United States Office of Research and Development
Environmental Protection Research Triangle Park NC 27711 September 1992
Agency Office of Air and Radiation
Washington DC 20001
&EPA The 1992 International
Symposium on Radon
and Radon Reduction
Technology:
Volume 1. Preprints
Session I: Radon-Related
Health Studies
Session II: Federal Programs and
Policies Relating to Radon
September 22-25,1992
Sheraton Park Place Hotel
Minneapolis, Minnesota
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The 1992 International
Symposium on Radon and
Radon Reduction Technology
"Assessing the Risk"
September 22-25,1992
Sheraton Park Place Hotel
Minneapolis, Minnesota
Sponsored by:
U.S. Environmental Protection Agency
Air and Energy Engineering Research Laboratory
and
U. S. Environmental Protection Agency
Office of Radiation Programs
and
Conference of Radiation Control
Program Directors (CRCPD), Inc.
Printed on Recycled Paper
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The 1992 International Symposium on Radon
and Radon Reduction Technology
Table of Contents
Oral Papers
Session I: Radon-Related Health Studies
Preliminary Radon Dosimetry from the Missouri Case-Control of
Lung Cancer Among Non-Smoking Women
Michael Alavanja, R. Brownson, and J. Mehaffey,
National Cancer Institute 1-1
Rationale for a Targeted Case-Control Study of Radon and
Lung Cancer Among Nonsmokers
Mark Upfal and R. Demers, Wayne State University and Michigan
Cancer Foundation; L. Smith, Michigan Cancer Foundation I-2
EPA's New Risk Numbers
Marion Cerasso, U. S. EPA, Office of Radiation Programs I-3
Interaction of Radon Progeny and the Environment and Implications as
to the Resulting Radiological Health Hazard
LJdia Morawska, Queensland University of Technology, Australia I-4
Does Radon Cause Cancers Other than Lung Cancer?
Sarah Darby, Radcliffe Infirmary, Oxford, England I-5
Measurements of Lead-210 Made In Vivo to Determine Cumulative
Exposure of People to Radon and Radon Daughters
Norman Cohen, G. Laurer, and J. Estrada, New York University I-6
The German Indoor Radon Study - An Intermediate Report After
Two Years of Field Work
Lothar Kreienbrock, M. Kreuzer, M. Gerken, G. Wolke,
H.-J. Goetze, G. Dingerkus, University of Wuppertal;
H.-E. Wichmann, University of Wuppertal and Center for
Environment and Health; J. Heinrich, Center for Environment
and Health; G. Keller, Saar University, Germany 1-7
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Session II: Federal Programs and Policies Relating to Radon
EPA's Radon Program
Stephen D. Page, U. S. EPA, Office of Radiation Programs 11-1
Revising Federal Radon Guidance
Michael Walker, U. S. EPA, Office of Radiation Programs II-2
Profile of Region 5's Tribal Radon Program
Deborah M. Arenberg, U. S. EPA Region 5 II-3
The Development of the Homebuyer's Guide to Radon
Paul Locke, Environmental Law Institute, and S. Hoyt,
U. S. EPA, Office of Radiation Programs II-4
Mitigation Standards for EPA's Radon Contractor Proficiency Program
John Mackinney, D. Price, and G. L Salmon,
U. S. EPA, Office of Radiation Programs II-5
Consumer Protection and Radon Quality Assurance: A Picture
of the Future
John Hoombeek, U. S. EPA, Office of Radiation Programs II-6
EPA's Proposed Regulations on Radon in Drinking Water
Janet Auerbach, U. S. EPA, Office of Drinking Water II-7
Session III: State and Local Programs and Policies
Relating to Radon
Radon in Schools: The Connecticut Experience
Alan J. Siniscalchi, Z. Dembek, B. Weiss, R. Pokrinchak, Jr.,
L Gokey, and P. Schur, Connecticut Department of Health
Services; M. Gaudio, University of Connecticut; J. Keitanis,
American Lung Association of Connecticut 111-1
Trends in the Radon Service Industry in New York State
Mark R. Watson and C. Kneeland, New York
State Energy Office III-2
Targeting High-Risk Areas
Katherine McMillan, U. S. EPA, Office of Radiation Programs III-3
How Counties Can Impact the Radon Problem
Jerakj McNeil, National Association of Counties, and D.
Willhoit, Orange County, NC, Board of Commissioners III-4
IV
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Innovative Local Radon Programs
Jill Steckel, National Civic League 111-5
Session IV: Creating Public Action
Indoor Radon: A Case Study in Risk Communication
Stephen D. Page, U. S. EPA, Office of Radiation Programs IV-1
Activating Health Professionals at the Local Level
Deborah McCleland, American Public Health Association IV-2
Translating Awareness Into Consumer Action
Mary Ellen Rse, Consumer Federation of America IV-3
Radon Testing and Mitigation as Applied in Corporate Relocations
Richard Mansfield, Employee Relocation Council IV-4
Ad Council Radon Campaign Evaluation
Mark Dickson and D. Wagner, U. S. EPA, Office of
Radiation Programs IV-5
Session V: Radon Measurement Methods
The U. S. Environmental Protection Agency Indoor Radon
Measurement Device Protocols - Technical Revisions
Melinda Ronca-Battista, Scientific and Commercial Systems Corp.;
A. Schmidt and T. Peake, U. S. EPA, Office of Radiation Programs V-1
A Performance Evaluation of Unfiltered Alpha Track Detectors
William Yeager, N. Rodman, and S. White, Research Triangle
Institute; M. Boyd, U. S. EPA, Office of Radiation Programs;
S. Poppell, Jr., U. S. EPA-NAREL V-2
An Evaluation of the Performance of the EPA Diffusion Barrier Charcoal
Adsorber for Radon-222 Measurements in Indoor Air
David Gray, U. S. EPA-NAREL; J. Burkhart, University of
Colorado; A. Jacobson, University of Michigan V-3
A Lung Dose Monitor for Radon Progeny
Harvel A. Wright, G. Hurst, and S. Hunter, Consultec
Scientific, Inc.; P. Hopke, Clarkson University V-4
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The Stability and Response to Radon of New and Recharged Electrets
William G. Buckman and H. Steen III, Western Kentucky University;
S. Poppell, Jr., U. S. EPA-NAREL; A. Clark, City of Montgomery, AL V-5
Design and Performance of a Low-Cost Dynamic Radon Test Chamber
for Routine Testing of Radon Detectors
P. Kotrappa and T. Brubaker, Rad Elec, Inc. V-6
Session VI: Transport and Entry Dynamics of Radon
Characterization of 222-Radon Entry into a Basement Structure
Surrounded by Low Permeability Soil
Thomas Borak, D. Ward, and M. Gadd, Colorado State University VI-1
Analysis of Radon Diffusion Coefficients of Concrete Samples
K. J. Renken, T. Rosenberg, and J. Bemardin, University of
Wisconsin-Milwaukee VI-2
Data and Models for Radon Transport Through Concrete
Vem C. Rogers and K. Nielsen, Rogers & Associates VI-3
Simplified Modeling for Infiltration and Radon Entry
Max Sherman and M. Modera, Lawrence Berkeley Laboratory VI-4
The Effect of Interior Door Position and Methods of Handling Return Air
on Differential Pressures in a Florida House
Arthur C. Kozik, P. Oppenheim, and D. Schneider, University
of Florida VI-5
Building Dynamics and HVAC System Effects on Radon Transport
in Florida Houses
David Hintenlang and K. AI-Ahmady, University of Florida VI-6
Radon Entry Studies in Test Cells
Charles Fowler, A. Williamson, and S. McDonough, Southern
Research Institute VI-7
Model-Based Pilot Scale Research Facility for Studying Production,
Transport, and Entry of Radon into Structures
Ronald B. Mostey and D. B. Harris, U. S. EPA-AEERL;
K. Ratanaphruks, ACUREXCorp. VI-8
VI
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Session VII: Radon Reduction Methods
Durability of Sub-Slab Depressurization Radon Mitigation Systems
in Florida Houses
C. E. Roessler, R. Varas, and D. Hintenlang, University of Florida VIM
A Novel Basement Pressurization-Energy Conservation System
for Residential Radon Mitigation
K. J. Renken and S. Konopacki, University of
Wisconsin-Milwaukee VII-2
The Energy Penalty of Sub-Slab Depressurization Radon
Mitigation Systems
Lester S. Shen and C. Damm, University of Minnesota; D. Bohac
and T. Dunsworth, Center for Energy and the Urban Environment VII-3
Design of Indoor Radon Reduction Techniques for Crawl-Space
Houses: Assessment of the Existing Data Base
D. Bruce Henschel, U. S. EPA-AEERL VII-4
Multi-Pollutant Mitigation by Manipulation of Crawlspace
Pressure Differentials
Bradley H. Turk, Mountain West Technical Associates; G. Powell,
Gregory Powell & Associates; E. Fisher, J. Harrison, and B. Ligman,
U. S. EPA, Office of Radiation Programs; T. Brennan, Camroden
Associates; R. Shaughnessy, University of Tulsa VII-5
Two Experiments on Effects of Crawlspace Ventilating on Radon
Levels in Energy Efficient Homes
Theodor D. Sterling, Simon Fraser University; E. Mclntyre, Hughes
Baldwin Architects; E. Sterling, Theodor Sterling & Associates VII-6
Session VIII: Radon Occurrence in the Natural Environment
Indoor Radon and the Radon Potential of Soils
Daniel J. Steck and M. Bergmann, St. John's University VIII-1
Nature and Extent of a 226-Radium Anomaly in the Western
Swiss Jura Mountains
Heinz Surbeck, University Perolles, Switzerland VIII-2
Radon Potential of the Glaciated Upper Midwest: Geologic and
Climatic Controls on Spatial Variation
R. Randall Schumann, U. S. Geological Survey VIII-3
VII
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EPA's National Radon Potential Map
Sharon Wirth, U. S. EPA, Office of Radiation Programs VIII-4
Session IX: Radon Surveys
Comparing the National and State/EPA Residential Radon Surveys
Jeffrey L Phillips and F. Marcinowski, U. S. EPA, Office of
Radiation Programs IX-1
Radon Testing in North Dakota Day Care Facilities
Arien L Jacobson, North Dakota State Department of Health IX-2
Ventilation, Climatology and Radon Activity in Four Minnesota Schools
Tim Burkhardt, E. Tate, and L Oatman, Minnesota
Department of Health IX-3
Estimates From the U. S. Environmental Protection Agency's
National School Radon Survey (NSRS)
Lisa A. Ratdiff, U. S. EPA, Office of Radiation Programs;
J. Bergsten, Research Triangle Institute IX-4
Session X: Radon in Schools and Large Buildings
EPA's Revised School Radon Measurement Guidance
Chris Bayham, U. S. EPA. Office of Radiation Programs X-1
Radon in Commercial Buildings
Harry Grafton and A. Oyelakin, Columbus, Ohio Health Department X-2
Iowa Multiresidential Building Radon Study
James W. Cain, Iowa State University Energy Extension X-3
Airflow in Large Buildings
Andrew Persiry, U. S. Department of Commerce X-4
Meeting Ventilation Guidelines While Controlling Radon in Schools
Eugene Fisher and B. LJgman. U. S. EPA, Office of Radiation
Programs; T. Brennan, Camroden Associates; W. Turner,
H. L Turner Group; R. Shaughnessy, University of Tulsa X-5
Radon Reduction in a Belgian School: From Research to Application
P. Cohilis, P. Wouters. and P. Voordecker, Building
Research Institute. Belgium X-6
VIII
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Multiple Mitigation Approaches Applied to a School with
Low Permeability Soil
D. Bruce Harris, U. S. EPA-AEERL; E. Moreau and R. Stilwell,
Maine Department of Human Services X-7
General Indoor Air Investigations in Schools with Elevated Radon Levels
Terry Brennan, Camroden Associates; G. Fisher and B. Ligman,
U. S. EPA, Office of Radiation Programs; R. Shaughnessy,
University of Tulsa; W. Turner and F. McKnight,
H. L Turner Group X-8
Comparison of ASD and HVAC System Control in School Buildings
Bobby Pyle, Southern Research Institute; K. Leovic, T. Dyess,
and D. B. Harris, U. S. EPA-AEERL X-9
Effectiveness of HVAC Systems for Radon Control in Schools
Kelly W. Leovic, B. Harris, T. Dyess, and A. B. Craig,
U. S. EPA-AEERL; Bobby Pyle, Southern Research Institute X-10
Radon Prevention in Construction of Schools and Other Large
Buildings - Status of EPA's Program
A. B. Craig, K. Leovic, and D. B. Harris, U. S. EPA-AEERL X-11
Session XI: Radon Prevention in New Construction
The Effect of Radon-Resistant Construction Techniques
in a Crawlspace House
David L. Wilson and C. Dudney, Oak Ridge National Laboratory;
T. Dyess, U. S. EPA-AEERL XI-1
Performance of Slabs as Barriers to Radon in 13 New Florida Homes
James L. Tyson and C. Withers, Florida Solar Energy Center XI-2
HVAC Control of Radon in a Newly-Constructed Residence with
Exhaust-Only Ventilation
Michael Clarkin and T. Brennan, Camroden Associates;
T. Dyess, U. S. EPA-AEERL XI-3
A Simplified Analysis of Passive Stack Flow Rate
Pah I. Chen, Portland State University XI-4
Factors that Influence Pressure Field Extension in New Residential
Construction: Experimental Results
Richard Prill, Washington State Energy Office; W. Fisk
and A. Gadgil, Lawrence Berkeley Laboratory XI-5
IX
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Evaluating Radon-Resisant Construction Practices in Florida
John Spears, H. Rector, and D. Wentiing, GEOMET Technologies XI-6
Laboratory Investigations for the Search of a Radon-Reducing Material
Lakhwant Singh, J. Singh, S. Singh, and H. Virk, Guru Nanak
Dev University, India XI-7
Session XII: Radon In Water
Risk Assessment Implications of Temporal Variation of Radon and
Radium Well Water Concentrations
Alan J. Siniscatehi, C. Dupuy, D. Brown, and B. Weiss,
Connecticut Department of Health Services; Z. Dembek, M. Thomas,
and N. McHone, Connecticut Department of Environmental
