Human health research and policy development: experience in the Great Lakes region

As a direct outgrowth of industrial and agricultural activities, the quality of the Great Lakes ecosystem has declined significantly because of toxic substances in the water, eutrophication, overfishing, and invasive species that have been introduced into the waterways. Although measures have been adopted to restore the health of the ecosystem, contamination of Great Lakes sport fish continues arising from conditions that still prevail, but on a more limited scale. As a consequence, the Great Lakes states have issued guidelines for the public in the form of health advisories for fish consumption to encourage practices that will minimize exposure to contaminants found in Great Lakes sport fish. Scientific research has strongly influenced many policy decisions, including the development of laws, rules, and guidelines applicable to public health not only in regard to fish advisories but also other issues impacting human health. This paper proposes to outline how policy has been influenced by scientific findings and the far-reaching effect that these decisions have had on the health status of the public in the Great Lakes area and its potential for influencing the nation as a whole and our global neighbors. Within the Great Lakes basin, polychlorinated biphenyls (PCB) and mercury are the subject of the greatest number of fish advisories. Great Lakes-based researchers have studied populations residing in the Great Lakes basin to determine their level of awareness concerning fish consumption health advisories. They found that almost 50% of the residents who consumed Great Lakes sport fish were aware of sport fish consumption advisories. Of those with awareness, almost 60% were males and only about 40% were females. The researchers attributed the greater awareness among males to the health advisory materials that males receive with their fishing licenses and to their contact with fishing-related groups. The lower level of awareness among women regarding fish consumption advisories subsequently prompted the researchers to recommend targeting risk communication programs for female consumers of Great Lakes sport fish, particularly women of reproductive age. The Wisconsin Department of Health and Family Services subsequently followed the recommendation and developed uniform outreach materials for women, minorities, and the general public to be used by the Great Lakes states. The policy change directing educational materials to at-risk groups (e.g., women of reproductive age and minorities) is a direct outgrowth of the finding of low awareness about fish advisories among women who were interviewed.     

Effects of a Personal Narrative in Messages Designed to Promote Healthy Fish Consumption Among Women of Childbearing Age

Women of childbearing age (WCBA) can attain health benefits of fish consumption while minimizing risks by following state and federal fish consumption guidelines, but many women avoid fish out of concerns about mercury exposure. This study tested the impact of brochures, informed by communication theory and research, to promote healthy fish consumption among licensed female anglers. We conducted a randomized, two-wave longitudinal experiment between May 2014 and September 2015 among 1,135 women ages 18–48 years (at baseline), drawn from a sample of licensed anglers in the Great Lakes region of the United States. We randomly assigned women to one of five groups, to either be sent one of four brochures in spring 2015 using a two (including a short personal narrative or not) by two (using certain or uncertain language) factorial design, or to a no-exposure control arm. Participants reported their fish consumption in summer 2014 and summer 2015 via an online diary. Exposure to brochure versions that included a short personal narrative helped move women whose baseline levels of fish consumption were furthest from federal recommendations closer to these guidelines; effects were clearest among women confirmed, by self-report or web tracking, to have seen the brochure. Narratives hold promise as a strategy to communicate effectively about the benefits of healthy fish consumption and risks of overconsumption among WCBA, but widespread dissemination may be necessary to achieve these effects.     

Sport fish consumption and body burden levels of chlorinated hydrocarbons: a study of Wisconsin anglers

Sport-caught fish consumption is the major source of polychlorinated biphenyls (PCBs) exposure for the general population. To assess this and 2,2'-bis-(p-chlorophenyl)-1,1-dichloroethylene (DDE) exposure, we surveyed 801 Wisconsin anglers for fishing and consumption habits and comprehension of and compliance with the Wisconsin fish consumption health advisory. The mean annual number of sport-caught fish meals was 18. Seventy-two percent of anglers were familiar with the health advisory and 57% had changed their fishing or fish consumption habits as a result of the advisory. The mean PCB serum congener sum level for 192 anglers was 2.2 micrograms/l (range = nondetectable to 27.1 micrograms/l); mean DDE was 6.3 micrograms/l (range = nondetectable to 40.0 micrograms/l). Statistically significant positive Spearman correlations were observed between sport-caught fish meals and PCB and DDE sera levels (R = .21 and .14, respectively) and between kilograms of fish caught and PCB sera levels (R = .25). These results demonstrate that anglers may provide a population for assessment of PCBs and DDE associated morbidity and mortality.     

