Efficacy of Risk-Based, Culturally Sensitive Ogaa (Walleye) Consumption Advice for Anishinaabe Tribal Members in the Great Lakes Region

The Great Lakes Indian Fish and Wildlife Commission (GLIFWC) has produced Ogaa (walleye— Sander vitreus ) consumption advisories since 1996 for Anishinaabe from GLIFWC member tribes in the 1837 and 1842 ceded territories of Wisconsin. GLIFWC's advisory maps were revised in 2005 to address cultural sensitivities (to protect tribal lifeways), to utilize recent mercury exposure information, and to incorporate changes in advisory levels for methyl mercury. Lake-specific, risk-based, culturally sensitive consumption advice was provided on color-coded maps for two groups: children under age 15 years and females of childbearing age, and males 15 years and older and females beyond childbearing age. The maps were distributed to, and a behavioral intervention program developed for, the six GLIFWC member tribes in Wisconsin as well as member tribes in Minnesota and the 1842 ceded territory of Michigan. Tribal fish harvesters, tribal health care providers, women of childbearing age or with young children, tribal leaders, elders, and children were targeted specifically for the behavioral intervention. The efficacy of the behavioral intervention was assessed using surveys of 275 tribal fish harvesters from Wisconsin, 139 tribal harvesters from Michigan and Minnesota, and 156 Wisconsin women of childbearing age. Significant increases in the percentage of survey participants who indicated awareness of advisory maps occurred among Wisconsin harvesters (increase from 60% to 77%), Michigan and Minnesota harvesters (29% to 51%), and women of childbearing age in Wisconsin (40% to 87%). A significant increase in preference for smaller Ogaa occurred among tribal harvesters in Wisconsin (41% to 72%) and tribal harvesters in Michigan and Minnesota (49% to 71%), although not among women of childbearing age. The GLIFWC map-based advisory program did not adversely affect tribal harvest of Ogaa, which increased from 63,000 to 88,000 fish in the three states after the intervention.     

Lognormal Distributions for Fish Consumption by the General U.S. Population

The rate of fish consumption is a critical variable in the assessment of human health risk from water bodies affected by chemical contamination and in the establishment of federal and state Ambient Water Quality Criteria (AWQC). For 1973 and 1974, the National Marine Fisheries Service (NMFS) analyzed data on the consumption of salt-water finfish, shellfish, and freshwater finfish from all sources in 10 regions of the United States for three age groups in the general population: children (ages 1 through 11 years), teenagers (ages 12 through 18 years), and adults (ages 19 through 98 years). Even though the NMFS data reported in Ref. 14 are 20 years old, they remain the most complete data on the overall consumption of all fish by the general U.S. population and they have been widely used to select point values for consumption. Using three methods, we fit lognormal distributions to the results of the survey as analyzed and published in Ref. 14. Strong lognormal fits were obtained for most of the 90 separate data sets. These results cannot necessarily be used to model the consumption of fish by sport or subsistence anglers from specific sites or from single water bodies.     

The Spokane Tribe''s Multipathway Subsistence Exposure Scenario and Screening Level RME

Exposure scenarios are a critical part of risk assessment; however, representative scenarios are not generally available for tribal communities where a traditional subsistence lifestyle and diet are relevant and actively encouraged. This article presents portions of a multipathway exposure scenario developed by AESE, Inc. in conjunction with the Spokane Tribal Cultural Resources Program. The scenario serves as the basis for a screening-level reasonable maximum exposure (RME) developed for the Midnite Uranium Mine Superfund site. The process used in developing this scenario balances the need to characterize exposures without revealing proprietary information. The scenario and resulting RME reflect the subsistence use of original and existing natural resources by a hypothetical but representative family living on the reservation at or near the mine site. The representative family lives in a house in a sparsely populated conifer forest, tends a home garden, partakes in a high rate of subsistence activities (hunting, gathering, fishing), uses a sweat lodge daily, has a regular schedule of other cultural activities, and has members employed in outdoor monitoring of natural and cultural resources. The scenario includes two largely subsistence diets based on fish or game, both of which include native plants and home-grown produce. Data gaps and sources of uncertainty are identified. Additional information that risk assessors and agencies need to understand before doing any kind of risk assessment or public health assessment in tribal situations is presented.     

