CERC Transcript 05 31 2016

Zika CERC Discussion: Clear Communication Techniques

Presenters: Cynthia Baur, PhD

Date/Time: May 31, 2016 1:00 pm ET

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Operator: 

Welcome and thank you thank you for standing by. At this time all participants are in a listen-only mode. During the question-and-answer session please press star 1 and record your information as prompted.

Today's conference is being recorded, if you have any objections, you may disconnect at this time. I would now like to turn today's meeting over to Dr. Cynthia Baur. Thank you, you may begin.

Dr. Cynthia Baur: 
    
Hello. My name is Cynthia Baur, and I'm in the CDC Office of the Associate Director for Communication. So my colleague, Dr. Barbara Reynolds, had to be away today and she asked me to step in and provide a presentation on Zika, CERC, and Clear Communication Techniques.

So part of my role right now is also to serve as the clearance reviewer for Zika communication materials for the Communication Office. So I have been seeing the majority of things that have been coming through the agency that are getting posted on the Website.

So what I'm going to show you today are some examples from CDC's materials in terms of how we are trying to apply both plain language and clear communication techniques.

So I'll spend about the first 20 minutes or so just talking about what some of those techniques are and showing you those examples and then we'll do what you've done in the other sessions, open up the line at about 20 or 25 past and just have discussion and Q&A.

So I am supposed to remind you where you can find the slides. They are at emergency.cdc.gov/cerc. That's emergency.cdc.gov/cerc and then you click on Zika CERC Discussions. And so what'll happen is I have the slides open, I will say next slide and you will just forward the slides as we go. As I mentioned there will be a Q&A portion at the end of the call and - yes, so I'll guess we'll just go from there.

So hopefully you have the slides up by now and you see the title slide, Zika Crisis and Emergency Risk Communication Discussion, Clear Communication Techniques. So next slide.

So when I teach the plain language and clear communication classes here at CDC, I usually start with a slide like this, and because - in part I start with this slide because people want to know why do we even need to focus on plain language and clear communication.

And it's in part because when people look at a lot of health materials, this is what they see is a wall of words. And it's very hard to figure out how to make sense of all of that text when we put it in a fact sheet or handout or Web page.

And so the plain language and clear communication techniques that I'm in charge of disseminating here at the agency are really designed to help us get away from this wall of words approach to information.

And I know that it can be challenging because of we've all been trained in various disciplines and we're very knowledgeable in our own respective areas and so we all have a lot of information that we want to communicate to the public. And so the challenge is is to take what we know and figure out the best ways to distill that information in a way that will enhance people's comprehension of that information.

So that's what I like to bring people back to is this notion that we're really about information for comprehension. That information for information's sake is not very useful but it's really information for comprehension. So next slide.

So I'd like to just take a minute and talk about why clarity matters so much during a crisis or emergency. So clarity is really what we focus on to enhance comprehension. We have done a lot of work to help people understand that there's a difference between simple and oversimplification.

So what we're striving for is simplifying the information in a way that enhances comprehension and not simplifying the information in a way that confuses or misleads people. And during a crisis or emergency situation, clarity matters a lot because people's ability to comprehend can change and that's for a number of reasons listed here on the slide. So I'll just take a minute or two and talk about these.

So the first one of course are the people's emotional reactions. So there's a lot of research from psychology, cognitive science, decision science that looks at how people react to information and respond to that information. And often times it's with an emotional reaction first, and if necessary, they may respond with a more rationale or reasoned approach.

But it's often times that emotional reaction first that informs people's response to a situation and that's going to be especially true in a crisis or emergency situation because people are - could - can be fearful, they can be concerned, they can be confused, they can even feel that their life might be in danger.

So that emotional reaction is very understandable but what it does is it affect people's ability to process information and there is a lot of experimental research that shows the kind of mental mistakes that people make when they're having an emotional reaction to something.

