The Health Risk Communicator

A Publication of the Subcommittee on Risk Communication and Education Public Health Service (PHS)

Federal Focus

New NIOSH Branch Provides Blueprint for Better Communications

Most people would not enter unfamiliar territory without knowing the local language, customs, and roads. Today, communicators have been thrust into new and unfamiliar territories with the rise of relatively new electronic and interactive media, coupled with the shifting needs and values of audiences.

In response to these changes, the National Institute for Occupational Safety and Health (NIOSH) recently established the Health Communications Research Branch (HCRB). HCRB will conduct ongoing research and evaluation concerning these new frontiers to provide the blueprints necessary for guiding NIOSH's occupational health communications in a changing world. Part of the Centers for Disease Control and Prevention, NIOSH conducts research to identify the causes of work-related injuries and illnesses, to evaluate the hazards of new technologies and work practices, and to create ways to control hazards.

"HCRB is a communications research unit in which new communication technologies along with innovative approaches to traditional health communications methods will be researched and evaluated," said Alan Janssen, MSPH, chief of the new branch. "The impact of these preventive health efforts on improving occupational health and safety problems will be the focus of this group."

HCRB is part of NIOSH's newly created Health Effects Laboratory Division in Morgantown, West Virginia. HCRB's primary functions are to

• Design effective health communication strategies using expertise in marketing, advertising, health education. communications, and social psychology.
• On the basis of research results, develop messages, materials, and methods to clarify and effectively communicate information vital for identifying and preventing work-related health risks.
• Target dissemination of research results to those at risk and those who can most effectively implement or promote prevention activities or measures.
• Form partnerships to foster more effective occupational health messages and dissemination of those messages to workers, employers, the medical and public health communities, and others.
• Evaluate the effectiveness of NIOSH's health communications and continuously revise, expand, and improve communication efforts based on these results.

Research has shown that health messages and campaigns are often ineffective because they do not take into consideration characteristics, language, educational, cultural, and social factors of the target audience that influence the effectiveness of messages and the most appropriate medium by which to deliver each message to each group. In recognition of this fact, HCRB staff (when complete) will include health educators, writer-editors, evaluation specialists, and a marketing specialist, medical anthropologist, medical officer, and graphic artist. HCRB will also draw on the expertise of those working closely with target groups and other general communications specialists in the academic, government, and private communities to develop, disseminate, and evaluate agency communications materials and programs.

Several current HCRB projects include assisting other NIOSH divisions in preparing a silicosis awareness campaign for five target groups identified through surveillance research; planning an interactive learning center for the lobby of a new NIOSH health research facility that will be opening this fall in Morgantown, West Virginia; evaluating occupational safety and health data for several target groups to identify communication intervention needs; and studying uses of multimedia technologies to disseminate agency information, such as video and sound on NIOSH's Internet site, and video "hazard alerts."

These efforts will provide target groups with information in an accessible, understandable, and culturally relevant format, so that they are better prepared and more likely to protect themselves and others against occupational safety and health hazards. HCRB's efforts will bring NIOSH closer to reaching many of the goals under the new National Occupational Research Agenda, including developing interventions for special populations at risk and increasing intervention effectiveness. The agenda, released by NIOSH and its partners in the occupational safety and health community this spring, identifies 21 priority research areas and provides a framework to guide occupational safety and health research for the next decade.

For more information about NIOSH's Health Communications Research Branch, contact: Alan Janssen, MSPH, Chief, HCRB, 1095 Willowdale Road, MS B167, Morgantown, WV 26505-2888; telephone (304) 285-6090; fax (304) 285-6126; e-mail axj3@niordsl.em.cdc.gov.

Technology and Innovation

EPA's New Government Information Locator Services (GILS)

EPA is announcing a new service that will help the public access environmental information. As part of the National Infrastructure and through the Paperwork Reduction Act of 1995, this new service, Government Information Locator Service (GILS) is an electronic service available via the Internet that provides a decentralized location to anyone who needs to locate, access, or acquire government information. GELS has an extensive listing of EPA's information resources, descriptions of the information in those resources, and the assistance necessary to obtain that information. The GILS is available on the World Wide Web at http://www.epa.gov/gils.

Training and Education

Risk Communications Training Module Available

The Rutgers Center for Environmental Communications has developed a training guide that will teach government officials how to communicate more effectively with the public about environmental issues. Planning Successful Risk Communication illustrates successful risk communication by using an actual case of agency officials, industry representatives, and citizens transforming an environmental controversy into a constructive dialogue,

Planning Successful Risk Communication includes a video, a facilitator guide, a participant guide, and other materials providing a complete training package to help participants reinforce risk communication concepts.