A Native American Exposure Scenario

EPA's Risk Assessment Guidance for Superfund (RAGS) and later documents provide guidance for estimating exposures received from suburban and agricultural activity patterns and lifestyles. However, these methods are not suitable for typical tribal communities whose members pursue, at least in part, traditional lifestyles. These lifestyles are derived from a long association with all of the resources in a particular region. We interviewed 35 members of a Columbia River Basin tribe to develop a lifestyle-based subsistence exposure scenario that represents a midrange exposure that a traditional tribal member would receive. This scenario provides a way to partially satisfy Executive Order 12898 on environmental justice, which requires a specific evaluation of impacts from federal actions to peoples with subsistence diets. Because a subsistence diet is only a portion of what is important to a traditional lifestyle, we also used information obtained from the interviews to identify parameters for evaluating impacts to environmental and sociocultural qualify of life.     

Using a Web‐Based Diary Method to Estimate Risks and Benefits from Fish Consumption

Accurate estimates of the amount and type of fish people eat are necessary to determine the health benefits and risks of consuming fish, and to assess compliance with fish consumption guidelines issued for fish affected by chemical contaminants. We developed a web‐based and mobile‐phone‐enabled diary methodology to collect detailed fish consumption information for two 16‐week periods in the summers of 2014 and 2015. We recruited study participants from two populations living in the Great Lakes region—women of childbearing age (WCBA) and urban residents who had purchased fishing licenses. In this article, we describe the methodology in detail and provide evidence related to participation rates, the representativeness of our sample over time, and both convergent validity and reliability of the data collection methods. Overall, 56% of WCBA and 50% of urban anglers provided complete data across both data collection periods. Among those who provided information at the beginning of Year 2, 97% of both audiences provided information throughout the entire 16‐week period. Those who participated throughout the two‐year period were slightly older on average (1.9–2.5 years) than other members of our original samples. We conclude that using diaries with web and smartphone technology, combined with incentives and persistent communication, has strong potential for assessing fish consumption in other areas of the country or for situations where the potential risks associated with fish consumption are substantial and the cost can be justified.     

Using Theory to Identify Beliefs Associated with Intentions to Follow Fish Consumption Advisories Among Anglers Living in the Great Lakes Region

Fish consumption advisories are issued by states, tribes, and federal agencies to provide guidance to consumers about eating sport‐caught fish potentially affected by chemical contaminants. Previous work has found that while anglers report being aware that advisories are available, awareness and use of specific advisory recommendations is low. This study uses the Integrative Model of Behavioral Prediction (IMBP) to identify beliefs with potential to increase intentions to follow fish consumption advisories in Great Lakes states. We conducted a mail survey of 1,712 licensed anglers in seven of eight Great Lakes states (excluding Ohio) to gauge advisory awareness, cognitive factors influencing fish consumption behaviors (informed by the IMBP), and sociodemographic characteristics. Results show that most anglers reported being generally or vaguely aware of fish consumption advisories and try to follow them, but far fewer report being aware of specific advice needed to decide whether or not to consume different types of sport‐caught fish. Informed by the IMBP, we also identify several behavioral, normative, and control beliefs that have sufficient room to change, strong associations with intentions to follow the advisories, and potential to be modified if targeted with strategic risk messages. Targeting these beliefs with strategic communication holds potential to increase the proportion of anglers intending to follow fish consumption advisory recommendations in choosing which fish to eat.     

Factors in Exposure Assessment: Ethnic and Socioeconomic Differences in Fishing and Consumption of Fish Caught along the Savannah River

South Carolina has issued fish consumption advisories for the Savannah River based on mercury and radionuclide levels. We examine differences in fishing rates and fish consumption of 258 people interviewed while fishing along the Savannah River, as a function of age, education, ethnicity, employment history, and income, and test the assumption that the average consumption of fish is less than the recreational value of 19 kg/year assumed by risk assessors. Ethnicity and education contributed significantly to explaining variations in number of fish meals per month, serving size, and total quantity of fish consumed per year. Blacks fished more often, ate more fish meals of slightly larger serving sizes, and consumed more fish per year than did Whites. Although education and income were correlated, education contributed most significantly to behavior; people who did not graduate from high school ate fish more often, ate more fish per year, and ate more whole fish than people who graduated from high school. Computing consumption of fish for each person individually indicates that (1) people who eat fish more often also eat larger portions, (2) a substantial number of people consume more than the amount of fish used to compute risk to recreational fishermen, (3) some people consume more than the subsistence level default assumption (50 kg/year) and (4) Blacks consume more fish per year than Whites, putting them at greater risk from contaminants in fish. Overall, ethnicity, age, and education contributed to variations in fishing behavior and consumption.     