Mortality among frequent consumers of Great Lakes sport fish

Commercial and sport-caught fish provide a healthy source of dietary protein, omega-3 fatty acids, and other micronutrients. Regular fish consumption has been associated with decreased risk of heart disease and health professionals encourage adults to include fish in their weekly diets. However, fish harvested from contaminated waters can contain higher levels of persistent, bioaccumulative chemicals such as methylmercury, PCBs, dieldrin, and DDT. To assess the beneficial effects of fish intake and the adverse effects of contaminant exposure, underlying and contributing causes of death were obtained from the National Death Index for 342 deceased members of a cohort of 2538 Great Lakes charterboat captains, 180 Wisconsin anglers, and 1141 referents who were established in 1993-1995. Multivariate analysis of death rates confirmed a dose-related protective effect of fish intake against all-cause and cardiovascular disease mortality, including coronary heart disease, among the referent group. This effect was not observed among consumers of Great Lakes sport fish, however. Cancer mortality was not associated with fish intake in either exposure group. While the number of deaths among this cohort is currently too small to support rigorous statistical analysis, these preliminary findings are consistent with other studies that have shown a protective effect of commercial fish on human health and longevity and raise concerns regarding the effect of persistent environmental contaminants that continue to be detected in fish from the Great Lakes Basin. It is hoped that continued monitoring of this cohort will improve our understanding of the complex interactions that exist between nutrients and contaminants found in fish harvested from the Great Lakes.     

Temporal changes in PCB and DDE levels among a cohort of frequent and infrequent consumers of Great Lakes sportfish

A variety of environmentally persistent contaminants of the Great Lakes Basin are able to bioaccumulate in the aquatic food chain and pose a threat to the health and reproductive success of people and wildlife that depend on locally caught fish as a source of dietary protein. Exposure to polychlorinated biphenyls (PCBs) and 1,1-bis(4-chlorophenyl)-2,2-dichloroethene (DDE) has been linked to higher rates of cancer, reproductive problems, and endocrine disorders. To investigate the effects of exposure to persistent contaminants of the Great Lakes Basin, the health departments of five Great Lakes states formed a health-assessment consortium. Between 1988 and 1994, the consortium collected demographic and fish consumption information from 2548 licensed charter boat captains, 182 anglers, and 1667 referents. Between 1994 and 1995, a subset of 619 participants in this study provided additional fish consumption information and donated blood samples that were analyzed for PCBs and DDE. Follow-up studies conducted between 2001 and 2005 re-assessed fish consumption rates and blood levels of PCBs and DDE in 293 of these individuals. While there was a trend for increasing overall fish consumption among most participant groups, sportfish and Great Lakes sportfish consumption decreased significantly in the captains over the study period. Serum DDE concentrations, which were highest in men in the captain and angler groups, declined in 90% of study participants. Mean DDE levels fell from 5.6 to 3.2 μg/L. Total PCB levels declined in 80% of participants with the mean concentration falling from 4.2 to 2.8 μg/L. Annual declines in serum DDE and PCB concentrations averaged 4.6% and 3.5%, respectively.     