The training package was funded by a grant from the U.S. Environmental Protection Agency (EPA), Northeast Hazardous Substance Research Center and an in-kind donation of video services from the EPA's Environmental Response Team. Planning Successful Risk Communication costs $100 and can be ordered by contacting the Center for Environmental Communication Cook College, Rutgers University, P.O. Box 231, New Brunswick, New Jersey 08903-0231; telephone (908) 932-8795; fax (908) 932-7815; e-mail CEC@aesop.rutgers.edu.

Feature Article

ATSDR's Health Risk Communication Demonstration Project

Background

The Agency for Toxic Substances and Disease Registry will pilot a health risk communication demonstration project for concept, message, materials, and strategy development and testing at two hazardous waste sites in fiscal year 1997. The purpose of the 1-year model program is to produce messages, materials, and other communications products that are credible, useful, and appealing to the diverse audiences that ATSDR serves.

ATSDR's mission is to prevent exposure and adverse human health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. In fulfilling this mission, ATSDR conducts health assessments, health studies, develops toxicological profiles, and implements a wide range of other public health actions.

Each of these activities generates information that must be communicated back to Federal, state, and local officials as well as to the public. Often citizens, health professionals, and the community at-large demand immediate explanations to complex environmental problems that involve ATSDR. To meet its legislative mandate, ATSDR must improve its capacity and methods by which environmental health risks are communicated to these groups and ATSDR's other partners and constituents.

Improved environmental risk communication is important to focus public attention on risks that, from a scientific standpoint, pose the greatest threat to health, and to allay fears about risks that pose a lesser or no apparent threat. Public concern about the dangers of exposure to hazardous substances is quite high, particularly near hazardous waste sites where the presence of contaminants has been verified.

The proposed project is unique in its focus on helping ATSDR staff to better understand the risk communication principles that will assist them in fulfilling their responsibilities to provide and receive from the general public needed environmental information and data about exposures and health risks at hazardous waste sites,

Audiences

The following are the target audiences for the proposed site-specific health risk communication project:

(1) ATSDR staff. ATSDR's divisions and offices have specific responsibilities for communicating to the public information about hazardous substances in the environment. The Division of Health Assessment and Consultation (DHAQ), for example, conducts public availability sessions, disseminates information, and provides risk communication training to its public health professionals. Each of these activities requires that information be responsive to public concerns and explains environmental risks clearly. Systematic communication planning and implementation, as proposed in the project, will assist ATSDR staff in

1. establishing clear and measurable risk communication goals and objectives,
2. identifying and segmenting target audiences,
3. developing and testing message concepts and materials, and
4. selecting appropriate distribution channels.

(2) Community members. Involving communities in ATSDR's site activities and in decision making requires a two-way exchange of information—the agency provides information to the public about toxic substances in the environment, health effects, and other related topics, and the community educates ATSDR about its wants, needs, concerns, and opinions. At any given site, community-based audiences include

1. residents and former residents,
2. local, regional, or national action groups,
3. the media, and
4. other formal or informal leaders.

The proposed project is designed to integrate risk communication considerations into overall program planning and design, thereby improving ATSDR's effectiveness in organizing and conducting public meetings, developing and delivering printed materials, and evaluating the agency's communications efforts.

(3) State, county, and local health officials. These professionals include scientists, physicians, epidemiologists, health assessors, and health education specialists, who often feel vulnerable and unprepared when they assume the role of risk communicator at hazardous waste sites. State, county, and local health professionals develop, manage, and evaluate Superfund programs that include risk communication. These health professionals are often confronted with the problems underlying what should be communicated, in what form, to whom, and with what expected outcome. Building the capacity of these front-line risk communicators to develop and deliver clear, accurate, and meaningful messages and materials about risk is the primary function of the proposed project.

(4) Public health professionals, including primary care physicians, nurses, health assessors, environmental engineers, sanitarians, and others who communicate health risk messages to the public or to other professionals. By learning how to communicate environmental health risk more effectively, these professionals can prevent unnecessary exposures to hazardous substances, increase public understanding of actual health risks, and improve the health of their clients at Superfund sites.

Project Components

ATSDR will work with a communications contractor to organize and conduct the following activities:

1. Document Intended Program. ATSDR staff involved in the development of the demonstration project will be interviewed to determine their expectations of the project's intended results. ATSDR will work with the contractor to develop a framework for planning and implementing the concept, message, and materials development and testing processes with hazardous waste sites as its primary focus.

