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Are we really informed by public health information?

Imagine that a hundred 40-year-old snusers use a box a day. None of them smoke. How many in such a group will typically die because of the snus before they reach 70 years? Was it easier to answer the question if you read up on public health information about snus first?

Well, probably not. In a new research work , we find that there are clear indications that the Norwegian authorities’ snus information can in practice lessen you. Most people overestimate the dangers of the snus already in the first place – and the public’s information hurts.

Must be understandable and clear

We need public authorities to inform about health hazards. Companies have little interest in telling us when their goods cause illness and death. Tobacco industry is the most glaring example – they knew the danger of addiction and cancer while using large resources to deny and doubt the same dangers outward.

But for public health information to be a true corrective, the information must be both focused, trustworthy and tailored to the target audience. Not least, you must design messages so that they reach those who need it and are understood correctly. People have limited time and attention, and not everyone has the same background for understanding complex academic questions and statistical statements. The information must be perceived to be relevant and important, understandable and clear, and appear to be credible and legitimate.

We can see if the information is working

We already know a lot about how to design good risk information. Among other things, the British Medical Association and the American FDA have summarized lessons learned from this from a number of disciplines. One of the most important points here is probably that there are no guarantees: If you want to make sure the information makes people more enlightened, you will need to investigate if this happens in practice. For example, a text may be professionally correct and seem clear and ready for professionals and bureaucrats on a field, but still fail completely when read by those we wish to reach.

In a new research work , we propose a new and simple method that can help us investigate this: People have a perception that could be wrong and we want to measure how they change perception after receiving more information.

The essence of the idea is very simple: If people have a malfunction about, for example, health hazards that should be corrected, you must know what the true risk is likely to be. Ask a group of people to estimate this risk without getting any information. Divide people randomly into different groups who read each and every information text, and then ask them to estimate the risk again. Thus, you can measure how people adjust their guesswork into practice.

If a text convincingly documented the true risk, anyone who got it would provide the correct answer in the second round. In practice, this will not happen, but we can investigate whether it is taking people in the right direction: Do we see that those who overestimate the risk adjust it down, while those who underestimate it adjusts? And what happens to average errors in relation to the “phase”? Are people on average better informed?

Tested the method of public snus information

To test the method in practice, we took public snus information and recruited 228 students at the University of Oslo for an experiment. We could see already before the experiment that public information did not follow guidelines for good risk communication, but how would they work in practice?

The students were asked to estimate how many snusers and daily smokers would die of their tobacco use before they were 70 years old, and they learned that there were cash prizes for those closest to the National Institute of Public Health. This was a natural fit since it is these Norwegian authorities are based, and thus these are the numbers the information should try to inform about.

Two of the three texts were from public authorities’ websites and applied to the risk of snus use, while the third was an interview from Aftenposten with a researcher who described cigarettes like dynamite and snus like cinema pads and two people disagree with this picture.

Overestimated the death risk of snus

The results were interesting and revealed clear differences in how the texts affected people’s estimates. Most overestimated the serious death risk of snus already the first time they were asked: Based on the reports of the Norwegian Institute of Public Health, we estimated that around 2.3 percent of snus users will die of various types of cancer triggered by snus.

The average student estimate, however, was that 17.3 percent of snus users would die from snus, and among those who received public health information, the average error (distance from facit) increased by 40-50 percent.

Among those who read the newspaper article about dynamite smoke and chinaputt snus, on the other hand, the average error fell by 37 percent. This despite the fact that those who read public information on average considered this as more credible, new and interesting, understandable and clarifying information than newspaper readers perceived the newspaper article.

Serious results

These results are serious, as they indicate that Norwegian authorities’ information about snus worsens people’s misunderstandings regarding death risk. All tobacco use entails risk, but the National Health Institute’s own figures estimate that daily smoking (20 per day) is about 16 per cent, and this is almost eight times as fatal as snuff. This is very important information to reach out to cigarette smokers with.

It was also interesting that public health information about snus also increased people’s risk estimates when it came to cigarettes, but to a lesser extent (10-20 percent). This, however, was a strong effect of the newspaper article, with the average error compared to cigarettes increased by 52 percent. This shows further how important it is to measure how the information affects the recipient and think carefully about what perceptions one wishes to influence and measure this in practice.

Should try out the method on a larger scale

A few points are in place for people in the administration who would be interested in using the method: We wanted to first and foremost investigate whether it was feasible and able to detect differences in the effect of different texts.

Where we used students, the authorities should use random population committees or big smokers who need information about the unnecessarily high risk they face by smoking instead of sniffing or using even less harmful “steam devices” (e-cigarettes). Where we measured short-term changes in estimates immediately after reading a text, the authorities may ask people to resubmit (online or SMS) a week or month after receiving the information to measure longer-term impacts.

To develop the method in such directions and to try it out in practical work had been exciting and we would like to be on the job.

Finally, it is also worth mentioning that international professionals expressed clear skepticism about the “facet responses” from the National Institute of Public Health, which we founded on snus, and thought these were excessively high in light of international professional knowledge. When the National Institute of Public Health has now been asked by the Ministry of Health and Care to update its 2014 report on the health risk of nuisance, this is something that should be reflected. In addition, we hope that the experience of this experiment can help improve the communication of updated risk estimates reported by the report.


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