An ecological study of lung cancer, cigarette smoking, and radon exposure was conducted in 20 Iowa counties. County-based lung cancer incidence data for white female residents of Iowa were stratified according to radon level and smoking status. Cancer incidence data for the period 1973-1990 were obtained from the State Health Registry of Iowa. Smoking level was determined from a randomly mailed survey. Radon level was determined according to an EPA supported charcoal canister survey. Within low smoking counties, rates for all lung cancer and small cell carcinoma were significantly lower (p < 0.05) in the high radon counties relative to the medium and low radon counties. However, within high smoking counties, rates for all lung cancer, adenocarcinoma, and small cell carcinoma were significantly higher (p < 0.05) in the high radon counties relative to the low radon counties. Variations in socioeconomic data for these counties, available through the 1980 and 1990 census, did not explain these results. Lung cancer rates also were significantly increased in urban counties even after holding smoking status constant. Multivariate analyses revealed significant interactions between smoking, urbanization, radon levels, and lung cancer. The results of this hypothesis generating study will be tested in a case/control study now ongoing in Iowa. Analysis will need to include separate evaluations by smoking status, radon level, and residence in urban or rural areas for the major morphologic types of lung cancer.