Friday, January 30, 2015

“Measles Elimination” – an important public health concept that gets lost in the FOG of Words

People should get vaccinated against contagious diseases for their own safety AND because vaccination is a critical way to eliminate that disease from a population. These two facts are central to public health messaging.
 The first message is sort of simple “Get Vaccinated." (Not saying that people’s responses to calls to vaccinate are not fraught.)

Today I’m focusing on the second function of the vaccination message- to foster the public’s understanding of disease elimination. Uncannily, health writers, especially when they're writing definitions, seem to fall into a haze of complex and circular Epi concepts and language, not shared by the general public. 

The Fog of Words   

(accessed 1/30/15)
Q: What does "measles elimination" mean?
A: Measles elimination is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area. In such areas, there may still be measles cases, but they are from infected people who bring the disease into the area.
A Health Literacy Load Analysis – (what the message assumes the reader knows)
·                                 “continuous disease transmission” – both read it and understand it.
                      above has a critical timeframe ( 12 months).

Q Public
So let’s just say I’m one of the millions in the US (actually at least 50 % of adults) who reads at 8th grade level or lower and who doesn’t have a solid foundation in health concepts.   I stumble across “the absence of continuous disease transmission”.
(To further fog things up, the link the reader sees takes you to
A JAMA Pediatrics  article with a reading level and science literacy level of post HS/college)

Here’s what I likely come up with trying to read and understand this definition.
  • ·      A person is “absent” from the area where the disease is.
  • ·      Or I skip over the one word I know, “absence” and start with “continue”.  So something about continuing the disease.  Maybe people can continue to get measles for 12 months.

This definition bypasses the easier to read active verb form.  Instead, it turns the verb into a noun-deactivates it (nominalizes it) รจ”the transmission of measles.”

We know that active forms of verbs and sentences are generally easier to read.
If we unpack the complex sentence above we get 3 active ones: 
The disease is transmitted.
The disease is transmitted continuously.
The disease transmission must stop for 12 months.

You could write the definition like this:
Q: What does "measles elimination" mean?

A: Measles elimination is when people living in the same geographic area stop spreading (transmitting) the disease from one person to another for at least 12 months. There is not more measles in the area. Measles may start again if an infected person brings the disease into    the area.   

Any other ideas?  

Monday, January 26, 2015

Anti-vacciners are so darn readable

I was reading a blog I always enjoy, Skeptical Raptor, a recent post, " Debunking the vaccine denier myths of the Argument by Package Insert."  While I stumbled over the title a few times before I did realize it was critiquing a standard anti-vaccine argument, the critique presents a good insight into a clever but flawed argument they use.
* The Raptor's 2009 blog is also a good read.
The thorough analysis shows how the anti-vaccine argument, like so many arguments do a lot of cherry picking of language from the drug inserts accompanying vaccine packaging.

Raptor rightly concludes the blog post with an appeal that consumers read the vaccine inserts very carefully.
"...However, package inserts must be read fully, without cherry picking data that supports your point of view. Taking information out of context, without spending the effort to understand it completely, just shows the level of denialism. The anti-vaccinationists are focused on finding any data, no matter the quality, that supports what they want to believe. But if you are truly on the fence about vaccinations, then the adverse events information in a package insert is not the place to start. There is so much information out there, but if you read that information with an open, critical mind, you will find that the scientific consensus strongly supports the safety and effectiveness of vaccines."

For millions,  a quote in "print" especially something like a medication label ( selective quoting used by anti-vacciners), or newspaper article still has verities.  It's taken as gospel.  The "dueling experts" that is stuck a staple of news coverage ( more newspaper then broadcast) has always presented serious problems to lay people.  You have x argument and y argument about the common Z.

A Dose of Consumer Reality 
And for all of you working in readability, health literacy, human factors/usability of health information, I don't have to restate how "high barrier" all of these inserts are and thus how hobbled are the millions who would try to read this packaging. The  "readability" of this content is routinely 12th - 17th grade and higher. 
For good measure here's 2 painfully tortured snippets of language acting badly. 

With over half the adults having difficulty reading info at 8th grade level or higher, and more Americans struggling to work with basic math, combined with our poor to null understanding of basic research, drug trials and how the FDA and pharma work.... the appeal to consume this insert information is so much more magical thinking. 

What really has always fascinated me about the anti-vaccine movement is how darn readable their arguments are!

Saturday, January 3, 2015

Flu Shots for Preschoolers in NYC - yet parent-friendly information hard to find

No need to look back to the introduction of the polio vaccine in the 1950s to know that, for many parents, the issue of vaccinating their child is fraught. What childhood vaccines to give? When? What's the evidence?   There's a robust anti-vaccine movement that uses straight talk, convincing stories and impassioned celebrities to argue against everything from MMRs to HPV and, yes, the polio vaccine too.  Paul Offit's Deadly Choices: How The Anti-Vaccine Movement Threatens Us All,
or Nadja Durbach's Bodily Matters, discussing the anti-vaccine movement in the US and Britain respectively are good reads.
Yesterday the NYT (1/2/14) reported that roughly 150,000 children in city-licensed day care centers and preschools must be vaccinated against the flu when they return to school next week. 
This morning I couldn't find any information, let alone a parent-friendly explanation, of the new requirement  on the NYC Dept. of Ed website.  There are things like “Family Activities for Winter Break”, “the Big Apple Awards”, and even “Ebola Virus Information.”

Can someone share the link  (or copy) of the letter parents received concerning this? Thanks.