1. Radon and Healthy Housing: What’s Happening Now, What’s in Store for the Future Bill Long US EPA

2. Acknowledgements Antonio Neri MD, MPH Medical Epidemiologist CDC Comprehensive Cancer Control Branch R. William Field, PhD, MS Professor, Department of Occupational and Environmental Health Department of Epidemiology, College of Public Health, University of Iowa Phil Jalbert US EPA radon program

3. Radon Decay Products Lead-210 Polonium-214 Bismuth-214 Lead-214 Polonium-218 Radon-222      Lead-206 Polonium-210 Bismuth-210    22 yrs 4 day 3 min 27 min 20 min 0.2 ms 5 day 138 day Stable Po-218 and Po-214 deliver the majority of radiation dose to the lung.

4. Ionizing radiation can directly and indirectly damage DNA Alpha Particle Defects in tumor suppressor genes – p53 At risk individuals–GSTM 1 (glutathione S-transferase M1) Double –strand DNA breaks Free radical formation

5. Reading Prong

6. From NCRP Report No. 160, “Ionizing Radiation Exposure of the Population of the United States” (2009)

7. U.S. Radon Potential n Based on geology and surveys n Expected closed building radon (pCi/L): Zone 1: 4.0 and above Zone 1: 4.0 and above Zone 2: between 2.0 & 4.0 Zone 2: between 2.0 & 4.0 Zone 3: 2.0 and lower Zone 3: 2.0 and lower EPA Radon Action Level 4 pCi/L

9. National Academy of Sciences BEIR VI 1999 Risk estimates based primarily on radon- exposed miners Estimated 18,600 lung cancer deaths each year in the U.S. from residential radon exposure

10. BEIR VI Conclusions  Serious public health problem  Second-leading cause of lung cancer  No evidence of a threshold  Effects of Radon & Smoking more powerful in combination  Radon contributed to 15K or 21K US lung cancer deaths in 1995 [2,100 or 2,900 in never smokers].  Reduction of residential radon levels above 4 pCi/L could prevent approx. 1/3 of the annual deaths

11. Residential Radon Case-Control Around the World European Studies 13 Studies from 9 Countries Austria Czech Republic Finland [nationwide] Finland [south] France Germany [eastern] Germany [western] Italy Spain Sweden [nationwide] Sweden [never smokers] Sweden [Stockholm] United Kingdom Total 7,148 cases and 14,208 controls North American Studies 7 Studies from 2 countries: New Jersey Winnipeg Missouri I [non-smoking women] Missouri II [women] IowaIowa Connecticut Utah-South Idaho Total 3,622 cases and 4,966 controls

12. In 2003, the EPA updated the BEIR VI risk estimates to 21,000 radon-related lung cancer deaths each year in the United States. http://www.epa.gov/radon/risk_assessment.html

13. EPA Radon Assessment Results  Modified & extended the NAS BEIR VI report [consultation with SAB and NAS panel members]  Best estimate of US population risk in homes is about 21,000 lung cancer deaths per year. [At US average indoor radon conc.]  Current Risks at Action Level  Smokers 6/100  Never Smokers 7/1000

14. Cancer Statistics 2014 CA: A Cancer Journal for Clinicians Volume 64, Issue 1, pages 9-29, 7 JAN 2014 DOI: 10.3322/caac.21208 http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full#caac21208-fig-0001 Volume 64, Issue 1, http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full#caac21208-fig-0001

15. CANCER MORTALITY – 2014 CANCER TYPEESTIMATED U.S. DEATHS in 2014 1. Lung and Bronchus 159,260 2. Colon and Rectum 50,310 3. Breast Cancer 40,430 4. Pancreas39,590 5. Prostate29,480 6. Leukemia 24,090 7. Liver and Bile Duct 23,000 8. Lymphoma20,170 9. Urinary Bladder15,580 10. Esophagus15,450 11. Ovary14,270 12. Kidney and Renal Pelvis13,860 13. Myeloma 11,090 14. Stomach10,990 15. Melanoma - skin9,710

16. CANCER MORTALITY – 2014 CANCER TYPEESTIMATED U.S. DEATHS in 2014 1. Lung and Bronchus159,260 2. Colon and Rectum50,310 3. Breast Cancer40,430 4. Pancreas39,590 5. Prostate29,480 6. Leukemia24,090 7. Liver and Bile Duct23,000 Radon- Induced Lung Cancer21,000 8. Lymphoma20,170 9. Urinary Bladder15,580 10. Esophagus15,450 11. Ovary14,270 12. Kidney and Renal Pelvis13,860 13. Myeloma11,090 14. Stomach10,990 15. Melanoma - skin9,710

17. Toxic Substances Control Act (TSCA) Title III (1988) Indoor Radon Abatement Act (IRAA) Section 306. Grant Assistance to States for Radon Programs Governor Designates the Recipient Recipient can be a Department, Agency or State Institution, e.g., University EPA Responsibilities Delegated to Regional Administrators & Assistant Administrator for OAR 17

