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1.  Perceptions of the risks and benefits of fish consumption: Individual choices to reduce risk and increase health benefits 
Environmental research  2009;109(3):343-349.
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.
PMCID: PMC4300128  PMID: 19193369
Recreational fish; Consumption; Fish; Mercury; Risk balancing; Benefits and risks of fish consumption; New York Bight
2.  Fish Consumption and Advisory Awareness in the Great Lakes Basin 
Environmental Health Perspectives  2005;113(10):1325-1329.
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.
PMCID: PMC1281274  PMID: 16203241
advisory; awareness; fish; Great Lakes; sport fish
3.  Need for Improved Risk Communication of Fish Consumption Advisories to Protect Maternal and Child Health: Influence of Primary Informants 
Fish consumption has established benefits, including the promotion of cardiovascular health and pre- and neonatal brain and eye development, but local freshwater fish may be a source of contaminants that are especially harmful to fetuses and young children, such as the neurotoxic and developmentally toxic methylmercury and polychlorinated biphenyls. Fish consumption advisories may be issued by state health departments to limit human exposure to these and other toxicants. This study examined the efficacy of a sign designed by the North Carolina Division of Public Health that was posted along a reservoir (Badin Lake) in central North Carolina, USA, for increasing anglers’ awareness of a fish consumption advisory, with a special focus on anglers who share their catch with women and children. In this study, 109 anglers were interviewed about their awareness of fish consumption advisories in general and their knowledge of the Badin Lake fish advisory in particular. Shore anglers were significantly less likely to be aware of the term “fish consumption advisory” and of the specific advisory for Badin Lake than boat anglers. Although a significant increase in knowledge of the specific fish consumption advisory was found for the entire sample of study participants after the sign intervention, a commensurate increase in knowledge was not found for a subsample of anglers who reported sharing their catch with women and children. Study findings underscore differences in fish consumption advisory awareness among subpopulations. Specifically, the study revealed the importance of characterizing the communication needs of shore anglers and anglers who share their catch with sensitive subpopulations (e.g., women and children) for the creation of more targeted communications of fish consumption advisories.
PMCID: PMC3709344  PMID: 23629591
fish consumption; communication; fish advisory; pregnant women; children
4.  Evaluating the Effectiveness of Fish Consumption Advisories: Modeling Prenatal, Postnatal, and Childhood Exposures to Persistent Organic Pollutants 
Environmental Health Perspectives  2013;122(2):178-186.
Background: Because human exposure to persistent organic pollutants (POPs) occurs mainly through ingestion of contaminated food, regulatory bodies issue dietary consumption advisories to describe safe intake levels for food items of concern, particularly fish.
Objectives: Our study goal was to estimate the effectiveness of fish consumption advisories in reducing exposure of infants and children to POPs.
Methods: We used the time-variant mechanistic model CoZMoMAN to estimate and compare prenatal, postnatal, and childhood exposure to polychlorinated biphenyl congener PCB-153 under different scenarios of maternal guideline adherence for both hypothetical constant and realistic time-variant chemical emissions. The scenarios differed in terms of length of compliance (1 vs. 5 years), extent of fish substitution (all vs. half), and replacement diet (uncontaminated produce vs. beef). We also estimated potential exposure reductions for a range of theoretical chemicals to explore how guideline effectiveness varies with a chemical’s partitioning and degradation properties.
Results: When assuming realistic time periods of advisory compliance, our findings suggest that temporarily eliminating or reducing maternal fish consumption is largely ineffective in reducing pre- and postnatal exposure to substances with long elimination half-lives in humans, especially during periods of decreasing environmental emissions. Substituting fish with beef may actually result in higher exposure to certain groups of environmental contaminants. On the other hand, advisories may be highly effective in reducing exposure to substances with elimination half-lives in humans shorter than the length of compliance.
Conclusions: Our model estimates suggest that fish consumption advisories are unlikely to be effective in reducing prenatal, postnatal, and childhood exposures to compounds with long elimination half-lives in humans.
Citation: Binnington MJ, Quinn CL, McLachlan MS, Wania F. 2014. Evaluating the effectiveness of fish consumption advisories: modeling prenatal, postnatal, and childhood exposures to persistent organic pollutants. Environ Health Perspect 122:178–186;
PMCID: PMC3915257  PMID: 24345328
5.  A longitudinal examination of factors related to changes in serum polychlorinated biphenyl levels. 
Environmental Health Perspectives  2003;111(5):702-707.