Protection; M. v.d. Werff, U. S. EPA Region 1 XII-1
Seasonal Variability of Radon-222, Radium-226, and Radium-228 in
Ground Water in a Water-Table Aquifer, Southeastern Pennsylvania
Lisa A. Senior, U. S. Geological Survey XII-2
Radon in Tap Water from Drilled Wells in Norway
BJ0m Und and T. Strand, National Institute of Radiation Hygiene XII-3
A Rapid On-site Detector of Radon in Water
Lee Grodzins, Massachusetts Institute of Technology, and
S.Shefsky, NITON Corporation XII-4
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Poster Papers
Session II Posters: Federal Programs and Policies Relating to Radon
Radon Measurement Proficiency Program: New Exam and Listing
for Individuals
G. Lee Salmon and P. Jalbert, U. S. EPA, Office of
Radiation Programs IIP-1
Social and Economic Considerations in the School Evaluation Program
Jed Harrison, U. S. EPA, Office of Radiation Programs IIP-2
The Health of the Radon Industry - Survey and Program Results
from Radon Proficiency Program Analyses
James Long, U. S. EPA, Office of Radiation Programs IIP-3
Session III Posters: State and Local Programs and Policies
Relating to Radon
The Radon Health Effects Committee Report and Its Consequences:
Getting Results in Radon Policy Development
Kate Coleman, E. Fox, and F. Frost, Washington State
Department of Health IIIP-1
Washington State's Innovative Grant: School Radon Action Manual
Linda B. Chapman, Washington State Department of Health IIIP-2
Teaming Up on Local Radon Issues
Robert Leker, State of North Carolina IIIP-3
Session V Posters: Radon Measurement Methods
A Decision-Theoretic Model for Evaluating Radon Test Procedures
Based on Multiple Short-term Measurements
Harry Chmelynski, S. Cohen & Associates VP-1
Operational Evaluation of the Radon Alert Continuous Radon Monitor
Emilio B. Braganza, III and R. Levy, U. S. EPA-LVF VP-2
A New Design for Alpha Track Detectors
Raymond H. Johnson, Key Technology, Inc VP-3
XI
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Measurements of Indoor Thoron Levels and Disequilibrium Factors
Yanxia Li and S. Schery, New Mexico Institute of Mining
and Technology; B. Turk. Mountain West Technical Associates VP-4
Comparison of Continuous and Occupancy Time Radon Measurements
in Schools Using Programmable E-Perms
Marvin Haapala, C. DeWrtt, R. Power, and R. Fjekd,
Ctemson University VP-5
Indoor Radon in New York State Schools
Susan VanOrt, L Keefe, W. Condon, K. Rimawi, C. Kunz,
and K. Fisher, New York State Department of Health VP-6
Session VI Posters: Transport and Entry Dynamics of Radon
Simplified Modeling of the Effect of Supply Ventilation on Indoor
Radon Concentrations
David Saum, Infittec; M. Modera, Lawrence Berkeley Laboratory;
K. Leovic, U. S. EPA-AEERL VIP-1
Determination of Minimum Cover Thickness for Uranium Mill
Tailings Disposal Cells
Jeffrey Ambrose and D. Andrews, CWM Federal
Environmental Services, Inc VIP-2
A Mathematical Model Describing Radon Entry Aided by an Easy
Path of Migration Along Underground Tunnels
Ronald B. Mosley, U. S. EPA-AEERL VIP-3
Radon Diffusion Studies in Soil and Water
Manwinder Singh, S. Singh, and H. Virk, Guru Nanak
Dev University, India VIP-4
Stack Effect and Radon Infiltration
Craig DeWrtt, Clemson University VIP-5
Relative Effectiveness of Sub-Slab Pressurization and
Depressurization Systems for Indoor Radon Mitigation:
Studies with an Experimentally Verified Model
Ashok J. Gadgil, Y. Bonnefous, and W. Rsk,
Lawrence Berkeley Laboratory VIP-6
XII
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Session VII Posters: Radon Reduction Methods
Radon Mitigation Systems - A Liability in Cold Climate Homes?
Kenneth D. Wiggers, American Radon Services, Ltd VIIP-1
Why We Like Diagnostics
John W. Anderson, Jr. and J. Bartholomew, Jr.,
Quality Conservation VIIP-2
An Approach to Computer-Assisted Radon Mitigation
Hormoz Zarefar, P. Chen, and P. Byrne, Portland State University;
C. Eastwood, Bonneville Power Administration VIIP-3
Radon Control - Field Demonstrations: Diagnostic and Mitigation
Techniques Used in Twenty-Six Radon Field Workshops
Craig E. Kneeland and M. Watson, New York State Energy Office;
W. Evans, Evanshire Company, Ltd.; T. Brennan,
Camroden Associates VIIP-4
Radon Mitigation at Superfund Remedial Action Sites: Field
Experience and Results
Jean-Claude Dehmel, S. Cohen & Associates; R. Simon,
R. F. Simon Company, Inc.; E. Fisher, U. S. EPA, Office of
Radiation Programs VIIP-5
Dose and Risk Projection for Use of Sub-Slab Radon Reduction
Systems Under Realistic Parameters
Larry Jensen, U. S. EPA Region 5; F. Rogers and C. Miller,
Centers for Disease Control VIIP-6
Session VIII Posters: Radon Occurrence in the Natural Environment
Influence of Meteorological Factors on the Radon Concentration
in Norwegian Dwellings
Terje Strand and N. Behmer, Norwegian National Institute
of Radiation Hygiene VIIIP-1
Soil Radon Potential Mapping and Validation for Central Florida
Kirk K. Nielson and V. Rogers, Rogers and Associates;
R. Brown and W. Harris, University of Florida; J. Otton,
U. S. Geological Survey VIIIP-2
XIII
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Correlation of Indoor Radon Screening Measurements with Surficial
Geology Using Geographic Information Systems
Charles Schwenker, J-Y Ku, C. Layman, and C. Kunz,
New York State Department of Health VIIIP-3
Analysis of Indoor Radon in New Mexico Using Geographic
Information Systems (GIS)
Richard A. Dulaney, Lockheed Engineering and Sciences Co VIIIP-4
A Radon "Pipe" (?) in the Brevard Fault Zone Near Atlanta, Georgia
L T. Gregg and J. Costello, Atlanta Testing & Engineering VIIIP-5
Session IX Posters: Radon Surveys
Summary of Regional Estimates of Indoor Screening
Measurements of 222-Radon
Barbara Alexander, N. Rodman, and S. White. Research Triangle
Institute; J. Phillips, U. S. EPA, Office of Radiation Programs IXP-1
Texas Residential Radon Survey
Charles Johnson, G. Ramirez, and T. Browning, Southwest Texas
State University; G. Smith, P. Breaux, and V. Boykin, Texas
Department of Health IXP-2
Radon Survey of Oregon Pubic Schools
Ray D. Paris and G. Toombs, Oregon Health Division IXP-3
Quality Assurance in Radon Surveys
William M. Yeager, R. Lucas, and J. Bergsten, Research Triangle
Institute; F. Marcinowski and J. Phillips, U. S. EPA, Office of
Radiation Programs IXP-4
Radon in Houses Around the Plomin Coal Rred Power Plant
N. Lokobauer, Z. Franic, A. Bauman, and D. Horvat,
University of Zagreb, Croatia IXP-5
A Radon Survey at Some Radioactive Sites in India
Jaspal Singh, L Singh, S. Singh, and H. Virk, Guru Nanak
Dev University, India IXP-6
Islandwkte Survey of Radon and Gamma Radiation Levels
in Taiwanese Homes
Ching-Jiang Chen, C-W Tung, and Y-M Lin, Taiwan Atomic
Energy Council IXP-7
XIV
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Session X Posters: Radon in Schools and Large Buildings
Solar Fresh Air Ventilation for Radon Reduction
Monty Holmes, Intermountain Radon Service, and Kelly
Leovic, U. S. EPA-AEERL XP-1
Characteristics of School Buildings in the U. S.
Kelly Leovic, U. S. EPA-AEERL; H. Chmelynski, S. Cohen
& Associates ; XP-2
Radon in Schools in Wisconsin
Conrad Weiffenbach and J. Lorenz, Wisconsin Bureau
of Public Health XP-3
Investigation of Foundation Construction Details to Facilitate Subslab
Pressure Field Extension in Large Buildings
Michael E. Clarkin, Camroden Associates; F. McKnight,
H. L Turner Group; K. Leovic, U. S. EPA-AEERL XP-4
Radon Measurements in the Workplace
David Grumm, U. S. EPA, Office of Radiation Programs XP-5
Radon Survey of Oregon Public Schools
George L Toombs and R. Paris, Oregon Health Division XP-6
Session XI Posters: Radon Prevention in New Construction
Model Standards and Techniques for Control of Radon in New Buildings
David M. Murane, U. S. EPA, Office of Radiation Programs XIP-1
Combined Ventilation and ASD System
David Saum, Infiltec, and F. Sickels, New Jersey Department
of Environmental Protection XIP-2
Evaluation of Passive Stack Mitigation in 40 New Houses
Michael Nuess, Washington State Energy Office XIP-3
Radon Remediation and Life Safety Codes
Lyle Sheneman, Chem-NuclearGeotech, Inc XIP-4
A Passive Stack System Study
Geoffrey Hughes and K. Coleman, Washington State
Department of Health XIP-5
xv
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Session XII Posters: Radon in Water
Radon in Water Measurements Using a Collector-Bubbler
Robert E. Dansereau and J. Hutchinson, New York State
Department of Health XIIP-1
Measurements of Radon in Water via Sodium Iodide Detectors
Paul N. Houle, East Stroudsburg University, and D. Scholtz,
Prosser Laboratories XIIP-2
Continuous Measurement of the Radon Concentration in Water Using
Electret Ion Chamber Method
Phillip K. Hopke, Clarkson University, and
P.Kotrappa,RadEtec,lnc. XIIP-3
Performance Testing the WD200 Radon in Water Measurement System
George Vandrish and L Davidson, Instruscience Ltd XIIP-4
Temporal Variations in Bedrock Well Water Radon and Radium, and
Water Radon's Effect on Indoor Air Radon
Nancy W. McHone and M. Thomas, Connecticut Department of
Environmental Protection; A. Siniscatehi, Connecticut Department
of Health Services XIIP-5
XVI
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Session I
Radon-Related Health Studies
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1-1
PRF.T.TMTNARY RADON DOSIMETRY FROM THE MISSOURI
CASE-CQNTRQI. QF LUNG CANCER AMONG NQN-SMOKTNG WOMEN
By: Michael C. R. Alavanja
Ross Brownson
Judy Mehaffey
National Cancer Institute
9000 Rockville Pike
Bethesda, MD 20814
ABSTRACT
Radon levels in the hones of 2000 study subjects were measured
by standard Alpha-Tract detectors and by CR-39 detectors that
measure the alpha decay of radon daughters imbedded in glass
objects owned by the study subject. Class objects appropriate for
CR-39 detectors were available for most study subjects.
Comparisons of the two dosimetry techniques yielded similar
estimates of radon exposure when 30 year radon dosimetry was
available for study projects. The advantages and disadvantages of
both techniques for epidemiologic applications are discussed as
well as plans for a future study.
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1-2
RATIONALE FOR A TARGETED CASE-CONTROL STUDY OF RADON
AND LUNG CANCER AMONG NONSMOKERS
Mark Upfal, MD, MPHa
Linda Smith, PhDb
Raymond Demers, MD, MPHC
Wayne State University9'0
Department of Family Medicine
4201 St Antoine, UHC-4J
Detroit, Michigan 48201
and
Michigan Cancer Foundation3^-0
110 E. Warren
Detroit, Michigan 48201
ABSTRACT
Unless there is strong synergy between radon and smoking, attempts to detect a
carcinogenic effect of residential radon among smokers may be unproductive, given
sample size requirements and available resources. Studies of nonsmokers may be a
more efficient and realistic way to test the hypothesis that radon in the home causes a
significant number of respiratory cancers. Only if the lung cancer risks of radon and
smoking are multiplicative will the relative risk of the exposed vs. the unexposed smoker
be as high as that of the exposed vs. the unexposed nonsmpker. Thus, studies of
smokers may be useful principally to test hypotheses regarding interactive effects rather
than the primary effect of residential radon.
In addition to targeting non-smokers, investigations should be performed in
regions with heterogeneous and relatively high radon levels, and should control for
potential confounders such as passive smoking, gender, family history and occupation.
Rapid reporting systems to identify living cases with lung cancer may improve access
to, and the reliability of interview data. Rationale for a study in Detroit, Michigan is
presented.
This paper has been reviewed in accordance with the U.S. Environmental Agency's peer
and administrative review policies and approved for presentation and publication.
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INTRODUCTION
Radon is a well established pulmonary carcinogen in both human^S and
animar)D studies. If risk estimates are correct, it may pose the greatest radiation
hazard in the United States. Risk estimates for exposure in the home have been
derived by extrapolation ftfpm the empirically documented dose-dependent
occupational risk of miners.1' However, these risks have not yet been adequately
confirmed or quantified through direct epidemiologic research in the residential
environment. In order to detect and empirically quantify the estimated effect of radon in
the home, investigations must be designed with adequate study power. The most
efficient yield would probably be achieved by studying a large number of histologically
confirmed cases with lung cancer in a region with relatively high radon levels and
heterogeneity of exposure. However, many of the studies performed to. date have been
ecologic in design,0-^-1 "'J suffer from small sample sizes, '1J>14 inadequate
exposure assessment,lt>>1b relatively low and homogeneous exposure levels,1/>7B or
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Effects of Ionizing Radiation, National Research Council, National Academy Press, Washington, DC,
1988.
