Overview of EPA’s State Indoor Radon Grants Program: A Focus on Activities Conducted during 2019

Overview of EPA's State Indoor Radon Grants Program:

A Focus on Activities Conducted during 2019

Radon is the second-leading cause of lung cancer after smoking. Effective, affordable measures to reduce
indoor radon are available and, when employed, can prevent radon-induced lung cancer and save lives. For
more than 30 years, the U.S. Environmental Protection Agency (EPA or the Agency) has provided critical
funding to support state, territory, and tribal efforts to reduce radon-related lung cancer through the State
Indoor Radon Grants (SIRG) program. This collaborative partnership between the states, territories, tribes
and EPA is critical in reducing radon risk and saving lives.

Despite notable progress, radon continues to
be a serious public health concern in the
United States. Millions of homes with elevated
radon levels remain, and approximately
21,000 Americans die annually from radon-
induced lung cancer, including people who
have quit smoking or never smoked. In fact,
lung cancer ranks among the top 10 causes of
cancer death in the United States among
adults who have never smoked.1 This
reinforces the need for outreach, awareness
and continued risk reduction measures in the
United States focused on radon.

State and tribal radon programs remain vital
to national efforts aimed at reducing radon
risk and complement the work of the National Radon Action Plan (NRAP) partners. (See the overview of the
NRAP above.) About 7 million homes are estimated to have levels of radon above the EPA action level.
Housing construction during the last 25 years has contributed a significant number of homes with elevated
radon levels.

National Radon Action Plan

This Plan represents a collaborative effort among
11 organizations dedicated to eliminating avoidable radon-
induced lung cancer in the United States, with the near-term
goal of reducing radon risk in 5 million homes and saving
3,200 lives annually by 2020. Led by the American Lung
Association, the Plan is aimed at sustainably incorporating
radon testing, radon mitigation and radon-resistant
construction into systems that govern purchasing, financing,
constructing, and renovating homes and other buildings. The
Plan builds on earlier federal action. View the plan at
www.radonleaders.orE/resources/nationalradonactionplan.

Reporting Cycle and Recent Appropriations

This report primarily covers activities conducted during the 2019 reporting cycle (October 1, 2018 -
September 30, 2019.) The report is not tied to a particular appropriation; grantees plan and conduct activities
during a specified reporting cycle using available funding.

Congress appropriated approximately $8,051 million to EPA for the SIRG program in FY18 ($7,867 million
after recession) and FY19 ($7,789 million after rescission). In recent years, the SIRG appropriation has been
accompanied by Congressional House Report language 2,3,4 which continues to reference recommendations
for application of SIRG funds in four broad areas (as outlined in House Report 114-632):

1 Samet, J. M., E. A vila-Tang, P. Boffetta, L. M. Hannan, S. Olivo-Marston, M. J. Thun, and C. M. Rudin. 2009. "Lung Cancer in Never Smokers: Clinical Epidemiology
and Environmental Risk Factors." Clinical Cancer Research 15 (18): 5626-5645.

2 House Report, 114-632. https://www.congress.gov/114/crpt/hrpt632/CRPT-114hrpt632.pdf.

3 House Report, 115-238. https://www.congress.gov/115/crpt/hrpt238/CRPT-115hrpt238.pdf.

4 House Report 115-765. https://www.congress.gov/115/crpt/hrpt765/CRPT-115hrpt765.pdf.

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

1. Awareness, education and outreach to the medical community and inclusion of radon within
state cancer control plans.

2. Promote radon awareness through real estate transactions.

3. Inform local school systems about radon exposure risks, provide testing and mitigation of schools,
and promote awareness through child care providers.

4. Education and technical support related to industry best practices and standards and the adoption of
radon-related guidelines in building codes.

EPA's Implementation of the SIRG Program

The primary aim of EPA's radon program is to protect public health, including the health of families, by
reducing the risk from radon exposure. EPA recommends that all homes be tested for radon; testing is the
only way to know whether a home or building has high radon levels. The most impactful risk reduction
strategies are those that directly result in expanded radon testing of existing homes, mitigation of high radon
levels within those homes, and radon-resistant new construction. Some state radon programs have
developed databases and systems for tracking residential radon testing, mitigation, and radon-resistant new
construction home building data.