2. Identify Message Concepts. The project is designed to identify a series of health risk communication concepts for potential development into messages, printed materials, resource tools, and strategies for public outreach and education. Message concepts to be tested may include but not be limited to

1. public perceptions of environmental risk,
2. scientific uncertainty and its influence on the public communications process,
3. priority health conditions at hazardous waste sites, and
4. risks versus benefits.

3. Pretest and Test Messages and Materials. All message concepts, draft materials, and existing materials will be pre-tested and tested. Testing will be undertaken to assure clarity of the message, acceptability to the target audience(s), and appropriateness for the media proposed.

Such testing may include, but not be limited to the following:

1. Focus Groups. Potential concepts, draft materials, story boards, etc., will be presented and tested using focus groups. Focus groups will be drawn from the target audience(s) using standard market research techniques and will be broadly representative of the target community.
2. Professional Review. Concepts, messages, and materials may be submitted for review by appropriate professionals, experts, and representatives of agencies involved in specific prevention efforts with specific target audiences.
3. One-on-One Testing. Some concepts, messages, materials, and strategies may be tested through a series of one-on-one discussions with members of the target audience. This might include, but not be limited to, face-to-face interviews in a variety of settings, including in-home.
4. Field Tests. Some messages and materials may require the use of field tests prior to agency-wide dissemination. The contractor shall have the ability to conduct such activities and quickly report on the outcomes before a broader dissemination.

For more information about ATSDR's proposed health risk communication demonstration project, please contact Dr. Tim Tinker, ATSDR, Division of Health Education at (404) 639-6298.

Environmental Education

BRANCHING OUT

Branching Out is an environmental education curriculum for middle-schoolers that is available on the World Wide Web. The curriculum consists of 14 easy-to-use lessons covering a wide range of topics including wildlife, forestry, non-source pollution, wetlands, recreation, planning and schoolyard stewardship. Branching Out's Internet address is http://www.ces.ncsu.edu/nreos/forest/steward/pdf/brantoc.html.

Branching Out was funded by the North Carolina Forest Stewardship Program, a cooperative program to encourage the voluntary management of private forest. Under the Forest Stewardship Program, landowners are provided assistance to manage their total forest resources according to their objectives. Target resources include timber, wildlife, soil and water, recreation, and natural beauty.

For more information about Branching Out contact the NC Forest Stewardship Homepage at http://www.ces.ncsu.edu/nreos/forest/steward/steward.html or e-mail at mmegalos@ces.ncsu.edu.

Associations

The North American Association for Environmental Education

Since its beginning in 1971, the North American Association for Environmental Education (NAAEE) has been dedicated to promoting environmental education and supporting the work of environmental educators around the world. NAAEE is an integrated network of professionals in the field of environmental education with membership throughout North America and in more than 40 additional countries.

There are many environmental interest groups, and many organizations dedicated to improving education. NAAEE uniquely combines and integrates both of these perspectives. NAAEE is a non-partisan advocacy organization deeply committed to environmental education.

The association recognizes the need for a coherent body of information about environmental issues, but its members also recognize that information and analysis are only part of an effective education program. To translate theory into reality and provide tangible support for environmental education and environmental educators, NAAEE engages in a variety of programs and activities. Perhaps the single most important activity of the association is the annual conference, scheduled November 1 through 5, 1996, in San Francisco, California.

In addition to its annual conference, the association undertakes the development of model programs and other selectively targeted initiatives on regular basis. Recent initiatives include creation of materials for use in NAAEE's Environmental Issues Forums (EIF) program. EIF provides a structured format and the necessary tools for adults in their communities, and for secondary and college students in their classrooms to work through controversial environmental issues and identify possible areas of agreement and cooperation.

A second initiative is the NAAEE Training Institute, which provides workshops and training courses on such topics as fund-raising and long range planning. A special feature of the Institute is environmental education courses for participants from developing countries.

A third high-priority initiative is NAAEE's emphasis on urban and multi-cultural environmental education. A key component of this effort is the VINE NETWORK, which promotes programs using volunteers to lead children in explorations of the ecology of their urban neighborhoods. In many United States cities, the organizations that sponsor VINE Programs work with high school students and elementary school teachers to cultivate broader community involvement.

In a fourth area of association focus and interest, NAAEE has launched a major project to develop standards for environmental education. The standards will be developed collaboratively with input from many sources and will cover educational materials, learner outcomes, and teacher preparation.

To obtain more information about the NAAEE, please contact Barbara Eager, NAAEE's Conference and Marketing Manager, at (706) 764-2926.

