CR3 News Magazine 2023 VOL 4: SEPT -- RADON CHILDREN and SCHOOLS | Page 41

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 .