Communicating Fish Consumption Advisories in California: What Works,What Doesn’t

State agencies face many challenges in creating sport fish consumption advisories that can be readily understood by diverse populations. In this study, our objectives were to identify barriers to understanding consumption advisories and recommend more effective approaches for communicating advisory concepts. We conducted key informant interviews with demographically diverse consumers of sport fish from the Sacramento‐San Joaquin Delta watershed in California to explore how intended audiences perceive consumption advisories and identify factors that influence comprehension. Some barriers to communication included the use of portion sizes that departed from commonly consumed amounts, poorly understood terminology, misleading category headings, and ineffective visual tools. Comprehension was enhanced when advisory information did not contradict existing beliefs about fish or fish consumption, and when advisories provided information about contaminant levels in specific kinds of fish. Using certain methods, such as portion sizes that reflect commonly consumed amounts, mercury meters to convey contaminant levels, three advice categories (e.g., high, medium, low), and population definitions that identify specific age ranges, improved the clarity of advisory concepts for intended audiences.     

Mercury,Polychlorinated Biphenyls,Selenium, and Fatty Acids in Tribal Fish Harvests of the Upper Great Lakes

The Chippewa Ottawa Resource Authority monitors fish contaminants in Anishinaabe (Great Lake Native American) tribal fisheries. This article updates previously reported trends in two persistent bioaccumulative toxic (PBT) substances that are the primary contributors to consumption advisory limits for these fish: methylmercury (MeHg) and polychlorinated biphenyls (PCBs). Also, we report, for the first time, an analysis of nutritional benefit bioindicators and metrics in these same Upper Great Lakes fish harvests: selenium (Se) and omega‐3 fatty acids (PUFA‐3s). A novel risk/benefit quantification originally presented by Ginsberg et al. is reported here to characterize the tradeoffs between fatty acid benefits and toxic MeHg health outcomes. We also report a Se benefit metric to characterize the possible protective value against MeHg neurotoxicity based on Ralston et al. Congruent with Anishinaabe cultural motivations to consume fish from their ancestral fisheries, nutritional content was high in locally caught fish and, in some respects, superior to farmed/store‐bought fish. These Great Lakes fish still contained levels of PBTs that require careful education and guidance for consumers. However, the contaminant trends suggest that these fish need not be abandoned as important (both culturally and nutritionally) food sources for the Anishinaabe who harvested them.     

Perceptions of Recreational Fishing Boat Captains: Knowledge and Effects of Fish Consumption Advisories

The impacts of fish consumption advisories on recreational and subsistence fishing, particularly in fresh waters, have been examined extensively. By contrast, little attention has focused on organized recreational fishing, such as from party and charter boats, and particularly for salt water fish. We interviewed 93 New Jersey boat captains to determine their knowledge about fish consumption advisories, and whether, in their opinion, clients knew of fish consumption advisories, and whether they thought advisories had an effect on recreational fishing and their businesses. Advisories were ranked by captains as a moderate influence on the success of their business, less so than number of fish caught, strength of the economy, overfishing by commercial boats, and management regulations. Only one boat captain had not heard warnings about eating fish, but what captains said they had heard was mixed in its accuracy and completeness. Clients expect captains to know about fish, and about half of boat captains said clients had asked about the safety of eating fish. Captains who felt advisories were affecting their businesses tended to fish for species without high levels of mercury (except for bluefish) or PCBs, the primary contaminants of concern for state advisories and federal advice. However, these captains worked closer to areas (e.g., Raritan Bay complex and New York Harbor) subject to advisories than did other captains, and were more prone to say that management regulations (e.g., fish size, creel limits, seasons) and marketing and advertising by the industry or state were strong influences on the success of their seasons. Comparing captains who thought advisories had some or great effect (60%) versus those reporting "no effect" (40%), there was no difference in the mean percentage of trips targeting high mercury species such as swordfish and shark. Many captains said they would or might post advisories, but 42% of the boat captains said they would not post consumption warnings if the state provided them. The significant portion (at least 15%) of saltwater fishing supported by these businesses suggests that these captains are an important conduit for future risk communication.     

