By Ruby Perin, Healthy Homes Branch Supervisor, Linn County Public Health, and James Hodina, Manager, Environmental Public Health, Linn County Public Health
Editor’s Note: In honor of National Radon Action Month in January, we are featuring Linn County, Iowa’s radon test kit distribution program, which was recognized as a Promising Practice through NACCHO’s Model Practices program in 2017.
Radon is a radioactive gas that is colorless, odorless, and tasteless. It occurs naturally outdoors and can become concentrated in homes. According to the Environmental Protection Agency (EPA), radon is the leading cause of lung cancer in nonsmokers and the second leading cause of lung cancer in smokers. It accounts for approximately 21,000 deaths each year. The entire state of Iowa is classified as an EPA Zone 1, meaning average indoor radon levels in every county are over the recommended action level of 4.0 pCi/L.
Linn County Public Health (LCPH) serves approximately 220,000 residents who live in over 90,000 housing units, 73% of which are owner occupied. In the last 21 years, only 10% of the housing units have been tested for radon. Historical analysis from radon test kits sold by LCPH indicates that about one in three homes has a result at or above the action level for radon. During the winter months, this rises to one in two tests showing results above the action level.
Currently, radon test kits are not widely available in medical settings. LCPH partnered with a health system in Cedar Rapids, Iowa, to test the hypothesis that parents or guardians who own their own homes and are given a radon test kit by their physician or nurse will be more likely to test their homes. LCPH and the participating health system have collaborated on many projects together, ranging from diabetes prevention to community health needs assessments, so this project was initiated due to the positive existing relationship.
At the start of the study, LCPH and the health system conducted two educational presentations at the medical provider’s office about the health effects of radon, how to test for and mitigate radon, the role of the medical provider in relation to radon mitigation, and how costs may be covered through a Health Care Flexible Spending Account (HCFSA). During the educational presentations, the pilot project was explained, examples of data collection tools were provided, and questions were answered.
Overall, 252 parents or guardians were provided radon education and interviewed by clinic staff to determine study eligibility. Eligible participants were homeowners who had not tested for radon within the previous two years. Participants were then randomly assigned to either Cohort A (control) or Cohort B (test). Of the 252 individuals, 118 met the eligibility criteria, and 13 of those declined to participate, bringing the total number of participants to 105, with 39 in Cohort A and 66 in Cohort B.
The participants in Cohort A were given a prescription for a radon test kit with an educational flyer. The prescription could be redeemed at no cost by LCPH. Participants in Cohort B were provided the radon test kit and educational flyer at the time of the exam.
LCPH monitored the rate at which radon prescriptions were filled at LCPH and the rate at which radon test kits were used by patients. As shown in the table below, of the 39 participants assigned to Cohort A, nine (23.1%) redeemed the radon test kit prescription at LCPH, though only six returned the test kit to be analyzed, resulting in a success rate of 15.4%. Of the 66 participants in Cohort B, who were provided a test kit onsite when attending their child’s well child exam, 22 returned the test kit to LCPH for analysis, resulting in a success rate of 33.3%.
Return Rate of Radon Test Kits
|Cohort||Number||Received Test Kit||Submitted for Analysis|
This active methodology was more than twice as effective as simply providing participants with a prescription to pick up the test kit from LCPH on their own.The results indicate that radon kit distribution through medical providers is an effective practice to increase the number of homes tested for radon.
Potential barriers and limitations of this study include the following:
- Providers’ motivation to engage participants and the frequency at which patients were engaged may vary.
- Characteristics of the parents interviewed could affect results, including age, sex, number of children, single vs two-parent household, smoking characteristics of household members, etc.
- Patients were randomized to the prescription or test kit group based on whether they were visiting on an even or odd numbered day of the month.
- Initially, an expiration date was placed on the prescription to encourage participants to visit LCPH in a timely manner to pick up their radon test kit. This expiration date could have potentially discouraged some people from picking up their kit if they did not do it by the expiration date.
- A family potentially could be asked multiple times to test their home for radon if they had more than one child that was visiting the clinic during the study period.
While this study cannot be generalized to all homeowners because the study was only performed among parents/guardians visiting their medical provider for a well-child visit, the results do indicate that the practice of medical providers distributing radon test kits is effective in getting homeowners to test their homes for radon. It removes barriers such as making an additional trip to pick up a test kit, and it builds upon positive relationships that already exist between providers and patients.