Catfish consumption as a contributor to elevated PCB levels in a non-Hispanic black subpopulation

The human body burden of polychlorinated biphenyls (PCBs) sharply declined after production was banned in the US in 1979. For the 10% of the US population that remains most exposed to PCBs, fish consumption is the primary source. National Health and Nutrition Examination Survey (NHANES) data indicates that the highest remaining PCB levels exist in a non-Hispanic black subpopulation. Our review suggests that catfish consumption may be a significant PCB source for the one million non-Hispanic black anglers who fish for catfish. In comparison to non-Hispanic white anglers, non-Hispanic black anglers consume more catfish, are more likely to eat the whole fish rather than just the fillets that contain less PCBs, and are more likely to fish in watersheds with high PCB contamination.Efforts to diminish potential racial disparities in PCB exposure are challenged by geographic, economic, cultural, and educational barriers. In response, we propose that a fish consumption survey be performed that identifies the extent of subsistence fishing by non-Hispanic black anglers for catfish in watersheds with PCB contamination, the type and quantity of catfish subsistence fishing provides, and what actions would help moderate PCB exposure due to subsistence fishing for catfish in such areas. Understanding the contamination and consumption factors that contribute to higher PCB body burdens will help identify and offer solutions to racial disparities in exposure to PCBs due to subsistence fishing while providing a model to prevent similar disparities in exposure to toxics ranging from mercury to polybrominated diphenyl ethers.     

Biomonitoring as an intervention against methylmercury exposure

Objectives

We evaluated the effectiveness of biomonitoring as an intervention against methylmercury exposure.

Methods

During 2004, the Wisconsin Department of Health Services assessed fish consumption and methylmercury exposure among 2,031 men and women who responded to a statewide press release. People whose hair mercury levels exceeded 1 microgram per gram (μg/g) were advised to reduce their intake of large, predatory fish. Others were informed that mercury exposure was not an issue for them and were encouraged to continue to eat fish as part of a healthy diet. In 2008, follow-up questionnaires and hair sampling kits were mailed to all 2004 study participants.

Results

Completed surveys and hair samples were received from 1,139 individuals. While overall fish intake for this group increased slightly, from 8,561 to 8,785 servings per month between 2004 and 2008, the intake rate was significantly reduced among people whose 2004 hair mercury levels were >1 μg/g, and 30% of the cohort reported eating different types of fish or smaller fish in 2008. The number of people who had a hair mercury level >1 μg/g fell from 300 in 2004 to 206 in 2008.

Conclusions

Hair mercury analysis and explanatory result letters appear to have had a long-term effect on methylmercury exposure and the selection of fish. These findings support the public health benefit of methylmercury screening in conjunction with results-based education among frequent consumers of commercial and sport-caught fish.Eating a diet that includes a variety of fish, especially fatty marine species such as herring, mackerel, and sardines, has been associated with a reduced risk of cardiovascular disease.^1–4 However, consumption of methylmercury-contaminated fish or grain has been linked to a variety of health problems ranging from developmental delays in prenatally exposed infants to neurological problems and heart disease.^5–11 Most state health departments advise children and women of childbearing age to reduce their intake of large, predatory sport fish, which are frequently high in mercury. Following publication of the 2000 National Research Council report on the toxicological effects of methylmercury,¹² the Wisconsin Department of Health Services began to offer hair mercury testing to concerned citizens and broadened its advisory to include dietary guidance for men and older women.The Great Lakes Regional Collaboration (GLRC) has set a goal of protecting the public from toxic substances through effective outreach and education, including protective fish consumption advice throughout the Great Lakes Basin Ecosystem.¹³ In addition, the GLRC has encouraged stakeholders to identify and fill knowledge gaps that limit our ability to manage public health risks posed by substances found in the Great Lakes and has recommended the use of consistent, easily accessible messages on fish consumption to protect human health. By 2010, the GLRC hoped to establish a regional biomonitoring program for persistent contaminants, and this initiative was recently funded through grants offered by the U.S. Agency for Toxic Substances and Disease Registry.In 2004, the Wisconsin Department of Health Services assessed methylmercury levels in 2,031 residents.¹⁴ Volunteers recruited using statewide press releases completed questionnaires that requested information about sport-caught and commercial fish consumption, and provided hair samples for analysis. Compared with responses from a fish consumption module included in the 2004 Wisconsin Behavioral Risk Factor Surveillance System (WBRFSS) survey, participants in this study ate more fish and were more likely to be licensed anglers. Nearly 20% of the hair samples exceeded the federal advisory level of 1 microgram per gram (μg/g). Levels were highest in male anglers and lowest in women of childbearing age. These results suggested that the advisory used prior to 2005, which advised women who were pregnant or were planning a pregnancy to avoid eating large, predatory fish, had been effective in reducing mercury exposure among this group and highlighted the need to provide consumption advice to men.To assess the effectiveness of the 2004 biomonitoring effort as an outreach and intervention tool, a follow-up investigation was conducted in 2008. The follow-up study was designed to evaluate the participants'' recall of their 2004 hair mercury level, as well as any changes in their fish intake and hair mercury level. This article presents findings from the follow-up study.     