And so we really have to think about designing our information in a way that recognizes that people are going to respond emotionally first and that that information has to be delivered in a way that helps them process information even when they're having that emotional reaction.

The second thing that happens often in a crisis or emergency is people get a lot of information at one time and that information can be conflicting, confusing or incomplete, and that's for all the reasons that we know and understand.

That we may not know everything when a crisis or an emergency hits, we may not have enough science that explains what's going on and so information may be coming out in bits and pieces over time but there may also be a lot of information coming at one time.

And so all of these things, again, affect people's ability to process information and you have to think about the way information is designed to, again, help people to the best that we can process that information in the way that we intend.

The fourth reason is people may be getting new information that they've never heard before so there's the issue of novelty and you have to think about that very basic level of information that you want to convey if it's brand new, or they may be getting information they've already heard about but in a new context.

So for example what's going on with Zika of course is that people may have heard a lot about mosquito-borne diseases before or why they should protect themselves from mosquito bites but Zika is, you know, forcing people to kind of think about this information about mosquitoes and mosquito bites in a completely new context because of the consequences.

And the last reason is that we tend to use a lot of jargon and a lot of numbers when we communicate health information, and so that's what I spend a lot of my time doing is helping my CDC colleagues find other ways than jargon and scientific language and data to communicate our information to the public.

And so we'll be looking at some of those examples today about how we've tried to do that during Zika. So next slide.  So I'd like to give you one clear communication principle for emergencies is to focus on small amounts of action-oriented information that is easily comprehended, and I think there's a couple of keys here.

Small is really important, right, because our tendency is to give people all the information that we have at one time, and for the reasons I just outlined on the prior slide, that can be a big challenge in terms of comprehension.

We know people want to know what to do to keep themselves, their family and their community safe so the information to the extent possible should be action-oriented rather than just informational in nature. And we should be focused on using these techniques that enhance comprehension that I'm going to talk about in a minute.

So you've seen this slide in Barbara's presentation before, these are the kinds of questions that we have to be prepared to answer them with that small amount of information that is action-oriented and easily comprehended. So are my family and I safe? What may affect me? What can I do to protect myself? Who or what caused this? And is this fixable?

And I think the standard that we have to think about for our health information materials is do our materials answer these basic questions in a way the public can understand. And so for me I'm always coming back to that notion of comprehension. That - do these materials foster comprehension or do they get in the way of comprehension? So next slide.

I want to introduce you to a tool that we created here at CDC and that I have been using in my review of Zika materials and that's the CDC Clear Communication Index.

So the Index is available online, it's free, it comes in a couple of different forms. You can use it as an Adobe-fillable form or there's a widget that you can download to your own Website but the Index opens with four open-ended questions and the very first question is the question I always think about as a communicator is, who is the primary audience?

And so we have been trying to get our programs that create the health materials away from this notion of the general public which is far too broad for thinking about effective communication and to really think about a primary audience. And the primary audience are the people who are going to use the information you are providing.

So it may be pregnant women, it may be women who are contemplating pregnancy, it may be the male partners of pregnant women. Those can be primary audiences but not the general public because not everybody is going to be interested in the same information. So the first question you have to answer is your primary audience.

The second thing you have to do is think about their health literacy skills and part of that, of course, is probably what comes to mind, reading and numeracy skills but also thinking about their prior knowledge and experience.

So what do they already know about the topic? What might be their prior experience with the situation or topic? These are things that can all affect their health literacy skills as well as the things that I already said about people having an emotional reaction.

So if we already know that people's emotions can potentially interfere with our information processing, then it becomes very important to think about these other health literacy issues in that context.

So the last two open-ended questions are about the information itself, your communication objective so that's why are you communicating with this primary audience, that's your communication objective.

And then you need one main message statement, and I would say that that's one of the biggest issues that we've struggled at - with here in implementing the Index is getting people to think about one main message statement rather than three or four or five.