2 Radon Reference Manual, US EPA Publication 520/1-87-20, Sept 1987.
3 Harley N, Samet JM, Cross FT, et al, "Contribution of Radon and Radon Daughters to Respiratory Cancer,"
EnvHlth Perspectives; 70:17-21,1986.
4 Cross FT, Palmer RF, Filipy RE, Dagle GE, Stuart BO, "Carcinogenic effects of radon daughters, uranium
ore dust and cigarette smoke in beagle dogs," Health Physics, 42:33-52,1982.
5 Chameaud J, Masse R, Lafurmn J, Influence of radon daughter exposure at tow doses on occurrence of lung
cancer in rats, Radiation Protection & Dosimetry, 1984; 7:385-8.
6 Health Risks of Radon and Other Internally Deposited Alpha-Emitters, BIER IV, Committee on the Biological
Effects of Ionizing Radiation, National Research Council, National Academy Press, Washington, DC,
1988.
7 International Commission on Radiological Protection, Lung cancer risk from indoor exposures to radon
daughters, ICRP Publication 50, Pergamon Press, Oxford, UK, 1987.
8 Archer VE, "Association of Lung Cancer Mortality with Precambrian Granite," Arch Environ Health,
42(2):87-91, March/April, 1987.
9 Fleischer RL, "A possible association between lung cancer and a geologic outcrop," Health Physics; 50:823-
827,1986.
10 Vonstille WS, Sacarello HL, "Radon and cancer: Florida study finds no evidence of increased risk," 7
Environ Health, 53:25-28,1990.
11 Edling C, Comba P, Axelson O, et al, "Effects of low-dose radiation: A correlation study," ScandJWork
Environ Health, 8 Supp 1:59-64,1982.
12 Edling C, Kling H, Axelson O, "Radon in homes: A possible cause of lung cancer," ScandJ Work Environ
Health; 10:25-34,1984.
13 Axelson O, Edling C, Kling H, "Lung cancer and residency: A case-referent study on the possible impact of
exposure to radon and its daughters in dwellings," ScandJ Work Environ Health, 5:10-15,1979.
14 Lees RE, Steele R, Roberts JH, "A case-control study of lung cancer relative to domestic radon exposure,"
IntJEpidemiology, 16:7-12,1987.
15 Svenssen C, et al, Indoor exposure to radon from the ground and bronchial cancer in women, IntArch
Occup Environ HIth; 59(2):123-131,1987
16 Axelson O, Andersson K, Desai G, et al, "Indoor radon exposure and active and passive smoking in relation
to the occurrence fo lung cancer," ScandJ Work Environ Health; 14(5):286-292,1988.
-------
include jDther substantial lung cancer risk factors which may obscure the effect of
radon.19
To date, perhaps the most important study, io. the domestic setting is that
performed by the New Jersey Department of Health.20'^1 This was the first reasonably
large residential case-control study using actual alpha-track measurements of radon
and obtaining smoking histories. In the study, 400 matched lung cancer cases and
controls that had lived in one residence for 10 to 30 years were evaluated. A statistically
significant trend associating risk with exposure was detected, with a relative risk
coefficient consistent with the prior mining studies. Limitations of this study, however,
include (a) few elevated radon exposures (only 24 cases and 12 controls had
exposures estimated to be above 2 pCi/l), (b) smoking accounting for most of the lung
cancers, since cases and controls were not selected among nonsmokers. (cj
incomplete cumulative exposure assessment (only one home tested per participant), (dj
possible selection bias due to limited participation among those eligible, and (e)
possible bias toward testing older homes due to home eligibility requirements (the
home must have been occupied for more than 10 years by the participant). It is of
interest that the association between radon and lung cancer was strongest among
those that smoked less than 15 cigarettes per day. This is consistent with the theory
that smoking induced bronchitis among heavy smokers may result in a mucus layer
covering ibe respiratory epithelium and acting as a potective shield against alpha
radiation/** Further, this suggests that a similar study which eliminates heavy smokers
may provide an important contribution to our knowledge base.
One large epidemiologic study recently performed in China failed to detect an
association between lung cancer and residential radon exposure.1" Although the study
was encumbered by significant limitations, it has been cited in the lay press as
evidence that radon in the home may not be a serious health risk. The investigation
was performed in the setting of a very high background incidence of lung cancer and
high levels of exposure to another potent carcinogen (benzo[a]pyrene).
case-controLand ecologic design studies have been summarized by
and Neuberger.*26 All of these suffer from design problems such as those
17 Schoenberg JB, Klotz JB, Wflcox HB, et al, "Lung cancer and exposure to radon in women: New Jersey,"
AfflflWf38(42):715-718,1989.
18 Schoenberg JB, Klotz JB, Wflcox HB, et al, "Case-control study of residential radon and lung cancer among
New Jersey women," Cancer Research, 50^520-6524,1990.
19 Blot WJ, Xu ZY, Bofce JD, et al, Indoor radon and lung cancer in China,"/Afarf Cancer Inst, 82:1025-
1030,1990.
20 Schoenberg JB, Klotz JB, Wflcox HB, et al, "Case-control study of residential radon and lung cancer among
New Jersey women," Cancer Research, 1990; 50:6520-24.
21 Schoenberg JB, Klotz JB, Wflcox HB, etal, "Lung cancer and exposure to radon in women - New Jersey,"
MMWR, October 27,1989; 38(42):715-8.
22 Cross FT, Palmer RF, Fflipy RE, Dagle GE, Stuart BO, "Carcinogenic effects of radon daughters, uranium
ore dust and cigarette smoke in beagle dogs," Health Physics, 1982; 4233-52.
23 Blot WJ, Xu ZY, Boice JD, et al, "Indoor radon and lung cancer in China," J National Cancer Inst 82:1025-
30,1990,
24 Upfal MJ, Johnson AJ, Jacobson AP, Brady PA, Campbell JA, Letter to editor, re: Indoor radon and lung
cancer in dua^'J National Cancer Inst 82:1722-3,1990.
25 Samet JM, "Radon and Lung Cancer," J National Cancer Inst, 1989; 81(10):745-57.
-------
aforementioned. As pointed out by Lubin, et al, detectionj>f lung cancer attributable to
radon will require large numbers and accuracy in exposure estimation."2' Ecologic
studies, while of interest descriptively, lack the ability to confirm or rule out an
association between radon and lung cancer.
The case-control approach is the epidemiologic method of choice for studying
residential radon exposure and lung cancer, but there are a variety of important
methodoiogic challenges. Such investigations require careful estimation of historic
exposure, with adequate attention to quality assurance, appropriate classification of
cases (e.g. histologic confirmation of cancer type), and careful selection of the study
population to ensure adequate and heterogeneous exposure levels, appropriate control
of potential confounders, freedom from the masking effects of other potent lung cancer
risk factors, and proper selection of referents. Perhaps one of the most important
limiting factors which may affect the success of such studies is the sample size
requirement. Even in the ideal situation, with perfect historic exposure estimation and
with no miscla^sifjcatipn in case definition, residential radon research requires very large
sample sizes. >JU'J1 This requirement, of course is inversely related to the estimate of
relative risk of the exposed vs. the unexposed, and directly related to the desired power
of the study.
Exposure estimation faces the challenge of reconstructing decades of historic
exposure with recent radon .measurements. Although some measurement difficulties
exist,J^ alpha-track devices*" may optimize the balance between practicality and
reliability in the measurement of current residential exposure. However, changes in the
construction of a home (e.g. architectural modifications such as additions, the
development of cracks in the foundation, weatherproofing, fire repairs) may alter radon
levels over time. In addition, the historic reconstruction of an individual's residential
history may not always be accurate. Furthermore, even when the residential history is
well established, some homes may not be available for measurement (e.g. demolition,
fire damage, non-cooperation of occupants or owners), and practical limitations may
require the exclusion of homes in which the case or control lived for a brief period (e.g.
less than two years). An alternate method of assessing exposure uses objects such as
26 Neuberger JS, "Residential radon exposure and lung cancer: An overview of published studies," Cancer
Detection and Prevention, 15(6):435-443,1991.
27 Lubin JH, Samet JM, Weinberg C, "Design issues in epidemiologic studies of indoor exposure to Rn and
risk of lung cancer," Health Physics, 1990;59(6):807-17.
28 Neuberger JS, "Residential radon exposure and lung cancer: An overview of published studies," Cancer
Detection and Prevention, 15(6):435-443,1991.
29 Lubin JH, Samet JM, Weinberg C, "Design issues in epidemiologic studies of indoor exposure to Rn and
risk of lung cancer," Health Physics, 199O,59(6):807-817.
30 Lubin JH, Gail MH, "On power and sample size for studying features of the relative odds of disease, Am J
Epidemiology, 1990;131(3):552-66.
31 Neuberger JS, "Residential radon exposure and lung cancer An overview of published studies," Cancer
Detection and Prevention, 15(6):435-443,1991.
32 Uncertainty exists in radon measurements, U.S. Government Accounting Office, Report to the Chairman,
Committee on Science, Space and Technology, House of Representatives, Publication No. B-236505,
Washington, D.C, October, 1989.
33 Indoor radon and radon decay product measurement protocols, U.S. Environmental Protection Agency,
Office of Radiation Programs, Problem Assessment Branch, EPA Publication No. 520-1,89-009,
Washington, DC, March, 1989.
-------
glass from picture frames owned by the study participant to provide a retrospective
integrated exposure level.
Even if exposure levels were accurately reconstructed, a variety of factors will
affect the individual's respiratory dose, including physical characteristics of the home
air, the individual's breathing patterns and rate, lung architecture and the condition of
the respiratory epithelium. Such errors in exposure assessment and in extrapolation to
an individual's historic dose, will tend to bias the study toward the null if the errors are
random. As a result, the sample size requirement may be increased in order to
detect an effect.
In order to maximize relative risk, investigations should be geographically located
where exposures are relatively high and heterogenous. However, it is recognized that
exposure heterogeneity will tend to decrease-with mobility of the population due to the
averaging effect of living in multiple homes.35 In addition, there should be freedom
from trie masking effects of other lung cancer risk factors.
LUNG CANCER RISK FACTORS OTHER THAN RADON
Examples of other potential risk factors for lung cancer include active and
passive smoking, occupation and family history. While many current studies include
smokers, and Jt has been suggested that studies should include both smokers and
nonsmokers,36 there may be compelling reasons to consider excluding smokers from
many studies. The first priority should be to quantify the residential carcinogenictty of
residential radon; the next priorities may be to determine other aspects of its
cartinogenitity such as its interaction with smoking, the effects of gender, temporal
patterns of exposure, etc. As shall be demonstrated, unless smoking and radon are
dose to multiplicative, studies of smokers will require considerably greater sample sizes
to achieve the power to detect an effect, as compared with studies of nonsmokers.
Resources should be directed to test the highest priority hypotheses and to test those
for which there is a reasonable likelihood of producing results.
ft is currently unknown whether the effect of smoking is additive, multiplicative,
submultiplicative or subadditive, or a combination of these interactions operating at
different exposure levels of smoking. The synergistic effects of smoking and another
respiratory carcinogen (asbestos) have been well established. Some studies have
suggested that such synergy with radon may be operative:"3' Further, it is known that
smoking induced changes in the mucociliary apparatus may decrease respiratory
clearance of foreign particles. On the other hand, it is conceivable that a thick mucus
layer on the respiratory tract due to bronchitis in a heavy smoker would shield the
mucosal surface from alpha radiation. Suspended smoke particles might also reduce
the ambient availability of the potentially more harmful "unattached fraction" of radon
34 Samet JM, "Radon and Lung Cancer,"/Afarf Cancer Inst, 81(10):745-757,1989.
35 Lubin JH, Samet JM, Weinberg C, "Design issues in epidemiologic studies of indoor exposure to Rn and
risk of lung cancer," Health Physics, 1990^9(6):807-817.
36 Neuberger JS, "Residential radon exposure and lung cancer An overview of published studies," Cancer
Detection and Prevention, 15(6):435^t43,1991.
37 L'Abbe KA, Howe GR, Burch JD, et al, "Radon exposure, cigarette smoking, and otehr mining experience
in the Beaverlodge uranium miners cohort," Health Physics, 60(4):489-95, Apr, 1991.
-------
decay products. Consistent with these latter hypotheses, two recent studies
demonstrated the strongest associations between radon and lung cancer among those
who smoked the leasL;p>Ły'4U Still, the net interactive effect of smoking and radon has
yet to be determined.*1 -^
Nonetheless, the actual effect of smoking may have important implications for the
design of investigations of radon and lung cancer, since smoking might obscure the
ability of a study to detect an effect of radon. The following hypothetical example
illustrates an important "masking effect" which may occur when studying radon among
smokers.
EXAMPLE RADON STUDY INVOLVING SMOKERS AND NONSMOKERS &
IMPLICATIONS FOR STUDY DESIGN
Suppose a case-control residential radon study (among adults) is planned in a
country of 250,000,000, with 175,000,000 adults, and that the prevalence of "ever
smokers" is similar to that of the United States (approximately 50%).43 The annual
number of lung cancer cases among the smokers (current or former) is 135,000 (154.3
per 100,000 adults) compared with 15,000 (17.1 per 100,000 adults) for the
nonsmokers. Exposed individuals will be defined as those in the top quartile of
cumulative radon exposure dose.
Given these parameters, and given a variety of relative risk levels for the
nonsmoker, table 1 summarizes the numbers of attributable cases, the attributable
incidence rates, the attributable percentages of cases, and the relative risks for
smokers. This analysis is performed for both the additive and multiplicative models. A
potent masking effect of radon can be appreciated. When nonsmoker relative risks for
lung cancer are 1.25, 2.0 and 200 under the additive model, the relative risks of the
smoker are considerably lower, at 1.026,1.091 and 1.49 respectively. This disparity in
relative risk occurs even though the smoker and nonsmoker will experience the same
number of attributable cases. These differences in relative risks are quite important
because of the increase in sample size requirement that can result from a decrease in
estimated relative risk.
