Residents’ perceptions of radon health risks: a qualitative study
Radon is a high impact environmental pollutant and is the second leading cause of lung cancer in Canada. Building design, extended winter, and geographical location expose residents of Ottawa-Gatineau (the national capital region in Canada) to an increased risk. It is surprising that residents have an inadequate awareness of the risk - despite its gravity - and have taken minimum preventive actions. This study explores perceptions of radon health risk and examines the factors that enable and hinder the adoption of preventive measures among Ottawa-Gatineau residents.
We conducted semi-structured interviews with 35 residents with varying educational and income levels to inquire about their knowledge and perception of radon, and to explore their views of enablers and obstacles to taking action to reduce radon risks. Thematic, inductive data analysis was undertaken.
The results indicate that: 1) Residents obtained information on radon from various sources that include the media, their education or occupation, their social network, and home renovation events. Limited references were made to the National Radon Program responsible for testing for radon and informing residents. 2) Awareness of radon risk varied, and the knowledge retained by some residents is insufficient to adequately protect their health. 3) Enablers for taking protective action included: having an understanding of the risk along with health consciousness; caring for family and children; knowing others who had contracted lung cancer and having financial resources. Obstacles consisted of: lack of awareness; cost; lack of home ownership; and potential difficulty in selling the house. 4) Residents attributed primary responsibility to public agencies for disseminating information, and incentivizing or mandating action through more stringent regulation.
Risk perceptions are subjective, and are influenced by micro and macro level factors. Inducing protective action to reduce risk requires comprehensive interventions taking into account the dual cognitive and emotional aspects of risk perception. Future research may explore the dual aspects of risk perception and examine the contents of the risk communication message. Policy should address the responsibility of both governments and residents in tackling the issue.
KeywordsRadon Risk perception Testing Mitigation Enabler Barrier Health communication Health policy
National Radon Program
Radon is a ubiquitous environmental pollutant that poses a significant health risk, especially in cold countries . In Canada, radon kills at least 3000 people annually, making it the second leading cause of lung cancer . This naturally-emitted soil gas enters buildings, typically by seeping in through foundations . Building design, extended winter, and geographical location expose residents to increased concentrations of radon gas [3, 4]. Radon decay gives off tiny radioactive particles that, when inhaled, can cause mutation in DNA of lung cells eventually resulting in lung cancer [5, 6]. Women and children appear to be more strongly affected , and the risk is up to threefold for smokers .
The National Radon Program (NRP) of Health Canada is responsible for raising public awareness through disseminating radon health risk messages . Despite multiple efforts, the program lags behind the desired public uptake. According to the latest national survey, 55% of Canadian households heard about radon, but only 6% of them tested for it . Similarly, a recent survey conducted in the national capital region in Canada, which is known for relatively elevated levels of radon, revealed that while 32% of those surveyed expressed some concern about radon health risks, only 12% tested for radon, and 3% took action to reduce radon health risks . The gap between risk awareness and actual testing rates presents a challenge for public health professionals [11, 12].
In Canada, like many other countries, residents are responsible for radon testing and remediation [1, 9]. The guideline issued by the federal government is voluntary; it assumes that residents will act rationally according to the provided information . This assumption, however, has been challenged by previous psychological and preventive health research relating to health risk perception [13, 14]. Further, Spiegel and Krewski , in a quantitative study, assessed the health risk perception of residents in high radon areas and concluded that the Canadian residential radon exposure guideline had not been effective at prompting homeowners to take action to reduce exposure.
The term ‘risk’ denotes the probability of experiencing a dangerous event and the magnitude of the consequences of that event . However, studies over the decades have provided convincing evidence that subjective perceptions of risk differ significantly from the scientific evaluation of risk [16, 17, 18]. For example, in a high seismic zone, the risk that a resident will die in an earthquake may be mathematically lower than the risk of dying in a car accident. Yet, residents are comfortable with driving but panicked of an earthquake . This is because residents do not mathematically or objectively calculate the risk. Slovic argues that no risk exists independently of human thoughts and culture . Attempts to reduce health risks would benefit from an understanding of people’s views. Research has identified that the success of any population-level awareness program is contingent on the views and actions of key decision makers at the household level . Therefore, it is important to understand residents’ knowledge and views of radon health risk.
