Risk Communication Activities of State Health Agencies Caron Chess, MS, Kandice L. Salomone, MS, and Peter M. Sandman, PhD
Intodudion
Results
Increasingly, government agencies have been concerned about how to communicate environmental health risks to the public. There is a growing literature prescribing how agencies should practice risk communication,"A describing case studies of agency efforts,'9 and investigating public perception of risk.""'3 Nevertheless, little is known about the risk communication activities and needs of public health agencies. We report briefly the results of a national survey of state health agencies. Two detailed reports, one dealing with the data's implications for risk communication training and the other dealing more fully with analyses of state health agencies' risk communication activities, are available from the authors.
According to staff respondents, the five environmental health issues on which agencies devoted the most time to communicatingwith the public in the past year were: drinking water contamination (90.6 percent); radon in indoor air (64.7 percent); potential cancer clusters (62.4 percent); clean up of hazardous waste sites (57.6 percent); and pesticides (43.5 percent). The dominant risk communication activity of agency staff is responding to inquiries (mean percentage of time = 62.1 percent). The remaining time is split between designing and planning outreach activities to alert the public to environmental health risks (21.8% percent) and soliciting input from the public on agency policies and actions (12.7 percent). Staff reported that their agencies communicate on a daily basis with individuals who contact them with questions about environmental issues, but they initiate contact only about once a week. They talk only once or twice a month with environmental advocacy groups, other groups that address specific environmental issues, and neighborhood community groups. When responding to inquiries, staff reported that the people with whom they speak most frequently have learned about a potential risk from the media and that they deal most frequently with people who have emotional responses to risk (Table 1). When soliciting input from people outside the agency on agency policies and environmental health issues, staff reported that their agencies used telephone contacts and informal meetings more frequently than seven other sources of input
Methods Early in 1989, the Association of State and Territorial Health Officials (ASTHO) distributed a risk communication survey (developed by the Rutgers Environmental Communication Research Program) to the health commissioners of the 50 states, five territories, and the District of Columbia. The survey was developed primarily to assess health agencies' risk communication needs. Therefore, the questions focused solely on risk communication rather than on the broader context of respondents' responsibilities, priorities, and resources. Health commissioners were asked to complete one survey themselves and to designate one person with technical background and one with communication background to complete individual copies of a similar survey. The surveys elicited returns from 128 respondents from 48 states and territories, with the 85 staff respondents accounting for 66.4 percent of all data analyzed and 43 commissioners accounting for 33.6 percent of analyzed data. Returned surveys reflect a 76.8 percent response rate for commissioners and a 75.9 percent response rate for agency staff.
Address reprint requests to Caron Chess, MS, Associate Director, Environmental Communication Research Program, Cook College, Box 231, Rutgers University, New Brunswick, NJ 08903-0231. Ms. Salomone is Research Methodologist at ECRP and Dr. Sandman is ECRP Director. This paper, submitted to the Journal December 20, 1989, was revised and accepted for publication August 13, 1990.
American Journal of Public Health 489
Public Health Briefs
ronmental risk communication is public misunderstanding" (82.4 percent); * "a major barrier to environmental risk communication is insufficient training for new and existing staff" (75.8 percent); and * "a major barrier to effective environmental risk communication is insufficient staff for risk communication" (67.2 percent). More than two-thirds of all respondents either "disagreed" or "strongly disagreed with these two statements: * "communicating with the public about environmental issues does not make much of an impact" (88.2 percent); and * "better to communicate less than to risk stirring up problems" (76.4%). More than half "disagreed" or strongly disagreed with * "the public should be encouraged to leave risk management decisions to the professionals" (57.1 percent).
