{"id":126325,"date":"2018-02-20T23:50:30","date_gmt":"2018-02-20T23:50:30","guid":{"rendered":"https:\/\/writemyessayfree.com\/environmental-health-2"},"modified":"2017-08-16T06:09:16","modified_gmt":"2017-08-16T06:09:16","slug":"environmental-health-2","status":"publish","type":"post","link":"https:\/\/www.benedictsol.com\/blogs\/environmental-health-2\/","title":{"rendered":"Environmental Health"},"content":{"rendered":"
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Nursing
Topic: Environmental Health<\/p>\n

Order instructions were not found<\/p>\n

Environmental Health
Case
As a nurse practicing within a family practice, you are interviewing a 55-year-old woman who is an executive assistant at a local law firm where she has worked for 9 years. She has a 7-year history of respiratory illness, which occurs several times throughout the year, not seemingly connected to the changes in season. She doesn\u2019t use tobacco products in any form. During your questions regarding her home and work environments, she reports that she enjoys working adjacent to the courthouse in a building over 100 years old as it is such a contrast to her brand-new home on a local golf course. When describing the health of her coworkers, she indicates, \u201cWe all share illnesses which seem to affect everyone else during the year, we just seem to be sicker more often!\u201d
Consider all of the facts reported in this case and address the following points:
\u2022 Identify information pertinent to your client\u2019s case.
\u2022 Identify possible contributory factors.
\u2022 Assess your client\u2019s risk.
\u2022 Identify an exposure pathway for your client.
\u2022 Determine actions you recommend to improve the health status of this client.
\u2022 Identify environmental risks that may affect the health of members of your community.<\/p>\n

Reference
Harkness, G. A. (2016). Community and Public Health Nursing: Evidence for Practice, 2nd Edition
CHAPTER 19: Environmental Health
Tarah S. Somers*
\u2022 For additional ancillary materials related to this chapter, please visit thePoint.
TEARS OF NATURE (A villanelle)
I think I just heard Mother Nature cry, Or was it one more broken, falling tree? You\u2019d think we\u2019d learn as time goes speeding by.
They tell us there\u2019s a big hole in the sky, We won\u2019t believe in something we can\u2019t see, I think I just heard Mother Nature cry.
Coal-fired chimneys reaching up so high, Even though the solar power\u2019s free, You\u2019d think we\u2019d learn as time goes speeding by.
We develop rocket ships that fly, But still can\u2019t stop pollution of the sea, I think I just heard Mother Nature cry.
Headlines: One more species set to die, Keep it quiet. . .use diplomacy, You\u2019d think we\u2019d learn as time goes speeding by.
Worry on the future? Pass it by! How can preservation start with me? I think I just heard Mother Nature cry. You\u2019d think we\u2019d learn as time goes speeding by.
Graeme King
chapter highlights
\u2022 Human health and the environment
\u2022 Assessing contaminants in the environment
\u2022 Exposure pathways
\u2022 Assessing the environment of a community
\u2022 Planning interventions to make communities healthier
\u2022 Evaluating interventions
\u2022 Environmental epidemiology
\u2022 Working toward healthy communities
\u2022 Environmental justice
\u2022 Global environmental health issues
objectives
\u2022 Comprehend the links between human health and the environment.
\u2022 Understand how the nursing process of using assessment, intervention, and evaluation can be used to examine the impact of the environment on human health.
\u2022 Describe the concept of an exposure pathway.
\u2022 Describe several environmental conditions to consider when assessing the environment of a community.
\u2022 Understand the concept of environmental justice.
\u2022 Identify major global environmental health issues.
key terms
Bioavailability: The amount of a substance that is absorbed or becomes available at the site of physiological activity.
Biomonitoring: Process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received.
Environmental epidemiology: Field of public health science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments.
Environmental health: A field of public health science that focuses on how the environment influences human health.
Environmental justice: The belief that no group of people should bear a disproportionate share of negative environmental health consequences (regardless of race, culture, or income).
Exposure: The total amount of a contaminant that comes in direct contact with the body.
Exposure estimate: Factors that determine a person\u2019s level of exposure to a contaminant.
Exposure pathway: Method by which people are exposed to an environmental contaminant that originates from a specific source.