Consumption of sport-caught fish from the Great Lakes is a recognized source of human exposure to polychlorinated biphenyls (PCBs). Understanding temporal changes in PCB body burden is crucial for evaluating exposure levels and augmenting validity of studies investigating their relationship to adverse health effects. Using data collected from 1980 to 1995, we evaluated longitudinal changes in serum PCB levels among 179 fisheaters and non-fisheaters of the Michigan Fisheater Cohort. Participants identified as fisheaters in 1980 ate 26 lb or more of sport-caught fish per year, whereas non-fisheaters ate less than 6 lb per year. We found a monotonic decline in serum PCB levels among all participants from a mean value of 24 ppb in 1980 to 12 ppb in 1994. This was paralleled by an 83% decrease in mean fish consumption among all participants over the same period. We combined demographic, lifestyle, and fish consumption information with PCB data and evaluated the data using regression models to identify predictors of PCB body burden over a 16-year period. Results of the mixed-effects linear regression model suggest that consumption of Lake Michigan fish before 1980, amount of sport-caught fish eaten in the past year, age, and year of data collection were significant determinants of current PCB body burden over the 16-year study period. PCB levels were particularly elevated for males who were classified as fisheaters in 1980, which may reflect higher levels of sport-caught fish consumption compared with female fisheaters.
PMCID: PMC1241478  PMID: 12727597
6.  Uterine Leiomyomata in a Cohort of Great Lakes Sport Fish Consumers 
Environmental research  2011;111(4):565-572.
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.
PMCID: PMC3111144  PMID: 21310402
DDE; fibroids; Great Lakes sport fish; leiomyomata; PCBs
7.  PCDDs, PCDFs, and PCBs in human blood in relation to consumption of crabs from a contaminated Fjord area in Norway. 
Environmental Health Perspectives  1996;104(7):756-764.
Consumption of fish and shellfish from contaminated areas may be an important source of human exposure to persistent organohalogen compounds such as polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs). We determined concentrations of 2,3,7,8-substituted PCDDs and PCDFs and 19 PCB congeners in whole blood samples from three groups of men, 40-54 years of age, with different consumption levels of crabs from a fjord area in southern Norway polluted with organochlorine compounds from a magnesium production plant. A significant increase of many PCDD/PCDF congeners was found in the blood when comparing the referents, moderate-, and high-intake groups. The greatest difference was observed for several of the PCDFs that are characteristic for the contamination of the marine biota of the fjord. PCBs, in general, play a minor role in the contamination of the fjord by the magnesium production process, except for the highly chlorinated congeners such as PCB-209. Nevertheless, almost all PCBs increased from the referents to the high-intake group. However, the relative concentrations of several highly chlorinated PCBs (particularly PCB-209) in blood are unexpectedly low compared to their abundance in crabs, indicating low uptake of these congeners. The exposure to PCDDs/PCDFs from crab consumption calculated from individual body burdens of these compounds were in good agreement with the intake estimated from previously measured concentrations in crabs, reported fishing sites, and consumption. Almost all subjects in the high-intake group exceeded the tolerable weekly intake of 35 pg TEQ/kg body weight/week proposed by a Nordic Expert Group.
PMCID: PMC1469397  PMID: 8841762
Individuals who fish, and their families that ingest self-caught fish, make decisions about where to fish, what type of fish to eat, and the quantity of fish to eat. While federal and state agencies often issue consumption advisories for some fish with high mercury (Hg) concentrations, advisories seldom provide the actual metal levels to the general public. There are few data for most saltwater fish, and even less information on variations in Hg levels in fish within a state or geographical region. The objective of this study was to provide Hg concentrations from 19 species of fish caught in different locations in New Jersey to (1) test the hypothesis that mean metal levels vary geographically, (2) provide this information to individuals who fish these coastal waters, and (3) provide a range of values for risk assessors who deal with saltwater fish exposure in the Northeastern United States. Selenium (Se) was also examined because of its purported moderating effect on the toxicity of Hg. Hg levels showed significant geographical variation for 10 of 14 species that were caught in more than one region of New Jersey, but there were significant locational differences for Se in only 5 of the fish. Mercury levels were significantly lower in fish collected from northern New Jersey (except for ling, Molva molva), compared to other regions. As might be expected, locational differences in Hg levels were greatest for fish species with the highest Hg concentrations (shark, Isurus oxyrinchus; tuna, Thunnus thynnus and T. albacares; striped bass, Morone saxatilis; bluefish, Pomatomus saltatrix). Fishers and their families might reduce their risk from Hg exposure not only by selecting fish generally lower in Hg, but by fishing predominantly in some regions over others, further lowering the potential risk. Health professionals might use these data to advise patients on which fish are safest to consume (in terms of Hg exposure) from particular geographical regions.
