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An Assessment of Mercury Risk, Fish Advisory Awareness, and Fish Consumption in a Latino Population in Wisconsin Jason Ricco MD/MPH Candidate UW School of Medicine and Public Health Acknowledgements This project would not have been possible without assistance and guidance from: Preceptor: Laura Anderko, RN, PhD, University of Wisconsin-Milwaukee School of Nursing Mentor: Henry A. Anderson, MD, Chief Medical Officer, Wisconsin Division of Public Health Steve Ohly, RN, NP, Clinic Manager at Walker’s Point Community Clinic The entire clinic staff and volunteers at Walker’s Point Community Clinic MPH program for Milwaukee Scholars funding Overview Mercury Background Fish Consumption Fish Advisories Study Design Results Recommendations Conclusion Mercury Background Highly neurotoxic heavy metal1 Ubiquitous in environment- both natural and anthropogenic sources1,2 2-to-5 fold increase in global atmospheric pool due to anthropogenic sources1 Mercury Background Atmospheric inorganic mercury deposited into aquatic ecosystems3 Converted to methyl mercury via bacterial methylation3 MeHg bioconcentrated and bioaccummulated up the food chain4 Levels in fish 106 times higher than levels in water4 Health Effects of Mercury High-dose methyl mercury exposure can affect the central nervous system at any developmental stage2,3,5 Fetus is highly sensitive to toxic doses of MeHg Delayed developmental milestones, blindness, deafness, cerebral palsy in children born to unaffected mothers2,3,5 Minamata Bay, 1956 Health Effects of Mercury Chronic, low-dose exposure to MeHg can lead to accumulation in nervous system, heart, liver, kidneys3 Visual, speech, and hearing abnormalities Ataxia and peripheral neuropathy Increased risk of heart attack and coronary artery disease?5,6 Fish Consumption Benefits High protein Low in Fat Contains important nutrients Affordability Risks: Most important source of methyl mercury exposure in humans1 Source of other contaminants (PCBs, etc.) Fish Advisories As of 2002, 45 states have mercury advisories for sport-caught fish1 U.S. EPA covers freshwater fish not under state advisories1 U.S. FDA issues advisories for fish bought in stores and restaurants 2004- Joint EPA/FDA advisory issued8 Mercury Risk Disparities Non-white populations in the U.S. have high fish consumption rates and high body burdens of mercury1 Subsistence fishing more common in low-income, indigenous groups9 Higher levels of blood MeHg in Mexican American and non-Hispanic black children than non-Hispanic white children7 Advisory Awareness Disparities In general, non-white and low-income populations have low advisory awareness1 1998-1999 12-state survey of women of childbearing age: Whites more likely to be aware of state advisories (22%) compared to Latinos (12%) and African-Americans (11%)1 Mercury and Fish Advisories in WI Considerable body of research in WI Majority of studies focused on sport-fish consumption among anglers with fishing licenses Ultimately, they focus on a predominantly non-Hispanic, white population Mercury and Fish Advisories in WI To date, no significant analysis of fish consumption, mercury and advisory awareness in a primarily Latino population in WI Growing demographic in WI Evidence of high risk status from other states Significant language and cultural barriers present in this group The Project Descriptive analysis of mercury awareness, fish consumption patterns, and Advisory awareness in adult Latino patients in Milwaukee Goal: To lay the foundation for further research and funding for culturally competent interventions in mercury risk reduction in this population The Site Aurora Walker’s Point Community Clinic Serves a primarily Latino uninsured population in south Milwaukee Study Design Survey on mercury and fish advisory awareness, fish consumption patterns developed Available in both Spanish and English Patients in clinic waiting room asked to participate (84 agreed to participate) Verbal consent obtained with assistance from interpreter Hair samples obtained from consenting individuals UW and UWM IRB approval obtained Study Design Additionally, a focus group was held with community members Social Marketing Theory utilized to identify: mercury risk perception barriers to advisory adherence input on culturally competent interventions that could succeed in the community % Reported eating fish in the last 12 months, 84 Survey Results N=74 Monthly tuna consumption, N=74 % reported eating 64 frequency-mean 2 Age, N=84 frequency-median 1 mean 39 Monthly restaurant median 39 consumption, N=74 Gender (%), N=84 % reported eating 59 male 40 frequency-mean 2 female 60 frequency-median 1 Fishing License (%), N=83 16 Monthly store-bought Effect awareness (%), N=83 consumption, N=74 overall 8 % reported eating 78 male 16 frequency-mean 2 female 4 frequency-median 1 license 15 Monthly sport-caught no license 7 consumption, N=74 Limit consumption (%), N=83 % reported eating 20 overall 19 frequency-mean 1 male 16 frequency-median 0 female 22 Total monthly license 23 consumption, N=74 no license 19 frequency-mean 7 Advisory Awareness (%), N=83 overall 7 frequency-median 4 male 6 Serving size (6 oz.