The effect is neither one of interaction nor confounding. In a public health context,
interaction is considered to be present when there is a departure from additiyity of
attributable risks (or incidence rate differences).44 Since the additive model implies no
interaction, smokers will have the same incidence rate for cancers attributed to radon as
38 Schoenberg JB, Klotz JB, Wilcox HB, et al, "Case-control study of residential radon and lung cancer among
New Jersey women," Cancer Research, 1990; 50:6520-24.
39 Schoenberg JB, Klotz JB, Wilcox HB, et al, "Lung cancer and exposure to radon in women - New Jersey,"
MMWR, October 27,1989; 38(42):715-8.
40 Axelson O, et al, "Indoor radon exposure and active and passive smoking in relation to the occurrence of
lung cancer," Stand J Work Env Hlth\ 14(5):286-292,1988.
41 Samet JM, "Radon and Lung Cancer,* JNatl Cancer Inst, 81(10):745-757,1989.
42 Samet JM, Morgan MV, Spengler JD, "Health effects and sources of indoor air pollution, Pan ll'Amer
Review RespDis, 137:221-242,1988.
43 "Cigarette smoking among adults - United States, 1990," MMWR, May 22,1992,41(20):354-362.
44 Rothman KJ, Greenland S, Walker AM, "Concepts of interaction," AmerJEpid, 112(4):467-470.
-------
Nonsmokers
only
Smokers *
Smokers
only
Smokers &
NoiMnioktfv
Smokers
only
'
NONSMOKER REL HSK: • - • ...
Arm f exposure related lung CA's in nonsmokers
Incidence rate (per 100,000 nonsmokers):
% of nonsmoker cases:
* 1.2S ., M*1 2*
: ! 8821 1,667! 3,000!
1.01! 1.90{ 3.43 !
5.9%! 11.1%! 20.0%!
5 2O "
200
7.500! 12,391! 14,704
8.6! 14.2!
16.8
50.0%! 82.6%! 98.0%
' i ' '" ! • ' • T
AoomvEMOOEL
Smoker relative risk
Annual t exposure related Jung cancers:
Incidence rate (per 100,000 person*):
% of all cases:
AIM * exposure related king CA's in smokers:
Incidence rate (per 100.000 smokers):
% of smoker cases:
UULTPUCATTVe MODEL
Smoker relative risk
Annual t exposure related lung cancers:
Incidence rate (per 100.000 persons):
% of all cases:
Arm t exposure related king CA's in smokers:
Incidence rate (per 100,000 smokers):
% of smoker cases:
t^* i^ *< V^*\\ - .xV^ ^s ^ XC' " V J '- I * ^ 1
! | :
1.026! 1.05: 1.091!
1,765! 3,333! 6,000!
1.01 ! 1.9OJ 3.43 =
1.2% I 2.2%! 4.0%!
882! 1.667J 3.000J
I.Oll 1.90J 3.43l
0.7%! 1.2%i 2.2%!
! i !
i ! !
1.25J 1.5! 2j
8,824! 16,6671 30.000 !
5.o! 9.5! 17.1;
5.9%! 11.1%! 20.0%!
7,941 j 15,000! 27,000]
9.1! 17.1 ! 30.9!
5.9%! 11.1%! 20.0%j
-.s . > ^ %
. . _
j „ j
1.24! 1.40!
1.49
15,000! 24,783! 29,409
8.6! 14.2!
16.8
10.0%! 16.5%! 19.6%
7,500! 1 2,391 ! 14,704
8.6} 14.2!
16.8
5.6% ! 9.2% j 1O.9%
j j
! {
Si 20|
200
75,00o! 123,913! 147.044
42.9! 70.8 1
84.0
50.0% | 82.6%; 98.0%
67,500: 111,522: 132.340
77.1; 127.5J 151.2
50.0%! 82.6%! 98.0%
v% f^ ^ ^ f^^
, 0 J Table 1. Radon and king cancer. Attributable numbers of cases, incidence rates and percentages of cases
g'sS;;? given a population of 175 miDfon adults, a 5O% ever-smoking prevalence. 25% exposure rate, varying
i*-« *•• degrees of nonsmoker relative risk and two models of interaction with smoking.
-^ -, * , ,-* < , - ••
% " ^.l
,i
-
-------
nonsmokers. For the example in figure 1, with a relative risk of 2.0 for nonsmokers, the
attributable incidence rate difference for smokers would be 164.6-150.9 = 13.7 for the
smoker, as compared with 27.4-13.7 = 13.7 for nonsmokers. However, because
smokers have such a high background rate of lung cancer, the percentage of lung
cancer cases in smokers that are related to exposure is far lower than that of
nonsmokers. If radon exposure were responsible for 20% of all lung cancers among
nonsmokers, only 2.2% of smokers' lung cancers would be due to exposure. Even if
exposure were responsible for 98% of all nonsmoker lung cancers in this model, it
would account for less than 11% of all lung cancers in smokers. Thus, given the
additive model, it would be improbable for even a perfectly executed study to detect an
exposure effect among smokers, given sample size limitations.
EXPOSED
UNEXPOSED
EXPOSED
UNEXPOSED
NON
SMOKER SMOKER
NON
SMOKER SMOKER
NON
SMOKER SMOKER
36,000
99.000
6.000
9.000
EXPOSED
UNEXPOSED
164.6
150.9
27.4
13.7
EXPOSED
UNEXPOSED
12.0
11.0
2.0
1.0
Figure 1a. Number
of lung cancer cases
Figure 1b. Incidence
rates
Figure 1c. Relative
risks
RGURE 1. ADDITIVE MODEL. Numbers of lung cancer cases, incidence rates and relative risks
among exposed and unexposed smokers and nonsmokers for the hypothetical population presented.
NON
SMOKER SMOKER
NON
SMOKER SMOKER
NON
SMOKER SMOKER
54.000
81,000
6.000
9.000
EXPOSED
UNEXPOSED
246.9
123.4
27.4
13.7
EXPOSED
UNEXPOSED
18.0
9.0
2.0
1.0
Figure 2a. Number
of lung cancer cases
Figure 2b. Incidence
rates
Rgure 2c. Relative
risks
RGURE 2. MULTIPLICATIVE MODEL. Numbers of lung cancer cases, incidence rates and relative risks
among exposed and unexposed smokers and nonsmokers for the hypothetical population presented.
Only when the effects of radon and smoking are multiplicative (table 1; figure 2)
will the relative risk of radon-induced lung cancer for the exposed vs. unexposed
smoker equal that of the exposed vs. unexposed nonsmoker. While studies of
nonsmokers will merely require a detectable carcinogenic effect of radon to reject the
null hypothesis, studies of smokers will require both a detectable carcinogenic effect of
radon and a potent synergistic effect. Unless the interaction between smoking and
-------
radon is at least multiplicative, nonsmoker studies will be more powerful, given the same
sample size.
The demonstrated masking effect occurs whether or not smoking acts as a
confounder. A confounding factor is one which is associated with both the exposure
and the outcome.45 While smoking is clearly associated with lung cancer, the masking
effect occurs whether or not smoking is associated with radon exposure level. If
smoking were associated with exposure, however (e.g. socioeconomic status may
affect type and location of housing, as well as smoking prevalence), then a confounding
effect may be present simultaneously. All studies which include smokers should control
for any association between smoking and the level of radon exposure.
The 1989 International Workshop on Residential Radon Epidemiology46
summarizes 14 ongoing investigations of approximately 9,400 cases and 13,000
controls. Approximately 80% of these studies include smokers. Given the extremely
challenging sample size requirements for demonstrating an effect, new studies which
aim to determine the extent to which residential radon causes lung cancer should be
limited to nonsmoking populations. Studies of smokers should primarily be undertaken
with the objective of examining interactive effects, rather than the effect of radon itself.
The same masking effect demonstrated by the example for smoking explains
why the aforementioned Chinese study of residential radon must be considered
indeterminate rather than supportive of the null hypothesis. This investigation had been
performed in the presence of high levels of exposure to benzo[a]pyrene, a potent
respiratory carcinogen, and a very high background rate of lung cancer. Since radon
exposures were not extremely high in the study population, the background rate of lung
cancer would be expected to eclipse the effect of radon.
Unfortunately, when indeterminate studies are performed, both the lay public and
scientists alike may inappropriately cite these as negative studies evidencing the
absence of carcinogenicity. In fact, such studies are non-contributory or at best, weakly
contributory to an assessment of the null vs. the alternative hypotheses. In addition to
the Chinese-Study, many ecologic studies have been cited by the lay press in the radon
debate.47-48 If the current studies of radon among smokers do not detect an effect of
radon, this would not be inconsistent with a potent effect of radon in the face of
submuto'plicative interaction with smoking. However, it is a realistic concern that such
outcomes might be misinterpreted by some as ruling out the carcinogenic effect of
residential radon.
45 Matthews DE, Farewell VT, Using and understanding medical statistics, 2nd edition, Karger, Basel,
Switzerland, 1988.
A6 International workshop on residential radon epidemiology: Workshop proceedings, U.S. Department of
Energy; Office of Energy Research, Publication No. DE90-005521, Washington, D.C, July, 1989.
47 "Recent new articles downplay radon risks,' Radon Bulletin, Conference of Radiation Control Program
Directors and US Environmental Protection Agency, 1991; 1(3).
48 Abelson PH, "Radon: EPA turns a blind eye to the facts," The Detroit News, Detroit, Michigan, May 19,
1991.
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RATIONALE FOR A STUDY OF NONSMOKERS IN THE
METROPOLITAN DETROIT AREA
Since 1978, rapid reporting procedures have been in place for the Detroit
Metropolitan Surveillance, Epidemiology & End Results (SEER) database at the
Michigan Cancer Foundation. Designed for the purpose of identifying patients for
special studies, this system has the ability to efficiently and expedttiously identify several
hundred new lung cancer cases among nonsmokers annually. Patients are selected
based on pathologic diagnosis and criteria established in specific study protocols.
Information on these patients is provided to the Interviewing Supervisor within 7-10 days
after diagnosis. Physician consent is obtained prior to contact of the patient for
interview. Interviews with study cases are usually finalized within 4-6 weeks after initial
diagnosis.
Among SEER cancer data collection programs, Metropolitan Detroit ranks
number one for both total lung cancer cases and incidence rates, with 14,542 lung
cancer cases recorded between 1984 and 1988 (incidence rate = 69.6). Of these,
3,376 (23.2%) were in blacks (creating the potential foe examining an issue important to
minority health), and 5,035 (35%) were in females.4Sit)U In 1989, the Detroit SEER
database added 2,722 newly diagnosed cases of lung cancer (15.4% of newly
diagnosed cancers in the SEER system).
The Michigan Cancer Foundation abstracting unit continuously collects data on
cancer site and histology from 52 hospitals, 7 major outpatient facilities and 17 radiation
therapy units. Cases can be identified within 2 weeks of diagnosis and interviewed
within 4 to 6 weeks. Recently, procedures to identify preliminary smoking status from
medical charts have been implemented for all cancers of the lung and bronchus. Of the
399 lung cancer cases already identified, 36 (9.0%) were nonsmokers. Thus, it is
estimated that on an annual basis, approximately 245 nonsmokers with lung cancer
could be identified.
The International Classification of Diseases for Oncology, Field Trial Edition,
March 1988, is used for coding histologic type. In accordance with SEER Program
Manual guidelines, the final pathologic diagnosis is usually coded by the abstractor,
however all pathology reports are reviewed to record the most specific histologic
diagnosis. Microscopic confirmation, along with the nature of the best evidence
available, is also recorded by the abstractor. Microscopic diagnoses based upon tissue
specimens take precedence, followed by cytologic and other microscopic diagnoses,
laboratory or marker tests, visualization by surgical exploration, radiographic
techniques, and clinical diagnosis. For the period between 1988 and 1990, 8171
incident cases of lung cancer were reported through the Detroit SEER registry, 7562
(92.5%) of these cases were microscopically confirmed via histologic or cytologic
diagnosis.
Newly diagnosed cases allow for interviews of the living patient in most cases,
rather than a proxy. Detailed data on residential and occupational histories are best
49 The SEER Program Code Manual, Cancer Statistics Branch, Surveillance Program, Division of Cancer
Prevention and Control, National Cancer Institute. NIH Pub. No 89-1999,1989.
50 Ries LA, Hankey BF, Miller BA, Hartman AM, Edwards BK, Cancer Statistics Review: 1973-1988, National
Cancer Institute. NIH Pub. No. 91-2789,1991.
-------
obtained from the subjects themselves. Temporal proximity of the interview to the time
of diagnosis would improve the reliability of data collected, and might also enhance
participation. An additional advantage of using a SEER rapid reporting system is that if
there is a future need to expand the study population, new cases participants will
always be available using the same methods of recruitment.
The study population has lived in an area in which residential radon levels have
been surveyed extensively with two important data sets. The American Lung
Association of Michigan (ALAM) has provided radon test kits to Michigan residents
since 1987. More than 15,000 charcoal canisters and 2,700 alpha track detectors have
been distributed. On the basis of 8,571 pre-mitigation, "lowest livable area," residential
charcoal cannister measurements, 21% of homes were found to exceed 4 pCi/l, and 2%
were above 20 pCi/l. By compiling the results from this testing, ALAM has been able to
establish significant exposure heterogeneity, with areas of both lower level exposure
and higher level exposure. For instance, over 5% of the homes screened in certain
communities (South Lyon, Milford & Novi) had readings above 20.0 pCi/l. Readings as
high as 120 pCi/l have been observed. While these results are not based upon random
sampling, the quantity of tests and known geological conditions give credibility to these
findings. Furthermore, patterns established during initial testing have been consistent
over the years as additional data have been added to this dataset.51
In addition, Michigan was one of the original ten states to participate in EPA's
State Survey Program. The Michigan Department of Public Health (MDPH) randomly
screened 2,082 owner occupied homes in 1987-88. From this survey, regional patterns
were established and MDPH estimated that 18% of homes in Oakland County would
screen above 4.0 pCi/l. Wayne and Macomb Counties were projected to have less than
10% of the homes screen above 4.0 Ci/l.5^
Population mobility and the unavailability of some homes in the Detroit area may
pose a challenge to investigators. This is currently being investigated through a
separate pilot study to develop a residential registry of nonsmokers with lung cancer.