Exposure history: Process to help determine whether an individual has been exposed to environmental contaminants.
Precautionary principle: If something has the potential to cause harm to humans or the environment, then precautionary measures should be taken even if there is a lack of scientific evidence for cause and effect.
Healthy communities: Communities that optimize the physical, social, and economic environments of the community.
Risk assessment: Process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of an exposure to an environmental contaminant.
Toxicology: The study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment.
Case Study
References to the case study are found throughout this chapter (look for the case study icon). Readers should keep the case study in mind as they read the chapter.
Chris is a public health nurse in a coastal town with a long, proud history of commercial and recreational fishing. Throughout the 20th century, many industries lined the edges of the harbor, creating additional economic opportunities for the town. From 1940 to the 1970s, polychlorinated biphenyls (PCBs) were used at the transformer facility that manufactured electrical capacitors and transformers. As a result, soil and groundwater at the site, as well as at the building, are heavily contaminated with PCBs. This facility is considered the major source of historic PCB contamination of the harbor.
The facility is now fenced, and there is no public access to the contaminated soil and buildings. The community is supplied by public drinking water sources which are not connected to the site\u2019s groundwater. Commercial fishing in the harbor is banned, and all commercial fishing takes place out at sea. However, some members of the community frequently fish in the harbor, and they eat the fish they catch to supplement their diets.
The community around the harbor enjoys seasonal recreational activities along the water and sometimes boats on the water, but swimming in the harbor is difficult, since the shores are steep and rocky and there is no beach area. Access to the water can really only happen from community-owned piers.
The environment can be considered as anything outside of ourselves whether human-made or natural. Environmental health is the branch of public health science that focuses on how the environment influences human health.
HUMAN HEALTH AND THE ENVIRONMENT
The environment can affect human health in many ways. Some of these effects are immediate and obvious, such as when drinking water supplies are contaminated by sewage and flood water after a hurricane. Other effects, such as contamination of a private well by arsenic, may be more difficult to discover. Where people live, work, and spend time can have direct consequences on their health. For example, living and working in highly urban environments may expose people to higher concentrations of some air pollutants, but living and working in an agricultural setting may expose them to more pesticides. Exposure occurs when there is contact between people and an environmental contaminant.
Peoples\u2019 environment can have positive or negative effects on their health. Conditions in the environment may exacerbate existing health conditions. For example, people with asthma may experience more asthmatic episodes on days when air quality is poor. The poor air quality may not cause asthma, but it may induce more frequent and severe asthma attacks in people who already have asthma.
The environment can also help improve people\u2019s health. If residents of a certain town believe that they can safely walk in their community, they may choose to walk instead of drive to the store or to schools. This can help increase their activity levels and decrease obesity or other chronic diseases. It could also lead to less pollution from cars, which, in turn, improves air quality. In some ways, the built environment can be intentionally designed to help make people healthier.
What is the use of a house if you haven\u2019t got a tolerable planet to put it on?
Henry David Thoreau
History of Environmental Health
Historically, people often did not clearly understand the links between environment and health and did not recognize how humans influenced their environment. As nations became industrialized, the effects on the quality of air and water became more apparent. People also began to take note of the impact on ecosystems as plants, animals, or other wildlife began to disappear. Many industries were loosely, if at all, regulated, and disposal practices of hazardous materials and industrial by-products were shortsighted. Disposal of waste materials often simply involved burying or dumping the waste into lakes, rivers, or oceans in the belief that the \u201csolution to pollution is dilution.\u201d The intent of this improper disposal of contaminants was not always malicious\u2014people did not understand the impact that the contaminants could have on human health and ecosystems. Materials such as PCBs and asbestos were commercially available, essential to certain manufacturing processes, and were not believed to be harmful. Over time, with the development of more research and understanding, we now realize that many contaminants and hazardous materials have adverse impacts on human health.