Discussion
(Table 1). However, no single approach was used very often-perhaps a few times a month, at most. Much the same can be said for the frequency with which agencies conduct activities to alert the public to potential environmental hazards. Across 14 different methods, the most any one method was practiced was a few times a month. Most methods were used monthly and a few were used less than once a month (Table 1). 490 American Journal of Public Health
We probed agency philosophy with 10 statements. More than two-thirds of all respondents either "agreed" or "strongly agreed" with the following five statements: *4"communicating with the public about environmental risk is an important agency priority" (90.6 percent); * "risk communication training is important to improve agency efforts"
(87.3 percent); * "a major barrier to effective envi-
These data suggest that agencies, in spite of their philosophical commitment, are expending more effort on responding to requests for information than on initiating dialogues with interested constituencies or alerting the general public to risk. Most agency efforts are devoted to responding to inquiries from the public, and most inquiries from the public are generated by the media. Although respondents indicated that their agencies spent more than 20 percent of their communication time on outreach activities, they reported using most outreach methodsincluding contacting the media-fairly infrequently (monthly or less), again suggesting that they may be reacting to communication events rather than shaping them. The majority of respondents disagreed with the statement that the public should be encouraged to leave risk management decisions to the professionals, but no methods to solicit input were used with any frequency. This may indicate the flexibility that is important when dealing with a variety of audiences, or it may suggest that little time is spent in soliciting public input and even less in developing plans and policies on how to solicit input. C
Acknowledgments This research was funded by a cooperative agreement between the Agency for Toxic Substances and Disease Registry (ATSDR) and the
Aprfl 1991, Vol. 81, No. 4
Public Health Bniefs
Association of State and Territorial Health Officials (ASTHO) which subcontracted the development, analysis, and interpretation of the survey to Rutgers University's Environmental Communication Research Program. The authors are grateful to ASTHO, ATSDR, and the Public Health Foundation (PHF) for their input into the development of the survey; to ASTHO for distributing and collecting the surveys; and to the PHF for tabulating the data. We also appreciate the assistance of Billie Jo Hance, who had considerable input into the development of the survey, and David Holtgrave, who advised us on methodology. The opinions expressed in this article are those of the authors alone.
References
3.
4. 5.
6.
1. Covello VT, Allen F: Seven cardinal rules of risk communication. Washington, DC: USEPA, April 1988. 2. Covello VT, McCallum D, Pavlova M: Principles and guidelines for improving risk communication. In: Covello VT, McCallum D, and Pavlova M (eds): Effective Risk Communication: The Role and Responsi-
7. 8.
bility of Government and Nongovernment Organizations. New York: Plenum Publishers, 1989; 3-18. Hance BJ, Chess C, Sandman PM: Improving Dialogue with Communities: A Risk Communication Manual for Government. Trenton, NJ: Division of Science and Research, New Jersey Department of Environmental Protection, January 1988. Sandman PM: Explaining Environmental Risk. Washington, DC: TSCA Assistance Office, USEPA, November 1986. Chess C, Hance BJ: Alerting the Apathetic and Reassuring the Alarmed: Communicating about Radon Risk in Three Communities. Washington, DC: Office of Policy, Planning, and Evaluation, USEPA, August 1988. Edelstein MR: Contaminated Communities: The Social and Psychological Impacts of Residential Toxic Exposure. Boulder, CO: Westview Press, 1988. Krimsky S, Plough A: Environmental Hazards: Communicating Risks as a Social Process. Dover, MA: Auburn House, 1988. Levine AG: Love Canal: Science, Politics, and People. Lexington, MA: D.C. Heath, 1982.
9. Office of Policy, Planning, and Evaluation, Program Evaluation Division, USEPA: Region 3/OPPE/State of Maryland Radon Risk Communication Project: An Evaluation of Radon Risk Communication Approaches. Washington, DC: USEPA, November 1988. 10. Fischhoff B: Managing Risk Perceptions. Issues Sci Technol 1985; 3:83-96. 11. Fischhoff B, Slovic P, Lichtenstein S: Lay foibles and expert fables in judgments about risk. In: O'Riordan Turner RK (eds): Progress in Resource Management and Environmental Planning, Vol III. New York: Wiley, 1981; 161-202. 12. Slovic P: Perception of Risk. Science April 17, 1987; 23:280-285. 13. Slovic P, Fischhoff B, Lichtenstein S: Facts and fears: Understanding perceived risk. In: Schwing RC, Albers W Jr (eds): Societal Risk Assessment: How Safe Is Safe Enough? New York: Plenum, 1980; 181-216.