New Publication

CDC's Applying Prevention Marketing

One of the Centers for Disease Control and Prevention's top priorities is preventing HIV transmission among people 25 years of age and younger because this group now accounts for half of all new HIV infections. Nationwide, countless community-based organizations (CBOs), AIDS service organizations (ASOs), faith-based AIDS ministries, HIV Prevention Community Planning Groups, state and local health and education departments, other federal agencies, and national organizations share this goal. Some are already using various aspects of social marketing in HIV and sexually transmitted disease (STD) prevention programs, drug use prevention programs, and other public health efforts.

Many HIV Prevention Community Planning Groups, in particular, have used key elements of social marketing in developing their plans. They have used epidemiologic and demographic data combined with information about possible audiences gleaned through focus groups, individual interviews, and other means, to define priority groups and their needs to guide decisions about interventions. Social marketing offers these groups and others a new perspective and systematic way to design, deliver, and evaluate prevention programs that are focused on behavioral goals.

This document is designed for a wide-ranging audience of those responsible for HIV prevention programs for young people. It was written to help organizations develop, deliver, and evaluate interventions by

1. increasing understanding of the principles and processes of social marketing to reinforce or change behaviors to prevent HIV infection,
2. providing a framework for creating, conducting, and evaluating effective social marketing-based HIV prevention programs in community setting, and
3. describing CDC's Prevention Marketing Initiative (PMI) and other interventions based on social marketing.

This document is divided into two parts. The first section describes social marketing—its key elements, real-life applications, and benefits—and illustrates its principles with sketches of successful programs. The second section provides community guidelines for implementing social marketing based HIV prevention programs.

To obtain a copy of Applying Prevention Marketing, please contact the CDC's National AIDS Clearinghouse at (800) 458-5231.

Who's Who in Health Risk Communication

Dr. Connie Ozawa, Ph.D., is associate professor in the Department of Urban Studies and Planning at Portland State University, in Portland, Oregon. Dr. Ozawa is also an associate at the Program on Negotiation, Harvard Law School. She has taught courses on environmental policy, environmental dispute resolution and negotiation at M. I. T. , Harvard University, and Tufts University, and has been a public member of the Massachusetts Hazardous Waste Facility Site Safety council since 1988. Dr. Ozawa conducts research on negotiation in environmental policy making and is author of Recasting Science: Consensus-Based Procedures in Public Policy Making (Westview, 1991) and several journal articles.

Dr. Ozawa's research has shown that conventional approaches to weaving scientific and technical information and analysis into public decisions in risky situations (e.g., cleaning up Superfund sites, regulating new chemicals, and citing noxious facilities) have the disturbing effect of generating distrust among the parties involved. She has experience with consensus-based approaches to decision making, explicit negotiations among stake holding parties to reach agreement on a course of action or a policy, and suggests that science can be integrated into the larger political debates in ways that augment rather than erode trust

To find out more about Dr. Ozawa's research and risk communication activities, please contact her at (503) 725-5126.

Upcoming Workshop

Environmental Health Risk Communication Workshop

The Association of State and Territorial Health Officials, in conjunction with the Agency for Toxic Substances and Disease Registry (ATSDR), and the Florida Department of Health and Rehabilitative Services (HRS) is sponsoring an environmental health risk communication workshop on September 24, 1996, in Tallahassee, Florida.

At this time the workshop is by invitation only, but inquiries about follow-up to the workshop can be directed to Mr. Lu Grimm, Environmental Risk Communication Workshop Coordinator, at (904) 488-3385.

The purpose of the 1-day workshop entitled Communicating Health Risks To Minorities, Underserved, and Sensitive Communities is to foster awareness of special considerations for effectively communicating environmental health risks to people with differing needs, cultures, and lifestyles. The workshop will feature an intensive full-day session designed to help participants

• List basic risk communication principles.
• Describe special considerations for communicating with minority, undeserved, and sensitive communities.
• Address community concerns using creative ideas to communicate health risk information.
• Develop a skeletal plan for applying principles and practices.

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 contributions 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, MS E33, Atlanta, Georgia, 30333. Dr. Tinker's telephone number is (404) 639-6206, fax (404) 639-6208, and Internet address txt2@atsod3.em.cdc.gov.

Editor-in-Chief: Barry L. Johnson (ATSDR)
Managing Editor: Tim Tinker (ATSDR)
Editorial Board: Mary Jo Deering (ODPHP), Max Lum NOSH), Bonnie Malkin (FDA), Dorothy Moore (NLM/ NIH), Maria Pavlova (DOE), and Chris Schonwalder (NIEHS)