The quality of the environment became a popular topic in the mid-to late 20th century. Books such as Silent Spring by Rachel Carson (1962) brought to public attention how human actions and pollution were affecting the quality of air, water, and land. In 1969, because of debris and oil in the river, the Cuyahoga River in Ohio caught on fire. The river had caught fire many times in the past, but the 1969 event caught the public\u2019s attention and helped increase awareness of how polluted some places had become. In July 1970, the White House and Congress established the Environmental Protection Agency (EPA) in response to the growing public demand for cleaner water, air, and land. The EPA had the daunting task of repairing the damage already done to the natural environment and to establish new criteria to making a cleaner environment a reality. For more information on the creation and current role of EPA, visit the EPA website. Several important pieces of legislation that helped highlight the importance of environmental health and protection are still used to help enforce environmental health and protection (Box 19.1).
box 19.1: Influential Environmental Laws
Clean Air Act
The Clean Air Act (CAA), passed in 1970, created a national program to control the damaging effects of air pollution. The Clean Air Act Amendments of 1990 went further to ensure that the air Americans breathe is safe. The CAA protects and enhances the quality of the nation\u2019s air by regulating stationary and mobile sources of air emissions. More information is available at http:\/\/www.epa.gov\/compliance\/civil\/caa\/index.html.
Clean Water Act
The Clean Water Act, passed in 1972, focuses on improving the quality of the nation\u2019s waters. It provides a comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality, including municipal and industrial wastewater discharges, polluted runoff from urban and rural areas, and habitat destruction. More information is available at http:\/\/www.epa.gov\/compliance\/civil\/cwa\/index.html.
Superfund
Superfund is the name given to the environmental program established to address abandoned hazardous waste sites. It is also the name of the fund established by the Comprehensive Environmental Response, Compensation and Liability Act of 1980. It allows the Environmental Protection Agency to clean up such sites and compel responsible parties to perform cleanups or reimburse the government for EPA-led cleanups. More information is available at http:\/\/www.epa.gov\/superfund\/about.htm.
Love Canal started it all. I visited the canal area at that time. Corroding waste disposal drums could be seen breaking up through the grounds of backyards. Trees and gardens were turning black and dying. One entire swimming pool had been popped up from its foundation, afloat now on a small sea of chemicals.\u2026 Everywhere the air had a faint, choking smell. Children returned from play with burns on their hands and faces.
Eckardt C. Beck, EPA Regional Administrator
Today, the public has better understanding of the impact of human actions on the environment and how the environment can in turn affect human health. However, there are still many environmental health challenges that people must face, including cleaning up past, as well as ongoing contamination, deciding what to do about newly recognized issues such as climate change and energy production, and dealing with emerging scientific advances such as nanotechnology. Even though new research and developments are occurring at a historically rapid pace, there are still large gaps in peoples\u2019 knowledge about certain subjects:
\u2022 How do certain contaminants affect human health?
\u2022 How do we assess exposures to contaminants?
\u2022 How does the environment influence health?
\u2022 How do we live as a population while maintaining a healthy environment?
Loads of chemicals and hazardous wastes have been introduced into the atmosphere that didn\u2019t even exist in 1948. The environmental condition of the planet is far worse than it was 42 years ago.
Gaylord Nelson, politician and principal founder of Earth Day, 1990
The Community Environment
The environment and its effect on human health is often considered in two ways. The first focuses on how contaminants in the environment, such as asbestos, lead, or radon, influence human health. The second focuses on how the entire environment surrounding the community, such as neighborhood safety, climate, access to grocery stores, and community design, affects health. These two ways of considering the effect of the environment on human health frequently relate to each other.
For example, lead was used in paint until the 1970s and is often found in houses built earlier. As the old paint breaks down, lead can be found in dust and old paint chips in homes (CDC, 2009a). In communities with older, deteriorating housing, children can be exposed to lead. In many cases, such housing is found in poorer communities. Many low-income communities also have fewer full-service grocery stores, and all residents do not have access to necessary healthy, iron-rich foods. Sufficient blood iron can protect against some of the effects of lead exposure (EPA, 2001). Some research suggests that the combination of iron deficiency and elevated blood lead levels may work synergistically to create greater neurological impacts in children than just iron deficiency or elevated blood lead levels. The impact of the contaminant, the lead, on children\u2019s health may be greater because of characteristics of the children\u2019s community environment (CDC, 2002).