Potential exposure to PCBs, DDT, and PBDEs from sport-caught fish consumption in relation to breast cancer risk in Wisconsin

In Wisconsin, consumption of Great Lakes fish is an important source of exposure to polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), polybrominated diphenyl ethers (PBDEs), and other halogenated hydrocarbons, all of which may act as potential risk factors for breast cancer. We examined the association between sport-caught fish consumption and breast cancer incidence as part of an ongoing population-based case-control study. We identified breast cancer cases 20-69 years of age who were diagnosed in 1998-2000 (n = 1,481) from the Wisconsin Cancer Reporting System. Female controls of similar age were randomly selected from population lists (n = 1,301). Information about all sport-caught (Great Lakes and other lakes) fish consumption and breast cancer risk factors was obtained through telephone interviews. After adjustment for known and suspected risk factors, the relative risk of breast cancer for women who had recently consumed sport-caught fish was similar to women who had never eaten sport-caught fish [relative risk (RR) = 1.00; 95% confidence interval (CI), 0.86-1.17]. Frequency of consumption and location of sport-caught fish were not associated with an increased risk of breast cancer. Recent consumption of Great Lakes fish was not associated with postmenopausal breast cancer (RR = 0.78; 95% CI, 0.57-1.07), whereas risk associated with premenopausal breast cancer was elevated (RR = 1.70; 95% CI, 1.16-2.50). In this study we found no overall association between recent consumption of sport-caught fish and breast cancer, although there may be an increased breast cancer risk for subgroups of women who are young and/or premenopausal.     

Reliability of sport fish consumption in the New York State Angler cohort study

This paper examines the reliability of sport fish consumption data from the New York State Angler Cohort Study (NYSACS). NYSACS is a prospective cohort study conducted among New York State registered sportsmen and fishermen. Sport fish consumption information for New York State waters including the Great Lakes between June 1990 and June 1991 were collected through self-administered questionnaires, Spouses of male anglers were asked to provide their husbands' fish consumption during the same time period. A short telephone interview after the cohort was ascertained was also conducted among about 100 study participants for the purpose of quality control. Percentage agreement, kappa, and weighted kappa were calculated to evaluate the reliability of the interview using spousal data and reinterview data. Overall, for the total fish consumption between June 1990 and June 1991, percentage agreement, kappa, and weighted kappa between spousal data and primary response were 67.28%, 0.5087, and 0.6157, respectively. For reinterview data, weighted kappa ranged from 0.4510 to 0.5285 for season-specific analysis and kappa ranged from 0.4615 to 0.7006 for fish species-specific analysis. Spouses may be a good source of proxy data for fish consumption. The reliability of sport fish consumption data for the NYSACS study is acceptable, suggesting that the food frequency measuring methods employed are a viable approach to obtain retrospective sport fish consumption data from sportsmen and subsistence anglers.     

