Transcript An Assessment of Mercury Risk, Fish Advisory Awareness

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
Survey Results
A ge, N=84
mean
median
Gender (%), N=84
male
f emale
Fishing License (%), N=83
Ef f ect awareness (%), N=83
overall
male
f emale
license
no license
Limit consumption (%), N=83
overall
male
f emale
license
no license
A dvisory A wareness (%), N=83
overall
male
f emale
license
no license
W IC enrollee in household (%),
N=74
Interested in more inf ormation
(%), N=74
39
39
40
60
16
8
16
4
15
7
19
16
22
23
19
7
6
8
23
4
26
92
% Report ed eat ing f ish
in the last 12 mont hs,
N=74
Monthly t una
consumpt ion, N=74
% report ed eating
f requency-mean
f requency-median
Monthly rest aurant
consumpt ion, N=74
% report ed eating
f requency-mean
f requency-median
Monthly store-bought
consumpt ion, N=74
% report ed eating
f requency-mean
f requency-median
Monthly sport -caught
consumpt ion, N=74
% report ed eating
f requency-mean
f requency-median
Total mont hly
consumpt ion, N=74
f requency-mean
f requency-median
Serving size (6 oz.=1
serving), N=74
mean
median
Total mont hly servings,
N=74
mean
median
84
64
2
1
59
2
1
78
2
1
20
1
0
7
4
1
1
8
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, Bellinger DC. 2008. Fish consumption, methylmercury and child
neurodevelopment. Curr Opin P ediat r 20:178-83.
3. van Wijngaarden E, Beck C, Shamlaye CF, Cernichiari E, Davidson P W, Myers GJ,
Clarkson TW. 2006. Benchmark concentrations for methyl mercury obtained from
the 9-year follow-up of the Seychelles Child Development Study. Neurot oxicology
27(5):702-9.
4. USEPA (US Environmental P rotection Agency). 1997. Mercury Study Report to
Congress, Volume III: Fate and Transport of Mercury in the Environment . EPA452/R-97-005. USEP A, Office of Air Quality Planning and Standards and Office of
Research and Development, Washingt on, DC.
5. Davidson PW, Myers GJ, Cox C, Wilding GE, Shamlaye CF, Huang LS, Cernichiari E,
Sloane-Reeves J, P alumbo D, Clarkson TW. 2006. Methylmercury and
neurodevelopment: Longitudinal analysis of the Seychelles child development cohort .
Neurot oxicol T erat ol 28(5):529-35.
6. Salonen JT , Seppanen K, Nyyssonen K, Korpela H, Kauhanen J, Kant ola J, T uomileht o J,
Esterbauer H, T atzber 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 P M, McDowell M, Osterloh J, Garrett ES,
Canady RA, Dillon CF, Sun Y, Joseph CB, Mahaffey KR. 2003. Blood mercury
levels in US children and women of childbearing age, 1999-2000. JAMA 289:16671674.
8. U.S. Environmental Protection Agency. 2007. Fact Sheet: FDA/EPA Consumer
Advisory on Mercury in Fish and Shellfish. Available at:
ht tp://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, Washingt on, DC.
10. Knobeloch L, Anderson HA, Imm P, P eters D, Smith A. 2005. Fish consumption,
advisory awareness, and hair mercury levels among women of childbearing age.
Environ Res 97(2):220-27.