Supplementing data collected during interviews, the Detroit area will have data
from two other important studies of risk factors for lung cancer. The first study, funded
by the National Institute for Occupational Safety and Health JNIOSH), is to develop a
system for routine surveillance of occupational cancer risks.**** The second, funded by
the National Cancer Institute (NCI), is a populatioobased study of lung cancer risk
among relatives of lung cancer cases and controls.54 Demographic and occupational
information, along with smoking histories, have been obtained in both studies. In
addition, the second study is generating data on family history of cancer, respiratory
diseases, and other health problems. Both studies have drawn cases from the Detroit
SEER database. The data collected in these studies may be valuable for the
examination of potential confounding effects.
51 Johnson GA, Residential radon screenings in Michigan, American Lung Association of Michigan, 1992.
52 Indoor Radon in Michigan: Report to the Governor, Michigan Department of Public Health, Bureau of
Environmental and Occupational Health, December, 1988.
53 Swanson GM, Prinicpal Investigator, "Occupational Cancer Surveillance: New Approaches," supported by
grant number OH02067 from the National Institute for Occupational Safety and Health.
54 Schwartz AC, Principal Investigator, "Familial Risk of Lung Cancer,* supported by grant number CA50383
from the National Cancer Institute.
-------
SUMMARY
Although radon is an established lung carcinogen, its risk in the residential
environment will be extremely challenging to confirm empirically. Case-control
epidemiologic studies will require very large sample sizes and attention to critical design
issues. The interaction between smoking and radon has not yet been determined.
However, if this interaction is less than multiplicative, then a study of smokers will tend to
require larger sample sizes for the same level of power, due to the high background
level of lung cancer among smokers. If smoking and radon are additive, then studies of
smokers are unlikely to detect an effect of radon in the home. Thus, negative studies of
smokers should be considered indeterminate unless synergy can be established.
Smoking populations are best utilized to study interactive effects rather than the primary
effect of radon. In addition to targeting nonsmokers, case-control studies should
ensure adequate exposure assessment, control for confounding factors and target
populations with relatively high and heterogenous exposures. The use of recently
identified cases may improve access to and the reliability of interview data.
-------
1-3
Title: EPA's New Risk Numbers
Author: Marion Cerasso, U. S. EPA, Office of Radiation Programs
This paper was not received in time to be included in the preprints, and
the abstract was not available. Please check your registration packet for a
complete copy of the paper.
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1-4
INTERACTION OF RADON PROGENY AND THE ENVIRONMENT AND
IMPLICATIONS AS TO THE RESULTING RADIOLOGICAL HEALTH HAZARD
By: Lidia Morawska
School of Physics
Queensland University of Technology
GPO Box 2434
Brisbane, Australia
ABSTRACT
The principal hazard associated with exposure to radon
progeny is lung cancer. Lung cancer is, however, also caused by
other factors, mainly by smoking. It is widely believed that if
both radon progeny and environmental aerosols are present in the
air - cigarette smoke in particular - the health hazard is higher.
It has to be recognized, however, that the simultaneous presence
of aerosols and radon progeny in the air requires that two
contradictive factors be considered: (i) radon progeny
concentration may be higher due to attachment to atmospheric
aerosols and smaller losses to indoor surfaces, but
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1-5
Does Radon Cause Cancers Other Than Luna Cancer?
By: Sarah C Darby
Imperial Cancer Research Fund
Cancer Epidemiology Unit
Gibson Building
Radcliffe Infirmary
Oxford 0X2 6HE
ABSTRACT
It is clear from studies of miners exposed to high
concentrations of radon that the major hazard resulting from
breathing air containing radon is an increased risk of lung
cancer and, as a result, analyses of many of the miners studies
have concentrated heavily on lung cancer, presenting little
information on cancers of other sites.
Recently, however, there have been suggestions from
ecological studies that .environmental radon may be causing a
variety of different types of cancer, and a collaborative effort
is now underway to evaluate these suggestions using data from the
miners' studies. The present status and interim results of this
effort will be described.
For further information, please refer to:
Darby, Sarah, and R. Doll, 1990, Radon in Houses: How Large is the Risk?,
Radiation Protection in Autsralia, Vol. 8, No. 4.
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1-6
MEASUREMENTS OF LEAD-310 MADE IN VIVO TO DETERMINE
CUMULATIVE EXPOSURE OF PEOPLE TO RADON AND RADON DAUGHTERS
By: N. Cohen, G. Laurer, and J. Estrada
New York University
ABSTRACT
Along with a well-defined dose-response relationship for
assessing the increased risk of lung cancer from the inhalation of
radon daughters, information is required to accurately estimate an
individual's past cumulative exposure to these decay products.
Due to a number of factors, physical as well as physiological (not
the least of which is the fact that past levels of radon daughter
concentration may have been extremely variable and poorly
characterized), it is particularly difficult to accurately
establish past, cumulative exposure magnitudes for any specific
individual.
The study to be described demonstrates the feasibility of
assessing these past exposures at environmental levels through the
in vivo measurement of Pb-210 in the human skeleton, thereby
allowing the individual to act as his/her own "integrating sampler
and dosimeter."
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1-7
THE GERMAN INDOOR RADON STUDY - AN INTERMEDIATE REPORT AFTER
TWO YEARS OF FIELD WORK
by: Kreienbrock, L.1; Kreuzer, M.1; Wichmann, H.-E.1'2; Gerken, M.J;
Heinrich,_ J.z; Wolke, G.1; Goetze, H.-J.1; Dingerkus, G.1;
KeUer, G.3
* Division of Labour Safety and Environmental Medicine, FB 14,
University of Wuppertal, 5600 Wuppertal 1, FRG
2 Institute for Epidemiology, gsf - Center for Environment and
Health, 8042 Neuherberg, FRG
6 Institute for Biophysics, Saar University, 6650 Homburg, FRG
ABSTRACT
Investigations on underground miners result in an increased risk of lung
cancer associated with exposure to radon and its decay products.
Epidemiologic studies on indoor exposure to radon progeny partly prove an
increase of lung cancer as well, although their results are inconsistent and not
yet sufficient for quantitative risk assessment.
Based upon low dose extrapolation the Commission on Radiation Protection
(FRG) estimates a 4 to 12 % portion of the total lung cancer cases in the
Federal Republic of Germany to be caused by indoor-radon. Applied to a total
annual amount of about 25000 lung cancer deaths in the western part of
Germany, this theoretical estimate corresponds to an annual number of 1000
to 3000 lung cancer deaths.
On this background a case control study of more than 3000 cases and the
same number of controls is conducted in several regions of the Federal
Republic of Germany since 1989.
This intermediate report describes the study design and experiences of the first
half of field work.
This study is supported by the Bundesamt fur Strahlenschutz (BfS), Federal
Republic of Germany. The work described in this paper was not funded by the
U.S. Environmental Protection Agency and therefore the contents do not
necessarily reflect the views of the agency and no official endorsement should
be inferred.
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INDOOR-RADON IN GERMANY
In Germany the highest radon concentrations in dwellings have been measured
in the eastern part (former GDR) especially in the regions of Thuringia and
Saxony with uranium mining or medieval ore mining (1). The western parts of
Germany and here the districts Upper-Franconia, Upper-Palatinate and Lower
Bavaria and in parts of the Saar and the Eifel also show higher radon
concentrations (2). Likewise parts of the Black Forest and of other highlands
show elevated concentrations, as indicated by the measurements of the local
dose rate of the terrestric radiation in dwellings.
In West-Germany the median indoor exposure is 40 Bq/jn^, the mean is 50
Bq/nr3 and 1 % of the population is exposed to 250 Bq/nr3 or more (2). For the
eastern part of Germany no overall-mean is available up to now, but in selected
areas in Thuringia and Saxony the median exposure is more than 250 Bq/nr*
and extreme concentrations of more than 100000 Bq/nr3 were found (2). Table
1 shows median concentrations in selected areas of Germany.
Table 1: Median indoor concentrations of radon in Bq/m3 and number of
measurements in selected regions of the Federal Republic of
Germany
Germany - West (2)
Upper-Franconia
Upper-Palatinate
Lower Bavaria
Saarland
Koblenz (area)
Cologne (area)
Germany - East (1)
Schneeberg (town)
Median
54
42
65
42
65
39
Median
>250
n
194
122
130
121
134
367
1068
n
app. 800
#> 100
19
10
23
3
21
14
90=8.4%
#> 100
71.1%
#>200
1
2
5
0
5
1
14=1.3%
#>250
51.8%
The German Commission on Radiation Protection therefore estimates a 4 to 12
% portion of the total lung cancer cases in the western part of the Federal
Republic of Germany to be caused by radon.
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CASE-CONTROL-STUDY ON LUNG CANCER RISK OF INDOOR RADON IN THE
FEDERAL REPUBLIC OF GERMANY
Based on this background a case-control-study on lung cancer risk of indoor
radon with more than 3000 cases and the same number of controls from the
general population in selected regions of the Federal Republic of Germany is
conducted (3, 4, 5, 6, 7 ). Radon exposure is determined by indoor
measurements in the present and former dwellings, further risk factors (active
and passive smoking, occupational exposure, .diet a. o.) are registered by
means of a questionnaire. The duration of the study is scheduled for six years,
including a pilot phase to test the feasibility of the various instruments, the
actual period of ascertainment and measurement and the statistical analysis.
STUDY REGION
The selection of the study region was determined by the level of radon exposure
(1, 2). Three sub-regions are indicated and regional coordinators are
established: one for the region of Saarland, Koblenz and Cologne, another one
for the region of Franconia, Upper-Palatinate, Lower Bavaria and a third one
for the region Thuringia and Saxony (see figure 1).
STUDY SIZE
The estimation of the study size was related to the concepts of risk assessment
from a 2x2-contingency-table (8) and to the exposure situation in West-
Germany (see above). Based on the IRCP extrapolation for the lifetime risk of
lung cancer by inhaled radon daughters (9), the expexted relative risk is
approximately 2 for 1 % of the study population compared to the median.
Thus, choosing a probability of type 1 error of 0.05 and of type 2 error of 0.10,
about 3000 cases and 3000 controls are needed to prove the expected relative
risk (for details see 6).
RECRUITMENT AND INTERVIEWING OF CASES
Incident cases less than 75 years with confirmed lung cancer in the study
region are included. The interviews with cases take place within three months
after diagnosis in cooperating lung hospitals, where the interviewers are
localized. The patients are informed about the study's objective and are asked
to participate in the interview and the radon measurement in their homes.
The standardized interview lasts about one hour and comprises questions on
indoor exposures, smoking habits (for non-smokers on passive smoking) and
occupational history. Furthermore the adresses of the participant's dwellings of
the previous 35 years are registered.
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Figure 1: Study region of German study on indoor radon and lung cancer
RECRUITMENT AND INTERVIEWING OF CONTROLS
A random sample of controls is recruited either from town registries or by
telephone with a technique of modified random digit dialing (10, 11) and
frequency matched to the cases by sex, age and area. The control persons are
interviewed in their homes.
RECRUITMENT AND INTERVIEWING OF NEXT TENANTS
Based on the information from the residential history of cases and controls and
if necessary, with the help of directories, the next tenants are contacted and
informed about the study's objective. Then they are asked to describe the
characteristics of their dwelling and to expose the radon dosimeters.
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RADON MEASUREMENT
Radon concentrations are measured by charcoal canisters and cc-track
detectors (Karlsruhe-type). A set of two detectors of each type together with the
instructions is delivered to the participant directly or by mail. The detectors are
placed in the participant's living room and in the bedroom. After three days of
exposure the charcoal canisters are sent back for analysis.
The a-track detectors are exposed for one year. A random sample of homes is
visited to ensure the correct position of the detectors.
Inhabitants of dwellings with elevated radon concentrations are given advice
with regard to radon mitigation techniques.
COOPERATIONS
To obtain information on the question, whether certain sub-types of lung
cancer preferably occur after radon exposure, the histological material of the
cases is classified by a reference pathologist and the cytological material by a
reference cytologist.
A further aim of the study is the investigation of the lung cancer risk due to
exposure to carcinogens at the working place. For this purpose the
occupational history is documented in detafl and the interviewers are trained
and supervised by a physician for industrial medicine.
The study center also takes part in a multinational European study on lung
cancer risk of indoor radon. This case control study with participants from
Belgium, France, Luxemburg and the U.K. has a comparable design and covers
the regions of the Ardennes and Eifel (12).
EXPERIENCES OF FIELD WORK
The study was designed at the end of the 80s before Germany was reunited.
For this reason two pilot phases were necessary to test the organisation, the
questionnaire and the technique of radon measurement in the different sub-
regions of the study area. In the western part of Germany a pilot phase was
performed, which was completed in summer 1990, the main phase started at
the end of 1990. Relating on this experiences and adjusting on the special
circumstances in the former GDR the principal phase in East-Germany starts
in spring 1991.
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INTERVIEWS
An existing standardized questionnaire {13, 14) was adjusted and tested during
both pilot phases. The central issues of the questionnaire refer to dwellings,
active and passive smoking and occupational history.
The questionnaire is based on a phase concept. This means that identical
questions are asked for each phase of residence (i. e. dwellings in the last 35
years), of smoking (i. e. periods of constant smoking habits since start of
smoking) and of occupation (i. e. jobs since leaving school), so that the
temporal course of exposures can be described.
Analysis of the interviews shows, that the questionnaire has a sufficient
reliability. Central training of all interviewers, controlling interviews with tape
recordings and central corrections form a good quality. A training effect of the
interviewers is demonstrated by a reduction of the interview's duration in the
course of the pilot phase, declining from an average length of more than two
hours at the beginning to a length of about one and a quarter hour at the end.
