Health‐related beliefs and consumer knowledge as determinants of fish consumption

Background: Despite scientific evidence on the positive effects of seafood consumption on human health, the consumption of fish remains below the recommended intake levels for the majority of Europeans. The present study aimed to explore cultural differences in potential determinants of fish consumption: consumers’ knowledge and health‐related beliefs, as well as the relationship between those variables, socio‐demographics and fish consumption frequency, using data from five European countries. Methods: A cross‐sectional consumer survey was carried out in 2004 with representative household samples from Belgium, the Netherlands, Denmark, Poland and Spain. The sample consisted of 4786 respondents, aged 18–84 years, who were responsible for food purchasing and cooking in the household. Results: European consumers had a very strong belief that eating fish is healthy. Consumers’ belief that eating fish is healthy, their interest in healthy eating and objective fish‐related nutrition knowledge, positively, but only weakly, influenced fish consumption frequency. Subjective knowledge was found to be a stronger predictor of fish consumption than the previously noted factors. Age and education contributed, both directly and indirectly through knowledge, to explain fish consumption behaviour. However, the path coefficients in the estimated model were relatively low, which indicates that fish consumption frequency was also determined by factors other than health‐related beliefs and consumers’ knowledge. Conclusions: The findings of the present study suggest that communication should focus on health‐related benefits other than fish consumption alone. Communicating that eating fish is healthy and stressing the health benefits of fish alone, as is still commonly performed (e.g. in generic promotion and other types of public information campaigns) will be insufficient to achieve higher levels of compliance with fish consumption recommendations.     

The good, the bad, and the ugly: weighing the risks and benefits of seafood consumption

The health benefits that long chain omega-3 fatty acids contribute in the reduction of coronary heart disease are well established through a number of scientific publications. A number of studies are also examining their potential role in mitigating other diseases and health conditions such as Alzheimer's and mental disorders. Some of the latest research have shown the importance of omega-3 fatty acids such as docosahexaenoic acid in cognitive development in infants. Extensive scientific research and recommendations to consume fish regularly from professional societies, health organizations, and government agencies consistently support dietary guidance to consume fish regularly. Nevertheless, increasingly consumers are being warned to eliminate or minimize their consumption of certain species. The warnings, which have been issued due to risks associated with chemical contaminates such as mercury, PCB, and dioxin in fish, have received extensive coverage in news articles and stories in popular magazines. There have been a series of mixed messages to the consumer about the benefits or risks in eating seafood. In some cases, the warnings have been issued by government agencies such as the Food and Drug Administration and Environmental Protection Agency's Joint Fish Advisory on methylmercury. In other cases, the warnings have come from advocacy groups and others. Unfortunately, the advice is often miscommunicated and misunderstood by consumers. The emerging news about the benefits and risks of fish consumption will be discussed in the context of their impacts on consumer's health and well-being.     

Bread consumption in the UK: what are the main attitudinal factors affecting current intake and its place in a healthy diet?

Despite efforts to promote the consumption of starchy foods, UK consumers are not meeting the recommended proportion of energy from starch for the population. Awareness of the nutritional benefits of starchy foods is poor and consumers tend to have highly divergent attitudes to, and beliefs about, these foods – although starchy foods are generally viewed as good for health, they are also often described as ‘fattening’ and avoided by those trying to lose weight. Concern about wheat allergy and other gastrointestinal problems commonly associated with bread in particular are also barriers to it being perceived as a ‘healthy food’. There is therefore clearly a mismatch between consumers' perceptions of starchy foods and current nutritional guidelines. This paper considers the evidence for and against the most common consumer perceptions around the health effects of bread and the possible impact of reduced levels of consumption on the nutrient intake of individuals.     