In the case of lead-based paint in the environment, it is fairly easy to determine the link between the environment and health. Sometimes, it can be challenging to determine which environmental factors have the greatest impact on health. Information about the way many contaminants affect humans is very limited. People are exposed to thousands of different things in their environment every day. One person may come into contact with a number of personal care products (e.g., shampoo, toothpaste, lotions, clothing detergent), food products (artificial colors, pesticide residue on foods, preservatives), other commercial products (e.g., inks, gasoline, dry cleaned clothing, flame retardants), and environmental contaminants (e.g., diesel particles) every day. In the modern world, it is nearly impossible to isolate people from all of the exposures they have every day.
The American Chemical Society, which provides the Chemical Abstracts Service (CAS) database for chemicals, had as of March 2013 over \u201c71 million unique organic and inorganic chemical substances, such as alloys, coordination compounds, minerals, mixtures, polymers and salts\u201d (American Chemical Society, 2013). Even if only a fraction of these chemicals eventually find their way into the environment and humans, the burden of chemical exposure to everyone in the United States is enormous.
Only a small number of these chemicals have ever been tested to see how they affect human health. Many groups have called for the use of the precautionary principle when it comes to the use of contaminants that find their way into the environment and humans. The precautionary principle maintains that if something has the potential to cause harm to the environment or humans, then precautionary measures should be taken if there is a lack of scientific evidence concerning cause and effect (Kriebel et al., 2001). Applying the precautionary principle to new technology and chemicals may help protect the environment and human health. For example, there is a concern that use of cell phones may create health effects, including changes in brain activity. The scientific evidence is not yet certain, but by applying the precautionary principle, nurses can encourage people to use their cell phones on speakerphone mode or with earpieces to decrease the exposure caused by holding the phone against their heads.
It can also be challenging to prove the existence of direct links between the environment and health status of community residents. It seems logical that if sidewalks are built, people will use them, thus improving their cardiovascular health. But is it possible to measure sidewalk use? If a community could measure sidewalk use, how could it show that using the sidewalks significantly improves cardiovascular health? Often, there is a lack of scientific data to determine how exactly the community environment impacts human health. It is also difficult to determine how genetic and behavioral factors shape the health of an individual or a population.
PRACTICE POINT
Proving causal links between exposure to environmental contaminants and health outcomes, or links between the community environment and health outcomes, is often very difficult.
Genetic and Behavioral Factors
Understanding the interaction between the environment and genetics as it relates to expression of disease is still an evolving science. The challenge for environmental health nurses is to use the best science available to assess how the environment affects human health, to formulate evidence-based or best practice interventions, and to evaluate the effectiveness of these interventions.
Hereditary factors may play an important role. Many scientists believe that there are people who are more genetically susceptible to a specific disease but that environmental triggers play a role in determining who actually develops the disease. The interaction between genetics and the environment may help explain why some people who are exposed to specific contaminants develop certain health effects but others do not. Genetic alterations to glutathione-S-transferase, which codes for a protein that enables chemicals to be excreted in urine, affect the body\u2019s ability to rid itself of toxins. People with this genetic alteration may have increased cancer risks when exposed to certain chemicals in the environment (Goodman, 2009).
Individual human behaviors may also interact with environmental exposures to influence human health. For example, radon, a naturally occurring radioactive compound, can be found in the basements of many homes. Exposure to this substance has been linked to lung cancer. Research has shown that people who live in a home with radon and who smoke have a greater risk of developing lung cancer than do nonsmokers who live in homes with radon. The exposure to cigarette smoke and radon seem to interact to increase the risk of lung cancer. More information about radon and health can be found on the EPA website.
Nursing and Environmental Health
Scientific understanding of how the environment affects human health has evolved since the days of Florence Nightingale, but nurses have long recognized that people\u2019s surroundings can influence their health. Even in the 19th century, nurses realized that clients who had clean food and water and fresh air had better outcomes than did those who were left in squalid conditions. Nurses can help lead the way in healthcare by understanding that clients are part of the environment and that the health of the environment has a direct impact on their health. Nurses are in a strong position to advocate for healthier environments in both the workplace and community.
Across the country, there are great examples of nurses working with communities, conducting research, and leading programs to help promote healthy people in healthy environments. Nurses are also involved in helping to ensure that the environmental impact of healthcare practices in the clinical setting and community setting are considered. For example, the group Health Care Without Harm has worldwide membership from health providers to raise awareness on issues such as safer chemicals (disinfectants, solvents in laboratories) in healthcare, green purchasing (less toxic, minimal packaging), and medical waste management. More information about their work can be found at the Health Care Without Harm website (Health Care Without Harm, 2014).
