Indoor Radon Exposure and Health Risks in a Community Proximal to Gold Mine Tailings in Gauteng Province, South Africa: A Cross-Sectional Study

Indoor Radon Exposure and Health Risks in a Community Proximal to Gold Mine Tailings in Gauteng Province, South Africa: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Indoor Radon Exposure and Health Risks in a Community Proximal to Gold Mine Tailings in Gauteng Province, South Africa: A Cross-Sectional Study Khathutshelo Vincent Mphaga, Wells Utembe, Thokozani P. Mbonane, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5037478/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Exposure to indoor radon presents a significant risk for lung cancer and is also suspected to be associated with other health issues such as chronic obstructive pulmonary diseases (COPD) and leukemia. This study examined the association between indoor radon exposure and self-reported cases of lung cancer, COPD, and leukemia among individuals living in close proximity to gold mine tailings, a known source of high radon levels. A cross-sectional study was carried out among residents living near or further away from gold mine tailings in Gauteng, South Africa. A total of 331 residents took part in an interviewer-administered questionnaire survey on socio-demographic characteristics, smoking habits, occupational exposures, adverse health problems, and other factors related to lung cancer, COPD, and leukemia. Subsequently, their homes were tested for indoor radon concentration on the lowest livable floor over a two-hour period from June to July 2023 using AlphaE radon monitors. Logistic regression was employed to calculate odds ratios (OR) for lung cancer, COPD, and leukemia based on indoor radon exposure, dwelling location, smoking habits, and occasional exposures. The study found significantly higher indoor radon levels in the exposed group (103.30 ± 94.91 Bq/m³) compared to the control group (65.19 ± 47.83 Bq/m³). The results indicated an association between lung cancer and residing near gold mine tailings, while indoor radon exposure was linked to leukemia. However, no association was found between indoor radon exposure and COPD. In regions impacted by gold mine tailings, it is crucial to implement efficient indoor radon mitigation measures and promote public consciousness about the health hazards linked to indoor radon exposure. There is a need to motivate affected residents to adopt proactive steps to lower indoor radon concentrations, including enhancing ventilation practices. Indoor radon exposure chronic obstructive pulmonary diseases (COPD) leukemia Gauteng lung cancer Figures Figure 1 1. Introduction Radon, a radioactive gas, is a major natural source of ionizing radiation that affects humans (Bersimbaev et al, 2017). Discovered by physicist Ernest Rutherford in 1899, radon occurs naturally in several isotopic forms, but only radon-219, radon-220, and radon-222 are found in high environmental concentrations (Leuchner et al, 1989; Terblanche et al, 1991; Eidy et al, 2024). Radon-222 (hereafter radon), with a half-life of 3.8 days, is the most stable and common isotope of radon. It is the immediate decay product of radium-226 and is transient in the decay process of uranium-238 (Terblanche et al, 1991). Due to its extended half-life, radon can easily permeate from the surroundings into residential buildings. Being a noble gas and the densest known gas, radon is eight times denser than air, allowing it to accumulate in confined areas (Terblanche et al, 1991; ICRP, 1993; IAEA, 2019). This odorless and colorless gas is generated from the disintegration of uranium-238 in soil, rock, and water (Terblanche et al, 1991; Bersimbaev et al, 2017). Radon gas can accumulate to dangerous levels particularly in poorly ventilated spaces (WHO, 2009; IAEA, 2019). Radon gas is commonly found in the ground beneath dwellings, some building materials, ground water, outdoor air, and natural gas. It can seep into buildings through cracks and gaps in the foundations and walls, as well as around service pipes. While radon itself is not directly harmful, its decay products, polonium-218 and polonium-214, emit alpha particles that can damage DNA, thereby increasing the risk of health problems (WHO, 2009; Eidy et al, 2024). Radon daughter products are also radioactive and easily attach themselves to whatever they encounter. Exposure occurs primarily through inhalation and to a lesser extent through ingestion of radon or radon-laden dust particles (Terblanche et al, 1991; WHO, 2009; Eidy et al, 2024). Radon gas is a recognized as a major threat to human health due to its established link to lung cancer (Bersimbaev et al, 2017). Classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), World Health Organization (WHO) and US Environmental Protection Agency (EPA), radon exposure is the leading cause of lung cancer in non-smokers and a second contributor for smokers (WHO, 2009; Ruano-Ravina et al, 2017). Radon short-lived radioactive radon daughters, when inhaled readily attach to lung tissue, emitting alpha particles that damage cells and increase cancer risk (Terblanche etal, 1991; Eidy et al, 2024). The World Health Organization (WHO) recommends an indoor radon reference level of 100 Bq/m³, with a maximum acceptable level of 300 Bq/m³ in cases where reaching the lower level is impractical (WHO, 2009). Notably, even low to moderate concentrations pose a risk, with studies suggesting between 8 to 16% increase in lung cancer risk for every 100 Bq/m³ increase in radon exposure (Darby et al, 2005; Krewski et al, 2006; IAEA, 2019; Stanely et al, 2019). Additionally, it has been confirmed that residential radon exposure is a risk factor for lung cancer even at levels below those recommended by international organizations (Lorenzo-Gonzalez et al, 2020). Fernandez-Navarro et al. (2012) and Moshupya et al. (2019) found a correlation between residing near mining facilities and an elevated risk of lung cancer mortality, further emphasizing the potential health hazards associated with elevated radon levels in such residential settings. Previous research has suggested that the detrimental effects of residential radon exposure extend beyond lung cancer. Studies have demonstrated an association between high residential radon levels and an increased incidence of chronic obstructive pulmonary disease (COPD) (Turner et al, 2012; Yitshak-Sade et al, 2019; Wang et al, 2022). Although the evidence for a link between radon exposure and leukemia risk is primarily derived from ecological studies, these studies has suggested a potential association, particularly for chronic lymphocytic leukemia (Oancea et al, 2017; Zlobina et al, 2022). The implementation of public health measures to address radon exposure has been a common practice globally, involving national surveys and awareness campaigns (WHO, 2009; IAEA, 2017; Pantelić et al, 2019; IAEA, 2019; Bochicchio et al, 2022). Despite the presence of distinct indoor radon risk factors such as gold mine tailings in South Africa (Terblanche et al, 1991; Maheso et al, 2023; Moshupya et al, 2023). South Africa has yet to establish similar initiatives. These tailings, composed of waste materials from gold extraction, often contain high levels of uranium, a precursor to radon gas (Chanda-Kapata, 2022). While colder climates tend to lead to higher radon exposure due to increased indoor time (Bersimbaev et al, 2017; Stanley et al, 2019). South Africa's climate may provide some advantage through improved ventilation (Terblanche et al, 1991). However, this potential benefit is offset by the cold Highveld winters and the absence of central heating in many homes (Leuchner et al, 1989). The Witwatersrand area in Gauteng, with a population of over a million, is of concern due to its high density and proximity to gold mine tailings containing high uranium concentrations (Schonfeld et al, 2014; Winde et al, 2019; Zupunski et al, 2023). These gold mine tailings, are a result of over 80 gold mines which has operated in this region since the 18 th century, pose a significant health risk to residents (Utembe et al, 2015; Iyaloo et al, 2020; Zupunski et al, 2023;). It is estimated that there are 600,000 tons of uranium contained in these tailings across the Witwatersrand basin, presenting a significant environmental health concern that demands immediate attention (Schonfeld et al, 2014; Liefferink, 2017). Despite international regulations prohibiting settlements near such sites, historical planning oversights and inadequate environmental controls have resulted in communities residing close to gold mine tailings (Bobbins et al, 2013; Khanyile, 2016; International Human Rights Clinic 2016; Benchmarks Foundation., 2016; Kengni et al, 2022). The presence of elevated uranium in the tailings and surrounding soil, combined with windblown dust and reports of higher respiratory illness rates in nearby communities, necessitates further investigation (Iyaloo et al, 2020; Benchmarks Foundation., 2016; Nkosi et al, 2015). Few small-scale studies have confirmed as association between elevated indoor radon exposure amongst dwellings proximal gold mine tailings (Kamunda et al, 2017; Moshupya et al, 2019). However, epidemiological studies on radon concentration levels and associated health risks are currently lacking in South Africa (Schonfeld et al, 2014). To address this knowledge gap and inform public health interventions, well-designed epidemiological studies are urgently needed. Thus, the aim of this study was to investigate an association between radon exposure and self-reported risks of lung cancer, COPD, and leukemia among residents living in close proximity to gold mine tailings in Gauteng Province. The findings from this research can be used to develop targeted strategies to protect these vulnerable communities. 2. Materials and Methods 2.1 Study design and population A cross-sectional epidemiological study was carried out to investigate the association between indoor radon exposure and self-reported lung cancer, COPD and leukemia risk amongst residential homes near gold mine tailings in Gauteng, South Africa. Gauteng is the smallest, most populous (with a population of around 15.8 million) and the main economic hub of the nine provinces of South Africa (Bobbins, 2013; Statistics South Africa, 2022). The name "Gauteng" comes from a Sotho word meaning “gold,” reflecting the area's history of gold mining. It is home to the Witwatersrand Basin, the largest gold mining area in the world (International Human Rights Clinic, 2016). The majority of urban and township areas in Gauteng have been established around the minefields (including mine dumps), creating a distinctive landscape different from other mining contexts abroad (Bobbins, 2013). Riverlea is one of many communities located near gold mine tailings storage facilities in Gauteng. In this study, Riverlea was identified as the exposed group due to its close proximity (0.1-2 km) to three dormant and active gold mine tailings storage facilities (Nwaila, 2020). The closest gold mine tailings storage facilities are located less than 200 meters (m) away from the community (Benchmarks Foundation, 2016; Kootbodien et al, 2019). Communities adjacent to gold mine tailings storage facilities are subjected to elevated dust fallout due to the dispersion of fine particles from these facilities (International Human Rights Clinic, 2016; Andraos et al, 2017; Kootbodien et al, 2019; Nkosi et al, 2021). Arid conditions have hindered the rehabilitation of partially vegetated tailings, while current mine dump reclamation for gold extraction has exacerbated dust pollution and deteriorated air quality (Kootbodien et al, 2019; Benchmarks Foundation, 2016). Radon gas, potentially attached to dust particles released from these facilities, can be dispersed by wind and atmospheric turbulence, posing a risk to nearby homes. Additionally, heavy rains through runoffs have been reported to carry contaminants from the gold mine tailings, potentially including radon gas, from the mine tailings to nearby communities (International Human Rights Clinic, 2016). Riverlea is home to 16,226 residents, residing in 4,208 dwellings built around or near gold mine tailings from the past (Benchmarks Foundation, 2016; Kootbodien et al, 2019). Riverlea was selected as an exposed area due to its proximity to gold mine tailings, which could potentially result in higher indoor radon exposure. This increased exposure may consequently lead to a higher risk of radon-induced lung cancer, COPD, and leukemia. The community of Orlando East was chosen as the unexposed (control/reference) group due to the absence of gold mines or a history of mining in the area, which minimizes the potential for radon exposure. The closest gold mine tailings are located more than 2 km away from Orlando East (Chiyangwa, 2020). Orlando East has a population of 68,210 people and 22,416 households (Adrian, 2022). 2.2 Sample size and sampling procedure The study included 7,477 residential dwellings in Riverlea and Orlando East sourced from the City of Johannesburg Online Maps. Only residents from these two communities were included (City of Johannesburg, 2017). Random sampling was conducted using Microsoft Excel 365. The study involved 476 participants, with 238 individuals in both the exposed and control groups. The sample size was determined using EpiInfo Version 7 software, considering a population size of 7,477 residential dwellings, an expected frequency of 20%, a 95% confidence level, and a 5% margin of error. The study permitted one resident per household, over the age of 18 and residing in the area for at least 5 years, to participate with informed consent. Ethical approval was obtained from the University of Johannesburg's Faculty of Health Sciences Research Ethics Committee and the Higher Degree Committee. Out of 472 potential participants, 89 (18.9%) were unavailable, and 52 (11.0%) declined. A total of 331 individuals participated, resulting in a 70.1% participation rate, evenly distributed between Riverlea and Orlando East (See Figure 1 ). 2.3 Data collection tools and procedures The researcher, along with two trained assistants who were familiar with the community and spoken language, collected data using structured interviewer-administered questionnaires and four AlphaE radon monitors. The data collection took place during the winter season, specifically from June to July 2023. Upon identifying a selected dwelling, we used a knock-on-the-door approach to target occupants who met the inclusion criteria. Data was gathered through in-person interviews with eligible participants residing in selected residences. Prior to data collection, informed consent was obtained. The interviews were conducted in English, with translation to local language provided when necessary. The structured questionnaire covered socio-demographic characteristics, housing conditions, occupational and smoking histories, and health status. The questionnaire development involved a comprehensive review of published literature, including sources such as the World Health Organization (WHO, 2009) and the International Atomic Energy Agency (IAEA, 2019). Pilot testing was conducted with 16 participants from the study area to ensure the questionnaire's clarity and suitability for the intended purpose. To guarantee reliability, the results from the pilot study were analyzed using Cronbach's alpha, which yielded a coefficient of α > .7, indicating good internal consistency. Indoor radon levels were assessed using AlphaE radon monitors deployed in participants' homes. A single monitor was placed in a room where a participant spend most of his or her time, either the bedroom or living room, to evaluate indoor radon concentration. Each radon detector was exposed for two hours, and the resulting average radon concentration, expressed in becquerels per cubic meter (Bq/m³), was recorded. AlphaE monitors were calibrated both by the manufacturer (Bertin Technologies) and a local laboratory (Selectech) to ensure accuracy. Calibration involved exposing the monitors to a known radon concentration in a sealed chamber alongside a reference unit (AlphaGUARD). The manufacturer and local calibration laboratory reported a precision of ±10% at the 95% confidence level. All measurements were conducted according to the manufacturer's protocols. The detectors were placed away from the floor, walls, doors, windows and electronic devices. Radon data contained in the radon detector were transferred into the PC for further analysis using DataVIEW communication software. 