Tips for Preparing Written Documents
Communicating your findings in an organized, clear, and concise way is just as important as conducting a scientifically sound evaluation. ATSDR has many communication resources that will help you communicate your findings clearly and succinctly.
As you prepare your documents, you will make many choices about how to organize material within each section, how much detail to provide, whether to use a question-and-answer format in various sections, and so on. Base your approach on the knowledge, expectations, and information needs of your audience.
Health assessors need to keep several tenets in mind when preparing written documents:
- Use plain language when preparing the Summary, Conclusions, Recommendations, and PHAP.
- Use clear language in the main text and appendices, which are the technical support parts of the documents.
- Summarize the primary information related to each part of the PHA process in the main text. Write the content like you are telling a story and leave other details for inclusion in the appendices.
- Look for ways to reduce redundancies and length.
- Organize your material in an efficient, logical, and transparent way, such as by using information mapping.
Practicing the following writing standards will help guide health assessors prepare documents that align with these key tenets. Also refer to ATSDR’s PHAT Module 8 for more information and examples (see text box).
Refer to Module 8, How to Write Clear Environmental Health Information, in ATSDR’s Public Health Assessment Training (PHAT) course. Learn how to develop clear and effective environmental health documents for the PHA process in this training module. The link below will take you to the module’s registration page in CDC TRAIN.
Identify your audience. Before you begin writing, ask yourself, “To whom am I speaking? Who will receive this message?” Keeping your audience in mind while you write helps you decide what material to include (and exclude), how to organize your ideas, and how to support your purpose. These basic questions will help you understand what your audience needs from you:
- What do my readers know about my subject?
- What will my readers expect to learn by reading?
- What are they least likely to care about?
- What kind of organizational pattern will help my audience follow my arguments?
As appropriate, ask one or more community members to read your draft material and provide feedback on whether it is clear and understandable.
Put the most important message first. The main message statement should be 1–3 short sentences, placed at the top of your document or section so readers can find it quickly and easily. Readers tend to skip over long stretches of text and might miss important steps or support in the process. Thus, to ensure your readers get all the information they need, keep your content as short as possible.
Organize the material in a logical order to answer those basic questions. If you are giving your reader a list of steps, present them in the order they need to be done (sequential). If the items in your list are not steps, organize the information in order of importance to the audience (i.e., most important first, least important last).
Write short sentences, paragraphs, and lists. Readers need natural breaks in text so they can pause to interpret the information. Follow these tips:
- Keep your sentences as short as possible — about 25 words or fewer — with simple construction, so they can be understood quickly and easily. When sentences are kept short, readers are less likely to miss what is most important. Long and complicated sentences are hard to read and remember. Divide long sentences into two or more statements or shorten them by removing “filler” phrases that do not add to the meaning.
- Limit paragraphs to five sentences or fewer so they are easier to read and understand. Having a mix of short and longer paragraphs also will draw more interest from readers.
- Use short bulleted or numbered lists containing seven or fewer items to focus and break up content, making for easier reading on a page. Bulleted lists are appropriate when you have a list of items with equal importance, while numbered lists can easily show a sequence, steps, or a hierarchy. Use a lead-in sentence to explain your list. Make the lists “parallel” (e.g., start each item with a verb) and use proper punctuation (i.e., place a period at the end of a sentence that follows a bullet but not for words and phrases).
Use meaningful headings. When possible, use a simple, specific, and meaningful heading for every few paragraphs to help organize the flow and information of your document. Aim for headings that contain eight or fewer words; do not use headings with more than 15 words. You can use different font styles (type, size, and color) and increased spacing to visually distinguish your headings from the body text of the document.
Delete unnecessary words, sentences, paragraphs, and pages. While writing, seek to only include information that is essential for your audience to know. After you write, read to see if there are words, sentences, paragraphs, and even entire sections that might be unnecessary. Cut anything that raises your word count without delivering value to the reader. Look to do the following:
- Remove repetitive sentences.
- Delete unnecessary background information.
- Eliminate weak transitions.
- Cut excess descriptions and adverbs (a word that modifies a verb, adjective, or other adverb such as “actually” and “completely”).
- Delete hidden verbs (also called “nominalizations;” these are verbs that use a weak noun in place of a strong verb or adjective). For instance, here is a hidden verb: “We must make a calculation for the exposure dose.” You would fix this by saying: “We must calculate an exposure dose.”
- Check for phrases that start with prepositions such as “of,” “to,” “on,” etc. These often start phrases you can remove or reduce to one or two words.
- Avoid noun strings. Clustering nouns turns all but the last noun into adjectives and confuses readers.
- Eliminate unnecessary words.
Use clear words and uncomplicated grammar. Avoid using scientific jargon, complicated grammar, acronyms, and overly technical language. Use simpler terms where possible, such as
- “breathe” instead of “inhale”
- “eat” instead of “ingest”
- “child” or “adult” instead of “receptor”
- “use” instead of “utilize”
- “start” instead of “implementation”
When writing, check the Environmental Health Thesaurus and Everyday Words for Public Health Communication to see if there are plain language alternatives for your scientific and public health terms and concepts. Depending on the document, you might need varying levels of technical detail, but always strive to keep the text simple. Define any technical terms used and use appendices as appropriate to provide more detailed technical information.
