A Publication of the Subcommittee on Risk Communication and Education Public Health Service (PHS)
Scientists at the Agency for Toxic Substances and Disease Registry (ATSDR) and the Centers for Disease Control and Prevention (CDC) seek to understand the history of exposure and the potential effects of exposure to radiation and toxic substances on human health. They also try to respond to community and worker concerns about such exposures. To fully understand these issues, ATSDR and CDC are committed to working directly with communities to address their health concerns. Forming the base of this commitment are efforts by ATSDR and CDC to establish a bond with communities and to collaborate with them in addressing the complex issues associated with exposure to radiation and toxic substances released from Department of Energy (DOE) facilities.
The public can be involved in raising issues and expressing concerns about Public Health Service (PHS) activities at DOE sites in several ways. Presently, ATSDR and CDC are working with communities at Hanford, Washington; the Idaho National Engineering Laboratory, near Idaho Falls, Idaho; and the Savannah River Site. Progress has been made in establishing Health Effects Subcommittees at these sites to involve communities in decision-making related to public health activities conducted at the sites. A charter for establishing up to six site-specific subcommittees under the Federal Advisory Committee Act (FACA) was approved on November 7, 1994; that action sets the stage for the establishment of additional subcommittees.
A major reason for the strong commitment to public involvement at these DOE sites is the fact that the U.S. government has actively developed nuclear weapons for approximately 50 years. During that time, residents of communities near weapons facilities and workers in the nuclear weapons complex were exposed to radiation and other hazardous materials. How much exposure these people received and the potential health outcomes are neither well known nor well documented. Because of this history of uncertainty, members of communities near these DOE facilities often lack trust in federal clean-up efforts. In fact, many residents, environmental organizations, and advocacy groups believe that DOE operations at these nuclear complexes have caused negative health effects and that they continue to threaten human health and the environment.
ATSDR and CDC are currently conducting public health activities at several DOE sites. ATSDR is required by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) to perform public health assessments, health studies, surveillance, exposure registries, and health education. Through a Memorandum of Understanding between DOE and the Public Health Service, the CDC's National Center for Environmental Health (NCEH) is responsible for conducting community health studies, and the National Institute for Occupational Safety and Health (NIOSH) is responsible for studies of the health of workers.
ATSDR and CDC are committed to working with citizen organizations, state and local officials, and other Federal agencies to ensure there is active community involvement in the planning, conducting, and reporting of health-related work at DOE facilities.
In February 1994, a workshop was held in Atlanta to encourage discussions between three groups: communities surrounding DOE facilities; Native American communities; and workers at DOE sites. Workshop participants addressed how advice would be given and received from the three communities and the impact of FACA on establishing a community involvement program. The workshop report identified four key topics of concern to the communities. The topics also are the principle elements of an implementation plain that was developed during the workshop. The plan outlines CDC and ATSDR activities that conform to the agreed-upon framework developed during the workshop. The plan will be modified regularly as the communities and agencies continue to interact. Following are details of four key topics.
Addressing the health concerns of individuals. To address individuals' health concerns, the agencies will develop partnerships with other organizations, provide information about organizations that can be used as resources, and establish grants to state and local health departments to provide incentives for working on issues confronting the communities.
Public participation in decision making. As many as six site-specific councils will be established. Regular meetings of representatives from each of the councils will be scheduled. Input from communities about the involved agencies' research agendas, and the opportunity for councils and DOE boards to communicate, will assist in the decision-making process. Means will also be available for input from small or less-affected communities that are not represented on Health Effects Subcommittees.
Education and training for communities. NCEH plans to fund two education and training projects; in addition, literature reviews are being conducted and partnerships with other agencies are being established. Workshops will be conducted to help develop a broad-based community education program.