Exposure assessment and initial intervention regarding fish consumption of tribal members of the Upper Great Lakes Region in the United States

The Ojibwe Health Study (OHS) has concluded 10 years of data collection and exposure assessment. Eight hundred and twenty-two participants from tribes in the states of Wisconsin, Michigan, and Minnesota (USA) completed fish consumption and environmental risk perception questionnaires. Many participants provided hair and blood samples for mercury and polychlorinated biphenyl (PCB) residue analyses as body burden indicators of these persistent environmental pollutants. Fish were collected by the tribal organizations and contaminants were analyzed for numerous tribal reports and professional environmental journal articles, these data were used by the Great Lakes Indian Fish and Wildlife Commission to produce tribal-specific geographic information systems maps as part of a public health intervention strategy. These maps are currently available at for six Wisconsin tribes that regularly harvest walleye. To determine the health impacts (if any) of pollutants on cancer, diabetes, and reproduction, it was necessary to know the recent trends in key indicators such as cancer mortality ratios and birth gender ratios. The Great Lakes Inter-Tribal Council provided the OHS and each participating tribe in Wisconsin and Michigan with a health profile. Total fish consumption (estimated by recall) for 720 tribal participants was self-reported as 60 g/day, but the highest actual consumption was measured as 11.2 g/day in one of the tribal groups. The highest blood concentrations in tribal participants were 18.6 ppb total serum PCBs and 11.8 ppb total blood mercury. Ninety percent of the participants had less than 3.8 ppb total serum PCBs and 2.6 ppb total blood mercury. Compared to other studies of subsistence fishing populations, these exposures were only moderately elevated and not high enough to warrant widespread restrictions on diets. Furthermore, the benefits of eating a fish diet must be continually emphasized. However, sport fishermen and their families who consume larger and more contaminated fish should abide by their state fish consumption advisories to minimize their health risks.     

Fish consumption and advisory awareness in the Great Lakes Basin

More than 61 million adults live in the eight U.S. states bordering the Great Lakes. Between June 2001 and June 2002, a population-based, random-digit-dial telephone survey of adults residing in Great Lakes (GL) states was conducted to assess consumption of commercial and sport-caught fish and awareness of state-issued consumption advisories for GL fish. On the basis of the weighted survey data, approximately 84% of the adults living in these states included fish in their diets. Seven percent (an estimated 4.2 million adults) consumed fish caught from the Great Lakes. The percentage of residents who had consumed sport-caught fish (from any water source) varied regionally and was highest among those who lived in Minnesota (44%) and Wisconsin (39%). Consumption of GL sport fish was highest among residents of Michigan (16%) and Ohio (12%). Among residents who had eaten GL fish, awareness of consumption advisories varied by gender and race and was lowest among women (30%) and black residents (15%). However, 70% of those who consumed GL sport-caught fish twice a month or more (an estimated 509,000 adults across all eight states) were aware of the advisories. Findings from this survey indicate that exposure to persistent contaminants found in GL fish is likely limited to a relatively small subpopulation of avid sport-fish consumers. Results also underscore the public health importance of advisories for commercial fish because an estimated 2.9 million adults living in these states consume more than 104 fish meals per year and may be at risk of exceeding the reference doses for methylmercury, polychlorinated biphenyls, and other bioaccumulative contaminants.     

Absence of nonresponse bias in a study of sport-caught Great Lakes fish consumption and conception failure