Fishing, fish consumption, and knowledge about advisories in college students and others in central New Jersey

Risks to humans and other organisms from consuming fish have become a national concern. Over the past 3 years there have been a number of national advisories regarding saltwater fish. Although information on fishing, consumption patterns, and public knowledge about advisories has been examined for at-risk populations, there is little information about the latter for a general population. Overall knowledge about advisories, ratings for information about the risks and benefits of eating fish, and the relationship between fishing, consumption patterns, and knowledge about advisories was examined in a sample of 180 college students and others residing in central New Jersey, USA. The null hypothesis of no differences in fishing, consumption, and knowledge about advisories as a function of age, gender, ethnicity, and education was tested. A significantly higher proportion of men fished compared to women, and significantly fewer Blacks and Asians fished than did Whites or Hispanics. More Asians who fished did so in salt water, compared to others. There were no gender differences in consumption patterns, and few age or ethnic differences, mainly due to low sample sizes in some ethnic groups. Significantly fewer young people and fewer Asians ate fish compared to others. Overall, more people knew about the benefits of eating fish than the risks. Half as many people had heard about advisories concerning tuna, and less than a third knew about advisories concerning shark and swordfish than had heard general warnings. There were no gender differences in knowing about advisories, but there were several ethnic differences: a lower percentage of Asians generally knew that there were advisories, and fewer Blacks knew that there were benefits from eating fish than others. People in the age group 21-45 years were less aware of both the benefits and the risks from eating fish compared to older people. These data suggest that risk managers need to target younger people for information about the risks and benefits of consuming fish, particularly given that this is the population that will become pregnant over the next few years. Contrary to some previous research, subjects trusted family, friends, and other fishermen less for knowledge about the risks and benefits of fish consumption than other sources, such as doctors, governmental officials, and university professors. Even with this limited sample size, it is clear that people have heard more about the benefits of fish consumption than the risks, and a relatively low percentage have heard about the recent US Food and Drug Administration warnings about swordfish and shark.     

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.     

Fishing, fish consumption, and awareness about warnings in a university community in central New Jersey in 2007, and comparisons with 2004

Fish are a healthy source of protein, but the risks from consuming fish have become a national concern. Over the past 7 years, there have been a number of national advisories regarding saltwater fish. Fish consumption patterns and public knowledge about advisories and warnings have been examined for at-risk populations, but there is little information about the latter for a general population, or of temporal trends in such information acquisition. Information about the benefits and health risks of consuming fish, health warnings from the New Jersey Department of Environmental Protection and the Food and Drug Administration, belief in these warnings, and trust in different sources of information were examined in a sample of 460 people within a university community in central New Jersey in 2007. The null hypothesis of no differences in fishing, consumption, and knowledge about advisories as a function of age, gender, ethnicity, and education was tested. In 2007, only 30% of the study population fished, and 83% of the study population ate fish, either commercial or self-caught. There were differences in fishing behavior, consumption patterns, and awareness of advisories as a function of gender, ethnicity, age, and education. Most notably, nearly twice as many men as women fished, Whites fished more and Blacks and Indian/Pakistanis fished less than other ethnic groups, and people aged 23-35 fished more than did others. About 8% of fish meals were from self-caught fish, 32% were eaten in restaurants, and 60% were of fish bought in stores and cooked at home. Men ate more meals of self-caught fish than did females, and Asians ate more meals of fish in restaurants, and Blacks ate more meals of store-bought fish than other ethnic groups. The total number of fish meals consumed per month increased significantly with age. Overall, more people had heard about the benefits (92%) than the risks (78%) of fish consumption. When asked whom they trust for information about health benefits and risks from eating fish, doctors were rated the highest, followed by professors; friends and fishermen were rated the lowest. We then examined whether there were any changes from 2004 to 2007 in the knowledge of the health benefits and warnings about fish consumption, and the trustworthiness of different sources of information. In other words, have communication efforts of the state and federal agencies resulted in any appreciable increase in overall awareness of the benefits or risks of fish consumption. The greatest change in the parameters examined from 2004 to 2007 was an overall decrease in fish consumption from an average of 7.9 meals per month in 2004 to about six meals per month in 2007. This suggests that the unintended effect of some of the warnings and advisories is to decrease overall fish consumption, rather than to switch from fish species with high levels of contaminants to those with low levels.     