Outreach to culturally diverse populations. The focus of this element is on developing a working relationship with national, worker, and grassroots organizations. A pilot program should be developed and implemented. To promote communication, a computer bulletin board may be established and made available to all councils. Funds also will be set aside for environmental health conferences,
The full results of the February 1994 workshop are presented in the report "Participants' Report on the Workshop on Community, Tribal, and Labor Involvement in Public Health Service Activities at Department of Energy Facilities." The report includes ATSDR and CDC responses. The implementation plan, which is incorporated into the report, is based on the participants' report, which reflects input from communities, tribes, and employees at DOE sites.
The workshop report specifically addresses the purpose of public involvement: "The purpose of the public involvement in education and training is the creation of a fair, representative and knowledgeable body of citizens, including people of color, workers, and Native Americans, to advise staff from the CDC and ATSDR on the selection, design, scope of work, and prioritization of their public health activities connected with DOE sites in terms of identifying exposed and potentially exposed persons and providing answers to their health related questions and needs. These advisory bodies shall also participate in the evaluation, decision making, and monitoring of the work, both ongoing and after completion, and if deemed necessary, help secure independent scientists for further evaluation and validation."
Principles of community, tribal, and labor involvement were developed by workshop participants:
The workshop participants agreed that the process for involvement should be a community decision with the option of choosing a FACA chartered body, a non-FACA-chartered body, a combination of both, or other vehicles that empower communities with decision making roles. ATSDR and CDC agreed with the desire to ensure that communities participate in an inclusive, open fashion that gives them the ability to influence decision making. Continued progress in agency responsiveness to public involvement will depend in large measure on the availability of resources. ATSDR and CDC will continue to respond to issues raised as a result of public involvement. Additional information about the CDC/ATSDR partnership activities at DOE facilities can be obtained from Art Robinson, Centers for Disease Control and Prevention (CDC), at (404) 488-7630.
Children at Risk From Ozone Pollution in the United States From 1991-1993
A national health objective for the year 2000 is to reduce exposure to air pollutants so that at least 85 percent of persons reside in counties that meet Environmental Protection Agency (EPA) standards (objective 11.5). Air pollution is an important contributor to lung disease, the third leading cause of death in the United States. Ozone, the principal component of summer smog, is the most pervasive air pollutant in the United States. The risks associated with ozone and other air pollutants are especially increased for children with asthma. However, children with no underlying pulmonary diseases also are at risk for adverse health effects associated with these pollutants. In addition, because children of racial and ethnic minorities are more likely to reside in areas with higher air pollution levels, they may be exposed to higher levels of ozone. The April 28, 1995, issue of the Morbidity and Mortality Weekly Report describes the characterization by the American Lung Association (ALA) of populations potentially at risk of adverse health effects from exposure to ozone air pollution in the United States during 1991-1993.
The ALA is committed to decreasing lung disease in children by emphasizing key messages for reducing air pollution. ALA recommends that persons drive less, support state and local clean air regulations, make their homes and workplaces smoke-free, and test their homes and workplaces for harmful pollutants (e.g., radon and carbon monoxide). As part of its outreach efforts, the ALA sponsors National Clean Air Month each May to educate the public about the relationship between clean air and respiratory health. The May 1995 theme was "Helping Kids Breathe Easier." During Clean Air Month, local lung associations throughout the country sponsor Clean Commute Days and Clean Air Challenge cycling and walking fundraising sling events. Additional information about ALA's public education activities can be obtained by calling its toll-free telephone number: 1-800-586-4872.
Risk Communication Training at the Association of State and Territorial Health Officials (ASTHO)
The Association of State and Territorial Health Officials (ASTHO) represents the directors of public health in each of the 50 states, the District of Columbia, and the U.S. territories. The purpose of the association is to formulate and influence the establishment of sound national public health policy and to assist and serve state health departments in the development and implementation of state programs and policies for the public's health and the prevention of diseases. The Agency for Toxic Substances and Disease Registry (ATSDR) cooperative agreement with ASTHO addresses the need to improve information exchange and transfer between states and Federal agencies and state health agencies, and to increase training opportunities to help state health agencies improve their capacity to communicate risk information to the public.
