to -''
      mitigate the dangers of
       ThetfnitedStates Environmental Protection Agency^,
   through their Radon. Program is committed to (a"fffq>gjl^
   based national effort designed to improve awareness of
   mdona's a potential healthrisk. BeyondthiseffoKt,andbf
   equal importance, is the initiative to actively encourage',,
   radon testing and,where warrante'd,miligation, WorJang •
   withbolhreatestateimdconslructibn industriesito utilize
   radantesistantbtdMng materials inhighpotentiaJareaS'
   is also amajor priority.      -                   ,,  ,
   help accomplish these goals. Thenationat partners net-
  , work is: composed of a variety of associations and other
   groups having 'aninterest in environmental health issues.
   As a first effort in this areat NEHA solicited applications
   (indselected25 local environmental healthpfofessionals
   to, take part in an intensive outreach and mitigation
   training class held in, Washington, DC, October 31 -No-
   vember 2, 1993(seeNEHA News.thisissue).  Thepar-
   tieipantswha completed this training will be responsible
  for conducting, in their individual communities, one-year
   radon program. , NBHA and USEPA anticipate other
   training opportunities for NEHA members as part of
   JtEHA's newly established role as a national partner.
                                                               December 1993 • Journal of Environmental Health • 27

                                         1. SCIENCE/POLICY
               Priorities for
               achieving risk
                              Network ol respected
                              sources that reach
                              targeted audiences
Incentives, ami
  Exhibit 7. Overview of key elements of the radon program strategy
    Today, EPA is continuing work in each of these four key
areas. EPA is advancing and refining radon science and policy,
expanding and improving the system for delivering programs,
incentives, and focusing all elements of this system on those
strategies which have a high potential for risk reduction.
    Although some scientists were aware of the U.S.  indoor
radon problem, it was not until the Reading Prong discovery in
1985, that the U.S. government developed a program  to address
this issue. The government was unequipped to begin to advise the
public on what,  if  anything, should be done in response to the
problem and how to do it. The overriding need at the early stages
of the Radon Program, therefore, was to develop guiding policies
and scientific principles on which to base national risk reduction
efforts.  In response to this need, federal agencies, the states, and
the scientific community initiated and have continued an extensive
research program  to establish  and refine several underlying
principles that serve to guide the entire radon effort and as a basis
for all radon messages.   These guiding scientific and policy
principles are outlined in Section HI of this paper.
    Early on, EPA recognized the importance of working with
    per year
                           Exhibit 2. Annual deaths from
                                   selected causes
                        RADON*  Drowning.   "*••
      Radon is estimated to cause about 14,000 deaths per year-nowever, this number
      could range from 7.00013 30,000 deaths per year. TTw numbei* of deaths rram
      other causes are acoMrial data taken frem I960 National Safety Council reports.
leading national organizations. EPA thus began to develop a
decentralized system in the late 1980s. In this system, EPA has
worked to empower states and key national organizations that
serve as additional sources of radon messages.  These partners
have  the special expertise, credibility, and communications
channels needed to reach target audiences. Such a decentralized
system is more flexible, innovative, and effective than the cen-
tralized system traditionally used in government. The Agency's
outreach system is explained in further detail in Section IV.
    Through this network, the Agency's principal approach has
been a non-regulatory public information campaign designed to
accurately and effectively inform and enable people to reduce
their health risk through voluntary action. However, after years
of public information efforts with limited public response, states
and national organizations have begun  to pursue a variety of
other, more direct strategies.  Similar trends in approach have
been observed during the evolution of other national health and
safety campaigns (1).  Many  initiatives are now underway to
actively encourage homeowners to test and fix their homes, as are
activities to provide incentives for radon action. Regulations that
require people to take action are being  piloted in  some  areas.
Congress, state governments and local authorities are also con-
sidering or implementing legislation that would mandate actions
to reduce radon risk (2). The continuum  of strategies being used
by EPA partners is described in Section V.
    Finally, the Agency is focusing its efforts in five major areas
recommended in a 1992 Radon Program Review that was con-
ducted by leaders inside and outside of EPA (3). These five areas
are: targeting efforts on the greatest risks first; promoting radon-
resistant new construction; supporting testing and mitigation in
connection with real estate transactions; using public information
and motivation programs to promote institutional change, and;
developing a coordinated research  plan.  Program plans to focus
efforts in these five key areas are summarized in Section VI.
Further detail on these plans is also provided in "Implementation
of OPPE Panel Recommendations," which is the Radon Program's
formal response to the Radon Program's Review panel (4).