How do residents learn about radon and how do they view the risks associated with it?
What are the enablers and barriers to mitigation of the risk according to residents?
What suggestions do they provide to enhance information dissemination and protective action?
Sampling and data collection
Sociodemographic characteristics of participants
Level of Education
Total Household Income
Less than $40,000
Between $151,000 and Above
Prefer Not to Answer
The interview guide included both closed and open-ended queries on sources of information on radon, views on radon health risk, and enablers and obstacles to taking action related to radon. We asked residents to provide suggestions on how awareness of radon health risks and actions to reduce such risk could be achieved. The first author conducted all the interviews, conferring periodically with the second author to update and discuss progress. All interviews were digitally recorded and then transcribed.
Our research complied with Canada’s Tri-Council ethics guidelines. The University of Ottawa Research Ethics Board ‘Health Sciences and Science REB’ approved the study protocol (H10–17-03). We secured informed written consent from all respondents for participation as well as for voice recording and direct quoting. We assigned a number to each participant to maintain anonymity and excluded identifying information from the quotes.
List of themes and associated sub-themes
Source of knowledge
Education and occupation
Home renovation shows
The current study
National Radon Program
Understanding health risk (cognitive awareness)
Concern for children and oneself (emotional awareness)
Social influence (knowledge of significant others)
Personalizing the risk
Lack of awareness of health risk
Cost of remediation
Reduced property value (assumed)
Voluntary nature of the guidelines
Residents’ suggestions for improving knowledge dissemination and protective action
Role of public agencies
Role of citizenry
Mandating and legislating
In this section, we report the results of our analysis of the sources of information and level of knowledge of participants. We then present participants’ views of enablers and obstacles to testing and mitigation. This is followed by a summary of participants’ suggestions regarding ways to improve disseminating information and taking action to reduce radon harm.
Source of knowledge
“There was a report in the Ottawa Residents, a local newspaper in the Kanata area” (SP19).
“I read something about it years ago, in the Maclean’s magazine” (SP18).
“I watch television programs. When I was listening to the news, I heard them talk about radon” (SP20).
“I read some articles online” (SP22).
“We had friends who live a few kilometers from here, who told us about radon. This increased our awareness” (SP1).
“A lot of my friends used to work in Health Canada; I heard from them” (SP35).
“We were told in a geological club to be careful of some of the rocks … that one of the byproducts of that was radon gas” (SP24).
“I was trained in hazardous materials operations; so, I came to know about radon gas” (SP32).
“I first heard about radon about 15 or 20 years ago when I was planning to set up a marble countertop, and the marble countertop scheme was up” (SP18).
“Several years ago, I attended a home and cottage show here in Ottawa, and I had to stop in a stall that I believe was by the National Research Council. There I learned about radon. That was the first source of information about radon for me. I then looked through the internet. I read widely” (SP16).
“When we moved here, the home inspector mentioned that radon might be an issue in this area (Kanata)” (SP34).
“I had not heard of radon till I was contacted to participate in your survey” (SP10).
“The first thing I heard about radon was your ad; from the links that you sent to me” (SP28); (please see recruitment ad in Additional file 1).
“I heard about it from your study” (SP25).
In sum, residents obtained information on radon from various sources, but this does not tell us whether the information they obtained and retained is accurate. We consider this issue next.
Level of knowledge and awareness of risk
“I have a biology background … I know how the situation can arise in a building, and what conditions generate the gas” (SP17).