Capacity of US Labs to Provide TLI in Support of Early HIV-1 Intervention werelocatod in houpi~~~......... .......
Ronald 0. Valdisen, MD, MPH, G. David Cross, MS, A. Russell Gerber, MD, Robert E. Schwartz, BS, and Thomas L. Heam, MS
................t
Introdution a..... .....h.pau
from
it
...m..4mI ubi
In 1989, the US Public Health Service recommended that all persons infected with human immunodeficiency virus type-1 (HIV-1) have CD4+ cell counts performed at least every six months.1 This recommendation is based upon the knowledge that CD4+ cell counts are a major predictor of disease progression in HIV-1 infection,2 and that information provided by this test is used to make therapeutic decisions about initiating antiretroviral therapy and prophylactic therapy for Pneumocystis carnii pneumonia.3 Because CD4+ cell counts are currently performed by flow cytometric analysis, a technique that is not commonly used in many laboratories, a survey was conducted by the Division of Laboratory Systems, Public Health Practice Program Office (PHPPO) of the Centers for Disease Control (CDC) to learn more about the national availability of this testing and
about testing practices in the laboratories currently providing CD4+ cell testing services.
Methods In August 1989, 1,658 laboratories were surveyed to learn more about their T-lymphocyte immunophenotyping (TLI) testing practices; 1,348 were currently enrolled in a voluntary HIV-1 antibody testing performance evaluation program conducted by the CDC,4 and 310 were enrolled in a flow cytometry proficiency testing program sponsored by the College of American Pathologists (CAP). The surFrom the Division of Laboratory Systems, Centers for Disease Control, Atlanta, GA. Address reprint requests to Ronald 0. Valdiserri, MD, MPH, Director, Division of Laboratory Systems, Public Health Practice Program Office (G25), Centers for Disease Control, Atlanta, GA 30333. This paper, submitted to the Journal March 9, 1990, was revised and accepted for publication August 6, 1990.
American Journal of Public Health 491
Intodudion
Results
Increasingly, government agencies have been concerned about how to communicate environmental health risks to the public. There is a growing literature prescribing how agencies should practice risk communication,"A describing case studies of agency efforts,'9 and investigating public perception of risk.""'3 Nevertheless, little is known about the risk communication activities and needs of public health agencies. We report briefly the results of a national survey of state health agencies. Two detailed reports, one dealing with the data's implications for risk communication training and the other dealing more fully with analyses of state health agencies' risk communication activities, are available from the authors.
According to staff respondents, the five environmental health issues on which agencies devoted the most time to communicatingwith the public in the past year were: drinking water contamination (90.6 percent); radon in indoor air (64.7 percent); potential cancer clusters (62.4 percent); clean up of hazardous waste sites (57.6 percent); and pesticides (43.5 percent). The dominant risk communication activity of agency staff is responding to inquiries (mean percentage of time = 62.1 percent). The remaining time is split between designing and planning outreach activities to alert the public to environmental health risks (21.8% percent) and soliciting input from the public on agency policies and actions (12.7 percent). Staff reported that their agencies communicate on a daily basis with individuals who contact them with questions about environmental issues, but they initiate contact only about once a week. They talk only once or twice a month with environmental advocacy groups, other groups that address specific environmental issues, and neighborhood community groups. When responding to inquiries, staff reported that the people with whom they speak most frequently have learned about a potential risk from the media and that they deal most frequently with people who have emotional responses to risk (Table 1). When soliciting input from people outside the agency on agency policies and environmental health issues, staff reported that their agencies used telephone contacts and informal meetings more frequently than seven other sources of input
Methods Early in 1989, the Association of State and Territorial Health Officials (ASTHO) distributed a risk communication survey (developed by the Rutgers Environmental Communication Research Program) to the health commissioners of the 50 states, five territories, and the District of Columbia. The survey was developed primarily to assess health agencies' risk communication needs. Therefore, the questions focused solely on risk communication rather than on the broader context of respondents' responsibilities, priorities, and resources. Health commissioners were asked to complete one survey themselves and to designate one person with technical background and one with communication background to complete individual copies of a similar survey. The surveys elicited returns from 128 respondents from 48 states and territories, with the 85 staff respondents accounting for 66.4 percent of all data analyzed and 43 commissioners accounting for 33.6 percent of analyzed data. Returned surveys reflect a 76.8 percent response rate for commissioners and a 75.9 percent response rate for agency staff.