Who consumes functional foods and nutraceuticals in Canada? Results of cluster analysis of the 2006 survey of Canadians' demand for food products supporting health and wellness

This research seeks to identify consumer segments related to consumption of functional food and nutraceutical products in Canada. The segments are differentiated by consumer receptivity to functional foods and nutraceuticals. In turn, receptivity is tied to attitudes, motivations and knowledge related to food/diet and connections with health. At one extreme, a segment emerges that is highly receptive to functional foods and nutraceuticals, and shows a keen interest in learning about foods that have health benefits. A second segment, conversely, has low receptivity, but demonstrates a higher degree of knowledge related to the relationship between food/diet and health. A key driver of receptivity towards functional foods and nutraceuticals appears to be perceptions of disease threat, which tend to increase with age. Pre-emptive use of messages relating to the preventative properties of these products does not seem to have a major impact on the receptivity of consumers.     

A content analysis of Internet resources about the risks of seafood consumption

Seafood consumption is a main source of human exposure to certain environmental contaminants. Therefore, it is valuable to assess the online health risk messages focused on this topic, as people in the US are increasingly accessing the Internet for health-related information. Previous research indicates that online health information tends to be written at a reading level that is more advanced than ability of the general population. The purpose of this research was to examine the content and readability of Internet resources targeted toward consumers in the US regarding the health risks from consumption of contaminated seafood. Sources for analysis were gathered through a targeted search of state and national government websites, as well as through a Google search. The overall mean readability level was Grade 9.21, which is slightly above the average reading level of US adults. Future research should evaluate the accuracy of the health risk messages, as well as consumer perceptions of risk.     

Comprehension of Fish Consumption Guidelines Among Older Male Anglers in Wisconsin

Although awareness of Wisconsin’s fish consumption guidelines is high among older male anglers, little is known about comprehension of guideline content, and many anglers have levels of contaminants high enough to be associated with adverse health outcomes. The Environmental Protection Agency Great Lakes Restoration Initiative supported evaluation and revision of Wisconsin’s fish consumption guideline program, using a web based survey of male Wisconsin anglers over the age of 50. A total of 3740 men completed the online survey; the median age of respondents was 62 years, and nearly all had lived and fished in Wisconsin for over 10 years. Comprehension of guideline content was relatively high, although two knowledge gaps were identified, one relating to mercury exposures and fish preparation, and the other to polychlorinated biphenyl content of certain fish species. The fishing regulations booklet distributed with annual fishing licenses and warning signs posted at fishing locations were commonly reported sources of guideline information in Wisconsin. Residents of coastal counties and consumers of Great Lakes fish were more likely to report guideline knowledge and behavior changes reflective of guideline knowledge, when compared to inland residents and those not consuming Great Lakes fish, respectively. In general, Wisconsin’s consumption guidelines do not appear to discourage men from eating the fish they catch; rather, the most common behavioral changes included modifying the species eaten or the water body source of their meals. Continued efforts to educate anglers about the risks and benefits of fish consumption are needed.     

Consumers' knowledge about their health insurance coverage.

This paper describes how much families know about their health insurance coverage and investigates whether consumer education and simplified benefit structures would improve knowledge. Families' perceptions about their insurance benefits were measured in two household surveys administered in six sites. Knowledge was assessed by comparing families' responses with policy data collected from the carrier. The vast majority of families understand insurance policies that specify one or two parameters in their benefit provisions. However, more complex payment structures are not well understood. Increased exposure to information in the plans leads to increased knowledge which suggests that education programs could improve the general level of knowledge. We conclude that if market strategies for allocating medical resources are pursued, simplifying insurance benefit structures and educating consumers about their insurance benefits would aid consumers in making more informed economic choices about medical care.     

Anglers' attitudes, beliefs, and behaviors as impacted by the Michigan Fish Consumption Advisory.

This study examines the relationship between a person's knowledge that a current ego-involving behavior may include health risks and the undertaking of a subsequent behavior change to reduce this risk. Specifically, 396 licensed anglers were surveyed concerning their beliefs about the health risks of consuming sport-caught fish, their knowledge of the risk information contained in the Michigan Fish Consumption Advisory, and their personal fish consumption behavior. Sixty-five percent of the anglers surveyed reported reading part or all of the Michigan Fish Consumption Advisory; however, as a group, they perceived the risks from eating sport-caught fish as small.     