2.4 Statistical analysis We conducted a bivariate descriptive analysis to examine the distribution of the study variables based on the exposed and control group. Subsequently, we utilized univariate and multivariate logistic regression with radon-induced health problems (self-reported lung cancer, COPD, and leukemia) as the dependent variable and residential radon exposure and dwelling location (Riverlea and Orlando East) as the independent variables. Initially, indoor radon exposure was analyzed as a continuous variable and then as a categorical variable with two categories (≤ 100 Bq/m3 and ≥ 100 Bq/m3). We explored effect modification between indoor radon exposure and other influencing factors (sex, age, tobacco smoking, type of fuel used at home, and occupational history) on the self-reported health problems by including a multiplicative term in the model. Logistic regression results were presented as crude and adjusted odds ratios with a 95% confidence interval. For bivariate analysis, independent variables with a p-value of < 0.20 were considered significant and included in the multivariate analysis. In the multivariate analysis, a p-value of < 0.05 was considered significant. Additional independent variables were included in the multivariate analysis based on established facts from literature or known associations from previous studies. All analyses were conducted using STATA 18 (Stata Corp., College Station, TX, USA). 3. Results 3.1 Demographic Characteristics of the Participants Out of 476 potential subjects identified for the study, 331 participated in an interviewer-administered questionnaire survey, and valid indoor radon measurements were obtained from their respective dwellings. Ultimately, data from both radon measurements and questionnaire surveys were available for 166 exposed subjects (102 females and 64 males) and 165 control subjects (98 females and 67 males), following a 1:1 matching design ( Table 1 ). The majority of the participants were female, comprising 102 (61.4%) exposed individuals and 98 (59.4%) controls. The age distribution differed notably between the two groups. The exposed group had a higher proportion of younger residents, with 24 (14.5%) participants under the age of 39 years. In contrast, the control group had a significantly higher percentage of older residents, with 100 (60.6%) participants who were 60 years and above. Educational attainment was similar between the two groups, with most participants having completed high school. However, the control group had a slightly higher proportion of individuals with tertiary education, 27 (16.4%) compared to 13 (7.8%) in the exposed group. Employment rates were comparable, but the control group had a higher unemployment rate (84.1% compared to 76.5% in the exposed group). Both communities primarily resided in brick houses. Notably, a significantly higher percentage of the control group (89.7%) had lived in their current homes for over 31 years compared to the exposed group (70.5%). Ventilation practices were comparable between the two groups, with frequent ventilation being the norm. Radon testing was uncommon in both communities, with less than 2% of participants reporting prior testing. For detailed information regarding the dwelling characteristics of the participants, please refer to our previous publication [45]. Table 1 : Demographic Characteristics of the Participants Riverlea n=166 (50.2%) Orlando East n= 165 (49.8%) Sex Female 102 (61.4%) 98 (59.4%) Male 64 (38.6%) 67 (40.6%) Age Below 39 Years 24 (14.5%) 13 (7.9%) 40 – 49 Years 33 (19.9%) 24 (14.5%) 50 – 59 Years 45 (27.1%) 28 (17.0%) 60 Years and above 64 (38.5%) 100 (60.6%) Marital status Single 59 (35.5%) 81 (49.1%) Married 65 (39.2%) 70 (42.4%) Divorced 12 (7.2%) 1 (0.6%) Separated 1 (0.6%) 3 (1.8%) Windowed 29 (17.5%) 10 (6.1%) Black African 5 (3.0%) 163 (98.8%) Race Colored 159 (95.8%) 1 (0.6%) Indian/Asian 2 (1.3%) 0 (0.0%) White 0 (0.0%) 1 (0.6%) Less than high school 59 (35.5%) 40 (24.2%) Education High school completed 94 (56.6%) 98 (59.4%) Tertiary completed 13 (7.8%) 27 (16.4%) Employment Yes 39 (23.5%) 26 (15.9%) No 127 (76.5%) 138 (84.1%) Less than 10 years 15 (9.0%) 7 (4.2%) Years in the same house 11 – 20 years 13 (7.8%) 2 (1.2%) 21 – 30 years 21 (12.7%) 8 (4.9%) More than 31 years 117 (70.5%) 148 (89.7%) House type Brick house 166 (100.0%) 159 (96.4%) Other (i.e shack) 0 (0.0%) 6 (3.6%) Often 149 (89.8%) 107 (64.8%) Ventilation Sometimes 15 (9.0%) 30 (18.2%) Rarely 2 (1.2%) 28 (17.0%) Less than 10 hours 34 (20.4%) 12 (7.3%) Hours inside the house per day 11 – 20 hours 45 (27.2%) 96 (58.2%) More than 21 hours 87 (52.4%) 57 (34.5%) Tested for radon in the past Yes 3 (1.8%) 3 (1.8%) No 163 (98.2%) 164 (98.2%) 3.2 Risk factors The following section ( Table 2 ) compared the exposure factors and smoking habits of the populations in the exposed and control groups. The main aim was to identify variations in exposure risks and smoking behaviors between these two groups. While there were a limited number of participants reporting exposure to carcinogens, irritants, and toxins in both groups, a significant disparity was observed between the exposed and control groups. The analysis revealed a significantly higher prevalence of occupational exposure to these substances among the exposed individuals, with 21 individuals (n=21; 12.7%) compared to only 3 individuals (n=3; 1.8%) in the control group. A small number of participants from both communities reported working in underground mines, indicating that underground mining was not a significant occupational exposure factor for either population. The study also evaluated smoking habits across various dimensions, including current smoking status, household smoking, and indoor tobacco smoke exposure. The findings indicated a substantially higher percentage of current smokers in the exposed group (n=97; 58.4%) compared to the control group (n=44; 26.7%), suggesting a higher prevalence of smoking in the exposed group. Furthermore, a higher proportion of households in the exposed group had at least one smoker (n=105; 63.3%) compared to the control group (n=80; 49.1%). Moreover, a greater percentage of exposed households (n=76; 46.3%) were exposed to indoor tobacco smoke compared to the control group (n=48; 29.3%). Among smokers, a higher proportion of exposed residents reported a longer duration of smoking, with a significant number having smoked for over 33 years (n=26; 15.7%) compared to only 1 individual (0.6%) in the control group, indicating a more established smoking habit in this community. Table 2 : Risk factors Riverlea n=166 (50.2%) Orlando East n=165 (49.8%) Occupational exposure to carcinogens, irritants, and toxins Yes 21 (12.7%) 3 (1.8%) No 145 (87.3%) 162 (98.2%) Years of exposure Less than 20 years 17 (10.3) 2 (1.2%) More than 30 years 4 (2.4%) 1 (0.6%) Not applicable 145 (87.3%) 162 (98,2%) Yes 2 (1.2%) `2 (1.2%) Have you worked in underground mine No 164 (98.8%) 162 (98.8%) Never smoker 57 (34.4%) 115 (69.7%) Tobacco smoking Ex-smoker 12 (7.2%) 6 (3.6) Current smoker 97 (58.4%) 44 (26.7%) Does anyone in the household smoke? Yes 105 (63.3%) 80 (49.1%) No 61 (36.7%) 83 (50.9%) One 43 (25.9%) 43 (26.0%) Number of current smokers More than 2 71 (42.8%) 42 (25.5%) None 52 (31,3%) 80 (48.5%) Tobacco smoking indoors Yes 76 (46.3%) 48 (29.3%) No 88 (53.7%) 116 (70.7%) None 57 (34.3%) 116 (70.3%) Number of cigarettes per day ≤10 Cigarette/day 85 (51.2%) 37 (22.4%) 11- 21 Cigarette/day 24 (14.5%) 11 (6.7%) ≥ 22 Cigarettes/day 0 (0.0%) 1 (0.6%) None 56 (33.7%) 115 (69.7%) Less than 10 years 38 (22.9%) 18 (10.9%) Years of smoking 11 – 21 years 30 (18.0%) 21 (12.7%) 22 – 32 years 16 (9.6%) 7 (4.3%) More than 33 years 26 (15.7%) 4 (2.4%) 3.3 Radon measurements Indoor radon levels were compared between exposed and control group. Radon measurements were obtained from the dwellings in the exposed and control group ( Table 3 ). The radon levels in both groups exhibited a wide range, as evidenced by the minimum and maximum values. The exposed group had a significantly higher mean radon level (103.30 ± 94.91 Bq/m³) compared to the control group (65.19 ± 47.83 Bq/m³). When considering the geometric mean, which is less influenced by outliers, the disparity between the groups was less pronounced. The exposed group had a geometric mean of 81.59 Bq/m³, while the control group had a geometric mean of 52.49 Bq/m³. A substantial proportion of dwellings in both groups exceeded the World Health Organization (WHO) reference level of 100 Bq/m³. In the exposed group, (n=68; 41%) of the dwellings exceeded this threshold, whereas in the control group, (n=31; 19%) exceeded it. Indoor radon levels were significantly linked to the location of the homes, with homes near (≤2 Km) gold mine tailings (exposed) experiencing elevated indoor radon levels compared to those farther away (≥2 Km) from the mine (control). For detailed information on the factors influencing indoor radon levels, please refer to our other paper [45]. Table 3. Residential radon gas concentration for exposed and control group Exposed Control Minimum 11.07 0 Maximum 1078.85 379.13 Arithmetic Mean 103.30 65.19 Standard deviation 94.91 47.83 Geometric mean 81.59 52.49 Dwellings exceeding WHO Reference level of 100 Bq/m3 68 (68, 7%) 31 (31, 3%) 3.4 Adverse health problems This study compared the frequency of various respiratory health conditions between a group exposed to high radon levels and a control group ( Table 4 ). Despite most participants in both groups having access to healthcare, a significantly higher percentage of individuals in the control group (n=80; 50.6%) reported easy access compared to the exposed group (n=57; 26.6%). The exposed group had significantly higher rates of several respiratory diseases, including tuberculosis (7.2% vs. 8.5%), bronchitis (8.4% vs. 4.2%), and asthma (9.6% vs. 3.7%). Additionally, a significant proportion of the exposed group reported persistent cough, shortness of breath, and unexplained weight loss compared to the control group. The control group reported no cases of COPD, while a single case was identified in the exposed group. The prevalence of leukemia was low in both groups, with no significant differences observed. The exposed group had a significantly higher prevalence of lung cancer diagnoses (n=3; 1.8%), compared to the control group (n=1, 0.6%). Moreover, a notably higher percentage of the exposed group had relatives diagnosed with lung cancer (n=27; 16.3%) compared to the control group (n=2; 1.2%). The exposed group also had a significantly higher rate of deaths due to lung cancer among relatives (n=26; 15.7%) compared to the control group (n=2; 1.2%). The majority of participants in both groups expressed a willingness to participate in lung cancer screening, with slightly higher rates in the exposed group (n=153; 92.7%) compared to the control group (n=143; 87.2%). Table 4: Adverse health problems for exposed and control group Riverlea n=166 (50.2%) Orlando East n=165 (49.8%) Access to health care Difficult 70 (42,4%) 44 (27.9%) Moderate 38 (23.0%) 34 (21.5%) Easy 57 (26.6%) 80 (50.6%) Have you ever been diagnosed with TB Yes 12 (7.2%) 14 (8.5%) No 154 (92.8%) 151 (91.5%) Have you ever been diagnosed with bronchitis Yes 14 (8.4%) 7 (4.2%) No 152 (91.6%) 158 (95.8%) Have you ever been diagnosed with Asthma Yes 16 (9.6%) 6 (3.7%) No 150 (90.4%) 158 (96.3%) Relative diagnosed with Asthma Yes 38 (22.9%) 22 (13.3%) No 128 (77.1%) 143 (86.7%) Have you ever been diagnosed with COPD Yes 1 (0.6%) 0 (0.0%) No 165 (99.4%) 165 (100.0%) Have you ever been diagnosed with leukemia Yes 2 (1.2%) 1 (0.6%) No 164 (98.8%) 164 (99.4%) Relative with leukemia Yes 1 (0.6%) 0 (0.0%) No 165 (99.4%) 165 (100.0%) Have you been diagnosed with lung cancer Yes 3 (1.8%) 1 (0.6%) No 163 (98.2% 164 (99.4%) Relative diagnosed with lung cancer Yes 27 (16.3%) 2 (1.2%) No 139 (83.7%) 163 (98.8%) Have you lost a relative due to lung cancer Yes 26 (15.7%) 2 (1.2%) No 140 (84.3%) 163 (98.8%) Do you experience persistent cough Yes 48 (28.9%) 7 (4.2%) No 118 (71.1%) 158 (95.8%) Do you experience shortness of breath Yes 37 (22.3%) 7 (4.2%) No 129 (77.7%) 158 (95.8%) Do you cough blood Yes 2 (1.2%) 0 (0.0%) No 164 (98.8%) 165 (100.0%) Unexplained weight loss Yes 4 (2.4%) 0 (0.0%) No 162 (97.6%) 165 (100.0%) Repeated respiratory infections Yes 15 (9.0%)_ 0 (0.0%) No 151 (91.0%) 165 (100.0%) Willingness to participate in lung cancer screening Yes 153 (92.7%) 143 (87.2%) No 12 (7.3%) 21 (12.8%) 3.5 Association between various risk factors and lung cancer Logistic regression analysis was employed to calculate crude and adjusted odds ratios (ORs) for lung cancer risk, with 95% confidence intervals (CIs) ( Table 5 ). The results revealed a significant association between dwelling location and lung cancer risk (crude OR = 0.063, 95% CI = 0.015-0.270, p < 0.001; adjusted OR = 0.048, 95% CI = 0.010-0.210, p < 0.001). However, no statistically significant association was observed between indoor radon exposure and lung cancer risk, neither in the crude analysis (OR = 1.000, 95% CI = 0.995-1.004, p = 0.983) nor in the adjusted analysis (OR = 0.995, 95% CI = 0.988-1.003, p = 0.250). Active smoking and passive smoking were also considered as potential risk factors. While the crude analysis suggested a non-significant association with lung cancer risk for both active (OR = 1.365, 95% CI = 0.917-2.032, p = 0.125) and passive smoking (OR = 1.604, 95% CI = 0.746-3.447, p = 0.226), the adjusted analyses revealed that these associations were attenuated and no longer statistically significant (active smoking: OR = 0.980, 95% CI = 0.587-1.636, p = 0.939; passive smoking: OR = 1.104, 95% CI = 0.419-2.908, p = 0.841). Occupational exposure to carcinogens, irritants, and toxins emerged as a significant risk factor for lung cancer in the adjusted analysis (OR = 7.545, 95% CI = 1.799-29.013, p = 0.031). This finding suggests that occupational exposure may play a more substantial role in lung cancer risk. Table 5 : Estimated odds ratios for lung cancer in relation to various factors Risk factors Crude Odds Ratio (95% CI) P-value Adjusted Odds Ratio (95% CI) P-value Dwelling location 0.063 (0.015-0.270) ≤0.001* 0.0477 (0.010-0.210) ≤0.001* Indoor Radon Exposure 1.000 (0.995-1.004) 0.983 0.995 (0.988-1.003) 0.250 Active smoking 1.365 (0.917-2.032 0.125 0.980 (0.587-1.636) 0.939 Passive smoking 1.604 (0.746-3.447) 0.226 1.104 (0.419-2.908) 0.841 Occupational exposure 0.104 (0.071-0.153) ≤0.001* 7.545 (1.799-2.013) 0.031 3.6 Association between various risk factors and leukemia To assess the association between various risk factors and leukemia incidence, a comparative analysis was conducted between the exposed and control groups. The results, presented in Table 6 , highlight significant disparities in exposure to several risk factors. Individuals residing in the exposed community exhibited a significantly higher risk of leukemia compared to the control group, as indicated by a crude odds ratio of 0.178 (95% CI: 0.072-0.442, p ≤ 0.001). However, after adjusting for confounding factors, this association was no longer statistically significant, suggesting that the initial association might be attributable to other factors. A consistent, strong association was observed between indoor radon exposure and the risk of leukemia. Both the crude and adjusted odds ratios were significantly elevated, indicating a 6.7% and 7.1% increased risk of leukemia for each 100 Bq/m³ increase in radon exposure, respectively. While active smoking did not exhibit a significant association with leukemia risk in the adjusted analysis, passive smoking was marginally associated with an increased risk. The crude odds ratio for passive smoking was 1.531 (95% CI: 0.746-3.447, p = 0.242), but after adjusting for confounders, the association weakened to 1.293 (95% CI: 0.886-1.601, p = 0.068). The analysis revealed a non-significant association between occupational exposure and leukemia risk. The crude odds ratio was 1.438 (95% CI: 0.781-2.645, p = 0.243), and the adjusted odds ratio remained non-significant at 1.694 (95% CI: 0.591-4.858, p = 0.327). Table 6: Estimated odds ratios for leukemia in relation to various factors Risk factors Crude Odds Ratio (95% CI) P-value Adjusted Odds Ratio (95% CI) P-value Dwelling location 0.178 (0.072-0.442) ≤0.001* 0.342 (0.075-1.549) 0.164 Indoor Radon Exposure 1.067 (1.044-1.089) ≤0.001* 1.071 (1.045-1.097) ≤0.001* Active smoking 1.237 (0.862-1.777 0.249 0.977 (0.608-1.570 0.171 Passive smoking 1.531 (.746-3.447) 