INTRODUCTION: We have reported that men's lifetime sport-caught Great Lakes fish consumption was associated with lifetime prevalence of conception delay or failure. Those cross-sectional data were based on responses to a postal questionnaire. The present study was conducted to evaluate whether nonresponse bias could explain the cross-sectional findings. METHODS: We conducted telephone interviews with 230 men and 38 women who did not respond to the original survey, and compared these individuals to the original responders with respect to key demographic, behavioral, and reproductive characteristics. RESULTS: Nonresponders were approximately 1.5 years older at interview, were more likely to be Caucasian, and reported higher incomes than responders. Among men, nonresponders had fished fewer days in the past year (12% reported no fishing, compared to 4. 3% of responders). Almost one half of nonresponders reported no fish consumption in the past year, compared to one quarter of responders. Nonresponders were more likely than responders to have ever conceived a live-born child, had more children, and were less likely to intend to have additional children in the next 5 years. Among both responders and nonresponders there was an increased prevalence of a period of conception failure among men who reported consuming greater quantities of sport-caught Great Lakes fish. DISCUSSION: Our study provides support for the cross-sectional analyses presented previously, insofar as nonresponse bias is unlikely to have a major role in the observed association.     

Risks and benefits of consumption of Great Lakes fish

Background: Beneficial effects of fish consumption on early cognitive development and cardiovascular health have been attributed to the omega-3 fatty acids in fish and fish oils, but toxic chemicals in fish may adversely affect these health outcomes. Risk–benefit assessments of fish consumption have frequently focused on methylmercury and omega-3 fatty acids, not persistent pollutants such as polychlorinated biphenyls, and none have evaluated Great Lakes fish consumption.Objectives: The risks and benefits of fish consumption have been established primarily for marine fish. Here, we examine whether sufficient data are available to evaluate the risks and benefits of eating freshwater fish from the Great Lakes.Methods: We used a scoping review to integrate information from multiple state, provincial, and federal agency sources regarding the contaminants and omega-3 fatty acids in Great Lakes fish and fish consumers, consumption rates and fish consumption advisories, and health effects of contaminants and omega-3 fatty acids.Data synthesis: Great Lakes fish contain persistent contaminants—many of which have documented adverse health effects —that accumulate in humans consuming them. In contrast, data are sparse on omega-3 fatty acids in the fish and their consumers. Moreover, few studies have documented the social and cultural benefits of Great Lakes fish consumption, particularly for subsistence fishers and native communities. At this time, federal and state/provincial governments provide fish consumption advisories based solely on risk.Conclusions: Our knowledge of Great Lakes fish has critical gaps, particularly regarding the benefits of consumption. A risk–benefit analysis requires more information than is currently available on the concentration of omega-3 fatty acids in Great Lakes fish and their absorption by fish eaters in addition to more information on the social, cultural, and health consequences of changes in the amount of fish consumed.     

Blood mercury levels among Ontario anglers and sport-fish eaters

We conducted two surveys of Ontario (Canada) fishers: a stratified sample of licensed anglers in two Lake Ontario communities (anglers, n=232) and a shore and community-based sample in five Great Lakes' Areas of Concern (AOC eaters, n=86). Among the 176 anglers consuming their catch, the median number of sport-fish meals/year was 34.2 meals and 10.9, respectively, in two communities, with a mean blood total mercury level among these sport-fish consumers of 2.8 microg/L. The vast majority of fish eaten by AOC eaters was from Ontario waters (74%). For AOC eaters, two broad country-of-origin groups were assembled: Euro-Canadians (EC) and Asian-Canadians (AC). EC consumed a median of 174 total fish meals/year and had a geometric mean total mercury level of 2.0 microg/L. Corresponding AC figures were 325 total fish meals/year and 7.9 microg/L. Overall, mercury levels among AOC eaters were higher than in many other Great Lakes populations but lower than in populations frequently consuming seafood. In multivariate models, mercury levels were significantly associated with levels of fish consumption among both anglers and EC AOC eaters. Given the nutritional and social benefits of fish consumption, prudent species and location choices should continue.     