But what I have found through testing different materials that have one main message versus two, three, or four or five main messages, you are more likely for your audience to get your message when you stick to one main message than when you give them multiple messages.

So I'm happy to during the discussion and Q&A come back and talk more about that but I want to keep going so that you can see the rest of the items that we look at in the Index. So next slide.

So these are the seven categories of Index criteria. So you begin by answering the four open-ended questions and then you go through the seven categories that have a total of 20 scored items. So you're answering yes or no to these 20 items about main message, and it asks not only do you have a main message but is it visible at the front? Does it have a visual that supports it?

We ask about does the material include a call to action, meaning have you offered people something to do, not just quote, be informed? We look at the language use so are you using active voice which we know enhances comprehension because, again, it focuses on the action rather than passive voice which hides who's doing - who should be doing an action.

And we also look at the language of the primary audience. So often times when I'm reviewing materials that's what I'm asking the creators of the material. I'm asking them to think about whether the language that they've offered to that material is their language, the language of public health and the language of, you know, of science or is it the language of the pregnant women that they're trying to reach?

So we have several items that look at how the information is organized so techniques like bullets and headings and chunking of information. We also have three items that look at health behaviors. So, again, not every material would have a health behavior but the majority of the Zika materials do talk about health behaviors that people can implement to protect themselves.

We look at numbers so it's not just a matter of the words being comprehensible but the numbers also have to be comprehensible. So we have several items that ask authors of materials to think about the numbers that they've used, and there's a technique for example about not asking people to do math.

So for example let's they have to - you're recommending that they mix a solution for something, you would do the math for them rather than forcing them to do the calculations because it opens the possibility for error and people can get anxious about doing math so there's just a number of problems with asking people to do mathematical calculations.

And then the final category is about risk statements because most everything we do in public health involves explaining risk either an increased risk or a decreased risk and so it's very important to think about the clarity of the risk statements in the materials. So next slide.

So here are some examples then of these criteria in action. So this is from the slide titled Build Your Own Zika Prevention Kit. So the slide - the Web page says if you live in a state or area with the mosquito that spreads the Zika virus and you are concerned about Zika, learn how to build your own Zika prevention kit.

So here's a clear case where we're giving a call to action, there's something that people can do if they have this concern about Zika. So it's a good way to see that you can do more than just say I want to inform you about Zika, I want to educate you about Zika. In this example we're actually giving people something that they can do to address that concern or fear that they have about Zika. So next slide.

Here's an example about the use of everyday language. So I'm sure many if not all of you have seen some of our language about Zika virus and sexual transmission. So this comes from the Web page Basics of Zika Virus and Sex. So it says a man with Zika virus can pass it to his female or male sex partners.

In the case the CDC knows about, men had symptoms. Zika can be passed before symptoms start, while he has symptoms and after his symptoms end. Men without symptoms may be able to pass the virus to their sex partners but CDC doesn't have reports of this.

In the case of CDC knows about, the men had vaginal or anal sex without a condom. In some of the cases CDC knows about, the men also had oral sex mouth to penis without a condom. Zika virus can stay in semen longer than in blood but we don't know exactly how long Zika stays in semen.

So this is an example of trying to talk about a very complicated topic with lots of different permutations and trying to use as much everyday language as possible so that people can, you know, understand the recommendations that we're making.

I also want to point out that this slide has some additional techniques that I talked about. So headings, bulleted lists, all of these are techniques to help chunk and organize that information so that people can skim and scan and see it more easily that way they can focus on the part of the information that they're interested in. So next slide.

So we have an item just like in the CERC principles about what we know and don't know and what we're doing about risk. So that's item number 11 in the Clear Communication Index and it says that authoritative sources should tell people what we know, what we don't know and what we're doing to find out.

So here's an example of two bulleted lists that talk about what we don't know about Zika and what CDC is doing to learn more. And we're very clear with those headings, you know, so people can know which section they want to go to. We've used bullets so that people can, again, skim and scan and figure out which of those bullets is interesting to them.