The need to communicate environmental health risk assessments and management decisions in a credible way that is trusted by the public has been well documented. ASTHO recognizes this need and provides environmental health risk communication workshops for interested states. State health agencies apply for 1 or 2 of the following topics to be addressed in a 1-day session: Practical Applications for Communicating Risk, An Effective Risk Communication Process, Overcoming Barriers to Risk Communication, Health Risk Communication With Minorities and Underserved Communities, Risk Communication in Public Meetings, and Working With the Media. When possible, the association recommends devoting the full day to one topic.
More than 700 state-level health professionals in 14 states have participated in ASTHO's risk communication workshops. Participants include physicians, nurses, nurse practitioners, health directors, environmental health specialists, public health educators, health planners, risk assessors, and environmental epidemiologists.
Through its Directory of Environmental Health Services, ASTHO provides to state health agencies and other interested parties a list of contacts and consultants who serve as toxicant specific experts on topics such as air, biotechnology, carcinogens, risk assessment, cluster investigations, lead, occupational exposures, pesticides, radiation, fish, reproductive hazards, risk communication, Superfund, medical wastes, water, and others.
To find out more about ASTHO's risk communication training courses, contact Lynn Bradley of ASTHO at (202) 546-5400 or Patricia Poindexter of the Agency for Toxic Substances and Disease Registry (ATSDR) at (404) 639-6205.
NIOSH's Dry Cleaning Risk Communication Campaign Pilot Project
The 1989 National Occupational Exposure survey (NOES) estimated that in 1982-83, more than a half million industrial workers, including dry cleaning plant employees, in more than 40,000 plants were potentially exposed to tetrachloroethylene (TCE). In 1994, the National Institute for Occupational Safety and Health (NIOSH) proposed a pilot study to address the question: What is the best way to effect changes in small dry-cleaning facilities to reduce the risk of PCE exposure and other health and safety hazards? The study topic is closely related to NIOSH priority areas of risk communication, control technology, and intervention.
The pilot study will address several issues related to developing messages and materials for dry-cleaning workers. First, simply informing dry cleaning owners and workers of the demonstrated health and safety hazards in their industry will not necessarily guarantee cooperation and compliance. Second, their perception of the relative seriousness of various hazards may not match that of scientific experts.
Third, owners and workers take factors other than physical preservation into account. Economic self-preservationkeeping a business going or retaining a jobis a powerful motivator. Small family-owned and family-operated businesses predominate in the drying cleaning industry. Often, all workers are family members, including teenagers and the elderly, and preschool children may be on the premises all day. Shop owners whose family members work in the shop naturally would not want to think that their families were being exposed to danger and therefore might not acknowledge any risk.
Finally, educational materials may need to address concerns of different age groups and be written at several levels of reading skill. For example, a sizable proportion of workers are women or members of minority groups, including non-English-speaking populations. As a result, issues of particular concern to women and minorities would need to be incorporated into the educational materials, or additional materials may need to be developed. The issue of literacy must also be taken into consideration.
The pilot study is in three phases and is designed to determine how best to communicate information on potential risks, to decrease solvent exposure, and to address other health and safety issues of concern to owners and workers in the dry cleaning industry. In the first phase, beginning in early 1995, focus groups were conducted with workers and owners to determine their knowledge of and perceptions about the occupational health risks involved in dry cleaning, and their knowledge of techniques to reduce exposure.
The second phase will focus on campaign design and implementation. Information obtained during the first phase of the study will become part of the educational message, i.e., how to reduce potential health and safety risks, to be delivered by the campaign, The campaign will be presented in several mediaprint, video, graphicso that the investigators can assess which medium conveys the message most effectively. The campaign will be implemented in 1995 and 1996. Economic and health benefits will be stressed.
