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An Assessment of Mercury Risk_ Fish Advisory Awareness_ and Fish


									 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
 This project would not have been
 possible without assistance and
 guidance from:
   Preceptor: Laura Anderko, RN, PhD,
    University of Wisconsin-Milwaukee School of
   Mentor: Henry A. Anderson, MD, Chief
    Medical Officer, Wisconsin Division of Public
   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

 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
           Mercury Background
 Atmospheric inorganic mercury deposited into
  aquatic ecosystems3

 Converted to methyl mercury via bacterial

 MeHg bioconcentrated and bioaccummulated
  up the food chain4

 Levels in fish 106 times higher than levels in
      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

 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
 Advisory Awareness Disparities

 In general, non-white and low-income
 populations have low advisory

 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
Mercury and Fish Advisories in WI

 To date, no significant analysis of fish
  consumption, mercury and advisory
  awareness in a primarily Latino population in

 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

 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
   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,
N=74                                  N=74
Interested in more information             mean                 8
(%), N=74                                  median               5
         Results Summary
 84% of respondents consumed fish in the past

 Average of 7 servings/month

 Commercial fish most frequently consumed

 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

 Should utilize local mass media (Spanish-

 Fish advisories must be culturally

   Spanish-language

   Acknowledge and address culturally-specific
    folk models of risk perception

 Combine sport-fish and
 commercial fish advisory
 information into a single

   For both ease of
   dissemination and

 Community members more receptive to
 mass media advisory information
 dissemination (television, radio,

   Previous efficacy with anti-tobacco

 Combination of significant fish consumption
  and very low mercury/advisory awareness
  makes this an at-risk population

 Language and cultural barriers must be

 New methods of information dissemination are
  required to reach this and other

 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
Thank You
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
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-
8. U.S. Environmental Protection Agency. 2007. Fact Sheet: FDA/EPA Consumer
       Advisory on Mercury in Fish and Shellfish. Available at: [Accessed on May 29,
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.

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