Perceptions of the risks and benefits of fish consumption: Individual choices to reduce risk and increase health benefits

Studies of fish consumption often focus on awareness of and adherence to advisories, how much fish people eat, and contaminant levels in those fish. This paper examines knowledge and accuracy of risks and benefits of fish consumption among fishers and other recreationists in the New York Bight, indicative of whether they could make sound dietary decisions. While most respondents knew about health risks (70%) and benefits (94%) of consuming fish, far fewer could name specific risks and benefits. Less than 25% of respondents mentioned mercury and less than 15% mentioned that pregnant women and children were at risk. Far fewer people mentioned polychlorinated biphenyls (PCBs). Nearly 70% said it was healthy to eat fish, and 45% were aware that fish were rich in healthful oils. Despite the lack of details about what specific risks and benefits of fish, well over a third did not feel they needed more information. Other respondents had basic questions, but did not pose specific questions about the fish they caught or ate that would have clarified their individual risk-balancing decisions. Knowledge of which fish were high in contaminants did not match the mercury or PCB levels in those fish. There was a disconnect between the information base about specific risks and benefits of fish consumption, levels of mercury and PCBs in fish, and the respondent's desire for more information. These data indicate that respondents did not have enough accurate information about contaminants in fish to make informed risk-balancing decisions.     

On the body of the consumer: performance‐seeking with wearables and health and fitness apps

Contributing to critical digital health research and the sociology of health consumption, this study investigates the phenomenon of self‐tracking and interpretation of consumer data via wearable technology and mobile fitness software applications (apps). It critically analyses qualitative data collected from members of running communities in the UK who are heavy users of apps and wearables. The study seeks to understand the meaning and practise of long‐term use of apps and wearables targeted at consumers interested in tracking fitness, and the collection of personal health information over time. The paper offers an interpretative perspective on runners as performance‐seeking fitness consumers engaged in long‐term self‐management of health. These consumers are driven by a profound motivation to visualise and embody a long‐term state of fitness. Participants were also hyper‐aware of advertising and promotional methods used to engage consumers. The findings raise concerns about the validity of personal fitness data, and how its collection promises improved personal health while visually promoting sought‐after fit bodies. Further research is required to understand the transformative impact of fitness‐tracking and how individuals negotiate personal classifications of health.     

Understanding consumers' perceptions of functional ingredients: Studies of selenium and protein

Consumer research provides important information on perceptions that have relevance for nutritional guidance and the development of the food supply. The National Centre for Excellence in Functional Foods supported research projects in consumer understanding of selenium-enriched foods and potential drivers of consumption of such foods. Second, research was undertaken on consumer understanding of the benefits of high-protein foods for weight control. This paper briefly outlines the projects and comments on the findings. The selenium study found little knowledge of the relationship between particular nutrients and particular health outcomes. While promoting information about the substantiation of benefit claims and highlighting vulnerability may increase perceived 'importance of Se enriched foods', confidence and ability are likely to drive consumption; therefore, efforts to facilitate ease of consumption will be required. The protein research found a suggestion that participants possessed 'attribute knowledge' but not 'consequence knowledge' of high-protein foods, indicating that there is incomplete knowledge or a belief that other factors may impact upon the weight control ability. There are implications for better communication strategies, so that consumers can make cognitive decisions to consume high-protein diets with subsequent improvement in sustained use.     

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.     