During the third phase, NIOSH will evaluate the effectiveness of the campaign. Reductions in workplace hazards will be measured using both standard and innovative industrial hygiene techniques. Additionally, intermediate outcomes, such as owner implementation of control technology and changes in knowledge and work practices by both owners and workers, and the economic impact of implementing controls, will be evaluated.
This demonstration project will be conducted in the tri-state (Ohio, Kentucky, and Indiana) area. If successful, it could be repeated in a city such as Chicago, where the wide ethnic mix among dry cleaners would require translation and adjustment of the message to take cultural differences into account. The project could serve as a model for future efforts to appraise current hazards in an industry, develop an intervention strategy, conduct a pilot project to evaluate the strategy, and disseminate successful interventions.
More information about NIOSH's innovative risk communication campaign can be obtained from Avima Ruder of the Division of Surveillance, Hazard Evaluation, and Field Studies/NIOSH at (513) 841-4440, or Ed Burroughs of the Division of Physical Sciences and Engineering/NIOSH at (513) 841-4275.
Toxicology Information Outreach Program Offers On-Line Access to HBCUs and Other Minority Institutions
As the world's largest research library in a single scientific and professional field, the National Library of Medicine (NLM) is an invaluable resource to health professionals and health science students around the world. In 1987, the Congress amended NLM legislation requiring the library to publicize its products and services and provided additional funds to develop outreach programs for all health professionals. Particular emphasis was placed on improving the information access of health science professionals serving minorities in inner cities and rural areas.
In August 1991, the NLM initiated a pilot project known as the Historically Black Colleges and Universities (HBCUs) Toxicology Information Outreach Program (TIOP). The project followed a number of articles and reports publicizing the disproportionate exposure of minorities to environmental and occupational hazards. Most HBCUs are located in minority communities and have a proven track record of educating a large percentage of our Nation's minority health professionals. The objective of the pilot project was to strengthen the role of HBCUs as conduits of instruction on the use of the programs and services of the NLM. The initial step was to train health science professionals employed at HBCUs to use toxicological, environmental, occupational, and hazardous waste information resources developed by the NLM. In turn, HBCU health professionals would incorporate into their class instruction the information and skills acquired through their training.
Health science professionals representing nine HBCUs were invited to participate in the pilot project. The selected HBCUs were Drew University School of Medicine and Science (Los Angeles, CA); Florida A&M University (Tallahassee, FL); Howard University (Washington, DC); Meharry Medical College (Nashville, TN); Morehouse School of Medicine (Atlanta, GA); Texas Southern University (Houston, TX); Tuskegee University (Tuskegee, AL); University of Arkansas at Pine Bluff (Pine Bluff, AR); and Xavier University (New Orleans, LA). These schools were selected because they
Representatives from the HBCUs were trained at the initial and advanced or instructor's levels and were provided free access to the NLM on-line files and databases for the duration of the project. In addition, training materials on NLM databases and on its products and services were distributed. Each participating HBCU also received a PC-based workstation with a full complement of state-of-the-art hardware and software, microcomputer-based tutorials, and the user-friendly software package, Grateful Med.
On-line searching has become an integral component of health and environmental program curricula at many of the HBCUs/MIs involved in the pilot project. Some HBCUs offer courses on searching the on-line databases of the NLM, while others use the databases as tools in specific classes. Training classes are being held periodically at each of the nine HBCUs to expose researchers, instructors, and students to the available resources. In a few cases, classes have been held for health professionals in neighboring communities.
