CR3 News Magazine 2020 VOL 4: September Radon, Schools & Home Study | Page 27

2 SAGE Open
the states that require radon testing also require mitigation if
levels are elevated. Vermont has had three radon bills proposed
since 1999, but still has no legislation requiring
schools to monitor and maintain radon levels within a safe
range (Environmental Law Institute, 2013; Vermont General
Assembly, 2016, 2018, 2019). Among the states with radon
legislation, there is wide variation in the scope and enforceability
of the laws (Gordon et al., 2018). A consensus on the
important components of successful radon regulation may
help facilitate the development and passage of new and
effective legislation.
Children exposed to unsafe levels of radon are thought to
be particularly vulnerable to an increased risk of developing
lung cancer compared with adults due to physiologic differences
in the shape, size, and ongoing development of their
lungs (Bearer, 1995; Grigg, 2004; Leith Sly & Carpenter,
2012). In addition, children have a faster respiratory rate than
adults, which may increase the relative amount of radon their
lungs are exposed to (Fleming et al., 2011). The Centers for
Disease Control and Prevention (CDC) estimates that the risk
of developing lung cancer may be twice as high in children as
adults with equivalent levels of exposure to radon (Agency
for Toxic Substances and Disease Registry, Environmental
Health and Medicine Education, 2013). School employees
are at increased risk based on the extent of time spent in
schools. Unlike students, faculty and staff spend a substantial
number of hours every week for years, or even decades, in
buildings that may be contaminated with radon gas.
For more than 20 years, the Vermont Department of Health
has provided free radon testing kits to Vermont schools.
However, as of 2016, only 73 of 266 total schools in the state
(27.4%) had been tested for radon. Of the schools tested,
13.6% of these schools had levels of radon that were above the
EPA’s recommended action level for mitigation. Of the schools
with radon levels above the EPA standard, 20% elected not to
take action to reduce the level of radon (Reddinger, 2016).
Although no reasons for failure to mitigate were reported, cost
may be a barrier for schools to mitigate elevated radon levels.
The cost to mitigate residential elevated radon can vary from
US$4,000 to US$75,000 depending on the severity of the
problem and the structure of the building (Radon Risk and
Public Health in Vermont, 2015). The cost to mitigate elevated
radon in schools would likely be comparable. This one-time
mitigation cost to a school is less than the total cost of an average
school bus which is US$87,000 (Daimler Truck Financial,
2016) and substantially less than the average cost of lung cancer
treatment, which is more than US$92,000/patient/year
(Mariotto et al., 2011).
Increased knowledge about radon has been previously correlated
with an increased likelihood to test for and mitigate
elevated radon levels (Wang et al., 1999). This creates a public
health incentive to assess parent and guardian knowledge
about radon in schools and promote population awareness
about the health risks associated with radon exposure, particularly
in children. This study aimed to (a) assess parent
knowledge of radon and its associated health risks, (b) elicit
parent perspectives about radon in schools, and (c) gauge
community support for legislation mandating testing for and
mitigation of elevated radon levels in Vermont schools.
Method
Participants
Inclusion criteria for both the survey and discussion groups
required participants to be a parent or guardian of one or
more kindergarten to 12th grade (K-12) children in a Vermont
school. Completion of the survey was voluntary, and parents
participated with the knowledge that their responses would
be anonymously used for research.
Procedure
We created a 29-question survey which was adapted from a
prior study about residential radon (Riesenfeld et al., 2007).
The survey addressed three main components: (a) parent or
guardian awareness of radon and its health effects, (b) parent
or guardian awareness of radon in schools, and (c) participant
demographics. Likert-like scales were used to assess
participant opinions.
Paper surveys and electronic survey links were distributed
to family and pediatric medicine clinics across the state,
a farmer’s market, and a local grocery store. In addition,
online surveys were distributed to parents via social media
platforms. Any survey that was not 100% complete was
excluded. Because the demographics section was considered
optional, surveys with missing demographic information
were included in the analysis.
Two Vermont parents participated in a discussion group
during which we asked open-ended questions and the conversation
was recorded and transcribed.
Data Analysis
LimeSurvey was used in the collection and analysis of the
descriptive data. Paper surveys were input manually to the
electronic form and were analyzed with the electronic surveys.
Data were imported into Statistical Package for the
Social Sciences (SPSS) to conduct independent samples t
tests to compare level of agreement with several statements
about radon testing, mitigation, and regulation among different
groups of respondents. A p value of less than .05 was
considered statistically significant. Descriptive statistics
were also generated using SPSS.
A thematic content analysis of the discussion group manuscript
was conducted using the Framework Method in
which all meaningful text was assigned a nonpredetermined
code. A master list of all codes was maintained, and the codes
were organized into a matrix by theme (Gale et al., 2013). A
subset of themes was selected to be highlighted in this text.