Use active voice rather than passive voice. For example, “ATSDR conducted a public health assessment of the site” is active voice. “A public health assessment of the site was conducted by ATSDR” is passive voice. Active voice is preferrable because it is clear, concise, and direct, and sounds more natural (as if you were speaking to the audience). However, there are some instances where you may choose to use passive voice (e.g., the subject is unknown).
Place words carefully in your document. Avoid inserting a lot of text describing the subject between the subject and verb or interrupting the sentence with a long phrase or clause. Because the natural order of an English sentence is subject-verb-object, readers expect the verb (action) in a sentence to be near the subject. When reviewing your document, read the text aloud. This will help you identify awkward or complicated writing.
This short paragraph uses active voice, brief sentences, and plain language. It also defines technical terms.
Groundwater on the island is in several distinct aquifers. An aquifer is an underground layer of rock that holds water. One of these aquifers has chemical contamination. The contaminated aquifer does not supply drinking water nor does it connect with the drinking water aquifer. Therefore, residents are not exposed to the contaminated groundwater.
Active vs. Passive Voice
A verb is in the active voice when the subject is doing the action in the verb.
A verb is in the passive voice when the receiver of the action is the subject of the sentence. It occurs by using a form of “to be” (am, is, are, was, were, has been) with the past participle of a verb.
The following guidance provides helpful tips for ensuring your written documents effectively communicate your conclusions and recommendations.
- Focus on the story. Present your information in a logical, well-organized manner and avoid irrelevant information. Try to focus on “telling the story.” Omit extraneous details that do not add to it. Often, chronology provides an effective way to organize information, particularly when writing for the public (see examples in the box below).
Example 1: Site X is an 8-acre facility that stored wastes and excess materials from 1956 to 1982. In the early 1980s, samples of the facility’s soil revealed the presence of polychlorinated biphenyls (PCBs) at unsafe levels. To protect public health, several clean-up efforts occurred at the site in the 1980s and 1990s. Tests performed in 1996 showed that the extensive cleanup successfully removed PCBs from the soil. Later tests found no trace of PCBs in the soil. Because of the extensive cleanup that removed all PCBs from soil, the town of Centerville could convert the site into a neighborhood park.
Example 2: The Pesticide Dump Site is a group of five formerly contaminated areas. EPA placed this site on its National Priorities List after discovering that soil and groundwater at the site were highly contaminated with pesticides. EPA and the potentially responsible parties (the organizations that might be responsible for the contamination) spent 5 years cleaning up the site. Even before this cleanup started, the contaminated groundwater had not flowed off the site, so local wells had not been contaminated and residents had not been exposed to contaminants in their drinking water. Tests in 1999 showed that the cleanup reduced pesticides in the soil to safe levels. EPA and the potentially responsible parties are now treating the groundwater and taking steps to help ensure that the water will not flow off the site and into public or private wells.
- Use language that respects community diversity and cultures. Some communities include certain ethnic or racial groups who might be affected in unique ways. For example, tribal communities can be uniquely affected if they hunt local game, consume local fish, or use of plants for medicinal purposes. Certain urban neighborhoods might have been exposed to multiple contamination sources. Keep in mind that diversity also exists within any particular neighborhood, ethnic, or racial group. As discussed in the Engaging the Community section, the site team should use cultural contacts and interpreters, as appropriate, and prepare health education documents (e.g., fact sheets) in the language of the community. Such efforts help ensure that communications are sensitive to the cultures and needs of different ethnic or racial groups within the community. As covered in the Engaging the Community section, be aware of environmental justice concerns. Ensure that all populations are treated equally. Consider whether an exposed or potentially exposed population is already experiencing economic or environmental burdens or social vulnerability.
- Put available environmental and health effects data into meaningful perspective for the community. You do not want to unnecessarily alarm the community. Make sure dose and exposure conditions drive your discussions. Avoid making general statements like, “chemical ‘x’ causes cancer” without discussing under what conditions such health impacts could occur. In addition, to help community members understand how technical information ultimately affects them, put available environmental and health outcome data into meaningful perspective for them (see example).
The following statement communicates the important message that no exposure is occurring. In cases where exposures are occurring, be sure to clearly explain whether the levels to which people are being exposed are expected to result in adverse health outcomes (or illness).
Trichloroethylene (TCE), a volatile organic compound, is present in the groundwater at the site. However, base personnel and local residents use public water, not groundwater, in their homes. As a result, no one is coming in contact with the TCE in groundwater.
- Relate information on a personal level, and use examples, stories, and analogies as appropriate. Use language that does not unnecessarily alarm the reader, nor downplay concerns and exposures. Avoid minimizing risk. As you strive to communicate as simply and clearly as possible, make sure that the information you convey remains accurate, particularly the information about health hazards. Use non-complex terms to explain that simply being exposed to a hazardous substance does not make it a hazard. State explicitly when a hazard does or does not exist and why or why not. Recognize people’s non-scientific concerns, such as their feelings and values; the psychological stress that living near a contaminated site may cause for some residents; and residents’ perceptions of different risks, which can significantly affect their responses to technical information.