Weighing Health Benefit and Health Risk Information when Consuming Sport-Caught Fish

Fish consumers may incur benefits and risks from eating fish. Health advisories issued by states, tribes, and other entities typically include advice about how to limit fish consumption or change other behaviors (e.g., fish cleaning or cooking) to reduce health risks from exposure to contaminants. Eating fish, however, may provide health benefits. Risk communicators and fish consumers have suggested the importance of including risk comparison information, as well as health risk-benefit comparisons in health advisory communications. To improve understanding about how anglers fishing in waters affected by health advisories may respond to such risk-risk or risk-benefit information, we surveyed Lake Ontario (NY, USA) anglers. We interviewed by telephone 4,750 anglers, 2,593 of which had fished Lake Ontario in the past 12 months and were sent a detailed mail questionnaire (1,245 responded). We posed questions varying the magnitude of health risks and health benefits to be gained by fish consumption, and varied the population affected by these risks and benefits (anglers, children, women of childbearing age, and unborn children). Respondents were influenced by health benefit and health risk information. When risks were high, most respondents would eat less fish regardless of the benefit level. When risks were low, the magnitude of change in fish consumption was related to level of benefit. Responses differed depending on the question wording order, that is, whether "risks" were posed before "benefits." For a given risk-benefit level, respondents would give different advice to women of childbearing age versus children, with more conservative advice (eat less fish) provided to women of childbearing age. Respondents appeared to be influenced more strongly by risk-risk comparisons (e.g., risks from other foods vs. risks from fish) than by risk-benefit comparisons (e.g., risks from fish vs. benefits from fish). Risk analysts and risk communicators should improve efforts to include risk-risk and risk-benefit comparisons in communication efforts, and to clarify to whom the health risks and benefits from fish consumption may accrue.     

Re-evaluation of the Reference Dose for Methylmercury and Assessment of Current Exposure Levels

Methylmercury (Me-Hg) is widely distributed through freshwater and saltwater food chains and human consumption of fish and shellfish has lead to widespread exposure. Both the U.S. EPA Reference Dose (0.3 μg/kg/day) and the FAO/WHO Permissible Tolerable Weekly Intake (3.3 μg/kg/week) are currently based on the prevention of paraesthesia in adult and older children. However, Me-Hg exposure in utero is known to result in a range of developmental neurologic effects including clinical CNS symptoms and delayed onset of walking. Based on a critical review of developmental toxicity data from human and animal studies, it is concluded that current guidelines for the prevention of paraesthesia are not adequate to address developmental effects. A dose of 0.07 μ/kg/day is suggested as the best estimate of a potential reference dose for developmental effects. Data on nationwide fish consumption rates and Me-Hg levels in fish/seafood weighted by proportion of the catch intended for human consumption are analyzed in a Monte Carlo simulation to derive a probability distribution of background Me-Hg exposure. While various uncertainties in the toxicologic and exposure data limit the precision with which health risk can be estimated, this analysis suggests that at current levels of Me-Hg exposure, a significant fraction of women of childbearing age have exposures above this suggested reference dose.     