The American Nurses Association (ANA) has created the ANA\u2019s Principles of Environmental Health for Nursing Practice with Implementation Strategies. These principles can help nurses incorporate principles of environmental health into nursing practice (Box 19.2). Nurses can use their core skills of assessment, intervention, and evaluation when considering the environment and its impact on individual patients or communities.
box 19.2: Principles of Environmental Health for Nursing Practice
\u2022 1. Knowledge of environmental health concepts is essential for nursing practice.
\u2022 2. The Precautionary Principle guides nurses in their practice to use products and practices that do not harm human health or the environment and to take preventive action in the face of uncertainty.
\u2022 3. Nurses have a right to work in an environment that is safe and healthy.
\u2022 4. Healthy environments are sustained through multidisciplinary collaboration.
\u2022 5. Choices of materials, products, technology, and practices in the environment that affect nursing practice are based on the best evidence available.
\u2022 6. Approaches to promoting a healthy environment respect the diverse values, beliefs, cultures, and circumstances of clients and their families.
\u2022 7. Nurses participate in assessing the quality of the environment in which they practice and live.
\u2022 8. Nurses, other healthcare workers, clients, and communities have the right to know relevant and timely information about the potentially harmful products, chemicals, pollutants, and hazards to which they are exposed.
\u2022 9. Nurses participate in research of best practices that promote a safe and healthy environment.
\u2022 10. Nurses must be supported in advocating for and implementing environmental health principles in nursing practice.
Source: From American Nurses Association. (2007). Principles of environmental health for nursing practice with implementation strategies. Silver Spring, MD: American Nurses Association.
ASSESSMENT
Assessing Contaminants in the Environment
Frequently, public health professionals are asked to help assess whether a specific contaminant or contaminants in the environment are making a person or community sick.
The state public health agency asks Chris to assist with an environmental health assessment when media attention on PCBs starts drawing public concern. People start calling their local and state health departments and asking if the PCBs are making their families sick.
Chris starts by doing research on PCBs. These substances are not naturally occurring, tend to be heavy, and quickly settle out of the air to the ground or water. Being hydrophobic, once in the water, they also settle out of water into sediment. They are slow to break down, and unless they are removed, they remain in soil or sediment for a very long time. The PCBs can build up in small animals and fish. As larger fish and animals eat the smaller ones, the PCBs become increasingly concentrated in the food chain. In general, what would be good sources of information to find out more about PCBs?
If ever we had proof that our nation\u2019s pollution laws aren\u2019t working, it\u2019s reading the list of industrial chemicals in the bodies of babies who have not yet lived outside the womb.
Louise Slaughter, U.S. Congresswoman
People in communities often want to know their risk of getting sick from known or suspected exposure to a contaminant. In other words, they want a risk assessment\u2014a process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of exposure to an environmental contaminant. The amount of risk can be a difficult thing to determine. There are different methods for conducting risk assessment for environmental contaminants. A simple way to understand risk is that the amount of risk equals the hazard plus exposure (risk = hazard + exposure).
The presence of a hazard alone does not determine the amount of risk the hazard poses. If a substance is hazardous, but there is no exposure to the substance, then a person is not at risk. For example, think of the sun. It is well known that exposure to too much sun can cause sunburns and put people at risk for skin cancer. However, if a person eliminates exposure by staying indoors or in the shade, he or she eliminates the risk. If a person puts on sunscreen or a hat or stays out of the sun in the middle of the day, he or she modifies the amount of risk by taking measures to reduce the exposure.
