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April 2014

Making sense of a health atlas

The UK's Small Area Health Statistics Unit (SAHSU) have launched their Environment and Health Atlas for England and Wales today.

We helped facilitate a series of user testing workshops for the maps with researchers, policy makers, local government, medical charities, professional and learned societies as well as patient groups and members of the public. The team at SAHSU used feedback from these workshops to minimise misunderstanding of the maps, adding context on tabs alongside each map and responding to likely questions that may arise from users.

Dr Rebecca Ghosh and Dr Anna Hansell from the Small Area Health Statistics Unit (SAHSU) recommend user testing:

"SAHSU worked with Sense About Science (SAS) to improve the accessibility of the Environment and Health Atlas for England and Wales. This consists of a book and an online mapping application. We held five workshops with SAS focusing on various aspects of this publication and one of the first and most important outcomes of the workshops was to clearly identify the audiences that we were targeting this publication at.

SAS helped us clarify that we had three target audiences: researchers, policy makers and the public, all of whom had common as well as differing needs. It became clear from the very first workshop that what we as academics thought was an accessible publication had been written in a very formal academic style! This knowledge enabled us to substantially rewrite parts of publication, removing or explaining the more technical language and adding features such as summaries and bullet points to ‘open up’ the text. 

Subsequent workshops allowed us to test and improve these changes as well as giving us first-hand information on concerns and potential misconceptions from the different target audiences. This has allowed us to not only tailor the publication but also to be better prepared in advance of publication for the types of queries we are likely to face. 

SAS gave us a new way of looking at our work. We have learnt a great deal about presentation, communication and perception of science more generally and this has helped in other work we have been doing such as the way in which we communicated findings of possible health effects of noise associated with cardiovascular disease near London Heathrow airport."

We encourage anyone releasing this type of tool to user test from an early stage. Please let us know if we can help.

Cancer Research UK also have an excellent blog up on what the maps can and can't tell you

The Welsh proposal to ban e-cigarettes in public places - following evidence trails

The Welsh government is consulting on whether to include electronic cigarettes in the ban on smoking in enclosed public spaces. The ban is proposed in a White Paper that Health Minister Mark Drakeford suggests would help “reduce the harms to health caused by smoking.” The BMA has raised concerns about e-cigarettes normalising smoking and acting as a gateway to tobacco, which prompted us to ask for evidence. The proposed Welsh legislation cites the BMA’s advice, who must now respond to our enquiry. We’ll be asking Professor Drakeford similar questions about the evidence behind his proposals.

Speaking on Radio 4’s Today programme, Professor Drakeford said he had concerns that after a thirty-year effort to make smoking less acceptable, “e-cigarettes might reverse that tide and act as a gateway to conventional cigarettes.” The White Paper says the ban “reflects increasing concerns amongst public health practitioners that, as e-cigarettes become more popular, there is a risk that smoking behaviours could be normalised.” The UK’s Chief Medical Officer Dame Sally Davies also raised similar concerns, saying, “I am also worried about once again making smoking seem like a normal activity.”

How do these claims and concerns stack up against the evidence?

There is no evidence that e-cigarettes make smoking tobacco more attractive or socially acceptable, as the Royal College of Physicians note in their recent statement. Those who claim that e-cigarettes could re-normalise smoking are yet to produce any convincing evidence to show that they actually do.

What about the gateway effect – do people who ‘vape’ e-cigarettes go on to take up smoking? The evidence suggests not, as the Parliamentary Office of Science and Technology notes. A survey by Action on Smoking and Health London corroborates this, with less than 1% of never-smokers using e-cigarettes.

The Daily Mail cites a US study on the link between e-cigarette use and smoking conventional cigarettes as saying that the marketing of e-cigarettes “is promoting regular cigarette smoking among youth.” This study did indeed find that “e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” but as this Forbes.com blog points out, not only does correlation not equal causation, it’s more plausible that the relationship runs the other way with heavy smokers using e-cigarettes as a way to help them quit.

Again, those suggesting that e-cigarettes could act as a gateway to tobacco haven’t produced evidence that they do, and the balance of the available evidence suggests that they don’t.

Perhaps the last word should go to Ash London: “There is little real-world evidence of harm from e-cigarettes to date, especially in comparison to smoking. In the absence of harm to bystanders, [we do not] consider it appropriate to include e-cigarettes under smokefree regulations.”