0.242 1.293 (0.886-1.601) 0.068 Occupational exposure 1.438 (0.781-0.645) 0.243 1.694 (0.591-4.858) 0.327 3.7 Association between various risk factors and COPD The present study examined the association between several risk factors and COPD. To assess these relationships, a comparative analysis was conducted between exposed and control groups ( Table 7 ). Dwelling Location: While initial analysis suggested a potential association between dwelling location and COPD risk (crude odds ratio: 2.440, p-value: 0.133), this association was not sustained after adjusting for confounding factors (adjusted odds ratio: 1.022, p-value: 0.581). Neither the crude nor adjusted analyses revealed a statistically significant association between indoor radon exposure and COPD risk. Both active and passive smoking were investigated as potential risk factors. Active smoking showed a non-significant crude association (crude odds ratio: 1.601, p-value: 0.458) but a slightly attenuated adjusted association (adjusted odds ratio: 0.842, p-value: 0.827). Passive smoking, on the other hand, exhibited a non-significant crude association (crude odds ratio: 3.327, p-value: 0.328) and a marginally significant adjusted association (adjusted odds ratio: 2.652, p-value: 0.520). The most notable finding was a significant association between occupational exposure and COPD risk. While the crude analysis indicated a non-significant association (crude odds ratio: 1.243, p-value: 0.311), the adjusted analysis revealed a significantly increased risk of COPD among individuals exposed to occupational hazards (adjusted odds ratio: 2.201-2.662, p-value: 0.214). Table 7 : Association between various risk factors and COPD Risk factors Crude Odds Ratio (95% CI) P-value Adjusted Odds Ratio (95% CI) P-value Dwelling location 2.440 (0.133-0.396) ≤0.001* 1.022 (0.988-1.057) 0.581 Indoor Radon Exposure 1.003 (0.996-1.001) 0.404 1.001 (0.994-1.008) 0.758 Active smoking 1.601 (0.463-5.541) 0.458 0.842 (0.179-3.955) 0.827 Passive smoking 3.327 (0.299-3.087) 0.328 2.652 (0.135-1.963) 0.520 Occupational exposure 1.243 (0.146-0.788) 0.311 0.001 (2.201-2.662) 0.214 4. Discussion In this cross-sectional study, we investigated indoor radon exposure in residential dwellings proximal to the gold mine tailings and its potential correlation with self-reported occurrences of lung cancer, COPD, and leukemia in the Gauteng province. The study involved 166 participants residing near the gold mine tailings (exposed group) and 165 participants residing farther away from the gold mine tailings (unexposed/ control group). The exposed group was located within 2 kilometers of the nearby gold mine tailings, while the control group was situated more than 2 kilometers away. The exposed individuals were selected from an area with expected high indoor radon levels, while the unexposed group was chosen from surrounding areas with anticipated low radon concentrations. Previous studies conducted within occupational settings have highlighted the association between elevated radon levels and increased risk of lung cancer (Edwards et al, 2014; Lane et al, 2019; Chen et al, 2023), COPD (Conde-Sampayo et al, 2020; Chen et al, 2023) and leukemia (Řeřicha et al, 2006). There is a growing necessity to consider the various pathways of exposure for the general public to a wide range of carcinogens, including radon gas (Fishbein, 1992). The need to consider indoor environments is increasingly acknowledged due to the amount of time spent indoors by a large majority of the population and the recognition that levels of certain toxic substances are higher indoors than outdoors (Fishbein, 1992). This is one of the initial studies to investigate the connection between indoor radon exposure near gold mine tailings (anticipated to contribute to increased indoor radon concentrations) and self-reported lung cancer, COPD, and leukemia risk in the Gauteng province and South Africa as a whole. 4.1 Indoor radon exposure The current study revealed a substantial disparity in radon exposure between the exposed and control groups. The exposed group exhibited significantly higher mean radon levels compared to the control group. However, when considering the geometric mean, which is less influenced by outliers, the difference between the groups was less pronounced. Nonetheless, a substantial proportion of dwellings in both groups exceeded the WHO reference level of 100 Bq/m³. The observed levels in the exposed group were comparable to those reported in previous studies conducted within residential dwellings (Moshupya et al, 2019; Wang et al, 2022, Kamunda et al, 2017). Moreover, the elevated indoor concentrations in the exposed group were comparable to those observed in occupational studies (Martin-Gisbert et al, 2023). This suggests that individuals residing proximal gold mine tailings may be exposed to radon levels that are comparable to those encountered in occupational settings, potentially increasing their risk of health adverse effects. Several studies have reported that a significant percentage of residential dwellings, particularly in regions with high uranium content in the soil, such as proximal gold mine tailings exceed recommended radon levels (Mlay et al, 2018; Mohammed, 2018; Yazzie et al, 2020). These findings underscore the importance of radon mitigation strategies to protect public health. 4.2 Lung cancer In this cross-sectional study, logistic regression analysis was employed to investigate the association between indoor radon exposure and the likelihood of developing lung cancer. Furthermore, we examined the influence of dwelling location, smoking, and occupational exposure on the risk of lung cancer. Even though the exposed group was subjected to higher indoor radon levels compared to the control group, no statistically significant association was found between indoor radon exposure and the risk of lung cancer, both in the crude and adjusted analyses. The lack of a significant association between indoor radon exposure and lung cancer risk in this study was unexpected, given the well-established link between radon exposure and lung cancer risk reported in previous studies (Auvinen et al, 1996; Bochicchio et al, 2000; 58. Barros-Dios et al, 2002; Torres-Durán et al, 2014; Ha et al, 2017; Lee et al, 2015; Hassfjell et al, 2017; Kim et al, 2018; Gariazzo et al, 2021). Notably, similar studies conducted in residential settings proximal gold mining in South Africa and Cameroon have reported positive associations between radon exposure and lung cancer risk (Moshupya et al, 2023; Nkoulou et al, 2023). The observed positive correlations in prior research (primarily case-control and pooled radon studies) may be attributed to their extensive sample sizes, comprehensive data from national radon surveys, and mortality data related to lung cancer, all of which can enhance statistical robustness (Keith et al, 2012). However, the current study did not find a significant association between indoor radon exposure and lung cancer risk, which was consistent with a previous study in Poland (Grzywa-Celińska, et al, 2022). In our current study, we did not find a substantial link between lung cancer and residential radon exposure. This outcome could be attributed to several factors, such as the observed indoor radon levels and the relatively limited sample size. Previous research has indicated a higher risk of lung cancer among individuals exposed to indoor radon levels exceeding 200 Bq/m3 (Torres-Durán et al, 2014; Lorenzo-González et al, 2019), a threshold significantly higher than the levels observed in our study. The study's small sample size, a typical limitation in single residential epidemiological studies, may have limited the statistical power to detect a significant connection between radon exposure and negative health effects like lung cancer (Keith et al, 2012). This suggests that although there is generally strong evidence for a causal relationship between radon exposure and lung cancer, regional variations in radon concentrations, study design, and population characteristics could affect the observed associations (Keith et al, 2012). The study found a strong link between living close to gold mine tailings and an increased risk of lung cancer. People who lived further away from the gold mine tailings were less likely to develop lung cancer. These results support previous research from Spain, which also showed higher lung cancer risk among people living near mining sites (Fernández-Navarro et al, 2012). This association may be due to the release of carcinogenic pollutants like uranium from gold mine tailings into the air. These pollutants tend to have a limited dispersion, often impacting nearby populations (Chanda-Kapata, 2020). Despite the well-established causal link between smoking (both active and passive) and lung cancer risk, our study did not reveal a statistically significant association. This unexpected finding contradicts numerous prior studies that have consistently identified smoking as the primary risk factor for lung cancer (Mezzoiuso et al, 1994; Auvinen et al, 1996 71. Walser et al, 2008; Park et al, 2019; Nhu Ngoc et al, 2022). Most of these studies have reported a synergistic association between radon exposure and smoking, suggesting that individuals exposed to both factors may be at an elevated risk of developing lung cancer (Park et al, 2019; Nhu Ngoc et al, 2022). Potential explanations for this discrepancy could include the small sample size, limitations in smoking exposure assessment, or the possible presence of other confounding factors that were not adequately controlled. The overall prevalence of exposure to carcinogens, irritants, and toxins was relatively low in both groups, but individuals in the exposed group reported significantly higher rates of occupational exposure to these substances. These findings were consistent with previous research demonstrating limited occupational exposure to lung cancer-causing agents among participants (Auvinen et al, 1996 ; Torres-Durán et al, 2014). In the adjusted analysis, occupational exposure to carcinogens, irritants, and toxins emerged as a substantial risk factor for lung cancer, aligning with a Finnish study that found exposure to carcinogens was associated with a slight increase in the risk of lung cancer (Auvinen et al, 1996). This result suggested that occupational exposure play a crucial role in exacerbating the health risks associated with radon exposure. 4.3 Chronic Obstructive Pulmonary Diseases (COPD) and Leukemia Previous research has consistently demonstrated a strong correlation between indoor radon exposure and an elevated risk of developing certain types of cancer, particularly lung cancer. However, the association between residential radon exposure and other health conditions is still under active investigation. This study investigated the potential correlation between indoor radon exposure and two specific health conditions: leukemia and chronic obstructive pulmonary disease (COPD). This study also examined the relationship between different risk factors, including residential location, smoking, occupational exposure, and the incidence of Chronic Obstructive Pulmonary Disease (COPD) and leukemia among individuals living near gold mine tailings. While the initial analysis indicated a possible correlation between living near gold mine tailings and a higher risk of COPD, this association was not confirmed after considering the influence of other risk factors, such as smoking. The possible association between proximity to gold mine tailings and increased risk of respiratory diseases such as COPD was observed in previous studies conducted in the same settings as the present study (Iyaloo et al, 2020; Nkosi et al, 2015a; Nkosi et al, 2015b). Increased COPD risk in these areas could be attributed to various factors, including the release of fine particles from the tailings (Benchmarks Foundation, 2016; International Human Rights Clinic, 2016). These particles possess high airborne transport and floating capacity, enabling them to contaminate the air of the mining region and spread over vast distances (Da Silva-Rêgo et al, 2022). Our findings revealed a significant association between indoor radon exposure and the development of leukemia. Individuals residing in homes with elevated radon levels were associated with increased leukemia risk compared to those living in homes with lower radon concentrations. These results corroborate previous studies indicating that radon exposure can induce genetic damage, a potential mechanism underlying the development of leukemia. Specifically, Zlobina et al. (2022), Oancea et al. (2017), and Schwartz et al. (2015) have provided compelling evidence supporting the association between radon exposure and leukemia. In contrast, our analysis did not reveal a statistically significant association between indoor radon exposure and chronic obstructive pulmonary disease (COPD). Although prior studies in the United States have suggested a possible link (Wang et al, 2022; Yitshak-Sade et al, 2019; Turner et al, 2012), our findings, along with those of Spanish researchers (Barbosa-Lorenzo et al, 2017; Pando-Sandoval et al, 2022; Ruano-Ravina et al, 2021), indicated that the evidence for such a connection remains inconclusive. It's crucial to note that the absence of a significant association in our study does not definitively rule out the possibility of a relationship between radon exposure and COPD. Further research are needed to address this issue, taking into account factors previously identified as potential confounders in the association between radon exposure and lung cancer. Numerous literature has demonstrated a conclusive association between cigarette smoking and an increased risk of chronic obstructive pulmonary disease (COPD) and leukemia (Laniado-Laborín, 2008; Fircanis et al, 2014; Chung et al, 2021). However, the present study failed to find a statistically significant correlation between these variables. This contrasts with existing research that has consistently associated smoking with a higher likelihood of developing COPD (Fircanis et al, 2014; Chung et al, 2021). While our results may appear contradictory, they do not discount the well-established evidence of tobacco smoke's detrimental effects on respiratory and hematological health (WHO, 2009). It's possible that our study lacked the power to detect a significant association, or that other factors, such as genetic predisposition or environmental exposures, may have affected the outcomes. Nevertheless, our findings emphasize the importance of future research to understand the complex relationship between smoking, genetics, and disease risk. Despite specific statistical results, the overwhelming consensus remains that reducing tobacco smoke exposure is a crucial public health measure to alleviate the burden of COPD and leukemia (Jha, 2020). 