And we've done this in several different places on the Zika Website where we've used this technique of what we know, what we don't know and what we're doing to find out. And so I just wanted to point out that here's a really great example of where a CERC principle and a clear communication principle are very well aligned. So next slide.

So I wanted to just give you some ideas in case you are interested in trying this more plain language approach to communication. We have created a document called Every Day Words for Public Health Communication. We have gone through our own Website and other public health materials and come up with frequently used public health jargon and offered plain language alternatives to that jargon.

And we also provide sample sentences. So a lot of people may say, oh, well, that's great, you know, and I can see how that might be a plain language alternative but I can't figure out how to use that. And so we took actual sentences from our Website and rewrote those sentences demonstrating how to use the plain language alternative.

You also have a lot of federal resources. There is a Federal Plain Language Website and that's listed at the end of the slides. The Federal Plain Language Guidelines are the guidelines we have to use here at CDC because we are covered by a federal law call the Plain Writing Act.

So we are supposed to use plain language in all of our public communication and we have adopted the Federal Plain Language Guidelines to do that. So next slide.

So I mentioned that we have these organization techniques that you've seen in the other slides so the bullets and the numbered lists are one of those. Chunking, which means one idea per information block. The headings that you've seen.

We did not see in the examples of opening summaries but I'm happy to talk a little bit more about that because a lot of times a summary might be - it functions just like an abstract for a journal article. It might be the thing that people read first and that might be all they read. So you want to give them the most important information in that opening summary.

And I did not have any visuals that I showed here but we can also talk more about that because that is an Index criteria that your visuals have to support your main message.

Often times people think, oh, well, I just need to provide a little visual relief so I'm just going to put a nice image on this page, on this Web page or this fact sheet and what happens is that image distracts people because people will often times look at your image first.

And so I often give the example of what can be distracting when you think about a lot of our information about heart disease. What we're trying to promote is, you know, that people do more physical activity for example. So people will choose an image of smiling, happy people doing physical activity and put that on their heart disease materials.

But they won't have a caption, they won't have a label, and they won't say anything about what these smiling, happy people are doing on a heart disease fact sheet.

So if we're talking about some very grim data about heart disease but yet we have these smiling, happy people exercising, if we haven't explained that connection for people, they could look at the visual first, get one message and then be very confused when they look at the text which is delivering - excuse me - a very different message. So it's very important to be aware of those visual distractors when you're choosing your images.

So that's the end of my examples and that was a very quick run through of the clear communication criteria that we have developed and are using here at CDC. I have listed the Web link for the Index and for those federal plain language resources that I mentioned.

These are the other Zika resources that you've seen on the prior Webinars that Barbara has offered. So I'm supposed to remind you that there is a mail box cercrequest@cdc.gov if you have questions after this Webinar or if you have questions at any other time, you can always use that mail box.

And also to remind you for the latest communication resources, we do have a section on cdc.gov where you can see the various communication resources. We have a section on the Website for information about specific groups, you may have seen that if not I would recommend that you check it out.

And that's the end of the formal presentation. So we have a good amount of time left for a discussion and questions so I hope you have been thinking about all of those questions that you've been dying to ask about clear communication and I will ask Carolyn, our Operator, to open the lines.

Operator:       
      
Thank you. We will now begin the question-and-answer session. If you'd like to ask a question, please press star 1, make sure your phone is unmuted and record your name slowly and clearly to introduce your question.

To withdraw your request, you may press star 2. Once again for questions or comments at this time, please press star 1 and record your name. We'll stand by for questions or comments.

Dr. Cynthia Baur:
    
So while we're waiting for people to think about their questions and comments, I will just say that I have been involved with a number of different crisis and emergency responses over the years I've been at CDC, and I do know that one of the things that we have consistently heard from other organizations, from our partners, from grantees and what not that they do appreciate it when we provide more plain language materials.