PMCID: PMC4300130  PMID: 21598171
9.  Fish Consumption and Mercury Exposure among Louisiana Recreational Anglers 
Environmental Health Perspectives  2010;119(2):245-251.
Methylmercury (MeHg) exposure assessments among average fish consumers in the United States may underestimate exposures among U.S. subpopulations with high intakes of regionally specific fish.
We examined relationships among fish consumption, estimated mercury (Hg) intake, and measured Hg exposure within one such potentially highly exposed group, recreational anglers in the state of Louisiana, USA.
We surveyed 534 anglers in 2006 using interviews at boat launches and fishing tournaments combined with an Internet-based survey method. Hair samples from 402 of these anglers were collected and analyzed for total Hg. Questionnaires provided information on species-specific fish consumption during the 3 months before the survey.
Anglers’ median hair Hg concentration was 0.81 μg/g (n = 398; range, 0.02–10.7 μg/g); 40% of participants had levels >1 μg/g, which approximately corresponds to the U.S. Environmental Protection Agency’s reference dose. Fish consumption and Hg intake were significantly positively associated with hair Hg. Participants reported consuming nearly 80 different fish types, many of which are specific to the region. Unlike the general U.S. population, which acquires most of its Hg from commercial seafood sources, approximately 64% of participants’ fish meals and 74% of their estimated Hg intake came from recreationally caught seafood.
Study participants had relatively elevated hair Hg concentrations and reported consumption of a wide variety of fish, particularly locally caught fish. This group represents a highly exposed subpopulation with an exposure profile that differs from fish consumers in other regions of the United States, suggesting a need for more regionally specific exposure estimates and public health advisories.
PMCID: PMC3040613  PMID: 20980220
angler; fish; hair; Louisiana; mercury; methylmercury
10.  Profiles of Great Lakes critical pollutants: a sentinel analysis of human blood and urine. The Great Lakes Consortium. 
Environmental Health Perspectives  1998;106(5):279-289.
To determine the contaminants that should be studied further in the subsequent population-based study, a profile of Great Lakes (GL) sport fish contaminant residues were studied in human blood and urine specimens from 32 sport fish consumers from three Great Lakes: Lake Michigan (n = 10), Lake Huron (n = 11), and Lake Erie (n = 11). Serum was analyzed for 8 polychlorinated dioxin congeners, 10 polychlorinated furan congeners, 4 coplanar and 32 other polychlorinated biphenyl (PCB) congeners, and 11 persistent chlorinated pesticides. Whole blood was analyzed for mercury and lead. Urine samples were analyzed for 10 nonpersistent pesticides (or their metabolites) and 5 metals. One individual was excluded from statistical analysis because of an unusual exposure to selected analytes. Overall, the sample (n = 31) consumed, on average, 49 GL sport fish meals per year for a mean of 33 years. On average, the general population in the GL basin consume 6 meals of GL sport fish per year. The mean tissue levels of most persistent, bioaccumulative compounds also found in GL sport fish ranged from less than a twofold increase to that of PCB 126, which was eight times the selected background levels found in the general population. The overall mean total toxic equivalent for dioxins, furans, and coplanar PCBs were greater than selected background levels in the general population (dioxins, 1.8 times; furans, 2.4 times; and coplanar PCBs, 9.6 times). The nonpersistent pesticides and most metals were not identified in unusual concentrations. A contaminant pattern among lake subgroups was evident. Lake Erie sport fish consumers had consistently lower contaminant concentrations than consumers of sport fish from Lake Michigan and Huron. These interlake differences are consistent with contaminant patterns seen in sport fish tissue from the respective lakes; GL sport fish consumption was the most likely explanation for observed contaminant levels among this sample. Frequent consumers of sport fish proved to be effective sentinels for identifying sport fish contaminants of concern. In the larger study to follow, serum samples will be tested for PCBs (congener specific and coplanar), DDE, dioxin, and furans.
PMCID: PMC1533095  PMID: 9560354
11.  Contaminant profiles in Southeast Asian immigrants consuming fish from polluted waters in northeastern Wisconsin 
Environmental research  2010;110(1):33-39.
