The Montana Radon Study: Social Marketing via Digital Signage Technology for Reaching Families in the Waiting Room

Objectives. I tested a social marketing intervention delivered in health department waiting rooms via digital signage technology for increasing radon program participation among priority groups.Methods. I conducted a tri-county, community-based study over a 3-year period (2010–2013) in a high-radon state by using a quasi-experimental design. We collected survey data for eligible participants at the time of radon test kit purchase.Results. Radon program participation increased at the intervention site (t₃₈ = 3.74; P = .001; 95% confidence interval CI] = 4.8, 16.0) with an increase in renters (χ²_1,228 = 4.3; P = .039), Special Supplementary Nutrition Program for Women, Infants, and Children families (χ²_1,166 = 3.13; P = .077) and first-time testers (χ²_1,228 = 10.93; P = .001). Approximately one third (30.3%; n = 30) attributed participation in the radon program to viewing the intervention message. The intervention crossover was also successful with increased monthly kit sales (t₃₇ = 2.69; P = .01; 95% CI = 1.20, 8.47) and increased households participating (t₂₃ = 4.76; P < .001; 95% CI = 3.10, 7.88).Conclusions. A social marketing message was an effective population-based intervention for increasing radon program participation. The results prompted policy changes for Montana radon programming and adoption of digital signage technology by 2 health departments.Indoor radon exposure accounts for 21 000 deaths (15% of lung cancer deaths) in the United States each year and is the second leading cause of lung cancer behind smoked tobacco.1 Radon causes 100 times more deaths than carbon monoxide poisoning2 and is the leading environmental cause of cancer in North America.3 Although lung cancer can be treated, the survival rate is one of the lowest for all cancer types. The estimate that Americans spend more than 90% of their time indoors further underscores the need to reduce residential exposures.4Montana, like other states in the Rocky Mountain Region, is a high-radon geographic area with all but 7 of Montana’s 56 counties designated by the Environmental Protection Agency as having the most serious radon risk (i.e., Zone 1).5 Although 49 of Montana’s 56 counties share the Zone 1 designation, only 4 have a Montana Department of Environmental Quality–funded radon program. Started in 1993, these state funds were appropriated to the health departments in the 4 fastest-growing counties in the state: Gallatin, Ravalli, Flathead, and Missoula counties. Health department administrators used these funds to purchase radon test kits, provide education and outreach, and manage a database of reported radon concentrations.A recent evaluation of the Gallatin County radon program showed that participants were predominantly nonsmoking, older, well-educated, and middle-class homeowners.6 A social marketing campaign was identified as a potential way to expand radon program participation to other high-priority groups. Social marketing is a strategy that has been effective across a wide range of topics, settings, and audiences including sexual health,7,8 asthma in older adults,9 and fruit and vegetable consumption in Special Supplementary Nutrition Program for Women, Infants, and Children (WIC) participants.10 Health department WIC clinics were identified as an ideal place to reach younger, lower-income families with children, and renters—subgroups not well represented among baseline radon program participants. In support of the goal to expand radon program participation to priority groups, the aim of the Montana Radon Study (MRS) was to test the efficacy of a social marketing intervention for increasing radon program participation by lower-income families, first-time testers, and families who rented their homes. Although current and former smokers are the groups at greatest risk of radon-related lung cancer, they were not specifically addressed in this intervention message designed to appeal to all residents of high-radon counties.