So I'm curious if those of you on the call today feel the same way. If you feel like we are providing more of that, if there is things that you would definitely like to see more of. All of that would be a great topic for a discussion.

Operator:            

And we do have a question or comment at this time if you're ready for it.

Dr. Cynthia Baur:   
  
I am. Thank you.

Operator:        
     
All right. Our question or comment is from David Redick. Your line is open.

David Redick:    
  
Hello, thank you very much for these, and I do appreciate the Webinars you've been conducting. My question actually came up a couple weeks ago and I wasn't able to ask it. It had to do with how we deal with Zika fatigue? How do we keep people interested in this without frightening them away but also letting people know how important it is to be prepared for this?

Dr. Cynthia Baur:    

Well, I think that's a great question, I would open that up to other people who are on the call because maybe they have ideas as well. I'm not sure - I don't feel like I can speak for Barbara for what she would say, I'll just give you my own opinion.

I would say a lot of the materials that I have been reviewing I think, you know, what we've been trying to do is follow those techniques that I was talking about. Try and make sure that we are speaking to a particular primary audience so not everybody is thinking, oh, all of these - you're recommending all of these things for me, right?

So I do think that we are trying to follow the principles of targeting and tailoring as much as possible so that people are not - would not be unduly alarmed but I guess I would like to hear a little bit more about what - do you perceive the biggest problem to be indifference or people being overly alarmed?

David Redick:     

Well, it's interesting, I was talking to an executive assistant at my office last week, I'm not in healthcare, that - she's not involved in healthcare. She was preparing for a vacation in the Caribbean and I said, well, are you - she has two children and I said are you anticipating getting pregnant again anytime soon because if you are I certainly hope you take care to protect yourself against Zika and she said, “What's that?”  

So I was just astonished that she didn't even - hadn't even heard of it or hadn't thought anymore about it. I quickly printed up some of the sheets from the CDC Website but from my point of view I think we've been talking about this for months now but it seems to - that was an interesting experience that she had no idea what I was talking about. That when I said it, she said oh, yeah, I've heard about that but she hadn't thought about the importance of protecting herself against mosquito bites.

Dr. Cynthia Baur:     

So in that case it's not fatigue, it's the fact that she hasn't been...

David Redick:    
  
Exactly.

Dr. Cynthia Baur:  
   
Reached by the messages.

David Redick:     

Exactly, exactly.

Dr. Cynthia Baur:   
  
And I think you're touching on something that we always think about as communicators is the reach of the messages. And so I know that we have been using all the channels at our disposal here to try and communicate with the public but we also rely on a lot of other organizations to amplify those messages and spread them in ways that CDC might not have that reach.

But this issue of reach, right, are we reaching everybody who needs the information is a perennial problem in communication and it's the - one of the things that when you do a communication evaluation, you spend a great deal amount of time on because if you haven't reached people with the message then all these other issues that I've been raising about comprehension are not even going to come into play, right?

So with your executive assistant, we hadn't even gotten to the point about worrying about comprehension because we haven't reached her yet.

David Redick:  
    
Right.

Dr. Cynthia Baur:    

So I think that's a - and, you know, a good reminder that you have to also think about reach as well as the messages and the materials themselves.

David Redick:      

Thank you.

Operator:             

Thank you. And again, as a reminder, if you have a question or a comment, please press star 1, make sure your phone is unmuted and record your name to introduce your question, and to withdraw that request, you may press star 2. Once again for questions or comments it is star 1. One moment please for questions.

Dr. Cynthia Baur:   
  
So one thing I think that it would be useful for us to hear about here at CDC would be the things - in the case of the example we were just talking about it was a matter of the messages had not reached someone but in the case where you know the messages are indeed reaching the intended recipients of the message, what all are you seeing is the most confusing part of the Zika information?