Recent immigrants to the U.S. from Southeast Asia may be at higher risk of exposure to fish-borne contaminants including polychlorinated biphenyls (PCBs), p, p’-dichlorodiphenyldichloroethene (DDE) and methyl mercury (MeHg) because of their propensity to engage in subsistence fishing. Exposure to contaminants was assessed in men and women of Hmong descent living in Green Bay, Wisconsin, where the Fox River and lower Green Bay are contaminated with PCBs, and to a lesser extent with mercury. Serum samples from 142 people were analyzed for PCBs and p,p’-DDE by capillary column gas chromatography with electron capture detection (ECD). Whole blood was analyzed for total mercury by cold vapor atomic absorption spectrometry and atomic fluorescence spectroscopy. Lipid-adjusted total PCB concentrations ranged from 8.7-3,091 ng/g (full range of the data), with a geometric mean of 183.6 ng/g (estimated after eliminating one outlier). DDE ranged from 0.3-7,083 (full range of the data) with a geometric mean of 449.8 ng/g (estimated after eliminating two outliers). Men had higher PCB and DDE concentrations than women. Serum PCB concentrations were significantly correlated with fish consumption (r=0.43, p<0.0001), whereas DDE concentrations were not (r=0.09, p=0.29). Instead serum DDE was strongly associated with the number of years spent in a Thai refugee camp before immigrating to the US (r=0.60; p<0.0001). PCB congeners 138, 153, 118 and 180 accounted for a smaller percentage of the total PCBs than has been reported in other fish eating populations, and several lightly chlorinated congeners were present in relatively large amounts. Mercury exposure was low in this population. In conclusion, Hmong immigrants in northeastern Wisconsin are at risk of elevated PCB exposure from consumption of locally caught fish. The pattern of exposure is somewhat different than patterns in other fish eating populations, possibly due to use of Aroclor 1242 by the paper industry in this region.
PMCID: PMC2795147  PMID: 19811781
PCBs; DDE; mercury; Southeast Asian immigrants; contaminated fish
12.  Levels of Polychlorinated Biphenyls (PCBs) and Three Organochlorine Pesticides in Fish from the Aleutian Islands of Alaska 
PLoS ONE  2010;5(8):e12396.
Persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs) and chlorinated pesticides, have been shown to have many adverse human health effects. These contaminants therefore may pose a risk to Alaska Natives that follow a traditional diet high in marine mammals and fish, in which POPs bioaccumulate.
Methods and Findings
This study examined the levels of PCBs and three pesticides [p, p′-DDE, mirex, and hexachlorobenzene (HCB)] in muscle tissue from nine fish species from several locations around the Aleutian Islands of Alaska. The highest median PCB level was found in rock sole (Lepidopsetta bilineata, 285 ppb, wet weight), while the lowest level was found in rock greenling (Hexagrammos lagocephalus, 104 ppb, wet weight). Lipid adjusted PCB values were also calculated and significant interspecies differences were found. Again, rock sole had the highest level (68,536 ppb, lipid weight). Concerning the PCB congener patterns, the more highly chlorinated congeners were most common as would be expected due to their greater persistence. Among the pesticides, p, p′-DDE generally dominated, and the highest level was found in sockeye salmon (Oncorhynchus nerka, 6.9 ppb, wet weight). The methodology developed by U.S. Environmental Protection Agency (USEPA) was used to calculate risk-based consumption limits for the analyzed fish species. For cancer health endpoints for PCBs, all species would trigger strict advisories of between two and six meals per year, depending upon species. For noncancer effects by PCBs, advisories of between seven and twenty-two meals per year were triggered. None of the pesticides triggered consumption limits.
The fish analyzed, mainly from Adak, contain significant concentrations of POPs, in particular PCBs, which raises the question whether these fish are safe to eat, particularly for sensitive populations. However when assessing any risk of the traditional diet, one must also consider the many health and cultural benefits from eating fish.
PMCID: PMC2928280  PMID: 20811633
13.  Predictors of serum dioxin levels among adolescent boys in Chapaevsk, Russia: A cross-sectional pilot study 
Toxicological studies and limited human studies have demonstrated associations between exposure to polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) and adverse developmental and reproductive health effects. Given that children may be particularly susceptible to reproductive and developmental effects of organochlorines, and the paucity of information available regarding childhood exposures to dioxins in particular, we undertook a pilot study to describe the distribution of, and identify potential predictors of exposure to, dioxin-like compounds and dioxins among adolescent boys in Chapaevsk, Russia. The pilot study was also designed to guide the development of a large prospective cohort study on the relationship of exposure to PCDDs, PCDFs, and PCBs with growth and pubertal development in peri-pubertal Chapaevsk boys.