///.  Guiding Scientific and Policy Principles
     EPA has used the best available scientific data in developing
risk assessments. Over the last several years, considerable effort
also has been spent to build a national consensus on the foremost
scientific issues related to radon and on the translation of this
scientific understanding into national policy. The most signifi-
cant  scientific and policy principles that have been developed
through this process are summarized below.

There is no known "safe" level of radon exposure
     Although uncertainty exists,  we know more  about radon
than most other cancer-causing environmental risks. In assessing
residential radon risk, EPA assumes  that the exposure-response
relationship is linear at low exposures (5,6). This assumption is
consistent with the evidence for  linearity at a wide range of
cumulative exposures in the radon  epidemiological studies of
underground miners. There is no evidence of a threshold for lung
cancer from radon exposure, that is, a level of radon exposure
 below which no increased risk of lung cancer would exist. It is
 28 • Journal of Environmental Health • Volume 56, Number 5

generally recognized that even at low doses of alpha radiation,
most DNA damage is not effectively repaired (5, 6). Research
further indicates that at low doses of alpha radiation the dose-
response relationship for cell transformation and tumorigenesis
is linear and independent of dose rate (5, 6).
     Continuing scientific research has helped to improve EPA's
projection of lung cancer risk to the general population due to
radon exposures in the home.  The Agency has refined its risk
estimates as additional data have become available.  EPA now
estimates that 7,000 to 30,000 lung cancer deaths per year in the
U.S. are caused by residential radon exposure. Exhibit 2 places
the estimated cancer deaths from radon in context by showing the
number of annual fatalities due to common occurrences that the
public tries to reduce through safety and health programs. Fur-
ther scientific evaluation of radon hazards may serve to refine
EPA's estimate of the annual number of radon-induced lung
cancer deaths. The Agency is committed to  seeking the best
science to guide its program.

Homes with indoor radon levels above 4 pCi/L (148 Bq/m3)
should be mitigated
    EPA recommends that homeowners fix their homes if radon
levels above 4 pCi/L (148 Bq/m3) are found and confirmed. This
action level is based on a combined analysis of risk (no known
"safe" level) and technological feasibility.
    Because we have assumed that there is no "safe" level of
radon exposure, EPAhas investigated a range of action levels and
found that mitigation technology available today can reduce
elevated radon levels to 4 pCi/L (148 Bq/m3) more than 95 per-
cent of the time (7). Available technology is  consistently less
able to reduce radon levels down to lower levels, although an
estimated 70 to 80 percent of homes with elevated radon levels
would be able to achieve an action level of 2 pCi/L (74 Bq/m3) at
reasonable cost (7). The 4 pCi/L (148 Bq/m3) guidelines is also
supported by research showing that it is more difficult to accu-
rately measure radon at lower levels (e.g.. measurement device
error is significantly greater at 2 pCi/L [74 Bq/m3] than at 4 pCi/
L [ 148 Bq/m3]) (7). Based on these considerations, EPA recom-
mends 4 pCi/L (148 Bq/m3) as the  action level but advises
homeowners that they should consider mitigating homes that
have confirmed radon levels between 2 pCi/L (74 Bq/m3) and 4
pCi/L( 148 Bq/m3).