To assess exposure, one method is to think about exposure pathways. An exposure pathway is a process by which someone is exposed to a contaminant that originates from a specific source (Agency for Toxic Substances and Disease Registry, 2005). Understanding exposure pathways is important because if the pathway is not complete or if it can be disrupted, the contaminant of concern should not affect human health. Frequently, people incorrectly assume that if a contaminant is near their home, work, or school, they will automatically experience adverse health effects from the substance. An exposure pathway helps illustrate that proximity to a contaminant is not the deciding factor in determining its effect on humans. An exposure pathway consists of five parts: (1) source of contamination, (2) environmental media and transport, (3) point of exposure, (4) route of exposure, and (5) receptor population. Figure 19.1 shows how each of these components is related, and the following discussion describes them in more detail.
figure 19.1<\/p>\n

Exposure pathway. (Data from Agency for Toxic substances and Disease Registry. [2005]. Public health assessment guidance manual. Available at http:\/\/www.atsdr.cdc.gov\/HAC\/phamanual\/ch6.html)
Source of Contamination
The source of contamination is used to describe what the contaminants are and from where they originate. Sometimes, a source of contamination is easy to identify (e.g., mercury coming from a former thermometer factory site). Other sources can be more difficult to identify, such as vapor intrusion into a home from contaminated groundwater. Sources of contamination can come from point or nonpoint sources. Nonpoint sources consist of many diffuse sources while a point source tends to be one specific identified source. For example, a non-point source of contamination could be if gasoline drips on parking lots and roads from thousands of cars and then is washed into a neighboring lake when it rains. A tanker truck carrying gasoline that crashed and spilled its contents into a pond is an example of a point source of contamination.
Knowing the type of contaminant is important to understanding its possible effect on human health. Some contaminants quickly break down in the environment, whereas others are very persistent. Contaminants that stay longer in the environment may influence health over a greater period of time. Generally, contaminants can be thought of in three categories: chemical (lead, mercury, volatile organic compounds), biologic (mold, anthrax, ricin), and radiologic (radium, radon). Table 19.1 lists some common environmental contaminants.
table 19.1: Common Exposure Pathways for Selected Environmental Contaminants table
Contaminant Most Common Sources Media and Transport Most Common Point of Exposure Route of Exposure Populations of Most Concern Health Effect
Lead Paint before 1978. Homes built before 1978 may have lead paint on walls, windows, or other painted surfaces inside and outside the home. As paint deteriorates, it can chip and create dust that contains lead. The chips and dust can accumulate in the house or be deposited into soil around the house. Inside the house as chips or dust Soil outside the house Ingestion Children frequently have greater exposures because they put their hands and other objects in their mouths, they may eat paint chips, and they play out-side in the soil more and may ingest the soil. Children\u2019s brains and nervous systems are sensitive to the damage done by lead. Elevated levels of lead can damage the nervous system and brain development, slow growth, create learning problems such as hyperactivity, and cause hearing problems and headaches. A blood lead level of 5 \u00b5g\/dL or greater is a level at which action is needed to stop exposure. However, there is no safe level of lead in the blood of children. Research shows that even low blood lead levels may cause neurological damage in children.
Dust can get into air. Lead vapor if lead is heated (as if with a heat gun used to remove paint). Inside the house Inhalation Children have faster respiratory rates and their breathing zone is closer to the ground, which may lead to a greater exposure.
Mercury Thermometers used in industry, batteries. Burning coal releases it into the air. Intentional or accidental spills of elemental mercury In area near a mercury spill, indoor levels can become unsafe with even small mercury spills. Inhalation People near the spill. Children have faster respiratory rates and their breathing zone is closer to the ground, which may lead to a greater exposure. High levels can harm the brain, heart, kidneys, lungs, and immune system of people of all ages. Mercury\u2019s harmful effects may be passed from the mother to the fetus, causing brain damage, mental retardation, blindness, seizures, and inability to speak. Children poisoned by mercury may develop problems of their nervous and digestive systems, and kidney damage.
Can enter the environment, settle into water, and bioaccumulate in fish Fish Ingestion Pregnant women and small children For most adults, fish eating is not a concern. Pregnant women and small children should avoid eating fish with high mercury levels such as swordfish, shark, tilefish, and king mackerel. Mercury\u2019s harmful effects may be passed from the mother to the fetus, causing brain damage, mental retardation, incoordination, blindness, seizures, and inability to speak. Children poisoned by mercury may develop problems of their nervous and digestive systems, and kidney damage.
Radon Naturally occurring radio-active gas. Product of decaying uranium and found in soils Moves into houses through cracks and holes in foundations Indoor air Inhalation People living in homes with radon present. People who smoke Can damage lungs. Exposure has been linked to lung cancer. Smoking combined with radon exposure is a serious heal<\/p>\n","protected":false},"excerpt":{"rendered":"

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