Communicating to an alarmed community about cancer clusters: a fifty state survey.

A survey of all 50 U.S. states conducted in 1989 showed that 1,300-1,650 requests for cancer cluster investigations were received by state health departments. Most states responded with a three-stage process aimed at prioritizing clusters at each stage. Those situations deemed most serious were passed on to the next stage of evaluation. Thirty-eight of the 50 states said that communicating risk information to informants was a productive outcome, and 26 states sent materials to informants explaining the causes of cancer, clusters, how clusters are investigated, and other health education materials. Many states requested detailed information about reported clusters from informants. States with a major commitment to protecting public health and environment were more likely to provide information than states with weaker programs. Some officials discouraged people from pursuing their requests by trying to convince informants that a problem did not exist and by overwhelming them with questions and information. We recommend that health departments train their respondents in risk communications and establish an organizational climate that provides financial resources and institutional support appropriate to the complex task of communicating risk information to a public alarmed about a cancer cluster.