The House Report recommendations were
considered in the context of the Indoor Radon
Abatement Act's statutory priorities. For all
grantees, additional consideration was given to
work underway in current work plans, capabilities,
state regulatory authority and capacity. Metrics
outlined in the House Report align with EPA's
implementation of the SIRG program and the
goals of the NRAP, to eliminate avoidable radon-
induced lung cancer in the United States.

Key Reporting Metrics

In addition to standard programmatic reporting
metrics, states and tribes reported this year on
work planned or already in progress in six activity areas aligned with EPA's radon-related strategic goals and
in response to Congressional direction. Key reporting metrics include:

1. Promote awareness about radon exposure to the medical community.

2. Include radon in state cancer control plans (CCPs).

3. Promote radon awareness through real estate transactions.

4. Test for and remediating radon in schools in high-risk radon areas.

5. Provide continuing education (CE) and technical support.

6. Include radon-reduction strategies in state and local building codes (industry codes).

International Residential Code (IRC) Update

Every three years, the content of the IRC is updated
through the consensus code development process.
Current requirements for radon-resistant new
construction appear in Appendix F: Radon Control
Methods. Even though Appendix F is regarded as
optional, many states, counties and municipalities across
the country adopt the IRC, including Appendix F. In 2019,
a radon testing requirement to verify radon systems are
working properly was approved to be adopted into the
IRC. Updating and advancing radon controls outlined in
building codes, represents one of the most significant
opportunities to strengthen public health protections for
families across the United States.

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

Overall Findings

State and tribal radon programs are making significant progress in implementing Congressional direction to
the Agency with regard to use of SIRG funds. The SIRG program received 49 responses describing state and
tribal efforts, representing a response rate of nearly 93 percent. EPA examined the planned and in-progress
activities and coded them into three categories. If a state or tribe had achieved actions with high potential for
risk reduction, the response was coded as "primary." Actions that seek to keep the public aware and
informed about the risks of radon, but may not directly lead to risk reduction were coded as "secondary." If
no plans had been made within a certain area, the response was coded as "not applicable." Building on work
initiated or accomplished in previous years, EPA found that nearly every grantee was addressing at least one
component of Congressional direction, and in many cases several components, through activities that
represent "primary actions" and opportunities for risk reduction. The summary of the states' and tribes'
responses tells a powerful story of risk reduction using SIRG funds in alignment with Congressional
direction.

Bad River Band of
Lake Superior Tribe
of Chippewa Indians

Passamaquoddy Indian Township

Jicariila Apachi
Natioi

Navajo Nation
Pueblo of Pojoaque

SIRG Funded

FY18and FY19

Not Funded

^ FY18 or FY19

American Samoa

Northern Marina Islands

Map showing states, territories and tribes that received FY18 & FY19 SIRG funding.

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

Key Take-Aways

• 46 of the 47 states (including the District of Columbia) and three of the six tribes expected to report for
the 2019 reporting cycle submitted information on planned and conducted activities.

• The majority of grantees (65%, 32 out of 49) performed or continue to implement primary actions aimed
at reducing radon exposure through code adoption and/or policy.

• Demonstrating a strong increase over the previous year, nearly 84% of grantees (41 out of 49) engaged in
primary actions related to real estate transactions, including training real estate professionals, reporting
total number of homes tested and/or mitigated and various other real estate related activities.

• Nearly all grantees (89%, 44 out of 49) are undertaking activities to address radon in schools. For some
grantees this included developing proposed rules or implementing final regulations focused on radon
testing and mitigation in schools and daycares. Many grantees reported increased testing in schools and
outreach or training events for education professionals during this reporting cycle.

• Grantees continue to leverage opportunities to update cancer control plans, resulting in 85% (40 out of
47) of state cancer control plans addressing radon. Similar to the previous reporting cycle, nearly 62% (29
out of 47) of state cancer control plans include specific objectives and/or strategies aimed at reducing
radon risk.

The below graph highlights the number of states and tribes undertaking actions to reduce radon exposure
risk in each of the activity areas.

State and Tribal Actions Within Activity Areas (n = 49)

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

Spotlight: Successful Approaches for Reducing Radon Risk

This section showcases examples of activities funded at least in part by EPA's SIRG program that states and

tribes are undertaking in alignment with Congressional direction.