Because of the significant impact of the pilot project, the NLM and the Agency for Toxic Substances and Disease Registry (ATSDR) agreed in 1992 to provide on-line training and free access to the NLM databases to other HBCUs and minority institutions (MIs) with degree programs in environmental and occupational health. Since that time, the program has been extended to include the faculty of nursing programs at the HBCUs and, recently, HBCUs located in the Lower Mississippi Delta Region. The HBCUs in the Lower Mississippi Delta Region are also involved in the Mississippi Delta Project, which is being jointly supported by several Federal agencies, state and local health departments, local community groups, and institutions of higher education. ATSDR supports all training costs and NLM provides to each participating school 1 year of free access to its online databases. To date, 49 additional HBCUs and MIs have participated in the extended project. Four years after the project began, the outreach efforts of the NLM have not only introduced on-line searching to HBCUs/MIs, but have produced a more environmentally aware and health-conscious HBCU/MI community.
For additional information about the HBCU Toxicology Information Outreach Program and other outreach programs sponsored by the National Library of Medicine, contact Dr. Melvin Spann, associate director, Specialized Information Services, at (301) 496-3147.
Minority Health Information in the Public Health Service
The Office of Minority Health Resource Center (OMH-RC), a service of the Office of Minority Health, Public Health Service, is responding to the growing demand for minority health information. OMH-RC maintains and disseminates material on five target populations: African Americans, Asian Americans, Hispanics/Latinos, American Indians/Alaskan Natives, and Pacific Islanders.
Information specialists at the center conduct customized database searches for callers interested in publications, organizations, programs, and funding sources related to minority health. OMH-RC also provides names of resource persons across the country who can offer technical assistance. To help organizations concentrate marketing efforts, the center provides mailing labels with addresses of minority newspapers and television stations.
The center's hours of operation are Monday through Friday, 9:00 AM to 5:00 PM, Eastern time. To speak with an information specialist, call 1-800-444-6472. Local callers (Washington, DC, and Rockville, MD) can dial (301) 587-9704/5. Hearing-impaired callers can dial (301) 589-0951.
Environmental Information on the Internet
Finding appropriate information on a complex and technical environmental topic is often difficult. Fortunately, the Internet is increasing access to useful educational tools. For example, the Internet is very good at providing access to the "gray literature" (fact sheets, bibliographies, and teaching guides), information produced by a state or organization but not widely distributed or indexed. Two Internet sites that provide pointers to environmental information are the Environmental Education Network (EEN) and the National Consortium for Environmental Education and Training (NCEET). Both Internet resources provide excellent pointers to other sources of information.
Based at the University of Michigan, NCEET was begun in 1992 with funding from the US Environmental Protection Agency. Information on this system includes, annotated bibliographies, teaching materials from states and organizations, audiovisual catalogs, software, announcements about grants and awards, news, and reference materials.
For more information, contact NCEET, School of Natural Resources & Environment, University of Michigan, Ann Arbor, MI 481091115; telephone: (313) 998-6726; fax: (313) 936-2195. The e-mail address is: firstname.lastname@example.org. To search via Internet, use the URL http://www.snre.umich.edu.
Cornell University's H. John Heinz III School of Public Policy and Management and EnviroLink (a nonprofit organization) sponsor EEN. EEN provides information on services such as environmental education resources for students and teachers and general educational resources. The address is http://www.envirolink.org/enviroed/.
The Agency for Toxic Substances and Disease Registry (ATSDR) publishes a series of case studies in environmental medicine. Two of these, lead and radon, are available at the following address: http://www.atsdr.cdc.gov/HEC/csem/. Lead and vinyl chloride are available on the National Library of Medicine (NLM) gopher.
For more information on these and other environmental education tools found on the Internet, contact Gayle Alston, information specialist, Division of Health Education, ATSDR. Ms. Alston can be reached at (404) 639-6205 or email@example.com.
Developing In-House Qualitative Research Expertise: The FDA Perspective
From 1994 to 1995, Division of Device User Programs and Systems Analysis (DDUPSA/FDA) staff trained as moderators of focus groups have conducted various qualitative research projects, predominantly focus groups, to investigate particular research questions. This article provides a summary of the strengths and weaknesses of the focus group process. The second article will focus on the lessons learned and problems encountered in trying to establish in-house expertise in focus group testing.