HANDLING AND MAILING OF RADON DETECTORS
Since the technique of radon measurement by charcoal- and a-track-
dosimeters is sufficiently documented and tested, the primary object has to be
layed on testing the acceptance, handling and mailing of the detectors.
Table 2 shows the response-distribution of the charcoal-canisters, which have
to be mailed back. For all participants who have sent back a charcoal canister
after two additional contacts the response distribution of returned a-track-
detectors is shown in table 3.
Table 2: Response of charcoal-canisters (all contacts) in the German study
on indoor radon and lung cancer (autumn 1990 - June 1992)
response categories
evaluation possible
died within reminding period
non-responder
all
# houses
1688
36
23
1747
% houses
96.7
2.1
1.2
100
The tables show, that the mailing procedures, which are necessary for reasons
of study size and distances in the study area, give a sufficient response for
estimating the radon exposure.
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Table 3: Response of cc-track-detectors in the German study on indoor radon
and lung cancer (autumn 1990 - June 1992)
response categories
no charcoal return
evaluation possible
died within measure period
non-responder
all
# participants
26
314
11
4
355
% participants
7.3
88.5
3.1
1.1
100
INVESTIGATING AND ACCESS TO NEXT TENANTS
As found in an earlier investigation (15) an average of 2-3 dwellings inhabited
by the cases and controls during the last 35 years can be expected. In the
ongoing study this value is 2.86. From these 35 years on average 25 years
should be covered by radon measurements to get an approximation of lifetime
exposure. A third of all participants (in rural areas 50 %) cover this 25-year-
window with their present home.
In the course of a preceding test phase and both pilot phases the investigation
of and access to the next tenants in the former dwellings was tested for
different approaches in the different study regions.
In the western part of Germany town registries, adress books and CD-ROM-
telephone-books can be used to recognize next tenants. The central population-
registry of the former GDR gives access to adresses situated in the eastern part
of the study region.
INTERMEDIATE DESCRIPTIONS OF THE PRINCIPAL PHASE
CASE-CONTROL-DATA
From autumn 1990 until June 1992, 971 incident lung cancer cases and 862
population controls have been interviewed, charcoal radon measurement has
been performed and a-track-measurement has been started in their actual
homes.
Table 4 shows the smoking status, defined as smokers vs. never-smokers (<
400 life-time cigarettes) by sex of these first participants of the study.
The proportion of smokers among lung cancer patients is expectedly high. The
statistical analysis of other selected variables from the interviews confirms the
expected distributions for Germany. Lung cancer is most frequently observed
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in the age group between 60 and 70 years, among persons with primary or
elementary school grades and with lower occupational qualification. An
occupational exposure to inhaled carcinogens is found in 10 % of the cases for
West-Germany and about 15 % of the cases in East-Germany.
Table 4:
Smoking status by sex of the first participants in the German
study on indoor radon and lung cancer (autumn 1990 - June
1992) (in brackets row-percent for males and females)
cases
controls
males
smokers
802 (98.3 )
528 (77.2 )
never- smokers
14(1.7)
156 (22.8)
females
smokers
104 (67.1)
63 (35.4)
never- smokers
51 (32.9)
115(64.6)
RADON-MEASUREMENTS
The distribution of the charcoal measurements for the whole study region is
outlined in figure 2, the sub-distribution of the eastern part is outlined in
figure 3. In relation to the overall distribution Jsee table 1) the number of
homes with Rn-concentrations above 250 Bq/m05 in the whole study area is
slightly higher, in the eastern area extremely higher than expected.
Pram* 260
Figure 2: Radon-distribution of 3638 charcoal-measurements in sleeping-
rooms and living-rooms from houses in the German study on
indoor radon and lung cancer (autumn 1990 - June 1992 / all
sub-regions)
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2L40K
6.75%
OS8% 0.91%
<-» ZB-BO
71-100 Wt-ttB W-WO W-178 178 - TO ZD1-22S 228-260 >2EO
Figure 3: Radon-distribution of 569 charcoal-measurements in sleeping-
rooms and living-rooms from houses in the German study on
indoor radon and lung cancer (spring 1991 - June 1992 / eastern
sub-region)
AKNOWLEDGEMENT
We like to thank Dr. Bolm-Audorff, Dr. Jockel, Dr. Konetzke for their help in
adapting the questionnaire, the involved physicians and interviewers in the
cooperating hospitals for their support and enthusiasm and the technicians for
the radon analysis.
REFERENCES
(1) SAAS: Radon-Messungen in Wohnungen in Schneeberg. Staatliches Amt
fur Atomsicherheit. Personliche Mitteilung des Bundesministers fur
Umwelt, Naturschutz und Reaktorsicherheit, 1990
(2) Schmier, H.: Die Strahlenexposition durch die Folgeprodukte des Radon
und Thoron. Schriftenreihe des Instituts fur Strahlenhygiene des EGA,
Neuherberg, 1984
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(3) Wichmann, H.E.: Erfahrungen mit einer Fall-Kontroll-Studie zu den
Rlsikofaktoren des BronchiaJkarzinoms - Eignet sich dieser Ansatz auch
zur Untersuchung der Radon-Problematik ? In: Aktuelle Fragen zur
Bewertung des Strahlenkrebsrisikos. Veroffentlichungen der Strahlen-
schutzkommission 12, G. Fischer Verlag Stuttgart, 1988, 237-249
(4) Wichmann, H.E.: Lung Cancer Risk by Radon in the Federal Republic of
Germany. Workshop on Residential Radon Epidemiology, Alexandria,
U.S.A., 1989, Abstract
(5) Wichmann, H.E.: Radon-Exposure from an Epidemiologic Point of View.
Blut61, 1990, 69
(6) Wichmann, H.E.; Kreienbrock, L.: Lungenkrebsrisiko durch Radon in der
Bundesrepublik Deutschland - Beschreibung einer Fall-Kontroll-Studie.
In: Kohnlein, W. et al.: Niedrigdosisstrahlung und Gesundheit. Springer-
Verlag Berlin, 1991,151-165
(7) Kreienbrock, L.; Wichmann, H.-E.; Gerken, M.; Heinrich, J.; Goetze, H.-
J.; Kreuzer, M.; Keller, G. The German Radon Project - Feasibility of
Methods and First Results, to appear: Radiation Protection Dosimetry,
1992
(8) Schlesselman, J.J.: Case control studies. Design, Conduct, Analysis.
Oxford University Press, New York, Oxford, 1982
(9) BEIR IV: Health risks of radon and other internally deposited alpha-
emitters. National Research Council. National Academy Press,
Washington, D.C., 1988
(10) Kreienbrock, L.; Lieb, G.; Gerken, M.: Auswahl von
Populationskontrollen mittels "random digit dialing". In: Guggenmoos-
Holzmann, I. / Hrsgb., Quantitative Methoden in der Epidemiologie,
Medizinische Informatik und Statistik Bd. 72, 1991, 221-228
(11) Kreuzer, M., Kreienbrock, L., Gerken, M., Lieb, G., Wichmann, H.-E.: Ein
integratives Verfahren zur Auswahl von Populationskontrollen. In: Van
Eimeren, W., Uberla, K., Ulm, K. / Hrsgb. Gesundheit und Umwelt.
Medizinische Informatik, Biometrie und Epidemiologie 75. Springer,
Berlin u.a.O., 1992, p. 96-100
(12) Poffijn, A., Tirmarche, M., Kreienbrock, L., Kavser, P., Darby, S.L.: Radon
and lung cancer: Protocol and procedures of the multicenter studies in
the Ardennes-Eifel region, Brittany and the Massiv Central Region, to
appear in: Radiation Protection Dosimetry, 1992
(13) Greiser.E.; J6ckel;K.-H.: Tlmm.J.; Wichmann,H.-E.: Luftverschmutzung
und Lungenkrebsrisiko - Untersuchungen zu Risikofaktoren des
Bronchialkarzinoms. Forschungsbericht 10 606 044 / 01-02 des
Umweltbundesamtes, 1988
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(14) Bolm-Audorff, U.; Ahrens, W.; Jockel, H.H.; Molik, B.; Greiser, E.;
Thimm, J.; Wichmann, H.E.; Woitowitz, H.J.: Experience with
supplementary questionnaires in a lung cancer case reference study. In:
Commission of the European Communities, Hemon, D., Goldberg, M.
(Eds.): Methodology of assessment of occupational exposures in the
context of epidemiological detection of cancer risk. Directorate General
Science, Research andDevelopment, Brussels, 1989, 117-169
(15) Wichmann, H.E.; Jockel, K.H.; Molik, B.: Luftverunreinigungen und
Lungenkrebsrisiko - Ergebnisse einer Pilotstudie. Umweltbundesamt,
1991 in Press
AUTHORS ADRESS
Bergische Universitat GH Wuppertal
FB 14, Arbeitssicherheit und Umweltmedizin
Gau^-Str. 20
5600 Wuppertal 1
Tel (0202) 439-2088
FAX (0202)439-2068
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Session II
Federal Programs and Policies
Relating to Radon
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11-1
EPA'S RADON PROGRAM
By: Stephen D. Page
U. S. EPA
Office of Radiation Programs (ANR-464)
401 M Street SW
Washington, D. C. 20460
ABSTRACT
The Environmental Protection Agency established the Radon
Action Program in 1985 to reduce the health risks of radon. This
discussion will highlight progress made in the effort to reduce
the nation's health risk from radon and discuss the future
direction of the Agency's radon program in light of 1) legislative
direction and 2) recommendations of the 1991-92 EPA Radon Program
Review Panel.
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11-2
REVISING FEDEDERAL RADON GUIDANCE
By: Michael Walker
U. S. EPA
Office of Radiation Programs (ANR-464)
401 M Street SW
Washington, D. C. 20460
ABSTRACT
It's no secret that the work of public health officials and
radon professionals is greatly affected by changes in federal
radon policy. Less obvious is the rationale for specific shifts
in guidelines and how those guidelines are communicated to the
public. Insight into the factors underlying change is crucial for
those involved in communicating and implementing radon policy
recommendations.
This paper examines the many factors that contributed to the
revision of federal guidelines for radon and their articulation in
the "Citizen's Guide to Radon." The Guide's wide-reaching and
controversial policy implications demanded an exhaustive review in
which virtually every work of the document was negotiated. This
paper will provide the reader with an understanding of how policy
decisions were made and why the presentation and verbalization of
information appears as it does in the Guide.
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11-3
PROFILE OF REGION 5'S TRIBAL RADON PROGRAM
by: Deborah M. Arenberg
U.S. Environmental Protection Agency/ Region 5
77 West Jackson Boulevard (AT-18J)
Chicago, Illinois 60604-3590
ABSTRACT
Region 5 has been successful in efforts to perform radon testing and
mitigation on Tribal Lands. Various mechanisms have been used to foster this
success, including 1) working closely with the Regional Indian Work Group; 2)
acquiring funds and services from the USEPA Radon Action Program for radon
testing and mitigation; 3) seeking out suitable tribal groups to assist our
efforts; 4) using Regional dollars for training through Interagency
agreements; and 5) actively urging other appropriate Federal Agencies to join
our efforts by frequently informing them of the issues, sharing testing
results with them, and inviting them to training courses.
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PROFILE OF REGION 5'S TPTBaT. TOUXN PROGRAM
The Uhited States Environmental Protection Agency (USEPA) in Region 5 is
home to 29 Indian Reservations that are spread across three of the six states:
Minnesota, Wisconsin, and Michigan (Figure 1). The approximate Tribal
population on the 29 reservations is 40,000, and there are about 10,000 homes.
Approximately half of the homes on these reservations are owned by the Uhited
States Department of Housing and Urban Development (HDD), and the other half
are privately owned. The Region 5 Radiation Program's goal is for every home,
school and business on Tribal lands be tested for radon gas, and mitigated if
necessary.
RADON SURVEYS ON REGION 5 TRIBAL LANDS
MENCMZNEE/ONEIDA PILOT PROJECT
December 1986 narks the Region 5 Radiation Program Staff's first
involvement with the Tribes with regard to radon. A staff member attended a
groundbreaking Region 5 tribal environmental conference designed to begin
implementation of USEPA1 s Indian Policy, which was hosted by the National
Congress of American Indians and the USEPA Region 5. The conference gave the
Radiation Program an opportunity to provide information to tribal leaders on
the health concerns of radon and USEPA's Radon Action Program.
One result of this conference was that in early 1987, the Radiation
Program Staff in Region 5 conducted a pilot radon study at the Menominee
Reservation and the Oneida Reservation in Wisconsin. We provided charcoal
canisters to perform radon screening tests in about twenty-five homes on each
reservation. Staff members from the Indian Health Service (IHS) deployed and
retrieved the detectors, provided radon literature to the homeowners
(Citizen's Guide to Radon), and filled out a questionnaire related to the type
of home, and the lifestyle of the occupants. Our objective with this
screening survey was to find out if there were homes with elevated radon
levels, as well as to familiarize ourselves, the IHS and some Tribal personnel
with the process of performing a radon survey on Tribal lands. The results of
the testing showed only a few homes with levels slightly greater than our
guideline of 4 picoCuries per liter (pCi/1). However, one home did have a
level of 78 pCi/1. We provided alpha track detectors for all of the homes
greater than four.
USEPA/STATE RADON SURVEY ON TRIBAL LANDS
In early 1987, the IHS expressed an interest to the Region 5 Radiation
Program Staff in performing radon testing in many homes on the Tribal lands,
since many of the reservations are located on potential radon "hot spot"
areas, based on geology. IHS submitted a proposal to the Region 5 Radiation
Program for assistance on a radon survey, to determine the significance of the
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-__. Soult Sit.
Boy Mllit lUorf.