Probing Consumer Benefits and Barriers for the National 5 A Day Campaign: Focus Group Findings

This research identifies benefits that target consumers from the national 5 A Day for Better Health media program find motivating, as well as barriers that these benefits must overcome. Conventional and “piggyback” focus groups were conducted with the target audience and with a comparison group (people who already eat five or more servings a day of fruits and vegetables). Consistent with prior research, target group participants saw little urgency to eating more fruits and vegetables and were not very involved with food planning. Benefits that seemed likely to encourage more consumption of fruits and vegetables were immediate benefits—such as feeling more energetic—rather than long-term benefits related to reducing health risks.Target consumers rejected as implausible or irrelevant other benefits that strategists had considered appropriate: feeling less stress and more in control and reducing one's risk of cancer. The target audience saw barriers of time and inconvenience in the “normal steps” in the comparison group's routine. Results have been used to develop communications. The findings suggest that nutrition educators should use messages with immediate consumer benefits and, consistent with prior research and theory, should offer “quick and easy” tips for consumers to attain the desired health-related behavior. The findings also underscore the importance of direct consumer research to ensure that program messages and strategies are relevant to the target audience.The study also illustrates the utility of piggyback groups to clarify differences and similarities between target and comparison segments and to assess how, if at all, comparison segments can effectively model desired consumer behavior.     

Choose a variety of grains daily, especially whole grains: a challenge for consumers

The 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is the first to include a specific guideline for grain foods, separate from fruits and vegetables, and recognize the unique health benefits of whole grains. This paper describes and evaluates major tools for assessing intakes of total grains and whole grains, reviews current data on who consumes grain foods and where, and describes individual- and market-level factors that may influence grain consumption. Aggregate food supply data show that U.S. consumers have increased their intake of grain foods from record low levels in the 1970s, but consumption of whole-grain foods remains low. Data on individual intakes show that consumption of total grains was above the recommended 6 serving minimum in 1994-1996, but consumption of whole grains was only one third of the 3 daily servings many nutritionists recommend. Increased intake of whole-grain foods may be limited by a lack of consumer awareness of the health benefits of whole grains, difficulty in identifying whole-grain foods in the marketplace, higher prices for some whole-grain foods, consumer perceptions of inferior taste and palatability, and lack of familiarity with preparation methods. In July 1999, the U.S. Food and Drug Administration authorized a health claim that should both make it easier for consumers to identify and select whole-grain foods and have a positive effect on the availability of these foods in the marketplace.     

Risk creating and risk reducing: Community perceptions of supervised consumption facilities for illicit drug use

Progressive public health authorities in high-income countries have advocated supervised consumption facilities, where people who use illicit drugs can consume them in a hygienic, supervised environment, as a way of reducing drug-related risks to both people who use drugs and communities. However, the planning of such facilities has often met with strong reactions from the local community. ‘Not in my backyard’ (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa. We explore perceptions of residents and business representatives to the proposed implementation of supervised consumption facilities, and examine their perceptions of risks from these facilities. We collected qualitative data from 2008–2010 using focus groups and interviews with 38 residents and 17 business representatives in these two large Canadian cities lacking supervised consumption facilities. We used thematic analysis to examine expressed benefits and risks regarding supervised consumption facilities amongst community members. These participants saw these facilities as potentially risk-reducing, but recognised that the facilities could also create risks for their communities. While community members accepted that facilities could have positive health effects, they expressed a level of concern regarding the risk of public nuisance associated with supervised consumption facilities that seemed unwarranted based on the existing evidence. Discussions on the risks involved in the establishment of supervised consumption facilities should move beyond a focus on the benefits to facility users, to exploring community-level benefits and risks, and integrate evidence regarding actual risk experiences from other locations. Similar approaches may apply to NIMBY concerns related to other contentious issues.     

Omega-3 fatty acids. What consumers need to know

The general public is increasingly aware of the health benefits associated with consumption of omega-3 fatty acids. While evidence of health benefits continues to mount, the underlying science is complex. Omega-3 fatty acids vary in their physiological efficacy. Consumers are typically unaware of differences in the efficacy of different omega-3 fatty acids and this lack of knowledge can result in consumers being misled within the marketplace. There is a need for consumers to be educated about the distinctions between omega-3 fatty acids. In the interim consumers remain at risk of purchasing premium fortified products and supplements that will not correspond to their desired health outcomes. This paper summarises the current understanding of fatty acid physiological metabolism and interaction for the purpose of highlighting this complex and multifaceted concern.