“I have some knowledge about uranium degradation. In a climate such as this, the effects are worse in the winter because the house tends to be closed up … I think radon is quite serious as it is odorless, you don’t know about it unless you test for it, so it kills people silently, and that’s why it’s serious” (SP29).
“70 Bq (Becquerel) is equal to one X-ray. We had 280 Bq - that is equivalent of basically 4 X-rays in a year” (SP24).
“The best time to test for radon is in the winter when the doors and windows are kept closed. In summer, we usually keep our doors and windows open and so the gas does not build up. There is variation in radon release. It varies even on a diurnal basis. There are other factors that impact radon release, so it is good to test often, and even better to have a real-time detector if you have the capacity to buy one” (SP11).
“Radon is present everywhere. It is the level of radon that is harmful. You should know what the level is. If it is within the guideline level, then, we can say that there is not much harm to your health … If you have multiple potential risk factors for the same disease, such as smoking and radon in this case, then the combination of the effects is probably more than the effect from a single factor” (SP16).
“I know it is a colorless, odorless gas, it seeps into the house through the basement, it is a product of deterioration of uranium. It is naturally occurring and it happens everywhere” (SP13).
“New houses have no radon: I suspect that my house does not have radon. Because of the age of the house – it is not ten years yet” (SP27).
“Houses built on clay, no chance of having radon” (SP26).
“It’s not a problem in Ottawa but in Winnipeg and Western Canada” (SP35).
“I don’t think there are sufficient studies to categorically say that this is serious enough” (SP20).
In sum, some of our participants did not specifically seek information, and were rather passively exposed to it through the media or by hearing from colleagues, while others took a more active stance, seeking advanced information. Awareness of risk varied, and it is important to note that the knowledge retained by some residents is faulty and potentially harmful to their health.
Enablers and barriers
We asked participants about the factors that would facilitate or hinder radon testing and preventive actions. Enablers to taking protective actions included: having an understanding of the risk, being health conscious, being responsible for providing care for family and children, having knowledge of others who had contracted lung cancer, and having financial capability. The obstacles consisted of lack of awareness of health risk, cumbersome procedures, cost, lack of home ownership, concerns about reduced property values, and the voluntary nature of the guidelines.
“My daughter has been sleeping in the basement for thirteen years; I wanted to know whether she has been exposed to radon for this long time” (SP29).
“My son used to sleep in the basement from time to time” (SP32).
“My daughter does sleep there quite often; so, I am concerned about her sleeping in the basement and a buildup of radon” (SP23).
“It's the concern about having lung cancer from radon. I am health conscious; if I know something is a risk factor, I would go for fixing that” (SP7).
“The desire to avoid any unnecessary health effects. There are health hazards while we drive on the highway and that’s why you make sure that your vehicle is in good shape and you also put on seat belts. The same kind of thing applies here. If you are aware of the health hazards, you take the appropriate measures” (SP16).
Knowledge of others who had contracted lung cancer seemed to influence some participants to take action. Specifically, seeing individuals who could be similar to oneself and who had contracted lung cancer, heightened risk perception (i.e. personalizing the risk through a vicarious experience):
“It was the concern about my health that encouraged me to test and fix the house for radon … I could not afford any more insult (exposure to radon) to my lungs” (SP24).
“There is a man of 60 in my neighborhood who got lung cancer” (SP30).
“We have friends who live a few kilometers from here, who told me that he was concerned about his home and he tested … I was surprised because my son used to live in the basement and so my husband became concerned when he got the information” (SP1).
“I was watching a medical program on TV that was doing a feature about women and cancer, specifically lung cancer. The women in the program who got lung cancer did not smoke. They had a healthy lifestyle, they were fit, they exercised, but they still got lung cancer. So, the doctor was trying to find out –how was that possible?... The cancer researcher, I don’t recall his name, said that there is a high possibility that it was radon gas … So, they recommended to stay healthy, to take action, and directed to have the house tested to see if there was radon gas” (SP7).
“Certainly, it would be expensive for people who are not as fortunate as we are” (SP1).