Are there particular areas that people are very confused about? Or do you feel like the information is being understood but people maybe are not, you know, perceiving the risk in the same way that public health professionals are?

Operator:         
    
And we do have another question or comment at this time.

Dr. Cynthia Baur:  
   
Okay.

Operator:     
        
Thank you. And we have a question or comment from Monique Davis. Your line is open.

Monique Davis:   

Hi. Thank you so much for these seminars, they're wonderful. A couple of comments and I'll share some of the things I've been doing up here in Hudson County, New Jersey.

With regards to the, what is the information that people are a little bit confused about or are looking for. As I go around in the community, I'm finding out that despite all of the information out there there are a lot of people that are unaware of the risks with sexual transmission. So I do spend a fair amount of time communicating those risks.

And then the other question that seems to come up a lot or a concern that comes up a lot is that people don't understand who is being targeted for testing right now. I think there is a misconception or a misunderstanding that they can simply walk into a doctor's office and request a test if they come back from traveling.

So those are two things that I spend some time talking about. And one of the things that I've done, for instance I was asked to just give a ten-minute overview at a Department of Corrections in-service. And so I knew my time was very limited and I needed to make sure I had my elevator speech ready and waiting.

And, you know, I targeted that message. If you're pregnant, don't go. If you're going, this is how you protect yourself and either way you need to be thinking about sexual transmission. So I knew I had a very limited amount of time, I knew that those messages would resonate with the audience that I had, and indeed, that was the experience.

Dr. Cynthia Baur:     

So I'm curious, the people's confusion about who's being targeted for testing, do you have a sense of where they're getting the information that is confusing them? I mean like are they hearing this through social media, through their friends, is it something that they found on a website somewhere?

Monique Davis:   

I just don't think that they have a clear understanding of it at all whether it's coming from something that they're reading, I don't know if it's social media or what but people just seem to have this misperception that they can request this test just by going to the doctor's office, and I take some time and explain it to them that at this point it's not available on a widespread basis.

Dr. Cynthia Baur:    

So once you explain that to them, do they seem to understand or is it still puzzling to them?

Monique Davis:   

No, they seem to understand, I'm not saying they like that.

Dr. Cynthia Baur:

Right.

Monique Davis:   

But they do understand. I explain to them that, you know, in many evolving diseases the diagnostic tests are limited to begin with and so we have to go with the primary audience that we're most concerned about, you know, the primary folks. And so right now it's limited to the pregnant women and/or their partners.

Dr. Cynthia Baur:     

I think that's a great example of what I was saying about people think - the people who create messages and materials thinking, oh, I need to reach everyone. So both of the comments we've had so far have talked about sort of what are some of the issues when you operate under that assumption. I'm not saying you are but I'm saying anybody who's thinking oh, I want to try and reach everybody.

Number one, that's a very hard thing to do, right? So we've just talked about reach being such an issue but I think that also you just talked about one of the consequences too is that people can, you know, inappropriately think something affects them when it doesn't, right, or they can miss the message if it should be reaching them.

So I think this notion of primary audience, you know, that's - we - that's the reason we started the Clear Communication Index was that first question about primary audience is that all of those other decisions about clarity and comprehension really flow from that choice of a primary audience.

And so I think you've both given - you've given us some great examples of what are some of the challenges when we don't - we aren't careful about primary audience and how those messages could be interpreted.

Monique Davis:

Thank you.

Operator:   
    
Thank you. And again as a reminder, if you have a question or a comment, please press star 1, make sure your phone is unmuted and record your name to introduce your question, and you may press star 2 to withdraw that request.

Again, for further questions or comments at this time, please press star 1. One moment while we stand by for further questions or comments. One moment please.

Dr. Cynthia Baur:    

So I'm curious if any of you have been doing your own - using other tools or doing your own approach to clear communication that you wanted to offer, or maybe you've heard about the Clear Communication Index and you've tried it on your materials, I'd be interested in hearing about those experiences as well.