People should use proficient radon measurement and
mitigation companies
    A basic function of the Agency has been to equip the public
with the information necessary to make knowledgeable radon
decisions, including information on competent measurement and
mitigation firms. Accordingly, the Agency has operated two
voluntary proficiency programs for several years — the Radon
Measurement Proficiency (RMP) Program and the Radon Con-
tractor Proficiency (RCP) Program — to evaluate the proficiency
of radon measurement and mitigation companies, respectively.
Last year, EPA added a new component to the RMP designed to
evaluate  the proficiency  of those persons offering residential
measurement services in the home.  Both the RMP and RCP
Programs provide a mechanism  for providing the public with

Radon Level
20 pCi/L
(740 Bq/m3)
10 pCi/L
(370 Bq/m3)
8 pCi/L
(296 Bq/m*)
4 pCi/L
< 148 Bq/m3)
2 pCi/L
(74 Bq/nr )
1.3 pCi/L
(48.1 Bq/m3)
0.4 pCi/L
(14.8 Bq/m3)
If 1,000 people who smoked were
exposed 10 this level over a lifetime...
About 135 people could get lung cancer
About 71 people could get lung cancer
About 57 people could get lung cancer
About 29 people could get lung cancer
Abuut 15 people could get lung cancer
Aboul 9 people could get lung cancer
About 3 people could get lung cancer
If 1,000 people who never smoked were
exposed lo this level over a lifetime...
About 8 people could get lung cancer
About 4 people could get lung cancer
Aboo! 3 people could ge! lung cancer
About 2 people could get lung cancer
About 1 person could get lung cancer
Less lhan 1 person could get lung
Less than 1 person could get lung
Exhibit 3. Radon risk comparison for smokers and non-smokers
information on proficient companies by publishing updated lists
of firms that pass all relevant criteria.  If a person plans to hire a
trained tester or radon reduction contractor, the Agency recom-
mends that he or she hire a qualified radon firm as determined by
the RMP or RCP Programs.  If a person plans to take his or her
own measurement, EPA recommends the use of an EPA-listed
radon measurement device.

All homes and schools should test for radon
    Elevated levels of radon have been found in all states and in
all types of homes. State/EPA radon screening surveys show that
individual homes in relatively low-risk areas may have high
radon levels,  depending on the complex  interaction of soil,
atmospheric, and ventilation factors (8).  Based on results from
EPA's National Residential Radon Survey, nearly one out of
every 15 homes in the United States is estimated to have annual
average indoor radon levels exceeding 4 pCi/L (148 Bq/m3) (8).
The only way to know the radon level in a given home is to test
it. Therefore, EPA and the Surgeon General recommend testing
all homes below the third floor. EPA estimates that about nine
million homes have been tested to date (8).
    Similarly,  based on data collected in its National School
Radon Survey, the Agency estimates that 2.7 percent of ground-
contact schoolrooms,  or about 75,000 rooms, have short-term
measurements greater than the recommended action level of 4
pCi/L (148 Bq/m3) (8). Nearly 20 percent of the public schools
nationwide, approximately 15,000 institutions, have at least one

Source —\ Message I — •

Channel j—



Exhibit 4. Basic communications model
                                                                  December 1993 • Journal of Environmental Health • 29

                      RMP/RCP  NAHB
      Science/Policy Foundation
 No Known Safe Level
 7,000 to 30,000 LCDs/Year
 Smokers At Higher Risk
 6% U.S. Homes > 4 pCi/L
^Long^errn^Te'sts Are Better^1 A
1 Re&uce;£eyels Over jCpCi/L? \
*jv  »'   r'     ^_* »' *»-A<(,V ? *< ^  -^
 .D/e^MP/RCPiParticlpan^ts 4 -
 Te^'Al^H6mes/Scrjpo|s/' | *';5 'i'
 Short-term'Tests "Can Be Used.
         1.  Target High Risk Areas
         2.  Promote Codes
         3.  Promote Real Estate Action
         4.  Use Information, Motivation &
            Incentives To Push Codes &
            Real Estate
        5.  Develop Coordinated Research
fll A	>-Local
HLM   ^Affiliates     _.
   RMP/RCP       0fflC|a|s

                                                                          /    \
                                                                         /     \
              Continuum of
       Radon Program Approaches
                                                     Information   Motivation
                         Incentives   Legislation
                 Strategic Approaches
                           Exhibit 7. Summary of key elements ofEPA's Strategy to Reduce Radon Risk
evaluating the distribution of indoor radon levels in counties
across the country, identifying geographic areas with the highest
potential for radon problems, research into the variation of radon
levels in new homes, and studies to determine the cost and
reliability of approaches for measuring, mitigating, andpreventing
elevated radon levels in a variety of building types. Only with a
better understanding of these and other scientific issues can the
Agency continue to articulate and implement effective national
policies for radon action.