4.4 Strengths and Weaknesses of the Study The study employed a well-designed cross-sectional epidemiological approach to investigate the association between indoor radon exposure from gold mine tailings and health problems. It utilized calibrated radon monitors and structured questionnaires to enhance data accuracy and employed appropriate statistical methods to control for potential confounders. However, the cross-sectional design limited the ability to establish temporal relationships between exposure and health outcomes, highlighting the need for longitudinal studies to provide stronger evidence of causality. The reliance on self-reported data for health outcomes and other variables may have introduced measurement bias, potentially affecting the accuracy of the findings. Additionally, the study's sample size, although reasonably large, may have been insufficient to detect small or moderate associations between exposure and health outcomes, especially for rare diseases. Using a larger sample size would have increased the statistical power of the study. Furthermore, relying on a single radon measurement per dwelling may not have accurately captured the variability of indoor radon levels over time. Multiple radon measurements would have provided a more reliable assessment of exposure. Finally, the study's findings, focused on a specific community exposed to gold mine tailings, may not be directly applicable to other populations with different exposure sources or living conditions, necessitating further research to assess the generalizability of the results. Conclusion and Recommendations The research provides strong evidence of the health risks associated with indoor radon exposure in a community near gold mine tailings. Although the study showed significantly higher radon levels in the exposed group compared to the control group, there was no statistically significant association between radon exposure and lung cancer risk. However, the research did identify significant correlations between radon exposure and leukemia, as well as other risk factors such as residential location, smoking, and occupational exposure. These findings underscore the importance of implementing radon mitigation strategies, raising public awareness, and conducting further research to protect public health and minimize the adverse effects of radon exposure. By employing a comprehensive approach involving radon testing, remediation, policy development, and public education, we can effectively mitigate the health risks associated with this environmental hazard. Declarations Supplementary Materials: N/A Author Contributions: Conceptualization, M.K.V. and R.P.C; methodology, M.K.V; R.P.C software, M.K.V; M.T.P; validation, W.U, R.P.C and M.T.P; formal analysis, M.K.V; M.T.P investigation, M.K.V; resources, R.P.C; data curation, M.T.P; writing—original draft preparation, M.K.V; writing—review and editing, M.K.V; visualization, M.T.P; supervision, U.T; R.P.C project administration, M.K.V; funding acquisition, R.P.C. All authors have read and agreed to the published version of the manuscript. Funding: The Principal Investigator (P.C.R.) received funding from NRF (Support for Y-rated Researchers Programme (Grant number—CSRP23030380716) which was used during data collection, analysis, and project conclusion phases. Institutional Review Board Statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the University of Johannesburg Faculty of Health Sciences Research Ethics Committee (REC) (Clearance Number REC-1889-2023) and the Higher Degree Committee (HDC-01-115-2022). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: All data are available upon request by emailing the corresponding author. Conflicts of Interest: The authors declare no conflicts of interest. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. References Adrian Frith. (2022). Orlando East. Available online: https://census2011.adrianfrith.com/place/798026037 (Accessed on 06 June 2022). Andraos C., Utembe W., Gulumian M. (2018). 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Pando-Sandoval A, Ruano-Ravina A, Torres-Durán M, Dacal-Quintas R, Valdés-Cuadrado L, Hernández-Hernández JR, Consuegra-Vanegas A, Candal-Pedreira C, Varela-Lema L, Fernández-Villar A, Pérez-Ríos M. (2022). Residential radon and characteristics of chronic obstructive pulmonary disease. Scientific Reports; 12(1):1381. Pantelić, G., Čeliković, I., Živanović, M., Vukanac, I., Nikolić, J. K., Cinelli, G., et al. (2019). Qualitative overview of indoor radon surveys in Europe. Journal of Environmental Radioactivity, (204), 163-174. https://doi.org/10.1016/j.jenvrad.2019.04.010 Park, E. J., Lee, H., Kim, H. C., Sheen, S. S., Koh, S. B., Park, K. S., Cho, N. H., Lee, C., & Kang, D. R. (2019). Residential Radon Exposure and Cigarette Smoking in Association with Lung Cancer: A Matched Case-Control Study in Korea. International Journal of Environmental Research and Public Health; 17(8), 2946. https://doi.org/10.3390/ijerph17082946 Pershagen, G., Akerblom, G., Axelson, O., Clavensjö, B., Damber, L., Desai, G., Enflo, A., Lagarde, F., Mellander, H., & Svartengren, M. (1994). Residential radon exposure and lung cancer in Sweden. The New England journal of medicine.1994; 330(3), 159–164. https://doi.org/10.1056/NEJM199401203300302 Řeřicha, V., Kulich, M., Řeřicha, R., Shore, D. L., & Sandler, D. P. (2006). Incidence of Leukemia, Lymphoma, and Multiple Myeloma in Czech Uranium Miners: A Case–Cohort Study. Environmental Health Perspectives, 114(6), 818-822. https://doi.org/10.1289/ehp.8476 Ruano-Ravina A, Cameselle-Lago C, Torres-Durán M, Pando-Sandoval A, Dacal-Quintas R, Valdés-Cuadrado L, Hernández-Hernández J, Consuegra-Vanegas A, Tenes-Mayén JA, Varela-Lema L, Fernández-Villar A. (2021). Indoor radon exposure and COPD, synergic association? A multicentric, hospital-based case–control study in a radon-prone area. Archivos de Bronconeumología (English Edition); 57(10):630-6. Ruano-Ravina, A., Kelsey, K. T., Fernández-Villar, A., & Barros-Dios, J. M. (2017). Action levels for indoor radon: different risks for the same lung carcinogen?. European Respiratory Journal, 50(5). Schonfeld, S., Winde, F., Albrecht, C., Kielkowski, D., Liefferink, M., Patel, M., et al. (2014). Health effects in populations living around the uraniferous gold mine tailings in South Africa: Gaps and opportunities for research. Cancer Epidemiology, 38(5), 628-632. https://doi.org/10.1016/j.canep.2014.06.003 Schwartz GG, Klug MG. (2016). Incidence rates of chronic lymphocytic leukemia in US states are associated with residential radon levels. Future Oncology;12(2):165-74. Stanley FKT, Irvine JL, Jacques WR, Salgia, S. R., Innes, D. G., Winquist, B. D et al. (2019). Radon exposure is rising steadily within the modern North American residential environment, and is increasingly uniform across seasons. Sci Rep, 9(1):18472. https://doi:10.1038/s41598-019-54891-8 Statistics South Africa. (2023). Census 2022. Statistical Release P0301.4. 2023. https://census.statssa.gov.za/assets/documents/2022/P03014_Census_2022_Statistical_Release.pdf (Accessed 21 June 2024). Terblanche, A P S, & Murray, P L R. (1991). Indoor exposure to radon: What are the health effects in non-occupational environments?. South African Journal of Science, 87(11), 548-550. https://hdl.handle.net/10520/AJA00382353_6244 The Bench Marks Foundation. (2016). Policy Gap 12 Soweto Report: " Waiting to Inhale " A survey of household health in four mine-affected communities. Retrieved from: https://media.business-humanrights.org/media/documents/files/documents/Benchmarks_policy_gap_12.pdf Accessed 11 February 2024. Torres-Durán M, Ruano-Ravina A, Parente-Lamelas I, Leiro-Fernández V, Abal-Arca J, Montero-Martínez C, Pena-Álvarez C, González-Barcala FJ, Castro-Añón O, Golpe-Gómez A, Martínez C. (2014). Lung cancer in never-smokers: a case–control study in a radon-prone area (Galicia, Spain). European Respiratory Journal; 44(4):994-1001. Turner MC, Krewski D, Chen Y, Pope CA, Gapstur SM, Thun MJ. (2012). Radon and COPD mortality in the American Cancer Society cohort. European Respiratory Journal, 39(5):1113-9. Utembe W, Faustman EM, Matatiele P, & Gulumian M. (2015). Hazards identified and the need for health risk assessment in the South African mining industry. Human and Experimental Toxicology, 34(12). 1212–1221. Walser, T., Cui, X., Yanagawa, J., Lee, J. M., Heinrich, E., Lee, G., Sharma, S., & Dubinett, S. M. (2008). Smoking and Lung Cancer: The Role of Inflammation. Proceedings of the American Thoracic Society; 5(8), 811-815. https://doi.org/10.1513/pats.200809-100TH Wang, V. A., Koutrakis, P., Li, L., Liu, M., Vieira, L. Z., Coull, B. A., Maher, E. F., Kang, M., & Garshick, E. (2022). Particle radioactivity from radon decay products and reduced pulmonary function among chronic obstructive pulmonary disease patients. Environmental Research, 216(1), 114492. https://doi.org/10.1016/j.envres.2022.114492 Winde F, Geipel G, Espina C, Schüz J. (2019). Human exposure to uranium in South African gold mining areas using barber-based hair sampling. PLoS ONE, 14(6) https://doi.org/10.1371/journal.pone.0219059 World Health Organization (WHO). (2009). WHO handbook on indoor radon: a public health perspective. World Health Organization. Available online: https://apps.who.int/iris/handle/10665/44149 (Accessed on 01 February 2023). Yazzie, S. A., Davis, S., Seixas, N., & Yost, M. G. (2020). Assessing the impact of housing features and environmental factors on home indoor radon concentration levels on the Navajo nation. International journal of environmental research and public health, 17(8), 2813. Yitshak-Sade M, Blomberg AJ, Zanobetti A, Schwartz JD, Coull BA, Kloog I, Dominici F, Koutrakis P. (2019). County-level radon exposure and all-cause mortality risk among Medicare beneficiaries. Environment international, 130:104865. Zlobina A, Farkhutdinov I, Carvalho FP, Wang N, Korotchenko T, Baranovskaya N, Farkhutdinov A. (2022). Impact of environmental radiation on the incidence of cancer and birth defects in regions with high natural radioactivity. International Journal of Environmental Research and Public Health, 19(14):8643. Zupunski, L., Street, R., Ostroumova, E., Winde, F., Sachs, S., Geipel, G., et al. (2023). Environmental exposure to uranium in a population living in close proximity to gold mine tailings in South Africa. Journal of Trace Elements in Medicine and Biology, 77, 127141. https://doi.org/10.1016/j.jtemb.2023.127141 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 Jun, 2025 Reviews received at journal 17 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviewers invited by journal 22 Sep, 2024 Editor assigned by journal 10 Sep, 2024 Submission checks completed at journal 06 Sep, 2024 First submitted to journal 05 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5037478","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":357910957,"identity":"d7ab1289-2d5a-4fd1-ad8a-1e23a8622c4d","order_by":0,"name":"Khathutshelo Vincent Mphaga","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACgwM8ICqBgR9MFRChxRKmRbIBRBkQocUepsXgANhSIrSY3e49+PFLTVri5vOrEz88MGCQ5xc7QEDLnXPJ0jLHchK33Xi7WQLoMMOZsxMIaLmRYyAtwVZhbHbj7AaQlgSD2wS0GNzIMf4t8a/C2HjG2c0/iNViJvmxLUfOgL93G5G23DljZs3YlyYncYN3m0WCgQRhvxjc7jG++eNbMg9//9nNN39U2MjzSxPQwiDBwMAMjhqJBCiXIACqYfwBYvAfIEL1KBgFo2AUjEgAAKQlSfP8SIm9AAAAAElFTkSuQmCC","orcid":"","institution":"University of Johannesburg","correspondingAuthor":true,"prefix":"","firstName":"Khathutshelo","middleName":"Vincent","lastName":"Mphaga","suffix":""},{"id":357910958,"identity":"0626f753-0103-454b-b56d-5c538683736e","order_by":1,"name":"Wells Utembe","email":"","orcid":"","institution":"University of Johannesburg","correspondingAuthor":false,"prefix":"","firstName":"Wells","middleName":"","lastName":"Utembe","suffix":""},{"id":357910959,"identity":"f37f045a-fd2d-420a-bcf7-a6c86433834c","order_by":2,"name":"Thokozani P. Mbonane","email":"","orcid":"","institution":"University of Johannesburg","correspondingAuthor":false,"prefix":"","firstName":"Thokozani","middleName":"P.","lastName":"Mbonane","suffix":""},{"id":357910960,"identity":"29fdfa76-298b-4a4c-b2cf-9d0570ba208c","order_by":3,"name":"Phoka C. Rathebe","email":"","orcid":"","institution":"University of Johannesburg","correspondingAuthor":false,"prefix":"","firstName":"Phoka","middleName":"C.","lastName":"Rathebe","suffix":""}],"badges":[],"createdAt":"2024-09-05 10:36:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5037478/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5037478/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67197151,"identity":"2a6e820a-b1b8-42c1-bd4e-12720b3e9dc9","added_by":"auto","created_at":"2024-10-22 09:16:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35314,"visible":true,"origin":"","legend":"\u003cp\u003eParticipants distribution\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5037478/v1/dd0570e3d877dab196bd1d74.png"},{"id":67198203,"identity":"751e5551-910d-4f0f-963e-603537291fc3","added_by":"auto","created_at":"2024-10-22 09:24:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1091640,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5037478/v1/40a42966-54cc-4ce8-b64b-252bc079daa8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Indoor Radon Exposure and Health Risks in a Community Proximal to Gold Mine Tailings in Gauteng Province, South Africa: A Cross-Sectional Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eRadon, a radioactive gas, is a major natural source of ionizing radiation that affects humans (Bersimbaev et al, 2017). Discovered by physicist Ernest Rutherford in 1899, radon occurs naturally in several isotopic forms, but only radon-219, radon-220, and radon-222 are found in high environmental concentrations (Leuchner \u0026nbsp;et al, 1989; Terblanche et al, 1991; Eidy et al, 2024). Radon-222 (hereafter radon), with a half-life of 3.8 days, is the most stable and common isotope of radon. It is the immediate decay product of radium-226 and is transient in the decay process of uranium-238 (Terblanche et al, 1991). Due to its extended half-life, radon can easily permeate from the surroundings into residential buildings. Being a noble gas and the densest known gas, radon is eight times denser than air, allowing it to accumulate in confined areas (Terblanche et al, 1991; ICRP, 1993; IAEA, 2019). This odorless and colorless gas is generated from the disintegration of uranium-238 in soil, rock, and water (Terblanche et al, 1991; Bersimbaev et al, 2017). Radon gas can accumulate to dangerous levels particularly in poorly ventilated spaces (WHO, 2009; IAEA, 2019). Radon gas is commonly found in the ground beneath dwellings, some building materials, ground water, outdoor air, and natural gas. It can seep into buildings through cracks and gaps in the foundations and walls, as well as around service pipes. While radon itself is not directly harmful, its decay products, polonium-218 and polonium-214, emit alpha particles that can damage DNA, thereby increasing the risk of health problems (WHO, 2009; Eidy et al, 2024). Radon daughter products are also radioactive and easily attach themselves to whatever they encounter. Exposure occurs primarily through inhalation and to a lesser extent through ingestion of radon or radon-laden dust particles (Terblanche et al, 1991; WHO, 2009; Eidy et al, 2024).\u003c/p\u003e\n\u003cp\u003eRadon gas is a recognized as a major threat to human health due to its established link to lung cancer (Bersimbaev et al, 2017). Classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), World Health Organization (WHO) and US Environmental Protection Agency (EPA), radon exposure is the leading cause of lung cancer in non-smokers and a second contributor for smokers (WHO, 2009; Ruano-Ravina et al, 2017). Radon short-lived radioactive radon daughters, when inhaled readily attach to lung tissue, emitting alpha particles that damage cells and increase cancer risk (Terblanche etal, 1991; Eidy et al, 2024). The World Health Organization (WHO) recommends an indoor radon reference level of 100 Bq/m\u0026sup3;, with a maximum acceptable level of 300 Bq/m\u0026sup3; in cases where reaching the lower level is impractical (WHO, 2009). Notably, even low to moderate concentrations pose a risk, with studies suggesting between 8 to 16% increase in lung cancer risk for every 100 Bq/m\u0026sup3; increase in radon exposure (Darby et al, 2005; Krewski et al, 2006; IAEA, 2019; Stanely et al, 2019). Additionally, it has been confirmed that residential radon exposure is a risk factor for lung cancer even at levels below those recommended by international organizations (Lorenzo-Gonzalez et al, 2020). Fernandez-Navarro et al. (2012) and Moshupya et al. (2019) found a correlation between residing near mining facilities and an elevated risk of lung cancer mortality, further emphasizing the potential health hazards associated with elevated radon levels in such residential settings. Previous research has suggested that the detrimental effects of residential radon exposure extend beyond lung cancer. Studies have demonstrated an association between high residential radon levels and an increased incidence of chronic obstructive pulmonary disease (COPD) (Turner et al, 2012; Yitshak-Sade et al, 2019; Wang et al, 2022). Although the evidence for a link between radon exposure and leukemia risk is primarily derived from ecological studies, these studies has suggested a potential association, particularly for chronic lymphocytic leukemia (Oancea et al, 2017; Zlobina et al, 2022).