Focus Groups Defined. Focus groups are a form of qualitative research adapted by market researchers from group therapy. A client asks for focus group research when there is a need for a specific target audience reaction to a product, campaign, or communication piece. Eight to 10 participants with similar characteristics (for example, demographics, product use, or life events) discuss a focused topic for 90 minutes to 2 hours. Through the moderator's systematic investigation of the topic, the perceptions, opinions, beliefs, and attitudes (POBAs) of the group are explored. As a rule of thumb, at least four focus groups are conducted to gather baseline data.
Qualitative research is not limited to focus groups. Other forms of qualitative research that may be considered for target audience reaction include, but are not limited to, self-administered questionnaires and in-depth interviews (IDI). Self-administered questionnaires do not require staff time to interact with respondents, can be anonymous, can reach difficult-to-reach groups, and are easy and quick for respondents. On the other hand, the response rate may be low (particularly for mailed questionnaires) and follow-up may be required. IDIs are used when responses are desired without group influence, when logistical problems make groups impractical, and when legal restrictions or confidentiality issues exist or the subject matter is intimate or sensitive.
Advantages. The advantages of focus groups include these:
Limitations. The limitations of focus groups include these:
Focus Group Procedures
STEP 1. Define the Project Purpose and Problem/Formulate the Research Question. It is important for the focus group director(s), moderator(s), and the contractor to have an initial meeting with the client to clearly define the project purpose and problem and to formulate the research question. The focus group director(s) and moderator(s) will use this meeting to find out what information is really being sought and how the information obtained will be used. The purpose should be clearly stated: To + action verb + what. For example, To determine dentists' understanding and implementation of FDA's guidelines on dental radiographic examinations.
Throughout the focus group project, the focus group director(s) and moderator(s) must remain objective. For example, the DDUPSA focus group director(s) and moderator(s) treat the project staff as clients; they are not stakeholders in the project. To remain in this objective role, the DDUPSA focus group director(s) and moderator(s) do not participate in the development of the project materials. Rather, they consult with the subject matter experts on the project to garner expertise in the field.
STEP 2. Identify the Target Audience/Participant Characteristics. Also in the initial client meeting, the client needs to identify the target audience. Are there specific participant characteristics that need to be considered during recruitment (e.g., sex, age, socioeconomic status, occupation)?
STEP 3. Points To Consider To Determine Appropriateness and Feasibility of a Focus Test Project
(2) Worth - What is the project's relative worth to the Center for Devices and Radiological Health?
(3) Impact - How will results of the focus testing be used? What will happen if focus testing is not done?
(4) Funds - Does the client have the funds to adequately cover the costs of focus testing, especially recruitment costs?
A detailed description of the remaining steps in the focus group process is beyond the scope of this article. They include determining in-house versus contractor components; writing the proposal, tasks, schedule, and costs; planning logistics; developing a moderator's guide; developing a recruitment mechanism, flyer, and screener; recruiting participants; conducting a pilot group; conducting the focus groups; transcribing the tapes; analyzing and interpreting the data; writing the report; and making a client presentation.
Additional information on each of these major steps can be obtained from Paula Silberberg at the Center for Devices and Radiological Health/ FDA at (301) 443-2436. Part 11 of this series will provide case examples and lessons learned from FDA's experiences with the focus group method.
EPA Awards Environmental Education Grants Totaling $2.9 Million
In July, 1995, EPA Administrator Carol M. Browner announced the award of 255 grants totaling more than $2.9 million for environmental education initiatives to state, local, and tribal governments, schools, universities, and not-for-profit organizations throughout the United States.
"Education is an important first step in our efforts to protect public health and the environment," said Browner. "I commend the winners for their excellent proposals."