Ethnic Differences in Risk from Mercury among Savannah River Fishermen

Fishing plays an important role in people's lives and contaminant levels in fish are a public health concern. Many states have issued consumption advisories; South Carolina and Georgia have issued them for the Savannah River based on mercury and radionuclide levels. This study examined ethnic differences in risk from mercury exposure among people consuming fish from the Savannah River, based on site-specific consumption patterns and analysis of mercury in fish. Among fish, there were significant interspecies differences in mercury levels, and there were ethnic differences in consumption patterns. Two methods of examining risk are presented: (1) Hazard Index (HI), and (2) estimates of how much and how often people of different body mass can consume different species of fish. Blacks consumed more fish and had higher HIs than Whites. Even at the median consumption, the HI for Blacks exceeded 1.0 for bass and bowfin, and, at the 75th percentile of consumption, the HI exceeded 1.0 for almost all species. At the White male median consumption, noHI exceeded 1, but for the 95th percentile consumer, the HI exceeded 1.0 almost regardless of which species were eaten. Although females consumed about two thirds the quantity of males, HIs exceeded 1 for most Black females and for White females at or above the 75th percentile of consumption. Thus, close to half of the Black fishermen were eating enough Savannah River fish to exceed HI = 1. Caution must be used in evaluating an HI because the RfDs were developed to protect the most vulnerable individuals. The percentage of each fish species tested that exceeded the maximum permitted limits of mercury in fish was also examined. Over 80% of bowfin, 38% of bass, and 21% of pickerel sampled exceeded 0.5 ppm. The risk methodology is applicable anywhere that comparable data can be obtained. The risk estimates are representative for fishermen along the Savannah River, and are not necessarily for the general populations.     

Estimated Distributions for Average Daily Consumption of Total and Self-Caught Fish for Adults in Michigan Angler Households

Fish consumption rates play a critical role in the assessment of human health risks posed by the consumption of fish from chemically contaminated water bodies. Based on data from the 1989 Michigan Sport Anglers Fish Consumption Survey, we examined total fish consumption, consumption of self-caught fish, and consumption of Great Lakes fish for all adults, men, women, and certain higher risk subgroups such as anglers. We present average daily consumption rates as compound probability distributions consisting of a Bernoulli trial (to distinguish those who ate fish from those who did not) combined with a distribution (both empirical and parametric) for those who ate fish. We found that the average daily consumption rates for adults who ate fish are reasonably well fit by lognormal distributions. The compound distributions may be used as input variables for Monte Carlo simulations in public health risk assessments.     

Fishing in Urban New Jersey: Ethnicity Affects Information Sources,Perception, and Compliance

Recreational and subsistence angling are important aspects of urban culture for much of North America where people are concentrated near the coasts or major rivers. Yet there are fish and shellfish advisories for many estuaries, rivers, and lakes, and these are not always heeded. This paper examines fishing behavior, sources of information, perceptions, and compliance with fishing advisories as a function of ethnicity for people fishing in the Newark Bay Complex of the New York–New Jersey Harbor. We test the null hypothesis that there were no ethnic differences in sources of information, perceptions of the safety of fish consumption, and compliance with advisories. There were ethnic differences in consumption rates, sources of information about fishing, knowledge about the safety of the fish, awareness of fishing advisories or of the correct advisories, and knowledge about risks for increased cancer and to unborn and young children. In general, the knowledge base was much lower for Hispanics, was intermediate for blacks, and was greatest for whites. When presented with a statement about the potential risks from eating fish, there were no differences in their willingness to stop eating fish or to encourage pregnant women to stop. These results indicate a willingness to comply with advisories regardless of ethnicity, but a vast difference in the base knowledge necessary to make informed risk decisions about the safety of fish and shellfish. Although the overall median income level of the population was in the $25,000–34,999 income category, for Hispanics it was on the border between $15,000–24,999 and $25,000–34,999.     

Development of a Public Participation and Communication Protocol for Establishing Fish Consumption Advisories

Enabling people to make an informed choice on whether to change consumption behavior is ultimately the objective of any fish consumption advisory. This will occur only if people are aware of the advisory, know and understand the advisory information, and believe the information to be true. Interactive, meaningful communication and the opportunity to participate in the process to develop and review advisories are key to achieving these attributes. A case study was undertaken in a community in Alberta, Canada (where an existing advisory was under consideration for review) to determine public awareness, knowledge, compliance, communication effectiveness, information needs, and desire for involvement related to the advisory. The information obtained from this case study was used to develop 14 guiding principles as a foundation for the incorporation of public participation and risk communication into the process of developing and reviewing fish consumption advisories.     