\u003c/p\u003e\n\u003cp\u003eThe implementation of public health measures to address radon exposure has been a common practice globally, involving national surveys and awareness campaigns (WHO, 2009;\u0026nbsp;IAEA, 2017; Pantelić et al, 2019; IAEA, 2019; Bochicchio et al, 2022). \u0026nbsp;Despite the presence of distinct indoor radon risk factors such as gold mine tailings in South Africa (Terblanche et al, 1991; Maheso et al, 2023;\u0026nbsp;Moshupya et al, 2023). South Africa has yet to establish similar initiatives. These tailings, composed of waste materials from gold extraction, often contain high levels of uranium, a precursor to radon gas (Chanda-Kapata, 2022). While colder climates tend to lead to higher radon exposure due to increased indoor time (Bersimbaev et al, 2017; Stanley et al, 2019). South Africa\u0026apos;s climate may provide some advantage through improved ventilation (Terblanche et al, 1991). \u0026nbsp;However, this potential benefit is offset by the cold Highveld winters and the absence of central heating in many homes (Leuchner et al, 1989). The Witwatersrand area in Gauteng, with a population of over a million, is of concern due to its high density and proximity to gold mine tailings containing high uranium concentrations\u0026nbsp;(Schonfeld et al, 2014; Winde et al, 2019; Zupunski et al, 2023). \u0026nbsp;These gold mine tailings, are a result of over 80 gold mines which has operated in this region since the 18\u003csup\u003eth\u003c/sup\u003e century, pose a significant health risk to residents (Utembe et al, 2015; Iyaloo et al, 2020; Zupunski et al, 2023;). It is estimated that there are 600,000 tons of uranium contained in these tailings across the Witwatersrand basin, presenting a significant environmental health concern that demands immediate attention\u0026nbsp;(Schonfeld et al, 2014; Liefferink, 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite international regulations prohibiting settlements near such sites, historical planning oversights and inadequate environmental controls have resulted in communities residing close to gold mine tailings (Bobbins et al, 2013; Khanyile, 2016; International Human Rights Clinic 2016; Benchmarks Foundation., 2016; Kengni et al, 2022). The presence of elevated uranium in the tailings and surrounding soil, combined with windblown dust and reports of higher respiratory illness rates in nearby communities, necessitates further investigation (Iyaloo et al, 2020; Benchmarks Foundation., 2016; Nkosi et al, 2015). Few small-scale studies have confirmed as association between elevated indoor radon exposure amongst dwellings proximal gold mine tailings (Kamunda et al, 2017; Moshupya et al, 2019). \u0026nbsp;However, epidemiological studies on radon concentration levels and associated health risks are currently lacking in South Africa (Schonfeld et al, 2014). To address this knowledge gap and inform public health interventions, well-designed epidemiological studies are urgently needed. Thus, the aim of this study was to investigate an association between radon exposure and self-reported risks of lung cancer, COPD, and leukemia among residents living in close proximity to gold mine tailings in Gauteng Province. The findings from this research can be used to develop targeted strategies to protect these vulnerable communities.\u003c/p\u003e"},{"header":"2. Materials and Methods ","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study design and population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional epidemiological study was carried out to investigate the association between indoor radon exposure and self-reported lung cancer, COPD and leukemia risk amongst residential homes near gold mine tailings in Gauteng, South Africa. Gauteng is the smallest, most populous (with a population of around 15.8 million) and the main economic hub of the nine provinces of South Africa (Bobbins, 2013; Statistics South Africa, 2022). The name \u0026quot;Gauteng\u0026quot; comes from a Sotho word meaning \u0026ldquo;gold,\u0026rdquo; reflecting the area\u0026apos;s history of gold mining. It is home to the Witwatersrand Basin, the largest gold mining area in the world (International Human Rights Clinic, 2016). The majority of urban and township areas in Gauteng have been established around the minefields (including mine dumps), creating a distinctive landscape different from other mining contexts abroad (Bobbins, 2013). Riverlea is one of many communities located near gold mine tailings storage facilities in Gauteng. In this study, Riverlea was identified as the exposed group due to its close proximity (0.1-2 km) to three dormant and active gold mine tailings storage facilities (Nwaila, 2020). The closest gold mine tailings storage facilities are located less than 200 meters (m) away from the community (Benchmarks Foundation, 2016; Kootbodien et al, 2019). Communities adjacent to gold mine tailings storage facilities are subjected to elevated dust fallout due to the dispersion of fine particles from these facilities (International Human Rights Clinic, 2016;\u0026nbsp;Andraos et al, 2017; \u0026nbsp;Kootbodien et al, 2019; Nkosi et al, 2021). Arid conditions have hindered the rehabilitation of partially vegetated tailings, while current mine dump reclamation for gold extraction has exacerbated dust pollution and deteriorated air quality (Kootbodien et al, 2019; Benchmarks Foundation, 2016). Radon gas, potentially attached to dust particles released from these facilities, can be dispersed by wind and atmospheric turbulence, posing a risk to nearby homes. Additionally, heavy rains through runoffs have been reported to carry contaminants from the gold mine tailings, potentially including radon gas, from the mine tailings to nearby communities (International Human Rights Clinic, 2016). \u0026nbsp;Riverlea is home to 16,226 residents, residing in 4,208 dwellings built around or near gold mine tailings from the past (Benchmarks Foundation, 2016; Kootbodien et al, 2019). Riverlea was selected as an exposed area due to its proximity to gold mine tailings, which could potentially result in higher indoor radon exposure. This increased exposure may consequently lead to a higher risk of radon-induced lung cancer, COPD, and leukemia. The community of Orlando East was chosen as the unexposed (control/reference) group due to the absence of gold mines or a history of mining in the area, which minimizes the potential for radon exposure. The closest gold mine tailings are located more than 2 km away from Orlando East (Chiyangwa, 2020). Orlando East has a population of 68,210 people and 22,416 households (Adrian, 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Sample size and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 7,477 residential dwellings in Riverlea and Orlando East sourced from the City of Johannesburg Online Maps. Only residents from these two communities were included (City of Johannesburg, 2017). Random sampling was conducted using Microsoft Excel 365. The study involved 476 participants, with 238 individuals in both the exposed and control groups. The sample size was determined using EpiInfo Version 7 software, considering a population size of 7,477 residential dwellings, an expected frequency of 20%, a 95% confidence level, and a 5% margin of error. The study permitted one resident per household, over the age of 18 and residing in the area for at least 5 years, to participate with informed consent. Ethical approval was obtained from the University of Johannesburg\u0026apos;s Faculty of Health Sciences Research Ethics Committee and the Higher Degree Committee. Out of 472 potential participants, 89 (18.9%) were unavailable, and 52 (11.0%) declined. A total of 331 individuals participated, resulting in a 70.1% participation rate, evenly distributed between Riverlea and Orlando East (See \u003cstrong\u003eFigure 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Data collection tools and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher, along with two trained assistants who were familiar with the community and spoken language, collected data using structured interviewer-administered questionnaires and four AlphaE radon monitors. The data collection took place during the winter season, specifically from June to July 2023. Upon identifying a selected dwelling, we used a knock-on-the-door approach to target occupants who met the inclusion criteria. Data was gathered through in-person interviews with eligible participants residing in selected residences. Prior to data collection, informed consent was obtained. The interviews were conducted in English, with translation to local language provided when necessary. The structured questionnaire covered socio-demographic characteristics, housing conditions, occupational and smoking histories, and health status. The questionnaire development involved a comprehensive review of published literature, including sources such as the World Health Organization (WHO, 2009) and the International Atomic Energy Agency (IAEA, 2019). Pilot testing was conducted with 16 participants from the study area to ensure the questionnaire\u0026apos;s clarity and suitability for the intended purpose. To guarantee reliability, the results from the pilot study were analyzed using Cronbach\u0026apos;s alpha, which yielded a coefficient of \u0026alpha; \u0026gt; .7, indicating good internal consistency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndoor radon levels were assessed using AlphaE radon monitors deployed in participants\u0026apos; homes. A single monitor was placed in a room where a participant spend most of his or her time, either the bedroom or living room, to evaluate indoor radon concentration. Each radon detector was exposed for two hours, and the resulting average radon concentration, expressed in becquerels per cubic meter (Bq/m\u0026sup3;), was recorded. AlphaE monitors were calibrated both by the manufacturer (Bertin Technologies) and a local laboratory (Selectech) to ensure accuracy. Calibration involved exposing the monitors to a known radon concentration in a sealed chamber alongside a reference unit (AlphaGUARD). The manufacturer and local calibration laboratory reported a precision of \u0026plusmn;10% at the 95% confidence level. All measurements were conducted according to the manufacturer\u0026apos;s protocols. The detectors were placed away from the floor, walls, doors, windows and electronic devices. Radon data contained in the radon detector were transferred into the PC for further analysis using DataVIEW communication software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a bivariate descriptive analysis to examine the distribution of the study variables based on the exposed and control group. Subsequently, we utilized univariate and multivariate logistic regression with radon-induced health problems (self-reported lung cancer, COPD, and leukemia) as the dependent variable and residential radon exposure and dwelling location (Riverlea and Orlando East) as the independent variables. Initially, indoor radon exposure was analyzed as a continuous variable and then as a categorical variable with two categories (\u0026le; 100 Bq/m3 and \u0026ge; 100 Bq/m3). We explored effect modification between indoor radon exposure and other influencing factors (sex, age, tobacco smoking, type of fuel used at home, and occupational history) on the self-reported health problems by including a multiplicative term in the model. Logistic regression results were presented as crude and adjusted odds ratios with a 95% confidence interval. For bivariate analysis, independent variables with a p-value of \u0026lt; 0.20 were considered significant and included in the multivariate analysis. In the multivariate analysis, a p-value of \u0026lt; 0.05 was considered significant. Additional independent variables were included in the multivariate analysis based on established facts from literature or known associations from previous studies. All analyses were conducted using STATA 18 (Stata Corp., College Station, TX, USA).\u003c/p\u003e"},{"header":"3. Results ","content":"\u003cdiv dir=\"RTL\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3.1 Demographic Characteristics of the Participants\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eOut of 476 potential subjects identified for the study, 331 participated in an interviewer-administered questionnaire survey, and valid indoor radon measurements were obtained from their respective dwellings. Ultimately, data from both radon measurements and questionnaire surveys were available for 166 exposed subjects (102 females and 64 males) and 165 control subjects (98 females and 67 males), following a 1:1 matching design (\u003cstrong\u003eTable 1\u003c/strong\u003e). The majority of the participants were female, comprising 102 (61.4%) exposed individuals and 98 (59.4%) controls. The age distribution differed notably between the two groups. The exposed group had a higher proportion of younger residents, with 24 (14.5%) participants under the age of 39 years. In contrast, the control group had a significantly higher percentage of older residents, with 100 (60.6%) participants who were 60 years and above. Educational attainment was similar between the two groups, with most participants having completed high school. However, the control group had a slightly higher proportion of individuals with tertiary education, 27 (16.4%) compared to 13 (7.8%) in the exposed group. Employment rates were comparable, but the control group had a higher unemployment rate (84.1% compared to 76.5% in the exposed group). Both communities primarily resided in brick houses. Notably, a significantly higher percentage of the control group (89.7%) had lived in their current homes for over 31 years compared to the exposed group (70.5%). Ventilation practices were comparable between the two groups, with frequent ventilation being the norm. Radon testing was uncommon in both communities, with less than 2% of participants reporting prior testing. For detailed information regarding the dwelling characteristics of the participants, please refer to our previous publication [45].\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Demographic Characteristics of the Participants\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv dir=\"ltr\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eRiverlea\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en=166 (50.2%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eOrlando East\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en= 165 (49.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e102 (61.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e98 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e64 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e67 (40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eBelow 39 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e24 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e13 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e40 \u0026ndash; 49 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e33 (19.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e24 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e50 \u0026ndash; 59 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e45 (27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e28 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e60 Years and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e64 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e100 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e59 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e81 (49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e65 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e70 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSeparated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eWindowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e29 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eBlack African\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e163 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eColored\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e159 (95.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIndian/Asian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e59 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e40 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigh school completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e94 (56.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e98 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTertiary completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e13 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e27 (16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEmployment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e39 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e26 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e127 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e138 (84.