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.     

Consumption patterns and why people fish

Recreational and subsistence fishing play major roles in the lives of many people, although their importance in urban areas is often underestimated. There are fish and shellfish consumption advisories in the New York-New Jersey harbor estuary, particularly in the waters of the Newark Bay Complex. This paper examines fishing behavior, consumption patterns, and the reasons that people fish in the Newark Bay Complex. I test the null hypotheses that there are no differences among Asians, Blacks, Hispanics, and Whites in consumption patterns for fish and crabs and in the reasons that they fish or crab. Most people either fished or crabbed, but not both. People who fish and crab ate more grams of crab than fish in a given meal; people who crab only consumed more grams of crab at a meal than those who fish only consumed of fish. Although 30% or more of the people who fished and crabbed in the Newark Bay Complex did not eat their self-caught fish or crabs 8-25% of the people ate more than 1500 g/month. Some people angling in the Newark Bay Complex are eating crabs at a rate well over 1500 g/month, and about 70% are eating crabs even though there is a total ban on both harvest and consumption because of the health risks from dioxin. Consumption patterns were negatively correlated with mean income and positively correlated with mean age. Most people rated relaxation and being outdoors the highest reasons for angling, although on an open-ended question they usually listed recreation. There were no ethnic differences in reasons for angling, although other studies have shown ethnic differences in consumption. Obtaining fish or crabs to eat, give away, trade, or sell were rated low, suggesting that consumption advisories fail partly because people are not primarily fishing for food.     

Gender differences in meal patterns: role of self-caught fish and wild game in meat and fish diets

The hypothesis that there are gender differences in consumption patterns of self-caught fish and wild game in the meat and fish diet was examined for 415 people attending the Palmetto Sportsmen's Classic in Columbia, South Carolina. Women were less likely to eat most types of wild fish and game than were men, although there were no gender differences in the percentage eating beef, chicken, pork, and restaurant and store-bought fish. Similarly, women consumed significantly fewer meals of wild-caught fish and game than did men, although the number of meals of most store-bought foods did not differ. Both men and women who ate more meals of fish ate a higher percentage of wild-caught fish than either store-bought or restaurant fish. People with low number of fish and meat meals ate mainly fish; people eating over 30 meals of meat and fish a month ate mainly meat. Only about 9% of those interviewed said that they changed their fish consumption patterns when they, or their spouse, were pregnant. These gender-specific data on protein consumption can be used for exposure assessment and risk management decisions regarding consumption advisories for wild-caught fish and game.     

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.     

A framework and information needs for the management of the risks from consumption of self-caught fish

Governmental agencies deal with the potential risk from consuming fish contaminated with toxic chemicals by issuing fish consumption advisories. Yet such advisories are often ignored by the general public, who continue to fish and consume self-caught fish that are the subject of advisories and are from contaminated waters. Further, people are often unaware of specific warnings (which species to avoid, who is vulnerable, when they are vulnerable). In this paper we propose a more inclusive framework for examining consumption behavior of self-caught fish and identify information needs for effective communication. We include not only the usual variables that are used for calculating risk from fish consumption (meal frequency, meal size, contaminant levels) but also other aspects of behavior that contribute to risk. These include attitudes (trust, risk aversion, environmental concerns), behavior (sources of information, cultural mores, personal preferences), exposure (physical proximity, ingestion rates, bioavailability, target tissues), contaminant levels, individual host differences, and hazards (levels of contaminants). We suggest that attitudes and behavior shape risk as much as exposure and hazards and that all four of these factors must be considered in risk management. Factors such as gender, age, pregnancy status, and nutrition all influence who is at risk, while other consumption factors affect these at-risk populations, including meals/week, meal size, cooking method, fish species and sizes eaten, and years of fish consumption. Similarly, contaminant levels in fish vary by fish species, fish size and age, part of the fish, and collection location. Elucidating the risk to individual consumers involves integrating this range of factors, and managing the risk likewise involves incorporating these factors. We suggest that development of appropriate advisories and compliance with advisories will occur only if managers, risk assessors, and public policy makers consider this whole range of factors and not just the traditional fish consumption rate (often underestimated) and contaminant levels in fish (often undersampled). Merely informing the public of contaminant levels or the risk from contaminants will not ensure a public that has enough information to make informed decision, or to be in compliance with consumption advisories, or to effect changes in consumption behavior where public health is at risk.     