Use of Quality-Adjusted Life Year Weights with Dose-Response Models for Public Health Decisions: A Case Study of the Risks and Benefits of Fish Consumption

Risks associated with toxicants in food are often controlled by exposure reduction. When exposure recommendations are developed for foods with both harmful and beneficial qualities, however, they must balance the associated risks and benefits to maximize public health. Although quantitative methods are commonly used to evaluate health risks, such methods have not been generally applied to evaluating the health benefits associated with environmental exposures. A quantitative method for risk-benefit analysis is presented that allows for consideration of diverse health endpoints that differ in their impact (i.e., duration and severity) using dose-response modeling weighted by quality-adjusted life years saved. To demonstrate the usefulness of this method, the risks and benefits of fish consumption are evaluated using a single health risk and health benefit endpoint. Benefits are defined as the decrease in myocardial infarction mortality resulting from fish consumption, and risks are defined as the increase in neurodevelopmental delay (i.e., talking) resulting from prenatal methylmercury exposure. Fish consumption rates are based on information from Washington State. Using the proposed framework, the net health impact of eating fish is estimated in either a whole population or a population consisting of women of childbearing age and their children. It is demonstrated that across a range of fish methylmercury concentrations (0-1 ppm) and intake levels (0-25 g/day), individuals would have to weight the neurodevelopmental effects 6 times more (in the whole population) or 250 times less (among women of child-bearing age and their children) than the myocardial infarction benefits in order to be ambivalent about whether or not to consume fish. These methods can be generalized to evaluate the merits of other public health and risk management programs that involve trade-offs between risks and benefits.     

Estimates of per Capita Fish Consumption in the U.S. Based on the Continuing Survey of Food Intake by Individuals (CSFII)

This paper presents estimates of daily average per capita fish consumption by age and gender for the 48 conterminous states. The estimated consumption rates are reported for three fish habitats: freshwater/estuarine fish, marine fish, and all fish. The estimates were generated from the combined 1989, 1990, and 1991 Continuing Survey of Food Intake by Individuals (CSFII), a national food consumption survey conducted by the United States Department of Agriculture (USDA). Point and interval estimates of per capita fish consumption were generated from the empirical distribution of daily average per capita consumption. The point estimates include the mean, 50th, 75th, 90th, 95th, and 99th percentiles. Ninety percent confidence intervals are provided for the estimated mean and 90% bootstrap intervals are provided for percentile estimates. Information in a recipe file provided by USDA was used to calculate the amount of fish in recipes which contain fish. The estimated consumption rates are based on the weight of fish in its prepared or "as consumed" condition. The estimated mean consumption rate for all fish for the U.S. population of the 48 conterminous states was 15.65 grams/person/day (C.I.:14.67–16.63) of which 4.71 grams/person/day (C.I.:4.17–5.25) was freshwater/estuarine fish and 10.94 grams/person/day (C.I.: 10.14–11.73) was marine fish.     

Effects of an Advisory Brochure on Fish Consumption of Urban Anglers in the Great Lakes Region

Past research has suggested that urban anglers are a group at high risk of being exposed to contaminants from fish consumption. Fish consumption advisories have been used in many regions to encourage healthy fish‐eating behaviors, but few studies have been designed to assess whether these advisories actually influence behavior as intended. We conducted a large‐scale, randomized experiment to test the influence of an advisory brochure on urban anglers’ fish consumption. We collected detailed information on anglers’ fish consumption in three urban counties in the Great Lakes region in the summers of 2014 and 2015. We provided a treatment group with fish consumption guidelines in an advisory brochure before the summer of 2015 and compared their change in fish consumption to a control group. The brochure led to a reduction in fish consumption for anglers who ate the most fish; these anglers reduced their consumption of high‐contaminant purchased fish (by ≥0.2 meals/summer for those in 72nd percentile of fish consumption or above), high‐contaminant sport‐caught fish (by ≥0.4 meals/summer for those in 87th percentile and above), and low‐contaminant sport‐caught fish (by ≥0.3 meals/summer by those in 76th percentile and above). The brochure also reduced sport‐caught fish consumption among those anglers who exceeded the advisories in 2014 (by 2.0 meals/summer). In addition, the brochure led to small increases in sport‐caught fish consumption (0.4–0.6 meals/summer) in urban anglers who ate very little sport‐caught fish (≤1 meal/summer).