EPA is the lead agency for environmental education under the National Environmental Act of 1990. In selecting grant winners, emphasis was placed on projects that improve environmental education by enhancing teaching skill; build state, local, or tribal government capacity to develop and implement environmental education programs; create environmental education partnerships; educate the general public; and develop environmental education practices, methods, or techniques that are new, have wide applications, and address high-priority environmental issues.
The grant applications were screened by EPA officials and by external reviewers. EPA headquarters in Washington, DC, awarded the 14 grants worth more than $25,000 each; EPA's regional public affairs offices awarded the remaining 241 grants.
The 14 grants awarded by headquarters were these:
NIEHS ENVIROHEALTH Clearinghouse
In October 1993, the National Institute of Environmental Health Sciences (NIEHS), in conjunction with Information Ventures Inc. (IVI), began development of a clearinghouse on environmental health sciences information for two reasons: 1) The parent organization of NIEHS, the National Institutes of Health, had been criticized by the U.S. Congress and patient advocacy groups for poorly communicating the results and benefits of research conducted and sponsored by its component institutes, and 2) to improve NIEHS communication efforts and broaden the dissemination of research results to the biomedical research community, public interest groups, and the public. The goal of the NIEHS clearinghouse was to provide interested parties with information on environmental health and how NIEHS research efforts relate to their specific areas of interest. During the first year of development, IVI thoroughly searched for existing environmental health information services. Subsequently, gaps in existing services were identified, and services were designed to fill the gaps.
The NIEHS/IVI effort led to the establishment of ENVIROHEALTH, debuted on October 3, 1994. Calls are answered by technical information specialists who are experts in providing on-line assistance on a variety of topics relating to health and the environment.
ENVIROHEALTH is the only comprehensive information clearinghouse in the United States that provides callers with information on any question regarding environmental health. Callers' questions range from how to get their water tested for lead, to the location of the nearest Superfund site, to the possible adverse health effects of chemicals in their workplaces. Callers are often referred to organizations in their communities that can offer direct assistance, such as their local health departments. When appropriate, callers are referred to other organizations, government agencies, information sources, and clearinghouses that have applicable expertise.
ENVIROHEALTH is free. It can be reached by telephone at 1-800-NIEHS94 or 1-919-541-3345, by fax at (919) 361-9408, or via e-mail at ENVIROHEALTH@NIEHS.NIH.GOV. The hours of operation are 9:00 AM to 8:00 PM Eastern Time, Monday through Friday. The volume of inquiries has steadily increased. Currently, ENVIROHEALTH receives approximately 400 calls per month. Responses include referral numbers and oral information on services in specific geographic areas, and mailings of appropriate brochures, fact sheets, and scientific journal articles related to a caller's specific question or area of interest. Initial target audiences were science educators, environmental justice organizations, and environmental journalists. As publicity efforts expand, a concomitant increase in the number of calls is anticipated.
Plans for the future of ENVIROHEALTH include a Homepage on the World Wide Web, which would allow users easier access to information. Negotiations are currently underway to make ENVIROHEALTH the primary provider of information on the health effects of electromagnetic radiation.
For more information about the Clearinghouse's specific activities and services, contact Jerry Phelps, Office of Program Planning and Evaluation/NIEHS, at (919) 541-4259.
Education and Communication at CDC's International Health Program Office (IHPO)
Many, if not most, of the Centers for Disease Control and Prevention's (CDC) health education program activities in the international arena are externally funded. The principal source of the funds is the U.S. Agency for International Development (AID). This means that most of the funded activities are carried out in developing countries that receive U.S. foreign assistance through AID. CDC is engaged by AID under interagency agreements to provide technical assistance in a variety of areas, including health education, to Ministries of Health and non-governmental organizations (NGOs) in these countries. Key disease control programs for which CDC assistance is provided include the vaccine-preventable diseases, diarrhea, malaria, and acute respiratory infections (ARI), all targeted at children under 5 years of age. Other priority areas of assistance are reproductive health, sexually transmitted diseases (STDs), (including HIV/AIDS), and tuberculosis (TB). Key target groups for these programs are adults at risk, e.g., women of reproductive age, prostitutes, truck drivers, TB and STD patients, refugees, and displaced persons. To find out more about CDC's international health education activities, contact Kathy Parker at (404)488-1107.