Translating principles and policies into radon action
    The scientific principles and policies guiding the Radon
Program have been distilled into succinct, "user-friendly" in-
formation for dissemination 'through radon public outreach
programs. For example, the 1992 version of the Citizen' 5 Guide
contains each of these key scientific and policy messages.
Consistent and accurate information about radon are critical to
the success of a non-regulatory health protection program like the
Radon Program. However, the message is only one component
of the overall communication process. Accordingly, EPA has
developed and employs a decentralized communications system
    for reaching the diverse audiences potentially atrisk from indoor

    IV.  Decentralized System for Reaching a Diverse Public
        As shown in Exhibit 4, a basic communications model has
    five major components.  The model starts with a source (e.g.,
    government agency) developing a message (e.g., "test for ra-
    don"). The message is then delivered through selected channels
    (e.g.,brochures,technical background documents, TV programs,
    and press releases) to  reach the intended audience  (e.g.,
    homeowners). Feedback and evaluation from the audience is
    used to refine the process until the desired effect is achieved.
        EPA recognizes that it should not be the sole "source" for
    communicating about radon risks for a variety of reasons.  First,
    EPA messages would have limited effect on many of the diverse
    audiences that must be reached with radon information. S econd,
    informational materials produced by bureaucracies are often not
    timely, and because they are written for a "generic" and general
    audience,  they will not reach many of the diverse groups that
    make up the U.S. public.  For example, national-level messages
    prepared for an "average audience," consisting of people at
                                                            December 1993 • Journal of Environmental Health • 31

• U.S. Anti-Smoking Campaign
    Beginning in 1966, the Department of Health, Education and
Welfare (later reorganized into HHS) began a public awareness
campaign to inform the public and reduce cigarette consumption.
While the campaign has achieved dramatic success over the past
26 years, this success has come only after concerted efforts
through a variety of strategies. Namely, HHS combined forces
with a number of cooperative partners (e.g., the American Lung
Association, states, the private sector, and others) to disseminate
public information and actively encouragepeople to quit smoking.
The campaign also has put in place incentives to stop smoking,
such as insurance premium discounts, and has sought and helped
to establish anti-smoking regulations (16).
• U.S. Seat Belt Program
    Since its beginning in the  mid-1970s, this program has
increased front seat belt use from about 11 percent to 49 percent.
Most of this increase followed the passage of state mandatory use
laws, which were enacted through the combined efforts of states,
medical and public health organizations, the automobile indus-
try, and grassroots organizations like Mothers Against Drunk
Driving. While  the passage of these laws in most states has
resulted in an initial, significant increase in seat belt usage, the
rate of belt use has subsequently stabilized or declined moderately.
This "post-law stabilization" is partly due to the fact that most
states are not actively enforcing mandatory use laws, nor are they
providing public information that calls attention to the laws and
the penalties for not wearing seat belts (17).
• Saskatchewan Seat Belt Program
    To combat the same "post-law stabilization" in seat belt use
rates in Canada as has been observed in the U.S., the Province of
Saskatchewan initiated a combined public relations and adver-
tising campaign. This campaign, which showed drivers being
ticketed for not wearing their seat belts, increased belt usage in
Saskatchewan to more than 90 percent in just a few years. Both
British Columbia and Quebec have implemented similar programs
and now have usage rates greater than 90 percent as well (18).
    A review of these and other national programs reveals  a
number of important lessons for EPA. For example, success in
changing human behavior takes time and only comes through
strong national and local networks  delivering consistent infor-
mation. The experience of these programs, as well as the Radon
Program experience, also shows that success requires a mixture
of diverse strategies.  The continuum of strategies use by these
programs is shown in Exhibit 6.
    Several of the strategies shown in Exhibit 6 are now being
used by states and cooperating national organizations. Federal
and state programs have developed and disseminated public
information materials and public education materials that inform
people about the risk of indoor radon and what they can do to
reduce that risk.  Over time, these materials have grown more
specialized, as large, technical documents are being replaced
with more  targeted materials designed to encourage specific
actions among certain groups. For example, the Home Buyer's
and Seller's Guide to Radon is specifically designed to encour-
age informed decisions during real estate transactions. Radon
brochures and public service announcements also encourage the