- Write a simple summary that will capture key points and give essential points. Environmental contamination, exposure, and health information is often highly complex. Your job is to boil down the science into a succinct explanation that is clear and accurate. On the other hand, you do not want to oversimplify information. Although residents might not be familiar with regulatory jargon, they can understand complex concepts if explained adequately (see examples).
Example 1: ATSDR’s estimated cancer risk for residents drinking carbon tetrachloride in their water is 2 in 10,000 for the birth to 21 years age group and 3 in 10,000 for those older than 21 years of age. This means there could be between 2 and 3 extra cases of cancer per 10,000 people for residents drinking water containing carbon tetrachloride at 262.7 ppb. Because the theoretical cancer risk range is ≥1 in 10,000 exposed persons, there is a concern for increased cancer risk.
Example 2: The estimated chronic reasonable maximum exposure dose for adults exposed to zinc in soil (0.1 mg/kg/day) was below the health guideline (0.3 mg/kg/day). Doses below the health guideline are not expected to harm the health of individuals. Therefore, chronic exposures to the levels of zinc in site soil will not be expected to cause non-cancer health effects in these adults.
Example 3: The estimated reasonable maximum exposure dose from 1,2,3-trichloropropane in drinking water for the birth to <1 year age group (0.50 mg/kg/day) was above the health guideline (ATSDR’s minimal risk level of 0.005 mg/kg/day) and above observed effect levels from animal studies. Thus, those in the birth to <1 year age group exposed to 1,2,3-trichloropropane at this dose level could experience liver effects.
- Use information mapping to organize information. As noted, information mapping is a way to structure and organize your information during your evaluation before you begin writing. It helps you identify the key messages to present your conclusions in a way that increase clarity for readers. This technique categorizes information for your conclusions that allows readers to identify the information that is relevant to them. Also refer to ATSDR’s Messaging Mapping Template, Worksheet, and Checklist to learn more about the information mapping approach.
- Keep conclusions focused and be sure that recommendations parallel the conclusions. Consistency is important in your documents. Make sure that the document is internally consistent. For example, develop conclusions that are focused and based on the information presented in earlier sections of the document. In addition, make sure that the recommendations parallel the conclusions.
- Avoid conflicting messages. When different agencies and groups provide conflicting information to the community, it undermines the credibility of all agencies, erodes trust, and generates confusion. To avoid this, you should be sure to communicate with other agencies at the beginning of and throughout the public health assessment process. Coordinate, as appropriate, to ensure that all agencies are presenting consistent messages and information. If conflicting information has already been presented, try to reconcile the messages as soon as possible, taking care not to compromise the validity of what is being said.
- State if information is unavailable and, as a result, drawing conclusions is not possible. Understandably, community members will want your statements and conclusions to be as definitive as possible. However, the PHA process is fraught with limitations. Clearly delineate what is known and not known, where and why there are limitations, and how you have accounted for these limitations in your conclusions. For any unresolved limitations, communicate how you will address those (see example).
The following example clearly communicates what is known and unknown about a contaminated drinking water conclusion and the conclusion that was reached.
The degree of health hazard posed by drinking contaminated well water is related to how much contaminated water was consumed. Unfortunately, we do not know how long the well water has been contaminated, so we do not know how long residents might have been drinking this water. To compensate for this information gap, we made a very conservative assumption in our calculations that residents had drunk the contaminated well water over their entire lifetimes (which we assumed to be 70 years, on average). This is a worst-case scenario. Making this conservative assumption means that our calculations are likely to be, if anything, more protective of health for most people than they would be if we had actual exposure information.
- Distinguish facts from judgments and opinions. Be objective (i.e., your tone should be neutral), and make a clear distinction between facts and other information (e.g., judgments and opinions). If information is unavailable and, as a result, no conclusions can be drawn, simply state so (see example).
The following statement expresses what is known and unknown about a health concern and expresses actions ATSDR will take if information becomes available.
ATSDR has gathered and reviewed all available information related to respiratory health concerns expressed by residents near the site. At this time, not enough information exists for the agency to draw conclusions about whether respiratory health effects are related to site contaminants. ATSDR will re-evaluate this concern if additional information becomes available.
- Communicate new information and corrections. If, after you have released results and conclusions to the public, new data become available that cause you to revise your conclusions, clearly explain how and why the new information has led to different conclusions. Also, if you realize you have provided inaccurate or misleading information, or there has been a miscommunication that has led the community to misunderstand what you intended to communicate, acknowledge the mistake or miscommunication and correct it as soon as possible.
- Use graphics. Use tables, figures, and graphs, as appropriate, to convey information instead of heavy text. When possible and appropriate, use simple graphics, tables, and figures to convey information. Using visual displays to convey information, such as statistical data, timelines, and processes, can help communicate and organize complex concepts into easy-to-understand and engaging formats.