221 boys age 14 to 17 participated in the pilot study. Each of the boys, with his mother, was asked to complete a nurse-administered detailed questionnaire on medical history, diet, and lifestyle. The diet questions were used to measure the current and lifetime consumption of locally grown or raised foods. Blood samples from 30 of these boys were sent to the Centers for Disease Control and Prevention (CDC) for analysis of dioxins, furans and PCBs.
The median (25th, 75th percentile) concentrations for total PCDDs, PCDFs and coplanar PCBs were 95.8 pg/g lipids (40.9, 144), 33.9 pg/g lipids (20.4, 61.8), and 120 pg/g lipids (77.6, 157), respectively. For WHO-TEQs, the median (25th, 75th percentile) for total PCDDs, PCDFs, and coplanar PCBs were 0.29 (0.1, 9.14), 7.98 (5.27, 12.3), and 7.39 (4.51, 11.9), respectively. Although TCDD was largely non-detectable, two boys had high TCDD levels (17.9 and 21.7 pg/g lipid). Higher serum levels of sum of dioxin-like compounds and sum of dioxin TEQs were positively associated with increased age, consumption of fish, local meats other than chicken, PCB 118, and inversely with weeks of gestation.
The total TEQs among Chapaevsk adolescents were higher than most values previously reported in non-occupationally exposed populations of comparable or even older ages. Dietary consumption of local foods, as well as age and weeks of gestation, predicted dioxin exposure in this population.
PMCID: PMC1168904  PMID: 15918907
14.  Organochlorine in the serum of inhabitants living near an electrochemical factory 
OBJECTIVES: To measure the impact of occupational and lifestyle factors on concentrations of organochlorine compounds in a general population sample living near an electrochemical factory with a high airborne concentration of hexachlorobenzene (HCB). METHODS: Serum samples from 608 people (328 selected from a random sample) were collected in 1994. Information on lifestyles, occupation, and medical condition was obtained by questionnaire. RESULTS: HCB and polychlorinated biphenyls (PCBs) were detected in all samples (means 36.7 ng/ml and 4.3 ng/ml respectively), followed by dichlorodiphenyl dichloroethane (DDE) and beta-hexachlorocyclohexane (beta-HCH), found in 98.7% and 87.3% of the samples respectively (means 4.6 ng/ml and 2.5 ng/ml, respectively). Concentrations of HCB were the highest ever reported. Occupation in the factory was the main determinant of the variation in concentrations of HCB (regression coefficients 1.52 (SEM 0.14) in 1n (HCB) for workers in the production department, and 2.13 (0.23) for workers in maintenance department) and explained the highest concentrations of HCB found in men of middle age. In retired workers, concentrations of HCB declined with time since retirement. The PCBs, dichlorodiphenyl trichloroethane (DDT), and beta-HCH were independent of the occupation and concentrations were similar to those found in other populations. Concentrations of beta-HCH and DDE in the whole population, and HCB among non-workers, were higher in women than in men. Concentrations of all measured organochlorine compounds increased with age and body mass index. Consumption of locally caught fish was an independent determinant of HCB and PCB concentrations. CONCLUSIONS: This population incorporated HCB directly through occupation in the electrochemical factory, by airborne pollution, and consumption of locally caught fish. Concentrations of other common organochlorine compounds were not higher than expected. Environmental exposures to these compounds deserve attention due to their persistence and potential health effects.
PMCID: PMC1757711  PMID: 10448322
15.  Assessment of dietary exposure to some persistent organic pollutants in the Republic of Karakalpakstan of Uzbekistan. 
Environmental Health Perspectives  2003;111(10):1306-1311.
A 1999 study heightened long-standing concerns over persistent organic pollutant contamination in the Aral Sea area, detecting elevated levels in breast milk and cord blood of women in Karakalpakstan (western Uzbekistan). These findings prompted a collaborative research study aimed at linking such human findings with evidence of food chain contamination in the area. An international team carried out analyses of organochlorine and organophosphate pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) on samples of 12 foods commonly produced and consumed in Karakalpakstan. Analysis consistently detected long-lasting organochlorine pesticides and their metabolites in all foods of animal origin and in some vegetables such as onions and carrots--two low-cost components of many traditional dishes. Levels of PCBs were relatively low in all samples except fish. Analyses revealed high levels of PCDDs and PCDFs (together often termed "dioxins") in sheep fat, dairy cream, eggs, and edible cottonseed oil, among other foodstuffs. These findings indicate that food traditionally grown, sold, and consumed in Karakalpakstan is a major route of human exposure to several persistent toxic contaminants, including the most toxic of dioxins, 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD). Intake estimations demonstrate that consumption of even small amounts of locally grown food may expose consumers to dioxin levels that considerably exceed the monthly tolerable dioxin intake levels set by the World Health Organization. Data presented in this study allow a first assessment of the risk associated with the consumption of certain food products in Karakalpakstan and highlight a critical public health situation.