Education and outreach to the medical community:

• The Illinois Emergency Management Agency (IEMA) has focused on expanding work with the medical
community. Recent initiatives include partnering with Southern Illinois University School of Medicine
(SIU-SOM) to create several online Continuing Medical Education (CME) courses for medical
professionals. The course currently has five modules, and SIU-SOM is developing additional modules
presented by medical professionals. SIU-SOM also updated initial patient questionnaires used by the
school's family practice clinics to include radon screening and education.

• The Minnesota Department of Health (MDH) partnered with the American Cancer Society and St. Luke's
Regional Cancer Center and Hospital to implement a project to increase radon testing rates in Northeast
Minnesota where testing is currently low. The project included coordinating three clinic events at St.
Luke's where free radon test kits and a publication based on the Health Belief Model were distributed in
the lobby of the hospital. MDH also used marketing through various social media channels and created a
public service announcement which aired on local television channels in Northeast Minnesota to
promote radon testing.

• The Missouri Radon program launched a campaign to distribute materials to oncologists and general
practitioners across the state to help increase their knowledge of radon dangers in the home. By printing
and sharing materials for physician's offices and waiting rooms, the state radon program hopes more
citizens will become educated about radon risks and physicians will encourage patients to test their
homes for radon.

• The Idaho Indoor Radon Project (IIRP) organized and facilitated the first meeting of a statewide Radon
Collaboration Workgroup during this reporting cycle. The workgroup includes representatives from the
American Cancer Society, the American Lung Association, the Idaho Division of Building Safety, Project
Filter, the Idaho Comprehensive Cancer Control Program, real estate and home inspection professionals,
and radon measurement and mitigation professionals. The IIRP discussed the health risks of radon
exposure, prevalence in Idaho, and resources currently offered by the Program. Together this workgroup
aims to increase radon testing and awareness across the state.

Inclusion of radon in state cancer control plans:

• The Utah Cancer Control Program workgroup meets quarterly, and smaller teams work together to
accomplish the activities and goals set in the state Cancer Control Plan. Utah identified radon as one of
its top collaboration priorities in the state's Cancer Control Plan. There are several strategies specifically
related to radon including, establishing a statewide surveillance program, educating residents about
radon and increasing testing and subsequent mitigation of high radon levels.

• The Alabama Cancer Control Plan for 2016 - 2021 lists smoking, secondhand smoke, radon and asbestos
as major risk factors for lung cancer. The plan specifically includes objectives and strategies aimed at
increasing knowledge of radon cancer risk through public awareness campaigns and promoting radon
testing in high-risk counties.

• The Minnesota Cancer Alliance Radon Workgroup completed a project to demonstrate the feasibility of
identifying and mitigating homes of low-income residents, including cancer survivors. The pilot project

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

used promotional materials to advertise free mitigation services to eligible applicants. A total of twenty-
two applications were submitted, and eight mitigation systems were installed for low-income residents.

Testing and remediation of schools in high-risk radon areas:

• Public schools in Connecticut are required to test for radon (according to Connecticut General Section
10-220) and testing must be conducted by qualified professionals. The Connecticut Department of Public
Health Radon Program requires schools and measurement professionals to submit summary radon
testing data, which is recorded in the state's surveillance system. The data was used to create a map of
prevalence rates of elevated radon levels (at or above 4.0 pCi/L) in public school buildings by county.

• During the 2019 reporting cycle, North Dakota tested 30 schools for radon. According to state records,
this is the biggest spike in annual schools testing since the 1990s. The North Dakota Department of
Environmental Quality (NDDEQ) has already identified 45 additional schools to be tested in 2020, and
NDDEQ is currently developing a training class for school maintenance personnel focused on radon risk
reduction and mitigation techniques.

• In collaboration with the Delaware Office of Child Care Licensing (OCCL) radon testing requirements were
included in the regulations governing child care licensure. According to the regulation: "A licensee shall
ensure radon testing is performed once every five years between the months of October and March and
within six months after any remodeling, renovations, or construction. If testing indicates a radon level
over 4.0 pCi/l, a licensee shall ensure acceptable radon mitigation occurs or a long-term radon test
indicates a level less than 4.0 pCi/l." The Delaware Division of Public Health Radon Program developed
sampling guidance for child care facilities and testing professionals and serves as a technical resource for
daycare testing.