Lac Court* Potawatoml
Uinneapolia-St. Foul
Upp«r Stoux p o
Prior Cak«
UKE
HURON
Chicago
Figure 1. MAP OF USEPA REGION 5 INDIAN RESERVATIONS
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radon problem in Tribal heroes. The Regional Radiation Program, in turn,
submitted a proposal to the Office of Radiation Programs (OKP) to include this
survey as part of the USEPA/State Radon Survey program. OKP accepted the
proposal to measure radon levels in 1000 Tribal homes, as a pilot screening
survey.
This radon screening survey took place during the winter of 1987-88. The
design was somewhat different than the usual random telephone survey used in
most states, since few Tribal homes have telephones. However, a random survey
was still desirable, so the data could be integrated with data from other
State surveys. Regional staff worked with ORP's contractor (Research Triangle
Institute) to develop a specialized random survey in which a list of random
addresses was generated from a list of every home on the Tribal lands.
The Region 5 Radiation staff worked with Research Triangle Institute to
modify the usual telephone interview survey forms, and helped develop a
training course for the Tribal interviewers who placed charcoal
canisters directly, and performed face-to-face interviews to determine
eligibility of the homes in the survey. We performed this training in
October 1987 at two locations. The interviewers in most cases were IHS
environmental staff.
GEOGRAPHICAL TRIBAL RADON SURVEY
In addition to the random radon screening survey that took place in
approximately 1000 Tribal homes during the winter of 1987-88, Region 5
purchased an additional 2400 charcoal canisters for use by the Tribes that
same winter. Approximately 1100 of these detectors were placed in a grid
arrangement on the reservations to ensure that all geographic areas were
covered in the survey, since there was concern that the random survey may have
missed remote areas on the reservation.
The combined results of the random and geographical screening surveys
performed during the winter of 1987-88 are shown in Figures 2 through 4, and
vary by reservation. Overall, approximately 27% of the homes tested had radon
screening levels greater than USEPA's action guideline of 4 pCi/1.
FCXICNOP RADON SURVEY
In the Spring and Summer of 1988, the IHS placed follow-up alpha track
detectors in all of the homes that exceeded 4 pCi/1 during the screening tests
(approximately 550 homes) . These long-term detectors were placed in the
living areas of the homes for a period of one year. The results of the tests
showed that over 15% of the homes tested have annual radon levels exceeding
USEPA's guideline.
COORDINATION WITH OlHtiK FEDERAL AGENCIES
In early 1987, the Region 5 Radiation staff began attending monthly
meetings of the newly formed Regional Indian Workgroup (RIW3) , to keep up with
environmental issues affecting the Tribes, to seek advice and to inform the
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TABLE 1. MINNESOTA RADON RESULTS
May 5, 1988
CHARCOAL CANISTERS
NO. OF
BOIS FORTE
GRAND PORTAGE
LOWER SIOUX
UPPER SIOUX
LEECH LAKE
MILLE LACS
PRAIRIE ISLAND
RED LAKE
FOND DU LAC
SHAKOPEE
WHITE EARTH
TOTALS
PLACED
59
46
52
16
200
44
12
185
60
10
95
779
RESULTS RECEIVED
59
46
16
16
194
35
10
185
60
9
88
718
NO. > 4 PCI/L
9
11
11
10
29
1
4
37
29
5
32
178
% > 4 PCI/L
15
24
70
63
15
3
40
20
48
56
36
25
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TABLE 2. MICHIGAN RADON RESULTS
Hay 5, 1988
CHARCOAL CANISTERS NO. OF
HANNAHVILLE
LAC VIEUX DESERT
BAY MILLS
SAULT STE. MARIE**
SAGINAU CHIPPEHA
GRAND TRAVERSE
KENEENAU BAY
TOTALS
**MACKINAC ISLAND 74 74 55 74
PLACED
13
27
28
155
59
31
107
420
RESULTS RECEIVED
10
27
28
153
59
30
102
409
No. > 4 PCI/L
1
1
1
57
2
0
4
66
% > 4 PCI/L
10
4
4
37
4
0
4
16
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TABTF T WISCONSIN RADON RESULTS
May 5, 1988
STOCKBRIDGE-MUNSEE
MOLE LAKE
BAD RIVER
RED CLIFF
ST. CROIX
LAC DU FLAMBEAU
WIS. WINNEBAGO
ONEIDA
MENOMINEE
FOREST CO.
LAC COURTE OREILLES
TOTALS
CHARCOAL CANISTERS NO. OF
PLACED
189
13
17
20
33
81
56
131
340
6
99
985
RESULTS RECEIVED
184
13
17
19
33
80
56
128
328
6
97
961
NO. > 4 PCI/L
99
4
.0
0
2
21
5
21
150
0
17
319
% > 4 PCI/L
54
31
0
0
6
26
9
16
46
0
18
33
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workgroup of the various radon Issues that occurred. The Workgroup is headed
up by the Region 5 Indian Coordinator.
REGION 5 MEMORANDUM OF UNDERSTANDING
In 1987 the KING began development of a Multi-Agency Memorandum of
Understanding (MOO) on Tribal environmental issues. The MDU was signed by
OSEPA Region 5, the United States Geological Survey (USGS) , the Bureau of
Indian Affairs (BIA) , and the IBS in the Fan of 1987. The Department of
Housing and Urban Development, Office of Indian Programs signed this MOU in
February of 1988 (copy attached in the Appendix) . The purpose of the MDU is
to identify areas of mutual interest and responsibilities of the five Federal
agencies and to establish a means for coordinating the agencies' respective
activities. Radon is specifically mentioned in the MDU as an area of tribal
environmental interest.
HDD INVOLVEMENT IN RADON ACTIVITIES
The Region 5 Radiation Program staff attended the quarterly MDU meetings
with the five agencies numerous times in 1987 and 1988 to update them on radon
issues, and to encourage participation by agencies other than the IHS in radon
activities. HUD was not able to attend many of the meetings for various
reasons. In the fall of 1987 the Radiation Program staff began a more active
campaign to inform the Region V HUD Indian Program of the Regional radon
activities and to request their support. This was viewed as an important
effort since HUD owns about half of the Region 5 Tribal homes. We attended
various HOD meetings to explain the health concern about radon, including
their quarterly staff meetings and Tri-State Housing Authorities meetings, and
wrote several letters to their Regional management requesting support with
radon activities. (At that time, we also informed the BIA. of our radon
activities by attendance at their meetings and letters to their Regional
In late 1988, after the Region 5 Radiation Program staff met with HOD
engineers to inform them of EPA's "Radon Reduction in New Construction"
document, the Region V HDD Indian Program sent a short letter to executive
directors of the various Tribal Housing Authorities briefly outlining various
ways to incorporate radon mitigation strategies into new home construction.
This letter requested that radon reduction information be presented to their
architects or consultants and those strategies that were ". . .deemed useful
and economically feasible should be incorporated into new construction
drawings for new housing and also in the bid packages." This letter was very
encouraging, even if it was not too detailed. It was our first evidence of
action from the HUD Indian Program on the radon issue.
_ In late Fiscal Year 1990, the Region V HOD Indian Program funded seven
USEPA Region 5 Indian tribes for radon testing and mitigation activities with
their Comprehensive Improvement Assistance Program (dAP) funds. The total
amount of money given to the seven Region 5 tribes was $119,824. An
additional $146,250 in dAP funds was given to four other tribes in various
USEPA Regions east of the Mississippi River, since that is the territory HUD
Region V covers. The Radiation staff coordinated with the HUD staff to ensure
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that the funding of these tribes would not overlap our funding efforts through
radon grant program that was just beginning.
TRIBAL RADON TRAINING AND MITIGATIONS
PILOT RADON MITIGATION COURSE
The Region 5 Radiation Program staff requested and received from the
Office of Radiation Programs discretionary fund $5,000 in the Spring of 1989
to develop and deliver a pilot radon mitigation course for tribal groups in
the Region. The University of Minnesota developed and taught this course with
an experienced radon mitigation contractor and a Native American instructor in
September of 1989, in Shawano, Wisconsin. The mechanism we used to get this
money to the University of Minnesota was through an Interagency Agreement with
the United States Department of Agriculture (USDA), since the University of
Minnesota is part of the USDA Extension Service. Eighteen participants
attended a one-and-a-half day classroom session and six of these participants
attended a two-day hands-on session and successfully mitigated a tribal home
on the Menominee reservation. The training was very well received. The
participants included IBS staff, Tribal enNdronmental staff and HUD Indian
Program staff. Wisconsin was chosen for this pilot course because screening
measurement results showed the greatest need to mitigate houses there first.
IHS RADON MITIGATION PROJECT
The results of the USEPA screening survey in Tribal homes on Mackinac
Island, Michigan (Sault Ste. Marie Tribe) in the winter of 1987-88 prompted
the IHS to undertake a radon mitigation research project in homes there during
the winter of 1989. This project was funded by the IHS Office of Research and
Development. These homes had radon levels ranging from 12.9 to 82.3 pCi/1 and
were all on crawlspace foundations. Using isolation and ventilation
techniques the radon levels in all the homes were reduced to less than
1 pCi/1. Homeowners performed the actual installation of the mitigation
systems.
RADON MITIGATION TRAINING BY MORC
In June of 1990, USEPA Region V gave $15,000 in Regional discretionary
funds to the University of Minnesota (again through an IAG with USDA) to
further train tribal groups in radon mitigation techniques. Three separate
training projects were performed by the University of Minnesota with this
money. In July of 1991, in consultation and coordination with the IHS, the
Midwest Universities Radon Consortium (MURC), which is run through the
University of Minnesota, held a House Evaluation Program Course at the Upper
Sioux Reservation in Montevideo, Minnesota.
In August of 1991, MURC conducted a House Evaluation Program Course at
the Grand Portage Reservation in Minnesota for the Grand Portage Housing
Authority. The Authority was involved in a $60,000 project to mitigate 41
houses under a HUD dAP contract previously mentioned. The Authority had
initiated a stop order until its contractor had received radon mitigation
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training. Unfortunately the MURC director found that of the several houses
the mitigation contractor had mitigated so far, the work did not meet the
existing USEPA guidance. Some of the mitigated houses had no prior radon
measurements and some of the year-long radon measurements were less than
2 pCi/1. The contractor had not participated in USEPA's Radon Contractor
Proficiency Program. The Authority reimbursed MURC for two-thirds of the cost
of the course and USEPA paid for the rest through the IAG.
In December of 1991, MURC provided a technical assistance project and
training with IBS personnel in the diagnostics and partial mitigation of
elevated radon levels in the Menominee Tribal Clinic in Keshena, Wisconsin.
INDIAN RADON PHOT PROJECTS IN REGION 5
FISCAL YEAR 1990
In the Fall of 1989, ORP, through the request of Region V and others,
began looking for a way to fund Tribal groups under the State Indoor Radon
Grant Program. Federally recognized Indian tribes could not be funded
directly under the Indoor Radon Abatement Act because Indian tribes are not
explicitly included under the Toxics Substance Recovery Act (TSCA) definition
of State. Instead, it was decided to use TSCA Section 10 authority to fund
Indian demonstration projects. ORP developed guidance for the Indian Radon
Pilot Projects (IRPP) and set aside $300,000 nationally to fund projects in
Fiscal Year 1990. The IRPP guidance is very similar to the SIRG guidance,
except that the matching requirement is only five percent.
The Radiation staff notified thirty-two tribal groups of the IRPP program
and gave them guidance on application for funds in May 1990. Three proposal
were received and forwarded to ORP in order to determine the Region 5
allocation of $55,000. Radiation Program staff held a conference for the
interested Tribal groups in June 1990. At the conference it was decided that
it would be most beneficial for the Great Takps Inter-Tribal Council, Inc.
(GLTTC), an umbrella organization for the Wisconsin Tribes, to utilize the
funds, since they could test more homes.
In September of 1990, Region V awarded $55,000 to the GLTTC to perform
radon screening measurements in homes on fourteen reservations in three
states. GLITC set up contracts with these Tribes to hire a person to place
and retrieve the detectors. They also budgeted money for a training course
regarding the placement of the detectors, which was conducted by MURC in early
1991. In all, approximately 1400 homes were tested with charcoal detectors.
FISCAL YEAR 1991
In Fiscal Year 1991, ORP made $200,000 available nationally for the
Indian Radon Pilot Projects. Region V worked with the GLITC to develop a
proposal for performing radon follow-up testing in all homes that tested
greater than 4 pCi/1 during the first year of the IRPP (approximately 436
homes). GLITC also budgeted for mitigation assessment demonstrations for a
number of homes, and for radon mitigation training through MURC. In May of
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1991, Region 5 received an allocation from ORP of $14,629 for GLTTC proposal.
The Region supplemented this allocation with $72,739 for a total award to
GLTTC of $87,368 in August of 1991. This work is still underway, with results
ej$>ected by the fall of 1990.
FISCAL YEAR 1992
For Fiscal Year 1992, ORP has set aside $200,000 nationally to fund the
Indian Radon Pilot Projects. The GLTTC has submitted a proposal to Region 5
for a radon mitigation pilot project for the hones that have tested greater
than 20 pCi/1. Also, the United States Geological Survey submitted a proposal
to perform radon in water testing on Wisconsin Indian Reservations to define
the distribution of radon in domestic ground water supplies. Both of these
proposals, which requested a total of $142,884 in federal dollars were
submitted to ORP in April 1992. GBP allocated $20,000 to Region 5 for these
projects. We plan to use state SIRG money as well to fund these projects by
September 1992.
TRIBAL MULTI-MEDIA GRANTS
USEPA has specific Trust responsibilities regarding the protection of the
environment within Indian tribal lands. It has become clear in recent years
that the multi-media approach is an effective way to deal with the
multiplicity of tribal environmental issues.
Region 5 has a goal of establishing a base level of environmental
protection for all tribes. Our model to achieve this goal is a core
continuing multi-media environmental program award with each tribe or
consortium of tribes. The size of the core program, and the nature of the
work performed under it will very from tribe to tribe, depending on the size
of the tribe and the level of environmental program development already
achieved. The objective is to assure that the environmental problems of all
tribes within the Region are addressed. The emphasis of this program is to
provide tribes with the flexibility to address their environmental needs.