Address reprint requests to Caron Chess, MS, Associate Director, Environmental Communication Research Program, Cook College, Box 231, Rutgers University, New Brunswick, NJ 08903-0231. Ms. Salomone is Research Methodologist at ECRP and Dr. Sandman is ECRP Director. This paper, submitted to the Journal December 20, 1989, was revised and accepted for publication August 13, 1990.
American Journal of Public Health 489
Public Health Briefs
ronmental risk communication is public misunderstanding" (82.4 percent); * "a major barrier to environmental risk communication is insufficient training for new and existing staff" (75.8 percent); and * "a major barrier to effective environmental risk communication is insufficient staff for risk communication" (67.2 percent). More than two-thirds of all respondents either "disagreed" or "strongly disagreed with these two statements: * "communicating with the public about environmental issues does not make much of an impact" (88.2 percent); and * "better to communicate less than to risk stirring up problems" (76.4%). More than half "disagreed" or strongly disagreed with * "the public should be encouraged to leave risk management decisions to the professionals" (57.1 percent).
Discussion
(Table 1). However, no single approach was used very often-perhaps a few times a month, at most. Much the same can be said for the frequency with which agencies conduct activities to alert the public to potential environmental hazards. Across 14 different methods, the most any one method was practiced was a few times a month. Most methods were used monthly and a few were used less than once a month (Table 1). 490 American Journal of Public Health
We probed agency philosophy with 10 statements. More than two-thirds of all respondents either "agreed" or "strongly agreed" with the following five statements: *4"communicating with the public about environmental risk is an important agency priority" (90.6 percent); * "risk communication training is important to improve agency efforts"
(87.3 percent); * "a major barrier to effective envi-
These data suggest that agencies, in spite of their philosophical commitment, are expending more effort on responding to requests for information than on initiating dialogues with interested constituencies or alerting the general public to risk. Most agency efforts are devoted to responding to inquiries from the public, and most inquiries from the public are generated by the media. Although respondents indicated that their agencies spent more than 20 percent of their communication time on outreach activities, they reported using most outreach methodsincluding contacting the media-fairly infrequently (monthly or less), again suggesting that they may be reacting to communication events rather than shaping them. The majority of respondents disagreed with the statement that the public should be encouraged to leave risk management decisions to the professionals, but no methods to solicit input were used with any frequency. This may indicate the flexibility that is important when dealing with a variety of audiences, or it may suggest that little time is spent in soliciting public input and even less in developing plans and policies on how to solicit input. C
Acknowledgments This research was funded by a cooperative agreement between the Agency for Toxic Substances and Disease Registry (ATSDR) and the
Aprfl 1991, Vol. 81, No. 4
Public Health Bniefs
Association of State and Territorial Health Officials (ASTHO) which subcontracted the development, analysis, and interpretation of the survey to Rutgers University's Environmental Communication Research Program. The authors are grateful to ASTHO, ATSDR, and the Public Health Foundation (PHF) for their input into the development of the survey; to ASTHO for distributing and collecting the surveys; and to the PHF for tabulating the data. We also appreciate the assistance of Billie Jo Hance, who had considerable input into the development of the survey, and David Holtgrave, who advised us on methodology. The opinions expressed in this article are those of the authors alone.
References
3.
4. 5.
6.