Operator: 
  
And we do have a question or comment from Colleen Ranky at this time. Your line is open.

Colleen Ranky:   

Hi, thank you. I'm from a state that's probably not going to have actual Zika transmission, I'm from up by Canada but we - I know that there are a lot of states in the southern part of the country that are, you know, fairly certain that they will have local Zika transmission at some point.

And I wonder if there is - you're finding that there is different messages between the two types of states, the ones that are likely to see Zika and the ones that are not in terms of local transmission because I find that we're trying to message not just for, okay, if you're traveling to Mexico, if you're traveling to Puerto Rico, this is what you have to do.

But at some point we're going to have to change our message to if you're traveling to Florida, if you're traveling to Texas, and I think that that's going to be a lot more tricky I guess, and I'm just wondering if anybody's been encountering that issue.

Dr. Cynthia Baur:    

I will - this is Cynthia. So I will just say I have not seen any materials come through yet - CDC - come through CDC yet that do that but I would, you know, be happy that we have - to have some discussion about that now particularly if we have southern states or states that have been identified as a higher likelihood, you know, what your thoughts are about that.

Operator:         
    
Does that conclude the question or comment?

Colleen Ranky:   

Yes, it does. I mean I'm just actually just curious. We have been - we've actually partially activated our incident command system just to try to get a handle and get ahead of the whole thing, and messaging is falling on me, I happen to be the PIO.

And some of that we're just having trouble trying to, you know, as soon as we add southern states, that muddies the message for Central and South America. And then it's not here yet so it's probably premature to do that. On the other hand, you kind of want people to sort of have that in the back of their mind.

So it's just a - been a - difficult - I mean not only the fact that this thing changes every day but that, you know, we expect that it will change in the future in terms of where we need to warn people and that sort of thing. So just - I'm just kind of throwing it out there to see if anybody has any other thoughts.

Dr. Cynthia Baur:    

Well, and I think that raises an interesting question too because if the message then is, you know, stay up to date, stay current on the information - on where Zika is, right, because that could end up being - I'm not saying that's the message but it could be the message, right?

If it's always - if the parameters of where Zika is are always changing then you might have to say - have a message that reflects that and says - and I think we have been messaging that in a lot of materials is that where Zika is will change over time, right? So that we've already prepared people for that but whether that part of the message is getting through or not, I think that's a really important question.

And so if the message were to become, you know, stay up to date on where Zika is, I think you've raised some really important questions about are people prepared to do that.

And there's that additional action step of potentially having to go to a Website, look at some maps or read a list of places and are people prepared to do that? And would they find information that would, you know, to be helpful to them like I'm travelling here, can I get that information? So I think it raises a number of important questions about messaging.

So if anyone has some thoughts about that, I know Barbara wanted to encourage not necessarily just Q&A but discussion among all of the callers if others of you on the line have some thoughts about that.

Operator:         
    
And again, for further questions or comments, it is star 1 and record your name, and it is star 2 to withdraw that request. Again, for further questions or comments, please press star 1. We'll stand by for further questions or comments.

Dr. Cynthia Baur:    

Well, I don't want to keep people on the line unnecessarily so if anyone has a further comment or question I'm happy to keep the line open but if not we can wrap up the call. So, Carolyn, do we have any calls or comments coming in yet?

Operator:            

I'm currently showing no further questions or comments at this time.

Dr. Cynthia Baur:    

Okay, great. Well, I thank you all for your time today and I hope the information has been useful to you as you think about your Zika messaging, and I will certainly pass on the comments that you all made today to people working in the emergency operation center.

And I was asked to remind you that the date of the next call is next Tuesday, June 7th, and the topic will be Risk Attributes, Risk Perceptions and Pregnancy. So thank you all for joining us today and have an enjoyable rest of the day. Thank you.

Operator:          
   
That concludes today's conference call. Thank you for your participation, you may disconnect at this time.