• Indiana enacted Senate Bill 632, which took effect in July 2019, and requires the Indiana State
Department of Health (ISDH) to provide education to schools on how to test for radon. In addition, the
bill requires the state to update its Indoor Air Quality in Schools Best Practices Manual with a section
dedicated to radon testing in schools. The Indiana State Department of Health held three workshops in
October 2019 to discuss policies and requirements for radon testing in schools, and has additional
workshops planned for 2020.

• The Illinois School Code recommends that all schools in the state be tested for radon at least once every
five years. Schools are also required to report the status of their testing to the State Board of Education
and the Board reports the status of testing once every two years to the legislature. In addition, the Illinois
Child Care Act mandates that all Department of Children and Family Services licensed daycare and pre-
school facilities perform radon measurements in their facilities at least once every three years. During
this reporting cycle, 96 schools and 10,507 daycares were tested for radon.

• One Navajo Nation Head Start Center was tested during this reporting cycle and testing indicated that
radon levels were safe. In October 2019, the Radon Program trained Head Start personnel in preparation
for Head Start Centers to test for radon across Navajo Nation in 2020.

• The New Jersey Department of Environmental Protection Radon Program (NJDEP) collaborated with the
state's Department of Community Affairs and representatives from EPA to discuss proposed
amendments to the Radon Hazard Subcode. The existing subcode incorporates minimum radon hazard
protections into construction requirements for buildings intended for use as residential or educational
buildings, but do not include adequate guidance for schools. The proposed amendments provide
updated specifications for schools. In April 2019, the draft proposal was submitted to the Division of
Codes and Standards and is currently awaiting review by the Code Advisory Board.

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

• The Vermont Legislature introduced a school radon testing bill (H.138) during the 2019 - 2020 session.
This bill proposes requirements for the Vermont Department of Health to perform radon measurements
in schools, specifically, testing at least 40 schools each year until all schools have been tested. It also
proposes to establish a School Radon Mitigation Study Committee designed to explore funding
opportunities for radon mitigation in schools and develop a contingency plan for loss of federal funding.

Addressing radon in homes and real estate transactions:

• Under Oregon statute (ORS 455.365), radon-resistant new construction (RRNC) is required in all public
buildings (including schools) and residences built after April 1, 2013, in seven Oregon counties.
Throughout 2019, the Oregon Radon Awareness Program focused on building partnerships and hosting
training events with the Oregon Home Builders Association (OHBA). Building a partnership with OHBA
allows the program to reach builders across the state with information about RRNC techniques that can
reduce the lung cancer risk in homes.

• During this reporting cycle, the Leech Lake Band of Ojibwe tested 70 homes for radon and mitigated 11
Leech Lake Housing Authority units. The Tribe is working with builders to incorporate RRNC features into
the newTribal Homeless Shelter being built. Looking forward, the Leech Lake Tribal Nation plans to have
30 new tribal homes build with RRNC features.

• The Nevada Radon Education Program (NREP) educated more than 110 Realtors and developed two real
estate continuing education classes entitled, "Radon: What Real Estate Professionals Need to Know" and
"Radon and the Real Estate Professional" through the State of Nevada Real Estate Division. Nevada
noted a nearly 25% increase in reported real estate testing over the previous year since offering these
continuing education classes.

• The Ohio Radon Program continues to offer a free 2-hour continuing education course to real estate
professionals. In collaboration with the state Department of Commerce the training course is updated on
an annual basis.

Continuing education and technical support:

• In 2018, The Iowa Department of Public Health Radon Program launched a new online licensing and data
reporting portal and continues to build the database and its capabilities. Individuals and labs can apply
for certification and renew certification(s) online. The portal allows measurement specialists to upload
radon test results and mitigation specialists can report mitigation system installation information.
Establishing a statewide tracking and data management system allows Iowa to develop critical radon
datasets related to certified professionals, annual radon tests performed, and number of homes
mitigated.

• The New Mexico Radon Program has partnered with the Pueblo tribes to assist them in establishing
and/or maintaining tribal radon programs. The state has worked to support workshops, consultations
and presentations for Pueblo tribal decision makers and providing radon testing assistance for tribal
programs.

Adoption of radon-reduction strategies in building codes or state/tribal policy:

• In Kansas, eight cities and two counties have adopted Appendix F of the International Residential Code
and require new homes to be built using radon-resistant techniques. The Kansas Radon continues to
promote the adoption of Appendix F and RRNC in local building codes through outreach and education
opportunities offered to local jurisdictions. In September 2019, the Kansas Radon Program invited local

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

building code officials, located in a city that has not pursued adoption of RRNC, to inspections of radon
mitigation systems in order to educate code officials about radon resistant new construction and radon
mitigation and gain support for adoption of RRNC building codes in that city.