Fish consumption and PCB-associated health risks in recreational fishermen on the James River, Virginia

Consumption of sport-caught fish contaminated with high levels of polychlorinated biphenyls (PCBs) may pose human health risks. To obtain estimates of fish consumption and fishing behaviors in recreational fishermen in Virginia, on-site interviews (n=143; 134 men and 9 women) were conducted at seven public boat landings along the James River. Using existing PCB concentration data from James River fish tissue samples collected from 1997, and 1999 to 2001, default and point estimates were calculated and Monte Carlo analyses conducted to estimate potential risks under different consumption scenarios. A mean of 55 fish meals/yr and 14 James River sport-caught fish (JRSCF) meals/yr were reported. Caucasians fished less often (mean of 58 d), consumed less fish (mean of 43 meals/yr) and had smaller portion sizes (mean of 11.7 oz) compared to other races combined (130 d; 82 meals/yr; and 15.6 oz). On average, respondents reported consuming 10 meals of James River catfish a year (5 kg/yr). Risk estimates produced from Monte Carlo analysis were consistently lower than the default and point estimates. Several individuals exceeded acceptable risk levels and the mean cancer and non-cancer risks among catfish consumers exceeded acceptable levels. Eighteen percent of individuals had no knowledge of fish advisories in Virginia and 4% of the subjects indicated they would consume fish under advisory. Based on reported consumption, a significant risk to recreational fishermen, as a result of consuming PCB-contaminated catfish, was found. Risks associated with consuming other species were within acceptable limits.     

Maternal recall of children's consumption of commercial and sport-caught fish: findings from a multi-state study

A randomized telephone survey of 3015 women was conducted in an effort to assess the effectiveness of local sport-fish consumption advisories. Survey participants were between the ages of 18 and 45 and lived in the states of Arkansas, California, Connecticut, Florida, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, and Wisconsin. At the time of the women's interview, fish and shellfish consumption information was obtained for children under 18 years of age living in the household. One child (aged 2-17) from each household (1852) was randomly selected to evaluate fish consumption among children. Based on maternal recall, 84% of these children had consumed fish or shellfish at least once during the previous 12 months. This percentage ranged from 73% in New Jersey to 94% in Louisiana and was higher among children who lived with a licensed angler compared to those who did not. Eight percent of the children ate fish and/or shellfish more than twice a week. Of the total number of fish and shellfish meals eaten by children, 67% was commercial finfish, 22% was shellfish, and 11% was sport-caught finfish. Among those who ate fish, the average consumption rate was 47 meals per year-slightly less than one meal per week. This consumption frequency rate varied by state of residence ranging from 37 meals per year in Montana and Wisconsin to 62 in Florida. Because of these regional differences, the use of national average fish consumption rates may over- or under-estimate consumption in localized areas. This survey suggests that targeting information to women who eat fish may also protect children; more than 80% of children have fish consumption patterns that are similar to that of their mothers. Additional research and biomonitoring is needed to improve our understanding of the risk and benefits associated with childhood consumption of fish and shellfish.     

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.     

Fish,shellfish, and meat meals of the public in Singapore

Understanding different patterns of fish consumption is an important component of the assessment of risk from contaminants in fish. While there have been extensive studies of fish consumption in Western cultures, less attention has been devoted to the role of fish and meat in the diets of people in other cultures. A survey of 212 people living in Singapore was conducted to examine the relative importance of fish, shellfish, and other meat in their diets and to ascertain whether there were differences as a function of age, income, education or gender. As expected, fish and shellfish played an important role in their daily diets. On average, people ate fish in about 10 meals a week, chicken for eight meals, and shrimp and pork for about six meals each. While nearly 8% never ate fish, 18% ate fish at all 21 meals a week and over 20% ate shellfish for all 21 meals. Income explained about 14% of the variation in the number of fish meals consumed, and age explained about 8% of the variation in number of chicken meals per week. There were no gender differences in the number of meals of each type. People less than 26 years old ate significantly more pork, chicken, and other meat meals and fewer shellfish meals than older people. People with higher incomes ate significantly more fish meals than those with lower incomes. Chinese individuals ate significantly more meals of pork, chicken, and other meat than other ethnic groups, and they ate only 26% of their meals at home, while others ate 33% of their meals at home. The data indicate a great deal of variation in the number of meals of fish, shellfish, and other meats eaten by the people interviewed, making dietary and risk assessments challenging.     