“I don’t think it is that much expensive, this is not a barrier for me” (SP2).
“First is knowledge, if people don't know anything at all – it's the first challenge” (SP11).
“I think most people are not aware of what the indoor air quality is in a house” (SP21).
“There is always the finance involved because one has to bring in a specialist and it may cost up to $4,000” (SP7).
“I just cannot afford it” (SP20).
“Other things may be where to get the kit, not knowing how much it may cost and how to do the test. There are the procedures to place the test kit at a certain place and wait for over 90 days and then send it to the lab by mail and wait for the result. These all take time … It also requires the willingness to go ahead and follow through with all the steps till getting the result. Some people may not have that time and patience” (SP16).
“If I am a renter and my landlord is not aware of this problem, he may not do the test” (SP5).
“ … for some, not owning the home - like tenancy, people who rent their houses” (SP15).
“If you are renting your house and do not own it, then it may be a challenge” (SP25).
“People may think that if radon is detected, it may be a problem in selling their houses. There is a stigma associated with this - that the house is contaminated. In areas where these types of contaminants are found, assessed property values tend to decrease” (SP24).
“ … because otherwise, they lose the value once they are going to sell the house” (SP32).
“If the building codes are voluntary and it costs even $100, nobody is going to do it as that means paying $100 from the builder’s pocket. But if it is mandatory, then only it will be done” (SP32).
“I think almost everything that is voluntary is not going to motivate people to take action. If it’s mandatory, then people will follow the guideline, even if they are not well aware of the issue” (SP33).
In sum, various enablers and barriers influence residents’ action-taking with respect to radon.
Residents’ suggestions for improving knowledge dissemination and protective action
Given the limited information that some participants had - and the fact that some of the knowledge they retained was not scientifically-based and could potentially be harmful - we sought to understand participants’ views of what should be done to raise residents’ awareness of the health risks and encourage them to take action. We believed it was particularly important to obtain residents’ views, given that there are national guidelines in place, yet these do not appear to be highly effective in educating the public or incentivizing it to take action [2, 10]. This indicates that the program is poorly matched with most residents’ needs for information and incentive. It was, therefore, particularly important to learn from residents what might be helpful for them.
“In television, there should be an image of some of the effects of radon, and it will be easier for people to understand” (SP25).
“One option could be sending a flyer to the mailbox as the hydro company does for energy efficiency, could be a newspaper article, could be online, could be television shows … or it could be a mix of all these things as different people have different choices and means to get the information” (SP29).
“Well, it could be the individual’s problem, it depends on a lot of things like people’s living habits. Some people smoke … that could contribute to that. So, this is an individual rather than an overall societal problem. In that particular case, the responsibility should go to the individuals, not to the government” (SP35).
“I think the responsibility goes primarily to the individuals. The government has the role of providing information, but it is the individuals who have to take steps to test and where necessary, to mitigate the issue” (SP16). These views were few in number.
“It's a societal problem, not individual because it runs from coast to coast” (SP7).
“I think it is an overall social problem, as it affects the health of everybody” (SP30).
“I think both have the responsibilities. Government can support, but homeowners should take the initiatives to do the test first” (SP11).
“The initiative should be taken by the homeowners; the government should be in support (SP12).
“You can get help from David Suzuki; he would be the best person to communicate this message” (SP15).
“The clinics can do this job by putting up signs that draw people’s attention” (SP1).
“It is not your issue or my issue, it is everybody’s issue, and we have to get together to stop this from happening” (SP20).
“People from the radon-prone areas should come forward” (SP13).
Suggestions regarding actions aimed at testing and/or mitigating were framed in terms of incentivizing and/or legislating procedures. For example, some participants stated that providing free test kits, tax rebates and subsidies would encourage some residents to take action given that “most people are not going to pay for the test. If someone has a minimum wage and you think he is going to test and fix his house by himself- it’s not going to happen” (SP27).