18. 18 21,000 Radon-related U.S. Lung Cancer Deaths Annually Leading Environmental Cause of Cancer Mortality Long-term Exposure to 1.25 pCi/L Average Indoor Radon Level in U.S. Homes 7,083,000 Homes ≥4pCi/L 2 ways to reduce risk: mitigate high homes; build homes radon-resistant EPA Radon Program

19. Radon Interventions ≤ $20 / test, $300 – $2,000 remediate < $250 – $750 to build radon resistant homes EPA $8 million to state radon programs/yr education, testing, remediation, policy-related radon activities Intervention = ↓ exposure Vent air from under house Seal basement cracks Laws 28 states + DC have laws specific to radon Req. testing, Req. Disclosure, Voluntary Testing Radon-Resistant New Construction o Int’l Building Code adoption Website: http://sktelokkalong.co.cc/buy-radon-test-kithttp://sktelokkalong.co.cc/buy-radon-test-kit

20. States with Radon-specific Cancer Activities 2005 – 2011 Tribes and Territories with Radon-specific Cancer Plan Activities include: Alaska Native Tribal Healthcare Corporation, Fon du Lac Tribe, Northern Plains Native American Tribal CCC Program, Tohono O'odham Tribe, and Guam. Note that Alaska, Hawaii, and DC do not have radon-specific cancer plan activities

21. States with Radon-specific Laws in 2014 * * Washington, DC has one radon-specific law. The ELI database does not review or track radon laws for tribes

22. Annual Radon-related Lung Cancer Deaths State 16-20 Draft

23. Annual Radon-related Lung Cancer Deaths State 17-20 Draft

24. Progress on Risk Reduction 7.1M Homes ≥4pCi/L Mitigate existing homes (2 – 4 pCi/L) 1,244,000 mitigation systems installed since 1986 9,100 lives saved (lung cancer deaths avoided) 1,542 mitigated homes saves 1 life Multi-pronged demand/supply strategy (partnerships [ELI, CRCPD, NCSL, NEHA, KSU], PSAs, real estate, home inspection, stakeholder trainings) 24

25. State Indoor Radon Grant (SIRG) Program 45 states participating 5 Not Participating (NH, MD, LA, AR, HI) Tribes: FY2013 10 Awards = $304,000Tribes: FY2013 10 Awards = $304,000 Philip Jalbert 343.9431, Jalbert.Philip@epa.gov http://www.epa.gov/radon/sirgpr ogram.html

26. Federal Radon Action Plan Federal leadership required to accelerate action on radon risk reduction – a key Healthy Homes concern An example of Inter-Agency Collaboration (USDA, DOD, DOE, EPA, GSA, HHS, HUD, DOI, VA) A special focus on families and low income communities

27. Framework for Federal Action: Our Areas of Focus Demonstrate Importance of radon risk reduction Provide Incentives to encourage testing and mitigation Build Demand for testing and mitigation

28. Key Milestones Tracking Our Progress Nov 2010:Held Federal Radon Summit where agencies agreed to develop the Federal Radon Action Plan Jun 2011:Launched the Action Plan at the Healthy Homes Conference Jan 2012:Released the Action Plan Scorecard Aug 2012:Celebrated one-year anniversary at CDC’s National Cancer Conference in Washington DC Feb 2013:Released the Accomplishments Report in conjunction with the unveiling of the Advancing Healthy Housing – A Strategy for Action.

29. AgencyGreen – CompletedYellow – On TrackRed – No Progress USDA6 DoD111 DOE22 EPA11 GSA11 HHS21 HUD31 DOI21 VA11 Multi13 TOTAL 19122 33 Total Commitments To access Scorecard visit www.epa.gov/radon/action_plan.html 33 Total Commitments To access Scorecard visit www.epa.gov/radon/action_plan.html Status of Commitments

30. www.epa.gov/radon

31. Build Demand for Testing & Mitigation The Department of Housing and Urban Development (HUD) wrote new radon testing and mitigation requirements for their multifamily housing mortgage insurance programs, estimated to reach 105,000 housing units in 2013. The Environmental Protection Agency (EPA) is investing in 4 new standards of practice. New provisional standard for radon mitigation in multifamily housing released this year. Provide Incentives to Encourage Testing and Mitigation The Department of Agriculture (USDA) issued new secretary-level guidance to all of its field office housing, community, loan (~301K this year), and public information programs to promote radon mitigation and new construction.

32. Demonstrate the importance of radon testing & mitigation The Department of Health and Human Services reported that 27 CDC sponsored state five-year cancer plans now include radon, representing 41% of existing cancer plans. –Of that total, two cancer programs have included radon activities for the first time and two have expanded radon activities within their plans.

33. Moving Forward: Leadership, Leverage and Visibility

34. Priorities for the Near-term Future Federal Radon Action Plan (FRAP) Allied Leaders Partnerships with NGOs Standards of Practice Code adoption Labelling programs 34