Fish and shellfish consumption estimates and perceptions of risk in a cohort of occupational and recreational fishers of the Chesapeake Bay

Exposure to persistent, bioaccumulating substances, through the consumption of contaminated fish is of concern in human populations. Consumption may be particularly high for subsistence, commercial, and recreational fishers, so it is important to obtain accurate consumption estimates to assess risks in these groups. The objectives of the work reported here were: to obtain estimates of fish and shellfish consumption (meals and portion size) in an occupational cohort; to determine what percentage of the consumption was from local fish; to evaluate reliability of two methods of reporting fish and shellfish consumption; and to examine risk perceptions in relation to consumption. Subjects included 99 recreational and occupational fishers in the Chesapeake Bay area, Virginia, who were recruited for a cohort study of estuary-associated syndrome. Subjects reported average fish and shellfish consumption (all species) on a weekly, monthly or yearly basis, and were asked species-specific information, which was summed. The median number of fish meals consumed a year was significantly different depending on the method used, 52 (interquartile range, IQR:24-104) (average method) and 65 (IQR:30-117) (sum of species-specific), respectively. Shellfish estimates were 24 (IQR:12-52) (average) and 47 (IQR:31-84) (sum) meals a year. Of those who consumed fish, participants reported an average meal size of 8.9±3.38 oz. (median 8 oz, range 4-16) with close to 70% of fish consumed self-caught and 50% from Virginia waters. Using multiple regression, occupation, and risk perceptions were found to be significantly correlated with fish consumption levels, and consumption of fish from locations under advisory.     

Fish consumption patterns,knowledge and potential exposure to mercury by race

Objective: Compared fish consumption patterns, fish advisory/benefit awareness and risk factors of consuming high-mercury (Hg) fish between Chinese and non-Chinese adults. Methods: 301 Chinese and 120 non-Chinese participated in this cross-sectional study. Participants self-reported demographics, fish consumption behavior, and awareness of warnings/benefits of fish consumption. Results: non-Chinese (62.5%) ate more high-Hg fish than Chinese (35.9%) although more Chinese ate fish in the last year. Over 90% of both groups knew general benefits of consuming fish; fewer knew specific benefits. Chinese were less aware of fish warnings (49.8%) than non-Chinese (86.7%); knowledge did not appear to affect their fish consumption. Conclusions: There were significant differences in fish consumption patterns and fish benefit/warning knowledge between the two groups. A higher proportion of non-Chinese reported consumption of high-Hg fish. Fish knowledge did not affect fish consumption behavior for either group. Public education efforts regarding fish consumption should emphasize details such as species and amounts.     

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.     

Respondent driven sampling in a biomonitoring study of refugees from Burma in Buffalo,New York who eat Great Lakes fish

Background

Refugees from Burma who consume fish caught from local waterbodies have increased risk of exposure to environmental contaminants. We used respondent driven sampling (RDS) to sample this hard-to-reach population for the first Biomonitoring of Great Lakes Populations program. In the current study, we examined the interview data and assessed the effectiveness of RDS to sample the unique population.

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.     

Comparative Analysis of State Fish Consumption Advisories Targeting Sensitive Populations

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.     

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.     

Awareness and knowledge of methylmercury in fish in the United States

In the 1970s several states in the Great Lakes region became concerned about mercury contamination in lakes and rivers and were the first to issue local fish consumption advisories. In 2001, the Food and Drug Administration (FDA) advised pregnant women, nursing mothers, young children, and women who may become pregnant not to consume shark, swordfish, king mackerel, and tilefish and recommended that these women not exceed 12 ounces of other fish per week. In 2004, FDA reissued this advice jointly with the U.S. Environmental Protection Agency (EPA) and modified it slightly to provide information about consumption of canned tuna and more details about consumption of recreationally caught fish. Though several studies have examined consumers' awareness of the joint FDA and EPA advisory as well as different state advisories, few used representative data. We examined the changes in awareness and knowledge of mercury as a problem in fish using the pooled nationally representative 2001 and 2006 Food Safety Surveys (FSS) with sample sizes of 4482 in 2001 and 2275 in 2006. Our results indicated an increase in consumers' awareness of mercury as a problem in fish (69% in 2001 to 80% in 2006, p<.001). In our regression models, we found that in both years, parents having children less than 5 years of age were more aware of mercury in fish and knowledgeable about the information contained in the national advisories about mercury in fish (p<.01) than other adults. In both 2001 and 2006, women of childbearing age (aged 18–45) were less aware and knowledgeable about this information than other women. However, women of all age groups had larger gains in awareness and knowledge than their male counterparts during this time. Participants' race, education, income, region, fish preparation experiences, having a foodborne illness in the past year, and risk perceptions about the safety of food were significant predictors of their awareness and knowledge.     