“The government needs to put in place building codes -every house built in such a way that a minimum requirement has to be met to prevent radon gas” (SP24).
“If there are CO (Carbon Monoxide) and smoke detectors in houses, why not a real-time radon detector?” (SP30).
“Testing and disclosure – both should be made mandatory” (SP34).
“I would be very upset if I find after the fact that there is radon in the house. I think it’s reasonable to have a clause in the sale agreement” (SP32).
Thus, the recommendations focused mainly on the role of public agencies in disseminating information, and in incentivizing or mandating action through more stringent regulation.
The objectives of this qualitative study were to gain an understanding of residents’ knowledge and perceptions of the risk associated with radon, to identify the enablers and obstacles to taking action, and to obtain their suggestions regarding how knowledge and action associated with radon can be improved. The results showed that residents acquire knowledge passively or actively from diverse media sources, their social network, their education and/or occupation, home shows and home inspectors. Most surprising was the fact that several residents came to know about radon for the first time from the current study. This supports the findings of our preceding study  and the conclusions of previous studies that the Canadian National Radon Program has not been highly effective in informing residents and in prompting action to reduce radon exposure .
While most of the residents had basic knowledge about radon, a few demonstrated in-depth knowledge. However, an important result from this study is that some residents have misconceptions about radon, showing what has been termed unrealistic optimism, which involves individuals holding an unreasonably low estimate of their own susceptibility to the risk . Studies in the US  and Ireland  have demonstrated that it is not uncommon for individuals living in high radon areas to underestimate the potential harm or to believe that radon is a threat to others but not to themselves.
Among the accounts from participants were references to a 60-year old neighbor, and to women in a TV show who were otherwise healthy and non-smokers, and who had contracted lung cancer. The availability of examples of harm may allow one to form a judgment that radon poses a health risk . Still, caution should be taken in assuming that merely being exposed to the risk information can lead to the formulation of appropriate conclusions or to taking appropriate action. Researchers [16, 26] have shown and argued repeatedly that information processing and behavior are highly complex and are influenced by multiple factors at various levels. For example, Weinstein et al.  stated that “an intervention capable of having a major impact on perceptions of risk may have to confront directly the mini-theories people construct to justify their optimism” (p.32), thus pointing to micro-level factors. The authors note that such interventions would be challenging to implement on a large scale given the various mini-theories that people construct . Specifically, in our study, the findings show that associating radon health risk with both personal (e.g. diagnosis of lung cancer) and family members’ (especially children’s) health appeared as an impetus for residents to test, mitigate and continuously monitor radon level. These are examples of events and occurrences that positively helped to shape individuals’ mini-theories.
The presence of such mini-theories suggests that the more varied the media, the more diverse the types of messages (e.g. cognitive and emotional appeals), and the more agencies delivering the message (e.g. different levels of government, associations, health clinics), the higher the likelihood that knowledge and action regarding radon will increase. Studies in the UK have shown similar results where multiple radon health risk communication campaigns effectively raised awareness , and health communication messages from authentic sources had positive effects especially in radon-prone areas .
As we have pointed out, risk perception is a subjective phenomenon. It is influenced not only by micro-level factors such as individual mini-theories and information processing but also by the macro-level context . At a macro-level, we encounter the social context of radon threat, where views of risk and of who is responsible for reducing the risk are influenced by the community or social framing of the issue . For radon, there is no collective community action built through consensus, and therefore, individuals show various views. Whereas some established social norms, consensus and groups (as on gun control in the US) can motivate people to act, the absence of such a community movement influences inaction even in high radon areas . In this vein, a few participants in our study called for residents to get together and to engage in collective action on the issue.
Another macro-level factor of relevance in interpreting the results of our study is that the health care system in Canada is publicly-funded and highly regulated. Federal, provincial and municipal government bodies have extensive regulations associated with various health risks. This helps account for residents’ views regarding the role of government in managing radon risks. The majority of participants viewed government as the primary actor with responsibility for informing the public and for incentivizing and mandating action to reduce radon risks. This points to the critical role that health policy can play in reducing risks.
