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Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking
Harvard School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02215, USA
US Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, Research Triangle Park, NC 27711, USA
Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, MA 02118, USA
* Author to whom correspondence should be addressed.
Received: 15 July 2011; in revised form: 5 September 2011 / Accepted: 6 September 2011 / Published: 13 September 2011
Abstract: Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors.
Keywords: residential radon; indoor air; cumulative exposure; risk assessment; lung cancer; combined risks; health disparities; disadvantaged communities; vulnerable populations; risk-based decisions
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Chahine, T.; Schultz, B.D.; Zartarian, V.G.; Xue, J.; Subramanian, S.V.; Levy, J.I. Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking. Int. J. Environ. Res. Public Health 2011, 8, 3688-3711.
Chahine T, Schultz BD, Zartarian VG, Xue J, Subramanian SV, Levy JI. Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking. International Journal of Environmental Research and Public Health. 2011; 8(9):3688-3711.
Chahine, Teresa; Schultz, Bradley D.; Zartarian, Valerie G.; Xue, Jianping; Subramanian, S. V.; Levy, Jonathan I. 2011. "Modeling Joint Exposures and Health Outcomes for Cumulative Risk Assessment: The Case of Radon and Smoking." Int. J. Environ. Res. Public Health 8, no. 9: 3688-3711.