Assessment of methylmercury exposure in Wisconsin

Between January 2004 and June 2005 the Wisconsin Department of Health and Family Services recruited more than 2000 adults for a methylmercury (MeHg) exposure assessment study. Study participants, including 978 men and 1050 women who ranged in age from 18 to 92 years, completed a fish consumption and advisory awareness survey and provided hair samples for mercury analysis. Fish intake estimates ranged from 0 to 60 meals/month (mean 7.7). Hair mercury levels ranged from 0.012 to 15.2 microg/g and were positively correlated with monthly fish meals. Despite reporting similar fish consumption rates, men tended to have higher hair mercury levels than women. Mercury levels exceeded 1 microg/g in 29% of the men and 13% of the women and increased with age. Approximately, half of the study volunteers were licensed anglers and 77% were familiar with Wisconsin's sportfish consumption advisory. Among consumers of sport-caught fish, 37% of the men and 18% of the women had a hair mercury concentration above 1 microg/g. These findings suggest that exposure to MeHg is widespread and that men may be a previously unrecognized high risk population.     

Contaminated fish consumption in California’s Central Valley Delta

Extensive mercury contamination and angler selection of the most contaminated fish species coincide in California’s Central Valley. This has led to a policy conundrum: how to balance the economic and cultural impact of advising subsistence anglers to eat less fish with the economic cost of reducing the mercury concentrations in fish? State agencies with regulatory and other jurisdictional authority lack sufficient data and have no consistent approach to this problem. The present study focused on a critical and contentious region in California’s Central Valley (the Sacramento-San Joaquin Rivers Delta) where mercury concentrations in fish and subsistence fishing rates are both high. Anglers and community members were surveyed for their fish preferences, rates of consumption, the ways that they receive health information, and basic demographic information. The rates of fish consumption for certain ethnicities were higher than the rates used by state agencies for planning pollution remediation. A broad range of ethnic groups were involved in catching and eating fish. The majority of anglers reported catching fish in order to feed to their families, including children and women of child-bearing age. There were varied preferences for receiving health information and no correlation between knowledge of fish contamination and rates of consumption. Calculated rates of mercury intake by subsistence anglers were well above the EPA reference dose. The findings here support a comprehensive policy strategy of involvement of the diverse communities in decision-making about education and clean-up and an official recognition of subsistence fishers in the region.     

Biomonitoring of mercury and persistent organic pollutants in Michigan urban anglers and association with fish consumption

The 32-mile Detroit River and surrounding tributaries have been designated as a Great Lakes Area of Concern due to pollution from decades of municipal and industrial discharges, sewer overflows and urban development. Key pollutants in fish samples from the Detroit River include mercury, polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (DDE), dioxins and furans. A biomonitoring study was conducted to assess exposures to these persistent toxic substances in Detroit urban shoreline anglers who may be at high exposure risk due to consumption of locally caught fish. Using a modified venue-based sampling approach, 287 adult shoreline anglers along the Detroit River were recruited and participated in the program. Study participants provided blood and urine specimens and completed a questionnaire following informed consent. We examined percentile estimates for total blood mercury, PCBs, DDE, and dioxin-like total toxic equivalency (TEQ) concentrations among study participants. Multiple linear regression was used to identify important predictors of contaminant concentrations. Participants consumed a median of 64 Detroit River caught fish meals in the past year. The Detroit urban anglers’ median total blood mercury concentrations was 3.2 times higher than that for the general adult U.S. population. PCB concentrations among the Detroit anglers aged 18–39 years were higher than the U.S. population of the same race/ethnicity. Elevated levels of DDE and total TEQ concentrations were not observed in the cohort. Eating more locally caught fish was associated with higher total blood mercury and serum PCB concentrations. The biomonitoring data served to inform public health officials and help guide environmental public health actions to reduce harmful exposures.     

