An Assessment of Mercury Risk, Fish Advisory Awareness, and Fish

Consumption in a Latino Population in Wisconsin

An Assessment of Mercury Risk, Fish Advisory Awareness, and Fish

Consumption in a Latino Population in Wisconsin

Jason RiccoMD/MPH CandidateUW School of Medicine and Public Health

Jason RiccoMD/MPH CandidateUW School of Medicine and Public Health

AcknowledgementsAcknowledgements 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

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

OverviewOverview

Mercury Background Fish Consumption Fish Advisories Study Design Results Recommendations Conclusion

Mercury Background Fish Consumption Fish Advisories Study Design Results Recommendations Conclusion

Mercury BackgroundMercury 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

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 BackgroundMercury 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

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 MercuryHealth 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

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, 1956Minamata Bay, 1956

Health Effects of MercuryHealth 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

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 ConsumptionFish 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.)

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 AdvisoriesFish 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

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 DisparitiesMercury 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

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

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

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

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

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

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

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 ProjectThe 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

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 SiteThe Site Aurora Walker’s Point Community Clinic

Serves a primarily Latino uninsured population in south Milwaukee

Aurora Walker’s Point Community Clinic

Serves a primarily Latino uninsured population in south Milwaukee

Study DesignStudy 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

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 DesignStudy 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

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 ResultsSurvey Results

Age, N=84 mean 39 median 39Gender (%), N=84 male 40 female 60Fishing License (%), N=83 16Effect awareness (%), N=83 overall 8 male 16 female 4 license 15 no license 7Limit consumption (%), N=83 overall 19 male 16 female 22 license 23 no license 19Advisory Awareness (%), N=83 overall 7 male 6 female 8 license 23 no license 4WIC enrollee in household (%), N=74

26

Interested in more information (%), N=74

92

% Reported eating fish in the last 12 months, N=74

84

Monthly tuna consumption, N=74 % reported eating 64 frequency-mean 2 frequency-median 1Monthly restaurant consumption, N=74 % reported eating 59 frequency-mean 2 frequency-median 1Monthly store-bought consumption, N=74 % reported eating 78 frequency-mean 2 frequency-median 1Monthly sport-caught consumption, N=74 % reported eating 20 frequency-mean 1 frequency-median 0Total monthly consumption, N=74 frequency-mean 7 frequency-median 4Serving size (6 oz.=1 serving), N=74 mean 1 median 1Total monthly servings, N=74 mean 8 median 5

Results SummaryResults 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%)

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 FindingsFocus 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)

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)

RecommendationsRecommendations

Fish advisories must be culturally competent

Spanish-language

Acknowledge and address culturally-specific folk models of risk perception

Fish advisories must be culturally competent

Spanish-language

Acknowledge and address culturally-specific folk models of risk perception

RecommendationsRecommendations

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

For both ease of dissemination and interpretation

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

For both ease of dissemination and interpretation

RecommendationsRecommendations

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

Previous efficacy with anti-tobacco campaigns10

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

Previous efficacy with anti-tobacco campaigns10

ConclusionsConclusions

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

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

ConclusionsConclusions

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

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 YouThank You

ReferencesReferences1. 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 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, Ta tzber 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, Dillon 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.