Comparative analysis of state fish consumption advisories targeting sensitive populations

Abstract

Objective: Fish consumption advisories are issued to warn the public of possible toxicological threats from consuming certain fish species. Although developing fetuses and children are particularly susceptible to toxicants in fish, fish also contain valuable nutrients. Hence, formulating advice for sensitive populations poses challenges. We conducted a comparative analysis of advisory Web sites issued by states to assess health messages that sensitive populations might access.

Data sources: We evaluated state advisories accessed via the National Listing of Fish Advisories issued by the U.S. Environmental Protection Agency.

Data extraction: We created criteria to evaluate advisory attributes such as risk and benefit message clarity.

Data synthesis: All 48 state advisories issued at the time of this analysis targeted children, 90% (43) targeted pregnant women, and 58% (28) targeted women of childbearing age. Only six advisories addressed single contaminants, while the remainder based advice on 2-12 contaminants. Results revealed that advisories associated a dozen contaminants with specific adverse health effects. Beneficial health effects of any kind were specifically associated only with omega-3 fatty acids found in fish.

Conclusions: These findings highlight the complexity of assessing and communicating information about multiple contaminant exposure from fish consumption. Communication regarding potential health benefits conferred by specific fish nutrients was minimal and focused primarily on omega-3 fatty acids. This overview suggests some lessons learned and highlights a lack of both clarity and consistency in providing the breadth of information that sensitive populations such as pregnant women need to make public health decisions about fish consumption during pregnancy.

Keywords: advisory/advisories; benefits; consumption; contaminants; fish; nutrition/nutritional; pregnant women; risks; sensitive populations; women of childbearing age.

Figure 1

Flow diagram for the comparative analysis of the 48 state fish consumption advisory Web sites assessed.

Figure 2

(A) Fish nutrients associated with beneficial health effects and (B) fish contaminants associated with adverse health effects in state fish consumption advisories. “Unclear or vague” refers to instances where either no nutrient or contaminant was mentioned or the reference was inexact. Advisory references to good or beneficial fats or oils presumably refer to omega-3 fatty acids and are included in that category. The developmental effects category includes general developmental effects (e.g., adverse effects including developmental damage or birth defects), whereas developmental effects that are specifically neurological in nature (e.g., adverse effects including delayed mental development or delayed or affected learning) are included in the neurological effects category. A similar approach was used to categorize beneficial health effects. PFOS, perfluorooctane sulfonate.

Figure 3

State fish consumption advisories targeted at the general population or sensitive populations: (A) clarity of risk information, (B) clarity of multiple contaminant information, (C) clarity of benefit information, and (D) emphasis of risk and benefit information. Results are shown separately for Web site documents specifically targeting sensitive populations (far right column) versus messages targeting sensitive populations both within Web pages and brochures specifically targeting sensitive populations as well as within Web pages and brochures that intermingle advice for the general population and sensitive populations (middle column).