                   D National    BIDgh Radon Areas
              National Demographics on Radon Awareness from CRCI'D Results (Coot'd)
public to act by linking radon to family health risks.  And the
Consumer's Guide to Radon Reduction provides guidance to
consumers who havealready tested forradon and are considering
their mitigation options.  At the same time, EPA is researching
incentive programs to promote radon testing and mitigation, such
as discounted or free test kits, especially for high risk popula-
    Finally, states and other organizations are pursuing a variety
of regulatory radon initiatives. Some states have already enacted
laws that require school testing and disclosure of potential radon
problems in real estate transactions.  Several states and local
jurisdictions are either implementing or considering radon-re-
sistant new construction requirements.  Many new homebuilders
are voluntarily usingradon resistantnew construction techniques.
Some real estate associations are voluntarily incorporating the
use of radon disclosure forms into their regular business trans-
actions. Congress is considering new regulatory options such as
mandatory testing of schools andFederal buildings, disclosure of
information about radon during real estate transfers, as well as
minimum radon reduction measures for new construction. In the
future, all of these strategies will continue to be  pursued in
combination by states, national organizations, EPA, and others to
combat the radon problem.

VI. Focus on Key Priorities
    Given the breadth of radon scientific issues and policies, as
well as the decentralized outreach system and range of strategies
outlined above, the number and diversity of ongoing  Radon
Program activities is significant. While flexibility is in itself an
important element of the program, it is also crucial, especially in
light of substantial budget constraints, that the program set
priorities to help concentrate efforts on those activities that will
be most effective in achieving the overall mission of radon risk
    The Radon Program has established these priority activities
based on recent recommendations from a broad internal and
external Radon Program Review which was coordinated by
EPA's Office of Policy, Planning andEvaluation (OPPE). In the
fall of 1990, the Radon Division requested that OPPE organize a
                                                                   December 1993 • Journal of Environmental Health • 33

 process to evaluate the Radon Program and make recommenda-
 tions on future directions to increase risk reduction.  OPPE
 organized a panel of senior headquarters and regional managers
 from across the Agency who  held a series of meetings with
 experts outside the Agency to include their perspectives. As part
 of its review, the panel discussed the relative merits of a range of
 radon strategics,  including geographic targeting,  testing and
 mitigation during real estate transactions, andpublic information
 strategies. Radon Program plans for focusing efforts in each of
 the fivekeyareas are further detailed in thestrategy paper entitled
 "Implementation of OPPE Panel Recommendations" (copies of
 which can be obtained from theEPARadon Division at202/233-
 9400). The Radon Program Review panel issued the following
 recommendations in their final report:
 • Target the greatest risks first.
     The Radon Program Review panel recommended that the
 Radon Program focus its efforts and resources in the near-term on
 high radon potential areas and smoking-related risks.
 • Promote radon-resistant new construction.
     The program should encourage and support pilot projects at
 the state and local levels to promote radon-resistant new con-
 struction, which have the potential to reduce risks in a very cost-
 effective manner.
 • Support testing and mitigation in connection with real estate
     Thepancl recommended that theRadonProgram encourage
 and support pilot projects at the state and local levels to further
 promote testing and mitigation as part of real estate transactions.
 • Develop a new strategy for public information.
     The Radon Program should continue its nationwide public
 information efforts such as the Citizen's Guide and the Adver-
 tising Campaign, focusing on  high radon potential areas and
 high-risk populations in the short-term. In the longer term, the
 panel recommended that the program  use public information,
 motivation and incentives programs to build institutional support
 for construction of radon-resistantnew homes and for regulations
 or policies to require testing and mitigation when existing homes
 arc sold.
 • Develop a coordinated research plan.
                                  High Radon Areas

