Modeling the Impact and Costs of Radon Policy for Lung Cancer Control

描述（由申请人提供）：肺癌发病率和死亡率的趋势遵循烟草使用的趋势，因为据估计，吸烟导致约90%的男性肺癌死亡和80%的女性肺癌死亡。然而，暴露于氡-一种无味的放射性气体，可以被困在家中-被认为是肺癌的第二大原因。氡与肺癌之间关系的一个非常重要的方面是氡暴露和吸烟在肺癌风险中的强烈相互作用。美国环保署估计，86%与氡有关的肺癌死亡发生在吸烟者身上。因此，绝大多数氡气造成的公共卫生负担是吸烟者和前吸烟者造成的。我们提出的研究的总体目标是阐明一组选定的公共政策的潜在影响和成本，旨在减少美国氡诱发肺癌的负担，考虑到氡暴露和吸烟之间的强烈相互作用，以及我们目前正处于吸烟减少的时代。我们的具体目标如下：1）通过纳入美国国家科学院电离辐射生物效应VI模型的修订结构和参数，修改现有的基于人口的动态模型，该模型预测烟草使用、氡暴露和肺癌死亡率; 2）利用修正后的模型估算1980-2005年氡对肺癌死亡率的影响，考虑到这段时间内成年人吸烟的减少; 3）使用修改后的氡模型进行各种关于氡检测/补救和烟草控制的政策模拟练习（包括针对吸烟者的氡教育/测试/补救措施）;以及4）对一套选定的降低肺癌死亡率的政策方法进行成本效益分析，比较以戒烟为重点的政策战略和以减少氡暴露为重点的政策战略。我们的工作旨在澄清一些问题，这些问题对于健全的氡公共政策至关重要，但尚未得到阐明。在我们提出的研究的中心是需要政策研究和话语，以更好地解释氡暴露和吸烟之间的相互作用对肺癌的影响。总之，我们的工作将有助于阐明住宅氡补救策略与吸烟减少氡相关的肺癌在21世纪世纪的相对影响和成本效益。

DESCRIPTION (provided by applicant): Trends in lung cancer incidence and mortality have followed trends in tobacco use, as cigarette smoking is estimated to cause approximately 90 percent of lung cancer deaths in men and 80 percent in women. However, exposure to radon-an odorless radioactive gas that can become trapped in homes-is considered the second leading cause of lung cancer. A very important aspect of the relationship between radon and lung cancer is the strong interaction between radon exposure and smoking in lung cancer risk. The EPA estimates that 86 percent of radon-related lung cancer deaths are in ever-smokers. As such, the vast majority of the public health burden of radon is among smokers and former smokers. The overall goal of our proposed research is to elucidate the potential impact and costs of a selected set of public policies aimed at reducing the burden of radon-induced lung cancer in the U.S., taking into account the strong interaction between radon exposure and smoking, and the fact that we are currently in an era of decreased smoking. Our specific aims are as follows: 1) to modify an existing population-based dynamic model that predicts tobacco use, radon exposure, and lung cancer mortality by incorporating revised structure and parameters from the National Academy of Sciences' Biological Effects of Ionizing Radiation VI model; 2) to use the modified model to estimate the impact that radon had on lung cancer mortality during the time period of 1980-2005, taking into account decreases in smoking among adults over this time; 3) to use the modified radon model to conduct a variety of policy simulation exercises regarding both radon testing/remediation and tobacco control (including the targeting of radon education/testing/remediation at smokers); and 4) to conduct cost-effectiveness analyses of a selected set of policy approaches to reducing lung cancer mortality, comparing policy strategies focused on smoking cessation and those focused on reducing exposure to radon. Our work seeks to add clarity to a number of questions that are central to sound public policy regarding radon but have yet to be elucidated. At the center of our proposed research is the need for policy research and discourse to better explicate the implications of the interaction between radon exposure and smoking for lung cancer. In sum, our work will help to elucidate the relative impact and cost-effectiveness of residential radon remediation strategies versus smoking reductions on radon-related lung cancer in the 21st century.