The suggestions we received from the participants pointed to the need to involve various public and non-governmental agencies, various types of messages, and various incentivizing and regulatory steps. This is particularly important because research has shown that simply providing information is not sufficient . For example, evidence has shown that when a health message is personally significant, people try to moderate the seriousness of the health risk, raise questions about the accuracy of the risk information, and process it in a subjective manner [30, 32, 33].
The primary audience of radon messages is the at-risk population who live in an area with high levels of radon. This segment could be challenging to persuade because they might process the information defensively when it is too intimidating . Defensive techniques include, for example, avoidance of message  and denial of susceptibility . However, there is also evidence showing that individuals’ motivation for action is driven more by the emotional aspects of perception than by cognition [10, 31, 35]. These various considerations reinforce the importance of using different approaches and messages.
Our study did not gather systematic information from participants about the content of messages on radon that they would find to be effective, as this was outside the scope of the study. However, some of the participants’ accounts indicated that the content is important. In fact, some research has indicated that individuals are likely to feel more threatened by a description that assigns an active rather than a passive agency to radon (e.g. ‘radon gas invades your home’ as opposed to ‘radon gas seeps into homes’) . Therefore, studying residents’ views of message content would help improve communication campaigns on radon.
A limitation is our inability to generalize from the current study to the population at large; however, this is a typical feature of qualitative studies . In fact, exploratory qualitative studies are not intended to provide generalizable data, but to enhance understandings that can be further tested in broader-based quantitative studies. Our study was also limited in the number of participants and locations. Future research would benefit from interviewing more participants and in other cities to generate additional insights. We believe that studies in cities where there have been condensed and concerted efforts to communicate with residents and incentivize action would provide an interesting extension of or counterpoint to this study.
This study sheds light on the vital topic of residents’ knowledge and views of radon and its risks. To date, studies on views of radon risk in Canada have tended to adopt quantitative approaches. The value of the qualitative approach is that it provides a deeper look into participants’ experiences, thus providing information to complement quantitative results. Our study showed that many people do not get the crucial information on radon and some retain misconceptions about the health risks of radon even after being exposed to information. Many residents report barriers in testing and engaging in protective action, even after receiving the pertinent information.
Our study underscores the importance of seriously considering how radon risk is understood and dealt with by residents. We identified that mere cognitive risk awareness is not enough; additional emotional awareness motivates residents to take action regarding testing and mitigating their houses for radon. Therefore, radon health communication will be more effective when programs address both these aspects of risk perception along with plausible regulations and incentives, where necessary. Future research can explore the dual aspects of risk perception and thus help to develop tailored risk communication messages capable of motivating residents to mitigate their homes for radon health risk.
We thank all the residents who took part in this research and allowed us to explore their experience of radon health risk. We are grateful to Dr. Daniel Krewski, Director, McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, who provided technical support in designing the initial survey questionnaire. Thanks to colleague Nicole Bergen for pre-reviewing the final manuscript.
Both the first author (SMK) and the second author (SC) designed the study, developed the concept and co-analyzed the data. SMK conducted interviews and drafted the manuscript. SC critically reviewed and revised the paper. Both authors read and approved the final manuscript.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Dr. James Gomes (supervisor of quantitative part of the study) bought radon test kits, and Dr. Samia Chreim (supervisor of the qualitative part of the study) paid for the subscription of the software atlas.ti from their institutional research funds.
Ethics approval and consent to participate
Our research complied with Canada’s Tri-Council ethics guidelines. The University of Ottawa Research Ethics Board ‘Health Sciences and Science REB’ approved the study protocol (H10–17-03). We duly secured informed written consent for participation, voice recording and direct quoting.
Consent for publication
The authors declare that they have no competing interests regarding this research and publication.
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