PMCID: PMC1241611  PMID: 12896851
16.  Mercury in fish and adverse reproductive outcomes: results from South Carolina 
Mercury is a metal with widespread distribution in aquatic ecosystems and significant neurodevelopmental toxicity in humans. Fish biomonitoring for total mercury has been conducted in South Carolina (SC) since 1976, and consumption advisories have been posted for many SC waterways. However, there is limited information on the potential reproductive impacts of mercury due to recreational or subsistence fish consumption.
To address this issue, geocoded residential locations for live births from the Vital Statistics Registry (1995–2005, N = 362,625) were linked with spatially interpolated total mercury concentrations in fish to estimate potential mercury exposure from consumption of locally caught fish. Generalized estimating equations were used to test the hypothesis that risk of low birth weight (LBW, <2,500 grams) or preterm birth (PTB, <37 weeks clinical gestation) was greater among women living in areas with elevated total mercury in fish, after adjustment for confounding. Separate analyses estimated term LBW and PTB risks using residential proximity to rivers with fish consumption advisories to characterize exposure.
Term LBW was more likely among women residing in areas in the upper quartile of predicted total mercury in fish (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.00-1.09) or within 8 kilometers of a river with a ‘do not eat’ fish advisory (1.05; 1.00-1.11) compared to the lowest quartile, or rivers without fish consumption restrictions, respectively. When stratified by race, risks for term LBW or PTB were 10-18% more likely among African-American (AA) mothers living in areas with the highest total fish mercury concentrations.
To our knowledge, this is the first study to examine the relationship between fish total mercury concentrations and adverse reproductive outcomes in a large population-based sample that included AA women. The ecologic nature of exposure assessment in this study precludes causal inference. However, the results suggest a need for more detailed investigations to characterize patterns of local fish consumption and potential dose–response relationships between mercury exposure and adverse reproductive outcomes, particularly among AA mothers.
PMCID: PMC4154616  PMID: 25127892
Low birth weight; Environmental public health tracking; Geographic information system; Preterm birth
17.  Resetting our priorities in environmental health: An example from the south–north partnership in Lake Chapala, Mexico 
Environmental research  2011;111(6):877-880.
Lake Chapala is a major source of water for crop irrigation and subsistence fishing for a population of 300,000 people in central Mexico. Economic activities have created increasing pollution and pressure on the whole watershed resources. Previous reports of mercury concentrations detected in fish caught in Lake Chapala have raised concerns about health risks to local families who rely on fish for both their livelihood and traditional diet. Our own data has indicated that 27% of women of childbearing age have elevated hair mercury levels, and multivariable analysis indicated that frequent consumption of carp (i.e., once a week or more) was associated with significantly higher hair mercury concentrations.
In this paper we describe a range of environmental health research projects. Our main priorities are to build the necessary capacities to identify sources of water pollution, enhance early detection of environmental hazardous exposures, and deliver feasible health protection measures targeting children and pregnant women. Our projects are led by the Children’s Environmental Health Specialty Unit nested in the University of Guadalajara, in collaboration with the Department of Environmental Health of Harvard School of Public Health and Department of Pediatrics of the New York School of Medicine. Our partnership focuses on translation of knowledge, building capacity, advocacy and accountability. Communication will be enhanced among women’s advocacy coalitions and the Ministries of Environment and Health. We see this initiative as an important pilot program with potential to be strengthened and replicated regionally and internationally.
PMCID: PMC3159500  PMID: 21722889
Environmental health; Priorities; Partnership; Barriers; Lake Chapala; Mexico
18.  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.
PMCID: PMC3261933  PMID: 21947562
dioxin; fish consumption; Great Lakes; methylmercury; omega-3 fatty acids; PCBs; risk assessment
19.  Potential exposure to PCBs, DDT, and PBDEs from sport-caught fish consumption in relation to breast cancer risk in Wisconsin. 
Environmental Health Perspectives  2004;112(2):156-162.
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.
PMCID: PMC1241824  PMID: 14754569
20.  Role of self-caught fish in total fish consumption rates for recreational fishermen: Average consumption for some species exceeds allowable intake 
Journal of risk research  2013;16(8):1057-1075.