In Fiscal Year 1990, Region 5 awarded a pilot multi-media grant to the
Bad River Band of the Lake Superior Chippewa in Wisconsin. This pilot has
been quite successful. In Fiscal Years 1991 and 1992 an appropriations bill
specifically authorizes multi-media environmental grants to Federally
recognized Indian tribes. In late Fiscal Year 1991, Region 5 awarded nine
multi-media cooperative agreements with a total Federal share of $460,898, to
cover 13 tribes. The awards were jointly developed by USEPA and the tribes,
tailored to the individual tribe's needs. Of the thirteen tribes awarded
multi-media grants, eleven of them included radon activities.
The funding sources for the multi-media grants in Region 5 have been
nationwide multi-media allocations and Region 5 program set-aside dollars.
The Region 5 Radiation Program is considering participation in the multi-media
program set-asides in the future, using some of the SIRG money allocated to us
from ORP.
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APPENDIX
REGION V
MEMORANDUM OF UNDERSTANDING
AMONG THE
ENVIRONMENTAL PROTECTION AGENCY
THE INDIAN HEALTH SERVICE
THE BUREAU OF INDIAN AFFAIRS
THE U.S. GEOLOGICAL SURVEY
AND
THE DEPARTMENT OF HOUSING & URBAN DEVELOPMENT,
OFFICE OF INDIAN PROGRAMS
I. STATEMENT OF PURPOSE
The U.S. Environmental Protection Agency (EPA), the Indian Health Service
(IMS), the Bureau of Indian Affairs (RIA), the U.S. Geological Survey
(USGS), and the Department of Housing and Urban Development/Office of
Indian Programs (DHUD/OIP) all have responsibilities and interests con-
cerning the environment and human health on Indian lands. It is the
purpose of this Memorandum of Understanding (MOU) to identify areas of
mutual interest and responsibilities of the five agencies and to establish
a means for coordinating the agencies' respective activities.
II. INTERAGENCY ACTIONS
The following actions are agreed to:
1. EPA, IHS, RIA, USGS and DHUD/OIP will work cooperatively with each
other and in close consultation with Tribal Governments to coordinate
environmental programs affecting Indian lands. Where applicable,
and within the constraints of available resources, each agency will:
a. Participate in Regional and local level information exchanges
to keep abreast of the other agencies' program activities and
regulations. The information will be disseminated through reports,
training programs, news releases, guidance, informational mailings,
information services, and direct interaction among the five
Federal agencies and the affected-Tribes.
b. Cooperate in providing program services to Tribal Governments.
c. Provide training and technical assistance in the areas of each
agency's special expertise to Tribal representatives.
d. Support the preparation of standards, guidelines, and regulations
through the provision of technical assistance for the purpose of
establishing Tribal environmental programs. Areas to be addressed
should be selected based on Tribal and environmental priorities,
where appropriate.
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-2-
e. Consult directly with the other agencies in planning activities
in the areas of mutual responsibilities and authorities. Planning
activities include policy development, budget planning, and
proposals for statutes and regulations.
f. Coordinate to the best extent possible, the provision of funding
assistance to Tribal Governments, where the funding authorities
of the five agencies are combined or complementary.
g. Cooperate in conducting needs assessments in areas required by
EPA statute or by environmental interest (i.e., drinking water,
wastewater treatment, air pollution monitoring and control,
solid and hazardous waste storage, disposal and cleanup, pesticide
use, radon, underground storage tanks, asbestos, clean lakes).
2. The EPA, IMS, RIA, HSGS, and DHUO/OIP will continue to identify and
develop coordination activities for the five agencies. Supplemental
agreements or actions specific to program coordination in each of
the above actions will be prepared, as appropriate.
3. The EPA, IMS, BIA, USGS, and HHUD/OIP will encourage their staffs to
implement the terms of this MOU. Where applicable, Tribal and/or
State agencies may be included as signatories.
III. ADDITIONAL AGENCY ACTIONS
The EPA, IMS, BIA, HSGS, and nHUD/OIP further agree to the following
additional actions:
1. The EPA retains primary enforcement authority on Ijidian reservations
under various environmental statutes: the Clean Air Act (CAA),
Clean Water Act (CWA), Federal Insecticide, Fungicide and Rodenticide
Act (FIFRA), Resource Conservation and Recovery Act (RCRA), Safe
Drinking Water Act (SDWA), Comprehensive Environmental Response,
Compensation, and Liability Act (CERCLA), Superfund Amendments and.
Reauthorization Act, (SARA), and the Toxic Substances Control Act
(TSCA). EPA will excercise its enforcement authority on Indian
reservations with consideration for the special needs of Tribal
Governments and in a manner consistent with the enforcement provisions
of the EPA Indian Policy and Implementation Guidance. The Administrator
of EPA issued the EPA Policy for Administration of Environmental
Programs on Indian Reservations on November R, 1QR4. The policy was
supplemented with an Implementation Guidance signed by the Deputy
Administrator on the same date.
-------
-3-
?.. The IHS will maintain its position as technical advisor to Tribal
Governments. The RIA's programs associated with Indian trust resources
include environmental quality through the authority of the National
Environmental Pol icy Act of 196Q, which establishes procedures which
are binding on all Federal agencies. The primary requirement is
that an Environmental Impact Statement (F.IS) be prepared for every
major Federal action significantly affecting the quality of the
human environment. BIA must also apply the Council on Environmental
Quality's (CEO) regulations and the Department of Interior's implemen-
tation procedures. The IISGS, as a natural resource research and
investigation agency, will provide technical assistance in the fields
of surface water and groundwater. The USGS is responsible for
developing basic scientific information on water resources through
research on hydrologic, chemical, and biologic processes. These
responsibilities derive from the statutory authorities defining the
USGS and its mission, including the Organic Act of 1R79 and the
subsequent annual Appropriations Act authorizing USGS programs. The
OHUD/OIP will carry out its mandate to provide resources to implement
its housing programs as well as UDAG and CROG programs for Indian
Tribes. The DHUD/OIP will continue to provide technical and financial
assistance on a routine basis relative to its requirements.
3. Rased upon availability of funds and resources, and within the scope
of EPA, IHS, BIA, USGS and DHUD/OIP's authority, the agencies will
assist Indian Tribes financially and technically in complying with
the requirements of EPA statutes and in assuming program responsi-
bilities under those statutes. In meeting their scientific and
technical needs, the above-mentioned Federal agencies and affected
Tribes will consider the capabilities of each Federal agency and
utilize its assistance to the extent feasible and appropriate. Such
assistance would include review of activities to assure that
unnecessary duplication of efforts does not occur.
IV. DURATION OF AGREEMENT
This MOU shall continue in effect until 30 days after EPA, IHS, BIA,
USGS, or DHUn/OIP provides written notice of intent to terminate.
V. REPORTS
No routine reports are required. Information will be supplied as required
under the provisions of the Agreement.
-------
-4-
VI. LIAISON OFFICERS
Upon the execution of • tjhe. MOU,. the designated. EPA Regional Office liaison,
the IMS Area and/or Agency Office liaison, the RIA Area and/or Agency
Office liaison, the IISRS District Office liaison and the tlHUD/OIP liaison
will serve as a focal point for all activities within their respective
geographical jurisdictions related to this Agreement. Alternate liaison
officers will also be designated. It is important that these liaisons
be able to represent all of their respective programs. In addition, the
following liaison officers will act as contacts and will be responsible
for maintaining communications with the other agency on the procedures
and activities of their respective agencies. When necessary, the liaison
officers, accompanied by appropriate staff, will meet to review progress
in carrying out the terms of the MOD and to develop recommendations for
its improved implementation. At a minimum, the five agency representatives
will meet on a quarterly basis. Each agency will notify EPA of any
personnel changes, who will in turn keep all parties informed.
-------
-5-
LIAISON OFFICERS
ALTERNATES
EPA: Kestutis K. Ambutas
Regional Indian Affairs Coordinator
U.S. EPA Region V
Planning and Management Division
Environmental Review Branch (5ME-14)
230 South Dearborn Street
Chicago, Illinois 60604
(312/353-1394)
William B. Franz, Chief
U.S. EPA Region V
Planning and Management nivision
Environmental Review Branch (5ME-14
230 South Dearborn Street
Chicago, Illinois 60604
(312/886-7500)
IHS: Mark Werre
Acting Associate Area Director for
Environmental Health Programs
Bemidji Area Office - IHS
Room 305 - Federal Building
Bemidji, MN 56601
(507/784-1063)
Douglas R. Jackson
Acting Chief
Environmental Health Services Branc
Bemidji Area Office - IHS
Room 305 - Federal Building
Bemidji, MN 56601
(507/784-1256)
BIA: James L. Sansaver
Assistant Area Director - TRIS
U.S. Bureau of Indian Affairs
15 South 5th Street - 10th floor
Minneapolis, MN 55402
(612/349-3581; FTS 787-3581)
Elmer N. Holm
Natural Resources Specialist
U.S. Bureau of Indian Affairs
Minneapolis Area Office
15 S. 5th Street
Minneapolis, MN 55402
(612/349-3588; FTS 787-3588)
USGS: Jim Krohelski
Acting Assistant District Chief
Hydrogeologic Studies Section
Wisconsin District
U.S. Geological Survey, WRD
6417 Normandy Lane
Madison, HI 53719-1133
(608/276-3850)
Jeffrey D. Stoner, Chief
Hydrologic Investigations Section
Minnesota District
U.S. Geological Survey, WRD
702 Post Office Building
St. Paul, MN 55101
(612/725-7841)
DHUD/OIP: Gertrude W. Jordan
Regional Administrator
U.S. OHUD
Chicago Regional Office, Region V
300 South Wacker Drive
Chicago, IL 60505-6765
(312/353-5680)
Leon Jacobs
Di rector
Office of Indian Programs
U.S. DHUD
Chicago Regional Office, Region V
300 South Wacker Drive
Chicago, IL 60606-6765
(312/353-1282)
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-6-
VII APPROVALS
FOR THE/U.S. ENVIRONMENTAL PROTECTION AGENCY:
Regional Administrator
U.S EPA - Region//
Date
I/to
Di rrfct
Benndji Program
Indian Health Servite
R THE INDIAWNHE1LTH SERVICE:
Date*
FOR THE BUREAU OF INDIAN AFFAIRS:
Di rector ^/
Minneapolis Area Office
BIA
OCT1S87
Date
FOR THE U.S. GEOLOGICAL SURVEY:
Chief Hydrologist
Water Resources Division
USGS
Date
FOR DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
.OFFICE OF INDIAN PROGRAMS
Regional Adntmstra^err
DHUD-Region V
Date
-
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11-4
THE DEVELOPMENT OF THE HQMEBUYER'S GUIDE TO RADON
By: Paul Locke
Environmental Law Institute
1616 P Street N. W.
Suite 200
Washington, D. C. 20036
Sarita Hoyt
U. S. EPA
Office of Radiation Programs
401 M Street S. W.
Washington, D. C. 20460
ABSTRACT
During the review of the revised "Citizen's Guide," reviewers
recommended that EPA provide specific guidance to homebuyers and
sellers for addressing radon at the time of real estate
transactions. EPA developed and then solicited comment on the
draft "Homebuyer's and Seller's Guide to Radon," which proposed
different testing protocol options, options for newly-constructed
homes and addressed other radon and real estate issues. The draft
was sent to 50 States, radiation scientists, Federal agencies,
real estate industry, radon industry, public health associates,
risk communication experts, consumer groups, the Committee on
Indoor Air Quality, EPA's independent Science Advisory Board, and
EPA Regional Training Centers.
This paper will examine the evolution of the "Homebuyer's
Guide" from its inception, through an extensive internal and
external review process, to the consideration of fundamental
policy issues such as a suitable testing protocol option. In
addition, this paper will outline the rationale for EPA policy
decisions made in the new "Homebuyer's and Seller's Guide to
Radon." This document should be available to the public in the
summer of 1992.
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11-5
MITIGATION STANDARDS FOR EPA'S
RADON CONTRACTOR PROFICIENCY PROGRAM
By: John Mackinney, David Price, and Lee Salmon
U. S. EPA
Office of Radiation Programs (ANR-464)
401 M Street SW
Washington, D. C. 20460
ABSTRACT
This paper discusses the U. S. Environmental Protection
Agency's proposed Radon Mitigation Standards. The standards
address design, installation, maintenance, and the evaluation of
radon mitigation systems. Their primary emphasis is on occupant
protection, worker protection, and system effectiveness,
durability and safety. The standards will replace the interim
standards released in late 1991 as part of the criteria for
listing under EPA's Radon Contractor Proficiency Program.
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11-6
CONSUMER PROTECTION AND RADON QUALITY ASSURANCE:
A PICTURE OF THE FUTURE
By: John Hoornbeek
U. S. EPA
Office of Radiation Programs (ANR-464)
401 M Street SW
Washington, D. C. 20460
ABSTRACT
This paper will describe a picture of the future of radon
consumer protection and quality assurance, as envisaged by staff
of EPA's Mitigation, Prevention and Quality Assurance Branch. The
paper is intended to initiate further dialogue among federal
authorities, state staff, radon industry representatives, and
others about the future of consumer protection and quality
assurance in radon measurement and mitigation.
The paper will provide a vision of future federal, state, and
private sector roles in radon quality assurance. It will describe
current structures for radon quality assurance in the United
States. It will also offer suggestions on how the private sector,
federal officials, and state officials can work together to
develop standard measurement and mitigation practices, mechanisms
to assure accountability to those standards, and materials to
assist consumers in obtaining high quality radon testing and
mitigation services.
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11-7
Title: EPA's Proposed Regulations on Radon in Drinking Water
Author: Jan Auerbach, U. S. EPA, Office of Drinking Water
This paper was not received in time to be included in the preprints, and
the abstract was not available. Please check your registration packet for a
complete copy of the paper.
-tfV.S. GOVERNMENT PRINTING OFFICE: MM - *tt-OOJ/«OOI»
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