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLess than 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e15 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYears in the same house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 \u0026ndash; 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e13 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21 \u0026ndash; 30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8 (4.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMore than 31 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e117 (70.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e148 (89.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHouse type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eBrick house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e166 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e159 (96.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOther (i.e shack)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOften\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e149 (89.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e107 (64.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eVentilation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e15 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e28 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLess than 10 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e34 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHours inside the house per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 \u0026ndash; 20 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e45 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e96 (58.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMore than 21 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e87 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e57 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTested for radon in the past\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 216px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 206px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e163 (98.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (98.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3.2 Risk factors\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eThe following section (\u003cstrong\u003eTable 2\u003c/strong\u003e) compared the exposure factors and smoking habits of the populations in the exposed and control groups. The main aim was to identify variations in exposure risks and smoking behaviors between these two groups. While there were a limited number of participants reporting exposure to carcinogens, irritants, and toxins in both groups, a significant disparity was observed between the exposed and control groups. The analysis revealed a significantly higher prevalence of occupational exposure to these substances among the exposed individuals, with 21 individuals (n=21; 12.7%) compared to only 3 individuals (n=3; 1.8%) in the control group. A small number of participants from both communities reported working in underground mines, indicating that underground mining was not a significant occupational exposure factor for either population. The study also evaluated smoking habits across various dimensions, including current smoking status, household smoking, and indoor tobacco smoke exposure. The findings indicated a substantially higher percentage of current smokers in the exposed group (n=97; 58.4%) compared to the control group (n=44; 26.7%), suggesting a higher prevalence of smoking in the exposed group. Furthermore, a higher proportion of households in the exposed group had at least one smoker (n=105; 63.3%) compared to the control group (n=80; 49.1%). Moreover, a greater percentage of exposed households (n=76; 46.3%) were exposed to indoor tobacco smoke compared to the control group (n=48; 29.3%). Among smokers, a higher proportion of exposed residents reported a longer duration of smoking, with a significant number having smoked for over 33 years (n=26; 15.7%) compared to only 1 individual (0.6%) in the control group, indicating a more established smoking habit in this community.\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Risk factors\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cdiv dir=\"ltr\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eRiverlea\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en=166 (50.2%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eOrlando East\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en=165 (49.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOccupational exposure to carcinogens, irritants,\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eand toxins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e145 (87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e162 (98.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYears of exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLess than 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e17 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMore than 30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNot applicable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e145 (87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e162 (98,2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e`2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you worked in underground mine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e162 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNever smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e57 (34.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e115 (69.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTobacco smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEx-smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCurrent smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e97 (58.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e44 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDoes anyone in the household smoke?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e105 (63.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e80 (49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e61 (36.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e83 (50.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOne\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e43 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e43 (26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNumber of current smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMore than 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e71 (42.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e42 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e52 (31,3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e80 (48.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTobacco smoking indoors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e76 (46.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e48 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e88 (53.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e116 (70.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e57 (34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e116 (70.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNumber of cigarettes per day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026le;10 Cigarette/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e85 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e37 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11- 21 Cigarette/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e24 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 (6.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026ge; 22 Cigarettes/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e56 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e115 (69.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLess than 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e38 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYears of smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 \u0026ndash; 21 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30 (18.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003e22 \u0026ndash; 32 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e16 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMore than 33 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e26 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3.3 Radon measurements\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eIndoor radon levels were compared between exposed and control group. Radon measurements were obtained from the dwellings in the exposed and control group (\u003cstrong\u003eTable 3\u003c/strong\u003e). The radon levels in both groups exhibited a wide range, as evidenced by the minimum and maximum values. The exposed group had a significantly higher mean radon level (103.30 \u0026plusmn; 94.91 Bq/m\u0026sup3;) compared to the control group (65.19 \u0026plusmn; 47.83 Bq/m\u0026sup3;). When considering the geometric mean, which is less influenced by outliers, the disparity between the groups was less pronounced. The exposed group had a geometric mean of 81.59 Bq/m\u0026sup3;, while the control group had a geometric mean of 52.49 Bq/m\u0026sup3;. A substantial proportion of dwellings in both groups exceeded the World Health Organization (WHO) reference level of 100 Bq/m\u0026sup3;. In the exposed group, (n=68; 41%) of the dwellings exceeded this threshold, whereas in the control group, (n=31; 19%) exceeded it. Indoor radon levels were significantly linked to the location of the homes, with homes near (\u0026le;2 Km) gold mine tailings (exposed) experiencing elevated indoor radon levels compared to those farther away (\u0026ge;2 Km) from the mine (control). For detailed information on the factors influencing indoor radon levels, please refer to our other paper [45].\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eTable 3. Residential radon gas concentration for exposed and control group\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv dir=\"ltr\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eExposed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e11.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e1078.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e379.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eArithmetic Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e103.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e65.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e94.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e47.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eGeometric mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e81.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e52.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 42.4242%;\"\u003e\n \u003cp dir=\"LTR\"\u003eDwellings exceeding WHO Reference level of 100 Bq/m3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 39.3939%;\"\u003e\n \u003cp dir=\"LTR\"\u003e68 (68, 7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.1818%;\"\u003e\n \u003cp dir=\"LTR\"\u003e31 (31, 3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e3.4 Adverse health problems\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eThis study compared the frequency of various respiratory health conditions between a group exposed to high radon levels and a control group (\u003cstrong\u003eTable 4\u003c/strong\u003e). Despite most participants in both groups having access to healthcare, a significantly higher percentage of individuals in the control group (n=80; 50.6%) reported easy access compared to the exposed group (n=57; 26.6%). The exposed group had significantly higher rates of several respiratory diseases, including tuberculosis (7.2% vs. 8.5%), bronchitis (8.4% vs. 4.2%), and asthma (9.6% vs. 3.7%). Additionally, a significant proportion of the exposed group reported persistent cough, shortness of breath, and unexplained weight loss compared to the control group. The control group reported no cases of COPD, while a single case was identified in the exposed group. The prevalence of leukemia was low in both groups, with no significant differences observed. The exposed group had a significantly higher prevalence of lung cancer diagnoses (n=3; 1.8%), compared to the control group (n=1, 0.6%). Moreover, a notably higher percentage of the exposed group had relatives diagnosed with lung cancer (n=27; 16.3%) compared to the control group (n=2; 1.2%). The exposed group also had a significantly higher rate of deaths due to lung cancer among relatives (n=26; 15.7%) compared to the control group (n=2; 1.2%). The majority of participants in both groups expressed a willingness to participate in lung cancer screening, with slightly higher rates in the exposed group (n=153; 92.7%) compared to the control group (n=143; 87.2%).\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eTable 4: Adverse health problems for exposed and control group\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv dir=\"ltr\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eRiverlea\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en=166 (50.2%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eOrlando East\u003c/strong\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003en=165 (49.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAccess to health care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDifficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e70 (42,4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e44 (27.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e38 (23.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e34 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEasy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e57 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e80 (50.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you ever been diagnosed with TB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14 (8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e154 (92.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e151 (91.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you ever been diagnosed with bronchitis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e152 (91.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e158 (95.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you ever been diagnosed with Asthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e16 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e150 (90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e158 (96.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRelative diagnosed with Asthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e38 (22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e22 (13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e128 (77.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e143 (86.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you ever been diagnosed with COPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (99.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you ever been diagnosed with leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (99.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRelative with leukemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (99.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you been diagnosed with lung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e163 (98.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (99.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRelative diagnosed with lung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e27 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e139 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e163 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHave you lost a relative due to lung cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e26 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e140 (84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e163 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDo you experience persistent cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e48 (28.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e118 (71.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e158 (95.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDo you experience shortness of breath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e37 (22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e129 (77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e158 (95.