                                   Tnt«!    T«tal MHipled =
    Finally, the panel recommended that the Radon Program
 develop a long-term research plan to prioritize and coordinate
 potential future research.
    TheRadonProgram.andcooperatingnational organizations
 have, for several years, focused on many activities that are
 consistent with the recommendations and directions developed
 by the Radon Program Review panel.  The program is now
 aggressively reviewing and expanding these ongoing efforts.

 Target greatest risks first
    The Radon Program is focusing resources and initiatives
 aimed at targeting to the greatest risk areas and populations.
 Examples of new and ongoing activities include: developing and
 releasing the National Radon Potential Map;  targeting State
 Indoor Radon Grant (SIRG) funds to highest risk geographic
 areas and populations; cooperating with the U.S. Geological
 Survey and the Department of Energy on a special project to
 develop a model which could further refine the identification of
 high radon areas; cooperating with the American Lung Association
 and others to target smokers; a new initiative in cooperation with
 the Consumer Federation of America to encourage mitigation
 among people who have tested and found high radon levels; a
 new cooperative program with the National  Association of
 Counties to establish 25 "Model  County Radon Programs" in
 high-risk areas; and others.

 Promote radon-resistant  new construction
    The Radon Program is expanding initiatives aimed at pro-
 moting radon resistant new construction especially in high-risk
 areas.  Examples of ongoing and new activities in this area
 include: completingreviewofandissuingtheEPAModelRadon
 Building Standards and Techniques; working with the national
 building code organizations to encourage incorporation of these
 radon resistant techniques into the national and regional building
 codes in high-risk areas; working with builders to encourage
 voluntary use of radon resistant construction techniques; coop-
 erative research to refine and improve existing techniques for
 reducing radon in new construction; a cooperative program with
 the National Association of Counties to  promote adoption of
 radon resistant techniques into local building codes and builder
 practices in high-riskareas; a cooperativeproject with the National
 Conferenceof States on Building Codes and Standards Initiatives
 to identify the  state and local building code authorities; and

 Promote radon action during real estate transactions
    The Radon Program is expanding initiatives aimed at pro-
 moting radon action in the context of real estate transactions.
Examples of ongoing and new activities include: releasing of
new Home Buyer's- and Seller's Guide to Radon; working with
national organizations and state governments to promote radon
disclosure;  testing and mitigation policies and  mandates in
connection with real estate transactions especially in high-risk
areas; conducting a series of forums in partnership with the
Environmental Law Institute to educate realtors on radon action;
research  with  the Massachusetts Institute of Technology to
34 • Journal of Environmental Health • Volume 56, Number 5

assess the efficacy of existing state radon disclosure require-
ments; and others.

Sustain public information campaign
    The Radon Program is- sustaining major national public
information programs and expanding initiatives to target key
populations. Examples of ongoing and new activities in this area
include: continuing to update and provide basic radon public
information materials such as the Citizen's Guide to Radon, the
Consumer's Guide to Radon Reduction, the Physician's Guide
and others; continuing the national radon TV, radio and print
advertising campaign; continuing National Radon Action Week;
and expanding advertising and cooperative minority and low-
income outreach programs aimed at achieving action on radon in
minority and low-income populations.  The Radon Program is
expanding initiatives aimed at  targeting high risk areas and
populations through  initiatives  such as a  cooperative public
service announcement with the U.S. Surgeon General aimed at
smoking-related radon risks; increasing the proportion of grants
to the American Lung Association, the Consumer Federation of
America, and the American Public Health Association affiliates
in high-risk areas; and working with the National Association of
Counties and the International City Managers Association to
develop dozens of model city and county radon programs in high-
risk areas.