An examination of the trade-offs in public health resulting from the use of default exposure assumptions in fish consumption advisories

Efforts to provide for public health protection from environmental contaminants in fish have resulted in various advisories or recommendations with regard to fish consumption from local, state, and federal agencies. These advisories are based on measured levels of contaminants in fish that are combined with values for body weight and portion size to produce an estimate of an "acceptable" consumption frequency (e.g., eat no more than once per month). Because values for body weight and portion size are generally generic default values, they do not necessarily relate to a specific population or to any individual in that population. Thus, the use of default values may result in underprotection or overprotection in any given case. Given the benefits of fish consumption and the risks from overexposure to various toxicants, vigilance is required by custodians of public health to ensure that populations are protected while being cautious not to over- or underprotect them. In this analysis, we examine the "acceptable" consumption limits derived for fish species/groups consumed by three specific populations and determine the extent of public health protection afforded by these limits. To accomplish this, the "acceptable" consumption frequencies are derived based, in part, on default assumptions and are compared to intakes calculated from empirically derived species-specific individual consumption and demographic data. Sensitivity analyses and population-specific probabilistic assessments of exposure are conducted to identify those values and/or assumptions which might significantly influence the resulting fish consumption advisories. Three populations were chosen for study based on their ability to represent populations of greatest concern: those most sensitive and/or those most exposed. We conclude from this investigation that consumption pattern data, contaminant data and body weight data together can be used to make fish consumption advisories more focused and, therefore, less likely to be under- or overprotective.     

The role of sport-fish consumption advisories in mercury risk communication: a 1998-1999 12-state survey of women age 18-45

BACKGROUND: In 2002, in the United States, 48 states issued advisories for sport-fish consumers that included 39 chemical contaminants. The most commonly identified chemical was methyl mercury, which is linked to reproductive and developmental effects. Advisories to reduce consumption of contaminated fish have been issued by states since the early 1970s. Advisories are being integrated to include both sport and commercial fish. METHODS: As part of a comprehensive risk-communication project, from December 1998 through August 1999 the Wisconsin Division of Public Health and the State of Maine Bureau of Health conducted a 12-state random-digit-dial telephone survey of 3015 women of childbearing age (ages 18-45). The goal was to assess the prevalence of fish consumption, understanding of mercury toxicity, and awareness of state sport-fish consumption advisories for mercury. We gathered information concerning respondents' demographic characteristics, understanding of mercury toxicity, fish consumption during the preceding 12 months, and sport-fish consumption advisory awareness. RESULTS: The overall survey completion rate was 57% with a Council of American Survey Research Organizations (CASRO)-calculated response rate of 50%. Completion rates varied from 37% in New Jersey to 73% in Minnesota. Fish consumption during the previous 12 months was reported by 87% of respondents (range by state of 82-90%). Nearly 10% of women reported consuming two or more fish-meals per week over the prior 12 months. Twenty-nine percent reported sport-fish consumption during the same time period, with a greater state-to-state variability (14-43%). Most women (71%) were aware of mercury's toxicity to a developing child (87% among those aware of an advisory and 67% among those unaware of an advisory). However, awareness of state advisories was only 20%, ranging by state from 8% to 32%. Women who were older, had more than a high school education, and had a household member with a fishing license were the most informed about mercury and fish-consumption advisories. CONCLUSIONS: Most women of childbearing age consume commercial fish and a substantial number also consume sport-caught fish. Despite this potential exposure to dietary mercury, most are unfamiliar with their state's mercury fish-consumption advisory. Most women were aware of the most toxic effects of mercury but less informed about mercury and its relationship to types of fish and fish characteristics. Minorities, women over age 30, family incomes above 25,000 US dollars, and those with some collage education were more likely to be consuming two or more fish-meals per week. Until source control and environmental remediation efforts can reduce the environmental burden of mercury below levels of concern, combined sport and commercial fish consumption advisories will remain the primary means of reducing human exposure to methylmercury. Assuring and assessing the effectiveness of such advisories is paramount. Our survey documents that current efforts to inform vulnerable populations are far from optimal.