Uterine leiomyomata in a cohort of Great Lakes sport fish consumers

Diet and endocrine disrupting persistent organic pollutants (POPs) have been associated with gynecologic conditions including uterine leiomyomata (UL), endometriosis, and ovarian cysts. Great Lakes sport fish consumption is a source of exposure to POPs such as p,p′-diphenyldichloroethene (DDE) and polychlorinated biphenyls (PCBs). This study was designed to examine retrospectively the effects Great Lakes sport fish consumption on the incidence of UL and to examine the effects of DDE and PCB serum levels on prevalent UL in women participating in the Great Lakes Fish Consumption Study. We hypothesized that associations of exposures with UL would be modified by breastfeeding status. Years of sport fish consumption, demographic, health, and reproductive data were assessed by survey. In a subgroup, serum was collected and tested for DDE and PCB levels. Effects of years of Great Lakes sport fish and sport fish consumption were modeled using time-dependent Cox proportional hazards regression and effects of POP exposures on UL were modeled using multiple logistic regression. Years of sport fish consumption were associated with UL, with an incidence rate ratio of 1.2 (95% CI 1.0–1.3) for each 10-year increment of fish consumption. Summary measures of POP exposures in the overall group were not associated with UL. In the subgroup of women who never breastfed and in whom PCB measurements were available, however, UL was significantly associated with PCBs and groupings of estrogenic, antiestrogenic, and dioxin-like PCBs. These findings support the possibility that PCB exposures from fish consumption may increase the risk of UL and highlight the importance of additional studies exploring biologic pathways by which they could be acting.     

Health advisories for consumers of Great Lakes sport fish: is the message being received?

Nationwide, 45 states issue health advisories for sport fish consumers. Chemical contaminants in some Great Lakes (GL) sport fish include compounds suspected of causing adverse reproductive and developmental effects. Although advisories to reduce consumption of contaminated fish, especially by women, have been issued by GL states (i.e., Illinois, Indiana, Michigan, Minnesota, New York, Ohio, Pennsylvania, and Wisconsin) since the mid-1970s, little is known about advisory awareness and GL sport fish consumption in the general population. To estimate the prevalence of GL sport fish consumption and health advisory awareness, we conducted a population-based telephone survey of 8,306 adult residents of the eight GL states. We gathered information concerning respondents' demographic characteristics, fish consumption during the preceding year, and sport fish consumption advisory awareness. The survey response rate was 69%. GL sport fish were eaten during the preceding year by 8.4% -95% confidence interval (CI), 7.6-9.2- of adults in the GL states, approximately 4.7 million persons. Women accounted for 43.9% (CI,39. 4-48.4) of consumers. Although 49.9% of GL sport fish consumers were aware of a health advisory, awareness varied significantly by sex: 58.2% (CI, 51.7-64.7) of males and 39.1% (CI, 32.6-45.6) of females were aware. Using logistic regression, we found awareness associated with male sex -odds ratio (OR) = 2.3; CI, 1.5-3.5), white race (OR = 4.2; CI, 1.9-9.1), college degree (OR = 3.1; CI, 1.3-7.6), and consuming >=24 GL sport fish meals/year (OR = 2.4; CI, 1.4-4.3). Only half of GL sport fish consumers reported awareness of a health advisory concerning eating GL sport fish. Awareness was especially low among women, suggesting the need of targeted risk communication programs for female consumers.     

Survey of fish consumption patterns of King County (Washington) recreational anglers

Three fish consumption surveys were conducted in King County, WA during 1997-2003. These surveys were conducted to support environmental analyses of proposed capital improvement projects planned by the King County Department of Natural Resources and Parks. Personal interviews were conducted at marine, estuarine, and freshwater locations throughout King County. Over 1300 anglers participated in the survey and provided consumption information. A majority of the respondents from the surveys (30-71%) were Caucasian, while the remaining respondents comprised various ethnic groups. The mean consumption rates for consumers of marine fish, shellfish, and freshwater fish were 53, 25, and 10 g/day, respectively. Results indicate that the consumption patterns of marine anglers from King County have remained consistent since the mid-1980s. The consumption distribution for marine anglers suggests that some respondents may consume fish as a large portion of their diet. The consumption habits of freshwater anglers are comparable to those of other recreational anglers throughout the United States. The survey results provide distributions of marine and freshwater fish consumption suitable for risk assessments conducted for anglers residing in King County, WA.