Develop coordinated research  plan
    EPA and other federal agencies have conducted extensive
research and collected large amounts of data on radon-related
issues. However, there are still many areas that require further
research. In order to ensure that  the Agency's additional radon-
related research efforts are coordinated, taken advantage of by
key organizations developing programs, prioritized, and do not
duplicate efforts by other offices within EPA or other agencies,
theRadon Division is working to develop a long-term coordinated
research plan. The Radon Division plan has three objectives: 1)
identify key research needs; 2)  identify research gaps; and 3)
encourage responsible agencies to fill research gaps. TheRadon
Division is initiating a plan to work with other EPA offices, the
Department of Energy (DOE), the EPA Science Advisory Board
and others to develop the overall coordinated research plan.

VII. Conclusion
    As  discussed in the preceding sections, EPA's strategy to
reduce radon risk consists of four key elements: guiding scien-
tific and policy principles; a decentralized management system;
a continuum of strategies;  and a strong program focus. These
elements are summarized together in Exhibit 7.
    The states, the scientific  community, the radon  industry,
local governments, national health and consumer organizations,
EPA, and others that contribute to the national Radon Program
have accomplished a great deal since 1985. In the seven years
since the Reading Prong discovery, radon awareness and un-
derstanding have significantly increased. A competent and well-
trained industry for radon testing and mitigation has emerged.
About nine million homes have been tested for radon, and
300,000 have been mitigated (14). Many builders now incorpo-
rate radon resistant features in new homes—about 300,000 have
been built with such features—and the first state and local radon
building codes have been adopted (19). Grassroots awareness
and support have produced real estate radon disclosure laws in
five states, and the real estate industry has voluntarily adopted
disclosure policies in many other areas of the country.  The
relocation industry regularlyrequires aradon testandremediation,
if necessary, as a condition of property transfer (19). About one-
fifth of U.S. schools also have been tested for radon (9).
    EPA is committed to focusing on environmental results to
assess programmatic progress. "The Radon Risk Communica-
tion and Results Study," a survey effort conducted by the Con-
ference of Radiation Control Program Directors (CRCPD) in
1993, is the first comprehensive study  of all 50 states and the
District of Columbia which addresses key radon program indi-
cators of progress. The extensive survey provides statistically
valid baseline information about a wide variety of indicators of
program progress, and indicates that national and state efforts
have been successful at achieving respectable levels of radon
awareness and testing throughout the country, particularly in
upper-income Caucasian families. Less success has been achieved
with both ethnic minorities and low to moderate income groups.
The results of the study will allow EPA and states to set program
goals and targets for increased risk reduction, to share successful
approaches, to assess and refine current efforts and to ensure that
the radon message is directed effectively at all populations at risk.
CRCPD plans to continue to conduct the study periodically to
assess the ongoing efforts of each state radon program.
    The agency is also committed to continuing scientificresearch
on health  risks.  EPA will continue to work closely with the
National Academy of Sciences (NAS), EPA's Science Advisory
Board (SAB), and other members of the scientific community to
use the latest scientific research to estimate risks to the general
population from indoor radon exposure.
Mensurable Goals for the Radon 1'royram
Ktv Area Current Estimates IW3
National High-Risk National
Awareness 63S? NA* t>5<5
Testing 9# NA* 2.5M
Mitigation NA* NA* 5JK^
School Testing1 22% NA* 29
    To build on initial success, EPA will also continue to deliver
consistcntradon information tothepublic.continuallyreinforcing
basic scientific principles andpolicies that guide theprogram. To
increase the likelihood that radon messages will result in public
action, the program also will continue to rely on its network of
stales and other organizations. Effective cooperating national
organizations serve as multiple sources of radon messages, have
special expertise and communications channels needed to reach
target audiences, and leverage EPA, state and local efforts by
enlisting their members and affiliates as sources and catalysts for
local radon action.  The program will continue to develop and
implement activities along a continuum of strategies. Efforts to
inform the public and encourage action are important and will be
continued, but they will be combined with incentive programs
and initiatives to build institutional support for building codes
and policies to require radon testing and mitigation when existing
homes arc sold, especially in high-risk areas. Finally, the Radon
Program will increase its focus on the priority activities recom-
mended in the Radon Program Review to ensure that the overall
