LETTERS TO THE EDITOR Readability of H1N1 Information From the CDC Web Site To the Editors: T he looming threat of the H1N1 strain of influenza this year has left many people confused as to what should be done to avoid contracting the virus and what precautions should be taken if one believes that they have the virus. The internet is becoming a major source of health-related information for patients. 1 It is important for this infor- mation to be written in a way that is easily understood by the average patient. The Na- tional Institute for Health suggests that ma- terial be written at no greater than a 4th to 6th grade level. 2 This brief study examines the information presented on the Center for Disease Control’s (CDC) Web site regard- ing H1N1. METHODS Text was extracted from the CDC’s H1N1 Web site (http://www.cdc.gov/h1n1flu) under the heading “General Info”. Four sec- tions were included from this Web site: “H1N1 Flu and You,” “What to Do If You Get Symptoms,” “Taking Care of a Sick Per- son,” and “2009 H1N1 Flu Vaccine.” Titles, headers, bulleted lists, figures, tables, abbre- viations, numbers, and confusing punctuation (parentheses, colons, semicolons, hyphens, quotation marks, and slashes) were removed to minimize errors in readability calcula- tions. Hyphens and slashes were replaced with a space to avoid unfamiliar words. All other mentioned items were simply deleted. All Web sites were condensed to one para- graph to omit paragraph markers as a pos- sible confounder. Two objective methods were used to determine the approximate grade level of each portion of the CDC’s Web site, the SMOG and Flesch-Kincaid formulas. Both of these have previously been used to de- termine the reading level of medical infor- mation presented to patients. 2 The SMOG formula uses the number of words with more than 2 syllables per sentence to deter- mine a reading level. 3 The Flesch-Kincaid formula takes into account the number of words per sentence in addition to the num- ber of syllables per word to determine a reading level. 4 The resulting number corre- sponds to the grade level that would need to be completed to comprehend the text. RESULTS The reading levels associated with each portion of the CDC Web site are listed in Table 1. The SMOG formula ranged from 11.7 to 15.33. The Flesch-Kincaid formula ranged from 9.26 to 13.9. Both of these formulas indicate a need for a partial college education to fully understand all of the text. COMMENT This study indicates that the material available to the public regarding H1N1 on the CDC’s Web site is far too advanced for the average reader. The average American seeking information on H1N1 is likely to end up on the CDC’s webpage. Making sure that the reading level of this text is at a reasonable level is a matter of public health. If the material is written at too high of a level it may discourage individuals from reading all of the information available. It may lead to misconceptions and patients may place themselves or other people at risk if they do not fully comprehend the recommendations put forth by the CDC. This indicates that it is necessary for the CDC to rewrite the information on the H1N1 section of their Web site so that it is more widely understood. Ian C. Hoppe, BA UMDNJ–New Jersey Medical School Newark, NJ REFERENCES 1. Horrigan JR. The internet’s growing role in life’s major moments. 2006 cited 2009 November 15. Available at: http://www.pewinternet.org/PPF/r/ 181/report_display.asp. 2. NIH. How to write easy to read health materials. 2007 cited 2009 November 15. Available at: http://www.nlm.nih.gov/medlineplus/etr.html. 3. McLaughlin GH. SMOG grading—a new read- ability formula. J Read. 1969;12:639 – 646. 4. Flesch R. A new readability yardstick. J Appl Psychol. 1948;32:221–233. Reply: C enters for Disease Control and Preven- tion (CDC) strives to produce health in- formation for the public that is both under- standable and scientifically accurate. CDC’s 2009 H1N1 influenza website serves not only the public, but also health care providers, state and local health departments, and a range of other partners. CDC’s web content is an im- portant part of a larger strategy to ensure that the public has the information it needs to protect themselves from 2009 H1N1 influ- enza. Materials targeted especially for the public are found on www.flu.gov, developed collaboratively with the Department of Health and Human Services. In addition, although many of CDC’s 2009 H1N1 influenza materials are written for professional audiences, CDC has pro- vided flu prevention information in lan- guage and formats that are accessible to the general public. CDC has invested in new media messages and channels that provide easy-to-understand health information and include pictures, graphics, and spoken mes- sages that make prevention steps easier to understand and perform. CDC has produced short, consu- mer friendly videos available on CDC-TV (http://www.cdc.gov/CDCTV/) and YouTube. CDC’s website www.cdc.gov/podcasts offers a library of 2009 H1N1 flu podcasts devel- oped to deliver audio and visual messages. These video and audio messages offer concise recommendations for staying healthy and avoiding the flu. In addition, new interactive tools such as widgets and eCards have been developed with easy-to-read (and see) mes- sages that can be downloaded by the public to their personal computers and shared with oth- ers. Partners can place CDC flu prevention widgets on school, church, business, and community organization Web sites. These vi- sually interesting materials include tips for reducing the spread of flu and quick facts about the importance of vaccine and antiviral medications. CDC widgets are available at: www.cdc.gov/widgets. The public can down- load CDC’s health eCards and send short flu prevention messages to their friends and family at http://www.cdc.gov/SocialMedia/ Campaigns/H1N1/index.html#eCards. CDC recognizes that even more can be done to reach the public with clear, understandable, and accurate information to protect themselves and their loved ones from the flu. We remain dedicated to that effort in coordination with our federal, state, and local partners. Anne Schuchat, MD National Center for Immunization and Respiratory Diseases RADM, US Public Health Service Centers for Disease Control and Prevention Marsha L. Vanderford, PhD Emergency Communication System Centers for Disease Control and Prevention Atlanta, GA TABLE 1. Readability Results of the H1N1 Section of the CDC Web Site SMOG Flesch-Kincaid H1N1 flu and you 13.83 11.98 What to do if you get symptoms 11.7 9.26 Taking care of a sick person 13.51 11.61 2009 H1N1 flu vaccine 15.33 13.9 The Pediatric Infectious Disease Journal • Volume 29, Number 5, May 2010 www.pidj.com | 479