Audrey R. Gotsch, Dr.P.H., CHES, is professor and chief, Division of Community Health Education, Department of Environmental and Community Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), and director, Public Education and Risk Communication Division, Environmental and Occupational Health Sciences Institute (EOHSI), a joint institute of UMDNJ and Rutgers University. She received her doctorate from Columbia University School of Public Health in sociomedical sciences and her master's degree from the University of Michigan School of Public Health in health education; she has also obtained Certification as a Health Education Specialist (CHES).
As part of her commitment to the enhancement of environmental health literacy of the public, Dr. Gotsch has developed and researched strategies to support the implementation of comprehensive environmental health education in classrooms and other community settings. She has been involved in the development and evaluation of age-appropriate curricular materials (kindergarten through graduate school) that involve students in outcome-based, hands-on learning activities. Participants are challenged to use critical thinking skills as they address environmental health issues presented through videos, interactive computer programs, case studies, and role playing. Classroom teachers are challenged to increase their understanding of environmental health science concepts, to increase their awareness of the impact of environmental factors on personal health, and to develop skills to infuse environmental health science issues into existing, multidisciplinary teaching plans. Safety and health professionals are offered a broad range of training topics that address issues specific to the workplace and the community. For more information about the education programs, call the EOHSI Resource Center at (908) 445-0110, or fax your request to (908) 445-0122.
Journal of Health Communication
Effective communication is critical at all levels of society. Of particular importance to the health professions are intercultural and international variables and barriers, the uses of new technologies, public health campaigns, health advocacy, and ethical issues. Journal of Health Communication, premiering in 1996, encompasses all of these areas and more.
The Journal of Health Communication is a scholarly, peer-review quarterly. It presents the latest developments in the field of health communication, including research in social marketing, shared decision making, communication (from interpersonal to mass media), psychology, government, and health education in the United States and the world. The journal publishes qualitative and quantitative studies, ethics essays, case studies, and book reviews.
The journal seeks to cultivate a synergistic relationship between research and practical information to help readers build a new health order Journal of Health Communication focuses on promoting the vital life of the individual and the good health of the world's people through the sharing of articles on research; progress in areas of technology and public health; ethics; politics and policy; and the application of health communication principles to the better health of individuals and communities. For more information, call the journal's editor, Scott Ratzan, M.D., M.P.A., at (617) 578-8745. Dr. Ratzan is director of the Emerson Tufts Program in Health Communication at Emerson College, Boston, Massachusetts.
The Health Risk Communicator is published three times each year by the Subcommittee on Risk Communication and Education, Environmental Health Policy Committee, Public Health Service. Health risk communication practitioners and researchers are the primary target audience. The newsletter's goals are to provide a forum for the exchange of news and ideas about contemporary health risk communication and education issues, and to dispense practical information on emerging trends, issues, and needs related to health risk communication principles and practices. The Communicator welcomes your its and comments about current health risk communication programs, activities, and issues. Send your news and information for publication to the managing editor, Tim Tinker, DrPH, at the Agency for Toxic Substances and Disease Registry (ATSDR), 1600 Clifton Road, NE, NIS E33, Atlanta, Georgia, 30333. Dr. Tinker's telephone number is (404) 639-6206, fax (404) 639-6208, and Internet address firstname.lastname@example.org.
Editor-in-Chief: Barry L. Johnson
Managing Editor: Tim Tinker (ATSDR)
Editorial Board: Mary Jo Deering (ODPHP), Max Lum (NIOSH), Bonnie Malkin (FDA), Dorothy Moore (NLM/NIH), Maria Pavlova (DOE), and Chris Schonwalder (NIEHS)
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