Developing New Hazard Category Language for the Agency for Toxic Substances and Disease Registry's Public Health Assessment Products
Ulirsch, Gregory, Orloff, Ken, Alexanian, Dan, Allen-Lewis, Sylvia, Fagliano, Jerald, Langmann, Danielle M., Larson, Karen, Miles, Donald, Prohonic, Elizabeth, Telfer, Jana, Robinson, Susan, Turner, Monique Mitchell, Berkowitz, Judy, Journal of Environmental Health
The Agency for Toxic Substances and Disease Registry (ATSDR) determines public health implications associated with hazardous waste sites and other environmental releases. Since its inception, ATSDR has continued to improve its approach to evaluating public health hazards in light of evolving science. For example, in response to concerns about the clarity, meaning, and understandability of the five conclusion categories outlined in its Public Health Assessment Guidance Manual (www.atsdr.cdc. gov/HAC/PHAmanual/index.html), ATSDR established an ad hoc work group to evaluate and recommend changes to the categories based on health and risk communication science.
All site-specific public health assessment reports must include a statement that assigns a hazard conclusion category to the site, a time period for exposure (e.g., past, current, or future), or an exposure pathway, as appropriate. This statement reflects one of the following: that the site does not pose a public health hazard, that the site poses a public health hazard, or that data are insufficient to determine whether any public health hazard exists. The language used to convey these categories, however, was difficult for community members and lay audiences to understand because it was not written clearly.
After initial input from partners and stakeholders, the work group modified the language to include more comprehensive, descriptive statements within each category and initiated a three-part review process to test and refine the messages. First, the language was reviewed by an expert panel of risk communication scholars and practitioners and by internal and external stakeholders. Next, by using this input, the work group revised the language and tested it in two focus groups with members of the public. Finally, the language was revised another time and tested again with members of the public.
Expert Panel and Stakeholder Review
Four nationally recognized risk communication experts were asked to provide feedback on the modified hazard category language to ensure that it reflected risk communication science, theory, and practice. The expert panel was first briefed on the public health assessment process and then asked to review the language and rate each message on 1) consistency with communication theory, 2) message clarity, and 3) readability.
Panel members also provided recommendations for modifying the language because they suggested that the revised messages still needed improvement. For example, panelists noted that the differences among several of the hazard categories were slight and that the proposed messages did not accurately convey these differences. Also, messages needed clearer, more understandable language with specific information about the nature of the risk and what people should do to avert or reduce exposure to it. In addition, the panel discouraged the use of subjective wording to avoid confusing the readers. The panel also recommended that the work group pay particular attention to the emotional responses the messages might cause and make the messages more empathetic. Lastly, the panel recommended that the work group use a standardized methodology to convey messages, such as message mapping (Covello, 2006), to ensure consistency, accuracy, and receptivity across ATSDR messages.
ATSDR provided the modified language to state cooperative agreement and federal government technical partners for review and comment. These partners provided comments similar to those received from the expert panel.
Given this feedback, the work group modified the language to clarify the intent of the public health assessment category, to focus the language on actions that needed to be taken, and to use words that were meaningful to a nontechnical audience.
Testing the Language in Focus Groups
The work group then tested the language with the lay public. Two focus groups were held in Atlanta, Georgia, in November 2006 in a professional focus group facility and lasted between 1. …