• In Colorado, the state radon program is involved in ongoing education and outreach to city and county
code officials to adopt RRNC requirements. Currently, 33 cities and 18 counties have adopted RRNC
requirements.

• The Pennsylvania Radon Program is advocating for modifying the Department of Labor and Industry on
the state's Uniform Construction Code. During the upcoming revision cycle, the Radon Program intends
to submit comments requesting that the radon requirements included in Appendix F are moved to the
body of the code.

• In Nebraska, the state's Radon Resistant New Construction Task Force recommended minimum
standards for radon resistant new construction to the Governor, the Health and Human Services
Committee of the Legislature, and the Urban Affairs Committee of the Legislature. During the 2019
Nebraska legislative session, a bill requiring a statewide Radon Resistant New Construction building code
was signed into law.

• In Florida, RRNC standards are included as appendixes of the state building code. Currently, four counties
and four cities have adopted codes for radon-resistant buildings.

• The District of Columbia's Department of Consumer & Regulatory Affairs (DCRA) published a second
notice of proposed rulemaking in July 2019, to adopt Appendix F radon-resistant system requirements
into the District's Construction Code Supplement.

• Guam introduced two bills related to radon in 2019. Bill 168 aims to protect children by requiring radon
testing and mitigation in school and child care facilities and Bill 169 requires that information about
radon, including testing results, be provided upon the sale of residential real property.

Additional State and Tribal Success Stories

This section showcases other exceptional radon risk reduction activities that may not have been explicitly

described in Congressional direction and/or in some cases draw on a different funding source.

• The Utah Department of Environmental Quality is working with the Confederated Goshute Reservation
to test all 350 homes on their reservation. Two homes on the reservation with elevated radon levels
were mitigated. The reservation has also requested HUD funding to train tribal members to mitigate and
pay for supplies to install mitigation systems.

• The North Carolina Radon Program collaborated with Wake County Environmental Services and Rutgers
University to provide training on testing and mitigating private wells for radon and other radionuclides.

• Following an earthquake in December 2018, the Alaska Radon Program, operated by the University of
Alaska Fairbanks (UAF) Cooperative Extension Services, adopted an increased focus on providing practical
public information on radon in response to natural disasters. After collaborating with the UAF to
complete post-earthquake radon testing, the Alaska Division of Homeland Security and Emergency
Management is working to codify recommendations for automatic radon re-testing as a part of an
emergency disaster protocol in Alaska.

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Overview ofEPA's State Indoor Radon Grants: 2019 Activities

• The Virginia Department of Health - Office of Radiological Health (VDH-ORH) partnered with two
vendors to set up and maintain a website that allows Virginia residents to order up to two radon test kits
for free, plus a small shipping fee. Test kits are shipped directly to homeowners. During this reporting
cycle, over 5,600 test kits were shipped with a usage rate of over 40% within the first two months of
receipt. The ordering process also includes a short survey which allows VDH-ORH to collect valuable
information regarding general radon awareness and the effectiveness of different advertising campaigns.

• Colorado continues to expand access to radon mitigation services to low-income households through its
state-funded Low-Income Radon Mitigation Assistance (LIRMA) program. During this reporting cycle, the
state mitigated 80 homes under the LIRMA program.

• The Michigan Radon Program, operated by the state's Department of Environment, Great Lakes, and
Energy (EGLE), has established a radon testing pilot project in two cities, Niles and Benton Harbor. In
collaboration with the Michigan Department of Health and Human Services, EGLE is testing homes in the
Healthy Homes program. Any home with an elevated radon level will receive a mitigation system,
supported by HUD funding.

• The Vermont Radon Program put together a compelling local story to increase public awareness about
radon in the form of a video entitled: Kathv's Radon Story. Kathy's Radon Story was the main focus of the
Vermont Radon Program's National Radon Action Month campaign in 2019 and it was shared with more
than half of Vermont households on multiple social media outlets and in a press release that was picked
up by local news organizations.

Moving Forward

The responses indicate that states and tribes are making
significant progress on radon risk reduction. Grantees will
report again in October 2020.

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