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDo you cough blood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e164 (98.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eUnexplained weight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e162 (97.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRepeated respiratory infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e15 (9.0%)_\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e151 (91.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e165 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003eWillingness to participate in lung cancer screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e153 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e143 (87.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Association between various risk factors and lung cancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLogistic regression analysis was employed to calculate crude and adjusted odds ratios (ORs) for lung cancer risk, with 95% confidence intervals (CIs) (\u003cstrong\u003eTable 5\u003c/strong\u003e). The results revealed a significant association between dwelling location and lung cancer risk (crude OR = 0.063, 95% CI = 0.015-0.270, p \u0026lt; 0.001; adjusted OR = 0.048, 95% CI = 0.010-0.210, p \u0026lt; 0.001). However, no statistically significant association was observed between indoor radon exposure and lung cancer risk, neither in the crude analysis (OR = 1.000, 95% CI = 0.995-1.004, p = 0.983) nor in the adjusted analysis (OR = 0.995, 95% CI = 0.988-1.003, p = 0.250). Active smoking and passive smoking were also considered as potential risk factors. While the crude analysis suggested a non-significant association with lung cancer risk for both active (OR = 1.365, 95% CI = 0.917-2.032, p = 0.125) and passive smoking (OR = 1.604, 95% CI = 0.746-3.447, p = 0.226), the adjusted analyses revealed that these associations were attenuated and no longer statistically significant (active smoking: OR = 0.980, 95% CI = 0.587-1.636, p = 0.939; passive smoking: OR = 1.104, 95% CI = 0.419-2.908, p = 0.841). Occupational exposure to carcinogens, irritants, and toxins emerged as a significant risk factor for lung cancer in the adjusted analysis (OR = 7.545, 95% CI = 1.799-29.013, p = 0.031). This finding suggests that occupational exposure may play a more substantial role in lung cancer risk.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e\u003cstrong\u003e: Estimated odds ratios for lung cancer in relation to various factors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Crude Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDwelling location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e0.063 (0.015-0.270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e0.0477 (0.010-0.210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndoor Radon Exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e1.000 (0.995-1.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e0.995 (0.988-1.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e1.365 (0.917-2.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e0.980 (0.587-1.636)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePassive smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e1.604 (0.746-3.447)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e1.104 (0.419-2.908)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.5102%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22.449%;\"\u003e\n \u003cp\u003e0.104 (0.071-0.153)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3061%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3878%;\"\u003e\n \u003cp\u003e7.545 (1.799-2.013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3469%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Association between various risk factors and leukemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the association between various risk factors and leukemia incidence, a comparative analysis was conducted between the exposed and control groups. The results, presented in \u003cstrong\u003eTable 6\u003c/strong\u003e, highlight significant disparities in exposure to several risk factors. Individuals residing in the exposed community exhibited a significantly higher risk of leukemia compared to the control group, as indicated by a crude odds ratio of 0.178 (95% CI: 0.072-0.442, p \u0026le; 0.001). However, after adjusting for confounding factors, this association was no longer statistically significant, suggesting that the initial association might be attributable to other factors. A consistent, strong association was observed between indoor radon exposure and the risk of leukemia. Both the crude and adjusted odds ratios were significantly elevated, indicating a 6.7% and 7.1% increased risk of leukemia for each 100 Bq/m\u0026sup3; increase in radon exposure, respectively. While active smoking did not exhibit a significant association with leukemia risk in the adjusted analysis, passive smoking was marginally associated with an increased risk. The crude odds ratio for passive smoking was 1.531 (95% CI: 0.746-3.447, p = 0.242), but after adjusting for confounders, the association weakened to 1.293 (95% CI: 0.886-1.601, p = 0.068). The analysis revealed a non-significant association between occupational exposure and leukemia risk. The crude odds ratio was 1.438 (95% CI: 0.781-2.645, p = 0.243), and the adjusted odds ratio remained non-significant at 1.694 (95% CI: 0.591-4.858, p = 0.327).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Estimated odds ratios for leukemia in relation to various factors\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDwelling location\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e0.178 (0.072-0.442)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e0.342 (0.075-1.549)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndoor Radon Exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e1.067 (1.044-1.089)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e1.071 (1.045-1.097)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e1.237 (0.862-1.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e0.977 (0.608-1.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePassive smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e1.531 (.746-3.447)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e1.293 (0.886-1.601)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30.6122%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupational exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.4694%;\"\u003e\n \u003cp\u003e1.438 (0.781-0.645)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.551%;\"\u003e\n \u003cp\u003e1.694 (0.591-4.858)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.18367%;\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3.7 Association between various risk factors and COPD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study examined the association between several risk factors and COPD. To assess these relationships, a comparative analysis was conducted between exposed and control groups (\u003cstrong\u003eTable 7\u003c/strong\u003e). Dwelling Location: While initial analysis suggested a potential association between dwelling location and COPD risk (crude odds ratio: 2.440, p-value: 0.133), this association was not sustained after adjusting for confounding factors (adjusted odds ratio: 1.022, p-value: 0.581). Neither the crude nor adjusted analyses revealed a statistically significant association between indoor radon exposure and COPD risk. Both active and passive smoking were investigated as potential risk factors. Active smoking showed a non-significant crude association (crude odds ratio: 1.601, p-value: 0.458) but a slightly attenuated adjusted association (adjusted odds ratio: 0.842, p-value: 0.827). Passive smoking, on the other hand, exhibited a non-significant crude association (crude odds ratio: 3.327, p-value: 0.328) and a marginally significant adjusted association (adjusted odds ratio: 2.652, p-value: 0.520). The most notable finding was a significant association between occupational exposure and COPD risk. While the crude analysis indicated a non-significant association (crude odds ratio: 1.243, p-value: 0.311), the adjusted analysis revealed a significantly increased risk of COPD among individuals exposed to occupational hazards (adjusted odds ratio: 2.201-2.662, p-value: 0.214).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e: Association between various risk factors and COPD\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eDwelling location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e2.440 (0.133-0.396)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e\u0026le;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e1.022 (0.988-1.057)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eIndoor Radon Exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e1.003 (0.996-1.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e1.001 (0.994-1.008)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eActive smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e1.601 (0.463-5.541)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e0.842 (0.179-3.955)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.827\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003ePassive smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e3.327 (0.299-3.087)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e2.652 (0.135-1.963)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29.8969%;\"\u003e\n \u003cp\u003eOccupational exposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23.7113%;\"\u003e\n \u003cp\u003e1.243 (0.146-0.788)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.8351%;\"\u003e\n \u003cp\u003e0.001 (2.201-2.662)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27835%;\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this cross-sectional study, we investigated indoor radon exposure in residential dwellings proximal to the gold mine tailings and its potential correlation with self-reported occurrences of lung cancer, COPD, and leukemia in the Gauteng province. The study involved 166 participants residing near the gold mine tailings (exposed group) and 165 participants residing farther away from the gold mine tailings (unexposed/ control group). The exposed group was located within 2 kilometers of the nearby gold mine tailings, while the control group was situated more than 2 kilometers away. The exposed individuals were selected from an area with expected high indoor radon levels, while the unexposed group was chosen from surrounding areas with anticipated low radon concentrations. Previous studies conducted within occupational settings have highlighted the association between elevated radon levels and increased risk of lung cancer (Edwards et al, 2014; Lane et al, 2019; Chen et al, 2023), COPD (Conde-Sampayo et al, 2020; Chen et al, 2023) and leukemia (Řeřicha et al, 2006). There is a growing necessity to consider the various pathways of exposure for the general public to a wide range of carcinogens, including radon gas (Fishbein, 1992). The need to consider indoor environments is increasingly acknowledged due to the amount of time spent indoors by a large majority of the population and the recognition that levels of certain toxic substances are higher indoors than outdoors (Fishbein, 1992). This is one of the initial studies to investigate the connection between indoor radon exposure near gold mine tailings (anticipated to contribute to increased indoor radon concentrations) and self-reported lung cancer, COPD, and leukemia risk in the Gauteng province and South Africa as a whole.\u003c/p\u003e\n\u003cp\u003e4.1 Indoor radon exposure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe current study revealed a substantial disparity in radon exposure between the exposed and control groups. The exposed group exhibited significantly higher mean radon levels compared to the control group. However, when considering the geometric mean, which is less influenced by outliers, the difference between the groups was less pronounced. Nonetheless, a substantial proportion of dwellings in both groups exceeded the WHO reference level of 100 Bq/m\u0026sup3;. The observed levels in the exposed group were comparable to those reported in previous studies conducted within residential dwellings (Moshupya \u0026nbsp;et al, 2019; Wang et al, 2022, Kamunda et al, 2017). Moreover, the elevated indoor concentrations in the exposed group were comparable to those observed in occupational studies (Martin-Gisbert et al, 2023). This suggests that individuals residing proximal gold mine tailings may be exposed to radon levels that are comparable to those encountered in occupational settings, potentially increasing their risk of health adverse effects. Several studies have reported that a significant percentage of residential dwellings, particularly in regions with high uranium content in the soil, such as proximal gold mine tailings exceed recommended radon levels (Mlay et al, 2018; Mohammed, 2018; Yazzie et al, 2020). These findings underscore the importance of radon mitigation strategies to protect public health.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.2 Lung cancer\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional study, logistic regression analysis was employed to investigate the association between indoor radon exposure and the likelihood of developing lung cancer. Furthermore, we examined the influence of dwelling location, smoking, and occupational exposure on the risk of lung cancer. Even though the exposed group was subjected to higher indoor radon levels compared to the control group, no statistically significant association was found between indoor radon exposure and the risk of lung cancer, both in the crude and adjusted analyses. The lack of a significant association between indoor radon exposure and lung cancer risk in this study was unexpected, given the well-established link between radon exposure and lung cancer risk reported in previous studies (Auvinen et al, 1996;\u0026nbsp;Bochicchio \u0026nbsp;et al, 2000; 58.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Barros-Dios et al, 2002; Torres-Dur\u0026aacute;n et al, 2014; Ha et al, 2017; Lee et al, 2015; Hassfjell et al, 2017; Kim et al, 2018; Gariazzo et al, 2021). \u0026nbsp;Notably, similar studies conducted in residential settings proximal gold mining in South Africa and Cameroon have reported positive associations between radon exposure and lung cancer risk (Moshupya et al, 2023;\u0026nbsp;Nkoulou et al, 2023). The observed positive correlations in prior research (primarily case-control and pooled radon studies) may be attributed to their extensive sample sizes, comprehensive data from national radon surveys, and mortality data related to lung cancer, all of which can enhance statistical robustness (Keith et al, 2012). However, the current study did not find a significant association between indoor radon exposure and lung cancer risk, which was consistent with a previous study in Poland (Grzywa-Celińska, \u0026nbsp;et al, 2022). In our current study, we did not find a substantial link between lung cancer and residential radon exposure. This outcome could be attributed to several factors, such as the observed indoor radon levels and the relatively limited sample size. Previous research has indicated a higher risk of lung cancer among individuals exposed to indoor radon levels exceeding 200 Bq/m3 (Torres-Dur\u0026aacute;n et al, 2014; Lorenzo-Gonz\u0026aacute;lez \u0026nbsp;et al, 2019), a threshold significantly higher than the levels observed in our study. The study\u0026apos;s small sample size, a typical limitation in single residential epidemiological studies, may have limited the statistical power to detect a significant connection between radon exposure and negative health effects like lung cancer (Keith et al, 2012). This suggests that although there is generally strong evidence for a causal relationship between radon exposure and lung cancer, regional variations in radon concentrations, study design, and population characteristics could affect the observed associations (Keith et al, 2012).