Studies of fish consumption focus on recreational or subsistence fishing, on awareness and adherence to advisories, consumption patterns, and contaminants in fish. Yet the general public obtains their fish from commercial sources. In this paper I examine fish consumption patterns of recreational fishermen in New Jersey to determine: 1) consumption rates for self-caught fish and for other fish, 2) meals consumed per year, 3) average meal size, and average daily intake of mercury, and 4) variations in these parameters for commonly-consumed fish, and different methods of computing intake. Over 300 people were interviewed at fishing sites and fishing clubs along the New Jersey shore. Consumption patterns of anglers varied by species of fish. From 2 to 90 % of the anglers ate the different fish species, and between 9 and 75 % gave fish away to family or friends. Self-caught fish made up 7 to 92 % of fish diets. On average, self-caught fish were eaten for only 2 to 6 months of the year, whereas other fish (commercial or restaurant) were eaten up to 10 months a year. Anglers consumed from 5 to 36 meals of different fish a year, which resulted in intake of mercury ranging from 0.01 to 0.22 ug/kg/day. Average intake of Mako shark, swordfish, and tuna (sushi, canned tuna, self-caught tuna) exceeded the U.S. Environmental Protection Agency’s oral, chronic reference dose for mercury of 0.1 ug/kg/day. However, computing intake using consumption for the highest month results in average mercury intake exceeding the reference dose for striped bass and bluefish as well. These data, and the variability in consumption patterns, have implications for risk assessors, risk managers, and health professionals.
PMCID: PMC3728903  PMID: 23914136
risk; fish consumption; mercury, U.S. EPA’s Rfd
21.  Elevated Contaminants Contrasted with Potential Benefits of ω-3 Fatty Acids in Wild Food Consumers of Two Remote First Nations Communities in Northern Ontario, Canada 
PLoS ONE  2014;9(3):e90351.
Indigenous communities in Boreal environments rely on locally-harvested wild foods for sustenance. These foods provide many nutritional benefits including higher levels of polyunsaturated fatty acids (PUFAs; such as ω-3) than what is commonly found in store-bought foods. However, wild foods can be a route of exposure to dietary mercury and persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs). Here, we show a strong association between the frequency of wild food consumption in adults (N = 72) from two remote First Nations communities of Northern Ontario and environmental contaminants in blood (POPs) and hair (mercury). We observed that POPs and mercury were on average 3.5 times higher among those consuming wild foods more often, with many frequent wild food consumers exceeding Canadian and international health guidelines for PCB and mercury exposures. Contaminants in locally-harvested fish and game from these communities were sufficiently high that many participants exceeded the monthly consumption limits for methylmercury and PCBs. Those consuming more wild foods also had higher proportions of potentially beneficial ω-3 fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These results show that the benefits of traditional dietary choices in Boreal regions of Canada must be weighed against the inherent risks of contaminant exposure from these foods.
PMCID: PMC3943865  PMID: 24598815
22.  Mercury in Commercial Fish: Optimizing Individual Choices to Reduce Risk 
Environmental Health Perspectives  2004;113(3):266-271.
Most attention to the risks from fish consumption has focused on recreational anglers and on fish caught by individuals, but the majority of fish that people eat are purchased from commercial sources. We examined mercury levels in three types of fish (tuna, flounder, bluefish) commonly available in New Jersey stores, sampling different regions of the state, in communities with high and low per capita incomes, and in both supermarkets and specialty fish markets. We were interested in species-specific levels of mercury in New Jersey fish and whether these levels were similar to data generated nationally by the Food and Drug Administration (FDA; mainly from 1990 to 1992) on the same types of fish. Such information is critical for providing public health advice. We were also interested in whether mercury levels in three common species of fish differed by region of the state, economic neighborhood, or type of store. We found significant species differences, with tuna having the highest levels and flounder the lowest levels. There were no significant differences in mercury levels as a function of type of store or economic neighborhood. There was only one regional difference: flounder from fish markets along the Jersey shore had higher mercury levels than flounder bought in other markets. We also examined mercury levels in six other commonly available fish and two shellfish from central New Jersey markets. There were significant differences in availability and in mercury levels among fish and shellfish. Both shrimp and scallops had total mercury levels < 0.02 ppm (wet weight). Large shrimp had significantly lower levels of mercury than small shrimp. For tuna, sea bass, croaker, whiting, scallops, and shrimp, the levels of mercury were higher in New Jersey samples than those reported by the FDA. Consumers selecting fish for ease of availability (present in > 50% of markets) would select flounder, snapper, bluefish, and tuna (tuna had the highest mercury value), and those selecting only for price would select whiting, porgy, croaker, and bluefish (all with average mercury levels < 0.3 ppm wet weight). Flounder was the fish with the best relationship among availability, cost, and low mercury levels. We suggest that state agencies responsible for protecting the health of their citizens should obtain information on fish availability in markets and fish preferences of diverse groups of citizens and use this information to select fish for analysis of contaminant levels, providing data on the most commonly eaten fish that will help people make informed decisions about risks from fish consumption.