mission of radon risk reduction is accomplished as rapidly and
efficiently as possible.
1.  ... (1990), Survey of Selected Public Awareness Campaigns, U.S.
Environmental Protection Agency, Washington, DC.
2.  ... (1992), Preliminary Research Report, Radon and Real Estate:
A Survey of Selected State Laws, Proposed Laws and Litigation, Envi-
ronmental Law Institute.
3.  ... (1992),RadonProgramRevie\v,U.S. EnvironmentalProtection
Agency Office of Policy, Planning and Evaluation, Office of Regulatory
Management and Evaluation, Program Evaluation Division, Washing-
ton, DC.
A,  ... (,l992)JmplcinentationofOPPEPanelRecommendations,lJ.S.
Environmental Protection Agency Radon Division, Washington, DC.
5.  ... (l9SO),InfluenceofDoseandltsDistributioninTimeonDose-
                                                              Response Relationships for Low-LET Radiations, NCRP Report 64,
                                                              National Council on Radiation and Measurements, Bethesda, MD.
                                                              6.   ... (1988), Health Risks ofRadon and Other Internally Deposited
                                                              Alpha-Emitters:  BEIR IV, National Academy of Sciences, National
                                                              Academy Press, Washington, DC.
                                                              7.   ... (19&9),CostofIndoorRadonReductionSystems,Memoiand\xn
                                                              to the U.S. EPA Radon Division Director, U.S. Environmental Protection
                                                              Agency/Office of Research and Development, Washington, DC.
                                                              8.   ... (1992), Technical Support Document for the 1992 Citizen's
                                                              Guide to Radon, U.S. Environmental Protection Agency, Radon Divi-
                                                              sion, Washington, DC.
                                                              9.   ... (1993), National School Radon Survey, U.S. Environmental
                                                              Protection Agency, Washington, DC.
                                                              10.  ... (1991), Internal Office ofRadiationProgram'sEstimate,U.S.
                                                              Environmental Protection Agency, Washington, DC.
                                                              11.  ... (1991), Telephone Survey, November 1991, Bruskin Associ-
                                                              12.  Johnson,F.R. (1990), Analysis of'theWirthlinSurveyRadonQues-
                                                              tions, U.S. Environmental Protection Agency Office of Policy, Planning
                                                              and Evaluation, Washington, DC.
                                                              13.  ... (199l),AnSAB Report: Correlation of Short-Term and Long-
                                                              Term Test Results for Indoor Radon, EPA-SAB-RAB-92-008-De-
                                                              cember 1991, U.S. Environmental Protection Agency, Washington, DC.
                                                              14.  ... (1992), A Citizen's Guide to Radon, U.S. Environmental Pro-
                                                              tection Agency Radon Division, Washington, DC.
                                                              15.  ...(1993),CRCPDRadonRiskCommunicationsandResultsStudy,
                                                              U.S. EnvironmentalProtection Agency, Officeof Air and Radiation and
                                                              CRCPD, Washington, DC.
                                                              16....(1989), Reducing the Health Consequences of Smoking, 25 If ears
                                                              ofSmoldng: A Report of the Surgeon General, U.S. Dept. of Health and
                                                              Human Services, Centers for Disease Control, Center for Chronic
                                                              Disease Prevention and Health Promotion, Office on Smoking and
                                                              17.  ... (1990), Occupant Protection Facts, National Highway Traffic
                                                              Administration, National Center for Statistics and Analysis.
                                                              18.  Medysei,M. (1990), Interim Evaluation of Saskatchewan's 5 Year
                                                              Occupant Restraint Program.
                                                              19.  ... (1992), Final Report on Radon Mitigating Practices of Home
                                                              Builders, National Assn. of Home Builders (NAHB) Research Center.
^    m
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36 • Journal of Environmental Health • Volume 56, Number 5