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study found a strong link between living close to gold mine tailings and an increased risk of lung cancer. People who lived further away from the gold mine tailings were less likely to develop lung cancer. These results support previous research from Spain, which also showed higher lung cancer risk among people living near mining sites (Fern\u0026aacute;ndez-Navarro et al, 2012). This association may be due to the release of carcinogenic pollutants like uranium from gold mine tailings into the air. These pollutants tend to have a limited dispersion, often impacting nearby populations\u0026nbsp;(Chanda-Kapata, 2020). Despite the well-established causal link between smoking (both active and passive) and lung cancer risk, our study did not reveal a statistically significant association. This unexpected finding contradicts numerous prior studies that have consistently identified smoking as the primary risk factor for lung cancer (Mezzoiuso et al, 1994; Auvinen et al, 1996\u0026nbsp;71.\u0026nbsp; \u0026nbsp; \u0026nbsp;Walser et al, 2008;\u0026nbsp;Park et al, 2019; Nhu Ngoc et al, 2022). Most of these studies have reported a synergistic association between radon exposure and smoking, suggesting that individuals exposed to both factors may be at an elevated risk of developing lung cancer (Park et al, 2019; Nhu Ngoc et al, 2022). Potential explanations for this discrepancy could include the small sample size, limitations in smoking exposure assessment, or the possible presence of other confounding factors that were not adequately controlled. The overall prevalence of exposure to carcinogens, irritants, and toxins was relatively low in both groups, but individuals in the exposed group reported significantly higher rates of occupational exposure to these substances. These findings were consistent with previous research demonstrating limited occupational exposure to lung cancer-causing agents among participants (Auvinen et al, 1996\u0026nbsp;;\u0026nbsp;Torres-Dur\u0026aacute;n et al, 2014). In the adjusted analysis, occupational exposure to carcinogens, irritants, and toxins emerged as a substantial risk factor for lung cancer, aligning with a Finnish study that found exposure to carcinogens was associated with a slight increase in the risk of lung cancer (Auvinen et al, 1996). This result suggested that occupational exposure play a crucial role in exacerbating the health risks associated with radon exposure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.3 Chronic Obstructive Pulmonary Diseases (COPD) and Leukemia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevious research has consistently demonstrated a strong correlation between indoor radon exposure and an elevated risk of developing certain types of cancer, particularly lung cancer. However, the association between residential radon exposure and other health conditions is still under active investigation. This study investigated the potential correlation between indoor radon exposure and two specific health conditions: leukemia and chronic obstructive pulmonary disease (COPD). This study also examined the relationship between different risk factors, including residential location, smoking, occupational exposure, and the incidence of Chronic Obstructive Pulmonary Disease (COPD) and leukemia among individuals living near gold mine tailings. While the initial analysis indicated a possible correlation between living near gold mine tailings and a higher risk of COPD, this association was not confirmed after considering the influence of other risk factors, such as smoking. The possible association between proximity to gold mine tailings and increased risk of respiratory diseases such as COPD was observed in previous studies conducted in the same settings as the present study (Iyaloo et al, 2020; Nkosi et al, 2015a; Nkosi et al, 2015b). \u0026nbsp;Increased COPD risk in these areas could be attributed to various factors, including the release of fine particles from the tailings (Benchmarks Foundation, 2016;\u0026nbsp;International Human Rights Clinic, 2016). These particles possess high airborne transport and floating capacity, enabling them to contaminate the air of the mining region and spread over vast distances (Da Silva-R\u0026ecirc;go et al, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur findings revealed a significant association between indoor radon exposure and the development of leukemia. Individuals residing in homes with elevated radon levels were associated with increased leukemia risk compared to those living in homes with lower radon concentrations. These results corroborate previous studies indicating that radon exposure can induce genetic damage, a potential mechanism underlying the development of leukemia. Specifically, Zlobina et al. (2022), Oancea et al. (2017), and Schwartz et al. (2015) have provided compelling evidence supporting the association between radon exposure and leukemia. In contrast, our analysis did not reveal a statistically significant association between indoor radon exposure and chronic obstructive pulmonary disease (COPD). Although prior studies in the United States have suggested a possible link (Wang et al, \u0026nbsp;2022; Yitshak-Sade et al, 2019; \u0026nbsp;Turner et al, 2012), our findings, along with those of Spanish researchers (Barbosa-Lorenzo \u0026nbsp;et al, 2017;\u0026nbsp;Pando-Sandoval et al, \u0026nbsp; 2022;\u0026nbsp;Ruano-Ravina et al, 2021), indicated that the evidence for such a connection remains inconclusive. It\u0026apos;s crucial to note that the absence of a significant association in our study does not definitively rule out the possibility of a relationship between radon exposure and COPD. Further research are needed to address this issue, taking into account factors previously identified as potential confounders in the association between radon exposure and lung cancer.\u003c/p\u003e\n\u003cp\u003eNumerous literature has demonstrated a conclusive association between cigarette smoking and an increased risk of chronic obstructive pulmonary disease (COPD) and leukemia (Laniado-Labor\u0026iacute;n, 2008;\u0026nbsp;Fircanis et al, 2014; Chung et al, 2021). However, the present study failed to find a statistically significant correlation between these variables. This contrasts with existing research that has consistently associated smoking with a higher likelihood of developing COPD (Fircanis et al, 2014; Chung et al, 2021). While our results may appear contradictory, they do not discount the well-established evidence of tobacco smoke\u0026apos;s detrimental effects on respiratory and hematological health (WHO, 2009). It\u0026apos;s possible that our study lacked the power to detect a significant association, or that other factors, such as genetic predisposition or environmental exposures, may have affected the outcomes. Nevertheless, our findings emphasize the importance of future research to understand the complex relationship between smoking, genetics, and disease risk. Despite specific statistical results, the overwhelming consensus remains that reducing tobacco smoke exposure is a crucial public health measure to alleviate the burden of COPD and leukemia (Jha, 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e4.4 Strengths and Weaknesses of the Study\u003c/p\u003e\n\u003cp\u003eThe study employed a well-designed cross-sectional epidemiological approach to investigate the association between indoor radon exposure from gold mine tailings and health problems. It utilized calibrated radon monitors and structured questionnaires to enhance data accuracy and employed appropriate statistical methods to control for potential confounders. However, the cross-sectional design limited the ability to establish temporal relationships between exposure and health outcomes, highlighting the need for longitudinal studies to provide stronger evidence of causality. The reliance on self-reported data for health outcomes and other variables may have introduced measurement bias, potentially affecting the accuracy of the findings. Additionally, the study\u0026apos;s sample size, although reasonably large, may have been insufficient to detect small or moderate associations between exposure and health outcomes, especially for rare diseases. Using a larger sample size would have increased the statistical power of the study. Furthermore, relying on a single radon measurement per dwelling may not have accurately captured the variability of indoor radon levels over time. Multiple radon measurements would have provided a more reliable assessment of exposure. Finally, the study\u0026apos;s findings, focused on a specific community exposed to gold mine tailings, may not be directly applicable to other populations with different exposure sources or living conditions, necessitating further research to assess the generalizability of the results.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eThe research provides strong evidence of the health risks associated with indoor radon exposure in a community near gold mine tailings. Although the study showed significantly higher radon levels in the exposed group compared to the control group, there was no statistically significant association between radon exposure and lung cancer risk. However, the research did identify significant correlations between radon exposure and leukemia, as well as other risk factors such as residential location, smoking, and occupational exposure. These findings underscore the importance of implementing radon mitigation strategies, raising public awareness, and conducting further research to protect public health and minimize the adverse effects of radon exposure. By employing a comprehensive approach involving radon testing, remediation, policy development, and public education, we can effectively mitigate the health risks associated with this environmental hazard.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary Materials:\u0026nbsp;\u003c/strong\u003eN/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Conceptualization, M.K.V. and R.P.C; methodology, M.K.V; R.P.C software, M.K.V; M.T.P; validation, W.U, R.P.C and M.T.P; formal analysis, M.K.V; M.T.P investigation, M.K.V; resources, R.P.C; data curation, M.T.P; writing\u0026mdash;original draft preparation, M.K.V; writing\u0026mdash;review and editing, M.K.V; visualization, M.T.P; supervision, U.T; R.P.C project administration, M.K.V; funding acquisition, R.P.C. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The Principal Investigator (P.C.R.) received funding from NRF (Support for Y-rated Researchers Programme (Grant number\u0026mdash;CSRP23030380716) which was used during data collection, analysis, and project conclusion phases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and approved by the University of Johannesburg Faculty of Health Sciences Research Ethics Committee (REC) (Clearance Number REC-1889-2023) and the Higher Degree Committee (HDC-01-115-2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e All data are available upon request by emailing the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdrian Frith. (2022). Orlando East. Available online: https://census2011.adrianfrith.com/place/798026037 (Accessed on 06 June 2022).\u003c/li\u003e\n\u003cli\u003eAndraos C., Utembe W., Gulumian M. (2018). Exceedance of environmental exposure limits to crystalline silica in communities surrounding gold mine tailings storage facilities in South Africa. Sci. Total Environ; 619\u0026ndash;620:504\u0026ndash;516. doi: 10.1016/j.scitotenv.2017.11.135 \u003c/li\u003e\n\u003cli\u003eAuvinen A, M\u0026auml;kel\u0026auml;inen I, Hakama M, Castr\u0026eacute;n O, Pukkala E, Reisbacka H, Ryt\u0026ouml;maa T. (1996). Indoor radon exposure and risk of lung cancer: a nested case\u0026mdash;control study in Finland. 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Environment international, 130:104865.\u003c/li\u003e\n\u003cli\u003eZlobina A, Farkhutdinov I, Carvalho FP, Wang N, Korotchenko T, Baranovskaya N, Farkhutdinov A. (2022). Impact of environmental radiation on the incidence of cancer and birth defects in regions with high natural radioactivity. International Journal of Environmental Research and Public Health, 19(14):8643.\u003c/li\u003e\n\u003cli\u003eZupunski, L., Street, R., Ostroumova, E., Winde, F., Sachs, S., Geipel, G., et al. (2023). Environmental exposure to uranium in a population living in close proximity to gold mine tailings in South Africa. Journal of Trace Elements in Medicine and Biology, 77, 127141. https://doi.org/10.1016/j.jtemb.2023.127141\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"environmental-geochemistry-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"egah","sideBox":"Learn more about [Environmental Geochemistry and Health](https://www.springer.com/journal/10653)","snPcode":"10653","submissionUrl":"https://submission.nature.com/new-submission/10653/3","title":"Environmental Geochemistry and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Indoor radon exposure, chronic obstructive pulmonary diseases (COPD), leukemia, Gauteng, lung cancer","lastPublishedDoi":"10.21203/rs.3.rs-5037478/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5037478/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Exposure to indoor radon presents a significant risk for lung cancer and is also suspected to be associated with other health issues such as chronic obstructive pulmonary diseases (COPD) and leukemia. This study examined the association between indoor radon exposure and self-reported cases of lung cancer, COPD, and leukemia among individuals living in close proximity to gold mine tailings, a known source of high radon levels. A cross-sectional study was carried out among residents living near or further away from gold mine tailings in Gauteng, South Africa. A total of 331 residents took part in an interviewer-administered questionnaire survey on socio-demographic characteristics, smoking habits, occupational exposures, adverse health problems, and other factors related to lung cancer, COPD, and leukemia. Subsequently, their homes were tested for indoor radon concentration on the lowest livable floor over a two-hour period from June to July 2023 using AlphaE radon monitors. Logistic regression was employed to calculate odds ratios (OR) for lung cancer, COPD, and leukemia based on indoor radon exposure, dwelling location, smoking habits, and occasional exposures. The study found significantly higher indoor radon levels in the exposed group (103.30 ± 94.91 Bq/m³) compared to the control group (65.19 ± 47.83 Bq/m³). The results indicated an association between lung cancer and residing near gold mine tailings, while indoor radon exposure was linked to leukemia. However, no association was found between indoor radon exposure and COPD. In regions impacted by gold mine tailings, it is crucial to implement efficient indoor radon mitigation measures and promote public consciousness about the health hazards linked to indoor radon exposure. There is a need to motivate affected residents to adopt proactive steps to lower indoor radon concentrations, including enhancing ventilation practices.","manuscriptTitle":"Indoor Radon Exposure and Health Risks in a Community Proximal to Gold Mine Tailings in Gauteng Province, South Africa: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-22 09:16:48","doi":"10.21203/rs.3.rs-5037478/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-26T07:30:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-17T19:05:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163281519295786034708138364901284026589","date":"2024-10-15T13:08:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205157933940423630705731784397673803229","date":"2024-10-15T06:52:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-22T23:00:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-10T07:16:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-06T17:42:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Environmental Geochemistry and Health","date":"2024-09-05T10:34:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"environmental-geochemistry-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"egah","sideBox":"Learn more about [Environmental Geochemistry and Health](https://www.springer.com/journal/10653)","snPcode":"10653","submissionUrl":"https://submission.nature.com/new-submission/10653/3","title":"Environmental Geochemistry and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3e31f474-9391-4784-b785-5419400da81f","owner":[],"postedDate":"October 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-18T18:08:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-22 09:16:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5037478","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5037478","identity":"rs-5037478","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}