1. Covello VT, Allen F: Seven cardinal rules of risk communication. Washington, DC: USEPA, April 1988. 2. Covello VT, McCallum D, Pavlova M: Principles and guidelines for improving risk communication. In: Covello VT, McCallum D, and Pavlova M (eds): Effective Risk Communication: The Role and Responsi-
7. 8.
bility of Government and Nongovernment Organizations. New York: Plenum Publishers, 1989; 3-18. Hance BJ, Chess C, Sandman PM: Improving Dialogue with Communities: A Risk Communication Manual for Government. Trenton, NJ: Division of Science and Research, New Jersey Department of Environmental Protection, January 1988. Sandman PM: Explaining Environmental Risk. Washington, DC: TSCA Assistance Office, USEPA, November 1986. Chess C, Hance BJ: Alerting the Apathetic and Reassuring the Alarmed: Communicating about Radon Risk in Three Communities. Washington, DC: Office of Policy, Planning, and Evaluation, USEPA, August 1988. Edelstein MR: Contaminated Communities: The Social and Psychological Impacts of Residential Toxic Exposure. Boulder, CO: Westview Press, 1988. Krimsky S, Plough A: Environmental Hazards: Communicating Risks as a Social Process. Dover, MA: Auburn House, 1988. Levine AG: Love Canal: Science, Politics, and People. Lexington, MA: D.C. Heath, 1982.
9. Office of Policy, Planning, and Evaluation, Program Evaluation Division, USEPA: Region 3/OPPE/State of Maryland Radon Risk Communication Project: An Evaluation of Radon Risk Communication Approaches. Washington, DC: USEPA, November 1988. 10. Fischhoff B: Managing Risk Perceptions. Issues Sci Technol 1985; 3:83-96. 11. Fischhoff B, Slovic P, Lichtenstein S: Lay foibles and expert fables in judgments about risk. In: O'Riordan Turner RK (eds): Progress in Resource Management and Environmental Planning, Vol III. New York: Wiley, 1981; 161-202. 12. Slovic P: Perception of Risk. Science April 17, 1987; 23:280-285. 13. Slovic P, Fischhoff B, Lichtenstein S: Facts and fears: Understanding perceived risk. In: Schwing RC, Albers W Jr (eds): Societal Risk Assessment: How Safe Is Safe Enough? New York: Plenum, 1980; 181-216.
Capacity of US Labs to Provide TLI in Support of Early HIV-1 Intervention werelocatod in houpi~~~......... .......
Ronald 0. Valdisen, MD, MPH, G. David Cross, MS, A. Russell Gerber, MD, Robert E. Schwartz, BS, and Thomas L. Heam, MS
................t
Introdution a..... .....h.pau
from
it
...m..4mI ubi
In 1989, the US Public Health Service recommended that all persons infected with human immunodeficiency virus type-1 (HIV-1) have CD4+ cell counts performed at least every six months.1 This recommendation is based upon the knowledge that CD4+ cell counts are a major predictor of disease progression in HIV-1 infection,2 and that information provided by this test is used to make therapeutic decisions about initiating antiretroviral therapy and prophylactic therapy for Pneumocystis carnii pneumonia.3 Because CD4+ cell counts are currently performed by flow cytometric analysis, a technique that is not commonly used in many laboratories, a survey was conducted by the Division of Laboratory Systems, Public Health Practice Program Office (PHPPO) of the Centers for Disease Control (CDC) to learn more about the national availability of this testing and
about testing practices in the laboratories currently providing CD4+ cell testing services.
Methods In August 1989, 1,658 laboratories were surveyed to learn more about their T-lymphocyte immunophenotyping (TLI) testing practices; 1,348 were currently enrolled in a voluntary HIV-1 antibody testing performance evaluation program conducted by the CDC,4 and 310 were enrolled in a flow cytometry proficiency testing program sponsored by the College of American Pathologists (CAP). The surFrom the Division of Laboratory Systems, Centers for Disease Control, Atlanta, GA. Address reprint requests to Ronald 0. Valdiserri, MD, MPH, Director, Division of Laboratory Systems, Public Health Practice Program Office (G25), Centers for Disease Control, Atlanta, GA 30333. This paper, submitted to the Journal March 9, 1990, was revised and accepted for publication August 6, 1990.
American Journal of Public Health 491