PMCID: PMC1253750  PMID: 15743713
commercial fish; consumption; fish; mercury; New Jersey; risk assessment; FDA
23.  Fishing, fish consumption, and awareness about warnings in a university community in central New Jersey in 2007, and comparisons with 2004 
Environmental research  2008;108(1):107-116.
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.
PMCID: PMC4026092  PMID: 18632098
Fishing; Fish consumption; Warnings; Advisories; FDA; Credibility; Trust; Temporal changes; New Jersey; Decreasing fish consumption
24.  Decline in Fish Consumption Among Pregnant Women After a National Mercury Advisory 
Obstetrics and gynecology  2003;102(2):346-351.
A well-publicized January 2001 federal advisory recommended that pregnant women limit consumption of certain fish because of concerns about mercury contamination. We endeavored to estimate the extent to which pregnant women changed fish consumption habits after dissemination of this national advisory
We performed interrupted time series analysis of data from a cohort of pregnant women (2235 who completed at least one dietary questionnaire) visiting obstetric offices in a multispecialty group practice in eastern Massachusetts, surveyed before the advisory from April 1999 through December 2000 and after the advisory from April 2001 through February 2002. Main outcome measures were consumption of total fish and of four fish types: canned tuna, dark meat fish, shellfish, and white meat fish. Subjects reported fish consumption on semiquantitative food frequency questionnaires administered at each trimester of pregnancy.
We observed diminished consumption of dark meat fish, canned tuna, and white meat fish after the national mercury advisory. These decreases resulted in a reduction in total fish consumption of approximately 1.4 servings per month (95% confidence interval 0.7, 2.0) from December 2000 to April 2001, with ongoing declines through the end of the study period. There was no change in shellfish intake.
After dissemination of federal recommendations, pregnant women in this cohort reported reduced consumption of fish, including tuna, dark meat fish, and white meat fish. Because these fish may confer nutritional benefits to mother and infant, public health implications of these changes remain unclear.
PMCID: PMC1989666  PMID: 12907111
25.  Blood organic mercury and dietary mercury intake: National Health and Nutrition Examination Survey, 1999 and 2000. 
Environmental Health Perspectives  2004;112(5):562-570.
Blood organic mercury (i.e., methyl mercury) concentrations among 1,709 women who were participants in the National Health and Nutrition Examination Survey (NHANES) in 1999 and 2000 (1999-2000 NHANES) were 0.6 microg/L at the 50th percentile and ranged from concentrations that were nondetectable (5th percentile) to 6.7 microg/L (95th percentile). Blood organic/methyl mercury reflects methyl mercury intake from fish and shellfish as determined from a methyl mercury exposure parameter based on 24-hr dietary recall, 30-day food frequency, and mean concentrations of mercury in the fish/shellfish species reported as consumed (multiple correlation coefficient > 0.5). Blood organic/methyl mercury concentrations were lowest among Mexican Americans and highest among participants who designated themselves in the Other racial/ethnic category, which includes Asians, Native Americans, and Pacific Islanders. Blood organic/methyl mercury concentrations were ~1.5 times higher among women 30-49 years of age than among women 16-29 years of age. Blood mercury (BHg) concentrations were seven times higher among women who reported eating nine or more fish and/or shellfish meals within the past 30 days than among women who reported no fish and/or shellfish consumption in the past 30 days. Blood organic/methyl mercury concentrations greater than or equal to 5.8 microg/L were lowest among Mexican Americans (2.0%) and highest among examinees in the Other racial/ethnic category (21.7%). Based on the distribution of BHg concentrations among the adult female participants in 1999-2000 NHANES and the number of U.S. births in 2000, > 300,000 newborns each year in the United States may have been exposed in utero to methyl mercury concentrations higher than those considered to be without increased risk of adverse neurodevelopmental effects associated with methyl mercury exposure.
PMCID: PMC1241922  PMID: 15064162

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