=1 female 8 serving), N=74 license 23 mean 1 no license 4 median 1 WIC enrollee in household (%), Total monthly servings, 26 N=74 N=74 Interested in more information mean 8 92 (%), N=74 median 5 Results Summary 84% of respondents consumed fish in the past year Average of 7 servings/month Commercial fish most frequently consumed (78%) Very low awareness of mercury health effects (8%) and fish advisories (7%) Focus Group Findings Low awareness of mercury and fish advisories in the community Language is an important barrier Most fish consumed is store-bought Advisories linked to licenses not effective in community Should utilize local mass media (Spanish- language) Recommendations Fish advisories must be culturally competent Spanish-language Acknowledge and address culturally-specific folk models of risk perception Recommendations Combine sport-fish and commercial fish advisory information into a single advisory For both ease of dissemination and interpretation Recommendations Community members more receptive to mass media advisory information dissemination (television, radio, newspaper) Previous efficacy with anti-tobacco campaigns10 Conclusions Combination of significant fish consumption and very low mercury/advisory awareness makes this an at-risk population Language and cultural barriers must be addressed New methods of information dissemination are required to reach this and other subpopulations Conclusions 98% of survey participants wanted more information on mercury and fish advisories Potential for future intervention efficacy Call for further research and grant funding for culturally competent intervention trials in this population Thank You References 1. Anderson HA, Hanrahan LP, Smith A, Draheim L, Kanarek M, Olsen J. 2004. The role of sport-fish consumption advisories in mercury risk communication: a 1998-1999 12-state survey of women age 18-45. Environ Res 95(3):315-24. 2. Oken E, Belli nger DC. 2008. Fish consumption, methylmercury and child neurodevelopment. Curr Opin Pediatr 20:178-83. 3. van Wijngaarden E, Beck C, Shamlaye CF, Cernichiari E, Davidson PW, Myers GJ, Clarkson TW. 2006. Benchmark concentrations for methyl mercury obtained from the 9-year follow-up of the Seychelles Child Development Study. Neurotoxicology 27(5):702-9. 4. USEPA (US Environmental Protection Agency). 1997. Mercury Study Report to Congress, Volume III: Fate and Transport of Mercury in the Environment. EPA- 452/R-97-005. USEPA, Office of Air Quality Planning and Standards and Office of Research and Development, Washington, DC. 5. Davidson PW, Myers GJ, Cox C, Wilding GE, Shamlaye CF, Huang LS, Cernichiari E, Sloane-Reeves J, Palumbo D, Clarkson TW. 2006. Methylmercury and neurodevelopment: Longitudinal analysis of the Seychelles child development cohort. Neurotoxicol Teratol 28(5):529-35. 6. Salonen JT, Seppanen K, Nyyssonen K, Korpela H, Kauhanen J, Kantola J, Tuomilehto J, Esterbauer H, Tatzber F, Salonen R. 1995. Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men. Circulation 91(3):645-55. 7. Schober SE, Sionks TH, Jones RL, Bolger PM, McDowell M, Osterloh J, Garrett ES, Canady RA, Dill on CF, Sun Y, Joseph CB, Mahaffey KR. 2003. Blood mercury levels in US children and women of childbearing age, 1999-2000. JAMA 289:1667- 1674. 8. U.S. Environmental Protection Agency. 2007. Fact Sheet: FDA/EPA Consumer Advisory on Mercury in Fish and Shellfish. Available at: http://www.epa.gov/waterscience/fish/advice/factsheet.html. [Accessed on May 29, 2008]. 9. National Environmental Justice Advisory Council. 2002. Fish consumption and environmental justice, Washington, DC. 10. Knobeloch L, Anderson HA, Imm P, Peters D, Smith A. 2005. Fish consumption, advisory awareness, and hair mercury levels among women of childbearing age. Environ Res 97(2):220-27.
"An Assessment of Mercury Risk_ Fish Advisory Awareness_ and Fish "