Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors.

Despite substantial attention toward environmental tobacco smoke (ETS) exposure, previous studies have not provided adequate information to apply broadly within community-scale risk assessments. We aim to estimate residential concentrations of particulate matter (PM) from ETS in sociodemographic and geographic subpopulations in the United States for the purpose of screening-level risk assessment. We developed regression models to characterize smoking using the 2006–7 Current Population Survey—Tobacco Use Supplement, and linked these with air exchange models using the 2007 American Housing Survey. Using repeated logistic and log-linear models (n=1000), we investigated whether household variables from the 2000 United States census can predict exposure likelihood and ETS-PM concentration in exposed households. We estimated a mean ETS-PM concentration of 16 μg/m³ among the 17% of homes with non-zero exposure (3 μg/m³ overall), with substantial variability among homes. The highest exposure likelihood was in the South and Midwest regions, rural populations, and low-income households. Concentrations in exposed households were highest in the South and demonstrated a non-monotonic association with income, related to air exchange rate patterns. We provide estimates of ETS-PM concentration distributions for different subpopulations in the United States, providing a starting point for communities interested in characterizing aggregate and cumulative risks from indoor pollutants.